Monthly Archives: September 2012

How far has therapy come since the 1970s?

Very far.

Note to clients: ethical therapists will not ask you to undress.

(thanks to V. Valenti)


@ 2012 Jonathan Miller All Rights Reserved

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Sleep Apnea: Depression’s subtle sidekick.

A client presents with irritability, drowsiness, lack of energy,  and hypersomnia. You’d suspect depression, possibly Bipolar Disorder, and you’d likely be correct. It might also be something more.

Just over a year ago, Texas governor Rick Perry was hailed as the Republican party’s best choice to win the White House in 2012.   Poor debate performances sank his candidacy, most notably when he couldn’t remember a third government department he planned to eliminate.  In his new book “Oops“,  Texas Tribune correspondent Jay Root claims Perry’s lapses were due to a sleep disorder:

“…by early October, days after the Florida fiasco, (Perry) had urgently consulted sleep specialists. After conducting overnight tests on Perry, they produced a rather startling diagnosis: He had sleep apnea, and it had gone undetected for years, probably decades.”

Rick Perry’s doctors: “Oops.”

Sleep apnea causes sleepers to stop breathing. These pauses can last several minutes and occur  thirty times or more per hour. Unknowingly, sufferers’ wake dozens of times per night. This sleep disruption can slip past diagnosticians because it shares so many symptoms with depression. When a client presents with  fatigue, forgetfulness and lack of motivation, a family doctor might refer them to counseling instead of a sleep study.  The assessing therapist might ask the person if they ever wake up gasping for air. More likely, they’ll focus on all of the mental health questions we have to squeeze into an assessment session.

Along with serious physical risks, sleep apnea can cause depression and memory troubles, via sleep deprivation.With depressed clients who report fatigue, but no trouble sleeping, it’s smart to ask about the following:

  • Morning headaches
  • Memory or learning problems and not being able to concentrate
  • Waking up frequently to urinate
  • Dry mouth or sore throat when you wake up
  • Snoring
  • Reports from bedmates that you stop breathing in the night.

Two years ago, I started to encourage clients to report such symptoms to their family doctors. An impressive percentage have returned with a positive diagnosis for sleep apnea. So far, each who pursued treatment have reported improved mood and energy. Each was genuinely depressed; disrupted sleep made each’s depression significantly worse. With sleep apnea, sleep deprivation can hamper therapy even when a client believes they sleep all too well.


@ 2012 Jonathan Miller All Rights Reserved

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Graham Greene on Antisocial Personality Disorder

In the postwar classic The Third Man, novelist Graham Greene’s protagonist, Holly Martins, confronts racketeer Harry Lime about his black-market sales of worthless, diluted penicillin.  Atop a ferris wheel, he asks his old friend, “Have you ever seen any of your victims?” Lime’s response is telling:

Orson Welles as Harry Lime in The Third Man (1949)

“Victims? Don’t be melodramatic. Look down there. Tell me. Would you really feel any pity if one of those dots stopped moving forever? If I offered you twenty thousand pounds for every dot that stopped, would you really, old man, tell me to keep my money, or would you calculate how many dots you could afford to spare?

…Nobody thinks in terms of human beings. Governments don’t. Why should we? They talk about the people and the proletariat, I talk about the suckers and the mugs – it’s the same thing. They have their five-year plans, so have I …

… in Italy for 30 years under the Borgias they had warfare, terror, murder, and bloodshed, but they produced Michelangelo, Leonardo da Vinci, and the Renaissance. In Switzerland, they had brotherly love. They had 500 years of democracy and peace, and what did that produce? The cuckoo clock.”

(Rabid cinéastes will point out Orson Welles added the lines about Italy and Switzerland himself.)


@ 2012 Jonathan Miller All Rights Reserved

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Filed under The Client's Side