What is Wrong & What Can be Done
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Q:  What is Wrong & What Can be Done

I know I have a problem I just am not sure what it is and I need your help.  I guess I will start from the beginning.  I started college when I was 23 and during my first semester I had some sort of breakdown.  Well, here is what happened – it had a lot to do with my speech class and I was doing very well in it as I received an A in the class but I have a huge fear of talking in front of people.  Well anyway there was a lot of encouragement in the class from both teacher and students so it helped.  The problem started when I began what I call racing thoughts through my head.  I would go over and over points that were said good or bad and then it even became delusional to where I thought the teacher had to be plotting something.  The more I think about it now I suppose maybe I just couldn’t believe I was doing ok in the class.  Anyway I did go to the hospital for 5 days and they put me on risperidol.  I think another drug halol was used first but it had a lot of side effects.  I was really thinking crazy at time.  This was the only instance I have ever been delusional.  I am now 30.  I have been on Xyprexa and Zoloft since and my doctor says that I am a success story for him.  The thing is I only go see him for 10 minutes and I am not completely honest with him because I feel inadequate.  He has labled me as schizoaffective and says that may be changed - but I am not all together sure he is right because I have a hard time talking to him and telling him everything that is going on.  I’ve wondered everything from Bipolar, Schizophrenia, and Mania to Avoidant Personality disorder.

Well here is what has been going on since that episode.  I have never been delusional like I said - thank god.  That was very scary.  I do however still suffer from racing thoughts.  I have what I think, narrowed the trigger of them down to what I call new situations that occur to me.  To explain, I have always been a very quiet person and to myself or introverted type.  I had never had any close relationships outside of family until the last two years.  I hadn’t had any friends that I spent time with and in fact kind of avoided situations where I might have encountered such relationships.  It is not that I don’t want these relationships – I do – I am just afraid of something but I don’t know what and it creates this anxiety in me.  When I got out of high school I pretty much worked with my dad in rental property and would not go anywhere.  I was afraid to go into stores for some reason.  

I spent some time with a psychologist and he really helped me a lot but he moved away.  It started out as what seems simple to most people, but for me was very terrifying.  I had to go to Burger King and eat.  Silly right?  Well it got me started anyways.  I did that a few times and got use to it and of course I had the racing thoughts along with it. I would do things like rerun an entire conversation back through my head how it should have been done or shouldn’t have or what bothered me about it.  This is definitely not what I call back to normal like before my episode at college.  Well therapy progressed and I came to the conclusion that I should work in a grocery store to overcome my fear of meeting and talking to people. I said I wanted to be a cashier.  I didn’t know how far I would go with this though.  Of course I had all kinds of horrible what if this happens thoughts.  Nevertheless I went through with it and got a job at a local grocery store.  Well I was very nervous at first and of course had lots of racing thoughts. I have been there for 5 years now and am the Customer Service Manager and am the direct supervisor of 50 employees.  Boy did I change in that respect.  The thing is though it is a controlled environment and as long as something new doesn’t happen to trigger my racing I am ok.  

I have a lot of friends at work now and over the last 2 years have become very close with several and we go out and to eat a lot and just talk.  They are great.

Something else I should mention is that I am on a drug Topamax because of what a neurologist calls essential tremors.  What happens is my hands will shake a lot when typing or trying to do some type of movement.  I am not so sure that this isn’t mental as well but it does seem to have gone away since I have been on the drug so no complaints.

Now I have started a new job working for Utility Company because I finally finished my degree in Computer Information Systems.  I am just starting in the call center to get in the door however, meaning that I am going to be on the phone a lot with customers faced with a lot of challenging situations.  I think I will be able to handle this ok but the racing is my biggest problem.  What is wrong with me.  

Something else that has developed to eliminate theses thoughts I suppose is that I might cuss just to stop this thought process.  I get so angry that I might yell out a four letter word four times in a row and it seem to at least stop this racing for a short moment anyways.  The strange thing is this only happens when I am alone or at home.   I seem to be able to control it so there must be some hope for me.  I just don’t know what it is.  It just drives me crazy and I feel so ashamed that this is happening to me and I don’t know what to do.  What is wrong and what can be done?

Dear John -- 
I can see why the diagnosis seems a bit uncertain -- there are a lot of different parts to your experience, including the racing thoughts and the anxiety and something that made somebody want to give you Zoloft as well as Haldol and Risperidone.  

So, when you're income is steady you could save up some money to pay a doc' for a consultation, for more input on diagnosis and treatment options (or ask your doctor for more time to discuss those things you're hesitant about; and if that's not available, check with your insurance company to see if can get a second opinion payed for).  Then, whatever the "working diagnosis" is, focus your treatment there for a while and see if you're making headway.  You might read up a bit on Tourette's Disorder to help the doctor evaluate whether there's an aspect of that in there too. 

Remember, there is a psychotherapy for social phobia; and for depression.  So you have options to consider in addition to medication approaches.  Good luck to you. 

Dr. Phelps

Published December, 2001


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