Your Mirror First

Q: Dear Dr. Guterson - I’m super upset with my son who doesn’t do his homework. Can you help him? A: I appreciate your concern for your son, but I’d like you to try looking at this from a different angle. The best way to help your son is to first look at yourself. To help him, it’s first important to identify why you are upset with your son. Is it anger - and if so, what is the true root of your anger? Or is it a feeling that your son’s lack of focus reflects poorly on you as a father? To communicate effectively with your son, it’s crucial that you are coming from a wholesome place. The journey to good mental health always starts with first looking in the mirror. Once you can get clarity inside yourself, you will then be better suited to help him.

Prozac Not Working - Help!

 Q: I keep taking Prozac but remain depressed. Can you help me? A: Thank you for your question, which I’m sure is relevant to many others. But let’s first sort a few things out. The first step is to make sure that your diagnosis is correct. Some people incorrectly think that a few days of sadness means they should take an antidepressant, but that is incorrect. You can take a Tylenol and the headache goes away. But you can’t pop a Prozac with the expectation that your sadness will quickly disappear. We humans are wonderfully complex and there are no quick fixes. To be diagnosed with Major Depression requires TWO straight weeks of symptoms like dysphoria, anhedonia (loss of pleasure), sleep and appetite disturbance, diminished concentration, easy agitation, low motivation, and in the more severe cases (what we see in the psychiatric hospital) death wish thoughts and suicidality. It is important to know that there can be a number of factors that can add to depression and render Prozac less effective. Things like inflammation (which is the body’s response to an infection or wound), thyroid disease, stroke, high blood pressure, diabetes, smoking, obesity, childhood abuse or neglect, and trauma, to name a few. Also, there are some medications that can have side effects of depression. I don’t mean to overwhelm you with all this, but any responsible psychiatrist should investigate these other possibilities before jumping too quickly to prescribing. You should also realize that Prozac (and other antidepressants) is certainly not the only approach for treating depression. In fact, in the more mild forms of a depressive illness, I would say that medication should not be recommended. We live in a world with lots of pill popping but sometimes that can be a way of avoiding the wonderfully challenging roads of life. Other treatments include good effective psychotherapy; this may take a while, but can be extremely powerful and long lasting. Exercise, healthy diet , and sleep are certainly crucial. Various forms of energy work, like Emotion Code, can help one release those trapped emotions that debilitate us. A life with meaning and purpose is essential for well-being. We have a soul that must be nourished. Be sure to take time each day to reach for transcendence. Without this, you can take all the Prozac you want but there will always remain a void inside.

Help! My psychiatrist and I are not seeing eye-to-eye

Q: Dear Dr. Guterson, Here's my question. I have a psychiatrist I like and respect a lot. I am comfortable with her level of expertise and her treatment plan for me. We've been together for 8 years. This time, however, I do not agree with her. I don't know how to tell her that I feel like she's not listening to me. I don't want her to think I don't trust her or I'm being disrespectful. How should I approach?

A: Thank you for your thoughtful question. The relationship between a psychiatrist and patient is certainly deep and intense. But it always needs boundaries. Because boundaries keep it safe and sacred.

You obviously think highly of your psychiatrist. You respect her greatly. First, I would advise that you look at past experience. Has there ever been a time before this where you felt she wasn’t listening to you? Or where you may have disagreed with her treatment advice? How did that turn out? Was her guidance in the end helpful - or not?

By definition, we humans are locked inside ourselves and often cannot see clearly. That’s why mentors, caring friends, and mental health professionals can be so helpful. You have been with her for eight years - so start with reviewing your past work together.

Next, any good and noble psychiatrist should not feel disrespected when a patient registers a different opinion or even a criticism. On the contrary, we psychiatrists should welcome such words. It gives us insight into our patients as well as ourselves. It opens wonderful doors of communication and vulnerability. Based on your description of her, my strong guess is that the conversation you desire will only enhance your already mutually trusting relationship. And thereby increase respect.

So talk with her. Start by addressing it as YOUR discomfort, what you’re going through internally. And on another note: your question reflects what we all go through in our life’s journey. A desire for connection. And that’s an essential part of who we are