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  Frequently Asked Questions About Psychiatry and Mental Health
Floyd P. Garrett, M.D.

What is a nervous breakdown?

"Nervous breakdown" is neither a medical term nor does it have a precise definition in popular usage. Generally it refers to any state of sustained emotional distress that is severe enough to disrupt normal functioning for several days or more. Like many other words and phrases, "nervous breakdown" whatever the person using the term chooses it to mean. It is ironic, therefore, that a very common fear is . . . having a nervous breakdown! Even though nobody knows for sure what a nervous breakdown is, the prospect of having one is a sinister and frightening one because it suggests a complete loss of control and perhaps even insanity.

Am I going crazy?

A surprisingly common concern and question. Many people are so afraid that they are going crazy that they don't dare to ask or bring the subject up for fear that others will find out the terrible truth about them! The majority of people have probably been seriously afraid of losing their minds at one time or another, typically in adolescence and young adulthood. Because the topic is seldom raised or discussed people do not realize how common, in fact almost universal this fear actually is. Secrecy and shame, as always, make matters worse and cause more anxiety and suffering.

The fear of insanity is so common that it might even be thought of as a normal part of development for many people. Just as with other developmental phenomena, people "outgrow" it after a while.

The presence of significant depression or anxiety or both is frequently associated with a fear of losing one's mind. Depression and anxiety alter the usual "feel" of the mind - and by introducing new and unpleasant emotions and thoughts, cause the individual to fear that he is losing control over his mind. It is this feeling and fear of loss of control that is usually misinterpreted as the approach of insanity. This of course causes still more anxiety and dread, especially when, as often happens, the individual is too frightened to discuss his fears with anyone. Thus people with obsessive-compulsive disorder or even with scattered obsessive-compulsive symptoms(rituals and repetitive or peculiar or frightening thoughts) quite commonly dread losing their minds.

What do my dreams mean?

This is a controversial area in which the answer you get largely depends on who you ask. Some scientists today insist that dreams are merely the random or background noise of the mind during sleep and mean nothing at all. But almost everyone knows from direct experience of their own dreams that at least some of the time dreams are complex and personally meaningful, if often obscure creations. Freudian dream analysis relies upon the dreamer's own connections and associations to his dream to unravel its contents. There is no real evidence that dreams can be reliably interpreted "by the book," i.e. by consulting a manual of symbols or common dreams. The meaning, if any of a dream seems to be highly specific for the dreamer.

What is "normal"?

People often wonder and sometimes ask if they are normal. The difficulty here is that, strange as it may seem, the mental health professions have never established or concurred in a definition of normalcy. There is reasonable though not complete agreement today concerning various abnormal states of mind and behavior - but any discussion of normalcy itself quickly becomes controversial. Perhaps the best that can be said for the moment is that normalcy is the absence of abnormalcy! A far more productive line of inquiry, therefore, is to ask whether one is happy and healthy, not whether he is normal. Freud's definition of good mental health -the ability to love and to work- is perhaps as good as any.

What is the difference between a psychiatrist and a psychologist?

Psychiatry is a specialty of medicine like surgery, internal medicine or pediatrics. All psychiatrists have therefore graduated from medical school and are M.D.s before taking additional training(usually three years or more) in the specialty of psychiatry. Psychologists have obtained the Doctor of Philosophy or PhD degree from a university and have not received but have not received the medical training of a physician.

Do I have to take this medication for the rest of my life?

Although experience shows that some types of chronic or recurrent depression and other conditions do best with longer rather than shorter treatment, no one really knows for sure in an individual case whether medication will be required indefinitely. New medications and treatments are constantly being developed that will almost certainly transform our approach to psychiatric disorders in the next few decades. The important thing is to maintain good communication with the prescribing physician and to make decisions about length of medication use after thorough discussion. A not uncommon scenario is relapse of depression or other symptoms when medication is discontinued prematurely and without medical guidance.

Is this medication addicting?

Medication itself is never addicting because addiction is a clinical syndrome characterized by pathological salience(the substance is abnormally important to the individual and becomes a life-dominating obsession), drug seeking behavior, dishonesty, excess and continued consumption despite negative consequences. Addiction, in other words, consists of a complex interaction between the individual and the substance. For reasons that are still unknown but which probably have to do with both heredity and environment, only certain individuals are vulnerable to the syndrome of addiction.

Certain medications, including alcohol, induce states of physical dependence in everyone who ingests them long enough and in sufficient quantity. Physical dependence means that there may be a withdrawal syndrome if the intake of the substance is suddenly stopped or drastically reduced. Physical dependence and withdrawal syndromes are not addiction. They are easily managed in non-addicts by the gradual reduction of dosage until the substance is finally discontinued.

Most but not all substances involved in addiction can cause physical dependence - but physical dependence alone is not addiction.

What is a chemical imbalance?

Although the phrase "chemical imbalance" has no precise definition it is commonly used to describe a type of depression(major depression, endogenous depression) that is thought to result at least in part from deficiencies in certain brain chemicals, called neurotransmitters. Certain anxiety disorders as well as bipolar disorder(manic depressive disorder) and schizophrenia also involve disturbances of normal brain chemistry. Serotonin, norepinephrine, dopamine and probably many other substances, some known, others not yet known, play a role in mood regulation. Antidepressants and other medications work by restoring normal levels of these brain chemicals. There are no currently useful laboratory tests for such imbalances. Evidence for the chemical imbalance theory comes from research. In ordinary clinical practice the diagnosis of a "chemical imbalance" is made from the patient's history and symptoms and from his response to treatment.

How do shock treatments work?

Shock treatments or electroconvulsive therapy(ECT) induce an artificial epileptic seizure by means of a small electric current applied to the skull. Before the ability of electricity to create a seizure was discovered various other methods, including intramuscular and intravenous injections of chemicals known to cause seizures were used. The ability of spontaneously occurring epileptic seizures to relieve certain mental illnesses was noted in the last century and led to a search for a safe and effective way to create seizures in non-epileptics. It is thus the seizure and not the electricity or any other means of causing it that is the effective thing in convulsive therapy. Modern ECT is always done under light anesthesia and after a powerful fast-acting muscle relaxant has been administered that totally blocks the visible bodily response to the seizure. Often the only evidence that a seizure has actually occurred is the readout on the EEG(brainwave monitor). For more information on ECT see

Will hypnosis help?

Hypnosis is simply a means of focusing attention. It can often be useful in strengthening motivation for change, e.g. smoking cessation, weight loss, exercising &etc. There is nothing magical about it, however. And although it is an intuitively appealing idea that hypnosis could provide a "short cut" to repressed or forgotten memories that might prove helpful in therapy, there is no reliable evidence that this is the case. Trying to access the unconscious directly by hypnosis is like trying to go someplace without actually taking the journey. The actual effective and lasting part of most therapy involves confronting and working through resistances and repressions, not bypassing them. The journey is actually the destination.

What is a split personality?

There is no category or phenomenon in psychiatry called split personality. The term is commonly used in popular language to indicate a contradictory or drastically and dramatically alternating type of behavior of the"Jekyll and Hyde" type. It is often confused with the medical illness of schizophrenia because the etymology of the latter(from the Greek schizein, to split + phren, mind) suggests, misleadingly, that schizophrenia is a type of split personality. In schizophrenia, however, the splitting is within one single personality as the individual's thoughts, feelings and emotions are seriously and confusingly disconnected from each other in a chaotic and random fashion. Schizophrenic individuals, far from having split or multiple personalities, actually have a great struggle maintaining the coherence and integrity of even a single self.

Can people still be sent away or committed to mental hospitals?

"Snake pit" and long term mental asylum images from old movies and popular literature still frighten many people but they no longer represent the way things are. Although individuals who are obviously mentally ill and dangerous to themselves or others can be legally detained and evaluated for safety, involuntary treatment(treatment against the individual's wishes) has become uncommon. There are all kinds of legal safeguards expressly designed to prevent abuses of psychiatric treatment - so many, in fact, that it is often difficult to treat desperately and dangerously ill individuals who do not recognize the condition they are in. Nor are people hospitalized for long periods of time any more. The old state mental hospitals where some patients lived for years, even their entire lives in some cases, no longer exist. Inpatient treatment today, if it is provided at all, is typically a matter of days or weeks, not months or years. Ironically, and unfortunately, the major difficulty patients today encounter is not getting out of a psychiatric hospital when they don't need to be there - it is getting in to one when they urgently require help.

Submit a question. Questions of broad or general interest will be considered for a general response in this section. All material on the "Psychiatry & Wellness" website is intended for general educational purposes only. We cannot respond to personal and specific questions, which should be directed to a local mental health professional.

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Intervention for Alcohol and Drug Dependence

Obstacles to Recovery from Addiction

Prescription Drug Abuse

Prolegomenon to the Metaphysics of Recovery

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Why is Recovery So Hard?

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