2 thoughts on “Is It Guilt Or Shame? My Depression Doesn’t Care

  • March 29, 2011 at 11:42 am

    Trying to identify guilt vs shame vs humiliation is helpful because the approaches used to help understand and live with these powerful emotions are different.

    You’re right ,repeating the mantra ‘feelings aren’t facts’ won’t work with shame-have you looked at some of the work on self compassion?

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  • April 4, 2011 at 8:45 pm

    What happens when a shrink feels himself slowly slipping into depression.I’ll tell you what didn’t happen with me. I did not consider this diagnosis until an UNreasonable amount of time had passed. Although I have an excellent psychology (MD/PhD – only 20 years older) and I mentioned to him that I’d written myself a script for Wellbutrin. All I needed was some pep in my step and I wasn’t about to ask friends to writer for Dexedrine or Desoxyn. None of my patients were harmed by my not taking care of business. One day, my mentor called my sister (she;’s a former DA and a Criminal Defense Attorney; they have worked together on cases and sis has been a patient, too.) Under the too-glib DDx of Generalized Anxiety Disorder, which I’ve treated with Xanax and Ambien 20mg/Desyrel 300mg for some time time, lay depression, just waiting for a few hards knocks in my personal and professional lives to come to fore. My PhD is in Psychopharmacology, although the diploma (and I didn’t get it side-by-side with my MD; I was in practice several years before taking my mentor’s — and Mom’s— advice to go back to school. When I had to take days off because I was too depressed to go into work, I realized I needed ANOTHER doc on the case. That happened to be my mentor. I was in danger of falling into the amphetamine trap because I always was so damned tired! Also, my neighbors have THREE ADHD kids — she has it herself — and one more script among the dozens wouldn’t be noticed. I “borrowed” Adderall IR and XR from my neighbor at various junctures when I really needed to get some work done — but I sought expert help before “cooking the C-II books” —I reduced my work week by one day and made sure my patients knew this was a temporary. “Doc” reached back into the past and wrote for Tofranil (imipramine); we found the optimal dose to be 200mg/day. He added Prozac we it seems the 40mg qAM dose is working fine, but that may change.

    It’s only been a few weeks, but I’ve been honest with my patients, especially those I know well. At 57, I’ve been practicing for close to 30 years. My patients were very understanding, although I was markedly careful about self-disclosure. (They all know I’m gay, so that wasn’t an issue.) This past weekend, I agree to cover for a younger doctor on a weekend trip. It was a Psych ER call. I had to put all else aside and use my expertise, knowledge of psychodynamic psychotherapy to treat this suicidal patient. I didn’t “snow” him with a AAP or even Haldol. I needed to use my therapeutic skills more than any others. I spent a few hours there. I needed to prove to myself that I can still do what I did when I was Chief of Psychiatry at that hospital…and I realized that if could please my most vitriolic, demanding critic — Dr. Joey — I was on the right track with my treatment.

    LOne lesson I learned is NOT to prescribe for oneself if you have a mood disorder. You need someone more experience who can observe and evaluate calmly and clinically. I picked my mentor because of our long-standing relationship and his phenomenal skills as a clinician, a therapist and a psychoanalyst.

    N.B. In many states, it is perfectly legal doer docs to write scripts for themselves. (In treating Impaired Physicians, I’ve noticed the scripts usually are written for family members — initially). We ALL can order Controlled Substances (even amphetamines and other C-ii drugs; all that;’s needed is DEA Form 222C) to “office use” or “dispensing in office.” DO NOT do this. It’s a recipe for disaster that I came close to whipping up, even though the first drug was innocuous enough — Wellbutrin XR.

    Let us never be afraid of seeking help frlom our friends and colleagues. This is the start of a long haul, but I’m rrady for it and ready to permit my mentor — whom I always referred to as “Doc” — BE THE DOCTOR ON THE CASE. Our insights and suggestions are valuable, but we cannot live in the pipe dream (cf, Eugene O’Neill’s The Iceman Cometh) that because we’re doctors or other therapists who can obtain scripts easily, that we can treat ourselves. I do a lot of pro bono work with gays kids who have problems with “tina” (methamphetamine HCl) and other street drugs; many are HIV positive because of the choice those drugs robbed them of being able to make.

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