TD Therapist

Good morning guys. Warning- this post is a little lengthy. I am a therapist who works mainly with men. I created a new username for this post because frankly, I don't want to connect my professional life with other posts or reactions I may have made here.

Every so often somebody posts here because they're going through a divorce, lost somebody, can't sleep, are having panic attacks, can't get off the couch, or generally feel like life has kicked them square in the nuts.

Usually the OT does what the OT does. Some good advice, some terrible advice, somebody says "lawyer up, delete Facebook, hit the gym," and within a page we're arguing about whether the OP's wife is banging her personal trainer.

But there are also people here who genuinely don't know much about mental health. And judging from some threads over the years, there are probably quite a few people reading who are struggling but aren't going to start a thread about it.

So here's Mental Health 101 for the OT. Psychobabble kept to a minimum.

Who the hell does what?

Therapist

The broad category most people mean when they say "I'm seeing somebody." This could be a clinical social worker, counselor, marriage and family therapist, psychologist, etc.

They help with things like depression, anxiety, trauma, grief, relationships, anger, stress, and figuring out why you keep doing the same stupid thing even though you know it's a stupid thing.

Psychologist

Usually has a doctoral degree (PhD or PsyD). Many provide therapy, and some specialize in psychological testing and assessment—ADHD, cognitive testing, diagnostic clarification, etc.

Most psychologists don't prescribe medication.

Psychiatrist

A physician (MD or DO) specializing in mental health. They can diagnose psychiatric conditions and prescribe medication. Some do therapy, but many primarily handle the medical/medication side.

Very roughly:

Therapist = let's work on this.

Psychologist = let's work on this and/or figure out exactly what's going on.

Psychiatrist = let's look at the medical/medication side.

What is depression?

Depression isn't just being sad.

Your team losing, your portfolio dropping 8%, or your wife saying you absolutely cannot buy a $70,000 bass boat is not necessarily clinical depression.

Depression becomes more concerning when there's a persistent change in mood, sleep, appetite, energy, concentration, motivation, interest in things you normally enjoy, or how you see yourself and your future.

And it doesn't always look like sadness. Particularly in men, "I'm just stressed" can look more like irritability, anger, drinking more, isolating, working constantly, or just feeling numb.

What about anxiety?

Anxiety is your brain's alarm system. You need it.

If a tiger walks into your backyard, anxiety is considerably more useful than mindfulness.

The problem is when the alarm keeps going off and there isn't a tiger.

That can mean constant worrying, feeling keyed up, muscle tension, trouble sleeping, avoiding things, or panic attacks.

Panic attacks can be especially convincing—racing heart, shortness of breath, dizziness, shaking, chest tightness, and feeling like you're losing control or dying.

If symptoms could be a medical emergency, though, don't diagnose yourself from the OT. Get checked out.

What can you do yourself?

The boring stuff actually matters.

Sleep. Exercise. Get outside. Eat reasonably well. Don't isolate yourself. Have people you can actually talk to.

And watch the alcohol. It's remarkably good at temporarily making anxiety disappear and remarkably good at making anxiety and depression worse when used heavily or regularly.

Pay attention when your life starts getting smaller—when you've stopped seeing people, stopped doing things you enjoy, aren't taking care of yourself, or are spending most of your free time drinking or staring at your phone.

Sometimes you also have to do things before you feel motivated to do them. Depression has a way of telling you to wait until you feel better before doing the very things that might help you feel better.

When should you talk to somebody?

There isn't a magic threshold, and you don't have to be falling apart.

If something has been hanging around, keeps coming back, is getting worse, or is interfering with your marriage, work, sleep, relationships, health, or ability to enjoy life, it's worth talking to somebody.

And therapy doesn't necessarily mean lying on a couch for seven years discussing your mother. Sometimes you have a specific problem, work on it for a handful of sessions, get what you need, and move on.

You also don't have to win the Suffering Olympics before you're allowed to get help.

If your transmission is making a horrible noise, you don't wait until it falls onto I-10 because somebody else's truck is on fire.

One serious part

If you start thinking people would be better off without you, there's no way out, you don't want to wake up, or you're thinking about killing yourself, tell somebody.

Don't sit alone trying to decide whether it's "serious enough."

In the U.S., call or text 988 for the Suicide & Crisis Lifeline. If you're in immediate danger or think you may act on suicidal thoughts, call 911 or go to an emergency department.

And if somebody tells you they're thinking about suicide, take them seriously. You don't need the perfect words. Stay with them, listen, and help them get appropriate help.

Asking directly, "Are you thinking about killing yourself?" does not put the idea in somebody's head.

Finally

Taking care of your mental health doesn't mean you're weak, crazy, or fragile.

Sometimes you need to sleep more, drink less, exercise, get out of the house, and talk to your friends.

Sometimes you need a therapist.

Sometimes you need a doctor.

Sometimes you need all of the above.

And sometimes your problem really is that you're an idiot.

Unfortunately, I'm not aware of an evidence-based treatment for that one.