Medical Treatment: More Legitimate than Mental Health and Substance Use Treatment?

Let me start off by saying that I believe medical, spiritual, and behavioral health are all linked. It is very naive to think that they are not.

One of my first questions when someone comes into my practice relates to medical issues, especially when nothing is indicated about their health. I think that, before you treat someone for mental health and substance abuse, you need to make sure nothing else is going on medically. Think about hypo or hyper thyroidism. That can affect your mood in a huge way. Diabetes, when not treated, can affect your judgement in a huge way. A traumatic brain injury can also appear to be many different mental health conditions. A physical is essential before treatment.

I also want to know about the length of their sobriety if someone has had substance use issues. A person who has been sober for less than 90 days is still dealing with the mental and physical readjustment of their body to this detoxification. You may be going through psychological withdrawal and, in my experience, the mourning phase of their sobriety. Saying goodbye to substances is a huge stress on you, especially emotionally and physically.
During these first sessions, some individuals are looking for "answers" and " a cure" to their emotional ailments. After all, medical doctors usually have a quick answer to what is wrong, usually in the form of medications. Why can't counseling do the same thing? That is usually when we have a discussion about how therapy is indeed not an exact science.

It is also at this time I discuss two points: first of all addiction and mental health has only been around for 150 years. It is, in many ways, in its infancy. It has come a long way during this time and does have lots of research that backs up certain treatments for several ailments, including CBT for mood disorders, EMDR for trauma, motivational interviewing for substance use, among many others. Psychophamacology, or meds, has also been well research and has proven beneficial for many mental health issues.

"But how do they (doctors) know what meds will help me? I've been told many names so which one is for me?" We usually than talk about how different body chemistry react differently to different medications. "So they don't know? That is why this psycho babble stuff doesn't work". I use to react negatively to these type of statements but I got to thinking about medical issues.

Is there only one treatment for diabetes? Is there only one cancer "cure"? What about heart conditions or cholesterol issues? Of course not. Medical professionals also explore different options, which includes behavior modifications for some of these ailments, including diet and exercise.  And we usually discuss at length these points and how behavioral changes may be the only thing needed to a combo of both pharmacological and behavioral change to even just a medication exploration only . I find that many individuals are moved by that argument and seem to understand why different medications and treatments can/should be explored before settling to only a few of them.

Is medical treatment better than mental health and substance use treatment? I believe that, once explained, they are more similar than one might think.

The "Right" Emotion

In counseling, we often here different assessments of emotions. One that I have heard more frequently in the last few weeks is how some emotions are better or "more right" than others.

I hear about it in different contexts. The first one is "What is the right emotion?" Let's look at this in the grieving process. The "correct" emotion according to many is sadness. We have no right to be angry, right? I challenge this by saying "Why not?". Elizabeth Kubler-Ross discussed the 5 stages of grief and included anger. While I don't completely agree with the stages of grief, I do believe there is more than one emotion that is acceptable or "right". Going through this "sequence" of emotions is not only healthy but probably a way to adjust to this loss.

When someone "wrongs" you or when they are "obviously", why would the only "right" emotion be anger? We see this in various situations: when we are driving, when we are disagreeing with "moral" issues, as well as politics, the workplace, and in our close relationships. While anger is probably very normal, Buddhists beliefs state that displaying an emotion of compassion and even sadness is probably ideal. This sounds probably counter-intuitive, but think about it: if we were able to use empathy and caring for what someone else believes/states/does, wouldn't this frustrating situation feel a whole lot easier to accept?

I also think that CBT is again one of the best theory to explain the distortion stated in the title. One of these cognitive distortions is emotional reasoning. This distortion states that if you feel a certain way, it must be true and, therefore, it is the ultimate truth. Any other emotions must be wrong. Looking at this objectively, have you "always" been right in your emotions? Think about it: the anger you have felt has sometimes felt out of place, right? What about your happiness about an event when it affects other people? We may argue that our emotion is right, but thinking it through is important.

You must also look at labeling as the other cognitive distortion involved in this "right emotion" concept. Related to overgeneralization, when we label a situation that can be emotionally charged a certain way, may make it difficult to change our view of our emotion. It makes our view of our situation feel "righteous" and also less flexible to change.

Emotions are tricky, as they emerge from the primitive part of our brain, the amygdala, which in animals, controls the "love-hate" reaction to any particular stimulus. Thankfully, in humans, we have a large cerebral cortex which helps us process emotions and situations in a more analytical way. When it comes to these types of extreme emotions, I try to work on perception and how they can be wrong. When I have individuals who struggle with that, I like to show them a Dali, an Escher, or an optical illusion to demonstrate the importance of seeing things differently.

Is there a right emotion? I still don't know the answer to that question. We can only hope to validate that many emotions are acceptable in any given situation.