What may often sound plausible to psychologists, psychiatrists and doctors is not always comprehensible to the layman. Therefore, this page contains interviews with experts who try to explain their specialty in a clear and understandable way. The interviews should serve as supplementary and varied information to the respective topics, which can already be found on the website.
Julius Krieg is head of psychosocial counselling and treatment at Caritas Passau. In an interview with the counselling centre, the 63-year-old talks about his experiences in dealing with alcoholics, how students are at risk and how one can recognise an incipient alcohol addiction in oneself and others.
Counselling centre: what is the proportion of alcohol addicts in the Caritas addiction counselling centre and what addictions are still treated there?
Julius Krieg: we look after about 800 clients a year. About half of them come to us because of an alcohol problem. This shows how widespread the legal drug alcohol is. This can also be seen in the fact that the treatment of people with problems with illegal drugs accounts for only about 25%. In addition, there are people with eating disorders or general psychological problems. But we also advise relatives of addicts.
Do a lot of students come to you with an alcohol problem?
This is difficult to say because we do not have any figures to that effect. One reason for this is that students who have alcohol problems do not usually become conspicuous so quickly, but only when he or she, for example, breaks off their studies. Alcohol problems often take place in secret for many of those affected. Because alcoholics are often supported by the system. If, for example, a student goes to his lectures and passes all exams, then he is not attracting attention and the alcohol addiction is not yet conspicuous. In your professional life, for example in the office, the smell of alcohol is more conspicuous.
According to a study by the University of Passau, students in Passau are more likely to abuse alcohol than the national average – a common habit among students?
I know that many students drink a little bit too much. There is always a high number of unreported cases of alcohol abuse in particular. Many people have an alcohol problem and drink too much, but do not stand out in any way, as in the example with the student. Because alcohol is established and tolerated in our society, we do not recognise many alcoholics at first. This is similar for students.
To what extent are students at risk of becoming alcoholics?
Nobody is born addicted. It is mainly a result of the environment. This can also easily happen with students. Because they can go to an environment where people like to party and alcohol is abundantly available. It used to be the same with students back in the day, except today illegal drugs are added. I believe that today many students are under pressure to perform, which they try to compensate with drugs. There are students who can only complete their studies with the help of drugs. I get the impression that not all students drink, but there are always some – 'the hard core'. Students used to like to drink and they still do today. Since alcohol affects all aspects of society, students are just as vulnerable as other demographics.
What are the typical consequences of alcohol addiction?
Initially, a distinction must be made between psychological and physical alcohol dependence. It starts with psychological addiction, the irresistible desire for alcohol. At first people are not prepared to admit it. For example, it may start with a quick drink after work: when I already start thinking at three in the afternoon about when I can finally drink my first beer? The psychological dependence is not noticeable at first. This psychological dependence evolves into physical dependence. In the morning you feel bad and need alcohol to get it together – these two factors provide an overall picture of alcohol addiction. It can take years to develop.
What is the difficult part of treating people with alcohol problems?
You have to motivate people to fight the disease. Most of our clients come to the counselling centre because they are referred by their physician, judge or partner, in other words, because they are forced to. It is important to motivate people to find their own solutions. Then it is also important to first determine the diagnosis of alcoholism and to confront the clients with it.
How do you recognise the onset of alcohol addiction?
When you have an irresistible desire for alcohol. If you decide not to drink and still drink because you start trembling in the afternoon, because you need alcohol.
How do you prevent it?
Alcohol dependence has to do with consumption. Controlled drinking is important. If you consume alcohol cautiously, the probability of becoming addicted to alcohol is relatively low. In other words, if you only drink a certain amount in a specified period. For example, it would be a good idea not to drink alcohol at all three times a week and then only 40 grams, i.e. about one and a half beers. I am not someone who thinks that alcohol should be banned, but it must be consumed in moderation.
What should be considered after parties, where too much alcohol was consumed?
If you drink too much once in a while, for example at the weekend, it is important for the body to have a longer recovery period, i.e. not to drink for about three weeks afterwards. Because alcohol is a massive poison. If the poison is taken in moderation and the body can recover, then it is still manageable and can be tolerated.
What can I do if I am worried about someone who drinks too much alcohol?
I recommend to talk to them privately and to say very clearly, 'Listen, I think you have an alcohol problem because ...' You should justify it with the things you have observed directly and say that you cannot help the person, but you know where they can get professional help. This may stir the person up a bit, because the conversation is probably unpleasant. After that you should always stay on top of it and ask if the person was already there to get help. It is not a disgrace to be alcoholic, but rather when nothing is done about it.
Thank you very much for the interview!
The questions were posed by Tim Ende.
Dr med. Stefan Gutwinski is the senior physician at the Charité Psychiatric University Hospital in the St-Hedwig Hospital in Berlin and head of the psychotropic substances research group. The psychiatrist or psychotherapist cares for people with various addictions. In an interview with the counselling centre, he talks about the effects of drug use and clears up prejudices.
Counselling centre: Which drugs do you deal with the most?
Stefan Gutwinski: most of the people we treat here have problems with the traditional substance groups such as alcohol, cocaine, heroin, benzodiazepines and barbiturates, amphetamines and cannabis. General consensus is that the importance of these drugs in the population has remained relatively constant in recent years. The use of cannabis, on the other hand, has increased in recent years, and new psychoactive substances are constantly being added.
Why do people take drugs? Have the motives changed over time?
I would say that the motives have largely remained the same. For some people, drug use is a kind of self-therapy to deal with stressful life events. For others, it is curiosity or everyday behaviour that lead to drug use. In regards to cannabis use, the inhibition threshold of the general population is likely to be lower for many people. Considering the fact that cannabis is still a relatively young drug, a relatively large number of people use it. This may be because the risks for most people appear to be assessable and almost everyone now knows someone who uses cannabis.
Are there any entry-level drugs?
It has not been scientifically proven that cannabis is a gateway drug. People who use drugs usually start with cannabis, but not all people who use cannabis automatically use other drugs. In general, a single time of using drugs, as many people do, does not automatically mean that you become addicted. There are exceptions, as in the case of heroin, for example, because it can happen that even a single drug use may lead to addiction. With almost all other drugs, it is more likely to be a process over several weeks, months or years before addiction develops. The sporadic individual use of most substances, on the other hand, does not end in dependence for most people.
What are the long-term consequences of drug use?
When psychoactive substances are used, long-term use is a particular problem. The single use of many substances designated as drugs in a typical dosage (i.e. not too high or contaminated) probably does not cause permanent harm to otherwise healthy adults, at least for a majority of substances. Someone consuming half a gram of cannabis once is unlikely to experience life-long adverse effects. All substances are dangerous if they are used continuously or by children, adolescents or people with mental disorders. The way in which the substance is supplied is also decisive for the type of physical effects. Cannabis is usually inhaled – resulting in increased rates of lung damage, for example. Continuous consumption of alcohol damages the oesophagus, pancreas and many other organs. In the case of heroin, contamination and infectious diseases caused by injections pose a particularly high risk. Moreover, almost all substances have specific secondary consequences. There are also psychological effects. Cannabis use can increase the probability of psychosis in humans. If children or adolescents smoke cannabis regularly, it is likely to affect their health and, in the long term, their intelligence.
In your experience, what percentage of students take or have taken drugs?
Drug use among students is roughly equivalent to the average population. This means that about a quarter of all students have had contact with drugs before.
How does drug consumption differ between students and other occupational groups?
There are only small shifts in comparison to drug consumption in the average population. Heroin use, for example, is lower, but cannabis use is slightly higher than in other social groups.
What role do performance-enhancing drugs play for students and what are the different types?
We are observing a slow increase in the prescription of amphetamine derivatives such as Ritalin, which are used to treat ADHD. In the area where people take performance-enhancing substances, people also use drugs that promote concentration or sleep-inducing substances that help people fall asleep more quickly and stay fit. Whether it actually leads to an increase in performance, especially in the long term, is probably not at all the case in otherwise healthy adults.
Can these substances become addictive?
Probably for some people. There is also a debate about whether the consumption of performance-enhancing drugs decreases the threshold for other addictions. Another question that should be asked during the discussion is whether it is fair to other students to write tests under the influence of substances. It is also a cultural question whether we can only achieve maximum performance of our society under the influence of drugs. And often, this is precisely the reason for substance abuse that has to be taken into account, because it is actually a sign of a great need when someone has to take substances in order to pass tests. The direct or indirect pressure coming from home, for example, must be extremely high. This debate, however, has many other facets with philosophical and sociological aspects that would go beyond the scope of this debate.
What does successful therapy look like today?
When it comes to therapy, you must first accept that relapses are part of the therapy process, because they are a learning process. Addiction therapy in general can only be successful if we understand the individual risk of the patient and integrate the willingness and need of the patient to stop the substance abuse into the therapy. For example, when a person from a violent parental home, who grew up in a children’s home and consumed alcohol daily for understandable reasons, starts treatment, it makes sense to understand these individual aspects. At the same time it is important to convey why addiction and consumption are still not helpful in the long term.
Thank you very much for the interview!
The questions were posed by Tim Ende.
Helmut A. Höfl is the general manager of the 'Marriage, Family and Life Counselling' service of the diocese of Passau. He specialises in relationship-based couple and family counselling as well as psychological life and sexual counselling. In an interview with the counselling centre, the 61-year-old talks about the consequences of excessive porn consumption, what effects it can have on relationships between two people and what successful treatment against online sex addiction looks like.
Counselling centre: what is online sex addiction?
Helmut A. Höfl: Online sex addiction is an uncontrollable desire to watch porn on the internet, which is mainly triggered by stressful tension and unpleasant feelings, and more rarely also by sexual desire. Porn consumption is strongly linked to the neuronal reward system, whereby addictive behaviour has a regulative and reinforcing effect.
How does this addiction start?
Same as with any other addiction, online sex addiction also has a feedback effect between stimulus and reward, which usually compensates for an inner void or tension. In addition to physiological satisfaction, the illusory reward is particularly pronounced in this type of addiction. Because of the way many films are made, the viewer has the feeling of being there live. Looking into the camera suggests that he is also targeted and that the actors 'love' him. When this threshold is crossed and consumers no longer distinguish between illusion and reality, then it becomes dangerous. Because online sex addicts look for their surrogate in internet pornography, their substitute for bonding and love relationships.
Who is particularly often affected? Is there a certain age group or target group?
The prevalence, i.e. the frequency of getting sick, is between 17 and 25 years for young men. Approximately 17% of German men watch porn every day, and around 500,000 people in Germany are internet sex addicts. Affected people are often under stress, feel pressure to perform under high pressure – and use the instant online reward for physical relaxation. Often online sex addicts fall victim to their own obsessive perfectionism – or possibly the exact opposite: disorganised personality. It often affects those who are alone a lot and are afraid or ashamed of the 'you' of a real love relationship. This addiction is thus usually a problem for people who avoid relationships under stress.
How does online sex addiction differ from other addictions?
The physical aspects of addiction can also be pronounced in online sex addicts – the physical and relational consequences predominate. Some people view porn many times a day and satisfy their own needs. Each time, relaxing and numbing messengers are released in the brain. After the mostly ritual consumption many feel empty and disappointed. The problem with online sex addiction: those affected do not regulate their needs for intimacy, security, excitement and exploration in real relationships and condition themselves to turn to porn when they are irritated. They see images that become harder and harder and trigger shame and self-reproach.
At what point can it be called an addiction?
When people affected by tension, frustration or lack of concentration begin to imagine pornography and to search for it as if under duress. Above all these videos must become more and more seductive with time and the pictures must become more extreme, so that the affected persons can even reach the orgasm threshold. The attraction of taboos naturally also plays a role; therefore, affected people can also be easily tempted to watch videos and pictures on the Darknet with taboo or particularly brutal practices.
How does online sex addiction effect couple relationships or the ability to build relationships of those affected?
Affected men seeking seek help report that their ‘normal’ sexuality is disturbed and that it is hard or impossible for them to achieve and erection during sex with their partner. More and more couples use porn for joint arousal or watch it during the act of making love. Some lose the desire to be close partners and prefer to satisfy themselves. The partners no longer feel desired or come under pressure to imitate the situations seen in porn. The subtle nuances of the game between 'desire/refusal/acceptance' give way to fast sex, in which people get objectified.
What does the treatment/therapy look like?
The most important thing is that those affected acknowledge that they are porn addicts. This first, important step is followed by the decision for abstinence. Addicts distance themselves from computers, tablets and smartphones, so that they no longer have the opportunity to access the internet. Thereafter, positive ‘analogous’ experiences are needed. Examples include brisk walks, to feel your own body, to sense your own needs. This is followed by regulation of emotions. Online sex addicts have forgotten how to control their tensions and moods without certain 'means'. The treatment includes self-observation, stress-regulation exercises, relaxation procedures and self-strengthening, e.g. through a diary, where successes are documented. Through deeper observation and distancing, affected people learn to control themselves and slowly see sexuality as a rich repertoire of relationship building.
What is the hard part of the treatment?
The difficult part is that there are phases in which those affected feel empty and do not believe that the newly learned techniques work properly. This is similar to smoking. Smokers are conditioned to reduce stress with a cigarette and to create a sense of pleasure and tranquility. Those affected have to learn to practise deconditioning – and not to give up if they relapse.
To what extent does shame play a role in the treatment of online sex addicts?
A very big one, because this topic is a very shameful one. It is never easy to admit addiction; many people are ashamed of not being able to control themselves. Many porn addicts use porn to compensate for shame and to counter negative feelings. It turns into a vicious cycle.
What can you do to prevent online sex addiction?
The best remedy in this situation is to establish relationships that provide security, where feelings are openly shared and needs are expressed. If you resort to porn, it must remain clear that this is the pretence of stereotypical patterns at the expense of abused and exploited actresses. The predictable artificiality of fake lust in the porn industry should be conscious. Your own imagination and the courage to invest in sexual relationships in body and soul is more helpful.
Thank you very much for the interview!
The questions were posed by Tim Ende.
EFL Counselling Centre Passau, Höllgasse 29, 94032 Passau. Tel.: +49 851 34337 (8:30 a.m. – 12:30 p.m.). Internet: www.efl-passau.de. Anonymous counselling is possible at the EFL counselling centre. If you suffer from sex addiction or have questions on this subject, please ask for an appointment with the head of the department, Helmut Höfl, and request anonymous advice.
Jens Molthan is a resident specialist for psychiatry and psychotherapy in Passau. In an interview with the counselling centre he talks about common causes of depression and how to avoid them.
What is depression?
The main symptoms of depression are a depressed mood, loss of interest, lack of joy, loss of drive, reduced energy, increased fatigue and often also loss of appetite. Sometimes suicidal thoughts also occur, and in severe cases a sick person may take his or her own life. A pessimistic future perspective, the feeling of worthlessness and reduced self-esteem are also part of the symptoms. Cognitive limitations such as attention and concentration deficits are often added. Some of the patients also complain about physical symptoms such as abdominal pain, tightness in the chest, lumpiness in the throat or headaches.
What are the common causes of depression?
Often several factors are triggers. Depressions may be caused by external events, such as certain life situations, misfortunes or work and study situations. It does not always have to be the result of special circumstances. Sometimes the combination of various burdens can simply become too much. Besides the high workload, burnout can also be impacted by other factors such as a stressful family or partnership situation. However, some patients may also be genetically predisposed. Moreover, learned thought patterns and the personality structure of the affected person can also play a role.
Who is particularly often affected by depression?
Depression and anxiety disorders are the most common mental illnesses. Depending on the survey, every 3rd to 10th person develops depression at some point in their lives; most studies assume that every 5th person develops depression. Statistically speaking, the proportion of women is higher, although in my experience women are also more likely to seek help and, after some examinations, the proportion of men increases. In terms of age, people over 50 are often affected. However, depression can occur in any age group. The study on adult health in Germany (DEGS1) found in the direct personal diagnostic examination that over 15% of women between the ages of 18 and 34 met the criteria for depression.
What is the difference between depression and an adjustment disorder?
The adjustment disorder is a psychological reaction to psychosocial stress factors. For example, if someone starts studying and then develops a mental disorder due to several factors (loss of the old circle of friends, higher demands or not coping with the new environment), this symptomatology is initially classified as an adjustment disorder. For example, this can be a depressive reaction, but also an anxiety reaction. If this symptomatology does not subside in a short period of time or if suicidal thoughts occur that inhibit social or occupational functions or the ability to study, then I recommend seeking help. Depression is the persistence of the symptoms mentioned at the beginning for at least 2 weeks. The severity of depression is classified according to the type and number of symptoms.
What types of therapy are available?
A basic distinction can be made between psychotherapy and drug therapy. Medicinal therapies may only be prescribed by physicians; the majority of antidepressants are not prescribed by psychiatrists, but by general practitioners. This is also due to the lack of availability of appropriate specialists and long waiting times for an appointment. Counselling and sometimes also psychotherapy is provided by counselling centres, such as the psychological counselling centre at the university, the social psychiatric service (located in Passau at the social welfare organisation), Caritas or other institutions. Within the health system, outpatient therapy is provided by psychological and medical psychotherapists, specialists in psychiatry and psychotherapy or specialists in psychosomatic medicine and, if prescribed by a physician, by specialised occupational therapists or nursing services. In Germany, outpatient care includes intensive psychology based psychotherapy, psychoanalysis and behavioural therapy. In the future, systemic therapy will also be approved and reimbursed by health insurance funds.
In addition to outpatient treatment options, inpatient or day clinic treatment in psychiatric or psychosomatic clinics is also possible. Other biological treatment methods, such as sleep deprivation therapy, light therapy, transcranial magnetic stimulation and electroconvulsive therapy, can also play a role in the treatment and are mainly initiated and performed by clinics. Access is usually triggered by general practitioners, specialists or psychotherapists. General practitioners are often the first point of contact for psychological problems.
What are potential problems during therapy?
A big problem is the lack of availability and the long waiting times at most places involved in mental health care. It is also not always easy for the affected person to find the right treatment option that is suitable for him or her, since, for example, the first appointment with the psychiatrist cannot be made very quickly. A psychiatrist can perform a professional diagnosis and explain the treatment options. He knows the people and institutions involved in the care and can also provide psychotherapeutic and medical treatment himself. Psychotherapists can also provide the indication for psychotherapy or other forms of treatment, e.g. within the framework of psychotherapeutic emergency consultation. In this context I would like to point out that the term psychotherapy is not protected and therefore not only doctors and psychologists with the appropriate classification operate under this term, but also completely different practitioners with very different qualifications and training. Accordingly, treatment does not always measure up to scientific criteria.
A variety of problems can occur during the treatment, like reduced or no effect as well as side effects of all possible therapy forms (even psychotherapy can have side effects); the therapy must then be changed or adapted. Unfortunately, the effect of most therapies does not start immediately, so that patience is required from patients and relatives.
What is the best way to protect yourself against depression?
A good work/life balance and a strong social network are important. It also makes sense to look for signs of an onset of depression, and then to consider whether you can take countermeasures yourself or whether you should seek professional help right away. Ignoring the first signs of mental illness is certainly a great risk, which even happens to experts, according to the motto: ‘That will never happen to me.’
If you know someone who is depressed, what is the best way to deal with them?
If you notice that someone might be depressed, I would ask them about my observation if the relationship allows it. Generally, most mentally ill people prefer to be treated normally. There are people who deal with their illness very openly while others do not. With the latter you have to accept that. If those affected accept help, it can be useful to motivate and praise them and thus help them. This can only be accomplished with intuition and in consultation with those affected. If an outsider notices that a friend or partner is not well and that something is wrong, it is OK to talk about it calmly and see how the person reacts. In rare cases, such as acute suicidal tendencies, it may also be necessary for relatives or friends to contact a physician, an outpatient clinic, hospital or the emergency medical service directly.
Is depression a widespread disease today?
As mentioned above, depression is a very common disease. Statistics by the health insurance companies show a clear increase in the number of diagnoses of depression as well as an increase in the number of sick days due to these diagnoses. Mental health issues and especially depressive disorders are the leading causes. Epidemiological studies often show no serious increase but also a high proportion of depressive disorders in the population. That is why it is applicable to call it a widespread disease. The fact that depressive disorders and other mental illnesses are gaining public awareness is very important for the de-stigmatisation of mental illnesses, which also increases the willingness to be treated and to make use of appropriate assistance programmes. It would be desirable to adapt the health system and also complementary assistance programmes to the increased demand. I also believe that preventive services should be expanded and that it should be possible to eliminate common causes of mental illness, such as excessive stress during vocational training and at work or constant overload.
Thank you very much for the interview!
The questions were posed by Tim Ende.
Claudia Heuschneider, 52, is a specialist in psychiatry and psychotherapy and worked for over 20 years at the Mainkofen District Hospital, a specialist clinic for psychiatry, psychotherapy, psychosomatics and neurology. Now she is the chief physician at the Passau District Hospital and talks in an interview with the counselling centre about prejudices of psychiatric treatment and gives insights into her everyday life.
Counselling centre: The Passau District Hospital has a 'psychiatric outpatient clinic' – what does that mean?
Claudia Heuschneider: Here we have various facilities that are operated under one roof. One is the inpatient area, where patients are treated as inpatients, and the so-called institute outpatient clinic, which functions similarly to a specialist practice for psychiatry and psychotherapy. The difference is that the patients who come to the institute outpatient clinic are usually seriously and repeatedly psychiatrically and physically ill, so that they cannot be treated sufficiently in the normal specialist practice. The special thing about this form of treatment is that it is more comprehensive. For example, social education workers and nursing staff visiting the patients at home are also included.
What other forms of treatment are there?
We are a general psychiatry and treat all psychiatric conditions. We have a total of 60 inpatient beds and 30 day clinic beds. Due to this small size, we reach our limits despite our efforts to treat all psychiatric diseases. For example, as far as the treatment of severely aggressive patients is concerned, because we are not equipped for this in terms of structure and personnel. Even a planned withdrawal of opiates is not possible with us. Otherwise, we treat all diseases such as addictions, depression, schizophrenia and anxiety.
What is the treatment in the day clinic like?
The programme in the outpatient clinic begins at 8 a.m. in the morning and ends at 4 p.m. in the afternoon. The patients spend the evenings and weekends at home. During the time in the day clinic a broad programme is offered. It starts with a morning round to see how the patients in the group are doing. In the morning there are further rounds of talks, individual talks and therapies such as occupational therapy. Patients can also do sports here. In between there are always breaks in which the patients can let the treatment have an effect on them. The biofeedback method, i.e. the measurement of physical reactions in patients with psychosomatic, i.e. psychologically conditioned physical problems, has proven helpful in the day clinic. The day clinic also serves to make it easier for patients who have been in hospital for a long time to return to everyday life.
Is the fear of psychiatric treatment still great in our society?
They still exist. Although I have noticed that the hurdle of the use of psychiatric treatment has fortunately decreased in the last 20 years. In Mainkofen, where I worked for a long time and where severely depressed people are treated over a longer period of time, the issue of how to deal with the treatment afterwards often arose before a patient was discharged. Patients thought about what they could tell other people where they had been for so long. Many patients told me afterwards that they were very surprised how little they were stigmatised. But that they were approached and often treated with understanding. It was not uncommon, for example, for neighbours to reveal themselves with sentences such as 'I was also feeling bad at times, I or my relative had to seek treatment from time to time'. One notices that the educational work of the last years is having an effect.
Are there still taboos and prejudices against psychiatric treatment?
Fortunately, the taboo is decreasing. A prejudice that in psychiatry 'only medications are administered' holds itself with a great tenacity. In fact, medication is a very important pillar of treatment for some illnesses and is often indispensable. In schizophrenia, for example, treatment without medication is hardly possible. And even with severe depression, it will not be possible without medication. A lot of educational work is often necessary to motivate people to take the medication and to explain to them that it is necessary to bring the patients back into a state in which they can consciously deal with their problems. The fact that a person has developed a mental illness has nothing to do with personal failure or weakness.
Why is it that most people do not talk about their mental illness or that they have been treated?
In mental illnesses, a lack of knowledge about the illnesses is often a problem that leads patients to look for guilt in themselves and convince themselves that they were 'not strong enough' and are therefore ill. This is something one would rarely do with a physical illness. Mental illnesses, like physical illnesses, are often just 'fate'. For the most part, it has nothing to do with the life one has led. These self-reproaches and the feeling to be to blame, could be reasons, why many concerning do not speak openly about their illnesses.
When is someone considered sick?
The spectrum of normality is very wide. This means that what one person would call sick is still normal for the other. I think that not everything that happens in the course of a lifetime should be considered pathological. Because there will always be times when you are not able to perform or when you feel bad. That is not the same as depression or illness. It is difficult to draw the line sharply between what is sick and what is not. Doctors and therapists use here the international classifications, in which the symptoms are compiled and according to which illnesses are diagnosed then.
Topic Anxiety States: When is anxiety still normal and when does it become so strong that it should be treated?
A very important point is the question: To what extent does fear affect me in my everyday life? How does it prevent me from doing the things I want to do? There are many people who have fears in their daily lives but have learned to cope with them. However, if these fears spread in such a way that you avoid many things or no longer leave the house, then the need for treatment has been reached.
Do such mental illnesses develop continuously or do they occur suddenly?
Both. Fear is something very natural and important. It protects us and keeps us alive. People without fear have great problems in their way of life. These people are often more affected than people who can feel fear. There are times in life when people suddenly develop fears in certain situations. But there are also gradual developments.
Are such and other mental illnesses genetically predisposed?
There are multifactorial reasons for mental illnesses, similar to physical illnesses. Genetics, i.e. inheritability, is one of them. There is no gene coding for certain psychiatric diseases. But a certain 'vulnerability' or susceptibility, for example to react anxiously or depressively to certain things or life situations, may also be genetically determined. However, there are also family role models, especially for fears. A very anxious mother can cause the development of her own anxiety disorder if there are other causes. The highest genetic proportion is found in bipolar disorders, i.e. manic-depressive illnesses. Nevertheless, even with these severe diseases the genetic proportion is not so high that one would advise these persons not to start a family.
What diseases do students often have to deal with?
Since mental illnesses do not take occupational groups into consideration, we also treat students with a wide variety of mental illnesses and problems here. We have students who develop psychosis, sometimes substance-related psychosis or who come to us because of a depressive illness or an anxiety disorder. In the day clinic we have students from time to time who come because of psychosomatic illnesses.
What are the causes of these diseases?
In the day clinic there are more often students who are generally a little more anxious, who have exam anxiety and are generally insecure. The fact that some of them are far away from home and have to get used to a lot of new things: independence, studying, which is perhaps more complex than expected, housekeeping, unexpected contact difficulties. This can lead to fears and depressive moods.
What would be a first step if you noticed that you are not doing well, that you are no longer going to exams and are withdrawing more and more and want to change something about it?
Those affected are welcome to contact us directly and obtain information about the day clinic and the corresponding treatment options. In addition to the psychological counselling centre at the university, the general practitioner is also a good first point of contact. He is able to assess the extent of the problem and decide whether the patient needs light medication, psychological support or psychiatric treatment. In principle, one should not be afraid of psychiatric treatment, because the prejudice that one is 'stuffed with medication' in psychiatry is certainly not true. We attach great importance to discussing the therapy options with the patient and defining the most helpful strategy so that the person can get better as soon as possible, sometimes including medication.
Thank you very much for the interview!
The questions were posed by Tim Ende.
Jörg Stadler is the head of the mental health counselling centre at Diakonie Passau, which is responsible for the city and district of Passau. About 7% of people seeking counselling who come to him every year are relatives of mentally ill people. According to Stadler, some of the people seeking help have diffuse problems – it is only in conversation that it becomes clear that the problem results from the mental illness of a loved one. In an interview with the counselling centre, the 61-year-old talks about the effects of mental illnesses on interpersonal relationships and gives relatives tips on how to deal with the illness of their loved ones.
Counselling centre: how can I recognise if someone is not well and that they may be mentally ill?
Jörg Stadler: especially changes in people’s behaviour. There are usually two patterns that can indicate the onset of an illness. One pattern is when someone withdraws for a longer period of time, his reactions change, e.g. when he becomes more sensitive, more anxious or easily irritable. The other pattern usually involves someone getting very excited, being preoccupied with irrelevant matters, being overly active or exhibiting exaggerated sexual behaviour. This may indicate psychosis or bipolar disorder. If both patterns occur or one of them occurs repeatedly over a period of two weeks, extreme caution is required.
When should the problem be addressed?
Sooner rather than later. Even if it turns out afterwards that it was not depression, but rather just a depressive mood, relatives show compassion and understanding. The key is to always address the problem openly and honestly and with respect. This is not the place for accusations. Furthermore, it is advisable to speak from the heart instead of reiterating what others observed.
What is the best way to address the illness of a family member?
Just like that, with respect, transparency and honesty. Actually, there should be a great deal of mutual understanding and trust within the family, which should make it easier to address problems. Examples could be when a father becomes depressed and is no longer interested in his daughter’s studies or when a mother reacts excessively anxiously when moving out. Those affected should first make it clear to themselves that this behaviour is not directed against them. It may be difficult not to take it personally in cases like these examples, but it is enormously important to be able to help the family members.
How do I treat someone who is mentally ill?
Actually, not any different than before. First, you should determine how close you are to the person, for example, whether you are dealing with your own partner. The effects of the illness are also an enormous burden for oneself, which should be acknowledged. Mental illnesses have a very strong impact on people’s relationship skills. Again, this requires transparency, honesty and appreciation in dealing with each other. Well-intended tips and advice are usually not very helpful. Sick people do not behave strangely because they want to, but because they cannot help it.
How can one help?
The first step: to find out more about the disease. In other words, how the disease will progress, what the symptoms are and what the treatment looks like. After all, if the relatives know about it, they also have a better understanding of the sick person’s situation. Talking openly about the disease can help the patient accept it. Furthermore, people can support activities initiated by the patient, i.e. if the patient wants to go for a walk.
Where does a person’s own responsibility towards a mentally ill person begin and end?
I think there is no way to get out of assuming responsibility, precisely because mental illnesses have an enormous (negative) impact on living together. If you want to change something about it and hold onto the relationship, you will most likely address the problem. Although everyone is responsible for themselves, the key is to work together on a relationship.
To what extent can the patient be monitored during treatment?
Assuming that the relatives have informed themselves sufficiently about the illness, they can talk about the therapy and medication and exchange information about whether the medication is well tolerated or whether it was taken correctly. It is important to establish a common foundation so that the care is more readily accepted by the patient.
When does care become too much of a burden for relatives?
I think you can tell quite quickly. Relatives should always ask themselves the question: how much of my own life do I have to put aside to take care of the mentally ill person? If it takes up more than 30% of your life, it becomes difficult. The mood can then possibly turn into aggression against the sick person. Then you should ask yourself: is this commitment still appropriate? If this is not the case, then it is time to look for help. Self-help groups have proven to be very effective because it is good to know how others deal with a similar situation.
What is there to consider when living with someone who has recovered from a mental illness?
Again, it is very important to talk openly. It is also helpful to ask the previously ill person about their ideas for living together in the future, i.e. whether there is something special to consider or how to deal with each other. Furthermore, it would be good to understand and recognise the stress limits of the recovering person to avoid unintentionally exerting unnecessary pressure with certain suggestions for activities.
Thank you very much for the interview!
The questions were posed by Tim Ende.
Dr Gabriele Pinkl, 51, is a social education worker and acts as a mediator and counsellor for marriage, family and life counselling in the diocese of Passau. In an interview with the counselling centre, she talks about interpersonal relationships, the difficulty of choosing a partner and formulates her thoughts on how those affected can deal with a separation.
Counselling centre: What are love and affection important for people?
Gabriele Pinkl: Humans are a social beings. Without social contacts and without a loving counterpart, the person withers away or dies. We know, for example, the situation of children who grew up in orphanages in then dictatorial Romania and were merely cared for, fed and washed and who otherwise had no affection. The consequences were irreparable. Some children have died or suffered severe mental disabilities. As a child, the nerve tracts interconnect. It is necessary to be stroked and lovingly treated so that this interconnection works properly.
So this means for parents to give their children boundless love?
Toddlers are still in the process of development and must therefore first learn that we need love and affection. They must learn to accept this love and affection and they must learn that it cannot always exist. The fact that someone cannot always be the centre of attention and that there are phases in which one can cope alone. In infatuation these experiences learned as a child are reactivated.
What does partnership mean to you?
We need relationships for a fulfilled life. Relationships to our parents, to our siblings, to our friends. We also long for close, intimate relationships, relationships that are understood as couple relationships. This always has something to do with exclusivity: the two of us and nobody else. But that is only possible to a limited extent. No one can ever replace the whole world. Because this idea is deceptive. For me, partnership generally means human coexistence. To support each other, to experience meaning, to satisfy needs. You should always look at what your partner can and cannot give you and how to deal with it.
How do you find a good partner?
I think that is where the miracle of the world begins. When clients come to us for advice and ask this question, I ask them what they do to find a partner. Where do you get in touch with people? Where do you give the miracle of encounter a chance? And are these realistic chances? Because sometimes people stand in their own way and limit themselves in the choice of partners. Then you should see where they are trapped and why their ideas are so narrowed down.
What do you think of dating portals like Tinder?
I think this is a chance to use things we have today. People used to meet, for example, at the country youth ball. Today we live in a pluralistic society and not all people of the same age gather in one place. You have to figure out where to meet like-minded people. A portal can be helpful here. But I think you should first check things out in the analogue world. Because love must always be lived analogously. If you know, for example, that you are more into sports people, then you can go to a sports club and search there. The problem with the Dating portals is – so I experience it in the consultation often – that many humans with too large hopes into such portals plunge and then are disappointed. Because what we partly do in these portals – to create the allegedly perfect partner – has often virtually arranged similarities with 'arranged marriage' here for me, and I do not think so much of that.
Is there really love at first sight?
I know people who say that. I rather believe in the fascination at first sight. Then anything can happen. Opinions can change and you ask yourself what attracted you to the other person. It can also go the other way round – love at second glance. Someone did not notice you before and then suddenly did.
Does 'friends with benefits' work?
In a pluralistic society we have more possibilities and that includes casual sex. If it works, ...? But many are very unhappy with it because it did not work out the way they imagined it would. Many mourn other opportunities that they have neglected as a result. Everyone must ask themselves: What do I expect and can I get it from such a relationship? Do we dare to invest in something and let love grow? Because love is also based on friendship; you must not forget that.
How do you cultivate a partnership, how do you maintain a good relationship?
As a church, we naturally have a special opinion about marriage and thus about relationships based on partnership. Church marriage is based on permanence, commitment and exclusivity. In a relationship commitment, time, attention and devotion are important. If you do nothing to nurture and grow the relationship, it withers. When I lament that there are no romantic occasions, but do nothing to meet people, I need not wonder if it does not work. In a partnership two people live together, but they have different lives. That is why you always have to make a date to meet up. To exchange tenderness or just to talk. You should negotiate how much time your partners need for each other. One may want to spend less time with the other, the other more. Because even if you live together as a couple, that does not mean that you really spend time together.
If something disturbs you in a relationship, how do you address it?
Everything in human coexistence has to be negotiated. How do you want it, how do I want it? Do we have breakfast together or not? Which sex do we have and when? Do we have children together? I tell my clients: help each other and say what you want before there is frustration. Living together in a relationship consists of compromises that have to be negotiated. You have to create room for manoeuvre, but you also have to plan time together.
If there is a separation, how do you deal with it? How do you let go?
If the separation does not take place by mutual agreement, frustration, sadness and anger arise. I mean, you cannot force anyone to love. You can give love a chance and try again. But if a person does not want to keep going, then it does not work. So when it comes to separation, I recommend: Give your grief space and time. Look for conversation partners with whom they can talk about it, with whom they can be sad. Avoid friends who say 'It wasn’t worth it anyway'. What value we give a person in our lives cannot be determined by others. Mourning should be given appropriate space. If it is not lived through, grief will catch up with you at some point. Counselling centres can help.
Thank you very much for the interview!
The questions were posed by Tim Ende.
Sabine Eggersdorfer is the head of the Lower Bavaria Aids Information and Counselling Centre. The institution, which is run jointly by the social welfare organisation (Diakonie) and Caritas and is responsible for all of Lower Bavaria, is celebrating its 30th anniversary this year. In an interview with the counselling centre, the 39-year-old talks about the risks of unprotected sexual intercourse, the prejudices prevailing in society about HIV and how people can protect themselves from infection.
Counselling centre: what is safe sex and what is not?
Sabine Eggersdorfer: safer sex is when people do not come into contact with potentially contagious body fluids during sexual intercourse, i.e. when the risk of infection is low. That would be the case with oral intercourse or foreplay. And of course during sex with a condom.
How do you protect yourself effectively against sexually transmitted diseases?
By practising safer sex. Using a condom offers the best protection. Apart from that, sexual partners can also pay attention and look for blisters in the genital area and then avoid sex or use a condom. In order to prevent sexually transmitted diseases, normal body hygiene with frequent showers and washing is also important.
Are there sexually transmitted diseases that are on the rise again?
We are observing a slight increase in cases of hepatitis C and syphilis. However, these are periodic fluctuations that occur over and over. With HIV, the number of newly infected people has fallen to just under 3000 a year. This is mainly due to the great preventive efforts carried out in Germany.
What is the best way to address the topic of prevention/protection in a new partnership or 'friendship with benefits'?
Actually you should always use a condom during sex at the beginning of relationship, regardless of how much you trust your sexual partner. Because sexually transmitted diseases are not visible on the affected person, there is always a risk of infection. In a partnership or among 'friends' you should talk openly about the subject. Some couples also take the HIV test together at the beginning of their relationship. It is possible that the infected person does not even know about their illness.
What is HIV/AIDS?
HIV is the virus you get infected with and AIDS is the disease that breaks out due to the virus infection. It destroys the immune system of those affected so that they can no longer protect themselves from external diseases. It can take 10 to 12 years for AIDS to break out. Due to the great treatment possibilities in Germany, AIDS hardly ever breaks out nowadays.
How do you get infected? What are the myths about infection?
Infectious body fluids (blood, sperm, vaginal fluid and breast milk) can penetrate the body through pressure or friction through mucous membranes or open wounds. The virus cannot be transmitted through spit, bleeding gums, shaking hands or sharing dishes.
Which groups are particularly at risk of contracting HIV?
Especially homosexual men, because intestinal mucosa is very sensitive and absorbent, so that there is a high risk of infection during unprotected anal intercourse. A small group of drug addicts who use the same syringes are also exposed to an increased risk. However, the entire spectrum of society is represented in our counselling centre.
If I had unprotected sexual intercourse and are unsure whether you have contracted it, where can I get help?
If there is reason to believe that the sexual partner after a one-night stand is HIV-infected, there is a kind of 'morning-after pill' that can be prescribed by a doctor and taken for four weeks. It is highly important to take the pill no more than 48 hours after sex. That is why it is best to go to an infectiologist or hospital. In Passau the hospital would be a point of contact.
How much does an HIV test cost?
It is free at the health department. In case of a justified suspicion, it can also be obtained free of charge from the doctor, depending on the health insurance company. Otherwise, it costs approx. 25 euros. We are currently advocating the introduction of home tests, which patients can order themselves and carry out at home. I believe that this procedure helps lower the inhibition threshold to take the test, because some people simply do not dare to go to the doctor.
What are the treatment options for HIV today?
Being HIV-positive no longer means a death sentence today, as was the case at the beginning of the 1980s, when the disease first appeared. Today there are such good medicines that infected people can expect a normal life expectancy and lead a normal life with work and family. However, the medication must be taken regularly for the rest of their lives.
Are there still prejudices and stigmatisations against people infected with HIV today?
Even though a lot of changed happened in the medical field, there is still a lot of exclusion and rejection on the social level. But this often has to do with a lack of social awareness. Some patients refuse to be treated by medical staff who are HIV-positive. Or worried mothers do not want to give their children to another HIV-positive mother to play, because they are afraid that their own child could become infected. The prejudices often result from fears that are mostly unfounded. By contrast, however, the fear of discrimination among HIV-infected people is usually greater than the discrimination they actually encounter. Essentially, it depends on the environment. In rural areas, infected people are more likely to conceal their disease than in urban areas.
Thank you very much for the interview!
The questions were posed by Tim Ende.
Dorothea Siller, 56, is a retired special needs teacher and is currently studying History at the University of Passau. She has approximately 30 years of professional experience as a special needs teacher and talks in an interview with the counselling centre about strategies for learning success, how to motivate yourself and how to overcome inner resistance.
Counselling centre: ‘Learning to learn’ – what does that mean?
Dorothea Siller: in short, it means learning to learn. In the context of school learning means acceptance and processing of new educational contents and experiences (this aspect also applies to a university education). They should be memorised according to plan and, depending on the need, committed to short or long-term memory, and should be retrievable based on the situation. This requires a couple of learning techniques, a balance between tension and relaxation for regeneration and ‘post-processing’ in the brain. Everyone should therefore become aware of the learning process and reflect on it.
Are there different types of learning and how do they differ?
There are six types of learning in specialist literature, but they rarely exist in their pure form. The six learning types are a pedagogical construct and refer to the acquisition of information in a school environment. They help as a first criterion to become aware of one’s own actions. A distinction is made between these learning types:
- a) the auditory learning type learns his vocabulary more easily when he hears it or speaks it out loud
- b) the visual learning type remembers contents of graphics and mind maps better than from texts or breaks texts down into smaller units
- c) the motor learning type needs more interactive action, e.g. memorise while walking or carry out experiments
- d) the communicative learning type strives through exchange with others, through speaking and listening
- e) the personal learning type needs a good teacher/role model who is there for him throughout the learning process
- f) the media-oriented type of learner can more easily extract virtual content from the media, using learning software and technical devices to monitor knowledge
How do you learn independently, without instructions and teachers?
- Identify your individual learning type and use it appropriately.
- Work as multisensory as possible, i.e. include several senses instead of just looking at your notes (read aloud, make index cards)
- For example, you can try out a few learning strategies for one or two weeks. If it works, keep them and expand them. If not, try another one.
- Accept your own biorhythm. Get away from the idea of 'working hard during the week – partying on the weekend'. The latter causes learning and liver stress. It is better to enjoy social contacts after work during the week and on weekends in a balanced way and to incorporate rest, silence and doing nothing.
- Find a quiet workplace for yourself. If possible, always use the same or similar location (for example, the library). Because the brain likes constants.
- Use your mobile phone moderately. Be conscious about taking some time for social media contacts and running errands, then put it away or switch it to flight mode.
How do you develop your own learning system?
You must learn more about yourself (learning type, biorhythm, duration of the ability to concentrate, etc.) and learning strategies that really benefit you. Different subjects require different strategies (memorising facts, calculations, transfer questions, etc.). Depending on the programme, you will receive good information from your student committee. Find team players who are happy to exchange ideas with you. Ask for a psychological consultation at our university, which also offers questions on the learning organisation. And there is a wealth of literature on learning strategies that you can try out.
How long does it take to learn systematically?
Start with baby steps. Take one to two weeks to try out a new strategy/weekly plan. ‘Mistakes’ are the best lessons because they show you the potential for change. It is generally assumed that the brain needs about six to seven weeks to change behaviour patterns if a person applies it consistently every day in order to develop new structures. Afterwards it is necessary to consolidate them through continued practise.
How do you avoid distractions?
Become increasingly aware of when procrastination or your 'inner couch potato' overwhelmed you again. Make a deal with him. So, envision rewards after the exercise or at the end of the day. Be kind to yourself instead of reprimanding yourself. Stay focused on your goal when you schedule a distraction-free lesson (start with small units and increase them slowly).
How much learning per day/week is healthy or useful?
There is no general answer or formula to this question, as there are individual differences between people. It continues to be important to keep an eye on your mental and physical health on a daily basis. There are people with a stronger urge to move than others, people with more need for communication than others, people with more need for silence than others. Useful here means fulfilling the required scope of services. For me, knowledge is an enormously exciting thing. But allow yourself to also skip a few things here and there. People who always give it a 100% and go above and beyond, inevitably have to make sacrifices in other areas.
You are a trained special needs teacher. Which experiences at school are transferable to the university?
The fact that both are types of schools, just at different levels, says it all. Although the requirement level for learning content and language, whose quality and quantity is considerably higher, although they are for adult students, two constants remain the same: the learning process and the human being as more or less the absorber in all his or her individual abilities. In this respect, many learning strategies that have been booming in our country since the 1990s in terms of continuing professional development and on the book market can certainly be applied or transformed to a university level.
What is the best way to get motivated when you do not feel like studying?
In the best case scenario, hard work is the result of an intrinsic motivation that leads to flow. Manfred Spitzer claims that people are motivated to discover new things. Boredom, unwanted results or failures can dampen motivation. We also generate extrinsic goals like 'I need/want this degree so I can lead a comfortable/good life' that motivate us to learn. But the brain does not feature an on/off function like a machine. It takes time to rework, rethink and relax. Sometimes taking a walk is enough, sometimes half a day away from the desk, a regular sports activity, sometimes a weekend with distant friends. In my experience, I can say that the more disciplined you are about taking breaks throughout the day and a conscious relaxation routine at the end of the day, the less episodes of total exhaustion arise. The latter require a longer recovery and remotivation phase.
Thank you very much for the interview!
The questions were posed by Tim Ende.