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Don't know how to talk to
Nov 16, 2005

So I have put together that my contraction of HIV may very well be linked to self destructive behavior on my part, resulting from temporary expulsion from school. I am only recently diagnosed although and it all coincided with a return back to school and a break up with a partner. Recently however my mind has been having difficulty concentrating and falling asleep. Meditation is more difficult and less effective. My appetite has decreased but my eating habits have not been affected as I know how much I need to consume to stay well. I do catch impulses and stray thoughts now about ending life in silly dramatic fashions, but always have a strong internal rebuke concerning the illogical nature of such thoughts. My school work has suffered. I am on probation, and my current academics would have me kicked out permanently from school. I do not want this, but I have found a disturbing lack of internal motivation. For example, I recently spent the entire day yelling at myself internally to get myself out of bed, but I did not, despite missing valuable deadlines and assignments for school. I only was able to get out after a sense of claustrophobia that drove me to walk around the entire city alone at night. Anyways, I have the realization again now that I could very well be engaging in self destructive behavior once again, towards my academics; I know and I want to complete my work--which is not even very difficult or confusing--but somehow I am being prevented from doing it. But I am not entirely certain if this is all also just a form of laziness and self-excusal. Now, I have met with 2 therapists, but so far have found neither one particular helpful. I feel I may intimidate them, as they have repeatedly said in the end that I had already iterated a lot of their own suggestions and observations about myself. I have not ever left knowing anything new, or feeling any different from these sessions. I initially only approached them for concrete actions within their power to do; however, so far their actual performance of said promises, or delivery of such, have been quite late or non-existent. One final object of note is the fact that I am very wary of medication, though now am more considering of it. I for one have seen too many of my peers have additional problems resulting from medication, and as well it has always appeared to me as a statement of white idle rich bourgeouis angst. Now what I see as a central problem is either my lack of willpower/motivation, or this possible self destructive component; where would medication be a solution to either? Now basically I really don't know who to turn to; I think I have identified my problems, but I am at a total loss for solutions? Whom or what would it be best to talk/consult with? Thanks Z PS as to what the source of the possible self destructive tendencies would be, I do have a number of considerations already. But equally if indeed true as a source, I am still at a lost of how to correct it.

Response from Dr. Horwath

Your experience with the 2 prior therapists is unfortunate, but you need to look further. Perhaps you need someone with more experience. There is an enormous range of experience and training in therapists. It is best to interview several potential therapists, choose the one who seems to be the best fit, and then try to stick with the treatment long enough to get some benefit.

You would also benefit from a consultation with a psychiatrist regarding the potential benefits of an antidepressant. Lack of motivation and self-destructive behavior may be signs of depression, and medication is not just "a statement of white idle rich bourgeouis angst." It is an effective and sometimes life saving medical treatment for a serious illness. You should be evaluated. You may find that you will be helped.



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