Disorder

dr. margie holmes

 "Sanity calms, but madness is more interesting" - Bertrand Russell




  • Sexual Addiction

    hi dr. margie, i have this problem of sexual addiction, and i read some of the symptoms and i have some of those. i often view porn sites and masturbate at it, i also do sex with someone i dont know, i am a bisexual and i am really bothered by my condition now, its really addictive.  Please advise before i lose some of my important persons and aspects of my life.  i am willing to undergo some recovery program.. can you advise what process should i undergo to cure this sexual addiction that i have? i appreciate your response on this... thanks  JOHN B

    Dear Carlos:

    Ang sexual addiction ay bagong diagnosis sa sex therapy.  Hanggang nagyon hindi pa sila nagkaka-agree kung ano talaga ang basehan ng sexual addiction.

    Pero ang mga binanggit mo—panonood ng porn sites, pagmamasturbate, at pakikipagsiping sa hindi kilala—ay maaaring aspeto ng sexual addiction pero IFF (if and only if) nakakasagabal ito sa takbo ng buhay mo o sa mga relasyon mo.  Kasi, alam naman natin na marami ang nanonood ng porn sites, nagmamasturbate, at nagsisiping rin sa mga di nila kilala, pero hindi naman sila sex addict.

    Kung feeling mo na out of control talaga ang iyong mga iniisip at ginagawa sa sex, kung natatakot ka talagang baka mawala mo ang iyong trabaho, mga minamahal sa buhay o ang respeto ng mga kapitbahay o kaibigan mo, KUNG ginawa mo na ang lahat para matigil ang mga ito ay hindi mo pa kayang gawin nang sarili mo,

  • Hindi Tuwid na Titi

    Dr. Holmes. Im one of your avid reader of your column hindi lang sa dyaryo pati sa website?..
    ask ko lang po if ok lang hindi tuwid and titi?me epekto po ba ito?anu po ba dapat ko gwn para mtuwid ito?..tnx  JUAN

    Dear Juan:

    Ayon sa isang manunulat, ang karamihan ng mga ari ng lalake ay HINDI tuwid.  Less than 30%  daw ng mga lalake sa mundo ay may aring hindi tuwid. Kaya kung kaunti lang ang pagkabaluktot ng ari mo at hindi naman ito nakakasagabal sa buhay mo, hindi ka dapat magalala. 

    Ayon rin sa aking karanasan bilang sex therapist, bihira talaga ang may ari na tuwid . May 4 mga situwasyon lamang na ibig sabihin kailangang magpatingin sa manggagamot: 

    1. Kung nasasaktan ka kapag umiihi ka;
    2. Kung nasasaktan (o nahihirapan) ka kung magsiping ka;.at 
    3. Kung maging masbaluktot ang ari mo sa katagalan (with the passage of time);
    4. Kung lumiit (shrink) o umigsi (shorten) ang iyong ari sa katagalan 
    Kung kahit isa sa 4 na situwasyon sa taas ay may problema, mas maiging pumunta ka sa  doctor. Maaaring may Peyronie’s disease ka, pero kahit mayroon ka nga, marami magagawa para magamot ka nito.

    SO…good luck at inaasahan kong good news ang resulta ng sulat na ito.  Ingat—MG Holmes

     

  • Regular Exercise

    Dear Dra. Holmes:

    Ano  po ang karaniwang epekto kung hindi regular ang pag-e-exercise ng mga kalalakihan, lalo na sa pagsisiping?  Salamat po.  MICK

    Dear Mick:

    Maraming salamat sa iyong sulat. Tingnan muna natin ang pinaka obvious na epekto ng hindi pag exercise, ok?  At yan ay pagiging mataba.  Hindi lang mas may appeal ang lalakeng maganda ang katawan, pero ang lalakeng mataba ay maaaring makaranas ng tinatawag na “disappearing penis.”

    Sa katotohanan lang, hindi naman talagang nawawala o lumiliit ang ari ng lalake. Kaya lang, kapag sobra ang taba niya, lalo na sa bilbil, maaaring tila lumiliit (o, umiigsi) ang kaniyang ari dahil ang taba sa bilbil ay nakakasagabal.  Dahil rito, ang ari ng lalake ay hindi makapasok ng 100%, kaya parang umiigsi ito. 

    In addition, kung ang bilbil ng lalake ay natatakpan ang ari ng lalake, hindi masyadong nakaka “L”  ito, diba?

    Pero ang pagiging mataba ay isa lang sa mga nakakaepekto ng sex life ng isang lalakeng hindi nage-exercise.

    Ang kaniyang cardiovascular fitness ng lalake ay naapekto rin  at ito ay may malaki nga ring epekto sa endurance (gaanong katagal makakapagsiping) ng lalake.

    Kapag hindi mag exercise ang lalake, mas vulnerable siya sa mga sakit kagaya ng diabetes, stroke, high blood pressure, sakit sa puso atbp.

    Palagay ko mas maraming mga ibat ibang epekto ang mabibigay sa iyo nga isang fitness expert, pero sa larangan ng sex, ang mga nabanggit ko ang may pinakamalaking epekto sa pagsisiping, Inaasahan ko na nakatulong ako sa iyo, Mick. Ingat—MG Holmes

  • Self-Mutilation

    Dear Dra Holmes:

    un daughter ko, we found out this morning n nagsusugat sya sa sarili, i read an article before about self-mutilation, takot na takot ako, tapos eto nakita ko sa anak ko,

    i feel guilty now, i know i have faults as a mom,

    how can we help our daughter??? please help me... i need to save my daughter. she's only 12 years old... i don’t know how to tackle this kind of things.  please help me.... help me save my daughter... hope to hear from you soon... thank you.  MRS FRIGHTENED

    Dear MF (Mrs. Frightened)

    Pasensiya nalang po sana kayo na hindi ko nasagot ang inyong problema kaagad.  Yan ay dahil may pagka super seryoso po at mabigat ang topic ng inyong problema at ibig kong siguraduhin na tama at pinaka bago (current)  and mga susulatin ko sa inyo tungkol sa dahilan at pagtulong rito (self harm, cutting, self mutilation).  

    Napakarami na po kasing mga  bagong nangyayari  sa mundo ngayon. Maraming karanasan ang ating mga bata na hindi natin naranas.  Nagbibigay rin ito ng napakaraming problema sa kanila.

    Halimbawa: ang mga  chatrooms sa internet saan lagi silang naguusap sa mga kilala o di kilala. Mga computer games na lagi nilang nilalaro , etc kaya hindi na gaanong lumalabas ang ating mga anak at naglalaro kadsama ng iba nilang kaibigan gaya ng dati.

    May epekto rin ito sa kanilang pagtingin sa sarili (self esteem) at sa kanilang pagtingin sa mundo,  May mga pananaliksik na nagpapakita na ang  mga taong masyadong matagal sa internet/computer (more than 11 hours a week) ay mas malakas ang probabilidad na mayroon silang clinical depression.

    Ang Friendster, Face Book at iba pang “social networks”  na nagpapakita kung sino ang kaibigan mo at sinong hindi at may maraming oportunidad para masaktan ang isang bata/adolescent at magisip na wala siyang kaibigan sa mundo. Paaano ito nangyayari?  Kung i-“reject” ka ng isang taong gusto niya sanang ilagay sa kaniyang friends list . 

    Minsan may cyber bullying pa na nangyayari.  Napakalungkot, pero may iilang mga suicides na nangyari dahil sa cyber bullying.

    Ang texting din ay isang bagong nangyayari na maaaring may masamang epekto sa tao. Maraming nagkakakilala mula sa texting lang, at minsan nagkakaroon pam sila ng boyfriend-girlfriend relasyon kahit hindi pa sila nagkikita. Kadalasan, naco-confuse ang babae dahil hindi niya alam ano talaga ang nangyayari.

    In addition, ang lahat ng oras na nilalagay sa texting ay maaaring ilagay sa ibang mga activities; kagaya ng pagkakaroon ng outing sa labas-in the sunshine and fresh air.  Marami ng pananaliksik na nagpapakita na malaki talaga ang naidudulot nito hindi lang sa kalusugang katawan,. Pero sa kalusugang pisikal rin.

    Mahalagang malaman lahat ito kapag mayroon tayong mga anak. Ang kanilang mundo ay iba sa atin at mahalaga talagang malaman ano ang nangyayari talaga sa kanila.  TO BE CONTINUED BELOW

    PART 2

    Dear MF (Mrs. Frightened)

    Natapos po natin ang kolum sa Lunes sa mga salitang “Ang kanilang mundo (ng ating mga anak) ay iba sa atin at mahalaga talagang malaman ano ang nangyayari talaga sa kanila.”   At dahil sa internet, chatting, texting, mas marami silang mga pressures na wala sa atin.  Nabanggit ko ito dahil ang napakaraming pressures at ang feeling na na-o-overwhelm ang bata ay isa sa mga dahilan na sila ay nag su-suicide o nagse-self harm.

    Ayon sa  mga pananaliksik na nagawa sa America tungkol sa pagsasaktan sa sarili (self harm) ang mga taong  gumagawa nito ay karamihang babae (65-85% ay babae daw, depende sa pananaliksik na binabasa ninyo). Sila ay kadalasang:

    Walang hilig sa sarili

    Sobrang sensitive sa rejection

    Laging galit, lalo na sa sarili nila

    Kadalasang hindi nilalabas o pinapakita ang kanilang galit (maliban sa self harm)

    Kadalasang impulsive (ginagawa kaaagad ang gustong gawin na hindi masyadong iniisip).

    ·Hindi talaga marunong mag plano para sa kanilang kinabukasan  (ang isang proof nito ay, kung marunong silang isipin ang future, hindi nila sasaktan ang kanilang sarili dahil may consequences ito,  Lalo na kung ang self harm ay gaya ng ginagawa ng anak ninyo na nagiiwan ng mga scars)
    ·Kadalasang depressed
    ·Kadalasang sobrang anxious…
    ·Mababa ang tingin sa sarili n sa sarili kaya akala nila ay hindi sila magaling mag-cope sa kanilang mga problema (na tila may katotohanan naman)

    IN addition, ang mga nagse-self harm ay hindi kayang i-regulate ang kanilang damdamin at maraming nagsasabing sikolohista na tila may basehan ito sa genes nila (minamana)

    Pero huwag sana kayong mag alala, MF.  Marami pa kayong magagawa para tulungan ang inyong anak  TO BE CONTINUED BELOW

    PART 3
    Dear MF (Mrs. Frightened)

    Natapos po natin ang kolum sa Miyerkules sa mga salitang: “Pero huwag sana kayong mag alala, MF.  Marami pa kayong magagawa para tulungan ang inyong anak”
     
    Eto po ang mga iilang mungkahi.  Kung ok lang sa inyo, ibibigay ko sa inyo ito sa Ingles muna, at kung mayroon kayong ibig kong linawin, gagawin ko po to sa Filipino.  Gusto ko lang pong gawin sa Ingles muna, para and mga nuances(?) ng mensahe ay hindi mawala:

    Eto po ang mga pinaka importanteng kailangan sanang gawin. 

    Understand your feelings.

    Be supportive without reinforcing the behavior.

    Take care of yourself.

    Kung kailangan ninyong pumunta sa sarili ninyong therapist, gawin po ninyo ito..
     
    Acknowledge the pain of your loved one.

    Educate yourself.

    Get as much information as you can about self-injury in general. Eto po ang iilang libro na makakatulong sa inyo.   Bodies Under Siege by Favazza, The Scarred Soul by Alderman, and A Bright Red Scream by Strong. Sayang lamng na wala pang mga libro na nasulat sa Filipino. Sana in time…

    Acknowledge the pain of your loved one.

    Kasing halaga po ang mga kailangang HINDI gawin:

    Don’t pretend it away -- you have to respond in some way.

    Don't take it personally. Hindi ito ginagawa ng anak ninyo para saktan kayo.

    Do NOT give Ultimatums… EVER.  They do NOT work.

    Inaasahan ko po na nakatulong itong mga suggestions sa inyo.  Kung mayroon pa po kayong gustonbg tanungin tungkol rito, sana po sulatan ninyo nanaman ako.  Gumagalang—MG Holmes

  • Husband fancies his friend’s GF

    Hi,
    I'm married and have 2 kids. hubby and I are ok (if we are talking about sex life)
    I just wanna ask if it's ok if my husband fancies his friend's gf who is a lot sexier than me.( though they seldom see each other)  the fact that he told me he finds this girl sexy and  parang kulang nalang  he  tells me he wants to screw her. I  honestly got offended but i didn't tell him thinking na it's normal for guys to admire  other girls.


    Do I have the right  to get mad at him for telling me that? or is it ok bec. at least he's telling me what's on  his mind?


    Thanks and more power to you!
    Raquel

    Dear Raquel:


    This is really a hard call. On the one hand, women want their  husbands  to trust and tell their wives “ everything”; and yet when they do, the wives get upset (angry, teary, insecure, etc.).


    Most women are guilty of the above, so don’t worry if you fall in the same category.  However, maybe it’s time to decide if you want (1) “no-holds-barred” communication with your husband of (2) “it depends” communication.


    In (1), your husband will answer all your questions with “no holds barred.”  You too, will answer you husband with the pure, unvarnished truth and to hell with tact, guilt or hurt feelings. 


    In (2) while you may actively lie to your spouse, when your answer to any of your spouse’s questions might cause “unnecessary hurt ,” then you don’t actively lie, but you don’t necessarily tell the entire truth either. 
    How, then should you answer?


    Well, “it depends,” doesn’t it?  On what other factors are involved.


    I myself like (1) because at least you know where you stand and you are not placed in a position where you have to lie simply to spare someone else’s feelings.


    Also, my clinical experience suggests (and merely suggests, not “proves:” or “confirms”) that couples who can be totally honest with each other usually are the strongest and most intimate.


    However, you and Mr. Raquel need to decide what is best for you.  And then  you will have clearer guidelines (as will he) on how to tell you about his attraction to other women.


    Though I must admit I am surprised by his volunteering such information about a mutual friend. 


    Was it because you asked him a question about her in the first place?  In which case, perhaps it’s a good idea  ask only questions whose answers you can take.  OR…


    Did he really volunteer the information of finding your girlfriend in which case maybe you should explore (and I would be very happy to do it with you) if there is something else going on in your relationship.


    To summarize, yes, it is very normal for men to admire, and even feel horny for, other women.  But that doesn’t mean they actually want to sleep with them.  Or,…even if they “wouldn’t mind” doing so, that doesn’t mean they actually will. 


    I think, it would be a good idea NOT to get mad at him because of that.  Like all marriages, there will be many other things you will gut levelly be mad at him about and maybe you should reserve your bile for such occasions.


    Anytime you can afford to think about whether you “should or shouldn’t,” in the first place, means the heat of the issue has neutralized and hooray! you now have control over your emotions;  And usually, the kinder, more gentle thing to do (not getting mad rather than getting mad) is the preferable response.


    I hope I have helped in some way.  Ingat—MG Holmes

     

  • Erection Problem

    Dear Dr. Holmes,

    my fiancée has recommended me your homepage. She is Filippina and I am German. We want to wait until our marriage to make love.

    Yet it has turned out that I have erection problems. I am not sure whether it is due to physical or/and psychological past experiences.

    So my questions are these two; how to find out what is the problem is and would you be so kind to give some advice what to read about it. Maraming salamat!

    Yours sincerely
    Michael

    Dear Michael:

    Many thanks for your letter.
     
    The best way to find the best and most current books to read would be to go either your closest university bookstore or to the German version of Amazon.com to look at the latest books on erectile dysfunction and/or on sex therapy.  The description of the books will give you an idea of whether it is only hype or actually has a lot to say.  I am partial to books by Leiblum and/or Rosen.  And I try to buy titles published in 2000 or later.

    The best way to find out whether your erectile problems are psychological, physical or a combination of both (usually the most common kind) is to go to a urologist, tell him your concerns and observations, and have him run a few tests.

    However, you might appreciate a few guidelines to help you figure some things out before your visit.

    Problems with erections can be either global or situational.
     
    A global erectile problem is when it happens under every situation, no matter what time, what place and with whom.  Such problems usually have a physical basis.

    A situational erectile problem happens only some of the time and not always; under certain circumstances and not all.  These problems are usually psychological.
    In the past, problems with a physical basis were most difficult to solve with grace and style, needing injections, vacuum pumps, and/or penile implants.

    Not anymore. 

    It started with antidialators like Viagra, Cialis, but with more refined diagnostics and more effective treatments, erection problems with a physical and or mixed physical/psychological causes can be more easily dealt with now.

    If the problem is more psychological in nature, you need not stay with a medical doctor  but go, instead, to a psychologist or social worker   Usually sexual histories and family, cultural and religious expectations are studied.  

    The most important solution, of course, is what you already seem to have: A warm, open and mutual relationship with a woman who loves you and for whom, it seems, you would do all you can to have a happy life with.  Thank you for showing, once more, that the best kind of sex is what happens in your hearts and between your minds, and not between your legs.  Mabuhay po kayong dalawa!  MG Holmes

  • Kakaibang urge pag depressed or may problema

    Dear Dra. Holmes:

    I am 34, female and still single. may urge po ako na parang gusto kong kurutin ang mga kids ages 3 below na mga lelembot lembot o mahihina, esp pag depressed ako o may problema.bakit kaya ako ganito?pls.help .I'm glad to hear from you soon,thanks.  Tess

    Dear Tess:

    Ang dahilan kung bakit gusto mong kurutin ang mga bata ay hindi madi-diskubre sa isang sulat lang.  Minsan ito ay kailangan di lamang ng napakaraming sulat, pero face to face therapy therapy ng maraming taon.
    Pero kung ito ay matinding pagnanasa na mahirap i-control, sana ay magpatining ka sa psychiatrist o psychologist sa lalong madaling panahon.

    Kung ito ay urge lang na kayang kaya  mong i-control, I wouldn’t worry about it.  Ang iyong mga depressions siguro ang mas mahalagang ayusin.   Ingat at sana nakatulong ako sa iyo—MG Holmes

  • Mapuputing mga Paa

    GOOD DAY DR.HOLMES

    BAKIT PO NA-A-AROUSE AKO SA MAGAGANDANG FEET NG MGA BABAE, LALO NA SA MGA MAPUPUTI AT NAMUMULANG TALAMPAKAN? KAPAG NAKAKAKITA AKO NG MGA PAANG MAGAGANDA, GUSTO KO PONG MAGMASTURBATE O KAYA'Y AMUYIN AT I-MASSAGE ANG KANILANG FEET – EDDIE

    Dear Eddie:

    Maraming salamat sa iyong sulat.  Hindi naqkakagulat ang iyong mga gusto.  Maaaring ikaw aymay tinatawag na foot fetish. 

    Pero, kagaya ng palagay ko hindi.

    Totoo, kagaya ng may mga foot fetish, ikaw ay naaakit, nagnanasa ng paa ng tao.
     
    Pero para maging fetish ang isang bagay, ibig sabihin ay hindi mo kayang magsiping kung wala ang bahaging ito.  Ang mga taong may foot fetish ay hindi maaaring magsiping kung hindi nila hinahalik o inaaamoy ang paa ng kanilang partner.

    Kung kaya mo namang malibugan kahit  hindi ka humahawak o humahalik sa (mga) paa ng (mga) partner mo, ibig sabihin ay wala kang foot fetish.

    Hindi ko alam kung bakit ka na-a-arouse sa magagandang paa. Kadalasan ang dahilan kung bakit tayo na-a-arouse sa isang bagay ay dahil sa mga nangyari sa atin noong tayo ay bata pa.  Minsan kasingbata ng tatlo o apat na gulang.

    At iba iba ang mga dahilan ng mga taong may foot fetish, kaya sa pamamagitan ng isang sulat lamang, walang sikolohistang makakabigay sa iyo ng mga dahilan ikaw ay mahilig sa mga paa.

    Pero ok lang siguro yun, diba, Eddie?  After all, maaaring hindi mo sasabihin ito sa lahat ng ka-opisina mo., pero wala naming kahihiyanm ang isang taong may hilig sa paa. Kahit na ito ay di lang hilig pero talagang isang fetish na, hindi pa rin kailangang magpagamot basta lang wala kang sinasaktan (kahit ang iyong sarili). 

  • “Premenstrual Depression”?

    Dear Dra Holmes:

    Good day Dra.  I want to know if it's normal to feel depressed once or twice a month? I've observed that I do feel depressed every month especially when I'm about to have my period.

    When this happens, I totally mess up with everything/everyone. I don't want to work or do anything. That's why I usually lock myself in the room while I'm having this lunatic attack to avoid conflict with anyone.

    Many times I tried to commit suicide pero punyetang sarili ko hindi naman kaya.   (But goddamn me, I can’t pull through with it)

    And even if I no longer feel so low, I also lose any desire or motivation to pursue anything I want with passion. Parang minsan excited pero most of the time wala na, nakakatamad  or nakakabagot na.  (It’s as if I can get excited, but most of the time the excitement vanishes and I feel lazy and frustrated about everything)  

    Dra. Holmes can you recommend an anti depressant pill which I can buy over the counter. I think that would help me become productive and redirect my energies into something worthwhile.  I think it will help me stop wallowing in self pity and remembering my past failures which obviously don't help me at all.

    Finally, I am just wondering how much it would cost me to consult a clinical psychologist like you.

    I appreciate very much all the knowledge you are imparting on your readers. I hope you could help me as well.
    Thanks and more power! :)  LINDA
    Dear Linda:

    Thank you very much for your letter and for showing so clearly how it feels to have a classic case of clinical depression.  Many of the symptoms you mention are symptoms of clinical depression:  self pity, extreme guilt, blaming oneself for past mistakes, not able to pursue anything with passion, not able to stay interested in anything, locking oneself up in a room (to avoid others?), etc.

    If postpartum depression is a depression important enough to include in the DSM IV (which Filipino and American psychiatrists and psychologists use to determine whether something is a mental disorder or not), then hopefully in time, “premenstrual depression” will too.   After all, PMS (premenstrual syndrome—many of the emotional roller coasting you go through) has already been successfully used as a defense against a ruling of homicide.  

    It is possible your depression is also “mixed,”  (combination of low points like feeling bad about oneself, but also agitated points which would lead to conflict with others if you didn’t lock yourself up in the room).

    It is also possible that you are bipolar.  Rage (which may be the reason for conflict) is a classic symptom of mania (or hypomania).  It is NOT a symptom of clinical depression.  

    There is also a theory that when one is depressed, one has no energy to attempt suicide; that the most number of suicides are attempted when one is just coming out of a depression and swinging into a manic phase.

    But enough about theory and on to solutions.  If you are depressed, an antidepressant would definitely be useful.  If you are bipolar, antidepressants would be useful, but usually a mood stabilizer (lithium being mood stabilizer of choice as it is a natural salt and is, therefore, not protected by drug patents which lead to phenomenally.(if not also unscrupulously) high prices.

    Lithium is thus the least expensive mood stabilizer [costing less than P 10.00 whereas others can be as high as P125.00]

    SSRIs (selective serotonin reuptake inhibitors) and SSNIs (selective serotonin and neuroepinephrine reuptake inhibitors)  which are the second/third generations of antidepressants are very expensive UNLESS their patents have run out.  Thus, a 20 mg prozac (branded) is over P110; whereas fluoxetine (which is its generic counterpart and juts as effective) is about 30 or 40 pesos!

    Antidepressants, however, are not OTC (over the counter) drugs.  You need a prescription to buy them, though I have heard of several pharmacies (or, to be more exact, several people working at said pharmacies) that do sell drugs that need prescriptions over the counter.

    Finally and in general, clinical psychologists and psychiatrists in private practice charge as low as P700 and as high as P3000 per session.  I would strongly recommend you go to a psychiatrist first, since he can prescribe medication whereas we “mere” psychologists cannot.  Hopefully, he will be a psychiatrist who listens and responds and doesn’t just write out prescriptions.

    There are many such psychiatrists around: with hearts as well as heads. However, if you are not blessed enough to find someone like that, look for a psychologist in addition, who can help with issues other than medication.

    A therapy originally designed(?) for,  and particularly helpful to mild and moderate depression is cognitive behavioral therapy (CBT) which is described in this website.  Severe clinical depression usually needs medication, hopefully in addition to CBT.  Research has shown that CBT helps with either preventing relapses all together or diminishing its frequency and intensity.  Good luck, dearest Linda, and safe journey from sporadic bouts of joy in the midst of depression and frustration…to a serene and long lasting feelings of well being.  With your courage, smarts and honesty  (no bola!!), I am sure you can make it especially now that you have taken the first step of asking for help.

    Please, pleaaaase write to me if there is anything else I can do for you. Depression is a terrible business and no one should have to suffer from it.  Especially nowadays when there is so much help in so many forms to overcome it.   All the best—MG Holmes

  • Isyu ng Inggit - Part 1

    Dear Dra. Holmes:

    Gud morning po i need po talaga your advice kasi po nakakranas na po ata ako ng Chronic Depression, sobra!

    Ganito po kasi yun 3 yrs na kaming nagsama ng hubby ko. Yung hubby ko may kapatid na bunso. 21 yrs.old ang bunso; si hubby naman ay 28 na.

    Itong bunsong ito ay nakabuntis na nung gf niya at dinala sa bahay nila eh ang dingding ng haus nila bahay din namin kaya di maiwasang dinig mo rin ang usapan sa kanila. 4-5 months pregnant na po ang asawa nung kapatid niya tapos narinig ko na boy ang magiging anak nila.

    Sobrang nakaramdam po ako ng Depression nung time na yun,, napaparanoid ako feeling ko lahat ng kapitbahay at barkada ng asawa ko ako ang pinaguusapan at ako ang topic kasi naunahan pa ang asawa ko ng kapatid niya na magkaanak. Tapos maganda pa at sexy ang asawa niya. Ako naman poy chubby at simple lang.

    Last year pa po namin gusto magkaanak kasi gusto na rin ng biyenan ko. May sapat naman po kaming kita para makabuhay ng pamilya samantalang yung sa kapatid ng hubby ko biglaan lang yun dahil nag-aaral pa ito at ang babae ang may trabaho.

    Kaya masyado po akong napu frustate Dra.Masyado ko ng kinaiinggitan yung kapatid ng hubby ko kasi magkakaanak na sila..

    Tapos ngayon po undergo po ako sa pagpapapayat dahil kelangan na talaga para sa baby kasi natigil din po ang regla ko. Ayon sa research natitigil daw po kasi yun kapag sobrang nag gain ka ng weight. Kaya puro fruits & vegies lang kinakain ko.

    Nakakaapekto din po ba na tagtag ako sa biyahe kasi naghahandle po ako ng HR sa negosyo ng Papa ko in San Pedro laguna tapos nauwi naman po ako sa Guadalupe Makati? Sabi po kasi ng iba tagtag ako kaya di din kami magkaanak.

    Tsaka mabilis lang po kaming nagsesex ng asawa ko kasi mabilis siya labasan. Nakaka apekto din po ba yon?

    Nagdecide din kami ng hubby ko na lumipat ng haus para maiiwas ko din yung sarili ko na mainggit kasi panigurado pag lumabas na yung bata makikita ko yung enjoyment sa kanila. Sobrang frustrated po akong magka-anak! Sana matulungan niyo po ang problema ko..aantayin ko po ang sagot salamat! ESTER

    Dear Ester:

    Inaasahan ko ring matulungan ko kayo ng kahit papano. Ang ibang mga tanong mo ay kailangan kong tanungin sa ob-gyne, pero isa ay masasagot ko na: Walang kinalaman ang pagiging mabilis labasan ang asawa mo sa iyong di pagka anak. As long as di napakabilis na nalabasan na siya hindi sa loob ng ari mo pero sa labas. Pero palagay ko di naman yan ang situwasyon, dahil siguradong isusulat mo rin yon sa akin, diba?

    Yan ang isang dahilan na, sa palagay ko, hindi ka clinically depressed. Napakadaldal mo! At ito ay nakakatuwa at nakaka aliw na pagdaldal, kahit na malungkot ang situwasyon mo. Bihira lang makaya yan ng clinically depressed na tao. PART 2 BELOW

  • Isyu ng Inggit - Part 2


    Dear ESTER:

    Maraming salamat sa sulat mo. Kung nakakaapekto man na tagtag ka sa biyahe, yan marahil ay dahil pagod ka sa biyahe at, kadalasan, kung pagod sa biyahe, pagod rin sa pagsisiping. OO nga, gustong guso mong magka anak, kaya sigurado akong lagi kang handang magsiping sa asawa mo dahil rito (at dahil mahal mo siya) pero kahit na gusto ng utak at ng puso,minsan hindi masundan ng katawan., dahil nga, pagod ka.

    Ang kapaguran ay minsan nakakaapekto ng pagrating sa glorya ng babae. At kahit HINDI naman lahat ng mga babaeng pagod ay hindi nakakaorgasm, at HINDI naman rin na lahat na nagoorgasm na babae ay nabubintis, minsan may kinalaman ang dalawa. Kapag nag orgasm ang babae, ang mga contractions niya ay maaaring magpabilis ng takbo ng semilya sa kaniyang itlog.

    Pero ang pinakamaiging gawin ay pumunta sa “fertility specialist” dahil 3 taon na kayong wala pang baby. Siya ang makakatulong sa inyo kung may problemang pisikal na maaayos.

    Marahil ang pinakamalaking tulong na mabibigay ko sa iyo ay ipaalala sa iyo kung ganong kamahal ka ng mister mo. Akalain mo, dahil sa iyong damdamin, handa siyang lumipat ng haus? Bihira ang mga asawang gagawa ng ganito. At nasasabi mo sa kaniya lahat ng mga feelings mo na walang takot na pagtatawaan ka o imamaliit ng mga ito. Napakaswete mo, Ester,…at napaka swerte rin niya, na mayroon siyang asawang kasing open at honest sa kaniya. Ang ganda rin na hindi mo tinatago ang iyong damdamin sa kaniya at sa iyong sarili Bihira ang taong ganyan, Ester.

    Sana tandaan mo ito kapag nagaalala ka kung pinaguusapan ka ng mga kapitbahay. Kung may time silang magtsismis, obviously ang buhay nila ay hindi kasing ganda o kasing puno ng pagmamahal, kagaya ng buhay ninyong mag asawa. Mabuhay kayo, Ester. Ingat—MG Holmes

  • Ano ang Bipolar Disorder?

    Dear Dra. Holmes:

    Matagal napo kaming nagaalala sa aming anak na si “Josephine, ” 31, na minsan ay malingkot at umiiyak at minsan naman ay parang napakasaya na wala naming dahilan.  Dinala na naming siya sa maraming doctor at iba iba ang kanilang sinasabi at iba ibang gamut ang kanilang binibigay. Ang huling pinuntahan namin ay nagsabing pasrang bipolar daw an gaming anak.

    Eto po an gaming mga tanong:

    1. ano ba ang bipolar?
    2. paano malalaman na ang isang tao ay bipolar?
    3. babae lamang ba ang nagkakaroon ng bipolar disorder at anong edad nade-detect ang sakit na ito?
    4. namamana o heriditary ba ang bipolar disorder?
    5. paano naapektuhan ng disorder na ito ang utak ng isang tao?

    Mr and Mrs Santos

    Dear Mr and Mrs Santos:

    Marami pong salamat sa inyong sulat Mahirap pong magkaroon ng anak na bipolar, pero kapag alam na ninyo ano ang problema mas gumagaang ang buhay. Minsan po kasi ang bipolar disorder ay nami-mis diagnose (inaakalang ibang sakit ng psychiatrist) bilang borderline personality, schizo- affective disorder, schizophrenia, atbp). Kung ma-mis diagnose ang problema, maaaring an gpinakamabuting tulong para sa tunay na problema ay hindi na-i-implement kaya mahalaga tyalaga ang tamang diagnosis.

    1. Ang bipolar disorder ay isang tinatawag na “mood affective disorder.” Ibig pong sabihin niyan ay ang problema ay hindi sa pagiisip, kagay ng schizophrenia, halimbawa. Sa schizophrenia, maaaring isip mo na ikaw si Mother Mary o si Gloria Macapagal (hindi naman sa tinutumbas (?)—put in the same category—ko sila). Maaari ring isipin mo na ang galunggong na kinakain mo ay nagsasalita sa iyo.

      Dahil ang bipolar disorder ay mood, at hindi thought , disorder, maraming may bipolar disorder, lalo na kung ito ay bipolar II, ay nakakatrabaho at nakakapag asawa, atbp.

      Kung may mood disorder ang isang tao, ibig sabihin ito ay tungkol sa iyong mga damdamin. Masaya ka ba o nalulungkot? O m,asaya ka ba pero may underlying (talaga sa tunay ay) mayroon kang) matinding kalungkutan.

      “Pero lahat naman tayo ay minsan masaya at minsang malungkot sa ating buhay. Ibig bang sabihin na lahat tayo ay may bipolar disorder?” maaari ninyong tanungin sa sarili ninyo.

      Hindi po. Ang kaibahan ng may mood affective disorder ay sa kadalasan, katindihan, at sa aksyon na ginagawa kapag malungkot o masaya.

      Ang bipolar disorder ay isa sa dalawang pangkaraniwang mood affective disorders.

      Ang una ay clinical depression na ang problema ay sobrang kalungkutan, guilt at pagbibintang sa sarili.

      Ang bipolar disorder ay may depression, pero rin mayroong mania (o hypomania). Ito ay sobrang kasiyahan, sobrang bilib sa sarili, sobrang paniniwala na kaya mo ang lahat, at kaibigan mo ang lahat ng tao at m,ayuroon ring silang pagmamahal sa iyo.

    2. Malalaman kung isang tao ay bipolar kung siya ay minsan depressed at minsan naman siya ay manic. Kailangan na ito ay tumagal ng 2 linggo o mas matagal pa doon. Ang mga symptoma ng depression ay ang sumusunod. Hindi kailkangan na lahat ng symptoma ay nandoon bago sabihin na depressed ang tao:
      • Una, kapag depressed ang tao, eto-eto ang mga symptoma niya:
        • sobrang lungkot
        • Wala ng interes o saya samga dating nagbibigay ng interes at saya sa kaniya
        • Hindi makakain o sobrang pagkain
        • Hindi makatulog o sobrang pagtulog
        • Masyadong magalaw o kulang ang pagkagalaw (psychomotor agitation or retardation)
        • pagakawal o pagkababaw ng energy
        • Madalas isipin na bale wala siya (worthlessness) at na may kasalanan siya (guilt)
        • kahirapang maka-concentrate kapag nag iisip
        • Madalas magisip ng suicide o kamatayan
      • Ang mga symptoma ng mania ay kailangang magtagal ng at least 1 week at naka epekto ng buhay ng tao. Hindi lahat ng symptoma ay nangangailangan ipakita ng tao bago siya ma-diagnose ng bipolar, pero mahalaga ring malaman ang lahat ng mga symptoma niito:
        • Sobrang saya, sobrang mapagbigay o sobrang madaling at matinding pagkagalit at pagka inip sa ibang tao.
        • Napaka bilib sa sarili
        • Hindi natutulog. Ang tapong nasa manic episode ay kayang matulog lang ng 2 oras, pero ang lakas pa rin ng energy niya.
        • Napakadaldal. At mabilis, malakas (loud) at lagi lagi kaya mahirap makasingit ang iba.
        • Racing thoughts—parang naghahabulan ang mga isip ng bipolar kapag siya ay manic. Irto ang isang dahilan na siya ay mabilis magsalita. Para masabi niya sa iba ang lahat ng kaniyang iniisip na minsan ay walang koneksyon sa dati niyang sinabi.
        • Madaling ma-distract ang tapong nasa manic phase ng kaniyang BD. Habang isang bagay ang pinapagusapan, ,maaaring mayroon siyang mapansin na walang koneksyon at yun nalang ang paguusapan niya.
        • Hyperactivity at goal-directed acitivity. Ang gusto niya, gusto niya ngayon at gagawin niya ang lahat na magagawa niya para makuha ito. kaso lang, napakarami niyang gusto sa larangan ng pisikal (at kadalasag sekswal) , social, financial at tungkol sa trabaho.

    3. Parehong babae at lalake ay maaaring bipolar at ang ratio ay 1:1.

    4. Oo; namamana ang bipolar disorder (BD) pero hindi ito ito kasing simple (straightforward) nang: kung mayroon isa mong magulang, magkakaroon ka rin nito.

      Maaaring ang pinagmanahan ay hindi ang tatay o nanay mismo, pero ang isang lolo o pinsan o tiya, o pinsan atbp.

      Ayon sa pananaliksik, ang probablidad na magkakaroon ka ng BD ay:
      a. 10% kung isang magulang mo ay may BD;
      b. 20% kung ang dalawang magulang ay bipolar;.

      Mas mataas ang probabilidad na maglkakaroon ka ng bipolar disorder, climical depression na umuulit (recurrent depression) o schizoaffective disorder (SaD). Ang SaD ay hindi kasing tindi ng schizophrenia at hindi kailangan pumunta sa mental institution ang taong mayroon nito.

    5. Hindi pa natin alam kung papaano talaga na-aapektohan ang utak ng isang taong bipolar. Ang alam lang natin ay ang opposite: ano ang nakaka apekto sa sakit na ito: Isa sapinaka mabisang pantulong sa bipolar disorder ay ang pag inom ng gamot. Yan ay dahil ang bipolar disorder ay may biological component kaya biology (kagaya ng gamot) ay isa sa pinaka mabisang paraan para ma-control ang BD.

      Kung ang taong may natutulungan ng lithium, napaka swerte niya dahil mura ang lithium sa ibang mga gamot sa BD, kagay ng depakote, lamictal atbp. ay nakakatulong ma-stabilze (para hindi na hindi sobrang saya o sobrang lungkot) ang isang bipolar. Mayroong theorya (theory?) na ang bipolar disorder ay parang epilepsy—na galing sa at yan ang dahilan na ang gamot para sa epilepsy ay nakakatuong rito.

  • A Suicide Risk? - Part 2

     

    Dear Cherryl:

    Thank you very much for your letter which was published in full last Thursday, November 8, 2007.  In that column, I answered your specific questions directly.

    I have gotten many emails since then, asking about suicide, so let me give more general signs and symptoms so you, and others with the same concerns can be helped even if the particulars are not necessarily the same. 

    At risk for suicide:

    • People who are depressed
    • People who are anxious and/or exhausted
    • People who have tried it before
    • People who have talked about it before
    • People who already have on hand, or can easily get,  lethal weapons and toxic substances (or have asked about how to get hold of a gun or you see there is rat poison in the cupboard when there never was before, etc.)
    • People who have talked about wanting to die
    • People who have, without seeming good cause,  given instructions about who gets what even to just one person;
    • People who have started to give away all (or most of) their treasures
    • People who suddenly have made a will when they haven’t before
    • People who are grieving the loss of a family member, a close friend, or even a beloved pet;
    • People who are facing a crisis
    • People who act and seem as if they think things are hopeless (kasi sometimes people don’t want to call attention to themselves or their plans so they won’t talk about suicide, so if we can be alert, that is a good thing.)
    • People who have been depressed a long time and all of a sudden seem hopeful and able to do things  (Not all people who fit this pattern are, of course, vulnerable to depression.  However for those who are, the reasoning  could go like this: “at last, I have something worthwhile to do, I can plan my death and thus not burden those I love with my problems”  Not realizing at that time,  of course, that suicide will devastate his family and friends so much more)
    • People with a family history of suicide.

    Of course, even if one doesn’t show any of these signs, it is still possible that an adolescent is vulnerable to suicide attempts.  However, should a person show signs of being at risk, one should be doubly vigilant and determine how best to establish a suicide watch.

    Hope this helps., please write once more if there is anything else I can do—MG Holmes

  • A Suicide Risk? - Part 1

    Dear Dr. Holmes:

    I follow your column for many years but don’t write you because I write in Bisaya and broken English.  But I very worried like susan.

    My son always talk of suicide now.  I don’t know what to do. Like susan, I feel hopeless. Think of killing myself if I cannot help son.

    Do I listen, do MORE than listen—like forcing him to go to psychiatrist?  Do I ignore because maybe only encourage him to talk and talk about suicide?

    It make me nervous and I don’t know what to do. Please help.   CHERRYL

    Dear CHERRYL:

    Thank you very much for your letter.  I hope you don’t mind if I occasionally write in Tagalog.

    First, definitely do NOT ignore any talk about suicide.  In fact, what we (psychologists) tell both parents and mental health professionals we train is, even if the person doesn’t talk about suicide, if you feel something is wrong and the person might consider sucide as a possibility, you must ask him about. It.

    Sometimes parents and psychologists, etc are frightened to bring up the subject because they feel that it might give the person “ideas.:

    First, a depressed person will NOT commit suicide simply because you brought it up.

    Second, most depressed people have already considered it and have either discarded it as a notion OR will be relieved you brought it up since it gives them the opportunity to talk about it.

    Definitely listen to what he has to say. Listen and then listen again. Usually, a parent’s tendency is to lecture a child. Please refrain from doing so.  What he needs most of all is NOT someone who tells him what to do, but someone who will listen to his feelings, no matter how unacceptable he thinks they are. What he needs is for someone to listen and not judge him.

    Do NOT force him to go to a psychiatrist if he doesn’t want to.  Sometimes, this may be yet another factor (your forcing him to do anything) in his considering suicide even more seriously.  You may suggest—even strongly suggest-he go to a psychiatrist, or you may suggest  he may want to talk to someone else in addition to you, but please don’t force him as he will once again think he is powerless to control his life.  TO BE CONTINUED …

  • Manic Depression

    Dear Dr. Holmes,

    I have manic depression disorder ever since I can remember...  But now it's back and a lot worst...  I'm 27  and it's affecting everybody and everything around me...  I'm so tired pretending that I'm alright when inside it's tearing me apart!!! i've been through a lot of psychiatrist in the past but none of them seem to work.  Hope I could have a session with you soon. Thank you... Brian

    Dearest Brian:

    You can definitely have a session with me, but I am in the Philadelphia right now won’t be back until NOV 30. I can see you first week of Decembe if you still want to.

    However, in addition to seeing me, a psychologist, you also have to see a medical doctor, more preferably a psychiatrist. Only a medical doctor can prescribe medication, you see, and bipolar disorder is strongly linked to the biology of our bodies and thus medication has been found to be extremely useful.

    While I am NOT a psychiatrist, I am researching about studies done on medication for bipolars, so if you can email me the meds you are taking, I can fwd to you some of the research i have done on it.

    Hang in there. I know manic depression (bipolar disorder)  can be devastating, BUT only until you find the right treatment for you. And while it seems to good to be true that bipolar disorder can be truly be contained, I reassure you, it can be. 

    Contained in the sense that even if, heaven forbid, a depression and/or manic episode or two may still come along, they will be not as severe NOR last as long. PLUS, the more you observe and monitor yourself and  follow the doctor's suggestions, the more you can control what has been such a devastating, debilitating  problem

    I realize, of course, that this is contingent on your finding a doctor you trust.  If you tell me more about the doctors you have seen--I will do my best to try and help you find one who is more effective for you.

    I very seldom promise people things, but I promise you bp CAN be managed to the extent that you and the people you love and love you, can breathe a sigh of relief--and not just for until the next depression or episode of mania comes, but for the rest of your life.

    Please feel free to write me again anytime...I will answer you though it may take (no more than) a week (usually much less) to answer you, ok?

    Hang in there, Brian.  Help is on the way... MG Holmes

  • Clinical Depression

    Hi Dra Margie,

    I've been trying to make sense of how I am and what I am feeling for many weeks now.  I don't know if I should even be writing this or am just overanalyzing my condition.  I tried to lookup "depression" in the internet and in the list of symptoms, I saw several there that I am actually experiencing.

    My question is when should I be alarmed of my condition or "illness?" Should I even consider this an "illness" or just a stage that I am going through and shall also pass over time?Can I overcome this by myself through exercises, research and sheer determination or should I seek professional help already? 

    See, I feel so down for several weeks already.  I feel tired and very low in energy.  I sometimes have bouts of crying especially at night.  I feel uninterested in sexual activities with my husband. Sometimes I make extra effort to do simple things. 

    I am a mother of two so I feel like I shouldn't be staying in bed and do nothing.  What should I do?  I don't know if my condition is alarming enough to seek professional help.  Is it possible that I am just "umaarte or I am just making this up?"  Can I simply change my perspective and awake and be back to my normal self again?

    I feel so guilty and undeserving of any attention because as I said, I just might be exaggerating things. Please enlighten me.

    Thanks so much!   Diana

    Dear Diana:

    You are most definitely NOT umaarte, exaggerating, or just “making it up.”   Depression is a real illness and has been around for ages. Many people have had clinical depressions, including poets Edgar Allan Poe, Sylvia Plath, Robert Lowell, actors, Luke Owen,  Margot Kidder, writers Ernest Hemingway, Artists Vincent Van Goth etc.

    You may have  noticed I have mentioned only foreign people with depression. Although there are many Filipinos with depression, I have not had express permission from them to include them in this column (though I have had permission to include them in a book I am writing,  so wait for that nalang?—oops!  Sorry for the digression.

    Depression is so rampant that it is called the “common cold” of mental disorders, with as many as 20% of the world having had it at one time in their lives or another.

    And yet, many people are apologetic, guilty, and confused about having this. That is because of the unfounded myth that one does not get over such a disorder (called a mood affective disorder). But one does. Very easily, in fact, as long as one seeks the appropriate help.

    You need not be alarmed over your condition in the sense that it is not life threatening. (well, unless depressions lead to suicide which occasionally they can, but from the way your letter sounds, it seems this is not something to worry about at the moment.  Please get help immediately, however, if you feel otherwise!!!).  

    At any rate, depressions are not life threatening, though they have many health implications. 

    I feel that is because, when we are depressed, we tend to take less care of ourselves: Our diets, sleeping patterns, exercise regimes go haywire, because we are feeling so bad that getting up in the morning is as much as we can do.

    Most of the time, depressions lift on their own, but it takes so long to do so that it would be unethical of me not to let you know that there are many options to getting better sooner. 

    Textbooks in abnormal psychology say most depressions lift on their own 18-24 months after they start.  Dr. Lee Dante, a psychiatrist based in Maryland and Pennsylvania said that before the advent of antidepressants, the average length of a depression was five years. 

    Can you imagine having to live through this “non life” longer than you have to, Diana?!!?   Especially when help is so readily available? 

    The help I am talking about is antidepressants and/or cognitive behavioral therapy (CBT).  Yes, exercise, being around family and friends who love you tremendously can help, but usually, this takes effect only after you have gotten over the worst part of your depression, after antidepressants and/or CBT have kicked in.  Before that, sheer determination and mind over matter are all for naught.

    So please, Diana, make an appointment with a psychiatrist.  That is because, in the Philippines, only psychiatrists can legally prescribe medication. 

    Some “well meaning” friends and/or “truly concerned” family members will try to convince you that “kaya mo yan, tibayin mo lang ang loob mo” (you can do this on your own if you try hard enough)  or medication is only for the weak. Please so not listen to them.  They don’t know what they are talking about.

    Yes,  medication is unnecessary if you are willing to wait the average 18-60 months to get better on your own, but most of us have lives to celebrate and children to care for and cannot/will not wait that long (and hooray for that!)

    Some psychiatrists not only prescribe medication but can also give psychotherapy.  If you find such a person, hang on to him/her because that doesn’t happen often.

    So, if your psychiatrist merely knows medicine, then by all means, look for a psychologist, social worker, etc. who is trained in therapy, who can take care of your mind and emotions.

    Hope this helps.  Please feel free to write me should you need more information.  All the best—MG Holmes  .

  • Can I marry? - Part 5

     

    Dearest Susan:

    Sa PART 4 inapos natin ang usapan na may pangakong paguusapan natin ang mga symptoma na kailangan hanapin, dahil ito ay mga panatang HUWAG tumira sa isang bahay sa PART 5.

    Hindi ko sinasabi na kailangang manirahan kayo sa isang bahay para magkaroon kayo ng happy family.  After all, maraming OFW ay hindi sa isang bahay, pero maraming OFW ay may masayang pamilya.  Of course, marami ring OFW ay nagloloko (at marami ring mga asawa na naiiwan rito ang nagloloko)  pero maraming beses, hindi lang ito dahil magkalayo sila.  Minsan, may “malat” na ang relasyon nila.  At kadalasan, kahit hindi sila nakahiwalay, magloloko pa rin yung tao.

    Hindi ko binabale wala ang kalungkutan na nangyayari kung magkahiwalay ang mag asawa  (lalo na kapag sila ay nasa ibang bansa) pero puwede pa ring tiisin ang huwag magloko kung talagang gusto ng mag asawa at kung (para sa talagan nahihirapan) maghanap sila ng tulong (maraming mga organization ng Pilipino sa ibang bansa) o magsubok sila ng mga paraan para hindi masyadong malungkot (magpadala ng tapes, siguraduhin na hindi pera lang ang pinaguusapan kapag nagte-telefono, atbp.) Kung sex naman ang nami-miss nila (at bakit hindi? Ito ay napakamahalaga sa maraming mag asawa) mayroong SOP, mga oportunidad sa internet na maaaring gumamit ng webcam, atbp.

    Pero napalayo tayo sa pinangako ko, Susan. Sorry.

    Gaya ng Lunes, ang impormasyon na ito ay ay nakuha sa libro na sinulat ni Rebecca Woolis, When Someone You Love Has  A Mental Illness: A Handbook for Family, Friends and Caregivers (New York, JeremyTarcher/Perigree, 1992).  Hindi ko sinasabinmg kailangan  kayong tumira sa isang bahay para maging masaya, pero mabuti na ring pag isipan ang mga kailangan na nadoon (present—na pinagusapan na natin  sa Lunes—at hindi naroon (must be absent) bago mag desidido na ang schizophrenic ay maaring manirahan sa parehong bahay:  (dahil kaunti nalang ang espasyo natin, hindi ko ito I-tra-translate sa Tagalog). Sana, Susan, (at ibang tagabasa) magsulat kayo kung gusto ninyong gawin ko ito.

    1. The person’s symptoms are so disturbing and disruptive that the rest of the family cannot live a normal life.
    2. The person has no outside activities or any external support system.
    3. Siblings live in the home who are negatively affected (e.g., are frightened or feel threatened by living with the person)
    4. The family as a whole feels angry,. Resentful and critical towards the person.
    5. The family consists of a single parent, living alone.


    Inaasahan ko na nakatulong ako sa iyo Susan.   Sana ay sumulat ka uli kung mayroon pa akong mapalilingkod sa iyo.   Sa makalawa, ay sasagutin ko ito sa Ingles.  Ingat—MG Holmes

  • Can I marry? - Part 4

     

    Dearest Susan:

    Sa PART 3, pinagusapan natin ang mga symptomang kailangan mong hanapin para magbigay sa iyo ng reassurance na okay para sa inyong manirahan sa isang bahay.

    Alam ko na maari kayong magpakasal kahit na hindi kayo tumira sa isang bahay, pero kadalasan, yung ang ine-expect ng tao kapag mayroon silang “happy family.”  Gusto ko lang ipalaman sa iyo na, dahil sa inyong special circumstances, maaari rin kayong magkaroon ng happy family,kahit hindi kayo naninirahan sa isang bahay, basta lang may supporta sa kaniyang pamilya at sa komunidad.   At siyempre, basta lang okay sa inyong dalawa na hindi kayo mabuhay sa isang bahay lang.

    Alam ko mahal na mahal mo siya.  Pero, kung hindi pa kontrolado ang mga symptoma niya (at ayon sa sulat o,parang hindi pa) baka sobra kang mahirapan at baka rin, mahirapan at ma-apekto ang mga magiging anak ninyo,  kung siya ay tumira sa inyo habang lumalaki sila.

    Bago tayo tumuloy sa mga symptoma, pagusapan muna natin ang mga anak na maaring dumating sa inyo.

    Hindi pa nila alam kung ano talaga ang cause ng schizophrenia.  Yan ay maaaring dahil maraming mga causes ito.   pero ang siguradong mga contributing factors ay (1) genetic  (namamana),  (2) stress—kasama na diyan ang klaseng pamilyang lumaki ang tao at (3) other environmental factors.

    Dahil malaking bahagi rin ang genetics, maaaring isa o mas marami pang mga anak ninyo ay may genetic vulnerability sa schizophrenia (or bipolar disorder).  So, baka gusto ninyong pagusapan kung magpla-plano kayong magkaanak biologically.  Kasi, anak mo na rin na tunay ang mga ina-adopt, diba, Susan?   So maaari itong isang option para sa inyo.

    Sa Part 3, pinagusapan natin ang mga dahilan na okay tumira sa parehong bahay ang pamilya ang schizophrenic.  .  Sa PART 5 naman, paguusapan natin ang mga symptoma na kailangan hanapin, dahil tio ay mga panatang HUWAG tumira sa isang bahay. 

    Gaya ng PART 3, ang impormasyon na ito ay manggagaling sa pagusapan nating ang probilidad na puwedeng mong ipakasal ang iyong boyfriend.  Sa aking palagay, ang basehan ng kaniyang kapasidad maging asawa mo ay hindi magkalayo sa basehan na ang taong may schizophrenia ay maaaring makatira sa bahay kasama ng iba. Hanggang PART 5, alagaan mo sana ang iyong sarili, Susan.  Ingat—MG Holmes

  • Can I marry? - Part 3

     

    Dearest Susan:

    Tinigilan natin ang PART 2 na may planong pagusapan ang paano makapili ng pinaka epektibong gamot at paano makumbinsi ang pamilya na huwag ikahiya ang kanilang kamaganak na may schizophrenia. Pero siguro bago yon, pagusapan nating ang probilidad na puwedeng mong ipakasal ang iyong boyfriend.  Sa aking palagay, ang basehan ng kaniyang kapasidad maging asawa mo ay hindi magkalayo sa basehan na ang taong may schizophrenia ay maaaring makatira sa bahay kasama ng iba.  Ito ay nakuha sa librong When Someone You Love Has  A Mental Illness: A Handbook for Family, Friends and Caregivers (New York, JeremyTarcher/Perigree, 1992).  Ayon kay Rebecca Woolis, ang manunulat ng librop,  maaaring makatira ang tao sa bahay kasama ng iba (gaya ng kaniyang asawa) kung: 

    1. the person with schizophrenia is doing well and has few obvious symptoms  (Ok naman ang bf mo at kaunti lang ang kaniyang mga symptoma na halata)
    2. The person with schizophrenia  has friends and activities he is involved with outside the family (ang boyfriend mo ay may mga kaibigan at mga interes maliban sa iyo)
    3. No siblings at home would be negatively affected by being around the person with schizophrenia  (ikaw ay hindi sobrang ma-a-apekto ng negative kung kayo ay tumira sa isang bahay
    4. The family as a whole feels calm, positive and nonjudgentakl toward the person  (Ikaw ay kalmado, positibo at hindi judgmental sa bf mo)  

    TO BE CONTINUED ...

  • Can I marry? - Part 2

     

    Dearest Susan:

    Maraming salamat sa iyong sulat. Sa part 1, pinapagusapan ang “positive” symptoms ng schizophrenia.  Ibig sabihin noon ay mga naririnig, nakikita, o naiisip ng mga may schizophrenia na hindi naririnig, nakikita o naiisip ng ibang tao. Kunwari na sila ay Prinsipe ng isang bansa o nakakarinig ng boses na may gustong pumatay sa kanila.

    Ang negative symptoms naman ay mga reaksyon o damdamin na hindi pinapakita ng mga may schizophrenia na ma-e-expect nating reaksyon at damdamin sa karamihan ng tao. Halimbawa, ang karamihan ng tao ay magpapakita ng ligaya at magsasabi rin ng “I love you” kapag ang mahal nila sa buhay ay nagsabi nito.  O ang karamihan ng tao ay malulungkot at mag-o-offer ng tulong kung ang kanilang girlfriend ay nakita nilang umiiyak.

    Ang positive at negative symptoms ng schizophrenia ang isang dahilan na mahirap maging optimistic (masiyahin, nag-e-expect na maganda ang takbo ng pagmamahal nila) tungkol sa relasyon sa isang schizophrenic.

    Pero hindi bad news ang lahat.

    Kahit na wala pang gamot para sa schizophrenia (Ibig sabihin, mananatili siyang schizophrenic buong buhay niya) hindi ibig sabihin na hindi siya mag-i-improve.  Para rin itong sakit ng bipolar disorder (manic depression).  Kahit na hindi na magpakita ng symptoma ang taong may bipolar disorder, hindi ibig sabihin na hindi na siya bipolar. Ibig sabihin lang na-control niya ang mga symptoma. Kadalasan hindi niya ito magagawa kung hindi siya uminom ng gamot para rito.

    Pareho rin ang schizophrenia. Bihirang bihrang makarining ng taong gumagaling ng walang tulong sa gamot AT sa pagmamahal ng kaniyang pamilya.  Paano makapili ng pinaka epektibong gamot at paano makumbinsi ang pamilya na huwag ikahiya ang kanilang kamaganak na may schizophrenia ang ating tatalakayin sa PART 3 .  Ingat and hang in there—MG Holmes

  • Can I marry? - Part 1

    I'm Susan, a tourism student and a part-timer in an outsourcing company. I’m afraid how to face my boyfriend's illness. He's schizophrenic and showing the negative symptoms of it...I can't help but cry everytime I'm with him. It breaks my heart everytime he doesn't hear nor react when i'm talking to him..he's responding on his medications for 8 months but still, it keeps on coming back.

    How will I face this kind of situation without my being hopeless and sunken ?I'm thinking about our future..will there be hope for us to have a happy family? We've been together for 5 years and I won't lift a finger to lose him. We love each other so much. What if there isn't any cure? What's the most positive thing that I could hear from you that he'll get back to normal?Your response will help a lot, Dra.Holmes..It really dreads me. I feel like dying.. SUSAN

    Dearest Susan: 

    Hangang hanga ako sa iyo.  Ang napaka tapat at loyal lang na tao ay kayang magmahal sa isang may mental illness. Hindi ko sinasabing imposibleng gawin ito.  Puwede, kaya lang napakahirap ituloy gawin ito. 

    Sa umpisa, parang madali lang, kasi sasabihin mo sa sarili mo:  Mahal ko talaga siya. Hindi ako magiging gaya ng iba, na tatalikuran lang siya kapag masyadong mahirap na. ater all, di ba yan ang tunay na kahulugan ng pagibig?  Na kahit mahirap ay nandoon ka pa? 

    Pero, kapag lagi laging may relapse ang tao, ma;alom amg tuksong (big temptation) sabihin lang:  “Masyado pala itong itong mahirap.  Di ko na kaya. Ok lang siguro kung ako lang, pero paano aman ang magiging mga anak naming?””

    Sa katotohanan lang,  walang magbibintang sa iyo kung yan ang maging desisyon mo. Mahirap talaga ang magpakasal sa taong may mental disorder.  Pero nangyayari ito araw araw, kahit jna alam ng isa na may problema ang kaniyang magiging asawa.  Ang ,mga mental disorder na kasama rito ay clinical depression, bipolar disorder (manic dep[ression) panic attacks, anxiety disorder, at schizophrenia.   Mayrrong mga taong kaya ang mapagasawa ang mayroon problemang mental at mayroon namang taong di kaya.

    May iba’t ibang basehan ng pagkaya ng tao o hindi.  Ang isa, talaga, ay ang pagkatindi at lalim ng pagmamahal nila para sa isa’t isa.

    Pero hindi lang yan ang importante, Susan.

    Mahalaga rin kung may pagasang gumaling ang tao o kung wala.

    Sa lahat ng mga poblemang sikolohikal, ang schizophrenia ang pinaka matagal na magamot (kung talagang magaganot ito—more on that later) at ang pinaka nakaka apekto sa buhay ng tao at ng mga nagmamaghal sa kaniya.  Yan ay dahil angh schizophrenia ay may kinalaman sa atinbg pagtingin sa mundo at sa ating sarili.  Sa schizophrenia, minsan nakakarinig tayo ng boses o nakakakita ng mga bagay na wala naman talaga doon (positive symptoms—ang pagkarinigm pagkakita o paglasa ng mga bagay na wala naman doon). 

    Mayroon ring mga negative symptoms,--ang walang aksyon o salita na nakikita ng tao sa iba.  Tila ang boyfriend mo ay may mas maraming negative symptoms. TO BE CONTINUED...

  • Marriage and Mania

    Hello Dr. Margie Holmes:

    My 47 year old mom was recently diagnosed with bipolar disorder. Recently, acting on her doctor's advice, my dad and I confined her. Within 6 hours, her doctor called and discharged her. Later did we found out that her meddling and intrusive sisters came to the hospital to get her out. Now, my mom is manic and has not been taking her medicines for a week. My dad and I don’t want to tell her to take it as we did before because we would look bad again. I have reported this to her sisters but they just seem to let it go.

    My mom is slowly deteriorating (her psychosis is back) and she's set to marry another guy. She had 3 husbands in the past and I have conveyed to her doctor my feelings regarding the marriage because i believe my mom doesn’t love the guy and she’s doing it for security purposes. Before my mom met this guy whom she’s about to marry, we had a family for 12 years. I am just so confused about her doctor, her act of discharging my mom and not having the proper discernment on the situation. The doctor said there is nothing I could do to stop the marriage. How could I allow such thing which I know will ruin my mom in the end?  I’m so helpless....

    Sari

    Dear Sari:

    Please forgive me for taking over a month to answer your letter. I was so touched by it, and wanted to give you the best answer possible.

    It is easy to feel helpless in the face of a bipolar person, especially at the height of her mania, , and to feel there is nothing you can do.  And that is because that is probably  the truth:  sometimes, there truly is nothing you can do. Especially in this case when even the doctor has seems to recognize the situation as such.

    It might be a good idea to talk to the doctor once things have settled down and ask her why she made the decisions she did.  If her reasons don’t make sense to you despite her explaining the situation, maybe you can explore the possibility of changing doctors.  Who is in charge of deciding who her doctor, Sari?

    It must be very difficult seeing your mom make plans to marry another man, especially since you had a taste of how good life can be when you had an intact family for 12 years.  As you know, these manic phases do not last forever, and I am hoping that, when she gets back on an even keel, she will realize all she had with you and your dad and be a family with you once again. 

    But that, too, will be temporary until your mom realizes she has a disorder and that taking her medicines will help her remain, hopefully, not only sane but happy.

    People with bipolar disorder usually have several  marriages in their lifetime,  the way your mom does, but with the proper treatment, a happy marriage and family life are still possible.  I wish with all my heart that that is a possibility also for you and your mom.

    You are a wonderful daughter to care for her so deeply, but please remember that you cannot live her life for her,  and that you are not to blame for any decisions she takes.  Sometimes the family of the bipolar tend to blame themselves for things that go wrong, wondering if they did enough, were patient enough, loving enough, etc.

    The implication behind these questions is that if they were enough, all this stress and heartache wouldn’t happen.  Not true, Sari.  Like any illness, mental or physical, all the love in the world is not enough unless the proper treatment is also in place.   And no one can make sure your mom gets treatment except for her. 

    Let me stop for now in case there is more you want to tell me.   There is supposed to be a support group for people with mood affective disorders and their families. Would you like me to find out more about this for you?   Hang in there—MG Holmes

  • Directionless,  Confused, etc.

    Dear Dra. Homes,

    Hello! I'm glad that i found your website,  i hope that u can help me out somehow.  I'm Liza May, 29years old, a govt. employee with no direction in life, kulang nalang i-label ko sarili ko as junkie. I suffered from depression since I was a kid and right now I'm taking anti-anxiety pills to somehow ease up the anxiety. I'm really confused and tired and mad from all problems-

    i don't know who the real ME is, or what I want in life, I also have a low self-esteem and lots of regressions in life, I’m still trapped in my past and cannot make a rebound, and so I thought that death is the only way to end up all my problems.

    I know for a fact that I can’t reach the age of 30, can u imagine at my age I haven’t experienced sensual love, i don’t have any bf, i get emotionally affected by things, by people, by society. And so I thought that death and drugs is the only solution. I read some books about my case but can’t find exactly what help it can do for me.

    Dra. Holmes, right now I'm reading this book by Jane Ussher called  Womens Madness: Misogyny or Mental Illness. Sometimes it keeps me sane but it also makes me ponder. Hehehe.  I need ur help or probably an advice will do. 

    Thank u so much in advance

    LIZA MAY

    Dearest Liza May:

    My heart goes out to you.  It is awful to feel alone, directionless, confused and so full of problems that death seems the only option.  Before I can help you further, I need to know more:   what are the regressions you suffer like?  What in your past makes you feel trapped?  How did the depressions start? 

    Aside from reading, what else keeps you sane?  Does anything—anything at all, no matter how seemingly mababaw (superficial)  give you joy, if even for a little while?  Is there anybody you can share these problems with?  And even if there’s no one (so far), is there anyone whom you regularly see or talk to?—an officemate, a neighbor?  Wo lives with you at home?

    Let me know and let’s take it from there, ok?  BTW, thanks for sharing this letter with others, as many feel as you do, but may not have the courage or the skills to put it down in writing.  Keeping my fingers crossed I hear from you soon….MG Holmes

  • Inferiority Complex

    Dear Dr. Holmes:

    how can i overcome my inferiority complex? it bothers me so much, i can't go out anymore with many people around. i hope you can help me.  Mai

    Dear Mai:

    I’d like to help, mai, but I need to know more about it.  Many times cognitive behavioral therapy (CBT) can help.  There is a primer on CBT that is on the mood affective disorders section of this website.  (click the icon called Other Than sex, then click on mood affective disorders).  CBT has been very useful for depression—just as effective as medication, in fact and since inferiority complexes are oftentimes linked to depression, it may also be useful for what you are feeling right now.

    Also, if you told me more about your inferiority complex, maybe the suggestions I gave might address your concerns more directly.  Looking forward to hearing from you again—MG Holmes

  • Manic depressive at Pagiging OFW

    (Since the following question was asked in Tagalog, Dr. Holmes feels a Tagalog answer would be better. Please write to her if you would like an English translation!)

    Dear Dra. Holmes:

    Gud am po. Si Ruben nanaman ito. Doktora, kung uminom ako nglitihum para sa manic depression ko, at maaari na akong magtrabaho rito, bakit ako hindi puede magtrabaho abroad? Gusto ko sana doon, mas malaki ang kita. Please reply.

    RUBEN

    Dear RUBEN:

    Maraming salamat sa iyong follow up question. Ibig sabihin talagang seryoso ka sa iyong pag aalaga sa iyong sarili. Bahagi kasi ng pagaalaga sa sarili ay di lamang ang mga gamot na kailangang inumin, pero rin ang pag alam ng mga bahagi sa buhay mo na mahalaga.  Para sa iyo mahalaga di lamang magtrabaho, pero magtrabaho sa ibang bansa.  On the one hand, hanga ako sa iyo na hindi mo pinapabayaan ang iyong dream na magtrabaho sa ib ang bansa.  On the other hand, importante ring tingnan kung lahat ng ating mga panaginip sa buhay ay kailangan nating ipwersang itupad o hindi.

    Minsan kasi, mas maigi na tanggapin nalang na kahit na mayroon tayong gustong-gustong mangyari, mas nakabubuti sa atin kung hindi ito mangyari. Hindi kita kilala ng husto, Ruben, kaya hindi ko masasabi kung ang iyong pagtrabho sa ibang bansa ay hindi para sa iyo.  Ang psychiatrist mo ang makakasbai sa iyo kung kaya mong magtrabaho sa ibang bansa o hindi.

    Kahit pare-pareho ang diagnosis ng 3 tao—sa iyong kaso, manic depression—iba pa rin ang kanilang sakit.  Ang isa ay kayang magtrabaho sa abroad; ang ikalawa ay makakaya in the future kung uminom siya ng gamot at hindi na maglasing, halimbawa, at ang ikatlo, kahit na siya ay matalino, mabait, at magaling sa trabaho ay hindi talaga kaya.

    Iba magtrabaho sa abroad, Ruben, kaya hanging hanga ako sa mga OFW natin.  Of course, hangang hanga rin ako sa mga kapwa Pinoy natin na nananatili rito sa Pinas, kahit na kurakot ang ating mga congressman at ang hirap maghanap buhay.

    Pero iba ring manirahan sa ibang bansa, Ruben. Ang layo mo sa mga minamahal at nagmamahal sa iyo.  Yan siguro ang pinakamalaking bagay. 

    Tapos, at least rito, mahirap ka man o mayaman, gaya ng sinabi sa akin ng isang taxi driver, “the Filipino is king.” Hindi ka second class citizen rito, bansa natin ito.  Siyempre, sa ibang bansa, sila ang king (at queen).  At minsan, ang mga hindi masyadong matalino o mabait sa kanila, ay dinudurot (like to emphasize) ito sa iyo: Na sila ang may karapatan sa bansa nila, at nagtratrabaho ka lang doon. Mahirap tanggapin yon, Ruben, ang kabastosan ng iba na hindi mo naman masagot ng derecho dahil ayaw mo mawalan ng trabaho.
    Tapos, iba ang pagkain, iba ang patakaran, iba kahit ang amoy  sa ibang bansa. Akala ng tao bale wala ito, pero malaking bagay ang amoy sa pagkain, halimbawa, at sa oagtulog, Minsan matagal bago tao talaga maka-adjust sa ibang bansa at ang stress ng pag-a-adjust ay maaaring sobra (o super laki) para sa iyo kung may manic depression ka.

    At ang daming tukso pa, Ruben.  Dahil malungkot nga ang buhay OFW, kung hindi ka matatag talaga, madali maglasing, manugal, magka-affair atbp.

    Ano ba yung sagot kung may magbitaw ng: “mahirap maghanap buhay”?

    “Mas mahirap ang walang hanap buhay.”  So, kahit sa ibang bansa o dito sa Pinas, Ruben, napakalaking bagay na ang  makatrabaho.  Ingat and all the best—MG Holmes

  • Manic Depression at Trabaho

    (Since the following question was asked in Tagalog, Dr. Holmes feels a Tagalog answer would be better. Please write to her if you would like an English translation!)

    Dear Dra. Holmes:

    Gud am po.  Manic depression po ang sakit ko. Curable po ba ito?  With lithium/quilonium puede pa ba ako work abroad? Please reply.  

    RUBEN

    Dear RUBEN:

    Maraming salamat sa inyong sulat.  Ang manic depression (o tinatawag na ngayon na bipolar disorder) ay isang mood affective disorder. Ang ibig sabihin yan ay na  ang “sakit” na ito ay sa “matinding kalungkutan” (depression)  AT ang kabaliktaran nito ng matinding kalungkutan, na tinatawag na sobrang kasiyahan (mania o hypomania).

    Ang pangkaraniwang gamot sa manic depression ay lithium/quilonium.  Kung ito ay may epekto sa iyo, napaka swerte mo, dahil ang lithium ay mas mura di hamak ng ibang gamot para sa manic depression. Yan ay dahil ito ay isang “natural salt” na hindi ginagawa sa laboratoryo, kaya walang kailangang bayaran sa mga malalaking pharmaceutical para sa “R and D” (research and development) o kahit para sa profit (tubo) nila.

    Ang problema lang ay na hindi lahat ng mga manic depressives ay nagagamot ng lithium. Kung ikaw ay isa sa mga swerteng manic depressive na nagagamot sa lithium, then makakatrabaho ka nga sa abroad.

    Pero, Ruben, hindi ako ang makakasagot ng tanong na ito para sa iyo. Ang kailangang mo ay ang iyong psychiatrist, na nakausap ka ng maraming beses, na alam kung ano ang kaya mo o hindi, alam ang reaksyon mo sa gamot o hindi, at alam rin kung iniinom mo ang gamot mo o hindi.

    Kung sabihin ng psychiatrist mo na puwede kang magtrabaho sa abroad, ok yun. Pero kung sabihin ng psychiatrist mo na hindi ka puedeng magtrabaho ng abroad, inaasahan ko na makakahanap ka ng trabaho rito sa Pilipinas na makakabigay ng hanap buhay sa iyo at makakatulong rin sa iyong kalusugan pisikal at mental.  Ingat and best of luck—MG Holmes

  • Will she (still) marry me? (A Conversation with JAMES)

    Dear Dr. Holmes:

    When I popped the question to my fiancé, Susan, she jokingly asked:  Wala ka bang lahing loko-loko?” (are you sure there are no loonies lurking in your family?)

    She probably saw how shocked I was, because she quickly tried to reassure me that it wasn’t that she was “prejudiced,” it was just that that will be the first question her dad will ask her once she tells him she’s marrying me.

    Is this typical behavior for a man with daughters (I am an only child), or is her father a Neanderthal?

    JAMES

    Dear James:

    I’m afraid you’ve presented me with a false dichotomy here. In certain parts of the country, this is typical, but that doesn’t necessarily mean her father isn’t a Neanderthal.

    In many provinces, her father is behaving not only normally, protectively (and thus, as he should be), towards his children.

    Admittedly, his question is rather direct. This is part of where the Neanderthal-ism comes in. he could’ve asked the question less belligerently.

    If he were more genteel, he could’ve said something like this instead: “Is there anything else we should know about the family, dear? –bad teeth, huge debts,  a strain of madness, perhaps?”   
                      
              Unless his purpose was to shock his daughter into the truth?  Or could that have been her purpose when she popped her own question to you?   If so, my question is: “Good God, man! Haven’t you talked about this before?”

              I realize mental illness isn’t exactly the first thing you talk about when out on a first date.  Or even on subsequent dates when you are out to sweep her off her feet so still on your best behavior.
    But marriage is a serious matter.  So along with moonlight, roses, and future dreams including how many children you both want to have, it is best to discuss other more serious but equally important issues like: death and taxes, debts and depression. I mention depression simply because it is so common among us that psychiatrists have called it the common cold of mental illness.

    Because she is not only marrying you as she sees you now, but you behind closed doors, before you’ve brushed your teeth and combed your hair.  And not just you now, public and private, but you in the future, when the slings and arrows of outrageous fortune have hit their mark and the dreams you may have had have clearly bitten the dust. 
    Will you still be brave and true even when things are not going your way?  Does your family have a propensity to bail you out whenever things get tough so you never learn to stand on your own two feet? What happens, then, when your parents pop off and you no longer have anyone to lean on?  Is there any strain of mental disorder which may rear its head once things get difficult? 
    These are all reasonable considerations and the more one knows before marriage, the better prepared one is, and the greater the chances of a happy, open and long lasting marriage.

              Because Susan misread my shock, Dr. Holmes.  It isn’t really because I felt her dad incredibly uncouth.  It’s because I’ve been diagnosed as clinically depressed twice before and haven’t told her. Must I?

    You don’t have to do anything you don’t want to, James.  But if you want your marriage to start out on an honest footing, then, yes, it would be a good idea to tell her about your previous depressions. 

              Just because depression can run in families, does that necessarily mean every depression has a genetic basis?
              No. Not every depression, but certainly many of them.

              Even if my depression has a genetic basis, can I still do something about it? 
    Abso-bloody-lutely.

              Thank God!  Does that mean Susan will still want to marry me?
    Actually, that depends on what sort of a person she is, doesn’t it?  If she’s bright and sophisticated, then no problem. She will know that even if depression runs in your family, you won’t necessarily be lumbered with it the rest of your life.  Especially with a loving, supportive wife by your side J.  A life partner who encourages you to take your medication (should you need it) and avoid lifestyle choices that may exacerbate your vulnerability to depression would help tremendously. She will know that past depressions do not make future ones inevitable, even if there is a 60% likelihood of a third depression if you’ve had two previous ones.  
    But these are mere percentages for ordinary mortals. By accepting your diagnosis (of having been clinically depressed twice) and taking steps to deal with it, you have risen above mere mortals.
    You accept your diagnosis, you are willing to be open about it to people close to you, you will do what it takes to prevent getting it again.  You have the best chance in the world, therefore, not to be depressed again.  But even if you do, it need not ruin your life. Hells bells. It need not even debilitate it to a large extent.
    Forewarned is forearmed.
    However, (going back to whether Susan will be willing to marry you or not) if she’s not terribly bright, then nothing you can do will convince her to marry you.  But then again, if she really is as prejudiced as her dad first sounded, if she’s the type to be scared off by what’s happened in the past instead of looking forward to the good that can happen in the future, why one earth should you want to marry her? 

    What do you mean?

    Well, if she’s bright and open minded, she will know beyond any reasonable doubt that depressions are not only curable, but preventable.  So no more future depressions (in the best of all possible worlds) or, in a world where crooked politicians still get elected, most potentially possible future depressions can still be prevented AND even the ones that may come up can be (1) cut off at the pass fairly quickly OR (2) be not as intense or long lasting.  She will realize that there is so much one can do to not only “cure” an existing depression, but more importantly to prevent future ones.
    However, if she is not bright and open minded, then no matter what you do or say, no matter how many journal articles on depression or how much methodologically sound research you show her will convince her that not only are you as good as any other man, but maybe even better!

    Dra, why can’t I just keep my depressions a secret and make sure it won’t happen again?

              Because you can’t, James.
    You can make sure you take your medications and go to CBT  if you need either or both; but you can’t make sure you won’t get depressed again.
    Life is not 100% under our control which makes it frustrating, but also exhilarating.  We can control whether we behave with integrity to anything that happens to us, but we can’t control what happens to us. Whoever said: “life is what happens when you’ve made other plans” hit it on the head.
              Even if she “blamed” her father, Susan asked you directly whether mental illness ran in your family, James.  I don’t see how you can get out of telling her the truth and still not be a bastard.
    What I hope, however, is that you shouldn’t want to.  Even more, I am hoping (at least after you finish this book) that not only do you NOT want to weasel out of this because you don’t want to be a liar, but you also see no need to lie.  So, you got depressed twice.  Yes, it may mean another depression or two (or even three) in your life. 
    Big deal. There are other things far worse, like beginning a marriage with a lie.

    So--sigh- it’s true then, na nasa lahi ito? (it runs in the family)
    Well, yes and no. 

    As in all important things in life, there are no simple answers.  Being depressed, like other familial reactions—either good or bad--, can be a function of both shared genes or shared experiences. 
    There are many reasons you might have gotten depressed. Even if other members in your family get depressed, the reason is not necessarily simply genetic. You were depressed either because you have a biogenetic vulnerability to depression and/or because living with your family, if only because some of them were depressed, stressed you out.  So even if it isn’t genetic, it is still familial (still runs in the family) because you share the same stressful stimuli.
    Another way it can be familial are the times you respond to situations/life events the same way they do because you learned to respond that way by watching or growing up with them. 
    For example, when stopped by a policeman for running a red light, some people may attempt bribes, others charm (works best when young and female) and others an indignant: “do you know who I am?!!?”
    Btw, James, running in families can be a good thing as well.  If your family taught you to look at the bright side of things: “Don’t worry, son. Even if you got a C in this test, at least it wasn’t a D!!!…and maybe you’ll get a B next time!” 
    Or your family taught you to be gentle to people “No doubt he behaved like an asshole, but pagbigyan nalang (let it go). he’s going through some pretty heavy shit at the moment”    
    In a way, all you learned from your family, all your family gave you via genes or via osmosis due to what they said or how they felt and behaved, is “nasa lahi.”(from the family).

    So you can escape it then, kahit na nasa lahi?
    Again, yes and no.
              If it is biogenetic, you can’t. But you can do things to lessen its impact. And you can do things, make lifestyle choices, to prevent having things happen that you don’t want to.
              For example, sleep.  Many people who have a biogenetic vulnerability to bipolar disorder need to make sure they get sufficient sleep because lack of sleep is one of the fastest triggers for (hypo)mania, which is usually but not always followed by depression.
    If it is a function of your environment, definitely you can, though some things are easier to escape than others.

    Does that mean that, if 2 siblings have been depressed, it isn’t necessarily inherited?  It could just be because of a string of bad decisions, or the way the kids were raised or even for entirely different reasons that have nothing to do with heredity?You’ve got that right, bro!

    What about a more extreme example, say, a mother and 3 out of 4 of her kids are depressed, surely that has a genetic component?
    Not necessarily.
    Among other things, we need to distinguish between what is genetic and what is biological but not genetic.
    We shall consider this at greater length should anybody ask me more about the causes of depression,ok, JAMES? even you!  Ingat—MG Holmes

  • Can I really get better? (A Conversation with GINA)

    Dear Dr. Holmes:

     I have been depressed these last eight (8) months, and have been going for counseling for even longer than that.  I also take supplements, exercise whenever I have the energy and pray like crazy to the Lord above.  Is there anything else I can do to get better?

    Can I really get better? 

    I am skeptical—even hopeless--because I have had this depression, on and off, for over 20 years now. I’ve tried everything I can think of:  prayers, friends, travel, even—and I am ashamed to admit it now—sex.  I’ve also tried counseling, asking forgiveness from my parents, the whole caboodle!! 

    Nothing works.  Can you help me? 

    GINA

    I’ll try, but it sounds like you may need a psychiatrist more than a psychologist at this point.
    Only a psychiatrist can prescribe medication, you see, and medication may be just the thing you need right now.
                     
    Sounds ominous. Is there no other way?
    In your case, probably not.  But I don’t really know.  By your own admission, you’ve tried everything except for medication and therapy.  Ironically, I think those are the very things that will work for you.

    But I’ve already tried counseling--innumerable times!!  Doesn’t that count?
    Counseling counts a lot when listening to yourself, clarifying all the different options in your life, and getting support during difficult decisions  is all you need.   But depression needs something more (or, at least, different), so counseling just doesn’t cut it, I’m afraid. 
    You need ‘let’s hunker-down-and work-on-this’ therapy and/or medication. 

    I guess that means I’m really sick if I need to take medication? Djahe (so embarrassing!)
    You are really sick even if you don’t need medication.  Depression is considered a mental disorder, Gina.  But so what? Lots of people get depressed and lots of people get sick in many other ways, both mentally and physically.  
    What is embarrassing is to deny that you have an illness.  What is tragic is if you do nothing to get better and/or try to prevent getting sick again.

    So tell me about medication…

    Medication is not for everyone, but it sure helps a lot of people.  Medications made to combat depression are called antidepresaants,  There are all sorts of antidepressants, starting with tricyclics, MAOs, but the most promising a the moment are the SSRIs (selective serotonin reuptake inhibitors). An example of this is Prozac (flouxetine) which, happily, can now be bought generically and thus less expensively.
    SSRIs have revolutionized not only the way people look at antidepressants specifically, but the way they view psychiatry in general.  Not just for the sickos and weirdos, but for people like ”you and me:”
    Because of prozac, most people know about antidepressants.  Depression is so common that as Peter Kramer said in explaining his book Listening to Prozac (Penguin, 1994) people have at most three degrees of separation from it:  either they themselves have been depressed, or they know someone who’s depressed, or they know someone who knows someone who’s been depressed.

    What about therapy? There are myriad kinds of therapy for depression, which is just as well, since there are many different kinds of depression.  If your depression is really anger turned inward, a theory proposed by Freud and his followers, then psychoanalysis is probably the way to go.  If your depression is due to learned behavior patterns that lead to your being in situations that most people would be depressed to be in, then behavior therapy is the way to go.

    At the moment, the two therapies considered most effective in dealing with depression are cognitive behavioral therapy (CBT) and Interpersonal Therapy (IPT).

    Cognitive therapy teaches patients to catch their irrational self-defeating automatic thoughts as they are occurring and substitute more rational constructive ones. Therefore, instead of wasting your time berating yourself for not completing what you’d planned to by a certain time, you tell yourself: “Right. Its 2:00 p.m. Instead of calling myself all sorts of names which I rightly deserve, let me do what I can to complete this project.”

    I guess one way of looking at CBT is that if we can think our way into depression, it is also possible to think our way out of it.

    How do we think our way into depression?  When we think illogically, are unaware that we do, and allow these thoughts to govern our lives and affect our feelings.

    Here’s an example: 

    Jeremy Baer has been dysthymic for the longest time.  “All my life,” he says.  But what Jeremy went to his psychologist (Louie) for was another depression (double depression) that came on top of that—when he was stuck for the longest time, unable to sleep, ruminating for hours about what to do and not seeing a way out.  Here are his words: “it (the depression) got alleviated after 1 or 2 sessions.  Because he showed me that I had got into a situation that I believed was either black or white…but he showed me there were gray options in between. I had become fixated on two solutions when there were many more that I hadn’t realized.  I still had to make a decision but he unblocked the thought process. There were more options and one could again think more clearly.  I had thought through my 2 options and I got stuck. But therapy with him unblocked the process.”

    Interpersonal therapy (IPT), on the other hand, assists patients through life's transitions and in overcoming deficits in social skills. At the 2002 American Psychiatric Association annual meeting, Ellen Frank PhD of the University of Pittsburgh recounted the case of a 28-year-old graduate student having to deal with the sudden death of her mother, a conflict with her thesis advisor, and a shift in her relationship with her father as a result of her mother's death. Using the skills she learned from interpersonal therapy, the student was able to resolve her dispute with her father, and her depression subsequently remitted.

    There is lots more to both CBT and IPT than mentioned here, of course, and we shall discuss it further If people are interested.  Ingat—MG Holmes

  • Labis na may Kulang

    (Since the following question was asked in Tagalog, Dr. Holmes feels a Tagalog answer would be better. Please write to her if you would like an English translation!)

    Dear Dra. Holmes:

    tawagin na lang po nio akong mitch. nagmahal po ako sa isang lalaki na mas bata sa akin. ako po 44 years old at sya ay 28 yrs old. sa japan po ako at may pamilya den d2. may nakilala po ako sa pinas cya po ay c baby ko...

    na inlove po ako sa kanya at pinakita ko sa kanya ang 2nay na pagmamahal ko. binigay ko po ang lahat ng mga gusto nya. pera, material, lalo na ho ang motor na gustong gusto nya sa lahat. Pero bigla ho cyang nagbago at sinabi nya na hindi pala nya ako 2nay na mahal..

    “Sorry” yun ang sabi nya. Alam nyang pauwe ako sa may para makita un mga inimbest ko sa kanya pero binigo nya ako after one month. pagkabigay ko ng motor...AYAW na nya sa akin...

    Ang sakit sakit po ng ginawa nya sa akin na hindi ko matanggap talaga...tinanong ko cya “bakit ka nagbago? sabi mo masaya ka sa akin?”

    “...oo masaya ako sa mga binigay mo pero hindi kita mahal......pinagaralan man kitang mahalin pero hindi ko talaga kaya.....panu un future ko?...salamat nalang sa mga binigay mo dahil malaki ang naitulong talaga sa akin ng mga ito... pero sorry talaga ayaw ko na!!”

    ang sa akin lang po sana anicip man lang nya na umuwi muna ako ang pasayahin... at ipakita un mga nainvest ko sa kanya..hindi un binigla nya ako...naguusap naman kami ng maayos nung una... ok naintindhan ko naman cya...pero habang tumatagal nakapagicip din ako na isang malaking PANLOLOKO ang ginawa nya sa akin... halos hanggang ngayon hindi ko pa den matanggap.. .

    Ang gusto ko masaktan den cya, guluhin cya... pagsalitaan na masasakit na salita....bawiin un motor na pinundar sa kanya....ipakulong na panloloko....estafa... pero hindi ko magawa kasi nga MINAHAL ko cya...naawa naman ako...pero paano naman ako ang sakit na nandito sa puso ko??..tulungan po ninyo ako para sa kagaangan ng loob ko na tanggapin na BIGO ako sa mga pangarap ko sa kanya...umaasa po ako na masagot agad ninyo ang problema ko...marami pong salamat.. MITCH

    Dearest Mitch:

    Masakit talaga ang nangyari sa iyo at inaashan ko na unti-unting mawawala ang sama ng loob mo .

    Ang munting payo na mabibigay ko sa iyo para sa ngayon, para bumaba lang ng kaunti ang ngitngit ng galit mo ay eto: Kumuha ka ng unan, pumunta ka sa isang lugar na walang makakarinig sa iyo, i-imagine mo na ito ang lalakeng minahal mo, at sigawan o bugbugin mo ito ng husto. Nakaka-release ito ng tension at galit, at gagaang ang loob mo ng kahit kaunti lang.

    Aaminin ko.

    “Palliative” lang ang solusyon na ito. (Hindi tatagal, hindi malalim). Pero kailangan mayroon kang gawin kaagad para ma-release ang tension na nararanas mo. Sa PART 2 sa ibaba, maghahanap tayo ng mga solusyon na di lamang palliative. Na di lamang para malunas ang sakit, magaangan ang bigat, pero makakatulong talagang matanggap ang bigo, makakita muli ng kasiyahan sa buhay, at maunawaan ang iyon ring kontribusyon sa mga nangyari. Ingat and all the best—MG Holmes

    P. S. Kung nagtataka ka kung bakit ko nilagay ang sulat mo sa MOOD AFFECTIVE DISORDER SECTION ng website, ito ay dahil maaaring mayroon kang cyclothymic disorder. Ang cyclothymic disorder ay low grade bipolar disorder o puede ring matawag na “manic depression lite.” Huwag ka sanang matakot. Maraming tao ang mayroong cyclothymic disorder at ok na ok ang buhay nila. Lalo na kapag sila ay kumuha ng tulong (kagaya nang ginawa mo nang sumulat ka sa akin) kung nangangailangan sila.

    Naisip ko na baka may cyclothymia ka dahil sa sumusunod na dahilan: pag na-in love ka, todo bigay kaagad. Hindi mo naisip—o naisip mo, pero di pinansin—na ang laking agwat di lang sa edad, pero sa kakayanan di ng buhay nintouhay ay baka maka apekto so relasyon ninyo. Napakabilis at napakatindi mo rin magalit, kaagad iniisip na mag –revenge sa kaniyang (tilang) panloloko. Finally, sa laki ng ginastos mo sa bf mo. Ang “spending sprees ” ay pangkaraniwang symptoma rin ng cyclothymia or full-blown manic depression.

    Gaya nang sinulat ko, Mitch, di ako nakakasigurado, pero kutob ko, oo (may cyclothymia ka nga). Kung nagkakamali ako, patawarin mo ako. (paano mo malalaman kung cyclothymic ka nga? Ang pinaka maiging solusyon siguro diyan ay magpunta sa isang psychiatrist.). Kung totoo naman, mabuti na siguro na pag isipan mo kung nakaka abala ito sa buhay mo (maliban sa nangyari ngayon) at anong magagawa mo para mas in-control ka next time.

    Haba ng P.S.!! (sorry, sorry) sa PART 2, tutuloy ko na ang sagot ko sa PART 1, ok? Ingat--

  • Labis na may Kulang - Part 2

    Dearest Mitch:

    Pinangako ko na sa PART 1 sa itaas na magbibigay ako ng “solusyon” na hindi palliative (mababaw lang at hindi talaga nasosolusyunan ang tunay na problema).

    Dahil hindi palliative itong payong ito. Hindi siya mabilisan at hindi siya madali, ok? Pero siya ay makakatulong para matingnan mo ang nangyari sa paraang banayad at accepting (hindi na kasing hirap tanggapin). Maaaring hindi ito mangyayari kaaagad, at maaring buwan—para nga sa iba, mga taon pa!!—bago matanggal ang kapaitan (bitterness) na nararamdaman mo.

    Pero ngayon mo na kailangang sikapin mawala ang kapaitan na nararamdaman mo. Kahit na matagal bago matanggal ito ng 100%, mabuti nang umpisahan mo na ngayon.

    Marami kang magagawa para sa sarili para tumaas ang probabilidad na maka-move on ka na sa situwasyon na ito.

    Kahit mahirap paniwalaan, mayroon rin sigurong mga mabuting nagbunga dahil rito (some good things have come out of this).

    Una, habang kayo ay magkasama, mayroon ka ring naranas na kasiyahan, diba, Mitch? Sa hirap ng buhay ngayon, sana ma-embrace natin ang bawa’t pagkakataon na nasisiyahan tayo sa paraang sinasabi ng iba na hindi “illegal, immoral o fattening.”

    Pero seriously, Mitch, sa kahirapan ng buhay ngayon, diba ok na rin na, even for a short span of time (kahit na hindi matagalan) nagmahal at (akala mo) minsahal ka ng iba?

    Totoo. Sinakatan ka niya. But that is the risk we all take when we fall in love. And sometimes we win (burray!) and sometimes we lose (booo—but we can always pick ourselves up again, diba?).

    Sinakatan ka niya at mahirap kalimutan. (More on this later). Pero kalimutan natin siuya sandali, at mag-focus tayo sa mas mahalaga: IKAW.

    Mahalaga na hindi ka devastated. (hirap na hirap na halos di ka na makabangon). Mahalaga na nakaka-recover ka na. Mahalaga rin na ikaw, hindi mo siya niloko. Na kahit nan in lover ka at maram kang iniisip, ang kilos at aksyon mo ay marangal, tapat at walang bahaging nagsasagasa sa iba.

    Posible kayang hindi niya sinadyang lokohin ka? Hindi mapwe-pwersa ang pagibig at mabuti nang sinabi niya sa iyo sa lalong madaling panahon. Maaari siguro siyang magkunwari na mahal ka pa niya para mas maraming makuha sa iyo, pero hindi niya ginawa ito.

    Kung sinadya ka man lokohin, eto ang magagawa mo, kung gusto mo, although hindi ko ito pinapayo:

    Mag konsulta ka ng abogado., Siya ang makakasabi sa iyo kung may basehan sa batas ang iyong gustong ganti. Walang duda ako na may moral (?) na implications na baka iba ang makakapayo, pero alam mo naman ang gobierno—hindi damdamin o moralidad ang inaasikaso kapag magsasampa ng kaso. Batas ang mahalaga. Kung wala kang basehang legal, bitiwan mo na ang iyong mga balak at sikaping mong bitiwan na rin ang sama ng loob mo (kahit na alam kong napakahirap dahil napakasakit ang nangyari).

    Hindi ko pinapayong magpunta sa abogado dahil sandali ka lang rito sa Pinas sa iyong bakasyon, diba? Bakit pa maghirap (at gumastos!!) para lang patigasin ang iyong mga damdamin? Kahit may basehan ka, pabayaan mo na kung kaya mo. Bitawan mo na ito hindi para sa kaniya, pero para sa iyong sarili, Mitch.

    Lalo ka pang gagastos. Lalo pa itong tatagal bago matapos, bago ka maka-move on. Higit pa sa lahat, lagi mong iisipin ano ang magagawa mo para sa kaso mo para umunlad ito. Kain, tulog, pagpunta sa sine, laging nasa likod ng isip mo ang kaso mo. YAn ang talagang nakakaloka, and not in a nice way either (at hindi magandang klaseng “dioskodai!! Nakakaloka!”)

    Mabuti nang aminin mo na naloko ka (maraming matatalino at mababait ay naloloko rin), maghanap ng leksyon (kung mayroon man) at move on.

    Hindi magdaling gawin subukan mong taos pusong pabayaan na ito. Kung ikaw ay rehilyoso, ibigay mo nalang sa Diyos. Siya nalang ang bahala sa dati mong boyfriend.

    Ang dapat mong asikasuhin ngayon ay IKAW, ang sarili mo. Hindi siya.

    Ang layunin ay HINDI pagkakalimot. Inteligente kang tao at walang diperensiya sa iyong utak o puso. Hindi natin nakakalimutan ang nangyayari sa atin. Pero maaari nating mapatawad ito.

    Papaano kung galit nag alit ka pa sa kaniya? Mahirap at maaaring matagal pero kaya mo yan, Mitch. Pero kailangang gustuhin mong ikaya.

    Huwag kang mag-expect ng milagro at huwag mong i-expe