Dear doctor, I am a 27-year-old female and I started having mental problems at the age of around 20. I think it is fair to say that I was physically and mentally abused, beaten by both parents who had no patience with me and I lived in fear.

I am experiencing now or have experienced at some point in my adult life an eating disorder, social phobia (self-diagnosed), no motivation, procrastination, difficulty making decisions, hopelessness and sense of impending doom, worrying over everything, angry fits, self-injurious behavior, maintain an imaginary group of friends (although I have never lost touch with reality, never blacked out and don't have delusions or hear sounds), suicide attempt, addiction (overindulging in food).

On a lighter note, I do like organizing meetings about topics which I believe in, I like to write, I am a good observer and I am extremely emotional. Deep down I think I am wasting my life and I think I do have the abilities to do more but I feel like I can't and I don't even want to.

What I am asking is an idea of what you think I am going through, what my problem is and what I should do about it. I would not like to get an anti-depressant again because I gained a lot of weight on Paxil and I just managed to lose. Also Paxil is very hard to get here in Romania and paying for it is unimaginable. Psychotherapy is not really practiced here or not well in my experience.

-Reka

Reka, I hope you are all right with the way that I condensed your letter. I attempted to extract the essence of your lengthier letter. I am a psychologist in private practice and not a physician. My sense is that you have suffered from depression and perhaps now you are also experiencing a bout of depression. I appreciate your concern about not wanting to try Paxil or another anti-depressant, and yet, you did suggest that your depressive symptoms were significantly diminished while taking the Paxil. If you know that the Paxil leads to weight gain, then it would be useful to start an exercise regime, which although difficult to initiate and then maintain, is very necessary and beneficial in working through your depression.

You indicated in your letter in several ways that “I'm afraid that I won't have a real passion in life and I don't see the point in almost anything.” What is it that you are doing with regards to employment or furthering your education? You mentioned that you started university, but you experienced a terrible homesickness ness. It is my belief that one needs to build a foundation for themselves so that they are more prepared to go out into the world (which can appear very scary when we are unable to provide and take ourselves and this generally begins with obtaining some post-secondary education. You seem interested in knowing your own human condition by researching yourself thoroughly (you have too much time on your hands which is spent focusing on your mental health issues) are you interested in pursuing some education in the area of counseling and working with people?(from your comments it sounds like your country could use some qualified psychotherapists!). It is difficult to be passionate about something when you are not in the world figuring out what you want to do with your life and the gifts you have been given. You obviously have a lot of fears that keep you isolated and contribute to your desire to be ‘safe'.

These fears (being raped, house exploding, robbed) are issues that can best be explored in therapy with someone (is there a psychotherapist in the community or outside the community, perhaps that you have not found yet, that can assist you? I travel to the United States to do my own therapy because I could not find someone locally who I wanted to work with) and are likely related to growing up in a household that was not very safe and being parented by parents who rather than protecting you, hurt you. When
we have experienced some trauma in childhood, we literally stop growing emotionally and consequently remain very young and life appears very scary and overwhelming (“the tasks then keep accumulating and I feel overwhelmed”). You need to find someone who can help you feel and express the sadness, grief, hurt and anger that you were not permitted or forgot to feel when you were a child, but process this in such a way that you do not get brought down by the intensity of the feelings, something which has happened to you(and happens to most of us who are emotional characters and do not know how to cope with the intensity of our feelings). You mentioned that you experience “angry fits where you hit the wall or furniture or myself or shout”. Try sitting down on the floor and take some pillows in front of you and keep your eyes opened and focused ahead of you and hit or wring the pillows while hissing or growling and then sit very quietly afterwards and see what emotion comes next (this kind of expression is a moving of the anger, which is just energy in its purest form, and is not abusive or hurtful to you or others in any way). Usually once we have expressed anger (which is really just a defense, but necessary to express to get to whatever emotion is lurking underneath), there is some sadness or hurt that springs forward. Just sit with whatever comes next, but do not be taken down by your feelings. Feelings are nourishment for you if you do not allow yourself to be crippled by them. Do not judge your feelings, particularly sad or hatred or anger as “negative”, they are as passionate and enlivening as feelings like happy or excited.

Thank you for your letter and I hope that you will take some risks in your life because my experience has been that by playing it safe in life, we are less likely to grow emotionally and spiritually. My sense from your letter is that you have some yearning to grow and that if you choose to play it safe, that can be a very deadening experience and keeps us in a victim like place.