I am Dr. Michelle Stevens, an expert on psychological trauma and author of SCARED SELFLESS. Ask me anything!

Hello Dr.Michelle!

I became seriously depressed after some traumatic events that I don't want to talk publicly here. I am currently taking sertraline (an SSRI), which makes me feel better but at the same time I feel like I am loosing all my focus and It's hard to keep concentrated on a single task.

If instead of going directly to an SSRI, I'd have taken serious psychotherapy sessions, would I have the same problem with my focus and concentration?

WobblyGobbledygook is correct in pointing out that I am a psychologist, so I don't prescribe meds. I do know an awful lot about treating trauma, though. When a traumatic event occurs, there are often physical symptoms, like depression and anxiety, as well as existential issues that need to be addressed (e.g., "Why did this happen?" "How will I go on?"). If a physical symptom like depression is very serious, I think meds are indicated. However, a lot of depression (if it is a single episode and clearly the result of an event) can be resolved from simply going to talk therapy. In NO CASE should some treat depression JUST with meds. Talk therapy is ALWAYS the primary treatment for depression, especially depression stemming fro trauma.

In your professional opinion if said depression is often severe and recurring...if the trauma had not be present is there a chance the person would have never dealt with depression? Out of curiosity because I am a survivor of childhood abuse and someone who has been dealing with recurrent depression (some of the episodes severe) for the past eighteen years.

Depression can be a product of nature or nurture. Some people who have recurring depression are genetically predisposed to the disorder. That's nature. On the nurture side, there is a direct link between childhood trauma and depression. (Indeed there is a direct link between childhood trauma and a laundry list of mental illnesses.) Therefore, unfortunately, it is absolutely possible that your depression is directly related to the abuse, and that you may not have suffered from it otherwise. There is a great deal of research to support the fact that children who are abused suffer permanent damage to parts of their brains as a result. I believe I am one of those people. The abuse I suffered permanently left me susceptible to depression and anxiety. As a result, I take medication every day to keep my mood stable.

Thanks! I've always been curious.

You see my father also suffers from depression but my grandfather probably also treated him poorly. It's interesting to me that it did seem to take some time for the depression to set in (I was fifteen when I was diagnosed) but I definitely dealt with some anxiety problems even prior to that. I was told at around age 25 or so that these would probably be lifelong problems for me that I'd just have to learn to manage....and so far that's true (I'm nearly 34). I'm in therapy and getting ready to restart the medication that I thought I'd be ok without (which I was wrong about).

I think it is human nature not to want to admit that we need meds permanently. Personally, I have gone off my meds several times--always with disastrous results! It's sad for me to accept that the abuse I suffered caused some damaged that cannot be fixed. Thank goodness there are meds now that really do help.

I think you're right and I agree fully!

:)

I've been doing therapy for years and gained a huge amount of personal insight, but last year the therapist I was working with suggested that I try to overcome one of the defense mechanisms that I was still experiencing during difficult therapy sessions. Shortly after that, I started to experience severe depression during sessions. Talking about my problems only made things worse. I had regular breakdowns every week.

I stopped seeing that therapist and went to another one, but I was still experiencing the same issues. While I still recommend therapy to other people, it unfortunately messed me up really badly. I'm currently on antidepressants but am not doing therapy, which I feel has been the right choice for me.

Would you still say that there are absolutely no cases in which medication without therapy should happen?

Obviously, without knowing a lot more about the circumstances, it's hard to answer you fully. I am concerned about the suggestion to "overcome one of the defense mechanisms" that you were using. My belief, based on my excellent therapist's advice, is that defense mechanisms exist for a reason. When we feel safe and ready to let them go, we naturally do. I don't think it's wise advise to force anyone to let go of their defenses--unless they are exceptionally unhealthy as is the case with drugs or alcohol. All that being said, I have to wonder why you suddenly started feeling so "depressed" during sessions. By "depressed" do you really mean sad? In letting down your defensive guard, were you actually starting to feel your real feelings? Were you sad and grieving? Is this what you mean by "breakdowns." If that is the case, I understand why you felt disconcerted. There is a fine balance between allowing yourself to actually feel pain and grief and learning how to contain those feelings so they don't make you feel overwhelmed. It seems like you may be afraid of your painful feelings, which I completely understand. BUT that is exactly why it is important that you face them, with proper support and containment. I wish you well, and I am sending you love.

I think you all missed the point of my question: Actually, I want to know if therapy can play any role on side-effects after getting over depression, like the SSRI did to me. It made me feel better but at the same time I am missing focus and concentration. This is not an observed side effect of sertraline, so I was wondering if this could be related to the cure of depression, no matter the method (Therapy or Meds).

Also, I can't start therapy right now because I am moving abroad in a couple weeks so I'd have to start over with another therapist.

Because I am not a medical doctor, I am not qualified to answer direct questions about a medication. But please know that not all side effects are always listed, and it seems that a lack of concentration could be a side effect of many different drugs. I highly recommend you talk to a psychiatrist about side effects. It may be that the dosage is wrong, or perhaps you need a change of meds. If you are getting the meds from a general practitioner, please know that they do not generally have enough knowledge about psychotropic meds to accurately answers questions about specific side effects. You will need a psychiatrist, because they are more verse in the kind of med you are taking. Hope that helps.

Psychologists don't prescribe drugs; psychiatrists do. She's a psychologist.

You make a valid observation!

So for those who are not familiar with your book, can you provide a synopsis backstory?

I worked with a very intelligent person who was a childhood abuse survivor, and she maintained that damage inflicted early in life is permanent.

Also, my psychoanalyst father mentioned a case once of a child who had grown up in a classic trailer-trash abusive environment, yet he wondered that this person,unlike all her relatives, was a balanced and productive person, basically untouched by the domestic havoc. Do you have an opinion or similar experiences you could share?

In a nutshell, I was born into a "classic trailer-trash abuse environment." Then, when I was 8 years old, my mother moved in with a guy who, unbeknownst to her, was a sadistic pedophile. This guy, who was also an elementary school teacher, tortured me so that I would become brainwashed into being his submissive sex slave. After that, he trafficked me in a child sex ring and forced me to act in child pornography. As a result of the abuse, I developed a laundry list of mental illnesses, including depression, suicidality, PTSD and multiple personalities. I spent decades overcoming the abuse and mental illness it created. Yet, until my book was published last month, only a handful of people knew of my history. All by way of saying, NO ONE can know what other people suffer privately. And while abusive backgrounds almost certainly do some damage (usually a lot of damage), it is possible to become a "balanced and productive person." I certainly have.

All by way of saying, NO ONE can know what other people suffer privately. And while abusive backgrounds almost certainly do some damage (usually a lot of damage), it is possible to become a "balanced and productive person." I certainly have.

That is very impressive and inspirational; I can sense your life mission in this, and applaud it unreservedly.

Thanks! Xo

Do you think the sadism part of it was a result of his own mental illness, or that "evil people exist"?

If mental illness caused sadism which caused trauma which caused mental illness, but every decade we grow much, much better at treating these issues and breaking down stigma (even if it is too slow and we have many miles to go), is there hope that as we fray the knot of illness/abuse that it will become exponentially better, as fewer cycles continue?

I cannot say for certain what made my stepfather a sadist. I don't believe anyone can. As a psychologist, I know that early childhood trauma (especially physical abuse and bullying at home) can make some boys sadistic. But others just seem to be born that way; it can sometimes be the result of problems in the cerebral cortex. For those who become sociopaths as a result of childhood abuse, I think it is sometimes possible to help them--especially if the intervention is done in the prepubescent or adolescent years. Unfortunately, it is the nature of both sociopathy and narcissism that the sufferers DO NOT BELIEVE THEY HAVE A PROBLEM. If a person doesn't believe they have a problem, they have no motivation to change.

For a previous job, I spoke to a child-adolescent psychiatrist who said in passing that a child who has chronic mental health problems at age 13 will never "recover" because regardless of whether the cause was nurture or nature, the damage has been done on a developing brain and that 'damage' (if you term it that) has thus changed the physical shape of the brain.

The psychiatrist didn't realise that I was actually also a patient and have been in treatment since I was 13 (17 years ago). So that hit me quite hard.

I wonder what your belief over this is? I didn't get the sense the psychiatrist felt people like me are "doomed", but rather than we will spend the rest of our lives learning to "manage" our mental health rather than one day live without a mental health problem.

Do you think this is true? Or do you think people with chronic mental health problems can one day live without a mental health problem? I struggle to understand how one can have an MH problem and be happy, see. Because IME having an MH problem means being in pain.

My book, SCARED SELFLESS, talks about this issue in depth. I was told by several therapists that I was essentially a lost cause, because I had been so damaged by abuse. Thank God I found a better therapist who told me I could heal and go on to lead a full and rewarding life! I worked very hard to overcome my chronic mental health problems, and I am happy to say I lead a very good life. Was my brain "damaged" as a child? Yes. Is it still damaged. Yes. But through therapy and time, I have learned how to work around most of my mental health issues so that they don't bother me anymore. The brain also has incredibly plasticity. This is true even in late adulthood. So, anyone who says anyone else is doomed by their past is just a pessimist. NOT HELPFUL!

What is a source of trauma that the general public doesn't take seriously enough?

Great question! I think most people would recognize that combat, assault, rape, domestic violence, and child abuse are all traumatic. What a lot of people don't realize is that growing up in homes where there is neglect, parents are addicts, and/or children witness violence are also very damaging. It is also very damaging to be the children of messy divorces, especially if one or both parents are more concerned with their new lives than they are with their children. In addition, verbal abuse, such as being called a loser, a liar, an idiot, etc., is very damaging to children.

But are all of those things "trauma"? That makes it seem like pretty much everyone I know has had a traumatic childhood.

Believe it or not, everyone does not grow up with these circumstances. There are actually lots of kids who grow up in fairly stable homes where the parents attend to the kids needs and offer love and support. In healthy homes, even if there are problems like divorce, the parents are mature enough to put the children's needs first. What I have noticed as a therapist is that people tend to surround themselves with people like them. So, if a person grows up in a toxic family, they tend to feel most comfortable with other people from toxic families. As a result, adults from toxic childhoods, surrounded by other adults from toxic childhoods, assume that's the way everyone grew up.

I think I would have sought help if I'd known that the neglect / "not as concerned with kids as with the new post-marriage life" thing was treated as on the same magnitude as more direct abuse. I couldn't say my parents don't love me, or that they hit me, but they're crazy, I never felt safe or like ot was ok to just be me, and dad ignored some escalating cries for help regarding his evil second wife (I eventually just took the bus home to Mom. My schedule was so bizarre the bus drivers and school didn't bother trying to figure it out), let alone just being more like a room mate who crossed paths with them only at meals or when they had wildly conflicting direction to give me.

I tend to interpret any trust break as a disqualifying one, and I have what I consider to be some kind of cyclothymia or depression kind of area thing. I had major depression from the divorce to about 2 or 3 years of living outside my parents' homes but hard to label these wounds that never healed.

I'm so sorry that you had to grow up in a toxic environment. While you may not have been physically abused, the neglect that you suffered certainly was not ideal for your development. The mixed messages you received as a kid (knowing you were loved but not necessarily wanted and valued) can be particularly damaging. These kinds of messages confuse kids, so that they equate love with feeling bad or frustrated or lonely. This can lead to huge trust issues in adulthood. I hope you take some time to learn more about how your upbringing may be affecting your adult life. You owe it to yourself to work on these trust issues, so that you can more fully receive the love you deserve.

I have and will continue to do so. My case seems positively rosy in the grand scheme. My friends and non-parental family love me deeply and unconditionally and I trust them absolutely. But like I said it's a precipitous drop from grace sometimes and I feel like objectively I overreact. Still. There's a lot more I worked through, worked past, or accepted. I never had therapy, but I did a lot of introspection and I have an analytical personality that I think gives me a good handle on myself as an outsider would view it.

I am so thankful that you have found people to love you unconditionally.

Not necessarily related to childhood physical abuse, but is there any validity to claim that an absentee father can cause his daughter to grow up with 'daddy issues'?

That's an interesting question--although a little bit beyond my area of expertise. I think many things in childhood could cause either gender of child to grow up with "daddy issues." For instance, having a dad who is abusive in the home or having a dad who lives with the family but doesn't really show interest in the children could cause "daddy issues." I think the most important thing, whether there is a father in the picture or not, is to give either gender child positive male role models. I, for instance, am in a lesbian marriage. We have a son, so there is no father. However, we try very hard to surround our son with other men (who we call "uncles") who love him and can show him how to be a good, loving, kind man.

What do you know about the body's endocannabinoid system and how it relates to psychological trauma? Is cannabis or any of it's constituents likely to be an effective treatment for psychological trauma?

I cannot stress this enough: there are two elements at play when it comes to the effects of trauma. There are physical symptoms, such as anxiety, depression, and dissociation. There are also emotional symptoms that lead to existential questions, such as "How could this happen?," "Why me?," "How can God allow such evil to exist?" Physical symptoms can SOMETIMES require medication. While I am not a medical doctor, I do know that cannabis can be useful for anxiety in some cases. HOWEVER, it can also be highly addictive and may actually WORSEN depression. There is no chemical shortcut to curing the emotional and existential symptoms of trauma. Survivors need to talk it out with supportive people who can validate their feelings.

First off cannabis is not highly addictive. Only about 9% of those who use cannabis will become seriously addicted, that's about the same rate at which people become seriously addicted to caffeine. Also, longstanding claims that smoking pot leads to depression have been rejected in a new longitudinal study published in the Journal of Affective Disorders. Also, cannabis is more than just THC, cannabis contains many bioactive constituents including CBD which is not psychomimetic and reduces some of the negative side effects of THC.

You clearly have a strong opinion on this! Cannabis is not my area of expertise. My comments are admittedly based on anecdotal evidence. I have seen marijuana addiction destroy the lives of many of my clients or the people that they love. But since it is 4/20, I will say no more! ;)

What do you know about depersonalization? What is your advice for persons who deal with it? In my case depersonalization maybe is caused with my philosophical views (etc. Life has no meaning..)? Thank you and sorry on my imperfect English!

When a client comes to me and says that "life has no meaning," I immediately assume that that client is depressed. People who are not depressed do not generally feel this way. Frankly, most people don't think too much about the meaning of life. They're too busy living it. Are you depressed? Is the belief that life has no meaning new for you, or have you always felt that way? Depersonalization is a type of dissociation in which a person does not feel that they are real. Do you not feel like you are real or that you exist? If so, I am very sorry. Personally, I know how awful and disconcerting that can feel. My advice to you is to recognize that what you are feeling is not about philosophy; it's about pain. I highly suggest you seek some help, and I am sending you much warmth and love.

Also i think it's better alone with that then go to doctor who will give me tablets?

I'm not saying you necessarily need medication. Not at all. I'm saying that you have a worldview that may need to be challenged. WHY do you believe life has no meaning? Where did that belief come from? Is that belief serving you well? If not, are you willing to entertain other views? I used to feel as you do, based on my traumatic background. (I am not assuming we share the same background, btw.) Eventually, I came to the realization that each person has to find their own meaning in life--a view I learned from Holocaust survivor Viktor Frankl. I now find that helping others and loving others has incredible meaning for me, and I am better for it.

Thank You for sharing your knowledge.

Are you familiar with re-evaulation counseling? And if so, what are your impressions of it?

It is my understanding that re-evaluation counseling is a repackaging of Scientology. While I am not hear to judge anyone's beliefs, I will say this: I believe that it is best to seek treatments that have been empirically shown to be effective. That means they have been studied in double-blind experiments and published in peer-reviewed journals. As much as talk therapy with a psychologist may look like "just talking" (as one would with a co-counselor in re-evaluation counseling), psychologists actually have YEARS of training in psychological issues and the empirically-validated best ways to treat them. Mental health professionals must have a master's or doctorate degree, get years of training in the field as interns, pass difficult state and national tests, get licensed, and maintain those licensed through continued learning. So, needless to say, I think a licensed professional is in a better position to help than re-evaluation counseling.

Hi Dr. Stevens, I discovered your book yesterday and am just over half way through. Do you think all adults suffering from chronic childhood trauma will eventually be healed/rehabilitated if they continue working in therapy? I had a breakdown after graduating from college and school was always my life-line. The people around me are so confused why I made it 22 years and then everything hit me - they just don't get it.

Wow, we share very similar stories! While I did have two suicide attempts in high school and college, my true breakdown also came at 22 year old--right after I graduated college. If school is your refuge (as it was mine), it makes sense that things fall apart once there is no driving purpose to keep things together. My fervent advice to you is to take your own health, healing, and happiness very seriously. DO WHATEVER IT TAKES to get the help you need. I know that's not always easy! But make a decision right now that you are going to deal with whatever you have to deal with in the healthiest way possible, so that you can eventually be "healed/rehabilitate." Is it possible to heal? Absolutely! Is it easy or quick? Probably not. Is it worth it to go through the time, expense, and pain of healing. Yes, yes, and yes! I am living proof that actively working on healing through quality therapy WORKS! You deserve to live the fullest possible life--a life in which you are free of anxiety and depression, in which you can fully give and receive love, in which you can pursue your dreams without undue baggage. If people in your life don't get it, find other people who do! I'm sending you warmth and love.

Sending you so much love back <3 I've cried along with you while listening to your book. You've really inspired me and through your book, I have finally found a purpose in my life - to continually heal and recover for the rest of my life. It gives me strength and purpose. Not too long ago, I resigned myself to a life of disability and living like a recluse waiting for death. One day when I am strong enough, I want to be a psychologist specialized in childhood trauma. Thank you for all of the work you have been doing to share our stories that need to be told!

I feel SO blessed and honored to be in a position to inspire you! THANK GOD you got the message that your life is not over just because of abuse and mental illness. While you've certainly been dealt a rotten hand in life, please know that in working through it, you will become incredibly strong. I absolutely believe that you can someday become a psychologist who helps other. Then, you will know the joy I am feeling RIGHT NOW! :)

I have very little in common with you except that I needed help from my support network and I felt awful about being a drain. Worse than a zero. Someone for whom things are done instead of the one who helps. But, they reached out to me saving me the horrible step of asking to be supported (not sure of your gender but I am male and I tie an unhealthy amount of my self-worth to being independent and helpful).

I'm on the other side now and I've had ample opportunity to pay it all back, literally and karmically. Working on you is the route to the other side.

Agreed! I believe that if every human being took their own mental health seriously, this world would be a better place because we'd all have so much more to give each other.

That's interesting to me. I was younger (15) when it really hit me but the abuse had been going on before then. I was a pretty anxious kid but then things snowballed in high school...it was really bad for me (multiple suicide attempts, bulimia, self-harm) until I was 22 and a housemate confronted me about my depression (which beyond post suicide attempt I'd had zero treatment for...my parents didn't put a lot of stock in medicine period much less mental healthcare ) and found out I was contemplating suicide and drove me to the ER....I actually told the truth and was admitted for five days and then given a plan for outpatient care...which I followed. I was good about treatment until a few years ago...and I regret dropping it because dealing with restarting on my own WHILE depressed has been very difficult.

Please don't beat yourself up for stopping treatment. There is no perfect way to approach mental healthcare. I went in and out of therapy and on and off meds many times before I figured things out. I hear what you're saying about how hard it is to find a good therapist when you're already in the throws of depression. If the depression is very bad, perhaps you should consult with your regular doctor right away about getting on anti-depressants. While they are no replacement for talk therapy, they can help take the bottom out of depression very quickly. Also, if you have a good friend that you can trust, enlist them to help you find treatment. When we are feeling weak, it is sometimes best to lean on someone stronger for support. Please, please, please take care of yourself and DO WHATEVER IT TAKES to get yourself some help. YOU DESERVE TO FEEL BETTER.

I've actually reconnected with a doctor at the psychiatrists office I'd been to before. I started therapy again last month but it's pretty clear that I'm still doing really bad at this point. I have an appointment with the psychiatrist on the 28th.

Good. Please hang in there. When you're in the pit, it's hard to remember that it can and does get better. Be very kind and gentle and patient with yourself until the treatment starts to help.

Why is child abuse brushed off so easily in the South?

I don't think it's necessarily brushed off just in the South. I think child abuse--often cloaked as "punishment"--is sanctioned in certain cultures. There are a lot of people who still absolutely believe that corporal punishment is okay, even though research suggests that the majority of physical abuse starts out as punishment that gets out of hand. Research also shows that physical punishment is simply not effective at teaching children to behave. If anything, it teaches them to be angry and deceptive. Unfortunately, many people parent with the mentality of doing just what their own parents did. I wish more parents would inform themselves!

Is there somewhere I could learn more about this? Angry and deceptive describes my childhood to a T.

Not to make a plug or anything, but I talk a lot about the effects of child abuse in my book, SCARED SELFESS: MY JOURNEY FROM ABUSE AND MADNESS TO SURVIVING AND THRIVING. While I personally suffered sexual abuse in addition to physical abuse, the book is about what happens to any child who is abuse. There's a chapter called "Rebel Without a Core" where I talk at length about how abuse turns kids into angry teens with chips on their shoulders. Personally, I lied, stole, and hated EVERYONE. I think you may learn a lot about yourself if you read my book!

I will check it out. Is it available in audio book format? I do a lot of driving in my current job and audiobooks are the primary way I get a lot of my literature.

Also, how impactful would your interactions/abuse from peers be contrasted to home or family abuse? Aside from my parents not liking my video game habits and the occasional argument over homework/grades I had a pretty decent homelife.

Yes, it my book is available in audio. I am the narrator.

Abuse from peers can be incredibly damaging, as evidenced by stories of bullying in the news. I have also worked with kids who grew up in violent neighborhoods--in or around gangs. Growing up with such peers can lead to psychological damage. It depends on the circumstances.

now do you prefer spicy doritos or normal doritos? now seriously how can you help a soldier whith ptsd after a close friend died next to him

As I'm sure you know, PTSD in soldier's in incredibly common. I am so very sorry that you had to live through the horror of watching your friend die next to you. That is bound to mess ANYONE up. Here's what I've noticed about soldiers with PTSD: they are very reluctant to seek help. When they do seek help, it is most often for the physical symptoms such as flashbacks, nightmares, and anxiety. These are often best treated with medication. HOWEVER, what you experiences is a life-altering crisis that has surely made you question yourself, humanity, and maybe even God. You cannot be a part of that kind of violence and watch a friend die without harboring some serious existential questions. THOSE QUESTIONS MUST BE ADDRESSED, and they must be addressed by talking to a wise person who can validate the horror you endured, the grief you are feeling, and the very real feelings and questions that have come up as a result of what you went through. Talking to a therapist who you can relate to (perhaps a vet) would probably be best. But if not a mental healthcare provider, then other vets or a pastor--someone who gets it. PLEASE, PLEASE, PLEASE take your health and happiness seriously and seek some kind of help. You will NEVER be the same as before this happened to you, but you can come out the other side wiser, stronger, and more empathetic than before this happened. I'm sending you lots of love.

thank you my whole family and gf is supporting me on this i talk whith vets and my grandpa who is a ww2 veteran but i always get this feeling i could have saved him i will try my best thank you

I'm so sorry you are struggling with feelings of guilt. It is very, very common to believe you could've done something differently to prevent a tragedy. Please ask yourself if this is, in fact, accurate--or if you are holding onto this belief out of survivor's guilt. Either way, at some point, you will have to make a conscious decision to let go of the guilt and blame you are feeling. You can let go of guilt and blame and still honor your friend's memory. it won't mean you cared for him any less.

Is it possible to clarify how common? I'm asking because I agree that is is common, certainly more common than in say, the civilian population, but still not as common as public perception? It feels like a lot of the civilian population is conflating "relatively common" with "majority" and developing a stigma because of it.

I've definitely met a number of people who hear someone is a veteran and almost assume by the default they this means they probably have mental health issues now.

This is a very complicated question. Obviously, there's a huge difference between veterans and COMBAT veterans. If we're talking combat veterans, the research seems to suggest that a majority DO eventually develop PTSD. Sometimes, vets don't recognize the symptoms for a while. But over time, more and more admit that they have PTSD symptoms as a result of combat. Here's a link to explain a bit more: http://veteransandptsd.com/PTSD-statistics.html

I love your book. Were you scared to be so brutally honest? Has there been any backlash from your honesty?

I was TERRIFIED to publish my book, because it was so brutally honest! But I made a decision, before I wrote the book, that I needed to be completely honest, because I didn't want to sugarcoat the truth about abuse or mental illness. These subjects are taboo. As a result, survivors and those who are mentally ill are often told implicitly and explicitly that they can tell their stories, which leaves us feeling so much shame. I thought there would be a lot of backlash. But so far, people have been wonderful and very supportive. I've seen a few people posting denials of abuse, recovered memory, and DID. But just a few...

Keep holding your head high; people will always challenge what they don't understand. As a kid, having DID saved my life/sanity. How could mental illness be better represented by the media? In what ways would changing the perception of mental illness help victims become survivors and thrivers?

Thank you

I think damaging portrayals of mental illness have been perpetuated by the media. Case in point: the movie SPLIT (which I wrote about in THE HOLLYWOOD REPORTER). All social change starts with people making noise. For instance, a lot of people complained about SPLIT, which raises awareness that these portrayals are not appreciated. I've seen a lot of people also complain about Halloween horror houses that are set in asylums. Again, this raises awareness within the general public about stereotypes. Challenging stereotypes is one of the main reasons I decided to publish my book: I wanted to let people know that you can suffer from a very serious mental illness and still be a productive person with a relatively normal life.

I loved your book and think you are an amazing human being. Was gutted to learn how you got your nickname, "Moochie." Curious how you are able to continue going by that name? Is it a "take back the power" kind of thing? Or literally just a nickname that stuck?

That's a great question--and one that I get asked a lot now. You know, the truth is that there's a lot of good I got from my abuser along with the bad. Gary was the one who piqued my interests in theater, writing, NYC, and history. He gave me the identity of being smart and talented, two things I would have never believed about myself if he hadn't come along. In accepting the story of my life, I've come to accept that there's no such thing as black or white. Gary was a monster, no doubt about it. But he also very much influenced who I became. So, I happily accept the good with the bad. I love my nickname!

What is your opinion on nature versus nuture?

This is a bit of an ambiguous question. Nature vs. nurture is what regard?

People often claim PTSD in lawsuits for things like car accidents, do you think there's validity for claims like that?

In order to be diagnosed with PTSD, a person must experience a horrific event in which he or she fears for his or her life. After the event, a person with PTSD might experience things like nightmares, flashbacks to the event, and anxiety. But these symptoms must persist for longer than a month and substantially interfere with the sufferer's functioning. Is it possible for someone to develop PTSD after a car accident? Yes. But it is probably less frequent than people claim. While half the population will experience at least one severe traumatic event in their lifetime, on 7-8% of the population will ever develop diagnosable PTSD.

You mention talk therapy and sometimes needing medication to treat the effects of trauma. Will my MFT know if I need meds? If she can't prescribe them to me, then how will I know I need to be on them and that talk therapy isn't enough?

It's all about your symptoms and history. If a client comes in who is depressed because he recently got divorced, but has no prior history of depression, I am not going to immediately suggest the med route. If his depression worsens though, or he starts talking about suicide, I'm going to refer him to a psychiatrist immediately. If another client comes in depressed, and has had recurrent episodes of major depression as well as a family history of mental illness, he is a likely candidate for being on meds for the rest of his life. It's situational and any good mental healthcare provider should be working with their clients to monitor symptoms and suggest a med referral if it seems warranted.

Have you come across any clients who don't respond to meds? I've been on over a dozen different antidepressants/mood stabilizers and none have ever had a positive effect. Most actually made me worse. So even though I fit your criteria for lifelong meds, I will no longer entertain the option. What now?

What you are describing is called drug-resistant depression. My question for you is: Where were you being prescribed these meds? A regular doctor or a psychiatrist? Even if it was a psychiatrist, did you try a DIFFERENT psychiatrist? Also, were you in talk therapy AT THE SAME TIME you were taking meds? The two should go hand in hand. Finally, if you really are drug-resistant, there are other options. Some people have had good results with neurofeedback. (It helped me, and my own therapist swears by it.) In extreme cases, electroconvulsive therapy is sometimes used on drug-resistant depression--which is not as scary as it sounds.

I forgot to add, I have been diagnosed with CPTSD and am beginning to wonder if my depression is rooted in that, rather than showing up of its own accord. What I mean is, I wonder if the depression would go away if I could find an effective treatment for the PTSD instead.

Certainly if you have trauma in your past that's severe enough to have caused CPTSD, that could be contributing to the depression. This is one of the problems with discreet diagnoses--depression, anxiety, PTSD can all be viewed as different problems needing different treatments. But the real issue may be that you need to work on the trauma. (I would assume this was happening when you had talk therapy?) Also, there's a lot of evidence that trauma, especially childhood trauma, can permanently change the brain, causing it to be more prone to depression and anxiety. I do not say that to be pessimistic; the brain is malleable even in late adulthood. I am just trying to point out that it's probably most effective to look at your mental health in a holistic way, instead of focusing solely on depression

Google neurofeedback. The research is still a bit mixed, mostly because there's not a lot of research. But it's non-invasive and relatively inexpensive, and a lot of people I respect swear by it. Personally, when I was suffering a bout of severe depression last year, I tried neurofeedback, and I believe it really did help me.

Child protection laws have been updated since the last generation where previously domestic abuse was viewed as a "family issue," there are many new laws and agencies out there to help.

But it seems sexual abuse was not addressed as efficiently/directly. Even when dealing with adults- the Globe and Mail gathered data from more than 870 police forces and found that 1 in 5 sexual assault cases were dismissed as baseless: initiating Ontario police and RCMP to review over 10 000 sexual assault cases.

Human trafficking is starting to appear in the media more often, but charges are not equivalent to the suffering of the victims; but rarely does the media connect trafficking to children and sexual assault that occurs.

Do you find the stigma related to being a victim of child sexual abuse or sex trafficking is heightened because of these issues. How can we create more awareness in the media?

I think its important to portray victims as real people, and that there is success and a real life after escape. That was happened doesn't ruin your whole life.

I haven't gotten a chance to get your book yet, but I'm hoping to purchase it very soon.

Yes, yes, and yes to all you are saying! There is definitely stigma attached to sexual crimes. As a result, our society is not well versed on these issues. I recently got an email from a police officer who was very disturbed by my book, because he realized that he and other police officers did not have adequate training in recognizing signs of sexual abuse. He said that he could spot a suspicious person in a crowd, could predict the way a bomb would detonate, but knew NOTHING of child abuse. That's why I published my book and am going on such a public campaign to promote it: Because WE MUST START TALKING ABOUT SEXUAL CRIMES MORE OPENLY. Rats can only proliferate in darkness. We also needs to let victims know that IT IS POSSIBLE TO HEAL.

Thank you for sharing your story. Hopefully the awareness you are spreading and that other sources are starting to produce more support and understanding for victims, and lead to harsher laws for offenders.

That is my life's work: to educate the public and inspire survivors. To that end, I provide a lot of good information on my website: MichelleStevensPhD.com and on my charity's website: Post-TraumaticSuccess.com

Ethically child sexual assault is considered as bad as, or by some, worse than murder. What length of charges do you think these perpetrators should get? Do you think they receive the required psychological helped needed in prison?

Admittedly, forensics is not my area of expertise. I am more versed in helping survivors than punishing offenders. I believe that our society's response to perpetrators is very complicated. Many, many people say pedophiles should be castrated or sentenced to death. But would people still think this is if the perpetrator was their husband, son, brother or friend. Because 90% of the time, it is. We seem to be a society of extremes when it comes to this issue--either lock 'em all up or deny that CSA exists. Unfortunately, this black and white thinking is not very helpful. The truth is: perpetrators are varied. Some are die-hard pedophiles who are intent on molesting as many children as they can. These guys probably cannot benefit from therapy and should be locked away or monitored very closely on the outside. Others molest a child not because they are pedophiles but because the circumstance presented itself. These guys may be able to be enlightened. I have personally worked with guys who are incarcerated for owning child porn. When I discuss what it feels like to be THE CHILD in those pictures, some guys clearly get it and may never look at child porn again. Some guys don't. They're too narcissistic to see it from the child's perspective. There is no easy answer here.

You are right there. I have a friend who has conflicting feelings of a close family member who victimized her- she accepts that the person was both a victim and an abuser, that they wouldn't have commited the abuse if they didn't start dating and marry the main offender. Whereas the main offender, and other offenders, she feels that they are a different type of offender that is more dangerous and needs more help. And thus has conflicting feelings.

Yes, it is an extremely complicated issue (as many issues are). There is no one-size-fits-all solution.

Good evening Dr. Stevens,

Thank you for sharing your inspirational story. Now that your book is out, what are your plans for the future? Another book? A speaking series?

I started this journey with a mission: to educate the public about child abuse and psychological trauma and inspire survivors to heal. Publishing SCARED SELFLESS was certainly a step in that direction, but I want to reach more people. In order to do that, I am currently in talks to develop a television program that will serve my mission. I am also beginning to speak more frequently (Pasadena, CA 6/3; St. Louis, MI 6/13; Waterloo, ON 6/20; Toronto, ON 8/15). In addition, I am currently developing workshops for survivors, which I will be offering around North America. If anyone wants to know more about seeing me in person, they can go to my website: MichelleStevensPhD.com

Any advice regarding overcoming ostracism as a child? I was ostracized pretty hard during my entire childhood at school, and within the family there was also some neglect issues. Nothing as extreme as you went through but i still have a very hard time accepting love and friendship.

I wish she had answered this - I too was and am still ostracized, even into my forties. I was neglected and abused by nearly everyone during my childhood (I was diagnosed with Complex PTSD and may have an attachment disorder) and face violence from strangers at least once a week due to the ostracism.

Me too ! :( my advice is hang in there and try to detach your worth from how people respond to you. People are horrible but you don't deserve to be treated badly, and anyone who does isn't worth caring about.

For me, I think looking to myself for worth and love has been the best. Going outside wearing sunglasses and a hat and walking around in the sun with music. No one knows who I am everyone leaves me alone.

Oh and getting a pet to give endless love to and receive no judgment.

Best of luck x

I have "detach [my] worth from how people respond to [me]", but their violence still poses a danger whenever I go out in public. Sadly, a disguise doesn't help.

Hi, everyone, when I hear the word "ostracism," I think of that as a form of passive aggression. We are social creatures. So, when others choose to ignore us, that is absolutely the same as bullying or aggression. Sixtyfifthbit, you seem to also describe some classic aggression/bullying. This issue is tough to answer succinctly, as different people are ostracized for different reasons. In my book, SCARED SELFLESS, I talk a lot about how I felt ostracized--mostly because I had never learned how to act correctly in social situations. Two things had to happen in my own life for me to stop feeling ostracized: 1) I had to actively work on developing better social skills, so that I could interact with other; 2) I had to heal a lot of old wounds until the chip on my shoulder finally fell off. Often, when we feel hurt by people, we develop an unfriendly or angry persona that pushes people away. The more I worked on myself and learned to trust others, the nicer they became to me. Try a little experiment. Go out and purposely smile at ten people and see what happens. You might be surprised by the warmth you receive from people if you put some out.

I have actively worked on developing better social skills for twenty years, but I've long ago reached the point where solo study works - but other human beings refuse to interact with me in anything other that in a hostile manner.

As for the wounds? I have suffered the equivalent of having my legs ripped off. I cannot perform some basic life functions without assistance or accommodation. These wounds cannot heal - I an injured past what current psychological science can handle.

As for trust - I cannot and will not trust another human being. The human race has proved itself completely untrustworthy multiple times over. They cannot re-earn this trust in the short lifetime I have left - not to mention they are actively working to harm me in the first place.

During the many attacks I have suffered, I have incurred significant nerve damage - some of which means I cannot smile correctly. Frankly, I look like the Joker or one of his Smilex victims whenever I try. I have tried this before, and I got punched in the face as payback.

I am so sorry that you have been let down by the people in your life. Please know that I am sending you loving energy.

Why do traumatic triggers in life tend to develop phobias?

Could you give me some hope what type of progress is being made now for the treatment of anxiety disorders. Specifically OCD? What cutting edge psychotherapies look promising ahead for treating this disorder?

The process by which traumatic triggers turn into phobias is something I cover extensively in my book, SCARED SELFLESS. In a nutshell, triggers are a result of classical conditioning (think Pavlov). At the moment we feel terror--say because we are being mugged a gunpoint--our brains are hardwired to remember everything in that dangerous moment so we can avoid danger in the future. Suddenly being terrified of guns or men in ski masks is obvious after a mugging. But we might also be afraid of seemingly innocuous things like brick walls (like the one in the alley where we were mugged) or neon signs (like the one we saw in the distance). Later, when we see a neon sign, we freak out, but we don't know why. This then creates a phobia of neon signs, because we don't want to feel panic again.

The best treatment for OCD is no new, but it is incredibly effective. That treatment in exposure therapy, meaning you face the thing you are afraid of. This can be done all at once (called "flooding") or gradually. But it MUST be done. Facing the phobia is the only way to eventually get over it.

OCD, which is different than a phobia, is usually an issue with the functioning of the brain. It is best treated with medication and therapy combined.

Hello Dr Michelle ,

A bit late to the party but I would really appreciate it if you could help me out on this ? In an average day, I get moments of brain freeze that stems form my fear of embarrassment that was from the past .Those moments appear when I do stuff infront of people . Due to those influx of freezes in a day ,it makes it harder for me to enjoy life or even a normal conversation with a person . Can you give me your opinion on this please ?

What you are describing is called social anxiety. It is incredibly common--probably one of the most common psychological afflictions. Google "social anxiety" or "social phobia" and you will start to understand a lot more about what is going on inside you when you have "brain freeze." Incidentally, I talk a lot about "brain freeze," which is a very common response to fear, in my book.

What's the best advice for a friend who consumes harming drugs but doesn't like to go to the psychologist?.

If you are saying that your friend has a substance abuse problem, then that person needs to seek treatment. Not necessarily from a psychologist. Instead, addicts need to seek treatment from programs that specialize in addiction. But if you are waiting for your friend to announce to you that they want treatment, you may be in for a long wait. Most addicts deny that they have a problem and refuse treatment until they are forced into it or hit rock bottom.

Hi Dr. Stevens, I have another question (if you have time to answer). According to WHO, depression is the leading cause of disability worldwide. What's your take on why depression is so widespread these days? It can't all be from chemical-imbalances can it? In cases where childhood trauma is a factor, I believe depression is a symptom of the trauma. How do you think societies should address this growing phenomena - clearly the conventional methods aren't enough. Personally, I am a huge supporter of therapy but sometimes even combined with medication, it doesn't seem to be enough for the severity of trauma that many of us have gone through.

I am aware of the statistics on worldwide depression. The question I have to ask is this: Is depression really increasing, or are we all just becoming more aware of it? Before the 1960s/70s, I doubt if the word "depression" was even used in mainstream society. So, I have to ask myself if people are really more depressed than they were fifty years ago, or if they just have a word for it now. (I also wonder if people nowadays have unrealistic expectations that they should feel more happy more of the time due to advertising, especially drug advertisements.) In terms of trauma-induced, treatment resistant depression, it's tough! Believe me, I know! I have suffered with depression all of my life and still struggle with it today, despite meds and therapy. The thing is: the more you work through the trauma and accept the symptoms of trauma (like depression), the less hold they have over you. If I feel depressed nowadays (and I do sometimes!), I accept that it is part of life. I don't overreact. I don't assume it'll be forever. I just accept that I'm in a hole, and I do the things I know will get me out of that hole based on past experience. I call my therapist. I exercise. I hang out with people who love me. Often, I just power through--work distracts me from my feelings. So, it's really a matter of ACCEPTING your feelings whatever they are, doing what you can to comfort yourself, and assuring yourself that IT DOES NOT LAST FOREVER.

Thank you so much for sharing your perspective! I have found similar relief with acceptance and mindfulness (learned via DBT).

Yes, DBT can be incredibly helpful. I was in a DBT group for a while during my healing process.

What's you opinion on marijuana, ketamine, MDMA, etc, research for PTSD?

At the risk of sounding like a broken record, I will say this again: There are TWO issues that need to be addressed with PTSD: the physical symptoms and the EMOTIONAL damage. What I have noticed is that people are constantly looking for quick fixes for the physical symptoms through the use of drugs (as all of these are). While medication can be effective at relieving symptoms, IT WILL NOT CURE PTSD. In order to fully resolve PTSD, the sufferer MUST seeks some form of talk therapy to deal with the pain, grief, rage, and disillusionment that trauma engenders. Is this more work, more expense, and more pain than popping pills? YES! But it is the long-term solution to PTSD.

Hi Dr! Thank you for doing this AMA, the world needs more people to bring attention to these issues and you're filling a hugely important role.

Anyways I'm just curious whether or not you'd heard of the work that MAPS and others are doing with psychedelics in the treatment of trauma and mental illness. I'm not expert but from what I've read it seems like MDMA is especially effective in the treatment of trauma, is that correct or am I missing something? Thank you again!

Hello. Thanks for this question. You will see my response above. :)

Have you run into mkultra (or similar) victims or those you felt were possessed rather than MPD?

I'm a psychologist, not a cleric.

Hi doctor I was just wondering how to deal with stress and anxiety due to high school? and also how to build up confidence? i was pretty confident about everything before puberty now i cant even look at anyone in the eye

This feels like a more complicated question than just how to deal with anxiety in high school. If you felt confident before puberty but not now, was there something that happened to change that? An incident? You should know that, during puberty, the brain goes through rapid development. Part of this development, unfortunately, makes middle schoolers suddenly feel self-conscious. That's why, starting around middle school, everything is suddenly "embarrassing." Do you think you are just suffer the aftermath of this brain development, or did something happen to you to make you feel less confident? If it is the latter, PLEASE talk to someone about it. If someone made you feel ashamed of yourself, you need to talk to someone kind who can help you overcome it.

emdr therapy made its way to the front page of treating ptsd (as far as the veterans community is concerned) what other up and coming treatments are you excited for?

If we are strictly talking about therapies to relieve physical symptoms of PTSD, EMDR can be effective. I have also heard a lot of good things anecdotally about neurofeedback. My own therapist swears by it now.

I am very interested in reading your book! I am curious, what is the best support a significant other can give a person who has experienced abuse? My husband has been through the gambit of emotional and mental/verbal abuse from childhood up through his ex-wife. I've helped a lot by being present, listening, and supporting him. Is there anything else you would suggest?

Wow, I commend you for being a supportive spouse. It takes a great deal of patience and empathy to deal with the crises survivors bring to a relationship. I know how much I've put my own spouse through! I hope you will read my book, SCARED SELFLESS. I wrote it as much for others as for survivors, because I really wanted people who love survivors to UNDERSTAND why we act so badly sometimes. It sounds like you are doing EXACTLY what is necessary--being present, listening, and supporting him. Healing is all about love.

How would you accurately describe "PTSD" versus other combat related issues, and do you feel "PTSD" is overused to a problematic affect.

I feel like I hear people toss the term around too easily, because they keep hearing the phrase on TV. I find myself constantly trying to point out to people that (correct me if I am wrong) PTSD is still different from say "combat stress" or "battle fatigue" (ex: the cumulative mental effect of being in a state of high stress or hyper awareness for days, weeks, months on end).

It seems like too many people just go "Acts weird now" + "was in the military" = "That guy must have PTSD".

Is there a example or list, cause or symptom wise that you might use to explain the idea to someone of something that IS PTSD, vs something that affects people including veterans but IS something else? Thanks.

I think the term PTSD is overused and that the condition is over diagnosed. In order to truly develop PTSD, a lot of conditions must be met. First, a person has to have experienced a horrifying, life-threatening crisis. Second, that person has to experience a whole myriad of troubling symptoms that are listed in the DSM. Third, those symptoms have to markedly interfere with the person's functioning. Fourth, those symptoms must last more than a month. About 50% of the population will experience a severe traumatic event that could cause PTSD, but only about 7-8% of the population will actually develop the disorder. The percentage of combat vets who develop PTSD is actually quite high because they are usually subjected to multiple severe traumatic events and can witness especially horrifying things.

Hi Dr. Stevens! Would your book be useful for those of us who haven't experienced the level of physical and emotional trauma that you have? I come from a very ...unfair situation with a narcissistic, violent, and largely absent parent. I raised myself and my sisters under the weight and strain of a mentally ill parent - handling their jealousy, constant gas lighting, and ..well name-calling (though it feels worse than that). I'm finally almost free from this situation (only took 27 years) but admittedly, I go through depressive swings with my emotions. And they're some of the hardest moments in my life. ..It makes me question my self. Mostly I think I'm scared that I can't afford treatments or things like medication. I'm always working through my past in some capacity, and it puts a good amount of strain on my husband. ..Is there an advisable way to proceed? Can I read books and think deep until I feel better? Can I overcome instability on my own? I have come a long way in my life and looking back I can see the substantial improvement I've made on my own. But reading AMAs like this make me question that progress. Make me question if doing things my way will work out. ..I really dont like the idea of medication. I feel like I can power through with force of will. But here we are, with a lot of talk about ..depression being a permanent aspect for those with traumatic childhoods.

Can my book help you? Yes, absolutely. Please read it. It will DEFINITELY help you to better understand how your past is affecting your present. Will you be able to overcome your past just by reading and thinking? I don't know. What I DO know is that someone with your background probably has a LOT of issues with trust and attachment. Unfortunately, you can't heal trust issues by yourself or by reading a book. Read my book first, and I think it will help you better decide how you want to proceed.

Hey, I take pregabalin/ lyrica for my acute anxiety and BPD conditions. What do you think about this treatment? It's currently working - takes away the voice that I hear, allows me to be more sociable etc and talk to people. Another question is, what do you think about the addictive side of this drug, and do you think it's maybe worth it if it's working? :)

I think that if you have a chronic condition and there are drugs that treat it with little side effect, then why wouldn't you take them? Personally, I take two psychotropic meds--one of which is extremely addictive. Do I like that I have to take these meds to feel emotionally stable? No. Am I grateful they exist and that they work? Yes.

Do you often get confused or mistaken for Michael Stevens, from Vsauce?

No, I do not have a beard.

I am somebody who is skeptical in psychology's ability to model reality. In particular, I don't really accept any results that are just done based on behavior observations or surveys without physiological evidence.

What would you say to me to convince me that your discipline in particular is a viable model of reality?

edit: I wrote psychologies instead of psychology's. error of plural versus possessive.

I'm a bit unclear about what you are asking. It seems that you are talking about research and how it relates to creating diagnostic criteria. Am I understanding correctly? In other words, you do not believe that simply observing someone's behavior or having them fill out a self-report can be used to diagnose someone if there is not physiological evidence to back up the diagnosis. Can you please let me know if that's what we're talking about?

yes. this is exactly what I mean. I am not convinced that filling out a survey or observing behavior yields a well rounded model of reality. and although I did not particularly say it, yes, I don't believe that a survey and observing a behavior is enough to diagnose somebody of a disease. So what would you say to me to convince me otherwise.

and just to put into perspective how I feel. Suppose I was held at gunpoint. And the man with the gun would spare my life if I could predict the time it would take for a ball to land when dropped from a building. My only resource is a physics textbook and the mass and chemical property of the ball, I would be very confident in the guess I make because physics is a very reliable model of reality.

but. if a man pointed a gun to my head. Had a child in front of me, asked me to predict if he has autism or something of the sort based on a survey and based on observations of how he interacts with people. And my resources were the appropriate textbooks for that topic of psychology, I would rather try to take the gun from him than guess if the child was autistic because that's how much I don't trust psychology to be an accurate measure of anything.

If you're asking me to convince you that psychology is hard science, sorry. No can do. While psychology is an empirically based field of study, diagnosis is usually based on the observation of behaviors and symptoms, as well as self-reports. That being said, some measures (such as the Minnesota Multiphasic Personality Inventory, which is a self-report) have been extensively validated over decades--meaning the test can accurately diagnose a variety of psychiatric conditions. But no psychological test is perfect. Then again, no medical test is either. Interesting, many psychological conditions that used to be diagnosed only by observable behaviors can now be verified by medical tests. Dissociative Identity Disorder, the condition from which I suffer, can now be seen on some brain scans.