Letters April 1-30, 2005

I was married to a lovely lady in the UK this year in January. I invited a good friend to be my best man. Unfortunately he was unable to fly to Great Britain for the wedding. I then asked my cousin to be my best man. He accepted and flew over a few days before the wedding.

Well during his entire stay, my wife doted on him and made him feel welcomed. I on the other hand found his attention to my wife unsettling and disrespectful. I can see now that I felt invisible at times. While setting up the reception hall, my wife, sought my cousins advice on plates, glassware and left me to my own devices virtually ignoring me. My cousin made lewd remarks to and seemed smitten with my wife. At this point I am becoming a tad bit upset.

Even through the course of the wedding and the reception their eye contact between one another just felt strange. Needless to say their behavior nearly ruined the wedding for me. As time past I was really itching to leave the reception for the wedding and but my wife felt we should stay. I had no other choice but to oblige her, and when we finally were in the car and ready to leave, she seemed overly concerned about my cousins transportation.

Well we finally made it to the hotel and I soon came to the realization that I had married a beautiful woman, so as I am admiring her, there is a knock on the door. It’s my cousin! Needless to say I can’t even watch my wedding video without noticing their whispers and stares to one another. Is this paranoid or what.

OoooWee In Georgia

Dear OoooWee in Georgia,

Just from your letter I can't determine if you are paranoid. There the famous quote by that "anonymous" person who said, "Just because you are paranoid doesn't mean that someone isn't out to get you." What strikes me about your letter is the fact that you don't make any reference to expressing your feelings to your wife. Why did you allow these things to happen without saying something? I can't tell you if your wife was just trying to be friendly to your cousin as a way of attempting to bond with your family or if your observations of your cousin and his "lewd remarks" and attentiveness to your wife was something to worry about. But if you are still bothered by it, it's something that you need to do something about.

How you feel about your wedding is almost irrelevant compared to how you feel about your marriage. Do you trust your wife? Are you willing to talk to her about how her interaction with your cousin made you feel? Beautiful women will get flirted with draw attention without necessarily doing anything. How your wife and you deal with such behaviors whether it is your cousin or anyone else is something that could me the difference between a successful or unsuccessful marriage. I urge to talk about your feelings to your wife. Somewhere there needs to be a happy medium struck. You need to feel secure about her fidelity and she needs to feel like she's not a prisoner in her marriage. I don't know if your situation requires marriage counseling but that is worth considering if the two of you can't reach that happy medium. Please let me know what you think.

happy(medium,largeandnowextralarge)shrink

Happyshrink gets a reply from -E-

Dear Happyshrink,

I really appreciate your posted response. Since my first email to you - I've continued to read up on panic attacks as well as visited forums where people on both Xanax and Zoloft post their experiences regularly. The more I read, the more I've seen positive postings - not only the negative.

Since I've been reading more and understanding a great deal more about how panic attacks feel - I think it's amazing that we live in a time where medications are available to help. It's funny you should mention that the ideal situation for my boyfriend to try a more natural remedy would be during vacation when stress is reduced. I was thinking the same thing. Unfortunately, he works 7 days non stop. It takes it's toll - I can see that clearly, but there's nothing he can do about it. Or, myself for that matter, unless one of us win the lotto =)

To better understand this, can you explain why anti-depressants are prescribed for panic attacks? I've read a lot that people who suffer from PA's are genetically predisposed to it having family with emotional disorders such as depression - but it really doesn't state that those who suffer from PA's also suffer depression. Is it that people who suffer from this develop depression because of the impact suffering from PA's can have on their lives?

Last, I've read a lot that people who suffer from PA's really have to work hard not to develop phobias as a result of their attacks. That said, even though my boyfriend works 7 days a week, he is also very active during his limited downtime... in that he's active in sports several times a week and just overall stays very busy. From what he's shared, I believe he does this because if he keeps busy - his mind is less likely to wander into the train of thought that leads to an attack. I feel the positive part of this - is that he hasn't allowed his attacks to keep him from doing the things he enjoys in life. The other side of this however, is that - isn't it possible to just get to the point where one would crash or cause themselves more stress from too much activity all around?

-E-

I appreciate your response to my response. As far as why they prescribe antidepressants for panic attacks has to do with some clinical studies that show that SSRI antidepressants can reduce the frequency as well as intensity of panic attacks. I'm not even sure they understand why but it isn't the first time that drugs that were developed to do one thing have been found effect in doing something else. Depakote is and has been an effective anti-seizure medication for more than 30 years. It was found in the last 10 years or so that it is an effective treatment for bipolar disorder. How this was discovered may have been some astute observations of doctors treating patients with both conditions. It may be possible that Serotonin may be a factor in panic attacks as well as depression but honestly, I don't know for sure.

As far as you boyfriend working 7 days a week and also keeping active seems a bit extreme to me. I realize that he needs to earn a living but working 5 days a week seems to suffice for most people. There is a movie called "The Human Stain" starring Anthony Hopkins and Nicole Kidman. A quote from that movie is, "Action is the enemy of thought." Perhaps you boyfriend uses an active life to repress unresolved issues in his life. Perhaps the panic attacks are symptomatic of those issues. This is all conjecture on my part but something to think about. For overall physical as well as mental health, people need days off from work as well as vacation time. If one is in a relationship it also requires time to devote to that as well. I would suggest you discuss these issues with your boyfriend so that both of you know what each other wants out of life. Good luck and please don't hesitate to write back.

I have been very fortunate in my life, but those blessings are now proving to be a challenge that I would like your advice on. I am a 25 year old single male attending grad. school but I also have a good full time job. I am very spiritual but not religious. Part of my spirituality is living simply. I live without a television, bed, and many other things even though I could easily afford them. I practice yoga, painting, and volunteering. I try to live an active lifestyle as opposed to a passive one.

The problem is that I have difficulty with meaningful relationships. With dating I simply haven't met a female recently that I mesh with. I have different problems with friendships. I am friendly and meet lots of people on a regular basis. I think with most guys I just don't have much in common. Single women tend to view me as a guy who is finally different from all their ex's. Whatever the reason, I have lost many very good single female friends because they wanted to date and I only had a platonic interest. I have also become aware of the potential for unhealthy friendships with women in committed relationships.

So my question is what do I do? I don't want to sequester myself away on my yoga mat. I am a social person, who enjoys meaningful conversations. I also want my relationships to be healthy and straightforward. I know this isn't a serious mental health issue, but I would appreciate your advice. I want to do the right thing.

People develop relationships with others through "context." That means two people need to find some commonality that they can relate to in order to relate to one another. Context could be interest in yoga, volunteering, and painting. It can also be sports, books, current events, hobbies, television, movies, politics, religion, etc. The more interests we have, the more context we have with others to develop relationships. With little or no context we may find a person kind, likeable and even feel warmth towards them but eventually they may become boring and insignificant in our lives.

I appreciate that you try to live a simple life and pursue a number of interests, but perhaps those interests are limiting in both the number of people you meet and the depth that your relationships attain. I might also wonder if people don't find you a bit eccentric. Let's start with not having a bed. It may make sense to some people who practice yoga, but for most people, I would guess they find that a bit weird. I know a number of people who don't have a TV and try to read newspapers or go on the Internet to find out about what is happening in the world, but it can limit how much you have in common with others. We are a media driven society and we may not like it at times but we do have to deal with it.

I'm also wondering if your lifestyle isn't a way of keeping people away and feeling safer. You seem to find people who find you to be safe. Perhaps that goes both ways. You seek out platonic relationship with women until you feel a need to get more out of the relationship.

So if you want more out of life than an intellectual and moral pursuit Challenged, you have to get in the game. That doesn't mean doing things you don't like or being a phony but it does mean broadening your interest. Other than strongly suggesting you get a bed (even if you choose not to sleep in it) that's my best advice. Please feel free to respond.

I have a friend who takes Clozaril. I asked him what he takes it for and he said, "It's for depression." Now, I have worked in the healthcare field for nearly 20 years, and I know that Clozaril is prescribed for Schizophrenia. Do you think he has been told that he is taking this drug for depression? Or is he afraid to tell me why he is taking it? I know that it is not prescribed for trivial reasons, due to the potentially fatal side effects (agranulocytosis).

Should I tell my friend that I know Clozaril is not for depression, or should I let it go and hope that he one day feels comfortable enough to tell me the truth. It seems to be working for him: as far as I can tell he doesn't have any positive symptoms, and he is working and living independently.

First let me say that it's nice hearing from you. It's been a while. Second, I am glad you wrote this letter so people can understand that even individuals suffering from a serious mental illness such as schizophrenia can live pretty normal lives. This isn't always the case but many schizophrenics live very active and full lives through medication and family support. It would be hard for me to believe that someone who works and lives independently has not been told by his psychiatrist that he is suffering from schizophrenia or any other psychotic disorder. I would guess that your friend knows the truth but also lives with the stigma of being schizophrenic. Depression is a much easier diagnosis to explain to people, but clearly Clozaril is taken for schizophrenia and other psychotic disorders.

I am a bit surprised that he is on this particular medication. As you know (as you have said in your letter) it is highly toxic. A blood test showing the toxicity levels must accompany all prescriptions. Prescriptions for Clozaril may only be for a 15 day period so that people on this medication get their blood tested twice a month. Clozaril is considered the medication of last resort for schizophrenics. Only when no other meds work is Clozaril is considered and I am curious that someone as independently functioning as your friend would be in need of such a medication.

Clearly, your friend has told you he suffers from depression as a means of avoiding dealing with his diagnosis and I suggest that you respect that. If you feel comfortable though, you might want to ask him if he is aware of the dangers of such a medication. My guess is that he is aware, but it doesn't hurt to ask and I know you are not shy (at least in that instance). Let me know what you find out. Good luck and keep in touch.

I found this in the New Yorker. I thought it was worth sharing to all of you who are thinking of having "Living Wills?"

1. If I should remain in a persistent vegetative state for more than fifteen years, I would like someone to turn off the TV.

2. If I remain motionless for an extended period and utter only guttural, meaningless sounds, I would like a Guggenheim.

3. If I am unable to recognize or interact with friends or family members, I still expect gifts.

4. If I am unable to feed, clean, or dress myself, I would like to be referred to as “Mr. Trump.”

6. If I do not respond to pinches, pinpricks, rubber mallets, or other medical stimuli, please stop laughing.

7. If I no longer respond to loved ones’ attempts at communication, ask them about our last car trip.

8. Once I am allowed to die a painless and peaceful death, I would like my organs donated to whoever can catch them.

9. If my death is particularly dramatic, I would like to be played by Hilary Swank, for a slam dunk.

10. If there is any family dispute over my medical condition, it must be settled with a dreidel.

11. Even if I remain in a persistent vegetative state for more than fifteen years, that still doesn’t mean bangs.

12. If my doctor pronounces me brain-dead, I would like to see the new Ashton Kutcher movie.

13. If I remain unconscious during a painful, lingering illness, I would like the following life lessons to be published in a book entitled “Tuesdays with Paul”:

14. I do not wish to be kept alive by any machine that has a “Popcorn” setting.

16. If my loved ones insist that the cost of my medical care has become an impossible burden, show them a Polaroid of their “beach shack.”

18. I would like my entire estate to become the property of my cat, Fluffy, who said, “He wouldn’t want to live like this, with that zit.”

19. Assume that, even in a coma, I can still hear discussions about my apartment.

20. If there is any talk of canonizing me, please remember that I have often held the elevator for people who were still getting their mail, that I have twice offered a cab to a woman in a fur coat even though I was totally there first, and that I always waited to make derogatory comments until after the couple with the double stroller was a block away.

22. At my memorial service, I would like my clergyman to begin his eulogy with the words “I suppose, in a way, we all killed him.”

I'm writing you after having posted on various websites seeking advice (and receiving no feedback) I truly hope you can help. It would be greatly greatly appreciated. My boyfriend is taking Xanax and Zoloft because he suffers from panic attacks. We've been together for about 4 months now and I realize that I've come to care about him a great deal. As time passes and I get to know this wonderful man better each day - I began to want to learn more about what panic attacks are and the medications he takes.

I thought I'd do some research. (I always research before taking new prescriptions for myself, so why not look up stuff he's on if I care about him right?) Anyway, the more I learn through my online research, coupled with what he tells me about his day to day health, the more concerned I become. Not so much about Xanax - but Zoloft. First off, can you tell me how long people are typically prescribed medication in general and Zoloft in particular for panic attacks? I'm not sure how long he's been taking it - as I don't pry. I am simply listening to him when he wants to share with me and have simply expressed that I appreciate his being comfortable to do so.

That said, having learned that panic attacks can be handled without medication (anxietycoach.com has been a good resource) and after reading on an infinite number of sites that Zoloft has so many negative side effects (of which I can see he suffers from at the very least a handful) My second question is this: Is there a gentle/tactful way to bring it up that perhaps he should examine his health - because it could be his reaction to Zoloft and it's potential side effects on him? As well as ask him to consider a non-prescription remedy? I am falling in love with this man so I more than anything want to help - but not upset him. I just think that it's possible he's not as informed about his medication and all of the alternative remedies available. More than anything I try to live my life by doing things and helping others as I would hope to be helped if the roles were reversed... So if some of the problems he's been experiencing are caused by Zoloft, shouldn't someone point this out?

I've personally never been on medication like this - nor have I ever suffered from panic attacks. So... I don't know how he or anyone in his position would react. Please know that any suggestions on how to broach this with him - or if perhaps I should just mind my own business - what ever you recommend would be appreciated.

I will answer your question and then some. Yes, there are non-medication approaches to dealing with anxiety attacks. There are relaxation exercises, homeopathic diets and remedies as well as behavioral approaches to psychotherapy. I am sure there are even more that I am not aware of. Clearly, any time you can find an alternative to psycho-active medication, it is advantageous to do so. The problem with many of the approaches to anxiety attacks without medication is that they only work on a small percentage of people. There are loads of anecdotal testimonies to people who have been helped and perhaps even cured of anxiety attacks through some of these alternative treatments. But the clinical data has been less impressive.

My suggestion to you is to suggest to your boyfriend that he look into some of these alternatives and perhaps try them during a time period when he is on vacation and his stress levels are reduced. Ultimately though, he needs to decide what is best for him. People do take medications like Zoloft for years. While some people do have adverse reactions and there are clinically significant ones that are listed in formularies on the web and can be obtained through your boyfriend's psychiatrist or pharmacist, clinical data has shown that a majority of people have little or no side effects after taking this medication for a period of time.

On the other side of the coin there are anecdotal reports of suicidal and even homicidal behavior blamed on Zoloft. Whether this is in fact the case or the assertions of an overzealous litigator, is something that I can't answer. I can tell you this: there are people who have been taking Zoloft for years without significant problems. As in any medication there is always a trade-off as to what are the benefits versus what are the side effects. For most people with anxiety disorders such as panic attacks, the benefits of psycho-active medications outweigh the negatives.

I don't have a crystal ball and I can't tell you what the long term effects of Zoloft will have on your boyfriend, -E-. His psychiatrist should be monitoring his medication (both type and dosage) carefully and your boyfriend should report any changes in his physical or mental status. I would certainly encourage him to look at alternatives to medication but with a realistic understanding that they may not be the answer. You need to understand that as well. Please feel free to respond to my comments. I will not ignore them.

There is nothing wrong with making up your own words and phrases to express different thoughts and feelings. Actually this has been something I have inherited from my parents, grandparents and ancestors. Here are a few of the expressions of my collective unconscious.

I am working for a very difficult man. Whilst I believe my output is quite stable (based on 15 previous years of employment!), his mood is variable and very often in the range of "rude, insensitive, unfair, etc".

Unfortunately I can't afford to change jobs in the immediate future, however something has piqued my curiosity. I have noticed that, without fail, if something goes wrong for him, he's actually much nicer to me. Now, far from wishing evil onto my boss just to have a easier life (for how tempting that may be), I am rather puzzled. Why would adverse circumstances bring out a nicer version of him?

Not knowing your boss, I can't really say for sure what motivates him to be nice or nasty. My guess would be that he may have somewhat of a bipolar personality. That is not to say that he suffers from a mental disorder but he may be the kind of person that has two or more gears. When his is in high gear he sees the world around him going too slow and expects it to speed up on his command. During this phase, he can be very aggressive and such aggression can bring out rudeness and insensitivity.

When something goes wrong he may then move to a more depressed state (going into low gear). In low gear he may be more sensitive and more empathetic. His own pace is slower and his expectations others may be less demanding. He may also have other gears in between where his is not quite as unbearable as high gear but may still be annoying.

Now that I have described what might be going on with your boss, I want to share a few thoughts about what may be going on with you. No boss has the right to be abusive in a work situation. If you have to deal with such behavior on a regular basis, it may have negative affects on your emotional well being and you may not even be aware of how it might affect your life outside of work. If in fact your boss is creating a hostile environment for you to work in, that may be grounds for a grievance with your State Labor Authority. Here again I don't know how rude he is and if it rises to the level of creating a hostile work environment. If you believe that you have grounds for such a grievance I would consider consulting with someone from your State Labor Authority. Let me know what you think

Edna's lawn mower has been broken for months ... she has been dropping hints for the past month that maybe Bubba should get up off his ass and fix the damn thing .. but he just sat there drinking one beer after another .. DIDN'T BUDGE .. 'cept to run to the Circle K for another six pack.

So with a little coaching from me she tried this: Yesterday when he pulled into the driveway after his daily "beer run" he found Edna was sitting in the middle of the front lawn, cutting the tall grass with a small pair of scissors.

He just stood there watching, scratching, burping and all making all sorts of other disgusting noises, shook his head and went into the trailer ... He was gone only a few minutes and when he came out he handed Edna a toothbrush.

"What is this for??" Edna asked him. He said "When you're finished cutting the grass, sweep the sidewalk." The doctors say he will probably walk again, but he will always limp!!

I guess the moral to this story is never mess with a woman with a pair of scissors.

-Me-

Dear -Me-,

Body Dysmorphic Disorder (BDD) was first identified as a condition in the late 19th Century, but it has become a much more widespread condition over the last 30 years. It is not surprising given the value that society places on appearance and the conscious and unconscious messages we receive from family, friends and the media that we are less that what we should be. Clinically though, the diagnostic criteria for BDD is:

A.	Preoccupation with an imagined defect in appearance. If a slight physical anomaly is present, the person's concern is markedly excessive.
B.	The preoccupation causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
C.	The preoccupation is not better accounted for by another mental disorder (e.g., dissatisfaction with body shape and size in Anorexia Nervosa).

Depression is most often accompanied with BDD, so your notion of it being a part of your condition is very possible. The treatment for BDD accompanied by depression is usually a combination of medication and some type of psychotherapy. The medications of choice are usually SSRI's (Selective Serotonin Reuptake Inhibitors) such as Paxil. If this medication is doing the job, no good psychiatrist will try and fix what isn't broken! However, the BDD part of your condition should include psychotherapy. The type of psychotherapy most prescribed for BDD is Cognitive Behavioral Therapy (CBT) Most commonly, CBT is done in groups but there are therapists who do individual treatment as well. There is no guarantee that this type of therapy will suit you best but I would begin a dialogue with either your psychiatrist or another mental health professional you feel comfortable with who can give you a referral.

You have taken a very big step acknowledging that you have a problem that extends beyond your depression. Now is the time to act and do something about it. BDD may always be an issue in your life, -me- but it can be treated and managed so that its effects are kept to a minimum. Get the help you need now. Let me know how it goes. Good luck.

happy(withhisrolliepolliebody)shrink

I am a man who has a lady friend that we seem to be very connected with thoughts and same behavior, Lately we now have headaches at the same time but we are not together when they occur. We spend all our time together but we are not boyfriend - girlfriend. Can you answer this question?

Actually, you have stumped me. (not an easy task) I have no clue as to why you would get headaches at the same time. This would happen to me when I was younger and went out drinking with my buddies. We all got headaches the next day but I think we all knew why. Actually, I have a question for you? If you are together just about all the time, why aren't you boyfriend and girlfriend. Who's the one with cold feet?.... or is this something that you both share in common as well?

It seems to me that the only reason why a two people spend almost all their time together is because one or both would like the relationship to be intimate. Maybe the two of you need to talk about where this "friendship" is going. One thing for sure S. If it continues the way it is, it's not going to be healthy for either of you. You need to commit to something deeper or move on. Let me know what you think.

This is Mildred and for a change I'm not going to talk about my crazy neighbor JeWitch or her white trash friend Edna. I'm having a problem with my husband Gilbert. Now I know I have always told you that there's not a finer man on God's earth than my Gilbert and I still feel this way, but there is something that has been taking up a lot of his free time and you might call it an obsession. I'm a bit worried that he's becoming so obsessed with these State quarters that he's not paying any attention to me and satisfying my needs if you know what I mean. Do you have any suggestions on how I might get my Gilbert interested in ME again?

You know what they always say, If you can't beat'em, join'em. I suggest you try to add some of these very rare State Quarters to Gilbert's collection. Just getting him one or two of these rare editions will have him eating out of the palm of your hand. Here they are but please remember, they are very hard to get.

Postings from April 1-30, 2005