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Having imaginary thoughts and difficulty focusing on work. Family history of mental illness. Worrisome

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Practicing since : 2003
Answered : 2190 Questions
Hello again.

I know there are no easy answers and I must be patient and try to resolve my problems in a better way. I thank you for the input you have given me and I am trying to respond to things differently.

I am reading the self help books and trying to listen to these tapes on mindfulness but I cant seem to focus on them because of these repetitive thoughts.

It is just that this intense level of obsessive thoughts and "splitting" or dissociation has been going on for months now and I am feeling quite down in wondering when it will quiet down a little. I cant figure out what is really bothering me and its hard to focus at work. I know they say to just let the thoughts come and go but they dont go, it's one hundred percent of the time I am awake and nothing seems to bring relief from the scenario that keeps replaying in my mind over and over and I am constantly having these imaginary conversations about the situation with whats happening with my mind.

This is making me feel really bad about myself and really abnormal. I hate being so preoccupied with my own thoughts but I cant get out of it. How long can I expect this to go on and is there anything else I can try to figure out what this is really about?

If I had to guess, it could be about blaming myself for my past mistakes or feeling responsible, defective and ashamed for having these traits. There was a lot of mental illness in my family and there was a lot of stigma attached to it growing up. It could be that I feel guilty for wasting so much of my time caught up in these obsessions and wasting the time of other people as well on "obsessions" that I was just hiding behind as an excuse not to move forward with my life.

Posted Thu, 7 Mar 2013 in Mental Health
Answered by Dr. Jonas Sundarakumar 12 hours later
Hello again and thanks for writing in.

I can understand that it can be quite difficult initially when you are trying to change certain things which you have gotten used to. I'm glad to see that you are taking sincere efforts to better yourself and acquire a healthier psychological state. Like I had mentioned earlier, these imaginary conversations or splitting of the mind are obviously an easier way out and since they have been pretty long-standing, the mind tends to fall back and continues to cling on to these defence mechanisms. What could have started off as a way to escape stress could have soon become habitual. Also, since these imaginary conversations somehow seem to be giving you some consolation, you may be finding it all the more difficult to let go of these.

Now, the basic problem here is that these are unhealthy defence mechanisms have risen out of poor conflict resolution / stress management skills. So, it will be difficult to just let go of these unless you have developed healthy defence mechanisms and mastered adequate coping skills and conflict / stress management methods. What I’m trying to say is that in order to give up an unhealthy way, it is first important to learn and master an alternative healthy way. So, I would suggest that you first focus on learning and acquiring coping skills and stress management techniques. Gradually try implementing healthy and adaptive defence mechanisms. Whenever your mind tends to fall back on the previous unhealthy psychological state, you have to tell yourself that it may be a easier short term alternative to avoid your conflicts, but facing them (though it may be more difficult or distressing) and trying to resolve or consciously cope with them is what will help you in the long run.

I would once again reiterate that the very fact that you are facing difficulties means that you are trying hard and are in the process of change. Because, changing a deeply embedded psychological state is not an easy task at all. And if you are not experiencing any difficulty, it would mean that you are continuing to be in the same state. So, get dejected at all. This process of change will take time and would be a gradual process.

If there is an obsessive nature to your repetitive thoughts and you are finding it very difficult to control them, then I feel that it would be a good idea to take anti-obsessive medication for a short duration. Though personally, I’m not convinced about a diagnosis of an OCD in your case, still even if there is a mild obsessive component to these thoughts / conversations, it would be worthwhile to give the benefit of doubt. More importantly, medication may give you a much needed initial push to implement the psychological techniques which you are currently facing difficulty in implementing and if you find improvement, then you can ‘ride this wave’ and go full fledged with the psychological therapies.

Wish you all the best.

Dr. Jonas Sundarakumar
Consultant Psychiatrist
Above answer was peer-reviewed by
Follow-up: Having imaginary thoughts and difficulty focusing on work. Family history of mental illness. Worrisome 2 days later
Thanks again, your advice motivates me to continue.

I thought splitting was when you see things as good or bad or in black and white, I never heard of it related to this type of negative fantasizing or rumination but that makes sense. Is there more than one type of splitting?

I wish I knew that's what I was doing years ago. I keep replaying the conversation from the visit with the doctor over and over, imagining I said this or that, or she said this or that. It is very annoying but my mind seems to enjoy it on some level, but I continue to try and practice the self help techniques and they are helping me realize things. Nothing seems to stop the thoughts but I am doing ok at not getting too distressed by it. And I can't exactly tell anyone this is going on, no one would understand.

Anyway, I will try to overcome my embarrassment to see about medication as a temporary solution. Thanks.
Answered by Dr. Jonas Sundarakumar 19 hours later
Hello again,

There are two meanings or perspectives for the term 'splitting' in psychiatry. One is (like you have said), splitting of thinking into black or white, all or none. This is more appropriately called "dichotomous thinking". The other meaning is the splitting of an individuals personality into two, where a person developes two psychological states or sometimes even two different identities at the same time. This is more closely associated with dissociation.

To help you understand better, the functions of the following three are normally integrated.
- consciousness
- memory
- identity

When this normal integration or unified functioning is broken, the person dissociates his/her consciousness from his/her memory or identity. Sometimes, the person can develop a splitting of his/her personality or identity itself.

You may be finding it difficult to let go of these imaginary conversations or fantasies because, they are providing you some sort of comfort from the external real world of stress / conlicts. But remember that when you have developed strong coping skills and conflict-resolution techniques, you will be able to let go of these and adopt healthier ways of handling stress. So, please be persistent and sincere in your efforts, and you can also try the option of medication on a temporary basis.

Wish you all the best.

Dr. Jonas Sundarakumar
Consultant Psychiatrist
Above answer was peer-reviewed by
Follow-up: Having imaginary thoughts and difficulty focusing on work. Family history of mental illness. Worrisome 8 days later

Thank you for your continuing support. I am feeling much better mood wise and less distressed about my diagnosis, which I recognize I am blowing out of proportion. But the obsessive conversations about the diagnosis continues in my mind on a loop all day long and is very distracting. I know it will go away. I guess part of me can't accept that there is something wrong, I want to believe I can control all of this.

I was wondering if you could give me some ideas how to ask for the medication from a doctor without having too say too much of the reason, it's hard for me to talk about and I'm very embarrassed. My doctor has no idea this is going on, he doesn't know about my diagnosis and I would rather not discuss it in detail with him. What could I say that would explain it, I can't even get the nerve to make an appointment I feel like I'm totally over reacting and weak somehow, but its really hard to focus with this noise in my head.

Thanks again to you.
Answered by Dr. Jonas Sundarakumar 22 hours later
Hello again,

Glad to hear that you are feeling better now. Like I had mentioned before, it may be worthwhile trying anti-obsessive medication because of the obsessive nature of your imaginary conversations. Though we know that the root cause of these conversations is more related to dissociation, still medication can be beneficial in providing some initial breakthrough, which you can then build on using the psychological techniques.

But, I would agree with you that your problem is quite complex and would be difficult to understand for anyone seeing you for the first time. It has taken multiple questions, clarifications and detailed explanations from your side, for me to have reached a reasonable understanding of your problem. Also, quite frankly, people can have a tendency to brush off things when they hear something very lengthy and complicated.

So, I think that you should put forth things in a simple and uncomplicated manner so that your doctor is able to help you with the medication. On a personal note, I would suggest that it would be better not to tell your doctor all the complexities about your conversations, conflicts, 'dissociation', etc. I'm saying this not because you have to hide anything, but simply because, it may be difficult for a non-psychiatrist to understand such complex problems and there is a tendency to misunderstand these conversations as indicative of a psychotic illness. So, the best way to put things across would be to just tell him that you have been having 'repeated, obsessive, unwanted thoughts in your mind, which you are finding it difficult to control and which you find are very distressing'. You can add on saying that you realize well that these are meaningless, unproductive thoughts, but still you not able to stop obsessing over them. You may also say that you have read up about OCD on the internet and feel that these thoughts have an obsessive nature. You can also tell him that you are practicing the psychological techniques advised by the psychologist, but would like to try anti-obsessive medication for a short term -since your symptoms are quite frequent and distressing.

Finally, I feel that you should not feel too embarrassed or fearful about seeing your doctor. Nobody is perfect and all of us have some weakness or the other. Whenever, we have a particular weakness or deficiency, we should not hesitate to come forward and take help to sort out our problem. It is our responsibility to take care of ourselves. Moreover, doctors are professionals and do not make judgments about people based on their weaknesses or problems. So, don't worry too much and go ahead and XXXXXXX your doctor.

Best wishes,
Dr. Jonas Sundarakumar
Consultant Psychiatrist
Above answer was peer-reviewed by
Follow-up: Having imaginary thoughts and difficulty focusing on work. Family history of mental illness. Worrisome 1 hour later
Thank you so much. I appreciate this so much and your advice is very helpful for me. I will cut out what you have said to help me remember what to say and for encouragement to make the appointment. I think you are a very kind doctor.
Answered by Dr. Jonas Sundarakumar 13 hours later
You're most welcome. I'm glad that my advise has been useful and helpful to you.

Wish you all the best.

Dr. Jonas Sundarakumar
Consultant Psychiatrist
Above answer was peer-reviewed by
Follow-up: Having imaginary thoughts and difficulty focusing on work. Family history of mental illness. Worrisome 15 days later
Hello again Dr. XXXXXXX

I am writing again just for someone to bounce things off of I guess and I can't talk to anyone about this.

I went to my doctor as you suggested and it didn't go well. I tried to give as little information as I could but he kept asking me questions and he wrote down everything I said and I was getting very nervous and I tried to downplay the whole thing because I didn't want to give too much information. So on one and i was saying i had serious obsessions and then i turned around and said i was fine.

In the end, he wanted to give me an anti psychotic medication of seroquel. I said I didn't want that because I am not psychotic, though I probably sounded like I am. He said they are used for mood disorders and I don't think I have a mood disorder at all.
I told him I don't have one and he seemed really confused and irritated with me.

I am a little depressed that the obsessive thoughts won't go away, but I guess they will eventually. In the end, the doctor agreed to give me Zoloft, but he said I have to go back in two weeks and I don't want to. He typed everything I said into a computer and asked who else knows about this, to which I said, nobody, why would I tell anyone this and who would understand anyway.

I took the prescription but I am not taking the Zoloft, because I don't want to go back in two weeks when my doctor now thinks I am crazy so there is no point starting it now. I am assuming most doctors are busy and don't care and he won't know or care if I ever return? I don't want to get in trouble for not following instructions if he thinks I am some crazy person.

I wish I had listened to you and not given much detail and I did try but I kept blurting stupid things out. I guess I need to move on and maybe the thoughts will go away if I quit looking for a cure and focus on living my life?

What do you think I should do?

Answered by Dr. Jonas Sundarakumar 13 hours later

I am sorry to hear that the meeting with your doctor did not go well. Unfortunately, like I had said before, since your problem is complex, people listening to your problems superficially may tend to misunderstand your symptoms (especially as indictations of a psychotic disorder). Though I do understand that it can be a very upseting experience to get the feel that your doctor is "writing you off as some crazy person", yet I think you should not feel very bad about this. The reason is because it's not really your fault that your psychological problems are complex and it is actually difficult for any non-psychiatrist to comprehend these complexities.

Looking at the brighter side of things, it's good that you have been able to stand up for yourself and convince the doctor that you were not psychotic or having a mood disorder. Moreover, the primary aim of seeing your doctor was to get help with medication for your obsessive thoughts, and you have actually achieved it. So, don't worry too much about what you spoke or what he wrote down in your records. Though things would have been confusing for him, still I don't think he would have written you off as "crazy". If that was the case, he would not have agreed to defer the anti-psychotic and give you an anti-obsessive medication (Zoloft is an SSRI anti-depressant which is an effective anti-obsessive agent).

I would also like to emphasize that when we have a problem or suffering, we should only focus on getting the necessary help we need, and not bother too much about what other people will think. A doctor who sees you for a few minutes is unlikely to be able to understand the years of problems and difficulties which you are trying to battle and resolve. And to him, you may just be one of the fifty or so patients he saw that day. So, once again, I would say, don't get too worried about what "impression" you would have created. It doesn't really matter. What really matters is whether you are atempting to overcome your problems in whatever ways possible - including the option of medication. Taking care of yourself is far more important than pleasing others.

At this point, my personal opinion would be that you can start the medication (because that was the primary purpose of meeting your doctor), and see your doctor after two weeks. I think this will help in two ways:
1) You will get the benefit of medication (and Zoloft is the appropriate medication for your obsessive thoughts)
2) By going for the follow up, you will give the picture that you have correctly followed the doctor's prescription advise and promptly come for the follow-up. This will probably serve to change any negative opinion he may have about you. On the other hand, by not taking the medication, you would only be denying yourself the benefit of medication (and I think you should not do that just because of an unpleasant experience with a doctor) and not going for follow-up would only end up re-inforcing any negative opinion he may have developed about you.

So, once again, relax yourself and stop pondering over this issue too much and it would be worthwhile to try the medication. Don't get pulled down by these little negtive events. Often, we have to face challenges in order to overcome difficult situations and come out with success.

Wish you all the best.

Dr. Jonas Sundarakumar
Consultant Psychiatrist
Above answer was peer-reviewed by
Follow-up: Having imaginary thoughts and difficulty focusing on work. Family history of mental illness. Worrisome 33 hours later
Thanks very much for your help again, and for getting me this far. I will overcome the embarrassment factor and let you know how it goes.
Answered by Dr. Jonas Sundarakumar 8 hours later
You're always welcome...

Best wishes,
Dr. Jonas Sundarakumar
Consultant Psychiatrist
Above answer was peer-reviewed by
Follow-up: Having imaginary thoughts and difficulty focusing on work. Family history of mental illness. Worrisome 12 days later

I hope you don't mind me writing, your advice is the best I have found. I wish I could talk to other doctors-the way I talk to you.

I went back to my doctor and he asked me about the Zoloft, I told him it had no effect on me yet, and I know that it takes time. He insisted on switching me to seroquel though I tried to stay on Zoloft, he said lots of his patients have success with it. He must have thinking I am psychotic as you say and I gave up arguing and XXXXXXX the prescription.

Is there any chance this medication might have the same effect in small doses as ananti obsessiveor should I throw it away. I'm so tired of the mess I have made over this. I was trying to do the right thing. I believe the details I gave last time made him give me the seroquel. Maybe I should take nothing and continue reading the books. My thoughts are still obsessive but I do feel better and am not depressed now.

I don't want to take it if it won't work for obsessions, it looks like an intense drug.
Answered by Dr. Jonas Sundarakumar 35 hours later

Seroquel (Quetiapine) is an anti-psychotic medication, which does have mood-sabilizing properties but not anti-obsessive properties. It is often used as an adjunct (second-line) drug for mood disorders, but not for obsessive-compulsive disorders. In small doses, it is also given for its overall calming effect when there is XXXXXXX or external agitation (even in the absence of psychosis).

So, in my opinion, if you are feeling depressed or experiencing frequent mood fluctuations or feeling internally agitated, then Seroquel may help you. But if we are looking at a medication specifically for your obsessive thoughts, then Seroquel is unlikely to work for you.

Dr. Jonas Sundarakumar
Consultant Psychiatrist
Above answer was peer-reviewed by
Follow-up: Having imaginary thoughts and difficulty focusing on work. Family history of mental illness. Worrisome 20 minutes later
Thanks. I think I'm done with medication anyway. I will just find a way to live with this until it gets better on its own, I can't go back to the doctor now, I feel,like it was all for nothing. Thanks very much for all your help. I know I will be fine.
Answered by Dr. Jonas Sundarakumar 15 hours later
I am able to understand your feelings very well, but don't get put down or dejected by these unpleasant experiences. Take this whole this as a learning experience. Hopefully, this should give you more confidence to rely on yourself and take it up as a challenge to overcome your problems. I'm sure you will do that and my best wishes are with you.

Dr. Jonas Sundarakumar
Consultant Psychiatrist
Above answer was peer-reviewed by
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