Chickens and Eggs

A man came into my office and tells me, in a blacked out rage, he physically assaulted his wife. Nothing like this had happened before, he stated. Other sources, including his wife, attested he had never been violent. When talking it became clear that he and his wife had increasingly been irritable with each other especially in the evenings. Discussing matters further, he was diabetic and had not been managing his medications and diet properly.

Here is an excerpt from an article in Psychology Today that presents this particular issue very well:

Humans are built like all the other animals—and animals get very unhappy when blood sugar is low. It is an evolutionary mechanism that is designed to make finding food a priority. This priority is important, for it helps to avoid starvation. But in us humans, low blood sugar can have a very negative effect on mood.

While the primitive animal goes into food-finding mode, sometimes our more complex human brain doesn’t realize it is a food issue, and instead simply feels anxious, depressed, angry, or even all three. That primitive part of us starts to stress about other issues (work, relationships) and the real culprit—low blood sugar—is not addressed.

There are often underlying medical conditions that contribute, if not outright cause, expressions of mental health disorders. If that client had not disclosed his diabetes, I’d have been trying to help him with intermittent explosive disorder, and it would not have helped. Instead I was able to focus on the communication with his wife, helping to alter language that reduces irritability, and worked with his physician to help him manage his diabetes. And wouldn’t you know, it got a lot better?

Too often health practitioners, therapists, doctors, psychiatrists, sometimes get lost following the rabbit hole of symptom management and forget to look upstream. As a rule the most easily addressed and treatable issues should be ruled out first. To mix metaphors, if one hears the beat of hooves, don’t expect to see an okapi coming over the hill.

Other conditions such as thyroid, and other hormonal conditions, blood pressure, diet, toxic exposures, infections can cause a wide array of mood and other psychiatric conditions. Kidney dysfunction can present as delirium, anxiety, panic, depression. Given all the variables it is important to find practitioners one trusts and are open to examining all possibilities, those who view the whole person and not just the injury.

Be well,

David Aronson LCSW


The New Arachnophobia: Lyme and other tick borne illnesses

This is not about the fear of spiders. This is about the lesser known, less often considered arachnid: the tick. For those who know or have experienced this small creatures abilities, they may be the scariest thing in the woods. Beyond their near invisibility, and penchant for sucking blood, they harbor a stealthy and persistent host of diseases that have the ability and seem to increasingly cause life changing symptom presentations. These are sometimes subtle and pervasive, sometimes overt and crippling, or both. While this may be known to many, what may be even less well known are the many neurological and psychiatric symptoms of Lyme and other tick borne diseases (TBD).

Lyme is known to present it self as virtually every available diagnosis in the Diagnostic and Statistical Manual (DSM). This is the manual defining known mental illnesses. In particular Lyme has the ability to exacerbate or create significant anxiety and panic conditions, disorientation, obsessive compulsive disorder, sleep disturbance, depression. Some may even experience psychotic symptoms. In my clinical experience while working in central Maine, a Lyme hot spot, I saw a disproportionate amount of people with treatment resistant mental illness coupled with chronic diseases such as fibromyalgia, unexplained seizures, and unknown autoimmune issues. This is not atypical, however, for patients with undiagnosed or under treated Lyme disease. If only I had known then what I know now.

Experiencing prolonged mental health symptoms, specifically things such as panic or markedly increased anxiety and/or obsessive compulsiveness, depression, insomnia, coupled with physical symptoms such as recurring fevers, neuropathic pain, migraines, fibromyalgia, or fatigue, one should consult their physician about ruling out Lyme disease or other tick borne infections. Potentially one might experience disorientation, such as driving and not knowing momentarily where you are or where you are going. Many experience aphasia, either forgetting or scrambling words, and other forms of confusion. Here are some links to more complete listing of symptoms associated with Lyme and other tick borne infections:

In addition I highly recommend the film Under Our Skin, and it’s sequel Emergence available on youtube.

They are powerful documentaries that will scare the pants off you, but more important will help illustrate this very complex disease and the even odder culture that surrounds diagnosis and treatment. It is very difficult to find good guidance with appropriate knowledge towards the right treatment course. There are so many conflicting points of view and some result in great harm to the patient. In my practice I work hard to advocate and make use of my specific knowledge to empower clients to manage and take command of their healthcare.

Be well,

David Aronson LCSW


Staying Better

Sometimes it doesn’t matter how a problem began, it just needs to end. However, many times the phrase those who cannot remember the past are condemned to repeat it, while simplistic, often rings true. This concept is well illustrated in addiction, or substance dependence.While insight is not enough to cure all our ills, it is also not enough to merely change behavior either.

Cigarette smoking: how many people smoke and are unaware of the health risks? Insight is not enough. If knowing smoking kills was all that was needed, no one would smoke. On the other end, how many more people used to smoke before they were aware of the health risks?

With addiction it is important to explore why one’s dependency developed in the first place. Otherwise, life will continue to present the circumstances with which one needs to cope: relationships, grief, employment, family, friends, financial stress, emotional stress, other people using substances. The list can be endless if one does not learn those circumstances that are most triggering.

There are several perspectives on causes of addiction. Environmental: it is the place, people and circumstances around someone that drive one to use substances. Genetic: people are born with “predispositions” that put them at risk of addiction. Learned behavior: using solves a problem or enhances an event in a meaningful way creating the desire to keep using. There are more nuanced variations of each of these, but these are the core principles. Nature vs. nurture. The answer is all of the above, nature and nurture. Our genes, and unconscious drives, and our overt efforts interact constantly to create the interactive versions of us that everyone knows and we know of ourselves. People can be born into the same circumstances and grow up completely differently. People can experience the same event, and because of the history and biological differences, they will have completely different perceptions of that same event. This is why there are some who are able to use drugs and alcohol and not become addicted, and those who are seemingly unable to avoid it.

When working with people who have long term substance use disorders, behavior and insight need to be enhanced. Once use is stopped, or greatly reduced, one’s personal causes of addiction can start to be understood. The behavior protects the present goals and the insight protects the future behavior.

Be well,

David Aronson LCSW

Opiate epidemic: it’s not the drug

Lately not a single day goes by here in Portland, Maine without an opiate related overdose. Working as a therapist and substance abuse counselor, not a single life I encounter is left untouched by this disease. Why now? Why the sudden increase? I have some thoughts. Working in community mental health I noticed, as I’m sure many others did, a steady increase years ago. In fact, it was predicted when Maine discontinued its medicaid coverage for medicated assisted treatment (Methadone, Suboxone) for those receiving treatment longer than two years. When this law passed it was retroactive. This meant that many people’s coverage for the medication that had helped many of them return to a life focused on their values was suddenly gone. Over the next few years pharmacy robberies increased, and heroin overdoses increased, dramatically. A strip of Suboxone on the street is $20 a dose, heroin can be $10 or less. Now there is a cheap and regular supply of heroin in Maine from increased demand due in part from state legislation.

But why use it in the first place? I will borrow ideas put forth in this Ted Talk (see link below). What most people understand about addiction and drug use is from early research with rats in cages with just two water bottles. One bottle has drugs in it, the other does not. The rats drink the drug water compulsively until they die.  Thus we draw the conclusion that if we go out and use addictive drugs enough times in a row we will become addicted. What’s really interesting is this is not at all true. Only a small percentage of people become dependent on drugs. “According to the Institute of Medicine of the National Academy of Science, 32 percent of people who try tobacco become dependent, as do 23 percent of those who try heroin, 17 percent who try cocaine, 15 percent who try alcohol and 9 percent who try marijuana” (see link below). Therefore, it’s not the drug.

Later rat experiments tried putting them not in empty cages, but with everything and anything a rat could possibly want, including other rats. Nobody overdosed, nobody became dependent, they hardly used. When one works with people dependent on drugs, none of them feel well connected, nor loved, nor understood. Another addiction specialist, Gabor Maté, said “we shouldn’t look at what is wrong with the addiction, but what is right about it.” That is to say, what is the problem it is fixing? If we are anything like rats in cages, which for a long time now scientists have felt it a reasonable model, than the problem is that of connection. People who are dependent and addicted are feeling disconnected when they start using. When we notice, how does society treat them,? With compassionate open arms, inviting them to return to the fold?

When trying to help those dependent on using substances to cope, it is important to understand this idea of connection. It is important to not judge, maintain a kind and compassionate disposition. A deer in the meadow will flee when approached head on. If a kind offer of an apple is left to be taken when wanted, than a connection becomes possible.

Be Well,

David Aronson LCSW

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Johann Hari: Everything we know about addiction is wrong

New York Times, Addiction: a brain ailment not a moral lapse