Got a question related to mental health? ASK DR KIM

[Chris_B]

Hi everyone,

This is a thread for asking questions of our resident GP and counsellor, Dr Kim, who pops into the forums regularly.

PLEASE NOTE as per our community rules, Dr Kim won't be able to answer questions about medications, these are best discussed offline directly with your mental health professional.

UPDATE - 01/03/2018
BEFORE YOU ASK DR.KIM PLEASE CONSIDER THE FOLLOWING POINTS:

• Dr Kim's time is limited! We cannot provide an ongoing dialogue with Dr Kim in this thread - one post/question per person please
•  We'd recommend you have a look through the forums before posting here to see if your question has already been answered by Dr Kim, our other members, or if there's information about it already on the beyondblue website. If a question pops up that has already been answered previously, or if alternate resources are available, one of our moderators will reply and direct you to the link.
• When writing your question, imagine you are speaking to someone in person i.e. provide a clear and detailed post with enough information that outlines how Dr.Kim can help you.

Background

After 20 years of experience working as a GP, Dr Kim realised in 2003 the aspect of her work she enjoyed most was talking to people and understanding the way they think and behave – and so she underwent training in counselling and therapy, where she now solely works.

Her experience includes working with a wide range of mental health issues including anxiety, depression and adolescent mental health.

“Given my training I also see couples, siblings, parents with their children and entire family groups,” she says. “In this work I hope to give families the skills to understand one another and have the strategies to communicate and manage relationships that are distressing them. I believe strongly that best therapy is achieved when there is trust in the therapist's ability but also their genuine desire to understand and help.”

[Dr_Kim]

james1 said:

Hi Dr Kim,

I realise it may be different for different doctors, but what is your opinion on the place of a GP in someone's mental wellbeing?

James

Hi James,

I am both happy and upset to hear this question. Happy because it gives me an opportunity to discuss what expectations you can have of your GP in this arena , but upset as I think your experience is unfortunately all too common in the community.

I think a “ good mental health GP “ is one who makes you feel
1, They care and you feel they are genuinely interested in your health.
2. They are on the journey with you (and your team) i.e.. organise reviews and or meetings
3. They can listen
4. They have time
5. Can explain the rationale for what they are advising.
6.Also importantly can sort out what of your symptoms are due to your mental health issues and what might be something else. eg if you are tired , is it because you are depressed or have Iron deficiency Re medications: So may people worry about the effects of anti depressant or anti anxiety meds that it is important that you feel your GP is monitoring you closely so you feel you understand the meds and are prepared for any possible side effects.

How do you find these magical GPs ?. They are often found through word of mouth, so ask around. A GP who is “good to talk to" is a good start and one who has been in a practise for a while is also a good lead sometimes as continuity of care is important.

Sometimes Community Mental Health clinics, Headspace clinics or even Emergency Departments have names of GPs that be helpful,and I noticed that the Black Dog website has some info on choosing a good GP and then a link to a website to help people find a GP and other mental health professionals in their area.

ALSO.. Always start with a double appointment when you meet your new GP ,so you have time to give them a good history and they can get to know you.

[Dr_Kim]

Ouat said:

Hi this is my first time posting. I have been suffering from anxiety and depression for the last few months and its only getting worse. I have been thinking and worrying contantly about my health and was wondering if your thoughts can create a sensation by obsessing thinking.

Yes , your thoughts can “cause a sensation” by obsessing and i think that is exactly what they try to do with anxiety and obsessional thinking . They try to distract you from your healthy thinking by saying “ Hey look at me!” "Over here!”.. at the expense of the other kind of “normal" thoughts that you could be thinking . So I guess you could say anxiety thoughts are drama queens and attention seekers!! The content of the obsession is not really relevant I find in clinical practice.

The first step to manage this is to develop "mindfulness" or an awareness of the origin of the thoughts in your head. Start to notice the thoughts in your head an see if you can distinguish thoughts that come from the anxiety part of your brain from ones that come from the healthy or rational part of your brain .

Once you can start to become cleverer at sorting out the thought origin you can then develop different strategies for the different thoughts.

For rational thoughts, by all means, give them due consideration, but if the thought is coming from the anxiety/ obsessional part your choices are to challenge it (CBT) , accept it (ACT) or distract yourself .

You could challenge the thought with asking yourself what evidence you have for those statements, or just accept that anxious thoughts are going to pop into your head and accept them as part of your internal landscape (oh , hi anxious thought !! you again !!) , or get busy to move away from them .

These techniques are covered by therapists or for a start ,you can read up on them in Sarah Edelman's book "Change Your Thinking" or Russ Harris' book "The Happiness Trap". Headspace or Smiling Minds apps are great for development of mindfulness.

[Dr_Kim]

Shaz1 said:

Hi,

I've been having treatment by my dr and physcologist for a few years for severe depression and anxiety. I'm at a loss what to do/try next. I freeze whenever (which isn't that often) I have appointments with either of them. I can't talk and they may say something that's totally wrong, but I can't speak up to tell them.

I feel so bad to hear you say that and I think your Dr and psychologist would too. I guess they are trying hard to make you feel you can trust them but the inability to trust and the suspicion that no one genuine cares for you I suspect started way before either of these people even met you .

I suspect that these feelings you have about not being worthy started way way back (something like attachment theory might be at play here). Maybe your self esteem took a beating many many years ago when you were not made to feel ok and worthy by the primary people in your formative years.

Not knowing your history , I can only take a wild guess at what is going on , but I think your psychologist may be onto something when they say that there is a voice of depression ( or low self esteem ) in your brain that gives you incorrect interpretations about the world. The seeds of doubt about yourself were likely planted a long time ago( by who I don’t know) and should have been weeded out by your primary care givers when you were way too little to do it for yourself. It is not your fault.

Now, you are left with an overgrown tangle of a brain garden !!! It is giving you all sorts of crazy and NASTY messages that should not be there .. It is time for you to get the pruning shears out when you see one of the nasty thoughts , visualise yourself snipping it iff at the roots!

I know I’ve simplified things and I’m not suggesting its easy , but please don’t blame yourself for the brain mess, start to push aside those nasty thoughts and start with a bit of trust in your Dr / Psychologist . Tell them gently next time when something isn’t ok … and trust the relationship you have will withstand the challenge!
Also, if you can , please look into meditation, relaxation, yoga or any mindfulness course or app ! It will help .

[JRBanks]

Hi Dr Kim. I am a 24/yo male, and I would appreciate your advice on what I think is a current undiagnosed mental issue of my own. I have a problem with missing details, which seems to be getting worse. Here's a few examples of what I mean:

- I'll be engaged in conversation with another person, whom I am listening intently to. During the conversation, I'll make a statement which the other person in the conversation made only moments below. The issue is not because I was not listening, but for reasons beyond me, my mind simply does not register certain details of a conversation as they occur. This gives the other person the impression that I am not listening to them, even though I am holding on to every single word that they say.

- When writing emails, I'll review it before sending. At the point of sending the email, I am certain that the email is 100% spelling and grammar correct. Then, after reading the email again after it has been sent, I'll notice extremely obvious typos and mistakes. Again, for some reason, my mind does not register this when I am in the act of doing, like my conversation example above.

- When putting the dishes away from the dishwasher, I'll check each dish and utensil to make sure they are clean before putting them away. In the act, I am certain that every item I am putting away is clean. However, after I have finished, my partner will point out that the dishes still have dirt on them, even though I swore in the act that they were clean.

- The three examples above would suggest that I'm simply a careless person, with a poor memory and a poor recall of details. I wish the answer was that easy! Many, many people have commented on my ability to recall very fine details, usually dates, times and places almost instantly from any point of a conversation. In most cases, I am recalling these facts many years after I learnt about them. With that said, I am very confused as to why I can recall a date, time and place from history, but can't differentiate between a clean and dirty fork!

My personal hunch is that I may have undiagnosed autism. I speak with a mild stutter that I cannot control and I do have issues with anxiety. I think that the points I've stated above are aligned with the symptoms of this condition, but I would like to know your professional opinion as I am no doctor!

[Doolhof]

Hi Dr. Kim,

I am loving this thread. Thank you so much for giving your time to us all in this meaningful manner!

I have been diagnosed with depression, PTSD, BPD, unresolved grief, stress and anxiety issues. One thing I have trouble handling at times is disassociation.

My family feel like strangers to me. I look at my husband and wonder who he is and why we live together.

My parents stay for a weekend and I wonder who they are and feel like we have no connection apart from titles like Parents-child.

I can attend training at a volunteer place every week for months, not go for a couple of weeks, return and wonder who everyone is and what am I doing there. Like they are all strangers even though I have been attending for years.

I can go somewhere I have been hundreds of times and suddenly feel like I have never been there at all.

Most days I feel like I am in a movie, playing a part. There but not really there. No real sense of connection. It is hard to explain. I've tried talking to various professionals about it, have tried stuff like mindfulness, but still feel the same.

My family and friends don't know how I feel about them. To me it would not matter if I never saw them again as they feel like strangers to me. It is a weird way to walk through life.

Thanks for listening!

Cheers from Mrs. Dools

[Just Sara]

Hi Dr Kim;

My post relates to two things I've discovered that's helped my anxiety/panic/depression.

1. During a conversation with a friend, I was trying to explain how confused I felt and the words; "It's as if I've developed PTSD from having PTSD symptoms" came out of my mouth before the thought. After talking this over with my friend, I felt so much better realising I'd been panicking about anxiety etc developing due to how devastating my previous experiences had been. I'd be triggered from slight shaking or too much coffee for instance and off I'd go. After this conversation, I'm mindful of physical triggers and tell myself it's just coffee etc and do something productive. This has really reduced symptoms.

2. I'm on antibiotics for an infection and have been taking a lactobacillius replacement for the gut flora it affects. I've found I've become more calm and balanced in my thoughts. I went off the replacement to see if there was a difference, and there was. So I'm back on Inner Health Plus daily and feeling much better.

These two things aren't spoken about on this forum often and I'm wondering if there's scientific or psychological understanding of my success.

Many thanks

[Cayden]

Hi Dr Kim,

Im having a lot of trouble trying to talk/explain/understand about what i believe is my undiagnosed depression.

Okay so after nearly 3 hours of writing and rewriting this i believe ill settle with: When im having a bad day i feel so certain that i do have depression but by the time i convince myself i need help, i dont feel so bad and start doubting how bad it really was despite the exact same thing happening within a couple days of it. Keep in mind, I know this kind of thing is common with depression, but that knowledge only makes me doubt myself more because.... its like i think i subconsciously make it up because i know about these symptoms? Its very confusing and frustrating.

[Dr_Kim]

JRBanks said:

Hi Dr Kim. I am a 24/yo male, and I would appreciate your advice on what I think is a current undiagnosed mental issue of my own.

Hi JRBanks, You present a symptom which could be a few things I guess depending on the context in which it arises.

It could be part of an Autism Spectrum issue as people with this disorder have issues with communication and social interactions. Sometimes people on the Autism spectrum are trying so hard to be in the conversation that they are concentrating on what they will say next, and in doing so, loose concentration on what the person is saying right at the moment.

This leads to a disjointed conversation where it seems that you have not been listening but you have in fact been engaged with your own thoughts. You don’t mention other things that people with Autism have though like repetitive behaviours, obsessions or sensory problems, or issues with comprehending the emotional worlds of others . Also it doesn’t quite explain the email or dishwasher issue. It may be useful to talk to your parents to talk about your early years and if you had any of these symptoms in your early childhood … It could give you clues.

The other possibility that comes to mind is dissociation. This is a psychological activity that occurs when then mind kind of “checks out” of being really conscious of whats happening in the moment. From the outside you may appear “normal” but its like inside you are blank and memories of this times are often hazy.

The common and extreme form of dissociation is found in cases of trauma or abuse where, using very understandable and unconscious defence mechanism, the mind takes itself away from the present and goes “somewhere else”. But we all dissociate to some degree. A common example is when you drive a common route to and from work . Sometimes you arrive home and realise that you can’t really remember the drive, its like you were on “autopilot” and your mind was elsewhere. Dissociation is seen quite commonly in anxiety or other mental health issues , and it even has its very own disorder !

Lastly, there are a few medical things that might need to be checked off the list , so a visit to a GP might be in order- rare , but possible e.g. some forms of epilepsy cause people to become vague for a short period of time.

[Dr_Kim]

Doolhof said:

Hi Dr. Kim,

I am loving this thread. Thank you so much for giving your time to us all in this meaningful manner!

I have been diagnosed with depression, PTSD, BPD, unresolved grief, stress and anxiety issues. One thing I have trouble handling at times is disassociation.

Hi Mrs Dools,

Thank you for your kind words about the forum. I’m going to try and frame things in a way that i hope is new to you and I hope it is helpful, but I really urge you to try and build a connection to a therapist. I know this is actually part of your issue - as you feel totally disconnected but I don’t think a therapist would take your feelings personally, so its a safe place to discuss this stuff openly and I think it might be a relief to have it out on the table.

People who experience dissociation have often had trauma in their past which has initiated their brains ability “check out”. It starts as a defence against experiencing terrible things but can become a habitual. With you it sounds less like dissociation and maybe more like you have built walls around your emotional self.

Its interesting as its seems that your amygdala (the reptilian brain) is over riding your cortex (the mammalian brain). It sounds like you may have had a lot of difficulty in your past (I am extrapolating from all your diagnoses) and that maybe there was some trauma in your early life, or possibly a feeling that you couldn’t rely on people around you to comfort or support you when you needed them.

If this was the case, your fight or flight " brain starts to perceive connections as dangerous or unreliable. Your amygdala is a very powerful part of your brain and hard to override with just logic. It seems that you want to trust and connect with people and you desire to change the message or the habit that your brain has created for you. This part of your brain is stubborn, but does respond well to simple repetitive messages and “ body work” e.g. exercise or breathing/ progressive muscle relaxation techniques.

Remember that nerves that fire together, wire together .. so if you keep noticing and drawing attention to the separateness, it will become stronger .

I hope that you can put a big radar on your head that notices the opposite i.e. ANY connectedness you feel to anyone or anything, whether it be to your husband, your pet or to a song you like !! When you notice it, really notice it . When you do this you are wiring neurons together that note connectedness.

Do this for a start at least once a day , then up to 5 times per day  .. until you are noticing and even recording any iota of connectedness. Your old sense of unconscious danger around this will finally get the picture that connections NOW do not cause threat.

[Dr_Kim]

Dizzy@home said:

Hi Dr Kim;

My post relates to two things I've discovered that's helped my anxiety/panic/depression.

I am really pleased to hear about these positive break throughs for you.

The first one I totally get! Know your soft spots and your triggers and mange them ! You will feel so much more empowered.

Many people have more stress from the POSSIBILITY of something happening then from the thing actually happening . For example, people with phobias spend a lot of time worrying about “what if’s” and the smallest trigger can send them off when the thing they are actually scared about isn’t even happening. e.g. lets take emetaphobia (a fear surrounding vomiting - doing , seeing it etc) .

One can spend so much time worrying about it, that you can get just generally anxious, avoidant or even depressed because of it, and like you with the coffee shakes, even someone coughing in public can make them terrified! But sometimes the last time they actually were in contact directly with vomit might have been months or years prior .

It is the FEAR of the event that paralyses people. So if people can be mindful as you have been of the power of this trap and notice for e.g. ,that someone coughing is just a cough and its normal and its going to give me a fright , but its ok and Im alright .. breath in for 3 , hold for 3 out for 3… now get on with my day.

The second association - between lactobacillius and anxiety, I had to double check the literature. All I could find was some studies looking at the use of it in IBS (Irritable Bowel Syndrome), but not for anxiety. Having said this , I would advise you that if you feel calmer on it and if you can afford it , I don’t think it is known to be harmful to take over the long term so i can’t see a down side to you continuing it. Go you!!