By Mike McMahan, LPC
 
Kudos to legendary rock ‘n’ roller Bruce Springsteen for opening up about his struggles with depression. Springsteen spoke candidly about the challenges he’s faced regarding the illness, which he has struggled with since entering his 60s. As we age, depression can be linked with facing later-in-life challenges such as medical conditions and the passing of friends and family members.
 
Springsteen stated that his depression symptoms “lasted for more than a year, and then it (the depression) would slip away. Then it would come back for a year-and-a-half. It sneaks up on you. I got to where I didn’t want to get out of bed, you know? And you’re not behaving well at home and you’re tough on everybody. Hopefully, not the kids. I always try to hide it from the kids. But, you know, Patti really had to work with me through it … her strength and the love she had was very important.”
 
Having a strong support system can be a key way to battle depression, as the disease itself tends to make one feel isolated and alone. This is part of the importance of someone like Springsteen speaking out. As Springsteen has been successful by literally any standard, it’s a reminder that depression can affect anyone of any age, successful or not.
 
The symptoms of depression can vary. They include: lack of energy; loss of appetite or excessive appetite and accompanying weight loss or weight gain; loss of interest in hobbies or activities you used to enjoy. A general feeling of sadness that goes on for over two weeks accompanied by some or all of the symptoms listed above may be a sign that you should speak to a doctor or mental health professional.
 
There are numerous treatments for depression. One technique I have used with clients is channeling the negative feelings of depression into art. If you look at artists, writers and musicians, many struggle with low self-esteem or other negative self-feelings. Many also struggle with mental illness, diagnosed or not. The need to “fight the fight” is at the heart of many artists’ drive to succeed in my opinion, which may be one of the reasons that painting, writing or composing can be therapeutic for those that have never expressed themselves in that fashion. Art can be a powerful way of releasing negative energy.
 
Springsteen will release his memoir, Born To Run, on September 27. If his promotional interviews are any indication, it promises to be a good read.
 
 
Mike McMahan, LPC, is a psychotherapist based in San Antonio, Tx.

By Mike McMahan, LPC
 
Kudos to ABC News anchor Elizabeth Vargas for speaking openly about alcoholism. It is a very difficult disease to cope with affects millions of people. A special will air tomorrow night, Friday September 8, 2016, but excerpts are already making the rounds. In addition, Vargas will publish a memoir, Between Breaths: A Memoir of Panic and Addiction, next week.
 
In the clip available in the E! Online story above, Vargas discusses the challenges that anxiety posed in her life and how she initially drank socially to deal with it. This is not an uncommon reason for people to start drinking. In fact, drug and alcohol use are a complicating factor when it comes to diagnosing things like anxiety; as a clinician, you have to ask yourself “are these symptoms due to substance use?” This is especially complicated in trying to figure out what, if anything, underlies the substance use. It can very easily become the classic “chicken or egg?” dilemma. Did the client start using to cope with something (anxiety, depression) or is the substance use creating the symptoms? For example, as alcoholism progresses, people can begin having withdrawal effects when they aren’t drinking. So if they come to you for help, how can you, as the therapist, be sure that the anxiety they are feeling at that moment isn’t due to not having a drink? This is why many times, clinicians recommend that a person get sober before looking at other issues. However, this in and of itself poses obvious challenges, as becoming sober is no easy task for people with long-standing drug or alcohol addictions.
 
The most striking element of the clip above was, to me, the moments when Vargas talked about her anxiety during the opening of the ABC Nightly News during her anchor spot. As she points out, she is gripping the table with fear, something that would not have been noticeable had she not called attention to it, but is painfully obvious once she points it out.
 
Vargas seemed to be in a place where total sobriety was the only solution. However, for substance users who have not reached the level of problems she described, there may be an alternative approach. I have had success with people who likely don’t meet the clinical criteria for full-blown alcoholism, and whose goal is to reduce drinking before it becomes a problem. This approach, part of Solution Focused Brief Therapy, involves a gradual reduction in alcohol usage. The client may say that they are drinking “3 or 4 beers a night” and want to “have a couple of beers on the weekend with friends.” This is an achievable goal, though is quite likely unrealistic for someone who is drinking 18 beers a night and blacking out. The treatment involves writing down the number of beers consumed each night, and gradually reducing the consumption. For example, a goal for one week might be to drink one less beer a night. Another week it might be to only drink on three nights. This client will hopefully learn coping skills on the nights with reduced or no drinking, and apply these skills to achieving their goal. These new skills can be highlighted and reinforced by the therapist during weekly sessions. I do want to say that I don’t recommend this approach without the assistance of a mental health professional or a doctor. While this is a rough outline of the approach, it is not intended as an instruction manual and any sort of alcohol or substance use (or the cessation of) can potentially be dangerous.
 
It's great that Elizabeth Vargas has made such a great turnaround. I hope she continues her success, as the fight against alcoholism and efforts to stay sober can be a daily challenge.
 
 
Mike McMahan, LPC, is a psychotherapist based in San Antonio, Tx.

By Mike McMahan, LPC
 
Kudos to actress Bella Thorne for opening up about her sexuality. The fact that this seems to be pretty much non-controversial shows how far we, as a society, have come in accepting LGBTQ role models. I believe society will benefit as a whole from this kind of openness—especially LGBTQ youth.
 
As a whole, there seems to be some confusion and skepticism about bisexuality. Many of us have heard comments such as “all women are bisexual” or “bisexual means they aren’t totally out of the closet” or “that means they’re just experimenting.” I have heard them both in my professional and personal life. All of these statements reflect different levels of misunderstanding.
 
Earlier this year, the National Health Statistics Reports published an article based on Department of Health and Human Services stating that “5.5% or women and 2.0% of men stated they were bisexual.” The higher rate of women who identify as bisexual may reflect a level of comfort with female same-sex attraction and sexual activity that does not extend to males. Whether pornography has contributed to this or simply reflects the phenomenon is likely open to debate. Either way, the statistics refute the idea that “all women are bisexual.” That said, like so many things in the world of psychology, the answer may not be so clear cut. Another study suggests that, in fact, women have a different physical response to sexual arousal. “Men who identify as heterosexual become aroused when watching films of women but not men. Gay men tended to be aroused by films of men. This is very different with the women in her research. No matter how they identified in terms of their sexual orientation, they were more likely to show the same pattern of arousal to men, women, and both.” Therapist Isaac Archuleta makes some interesting points about the bisexual experience. He comes from a personal perspective on the matter and has written openly about his experiences.
 
Many mental health experts believe that sexuality exists on a spectrum, which makes it difficult to say with a degree of scientific precision who is “gay” or “straight.” In my personal work with clients, I go with how they self-identify. If someone tells me they are bisexual, I accept that at face value. On the other hand, if a woman tells me “I’m straight, but I like to hook up with girls occasionally,” I accept that at face value as well. There is no benefit for the client if I respond “you’re not straight, you’re bisexual.” If the same female client mentioned above said “I think I’m straight, but I like to hook up with girls occasionally and I’m not sure what to call myself or what to think,” that would be an entirely separate matter. I would want to explore with her how she would like to self-identify, how much she would want to share with the world at large, her family and so forth. In short, the area of sexual identity may not be clear cut for a number of people.
 
These issues can be difficult for young people, which led to the creation of the “It Gets Better” project, which features people talking about the challenges of growing up LGBTQ, and the way that young people’s lives may improve once they get through youthful challenges. One of the key purposes of the project is to reduce the appalling number of suicides among LGBTQ youth.
 
However bisexuality is defined, Bella Thorne deserves credit for addressing the issue head-on. Somewhere out there is a young woman struggling with these very issues and she is undoubtedly comforted by the fact that she has an ally to look up to.
 
 
Mike McMahan, LPC, is a psychotherapist based in San Antonio, Tx.

By Mike McMahan, LPC
 
When Robin Williams committed suicide two years ago, the entire nation mourned. He left behind a vast library of work that covered a wide range of the emotional spectrum, from Jumanji to Good Will Hunting to What Dreams May Come to One Hour Photo. We all have our favorite(s).
 
But while we may have felt his loss acutely, that feeling likely doesn’t compare to what his family members went through. His daughter, Zelda Williams, recently spoke about her journey through grief and the death of her father.
 
When I have a client that has a loss in their life, I remind my clients that though their loved one has passed, they will still live on in our memories and our heart.  I ask them to consider what their loved ones would say to us if they were here. I also ask clients to consider how they will keep their loved one’s contributions to the world alive for others. In the case of Robin Williams, this may be an easy question. After all, his most famous films will likely be enjoyed for years to come. But that is an answer for us, as the public and does not reflect how a close family member might feel. Perhaps they treasure those movies as much as we do; perhaps not. Until his family members address that subject, we have no way of knowing.
 
There are also coping strategies that can help a person cope with grief. I was impressed to see that Zelda was using several good ones. “…for a while, I was kind of left to my own devices and a lot of stuff came out of that, because I ended up writing 12 scripts.” Writing and other artistic pursuits can be a great coping mechanism. Art can be a great way of exorcising emotional turmoil, as evidenced by, well, every artist ever. There must be a reason that artists seem to live volatile, troubled lives. Many would likely agree that artists feel things deeply and see things in ways that others may not. This perspective gives them insight, but may come at a cost.
 
In the article cited above Zelda also says that she has “gotten involved in one charity that dealt with ‘rescue dogs, people suffering from disabilities, and our nation’s wounded veterans’ — freedomservicedogs.org.” Volunteering can help a person get out of their own head and making a positive impact in the world can help us move on from grief in a healthy way.
 
Kudos to Zelda Williams for speaking out and setting such a great example.
 
 
Mike McMahan, LPC, is a psychotherapist based in San Antonio, Tx.