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>> Good evening.

I'm psychiatrist Jay Fawver live from Fort Wayne , Indiana.

Welcome to Matters of the Mind now entering its twenty eighth year Matters of the Mind as a live call in program where you have the chance to choose the topic for discussion.

>> So if you have any questions concerning mental health issues, give me a call in the Fort Wayne area by dialing (969) 27 two zero and calling long distance coast to coast you may dial toll free at 866- (969) to seven to zero now on a fairly regular basis we are broadcasting live every Monday night from our spectacular PBS Fort Wayne studios which lies in the shadow of the Fort Wayne campus.

And if you'd like to contact me with an email question that I can answer on the air, you may write me at via the Internet matters of mind all one word at a dog that's matters of the mind at WFYI Dog and I'll start tonight's program with an email I recently received.

>> It reads Dear Daughter Father I suspect that one of my family members is suffering from religious or spiritual schizophrenia.

Is this actually a medically recognized diagnosis?

>> Well, schizophrenia is a medically recognized diagnosis.

It starts typically in one's adolescence for males it has an average onset of 16 years of age for females average onset of 24 years of age.

The estrogen tends to protect the females and that's why they have at a later onset is characterized by not uncommonly hearing voices talking to you that nobody else can hear having fixed false beliefs where people have what we call delusions.

You can't talk them out of these beliefs.

They will have difficulty thought processing where they'll go from topic to topic and you'll have a hard time following them.

They often have trouble with a lot of social anxiety.

>> They will have difficulty with interpersonal relationships and they often don't take care of themselves very well.

>> It's an ongoing process.

It's not something that's intermittent.

It doesn't come and go typically it's an ongoing problem now many times people as part of their delusional process will have an inappropriate spiritual insight, a delusion itself that doesn't make any sense and it's not functionally enhancing for them a spiritual or religious type of experience should be functionally enhancing.

>> It should improve your life .

These people are often having religious and spiritual experiences that actually are detrimental to their overall functioning.

So schizophrenia, real diagnosis, the spiritual or religious aspect in which people become preoccupied sometimes is a fixed false belief also known as the delusion that doesn't tend to enhance their quality of life.

>> Thanks for your email.

Let's go to our first caller.

Hello James.

>> Welcome to Matters of Mind.

James, you want me to discuss Hox carbamazepine?

Arctica Aesopian is a medication that's also known as Trileptal and you mentioned that you've used it as a mood stabilizer and you want to know about the side effects.

>> It is a mood stabilizer that is a chemical cousin to carbamazepine also known as Tegretol Orks.

>> Carbamazepine has fewer side effects, a little bit less drug interactions, orks, carbamazepine and caba carbamazepine will both tend to induce the metabolism of a lot of medications.

In other words, if you're taking other medications they'll lower the blood levels of them.

You got to be careful about that.

And for females it doesn't sound as if you're a female James.

But females will often have difficulty with birth control efficacy because they don't tend to work as well if they take carbamazepine or carbamazepine.

Main side effects of carbamazepine would be dose related and the higher dosage you go you can have difficulty sedation, mental dollying and sometimes tremor.

But most people tolerate it very well if the dosage is kept low enough it can be used as a mood stabilizer.

>> It's been around since so the 1990s so it's been around for a while and it's a medication that has been used as a mood stabilizer for a lot of different people.

People will take it once or twice a day.

>> James, thanks for your call.

Let's go our next caller.

Hello Katie.

Welcome to Matters of Mind.

>> Kay, do you want to know how you can strengthen your willpower to overcome overwhelming temptation?

Well, number one, Katie, if you have overwhelming temptations in front of you, try to get away from a try to avoid circumstances that puts you in the position of experiencing overwhelming temptations.

>> OK, that's the easy part.

Secondly, if you are encountering these temptations for various reasons, do the best you can do identify yourself as somebody who doesn't participate or interact with those temptations.

>> In other words, instead of saying I can't do that, I'm not supposed to do that.

Identify yourself as somebody who just won't do that.

>> You don't participate in those type of temptations.

>> You just don't do it.

That's your part of your identity.

If you can identify it, make your personal habits part of your identity, you're more likely to carry them out or not carry them out.

>> For instance, I used to room with a Hindu student years and years ago and when I room with him I always asked him, you know, why don't you have any any temptation to eat meat because Hindus don't eat meat typically.

And he just said it's not something that ever comes to his mind because he doesn't eat meat as a Hindu he identified himself as somebody who didn't eat meat.

>> If you identify yourself as not participating in certain activities, you won't be tempted with them myself.

I did grow up with some individuals who had some fairly unsavory conduct and for sure I had a very supportive subculture in which I also interacted.

>> But the individuals with the unsavory conduct they would do things that I would identify myself as just not willing to do as an example using marijuana, using cocaine nobody has to tempt me at those type of things.

>> I don't use those kind of substances.

>> That's part of my identity.

If I try to make excuses and say well I'm not really supposed to or I really can't because I'll get in trouble, then your willpower will cave in on you.

And the more things in which you're tempted, Katie, the more difficulty your willpower will be to suppress to to suppress those temptations.

In other words, your willpower itself only have so much bandwidth.

So if you have a lot of temptations hitting you from all sorts of different areas, they've done studies on this people are more likely to cave into their willpower if they have them so no one try to stay away from the temptations, avoid them, don't even have them in your presence.

>> If you have trouble eating donuts, don't buy donuts, keep them off the shelf.

Just have them on specific selective encounters perhaps but don't have donuts on yourself if you're having a hard time avoiding donuts.

Secondly, even better identify yourself as somebody who's interested in their health to such a point that you don't eat donuts just as something you don't do when you can say to yourself you don't participate in certain activities you're much more likely to to be able to avoid them and pay attention to your willpower at that time.

>> Thanks for your call.

Let's go our next caller.

Hello Fran.

Welcome to Mastermind Fran.

>> You want to know how can someone overcome bad experiences from their past?

We all have experiences from our past that we wonder why did that happen and what did that what did I have to go through that and you can foster anger about it.

>> You can feel as if you've been victimized and you can just have those bad experiences foster in your head and just ruminate and that's not good for your mental or your physical health if you just ruminate on your past misgivings, past consequences, past victimization and the one of the best ways to get past the bad experiences you've encounter is to try to understand why they might have occurred.

>> It's called reframing and the person who the psychiatrist who really got it started I've mentioned him on the program in the past Victor Frankl.

He wrote Man's Search for Meaning Back in the 1940s he was a psychiatrist, is in his 40s and he was in various prison camps camps including Auschwitz and and he noticed that the people who died in these prison camps lost all purpose and meaning to their lives.

>> So as he was saying with any bad experience, we need to kind of look around us and figure out, OK, why did God put us in this particular position?

You know, how can I reframe what's going on?

How can I actually make use of this and become a better person even though it's a bad experience?

>> You never want to go through the bad experiences.

So that's called logo therapy and it was developed in the 1940s and back in the 1970s was frustrated as was Victor Frankl that much of the prominent psychotherapy was psychodynamic and psychoanalytical.

>> And you know, it's nice to understand the why behind why you might behave as you do but it might not be for everybody.

It might not be as fulfilling as cognitive reframing.

And of course Aaron Beck started cognitive behavioral therapy and the whole premise of that is basically to try to reframe your life experiences, take out the automatic thoughts that you might have and be aware of those around that kind of took loga therapy and took it up a level with cognitive behavioral therapy.

>> But I think you can go back to the Book of Genesis with Joseph.

You might have heard about the play Joseph Joseph and The Amazing Technicolor Coat I think it was called as a musical but the whole premise of that is in the latter part of Genesis Joseph is the great grandson of Abraham.

Most people know about Father Abraham.

So Abraham was the father of Isaac who is the father of Jacob and then Joseph was one of the son of Jacob's and basically Joseph was sold into slavery by his brothers, goes to Egypt for several years, is imprisoned.

>> He could have cried out why why why why me?

>> And he definitely was a victim but he didn't let it consuming.

He actually became a model prisoner, was able to have the God given ability to interpret dreams and in doing so he really progressed up the line, interpreted some of the pharaoh's dreams and became second in command of all of Egypt and likely saved his entire Israelite population during a time of famine and from a whole concept of reframing, he's a classic example one of the best examples in all the literature of somebody who had horrible life circumstances that being sold into slavery by his brothers and reframing it because he welcomed his brothers back into the community when they were starving and they needed food from Egypt and he allowed the Israelites to move to Egypt and that's save the population for the time being.

>> But he reframed his life circumstances and that's really the premise of loga therapy and cognitive behavioral therapy where you've had bad experiences happen to you and instead of assuming the role of a victim and being consumed with other people who victimize you instead of feeling as if you had your honor violated and seething with anger and ruminating about all these different things, it's best to reframe experiences and figure out how could I become a better person for this and use my God given abilities, resources and look at the purpose that I have in life based on these experiences.

>> But our experiences do shape us.

We don't want to go through these bad experiences.

>> We don't like when people do bad things to us and often it's not justified I get it.

But at the same time if you can utilize those bad experiences and help other people or do things in life that you ordinarily wouldn't have done, that can be highly advantageous.

>> Thanks for your call.

Let's go our next caller.

Hello Peter walk an American mind Peter.

You want to know how does peer pressure affect decision making if you have a bunch of people around you who are doing things that maybe you don't agree with but they all seem to be right in their minds and doing it and there's a lot of pressure in their conversation.

They all have certain beliefs.

They'll have certain values.

What happens if you try to resist those beliefs or values or the means of decision making if you try to resist this part of your brain right here it's in the temporal lobe called the amygdala really lights up.

They've actually done brain scans on this with people where they've had researchers who staged it peer pressure and points of conflict.

And if you avoided the peer pressure and you stuck to your guns and stuck to your values and said I don't agree with that this part of your brain right here called the amygdala lights up the amygdala is the side of the brain that's responsible for anger, irritability.

>> It's responsible for anxiety.

It's it makes you anxious and it's uncomfortable to stand up for your own values when you're in the presence of other people who don't believe what you believe.

>> So this amygdala lights up.

What happens if you succumb to those beliefs even you don't believe them?

>> Well, that's right.

Side of your brain lights up on the parietal lobe.

This is the part of the brain that deals with perception.

So you feel it's kind of a soothing, more comfortable means of this kind of going with the flow saying that you agree with your beliefs even though deep down you don't.

>> But if you accept their beliefs it will influence your decision making because that's right side of your brain that's responsible for perception itself.

>> Well, really isn't dealing with the conflict that you might feel so it's a means by which if you're around the wrong group for a long period of time I mentioned that earlier with some of the unsavory characters and with whom I associated as a youth if you're in the wrong group you can be influenced by their peer pressure unless you have a subculture around you.

Another group of people who are much more supportive and people who are going to be well more amenable to your values.

So for those people we all need to have that supportive group of people who can call us out when we need to be called out and who can encourage us when we need to be encouraged.

>> Thanks for your call.

Let's go to our next email.

Our next email reads Dear Daughter Father, could you talk about the interplay between chronic fatigue and mental health ?

Yeah, I don't want to be inclusive.

>> I know there was a follow up on this particular email concerning the things I don't mention when I talk about chronic fatigue.

>> I don't mean to be inclusive on this program.

I want to emphasize that when somebody is tired we need to psychiatrist to look beyond the assessment.

>> I'm just saying oh you must have depression now.

Depression can make you tired, I get it but you can also have fatigue and I mentioned the the most common areas where people have fatigue and sleepiness and that can be sleep apnea, low thyroid, diabetes, low iron.

>> Those are just four common things we'll see.

But you're exactly right.

I read the rest of your email and you said what about covid and the after effect of that with long Horler syndrome we call it of course you can have fatigue from different areas, autoimmune conditions.

>> My point is when we assess fatigue as psychiatrists we should simply stop at saying it's you're depressed and keep giving you antidepressant medications.

You should have a thorough assessment often a neurologist rheumatology endocrinologist can be involved with that.

>> But fatigue can be from many different areas in psychiatry.

We're also seeing people with what's called idiopathic hypersomnia just because people are tired and nobody knows why .

So there are medications to fire people up and I'm always trying to look for the underlying reason why I'm the most common reasons as I mentioned previously were low thyroid sleep apnea, low iron and diabetes.

>> But there are many, many other conditions that can be considered.

>> So thanks for your email.

Let's go to our next caller.

Hello Estelle.

Welcome marries the mind Nestel you want to know how can menopause possibly cloke other mental disorders?

Menopause will make you have difficulty with concentration because your little temporal lobe which is responsible for concentration and memory is studied with estrogen receptors .

When you go through menopause estrogen is going down, down down with menopause with estrogen going down, down down you can have more trouble with concentration.

So many people as they slide into menopause average age 51 years of age and ages seems to be decreasing now the average age of menopause around 51 years of age you can have more difficulty concentration and sometimes fatigue.

>> Progesterone is also going down when people have lower progesterone, often have more anxiety, more difficulty with sleep disturbances overall.

So we'll hear more about that as people are going through those different phases of life.

>> Now if you have surgical menopause where you've had your ovaries taken out, it's called a overactivity.

If you've had that you're going to go into menopause really quickly and that's where your clinician may give you estrogen replacement as a means of helping you kind of transition into the menopause.

But there are some very nice bioidentical estrogen replacement treatments out there that will help people with these menopausal symptoms will sometimes you give antidepressant medications because they have an underlying depression that was there even before the menopausal symptoms and will give certain antidepressant medications to particularly help with concentration and focus.

We're often giving people medications like trend telex all valide sometimes prestige if they're having menopausal symptoms to help with concentration and focus.

>> Thanks for your call.

Let's go to next.

>> Hello Chris .

Welcome to Matters of Mind.

Chris , you want to know what are the benefits of boredom?

Does disconnecting for long periods actually help with productivity?

It's called kind of like meditation where you block everything else out if I don't know if I'd call it boredom boredom is where you're a little bit anxious about not having enough to do so if you are meditating you're trying to block out all outside stimuli.

You can go into a brief nap which I think is actually even more important for a lot of people.

A stress relieving technique is meditation where you're trying to block out outside distractions.

But quite frankly I often hear people say they get a lot better benefit if they just take about a twenty or thirty minute nap in the mid to late afternoon as a means of recharging the brain because if you take a 20 or 30 minute nap in the mid to late afternoon you're simply recharging the left front part of the brain especially this is the part of the brain that used for focus and concentration and keeping your mind on things you can actually recharge that by a brief nap in the mid to late afternoon.

>> It's called a power nap.

Albert Einstein had power naps on a regular basis.

The key is don't sleep more than about 45 minutes or so if you get into a deep sleep for two or three hours, you're not going to sleep very well at night.

>> So a brief power nap late afternoon probably does enough to recharge the brain and can enhance productivity overall.

>> Thanks for your call.

Let's go to an email question.

Our next email question reads You're not a favor.

I experienced a traumatic event recently and I spent several days feeling very nervous and jumpy.

You might say that I was a wreck.

Is it normal to spend several days in the state?

Several days.

It's called acute stress reaction if you have a traumatic event.

You bet.

What happens is when you experience a traumatic event the middle part of your brain called the brainstem gets fired up.

>> You get adrenaline pumped out of there and all the adrenaline like chemicals and it will cause you to be a little bit more on edge because if you can think about it, a traumatic event makes your brain remember that traumatic event and you can download these memories in your hippocampus out here in the temporal lobe.

It can make you expect to have more traumatic events in the future so the whole idea there is to try to get past that, try to keep yourself active and busy in areas that might kind of simulate the traumatic event to convince your brain that traumatic event will not occur again and again.

A good example of that would be a motor vehicle accident.

Nobody wants to experience a motor vehicle accident.

>> If you encountered a motor vehicle accident, you're going to be really jumpy in your driving for a good number of days.

>> But the key is to as they used to say, get back on the horse.

You want to get back out there on the road again and try to get your brain convinced.

Simply getting the car is simply driving does not automatically mean you're going to have another traffic accident.

So you need to deconditioned your brain to perceiving that that is always going to be a dangerous situation.

So the whole idea of treatment for an acute stress disorder is to try to not allow it to go past a month if it goes past a month and you're having symptoms of jumpiness, you're having nightmares, you're on on edge, you're irritable, goes past a month.

>> It's called post-traumatic stress disorder and that is more difficult to treat compared to if it's treated acutely.

We do treat people acutely within the first 48 hours of experiencing a traumatic event with a medication called a beta blocker.

>> A beta blocker is basically blocking adrenaline.

So if you can get treatment within 48 hours of experiencing a very traumatic event and block your excessive adrenaline that's occurring at that time, you can potentially decrease the likelihood of having all these awful symptoms of acute stress disorder or post-traumatic stress disorder.

But it's got to be caught within the first 48 hours of the trauma itself thanks to your call.

>> Let's go to our next caller.

Hello, Paul.

Walk on of the mind.

Paul, you had mentioned that when when should you wish you'd asked when should you tell the person you're dating that you're working on your mental health and take medication to stabilize your mood?

>> I think it's similar to talking to that person about any kind of medical condition.

This person as you get to know them as you develop trust, that's when you're probably going to be talking about them with other medical conditions.

So if you can think of other medical conditions you could have well think about it.

Do you have that level of trust with that other person?

We don't have as much stigma about mental health as we did twenty or thirty years ago.

We have a better understanding about mental health now but you never know this person you're dating might have family members or friends who also have mental health issues and they realize that mental health issues can be treated.

>> I think from your perspective you can say how you've been doing with your mental health treatment, the rationale behind being treated and what it's done for your life and how you've been then hopefully become have you you become a better person because you are getting treated for it.

>> But you might be surprised a lot of people with whom you may encounter have friends, families or maybe personal experiences with their mental health journeys.

>> It's more prominent than you really think.

>> Thanks for your call us Goyeneche next caller.

Hello Mike Walker, the mastermind like you mentioned you have a friend who talks to himself that caused by loneliness, mental health issues.

Are they thinking out loud?

I'd say all of the above, Mike.

I mean on one hand if your friend talks to him or herself ,if they're responding to voices and that will often occur when they're looking side to side because they're actually hearing voices talking to them and some of these voices will be heard outside their head.

That's called a complete auditory hallucinations.

And when they have those kind of experiences, OK, that's a mental health issue that's occurring with schizophrenia not uncommonly sometimes with bipolar mania, sometimes with depression.

We'll hear about that.

>> But if somebody is hearing a voice and they're responding to a voice, that's a whole nother phenomenon.

But most people, Mike, are talking to themselves because they're trying to think out loud.

>> If you think out loud what you're doing there, Mike, is basically when articulating a word and you're saying something, you're using your front part of your brain.

>> It's called Broca's area and you're actually saying something you're talking about something OK when you can articulate that and it goes to your auditory cortex back here, the warning area you can sometimes remember what the information is.

So one means by which people can kind of remember things better will be to talk out loud and kind of articulate things.

>> We often will hear about that with students if students can explain to another student what they're learning and actually teach them, coach them, mentor them in some ways they can remember the actual material better themselves.

So you often hear about the phenomenon of watch a particular procedure, teach one and or do one itself and then teach one.

The whole idea there is you're actually articulating how to actually perform something and that's really the best way to learn.

>> So your friend may be simply thinking out loud and that's not considered to be pathological.

>> Let's go to our last email question.

Our last email question reads Dear Dr. Favore why do people keep making the same mistakes in choosing abusive relationships?

Is that the same as Stockholm Syndrome?

Well, Stockholm Syndrome is a phenomenon that occurred back in nineteen seventy three where a couple of bank robbers broke into a bank in Stockholm, Sweden and they took several tellers and bank personnel captive the tellers and bank person over the course of several days developed an empathy and a bonding with these captors even though they were threatening them at times but they actually became attached to their captors in various ways because these captors sometimes would promise nice things and do small favors for them.

The captors eventually were let go.

>> They insisted that the police not harm the captors or the people who took them captive and they wouldn't even testify against these criminals in court thereafter.

>> So that's called Stockholm Syndrome where you actually empathize with somebody who's doing a trauma.

>> There's a different phenomenon where you tend to get involved in relationships with abusive people and that's called repetition compulsion.

>> Sigmund Freud did talk about that about 100 years ago.

>> Repetition compulsion is where you keep making the same mistakes over and over again because you're comfortable with that experience, you're comfortable with that environment.

>> So if you've grown up with abusive relationships you might choose to continue to encounter those abusive relationships in your later life and that's called repetition compulsions.

>> The Stockholm Syndrome is a different phenomenon called identify with the aggressor a whole different phenomenon overall.

>> Thanks for your email and for I'm out of time for this evening.

If the only questions I can answer on the air you may write me via the Internet at matters of the mind that WFYI dot org I'm psychiatrist Jeff Offer and you've been watching Matters of Mind now available on YouTube.

Have a good evening.

Thanks for watching night