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Forum Name: Psychiatric Topics

Question: Dr. K. Eisele, what do you think is wrong with me?


 AHBCVR - Sat Sep 01, 2007 6:44 pm

Dr. K. Eisele,
I have read for quite some time the messages you have written on this message board and so far I like everything you have written. Ideally, I would like to engage with you in a discussion about my problems, but if that’s not possible, your objective diagnosis is sufficient. Before I explain my problem, I’d like to mention that I am a healthy 26 year old male.

Seven years ago, I was emotionally devastated due to personal problems I was having with some of my roommates. I decided to talk to a psychologist at my school about the situation I was currently in, and I ended up being diagnosed with depression. At the end of our first and last meeting, the psychologist told me there was nothing she could do for me and sent me on my way to get medications from a psychiatrist. This is what the psychologist told me just before the end of our meeting after I asked her for advice: “There’s nothing I can tell you because you are depressed, and when someone is depressed they won’t listen to anything you tell them.” That response made me feel very angry and upset; I felt patronized and disrespected. But what made me feel really upset was her reaction to my answer to an earlier question about whether I drank or did drugs. I did not feel offended by the question itself, as it is a perfectly valid question for a psychologist to ask a patient, but I felt offended by the fact that after I truthfully answered her question, after I told her that I do not drink or do drugs, there was an awkward moment of silence that lasted a good five to ten seconds. During that pause, she looked straight to my eyes as if looking for clues that would help her determine the truthfulness of my answer. Eventually, she uttered an almost inaudible “ok…” and continued asking more questions. I felt extremely insulted and offended by her reaction. I felt judged and I felt like I had just been called a liar.

I followed the psychologist’s advice and went to see a psychiatrist a few times, and was on Prozac for a month. The psychiatrist didn’t tell me anything that I considered insightful or that I didn’t know already. Basically, she would ask me questions about the feelings I felt regarding my personal problems, I tried to rationalize those feelings, and then she rebuffed, with arguments, the parts of my answers that she did not agree with. That’s not exactly the type of help I was looking for, but at least the psychiatrist didn’t do or say anything that upset me. I did not feel ‘happier’ and my personal problems did not go away after talking to that psychiatrist and being on Prozac for a month, but at least I got my life back on track and never felt the need to see a mental health professional ever again, partly because I felt I was able to cope with my problems on my own and partly because I felt disappointed with the treatment I received.

The reason I told you that brief story is because I want you to understand where my fear and resentment towards mental health professionals comes from. As unbelievable as it may sound, to this day, seven years after the events in question, I still replay in my head the meeting with the psychologist I mentioned. I also fantasize about things I should have said to the psychologist and things I should have kept to myself; I think about how things would have been different if I had talked to a different psychologist or to no psychologist at all; and I try to understand the psychologist’s behavior and the impression I must have caused on her. A few times, when I am alone in my room thinking about my meeting with the psychologist, I have actually caught myself verbalizing my thoughts and talking out loud, as if rehearsing the words I feel I should have told the psychologist. I do not enjoy mulling over negative memories, but for some reason, the memory of my meeting with the psychologist keeps haunting me to the point that I honestly believe that, all in all, that meeting did me more harm than good because if I hadn’t talked to that psychologist, at least right now I wouldn’t be stewing about an event that took place so many years ago. Every time I remember my meeting with the psychologist, I feel a great deal of anger and pain; I also feel judged and humiliated, even railroaded. The feelings I felt during the therapy session remained very well attached to the memory of the therapy session, and the memory of the therapy session never went away; and it doesn’t help to try to think about something else whenever that memory comes into my head, because eventually I forget I should be thinking about something else and the next thing I know is my mind is back to where it started. I don’t ruminate every day about my meeting with the psychologist, but as of lately that memory has been haunting me a few times per week, to the point that I’ve started to wonder whether I need professional help. (I’m confident you’ll understand why it’s going to be tough I’ll visit a psychologist or psychiatrist ever again.)

I wonder whether some major event in my life triggered the memory of my meeting with the psychologist and all the negative feelings that come along with it. Like, maybe I am depressed, once again, but now I am using that memory as a scapegoat for certain feelings I don’t quite understand in an effort to rationalize them. That’s just a semi-objective guess, anyway. If that’s indeed what’s happening, I am not doing it consciously.

Dr. K. Eisele, please give me your honest assessment of my situation. If you want to ask me some questions, I’ll be glad to answer them for you.
 Dr. K. Eisele - Sun Sep 02, 2007 2:40 am

User avatar Dear AHBCVR:

Anger and resentment are toxic emotions when allowed to sit and fester for long periods of time. I think what may be most helpful for you now is to explore why the psychologists' response triggered such strong feelings in you.

We all want to be believed, especially when we are telling the truth, and especially when we are relating something about ourselves of which we are proud or feel good about. I've seen others who've come with a similar complaint--that it is eating them up, so to speak, that they were not believed or that they were misunderstood. At any rate, they feel they weren't given a fair chance.

My questions to you at this time:

1) Do you feel as though people around you make assumptions about you that are not true?

2) Do you feel that you are more self-aware than others?

3) Do you have symptoms of depression such as sadness, lack of interest in doing anything--even taking care of yourself adequately--or feel hopeless or worthless?

4) Any changes in sleep pattern, appetite, ability to concentrate, change in energy, or even find yourself wondering what it would be like to be dead?

5) Do you find yourself worrying about anything and everything, and are unable to stop?
 AHBCVR - Sun Sep 02, 2007 10:56 am

Dr. K. Eisele, thanks for your prompt response. I'll answer your questions:

1) Do you feel as though people around you make assumptions about you that are not true?

It depends on who the people around me happen to be. Friends and family members? No, they know me well. College professors? No, the ones I met were very nonjudgmental and open-minded. Strangers? Sometimes I am misjudged by some strangers. At an intellectual level, I understand it probably means I don’t resemble their mental image of what a kind, hardworking, law-abiding, educated person looks like, but deep inside, at an emotional level, I become quite unstable. I’d like to mention that I understand my emotional reactions are nobody’s fault but my own. Metaphorically speaking, it’s like, I never quite accepted the fact that people are people and that I can’t always expect them to act and think like enlightened monks.

2) Do you feel that you are more self-aware than others?

My dictionary defines “self-aware” as “having a balanced and honest view of your own personality, and often an ability to interact with others frankly and confidently.” As far as that definition goes, I think I have a balanced and honest view of my own personality, but when it comes to interacting with others 'frankly and confidently,' I tend to open up a lot more when I am talking to someone on the internet than when I am talking to someone in real life. I also think I have a balanced view of my own strengths and limitations. I introspect a lot and also try to get inside people’s heads (especially when I feel they have wronged or misjudged me in some way), which I think most people normally don’t do.

3) Do you have symptoms of Depression such as sadness, lack of interest in doing anything--even taking care of yourself adequately--or feel hopeless or worthless?

I was very motivated when I was in high school; I had a lot of dreams and ambitions. But then I failed to get accepted to the school I wanted to go to, and everything has been going downhill from that point on. I ended up going to a less desirable school, and did well academically, but I wasn’t studying because I wanted to go far in life; I was studying because I knew I would have ended up feeling extremely miserable and remorseful if I didn’t have an undergraduate degree. I eventually graduated from college, spent quite some time unemployed, and when I finally found a job, it was a boring and repetitive job that doesn’t have anything to do with my field of study, at a company where there are little to no chances of advancement. I’m still stuck at that job, and would rather continue stuck there than go back to being unemployed. Ideally, I would quit my current job and find a ‘better’ one, but I know, from experience, that I am not exactly the type of person who’s good at charming interviewers with his interviewing skills. And even if I had the interviewing skills, it’s unclear to me whether those skills would effectively prevent my poor social skills from being displayed during an interview. In my case, I understand it’s going to be difficult, but not impossible, to find a more desirable job.

4) Any changes in sleep pattern, appetite, ability to concentrate, change in energy, or even find yourself wondering what it would be like to be dead?

I can concentrate for hours at a time when I am doing something that I like doing, but I have a hard time concentrating when I am doing something that I don’t like doing, like when I am at the office doing my work. Sometimes, instead of working, I just sit at my desk staring at my computer screen while my mind entertains the memory and memories like the memory I described in my first post.

5) Do you find yourself worrying about anything and everything, and are unable to stop?

I don’t worry about ‘anything and everything,’ but I have a hard time letting go of negative memories; they are like open wounds. When it comes to decision making, I tend to over think different courses of action and as a result often end up talking myself out of doing things that moments earlier I thought I wanted to be doing.


Please let me know what you think about my answers. Thanks.
 Dr. K. Eisele - Mon Sep 03, 2007 4:19 pm

User avatar Dear AHBCVR:

People who hang on to someone's misperception tend to be insecure in who they are. You, on the other hand, write as though you are very secure, i.e., very sure, of who you are and your place in your world.

I think you have low self-esteem, and have reached a point of stagnation in your life. Your self-esteem plummeted back in high school when you were not accepted into the college you hoped for.

What I hear you telling me are reasons/excuses for your perceived lack of fulfillment by making a very realistic-sounding argument about knowing your strengths and weaknesses. I think you are taking the superficially easier path in your life without even knowing it. The psychologist's treatment of you is a result of not seeing the bigger picture. The consequence of this is that you feel wronged or misjudged and you carry your resentment around with you. You aren't sure whether you can get a better job or not. If you felt secure about yourself, the psychologist's attitude toward you would amount to nothing at all. Who cares what she thought? That was seven years ago, and people are wrong about others all the time. In addition, you are unfulfilled and "stuck" in your current job. You aren't sure whether you can get a better job or not.

This is your problem: you're talking about a job, when what you really want or need is a career, a way of life in which your work is part of who you are. That way, going to work is just as natural an event as brushing your teeth. A career can be in food service, health care, law, government, business, etc.

You lost sight of your dream in high school when you didn't get into the college you wanted. There is always more than one way to get what you want. For example, let's say that there's a guy who graduated high school 10 years ago, never went to college, but knows that he will never be happy unless he can somehow figure out a way to be a doctor. He knows that it is difficult to get into medical school and that he needs to go to a good undergraduate school for anyone to pay attention to his application. He can't afford much at this point, though, and his high school education was a long time ago.

His best option is to start small, at the community college level. It's all he can do at the moment, so it will have to do. He knows that his chances of getting into med school are slim because of this problem, but he feels that an exceptionally strong academic performance will outweigh the "damage" going to a community school will do to his resume.

You need to develop a goal for yourself. Next, you need to make a list of what you need to achieve that goal. Finally, make a realistic plan for reaching your goal, keeping in mind the things that you need from your current situation in order to survive while you work towards your goal.

That's what I think your problem is right now. Good luck.
 AHBCVR - Mon Sep 03, 2007 10:26 pm

Dr. K. Eisele,
Once again, thanks for your help. I want to make a few comments about your answer.

I agree with you in that I have low self-esteem, in that I have reached a point of stagnation in my life, in that I'm not sure if I can get a better job or not, in that I shouldn't care what the psychologist thought about me, in that I need to find a career, in that I need to start small, in that I need to develop a goal for myself, in that I need to make a list of what I need to achieve that goal, and in that I need a realistic plan for reaching that goal. I understand all that.

Some of those improvements I think are within my power. Some, I honestly believe, are not. More specifically, I can’t stop preoccupying with negative memories. I’ll ask myself “why are you worrying so much about this? You shouldn’t care,” but that’s not enough to make the memories go away. I believe this is not normal and that there is more to it than low self-esteem and insecurity. All those thoughts are eating me alive to the point that I often think I am losing my sanity. I’ll tell you a few more things that I and some people think are ‘wrong’ with me:

I have almost no friends; I have just a couple of friends from high school, and a couple of friends from college. I rarely see them and I rarely talk to them.

Through high school and college, I was a loner. I was the type of guy who sat quietly in the classroom, didn’t speak unless spoken to, and unintentionally made some people feel uncomfortable. The reason I avoid talking to people is because I feel very anxious in social situations and fear that I am going to be rejected and that people are not going to like me once they learn how socially inept I am. Nowadays, though, I make an effort to be more sociable, as I understand it is difficult to get away with introverted behavior in the world of work.

I have never had a girlfriend, not even a close female friend. I haven’t made an effort to attract a woman in almost a decade. I just reasoned I didn’t know how to attract women and decided it was time to stop humiliating myself. Now, whenever I see an attractive woman, I consciously make an effort to look away. I totally ignore attractive women, like they don’t exist. That makes me feel in control of the situation, as I know from experience it’s highly unlikely women will show an interest in me. And even if they were to show some interest in me, I wouldn’t know how to respond to that interest and I’d feel very uncomfortable and inappropriate. Instead of waiting for them to disqualify me, I disqualify myself. I know that if I try to attract women one day I might get lucky but, to be honest, I just don’t feel like the reward is worth the pain and effort.

I’m not the type of person who goes out on Friday or Saturday nights. During the weekends, I just stay at home watching TV or sitting in front of my computer. I am not the type of person who drinks, smokes, goes to parties or goes to bars. I don’t see anything wrong with that behavior, but I know some people find my behavior ‘strange’ at best.

Again, I obsess a lot about certain things. A lot of the people I talk to online, often snap at me because they say I drive them crazy with my constant whinnying about the same things over and over (like my meeting with the psychologist). Some of them have suggested I should be on medications.

I refuse to visit some of my relatives because I have bad memories of them and fear that if I meet them again, if they say something to me that I don’t like, I am going to feel extremely upset and I’ll end up dwelling on those memories for years to come. I know, from experience, that’s exactly what’s going to happen should any of them say something that I find judgmental or insulting. My behavior is stupid, I know, but I just can’t tell my brain to stop functioning the way it does.

For the last two years or so, I’ve gotten myself into the bad habit of going to online message boards to post messages full of self-pity and to whine about the unfairness. When someone tries to help me, I usually argue with them and try to prove them wrong, as I honestly believe their advice is often either too simplistic or doesn’t apply to me. I am often accused of displaying a mixture of arrogance and low self-esteem, and several individuals have told me that I need professional help. At first I thought those individuals were being mean, but I get told so often that I need help, that I think it’s highly unlikely I don’t. Let me give you an example: I think all the advice you gave me is valid, but you didn’t tell me anything that I hadn’t already figured out on my own. I know you are a psychiatrist and I respect the fact that you went to medical school and that you are honestly trying to help people, but if some random anonymous internet user had given me that advice, I would have written a lengthy response explaining how I find their advice unoriginal and insulting.

As I write this, I fear that one day someone will read this message and somehow figure out it was 'me' who wrote it and use it against me.

Some of my worst fantasies include being imprisoned for a crime I did not commit and being locked up in a mental institution after being diagnosed with a mental illness I don’t have. I see myself trying to prove my innocence, but nobody believes me and I get sent to prison or a mental institution where I spend the rest of my days in agonizing psychological pain.

That’s everything I can think of for now. Please let me know what you think. Thanks.
 AHBCVR - Thu Sep 06, 2007 5:22 am

Dr. K. Eisele?
 AHBCVR - Fri Sep 07, 2007 7:03 pm

I think Dr. K. Eisele gave up on me ;)

If someone wants to throw their five cents in, be my guest ;)
 Dr. K. Eisele - Sat Sep 08, 2007 8:09 pm

User avatar Dear AHBCVR:

I did not give up on you; I simply wanted to be able to spend some time on this problem, and I think it interesting to point out at this time what you said (with added emphasis):

I know you are a psychiatrist and I respect the fact that you went to medical school and that you are honestly trying to help people, but if some random anonymous internet user had given me that advice, I would have written a lengthy response explaining how I find their advice unoriginal and insulting.


I have no intention of insulting you now and did not with my original post, and I'm sorry if that is your perception. By pointing out the inconsistency in your most recent post, I think there is something here to be learned. The part that I put in bold describes exactly what you did, even though you had just stated that you weren't doing that at all.

In the interest of helping you further, I would like to ask you a few more questions:

1) What is your goal for this conversation?
2) What are your goals for your life?
3) What is it that you want but think you can never have?
 AHBCVR - Sun Sep 09, 2007 1:56 am

I have no intention of insulting you now and did not with my original post, and I'm sorry if that is your perception.

Dr. K. Eisele, that is not my perception. I did not feel for a moment as though you were trying to insult me. I would only have felt insulted if the advice you gave me had come from a “random anonymous internet user.” It is true that you also fall into the category of “random anonymous internet user,” but when I posted my previous message, I was thinking something along the lines of “some random, anonymous, layperson who happens to be an internet user,” as opposed to “some random, not-so-anonymous psychiatrist who happens to be an internet user.” Maybe you are not a psychiatrist, and maybe there is no “Dr. K. Eisele,” but so far I have assumed that you are who you claim to be. (If the fact that I made that assumption means that I am gullible and stupid, so be it.)

I do admit, however, that I felt the advice you gave me was somewhat predictable and not what I wanted to hear. (That's not to say I don't thank you for your sincere desire to help.)

By pointing out the inconsistency in your most recent post, I think there is something here to be learned. The part that I put in bold describes exactly what you did, even though you had just stated that you weren't doing that at all.

I apologize for this misunderstanding.

I’d like to point out that I find your response to my previous message very interesting, as it illustrates a problem that I often have with people: I fail to communicate properly and as a result people misunderstand me. Is there some type of therapy for people with this kind of problem? Or does my failure to communicate properly simply mean I’m not too intelligent?

In the interest of helping you further, I would like to ask you a few more questions:
1) What is your goal for this conversation?


Assuming that my description of the meeting with the psychologist seven years ago is accurate, I want you to acknowledge the fact that it seems like I talked to a bad/inexperienced psychologist, if it seems to you like I talked to a bad/inexperienced psychologist. If you believe the psychologist’s actions are acceptable, please explain why.

Also, if you are to believe what I told you about me, I want you to tell me what is wrong with me besides having low self-esteem and being insecure. Do I sound like I am still depressed? What other psychological problems do you think I have? Any personality problems, mental imbalances, anxieties, irrational fears, thought disorders? Do you think I should be on medications? Do you think I would benefit from talking to a psychotherapist or some other type of mental health professional?

2) What are your goals for your life?
3) What is it that you want but think you can never have?


I think you are just asking those questions in an effort to prove that my goal for this conversation doesn’t have a lot to do with my goals for life, so I prefer not to answer those questions. I hope you understand and I sincerely apologize if I am wrong about your intentions. At this point, I just want to know what’s wrong with me, as I honestly believe there is no advice you or anyone can give me that will make me change my outlook on life or motivate me to try to be a different person. I hope you understand and once again, I apologize.
 Dr. K. Eisele - Sun Sep 09, 2007 7:42 pm

User avatar Dear AHBCVR:

First of all, you can be assured that I am who I say I am. The Doctor's Lounge does check medical licenses to be sure that those answering questions are in fact, doctors or nurses, or whoever they claim to be.

You want me to say whether or not I think the psychologist's behavior was right or not. Quite frankly I wasn't there, so I don't know. However, if your recollection of this event from seven years ago is correct, and if your perceptions at the time can be considered accurate, then I would have to say that the psychologist's behavior is less than desirable. On the other hand, I'm not a psychologist, so it is possible that she was employing some technique about which I am unfamiliar.

Failure to communicate....I think your communications are extremely thorough, possibly too thorough. People might get the impression that you think they are dumb, because your style of communication is so inclusive. It doesn't mean you are unintelligent. It simply means that you may have difficulty picking up on cues from others with whom you interact. Internet or written communication would then be extremely difficult for you.

The reason I asked you the last two questions was partly a sincere effort to understand you, but also to see how you would respond, also in an effort to know you better. At this point, I think I have an answer for "what is wrong with you," but I hope you understand that I do not believe in "normal" or "abnormal." Our reality is based on perception, and what one person sees as normal is another's perception of abnormal. In other words, everything is relative.

Having said all that, I am wondering if there is any history in your family of others having difficulty interacting. This could be a sign of disorder that lies on the spectrum of autistic disorders. On this spectrum, autism is the most severe, and the mildest is Asperger's syndrome. Some of your responses sound to me like you could be affected by Asperger's syndrome.

The only way to test for this problem is a very extensive set of psychological exams. The treatment for Asperger's is what we call supportive. We would treat the symptoms that you report--for example, an antidepressant could be very useful for you if you're feeling unmotivated, sad, hopeless, worthless, etc. I do think you would benefit from an antidepressant.

Some people with Asperger's syndrome also have very obsessive thought patterns, for which antidepressants are also very useful. The best medicine by research for obsessions is clomipramine (brand name Anafranil). Other medicines with fewer side effects are effective as well, such as Prozac, Paxil, Zoloft, and Luvox.

People with Asperger's syndrome come in all shapes and sizes and have different capabilities. Some are very intelligent, others not so much. You do not sound unintelligent to me.

I hope this answers your questions.
 AHBCVR - Mon Sep 10, 2007 12:40 am

Hello Dr. K. Eisele,
Thanks a lot for your reply. I want to observe a few things. You told me that:

Failure to communicate....I think your communications are extremely thorough, possibly too thorough. People might get the impression that you think they are dumb, because your style of communication is so inclusive. It doesn't mean you are unintelligent. It simply means that you may have difficulty picking up on cues from others with whom you interact. Internet or written communication would then be extremely difficult for you.

And I hear what you are saying, but in real life, when it comes to face-to-face conversations, I am often very inarticulate. Did you listen to Miss South Carolina's answer to an extremely simple question during the Miss Teen USA 2007 beauty pageant? I compare my interviewing skills to hers. Alright, I am exaggerating, but I know that being articulate in speech is not exactly what I am good at. Frankly, I just don't have the clarity of thought and processing speed necessary to spontaneously translate abstract thoughts into spoken words. I see things, I observe things, and I feel certain ways, but when it comes to communicating those ideas I need to make an effort. I do a bit better (marginally better) when it comes to expressing my ideas in writing, because I have time to think about the ideas I am trying to convey and I get a change to go back and edit my sentences if after re-reading them I get the feeling they don't make sense or could have been written more succinctly and concisely.

Speaking of communications skills, when I was a college freshman, an English professor commented that my papers were often disorganized and that I tended to "miss the point," and asked me if I had ever been diagnosed with ADD. (Just for the record, I have never been diagnosed with ADD and that was the only time I have ever had a teacher or professor complain about my academic performance.)

Dr. K. Eisele, I do feel I have a hard time concentrating, and I think I talked about this in my first post, but so far you haven't said anything about ADD. Let me illustrate how I have a hard time concentrating: I am reading some written material, something in the reading catches my attention, and my mind goes from A to B, from B to C, from C to D, until I'm thinking about something that doesn't have anything to do with the stuff I am reading. Sometimes, something similar happens, except that my concentration is interrupted by obsessive thoughts that don't have anything to do with the reading. And very often, when I am reading a sentence, I often have to reread it several times until "it sticks" to my head. By the way, I think it's worth mentioning that during the short time I was on antidepressants, I felt that my concentrating skills increased considerably.

Having said all that, I am wondering if there is any history in your family of others having difficulty interacting.

I don't know about the medical histories in my family, but I know there are some people in my mother's side of the family with strange personality types. I have a grouchy uncle whom people can't say anything to because he interprets almost everything the wrong way and gets offended. (I have been compared to him.) And I have a cousin who is in his mid fifty's, single, and never really worked, presumably because he thinks he is "too intelligent" for work. My mother isn’t social but she does not have a hard time interacting with people and is well-liked by her peers. I did not grow up with my father, but judging by what I've seen the times I have visited him and heard the times I have talked to him on the phone, I have theorized that he suffers from bouts of depression, though he is not shy and introverted like I. He is actually quite extroverted and tends to be “the life of the party.”

People with Asperger's syndrome come in all shapes and sizes and have different capabilities. Some are very intelligent, others not so much. You do not sound unintelligent to me.

I like the way you say "some are very intelligent, others not so much" and then "you do not sound unintelligent to me." In other words, I might be intelligent or I might fall somewhere in between intelligent and unintelligent. (I think you meant to say the latter.) You see, I tend to pick up on this type of comments and they bother me a lot. That's fine. I learned a long time ago that I was not as intelligent as I wanted to be, and nowadays I don't obsess so much about my level of intelligence as I used to back in high school.

I am surprised to hear you say that you think I have Asperger's syndrome. I had actually already considered the possibility that I have Asperger's syndrome, but I ruled it out the moment I learned that Asperger’s syndrome is often seen as something along the lines of "autism for the very smart."

Dr. K. Eisele, do you still think I have Asperger’s syndrome? And if that’s the case, how do I go about getting tested for this "problem"? What about ADD and social anxiety? Do you think I also suffer from those problems? Or are they just side effects of Asperger’s syndrome?

Also, back to the topic of my communication skills, how I learn to pick up on cues from others with whom I interact? Is there some type of therapy for this?

And one more question, what is it that I said that made you think I might be affected by Asperger’s syndrome?
 AHBCVR - Thu Sep 13, 2007 5:54 pm

Dr. K. Eisele?
 AHBCVR - Fri Sep 14, 2007 6:35 pm

Dr. K. Eisele, I honestly believe you are sincerely trying to help. Please forgive me if I said something you didn't like :(.
 Dr. K. Eisele - Mon Sep 17, 2007 11:45 pm

User avatar Dear AHBCVR:

Whew! What a week. Sorry to take so long getting back to you.

Actually, I don't watch the beauty pageants, but I see what you're telling me--that in person, your ability to express yourself is much more difficult than in writing, for whatever reason. Thus, you would be more likely to offend people when communicating by such venues as e-mail or internet, even if you are much more articulate that way. The trouble you have with in-person communication is likely due to low self-esteem. This is further reason to think about Asperger's Syndrome--such patients are aware of their social deficits and it causes them to be nervous. They may be completely unaware of what it is that makes people shy away from them, but all too aware that it happens.

Since you had only one teacher mention ADD, and that was in your college years, I doubt that ADD is at the root of the problem. The reason I haven't said anything about ADD is that your problem seems to have more to do with thought processing after the fact, rather than before the fact. What this means is that a person with ADD will hear a phrase such as:

"The girl went to the bar, talked to ten men, but gave her phone number out to only a few of them."

and if asked to paraphrase, would say that "the girl went to the bar, talked to some men, and, hey, that's a really cool shirt you have on."

After-the-fact refers to the person who hears all of the statement, but then interprets it differently than most would, such as:

"the girl went to the bar, but because she had a sore throat, she didn't leave with anyone."

In other words, the person with ADD doesn't get all the information to begin with. Of course, the output would then be disorganized. The person with after-the-fact thought processing errors would also sound disorganized, but for a different reason. You mention difficulty concentrating, but it sounds much more like the poor concentration people who are depressed experience. It's almost as though they haven't the energy to make themselves focus on even a very simple task.

Also, people with Asperger's Syndrome do have obsessions and compulsions, as do those with autism. Ask any parent of an autistic child about the child's choice of playthings, and you will here something like this: "this week it's buttons and any other small, round objects; last week it was string." People on the Autistic D/O spectrum will "obsess" over things for a period of time, only to abandon it completely for another beloved type of object.

I haven't personally been around anyone testing children for psychiatric disorders in many years, so I am somewhat out of the loop as far as testing for this condition. A neuropsychologist would be the professional to consult, however.

You also asked about social anxiety, which I do believe is present in you. However, it could be part of an autistic spectrum disorder, such as Asperger's Syndrome.
 AHBCVR - Tue Sep 18, 2007 11:14 pm

Dr. K. Eisele, thanks a lot for your answer!

"The trouble you have with in-person communication is likely due to low self-esteem."

Let me give you another glimpse into my thought process. I interpret the statement above in two ways:

"It is likely, that if you did not have low self-esteem:
A) you wouldn't have the trouble that you have with in-person communication.
B) you'd be more willing to communicate in-person, even if in a clumsy way."

I interpret A as being logically equivalent or almost logically equivalent to your original statement, but such interpretation is not "satisfactory," as it leaves the door open for some other type of in-person communication trouble I might still have even if I did not have low self-esteem. Besides, are we even on the same page as far as the "trouble [I] have with in-person communication" is concerned? Since you have probably never met me in person, how can you know what the "trouble [I] have with in-person communication" is? Can you really know just by reading a few of my posts? In other words: if you meant to say A, you told me next to nothing.

Now, if I get paranoid about your statement, I'd most likely assume that you implicitly meant to say B. It's almost like, in your effort to help me, you tried to make me think that if I got my self-esteem fixed, I'd be a better communicator, when in fact what you really had in mind is that if I improved my self-esteem, I'd still be the same lousy communicator but more willing to communicate since I'd be less inhibited. I understand that this interpretation is mostly the product of my own imagination, but at the same time I realize that just because it is the product of my own imagination, it doesn't mean that my interpretation is inconsistent with what you really had in mind (only you know the answer to this one).

This is further reason to think about Asperger's Syndrome--such patients are aware of their social deficits and it causes them to be nervous. They may be completely unaware of what it is that makes people shy away from them, but all too aware that it happens. "

Correct, I am aware of my social deficits and I feel nervous in social situations. But I'm also aware of what I think makes people shy away from me: I'm quiet, and the few times I try to speak either I fail to communicate effectively or run out of things to say, which I think makes people think that either I don't like them or that I am dumb/boring. The truth is that I have a hard time establishing and maintaining conversations with people: I don't know how to tell stories (when I try I end up reciting a list of facts), I don't know how to build suspense or deliver a punch line, I don't get the timing right (either I speak too fast or make long pauses between sentences), I don't know how to use my body language/tone of voice to add meaning to my words, and I suspect that I'm not very good at reading other people's body language. Add to all that the fact that I have a hard time organizing my thoughts in a logical fashion and you end up with someone who is a complete mess when it comes to in-person communication. In short, I think my in-person communication trouble goes beyond low self-esteem.

Speaking of being deficient when it comes to in-person communication, I also find that sometimes I have a hard time explaining things to myself. I can see the ideas in my head, or at least I think I can see them, but when I try to put those ideas into words, just for practice, I often come up with internal monologues that don't make a lot of sense. I constantly marvel in great sadness at my inability to articulate sentences even when I am alone and without people listening. Deep inside, I almost feel grateful that people can't listen to my thoughts.

The reason I haven't said anything about ADD is that your problem seems to have more to do with thought processing after the fact, rather than before the fact. What this means is that a person with ADD will hear a phrase such as:

"The girl went to the bar, talked to ten men, but gave her phone number out to only a few of them."

and if asked to paraphrase, would say that "the girl went to the bar, talked to some men, and, hey, that's a really cool shirt you have on."
After-the-fact refers to the person who hears all of the statement, but then interprets it differently than most would, such as: "the girl went to the bar, but because she had a sore throat, she didn't leave with anyone."



When I read that sentence, I summarized it in my head as follows: "The girl went to the bar, talked to some men, but gave her phone number out to only a few of them."

I am actually worried about your observation that my thought process is "after-the-fact," and I'm not sure how to interpret that observation. In my opinion, someone who comes up with a summary along the lines of "she didn't leave with anyone because she had a sore throat," when absolutely nothing was mentioned about sore throats or any other type of physical discomfort, or about anyone leaving unaccompanied or otherwise, sounds like an illogical and unintelligent person. (I'm starting to wonder whether you are sending me all these mixed signals in an effort to measure "something" about my thinking process. Maybe you wanted to see if I'd point this out?)

Speaking of logic and concentration, the other day I took a sample LSAT, just for fun, as I don't intend and have never intended to go to law school. I did "satisfactorily" in the logical and analytical reasoning sections of the exam, but when it came to the reading comprehension section, I did a terrible job. For every set of questions for a particular passage, I answered less than half the questions in the set correctly. I figured that maybe I didn't have enough time to read the passages, so I went back and reread them at my own pace. I answered the questions once again, but I still got less than half correct. Not wanting to give up, I looked up the correct answers, marked them on the exam and reread the passages a third time. Guess what? I had a hard time understanding why the correct answers were correct and even then I had my doubts. Is this an example of "thought processing after the fact" errors or is it something else?
 AHBCVR - Tue Sep 25, 2007 6:49 pm

Dr. K. Eisele, thanks for your help.
 AHBCVR - Wed Sep 26, 2007 9:03 pm

Dr. K. Eisele, I am trying very hard to believe that you haven't replied to my post because you have been very busy with your day job. That's probably the case, but just to be on the safe side, I sincerely apologize for whatever I said that you did not like. I also want you to know that I think a patient who talks to a psychiatrist should speak whatever is in his or her mind and that's exactly what I've been doing so far.

Dr. K. Eisele, please reply to my post before the post before this post! I understand this discussion has been dragged on for too long. I won't bother you again.
 Dr. K. Eisele - Thu Sep 27, 2007 1:14 am

User avatar Dear AHBCVR:

Don't worry, you are not bothering me.... Of course there is a reason it takes so long sometimes, but reasons do begin to sound like excuses, don't they?

Anyway, back to what troubles you. I have been observing your style of communication, and even though it has been only a few posts, as you have pointed out, they have been lengthy, and I've noticed some patterns. You must remember, AHBCVR, I do study people, all day, everyday.

Here are some of my observations that particularly stand out:

1) you analyze things intensely, and that analysis includes curiosity about my intentions

2) you are a very literal person--when I gave the example of the girl who goes to the bar and how different people might process the vignette differently, you responded with a very literal interpretation

3) you tend to make judgments in regards to intelligence and/or logic

4) you see in color when you're looking at something that is black and white (a metaphor for making things more difficult than they really are or need to be)

In our discussion, I have allowed you to "speak" about whatever is on your mind. I have also lead you in a couple of different directions to observe how you respond. You picked up on that, but then, you analyzed why I might do that (see #1 above), but I am only doing what any good psychiatrist does: try to help the person arrive at their own answers. In this setting, however, this is a very difficult thing to accomplish, and the only reason we went there was because you needed it.

In your second post, you wondered why you would still care about the psychologist, and then commented that simply knowing that this is a preoccupation is enough to "make the memories go away." You have also made the observation that "all those thoughts are eating me alive," which shows insight into your problem. The question I have at this point is why should the memories "go away?" Yes, I know this sounds like an exceedingly simple question, for which many people might answer "because I need to forget all that," or perhaps, "isn't that what is supposed to happen?"

I think to expect the memories to go away is asking for something that you really don't want (this means I think if you knew what you were really asking for, you wouldn't want it). This may amount to semantics, but semantics do guide the way we think about things. Instead of wishing those memories away, why not try to simply let the memory be? What needs to change is your response to the memory. I often tell patients that right vs. wrong or likes vs. dislikes is useful and proper, but it is not always reality. We need to function within the reality that our society has created, AND we need to function within the reality each of us has, as individuals. Reality cannot be changed so much as it can be viewed objectively. All I'm saying here is that the only thing you can change is how you respond to various stimuli.

Here's the solution, in my mind: if the front door is too small to be walked through while upright, then you decide if walking through the doorway is consistent with your values, and if walking upright through the doorway is consistent with your values. If walking through the doorway meets the test, and if walking upright meets the test, then you either have to find a larger door, or you have to become smaller. At this point, you'll have another decision to make... The goal is to get to the other side of the door the most efficient way possible. Note that I did not say the easiest way or quickest way possible. Your decision will reflect not only your values, but also your priorities.

If you approach situations this way, you will gradually see that your "locus of control" is within you, not out there somewhere. Locus of control simply refers to your estimation of whether or not you will control your life and future. A perceived external locus of control puts one in the dependent, or childlike position. A perceived internal locus of control puts you in charge of your own happiness and well-being, which puts you in the driver's seat.

What happened to you that is "wrong with [you]," has to do with how you responded to a situation in which you perceived an injustice had been done, and then you very effectively taught yourself to react the same way to other situations to avoid being hurt again. This is human nature. The problem is that relocating your locus of control externally has undermined your self-esteem, your ability to feel intelligent, your interactions with others, etc., etc., ad infinitum. Everything affects everything.

You need to take that locus of control back inside. You may get hurt, but at least you'll feel that you are responsible for your feeling hurt, but you'll also feel responsible for the rewards, which is a far better feeling than the hurt is bad.
 Dr. K. Eisele - Thu Sep 27, 2007 1:20 am

User avatar Oops--I meant to write:

(Paragraph 5)--In your second post.....and then commented that simply knowing that this is a preoccupation is NOT enough to "make the memories go away."
 AHBCVR - Fri Sep 28, 2007 12:01 am

Dr. K. Eisele, thanks for your response. It was very thought-provoking. I was going to go away, but since you said that I am not bothering you, I'll ask you a few more questions. (I started writing, realized I had written a response that was several pages long, and decided to erase it all and cut to the chase.)

You told me that:
[Your replies] have been lengthy.
1) you analyze things intensely, and that analysis includes curiosity about my intentions
2) you are a very literal person
3) you tend to make judgments in regards to intelligence and/or logic
4) you see in color when you're looking at something that is black and white

But you never told me exactly what those four points say about my mental state, especially as they relate to Asperger's Syndrome. You probably gave me an implied answer somewhere, but pragmatics is not exactly what I'm good at. Can you please be more specific?

So I need to start feeling in control of my life and future if I am ever going to fix my problems. But if I indeed have Asperger's Syndrome, can this even happen? I might be able to feel in control of my life and future, but will my problems go away? I don't think the answer is "yes." I think the most likely outcome is that I'll feel better about the way I am, but I'll continue being 'weird', making people feel uncomfortable and getting rejected. I'll probably never realize my professional goals because as we all know, we need social skills and people have to like us if we want advance up the food chain. The way my life is going, I'll probably reach old age depressed, poor and lonely.

Maybe it's time to forget about the talk therapy and seek hands-on therapy, like social training classes. (I still hope you'll answer my questions.)
 Dr. K. Eisele - Sun Sep 30, 2007 2:52 pm

User avatar Dear AHBCVR:

So, what's wrong with weird? Weird doesn't mean bad, or even abnormal (and, who's definition of "normal" is correct, anyway?). What I'm getting at is that you can be weird and still be successful!

I think you may be still looking for an excuse to settle for a life of mediocracy. No offense intended. Many people do this simply because they believe they can't. The belief becomes a self-fulfilling prophecy. Try to take a "can-do" attitude.

The idea that I've been trying to get across is that you need to take a different perspective. Your attitude is that you are a failure because you are not "normal" and you're currently looking for psychopathology to explain it. You are looking for comfort in all the wrong places--even if you do have psychopathology, and I believe you do have depression, it still doesn't excuse you from having goals and pursuing them. While you are depressed, it will be harder or even temporarily impossible to work on your goals constructively. You may need to put them off, but only TEMPORARILY.

Get yourself to a psychiatrist for a definitive diagnosis and treatment.
 AHBCVR - Sun Sep 30, 2007 7:39 pm

Dr. K. Eisele, thanks a lot for all your help. You saved me a lot of time and money, and you spared me the negative feelings I would have experienced if I had talked to a psychiatrist in a face-to-face setting.

Thanks again for all your help and thanks for pointing me in the right direction. I always knew there was more to my problem than depression and a lousy attitude.
 AHBCVR - Sat Jan 12, 2008 10:49 am

Dr. K. Eisele, I'd like to continue this conversation where we left off over three months ago. I'd also like to thank you in advance for all your help.

In short, the invasive memories have continued; they still affect my productivity and my every day happiness. I'm still dwelling on the memory of my meeting with the psychologist I saw several years ago, and this problem, combined with my knowledge of the possibility that I have Asperger's Syndrome (you suggested I could have this condition), motivated me to contact the mental health office at my former school to request access to my mental health record. A few weeks ago I went in person to the mental health office and a new psychologist was assigned to go with me over my record. The record seemed fairly straightforward and it contained few surprises, but the new psychologist seemed curious as to why I suddenly decided to access my records. I revealed to her that part of the reason I wanted to see my record is because I suspect I have Asperger’s Syndrome and was looking for clues in my record that support the theory that I have this condition. She asked me why I thought I have this condition and, in an effort to obtain her validation, I listed a series of quirks and problems I have which I believe are present in a lot of people who have Asperger’s Syndrome: social awkwardness, difficulty making small talk, very few friends, tendency to not make eye contact, not being taken seriously, trouble expressing thoughts and emotions, obsessive memories, concentration problems, short-lived interests, and so on. She seemed skeptical, and she told me that every single one of those symptoms could likely be due something else. Not wanting to be laughed at for believing stuff I read on the internet, I stopped short of telling her that the reason the idea that I have Asperger's Syndrome entered my mind is because some doctor I talked to online suggested I could have this condition.

I currently feel upset because this psychologist, while very kind and very professional, was dismissive of the possibility that I have Asperger’s Syndrome. According to her, I only have anxiety (the one comorbid condition I think I have which I forgot to mention when I made my case about having Asperger's).

Dr. K. Eisele, what are your thoughts on this psychologist’s skepticism and the way I currently feel? If such an innocuous meeting caused me so much emotional distress, how do you think I'll feel the day I see a mental health professional who is more direct or insensitive? I think we already know the answer to that question. As you can probably imagine, I'm currently in the middle of a dilemma: I feel I'd benefit from professional help but the potential emotional pain that talking to a mental health professional is likely to cause me dissuades me from seeking that help. Please let me know what you think.
 Dr. K. Eisele - Sun Jan 13, 2008 2:31 pm

User avatar AHBCVR:

A psychologist that you have spoken with, face-to-face, has told you that you do not have Asperger's Syndrome. Guess what? She's probably right. I cannot possibly make an "actual diagnosis" from communication over the internet. Remember when I said:

Dr. K. Eisele wrote:The idea that I've been trying to get across is that you need to take a different perspective. Your attitude is that you are a failure because you are not "normal" and you're currently looking for psychopathology to explain it. You are looking for comfort in all the wrong places--even if you do have psychopathology, and I believe you do have depression, it still doesn't excuse you from having goals and pursuing them. While you are depressed, it will be harder or even temporarily impossible to work on your goals constructively. You may need to put them off, but only TEMPORARILY.

Get yourself to a psychiatrist for a definitive diagnosis and treatment.


I think this still applies.

Best of luck to you.
 AHBCVR - Sun Jan 13, 2008 4:18 pm

Dr. K. Eisele, the psychologist did not say I don't have Asperger's. The psychologist simply said that my problems could be due to something else. Personally, I think the psychologist was skeptical mainly because I mentioned the possibility of having Asperger's. As you probably know, doctors tend to be skeptical of patients who self-diagnose.

I still don't rule out the possibility that I have Asperger's. Why? I talk to people with Asperger's Syndrome (I've joined a few message boards for people with this condition) and it's like we speak the same language. Unlike neurotypical people, they identify with the problems I go through. Ialso identify with a lot of the problems they go through. Does that mean I have Asperger's? No, but it makes it more likely. And let's not even mention that a lot of these folks tell me that they went through the same hurdles I'm currently going through before they were finally diagnosed with Asperger's.

I simply don't believe the psychologist I talked to knows better than you do. In real life, I can't express myself the way I do in writing, so it's not surprising that the psychologist didn't fully understand what I am about. And just for the record, I feel extremely grateful with you for pointing me in the right direction. You have no idea how therapeutic it has been knowing what is wrong with me and talking to people who have the same condition. I'd still be in the dark if it were not for you.

If the next time I talk to a mental health professional, if there is a next time, I hand over a print out of this discussion to him or her before I open my mouth, how do you think the meeting will go? Is it likely I'll be met with more skepticism or just get labeled with another psychopathology?
 Dr. K. Eisele - Thu Jan 17, 2008 12:54 am

User avatar Dear AHBCVR:

You may print anything you wish off any website. I really can't say how a printout of this discussion would be accepted. Some doctors might take that as an immediate condescension from you, others might appreciate the extra bit of history! I would hope that the simple fact that you come with a print out in hand would not result in labeling you with any particular psychopathology. There is much, much more to making a diagnosis.

I do wish you all the best.

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