What do you say to people who ask if you’ll eventually stop taking medication?
I say to people that they don’t expect a diabetic to stop taking insulin, or someone with a heart condition to stop taking blood thinners. I have a chronic, lifetime disease and the only responsible thing for me to do is stick with my medications.
People wonder about medications’ long-term effects on the brain. I explain that while the medications’ effects appear to be reversible as soon as you stop taking them, the long-term effects of having repeated depressive episodes appear to be absolutely dire. There is lesioning of the hippocampus, and brain cells die. And this is in addition to the havoc that such repeated episodes cause in your daily life.
Imagine you have heart disease. You’re prescribed medication, you do better for a while, so you stop the meds. Then you have another heart attack, so you go back on the medication to get better. Twelve heart attacks later, what kind of shape are you in? It’s obviously crazy. If you have recurrent depression, you are not being “courageous” or “genuine” to go off your medication. You’re being foolish.
Can you explain the importance of balancing therapy and medication?
Different treatments work for different people, and I am open to the endless possibilities out there. But for most people, a combination of medication and therapy is the surest-fire way to handle depression.
The medication alleviates the worst symptoms and lets you function again. It makes life and the world bearable. But once you have emerged from the horror, you need to learn skills for managing the illness. You need to understand where it comes from. You need to make your peace with the idea that you cannot be fully yourself without the use of medications or other support structures.
And you need someone capable who can keep an eye on you. Ideally, you also need to understand the structure of your own personality and who you are; this gives you a feeling of peace and allows you to get through a difficult time with dignity.
By his mid-twenties, Solomon established himself as a multi-disciplinary wunderkind, earning international accolades for his work as a novelist, journalist and historian. After the death of his mother, the then 31 year old Solomon descended into a major depression, rendering him unable to work or even care for himself. He was helped by a combination of medications and talk therapy. This experience formed the bedrock for his National Book Award-winning “Noonday Demon: An Atlas of Depression”, a tour de force examining the disorder in personal, cultural, and scientific terms.
From an article in Christianity Today, February 9, 1998
“The only army that shoots its wounded is the Christian army,” said the speaker, a psychologist who had just returned from an overseas ministry trip among missionaries. He summed up the philosophy of the group he worked with as:
1. We don’t have emotional problems. If any emotional difficulties appear to arise, simply deny having them.
2. If we fail to achieve this first ideal and can’t ignore a problem, strive to keep it from family members and never breathe a word of it outside the family.
3. If both of the first two steps fail, we still don’t seek professional help.
I have been a Christian for 50 years, a physician for 29, and a psychiatrist for 15. Over this time I have observed these same attitudes throughout the church—among lay leaders, pastors, priests, charismatics, fundamentalists, and evangelicals alike. I have also found that many not only deny their problems but are intolerant of those with emotional difficulties.
Many judge that others’ emotional problems are the direct result of personal sin. This is a harmful view. At any one time, up to 15 percent of our population is experiencing significant emotional problems. For them our churches need to be sanctuaries of healing, not places where they must hide their wounds.
THE EMOTIONAL-HEALTH GOSPEL
Several years ago my daughter was battling leukemia. While lying in bed in the hospital, she received a letter, which read in part:
Dear Susan, You do not know me personally, but I have seen you in church many times….I have interceded on your behalf and I know the Lord is going to heal you if you just let Him. Do not let Satan steal your life—do not let religious tradition rob you of what Jesus did on the cross—by His stripes we were healed.
The theology behind this letter reminded me of a bumper sticker I once saw: “Health and Prosperity: Your Divine Right.” The letter writer had bought into a “healing in the atonement” theology that most mainstream evangelicals reject.
According to this traditional faith-healing perspective, Christ’s atonement provides healing for the body and mind just as it offers forgiveness of sins for the soul. The writer meant well, but the letter created tremendous turmoil for my daughter. While evangelicals have largely rejected “health and wealth” preaching—that faithful Christians will always prosper physically and financially—many hold to an insidious variation of that prosperity gospel. I call it the “emotional-health gospel.”
The emotional-health gospel assumes that if you have repented of your sins, prayed correctly, and spent adequate time in God’s Word, you will have a sound mind and be free of emotional problems.
Usually the theology behind the emotional-health gospel does not go so far as to locate emotional healing in the Atonement (though some do) but rather to redefine mental illnesses as “spiritual” or as character problems, which the church or the process of sanctification can handle on its own. The problem is, this is a false gospel, one that needlessly adds to the suffering of those already in turmoil.
This prejudice against those with emotional problems can be seen in churches across the nation on any Sunday morning. We pray publicly for the parishioner with cancer or a heart attack or pneumonia. But rarely will we pray publicly for Mary with severe depression, Charles with incapacitating panic attacks, or the minister’s son with schizophrenia. Our silence subtly conveys that these are not acceptable illnesses for Christians to have.
The emotional-health gospel is also communicated by some of our most listened-to leaders. I heard one national speaker make the point that “At the cross you can be made whole. Isaiah said that ‘through his stripes we are healed’ … not of physical suffering, which one day we will experience; we are healed of emotional and spiritual suffering at the cross of Jesus Christ.” In other words, a victorious Christian will be emotionally healthy. This so-called full gospel, which proclaims that healing of the body and mind is provided for all in the Atonement, casts a cruel judgment on the mentally ill.
Two authors widely read in evangelical circles, John MacArthur and Dave Hunt, also propagate views that, while sincerely held, I fear lead us to shoot our wounded. In his book “Beyond Seduction”, Hunt writes, “The average Christian is not even aware that to consult a psychotherapist is much the same as turning oneself over to the priest of any other rival religion,” and, “There is no such thing as a mental illness; it is either a physical problem in the brain (such as a chemical imbalance or nutritional deficiency) or it is a moral or spiritual problem.”
MacArthur, in “Our Sufficiency in Christ”, presents the thesis that “As Christians, we find complete sufficiency in Christ and his provisions for our needs.” While I agree with his abstract principle, I disagree with how he narrows what are the proper “provisions.” A large portion of the book strongly criticizes psychotherapy as one of the “deadly influences that undermine your spiritual life.” He denounces “so-called Christian psychologists and psychiatrists who testified that the Bible alone does not contain sufficient help to meet people’s deepest personal and emotional needs,” and he asserts, “There is no such thing as a ‘psychological problem’ unrelated to spiritual or physical causes.
God supplies divine resources sufficient to meet all those needs completely.” Physically caused emotional problems, he adds, are rare, and referring to those who seek psychological help, he concludes: “Scripture hasn’t failed them—they’ve failed Scripture.”
A PLACE FOR PROFESSIONALS
When adherents of the emotional-health gospel say that every human problem is spiritual at root, they are undeniably right. Just as Adam’s fall in the garden was spiritual in nature, so in a very true sense the answer to every human problem—whether a broken leg or a burdened heart—is to be found in the redeeming work of Christ on the cross. The disease and corruption process set into motion by the Fall affected not only our physical bodies but our emotions as well, and we are just beginning to comprehend the many ways our bodies and minds have been affected by original sin and our fallen nature. Yet the issue is not whether our emotional problems are spiritual or not—all are, at some level—but how best to treat people experiencing these problems.
Many followers of the emotional-health gospel make the point that the church is, or at least should be, the expert in spiritual counseling, and I agree. Appropriate spiritual counseling will resolve issues such as salvation, forgiveness, personal morality, God’s will, the scriptural perspective on divorce, and more. It can also help some emotional difficulties. But many emotional or mental illnesses require more than a church support network can offer.
I know it sounds unscriptural to say that some individuals need more than the church can offer—but if my car needs the transmission replaced, do I expect the church to do it? Or if I break my leg, do I consult my pastor about it? For some reason, when it comes to emotional needs, we think the church should be able to meet them all. It can’t, and it isn’t supposed to.
This is why the emotional-health gospel can do so much harm. People who need help are prevented from seeking it and often made to feel shame for having the problem. Thankfully, more and more people in the Christian community are beginning to realize that some people need this extra help. If professionals and church leaders can recognize the value of each other’s roles, we will make progress in helping the wounded. Forty percent of all individuals who need emotional help seek it first from the church, and some of these will need to be referred to mental-health professionals.
Church leaders should get to know Christian therapists in their communities so they can knowledgeably refer people with persistent emotional problems.
“The heartfelt counsel of a friend is as sweet as perfume and incense.”
Proverbs 27:9, NLT
“Wise words are more valuable than much gold and many rubies.”
I’ve discovered that good counsel invariably comes from a good person.
But its more then that, not everyone can do it. At one time I thought any mature Christian believer had a right to give guidance, but that really wasn’t the case. I also believe that every believer will receive a minimum of a ‘spiritual semester’ in counseling. The Holy Spirit will come to teach you. We have to learn there is wisdom, and there is counseling. And at times, “wise counseling.” Choose your rainy day people carefully. Mark them out beforehand; before things get out of hand.
“From a wise mind comes wise speech; the words of the wise are persuasive.”
Proverbs tells us that giving good advice is as rare as gold or silver. I have met so many people who have an opinion about my problems, but few want to listen. And listening skills are what my counselors need. Job’s friends were the best counselors when they sat quietly in the ashes with him. They were sterling silver until… well, you know what happened next.
I need to unload my issues. Personally, I need someone who has been profoundly depressed and finally stumbled out into the light. It’s not that I don’t love certain believers, but they haven’t been “checked out” on this particular problem. It’s like flying a plane, or operating heavy equipment. If they haven’t suffered, then leave me alone–but, please do pray for me.
I read this somewhere, “Unless you have been lost in this particular section of hell– just shut up!” I don’t want to be rude, or ungrateful, but I really need someone who has visited hell on occasion. And especially down this specific corridor. People who have been damaged by life know what I mean.
Often counselors are offering a very small part of the needed wisdom. They must accept this. I place a premium on the counsel of a few dear friends, even though I have hundreds of Christian relationships. I don’t diminish those relationships, but I do know that certain people are not tested on certain problems. This may be simplistic, or a little harsh. But when I had my brain tumor, I did not want my car mechanic to fix me, I wanted a neurosurgeon. And both are wonderful people. I’m fortunate to have them.
If you’re reading this, and you have a mental illness issue that’s starting to escalate, you need to reach out. Realize, that 1 in 70 people, [more or less] are qualified to deal with mental illness. Ask the Holy Spirit for his help in this. He is the Comforter and the Wonderful Counselor. He will direct you, and help you. That is what He does.
“If you have knowledge, let others light their candles at it.” –Thomas Fuller
“A saying I heard years ago: ‘It doesn’t matter what you do. Just do something, even if it’s wrong!’ That’s the most stupid counsel I’ve ever heard. Never do what’s wrong! Do nothing until it’s right. Then do it with all your might. That’s wise counsel.” –Chuck Swindoll
“It is through much tribulation that we enter the kingdom of Heaven.”
As a broken believer this happens. I breakdown, my faith is questioned, and I feel all alone. Issues like a simple hot shower and eating something seem impossible. I’m embarrassed to say I once went 34 days with a shower. I laid in bed unable to function. That is the insidious truth about chronic depression, I know it well. God seems far, far away from me. Life doesn’t matter anymore.
There is much I can do before it gets to this point. And although life seems insurmountable. Clinical depression kills people. It slowly devours “a sound mind.” It cripples before it takes away your life. There is nothing quite like it; people tell you it will pass, and that you’ll see the sun again. But at the time that seems to be the worst advice ever given.
“For God has not given us a spirit of fear, but of power and of love and of a sound mind.”
2 Timothy 1:7
Meds help a lot. I take Zoloft and that is a godsend. I never miss a dose. I know I’m not bulletproof. I’ve taken it for several years now. (It’s like insulin for a diabetic).
Afflicted souls are special to God. And that truly comforts me. Sometimes it seems like there is an invisible tether that holds from completely dropping off the edge. When I do pray, it is desperate and brief. More like a quiet scream for help. There are no frills and no eloquence, but I know I’m being heard by Him who guards my soul.
People for the most part, are of little help. I admit that my attitude can be less than stellar. “Unless you have been lost in this section of hell yourself, it’s best if you just shut up.” (I don’t really say this, but I’m tempted to.)
But there are a few that can speak. Almost always these are the ones who have been through some affliction themselves. They have been hurt and they ‘walk with a limp.’ I’m convinced that they can speak in direct proportion to the pain they themselves have suffered. I once woke up to another pastor praying prostrate on my bedroom floor. He didn’t have to do or say anything else. He left without saying some ‘pious’ word to me, what he did was wonderfully done.
“I will trust Him. Whatever, wherever I am, I can never be thrown away. If I am in sickness, my sickness may serve Him; in perplexity, my perplexity may serve Him; if I am in sorrow, my sorrow may serve Him. My sickness, or perplexity, or sorrow may be necessary causes of some great end, which is quite beyond us. He does nothing in vain.”
John Henry Newman
Take care of yourself. If this isn’t your first major depression, prepare in advance spiritually for the next. Identify those ‘dear-hearts’ who can help you in advance. Keep taking your meds, even if you think your o.k. And speak often with the Lord, and learn to listen to His voice. That “sound mind” is a promise for those who truly need it.
Does your child have extreme behavior changes too? Does your child get too excited or silly sometimes? Do you notice he or she is very sad at other times? Do these changes affect how your child acts at school or at home?
Some children and teens with these symptoms may have bipolar disorder, a serious mental illness. Read on to understand more.
What is bipolar disorder?
Bipolar disorder is a serious brain illness. It is also called manic-depressive illness. Children with bipolar disorder go through unusual mood changes. Sometimes they feel very happy or “up,” and are much more active than usual. This is called mania. And sometimes children with bipolar disorder feel very sad and “down,” and are much less active than usual. This is called depression.
Bipolar disorder is not the same as the normal ups and downs every kid goes through. Bipolar symptoms are more powerful than that. The illness can make it hard for a child to do well in school or get along with friends and family members. The illness can also be dangerous. Some young people with bipolar disorder try to hurt themselves or attempt suicide.
Children and teens with bipolar disorder should get treatment. With help, they can manage their symptoms and lead successful lives.
Who develops bipolar disorder?
Anyone can develop bipolar disorder, including children and teens. However, most people with bipolar disorder develop it in their late teen or early adult years. The illness usually lasts a lifetime.
How is bipolar disorder different in children and teens than it is in adults?
When children develop the illness, it is called early-onset bipolar disorder. This type can be more severe than bipolar disorder in older teens and adults. Also, young people with bipolar disorder may have symptoms more often and switch moods more frequently than adults with the illness.
What causes bipolar disorder?
Several factors may contribute to bipolar disorder, including:
Genes, because the illness runs in families. Children with a parent or sibling with bipolar disorder are more likely to get the illness than other children.
Abnormal brain structure and brain function.
Anxiety disorders. Children with anxiety disorders are more likely to develop bipolar disorder.
The causes of bipolar disorder aren’t always clear. Scientists are studying it to find out more about possible causes and risk factors. This research may help doctors predict whether a person will get bipolar disorder. One day, it may also help doctors prevent the illness in some people.
What are the symptoms of bipolar disorder?
Bipolar mood changes are called “mood episodes.” Your child may have manic episodes, depressive episodes, or “mixed” episodes. A mixed episode has both manic and depressive symptoms. Children and teens with bipolar disorder may have more mixed episodes than adults with the illness.
Mood episodes last a week or two—sometimes longer. During an episode, the symptoms last every day for most of the day.
Mood episodes are intense. The feelings are strong and happen along with extreme changes in behavior and energy levels.
Children and teens having a manic episode may:
Feel very happy or act silly in a way that’s unusual
Have a very short temper
Talk really fast about a lot of different things
Have trouble sleeping but not feel tired
Have trouble staying focused
Talk and think about sex more often
Do risky things.
Children and teens having a depressive episode may:
Feel very sad
Complain about pain a lot, like stomachaches and headaches
Sleep too little or too much
Feel guilty and worthless
Eat too little or too much
Have little energy and no interest in fun activities
Think about death or suicide.
Do children and teens with bipolar disorder have other problems?
Bipolar disorder in young people can co-exist with several problems.
Substance abuse. Both adults and kids with bipolar disorder are at risk of drinking or taking drugs.
Attention deficit/hyperactivity disorder, or ADHD. Children with bipolar disorder and ADHD may have trouble staying focused.
Anxiety disorders, like separation anxiety. Children with both types of disorders may need to go to the hospital more often than other people with bipolar disorder.
Other mental illnesses, like depression. Some mental illnesses cause symptoms that look like bipolar disorder. Tell a doctor about any manic or depressive symptoms your child has had.
Sometimes behavior problems go along with mood episodes. Young people may take a lot of risks, like drive too fast or spend too much money. Some young people with bipolar disorder think about suicide. Watch out for any sign of suicidal thinking. Take these signs seriously and call your child’s doctor.
How is bipolar disorder diagnosed?
An experienced doctor will carefully examine your child. There are no blood tests or brain scans that can diagnose bipolar disorder. Instead, the doctor will ask questions about your child’s mood and sleeping patterns. The doctor will also ask about your child’s energy and behavior. Sometimes doctors need to know about medical problems in your family, such as depression or alcoholism. The doctor may use tests to see if an illness other than bipolar disorder is causing your child’s symptoms.
How is bipolar disorder treated?
Right now, there is no cure for bipolar disorder. Doctors often treat children who have the illness in a similar way they treat adults. Treatment can help control symptoms. Treatment works best when it is ongoing, instead of on and off.
1. Medication. Different types of medication can help. Children respond to medications in different ways, so the type of medication depends on the child. Some children may need more than one type of medication because their symptoms are so complex. Sometimes they need to try different types of medicine to see which are best for them.
Children should take the fewest number and smallest amounts of medications as possible to help their symptoms. A good way to remember this is “start low, go slow”. Always tell your child’s doctor about any problems with side effects. Do not stop giving your child medication without a doctor’s help. Stopping medication suddenly can be dangerous, and it can make bipolar symptoms worse.
2. Therapy. Different kinds of psychotherapy, or “talk” therapy, can help children with bipolar disorder. Therapy can help children change their behavior and manage their routines. It can also help young people get along better with family and friends. Sometimes therapy includes family members.
What can children and teens expect from treatment?
With treatment, children and teens with bipolar disorder can get better over time. It helps when doctors, parents, and young people work together.
Sometimes a child’s bipolar disorder changes. When this happens, treatment needs to change too. For example, your child may need to try a different medication. The doctor may also recommend other treatment changes. Symptoms may come back after a while, and more adjustments may be needed. Treatment can take time, but sticking with it helps many children and teens have fewer bipolar symptoms.
You can help treatment be more effective. Try keeping a chart of your child’s moods, behaviors, and sleep patterns. This is called a “daily life chart” or “mood chart.” It can help you and your child understand and track the illness. A chart can also help the doctor see whether treatment is working.
How can I help my child or teen?
Help your child or teen get the right diagnosis and treatment. If you think he or she may have bipolar disorder, make an appointment with your family doctor to talk about the symptoms you notice.
If your child has bipolar disorder, here are some basic things you can do:
Encourage your child to talk, and listen to him or her carefully
Be understanding about mood episodes
Help your child have fun
Help your child understand that treatment can help him or her get better.
How does bipolar disorder affect parents and family?
Taking care of a child or teenager with bipolar disorder can be stressful for you too. You have to cope with the mood swings and other problems, such as short tempers and risky activities. This can challenge any parent. Sometimes the stress can strain your relationships with other people, and you may miss work or lose free time.
If you are taking care of a child with bipolar disorder, take care of yourself too. If you keep your stress level down you will do a better job. It might help your child get better too.
Where do I go for help?
If you’re not sure where to get help, call your family doctor. You can also check the phone book for mental health professionals. Hospital doctors can help in an emergency.
I know a child or teen who is in crisis. What do I do?
If you’re thinking about hurting yourself, or if you know someone who might, get help quickly.
Do not leave the person alone
Call your doctor
Call 911 or go to the emergency room
Call a toll-free suicide hotline: 1-800-273-TALK (8255) for the National Suicide Prevention Lifeline.
Contact NIMH to find out more about bipolar disorder.
National Institute of Mental Health
Science Writing, Press & Dissemination Branch
6001 Executive Boulevard
Room 8184, MSC 9663
Bethesda, MD 20892-9663
8 “Then Jesus said,“Come to me, all of you who are weary and carry heavy burdens, and I will give you rest.29 Take my yoke upon you. Let me teach you, because I am humble and gentle at heart, and you will find rest for your souls.30 For my yoke is easy to bear, and the burden I give you is light.”
Matthew 11:28-30, New Living Translation
Weariness and burdens are our common plight. We all have them. They are shared as sort of common identity, like eye color or hair color. We all have them, and wish we didn’t. Sometimes we feel like shutting down.
Weariness, that bone-tiredness that sleep doesn’t seem to help. We seem to be chronically fatigued by life and what it brings us. We have heavy burdens, we carry a load that only gets heavier (and never lighter.)
Money problems, bills that are past due, marriages, straying children, cars that need fixing, family problems, job hassles, health problems… the list goes on ad nauseam. There are far too many issues, too many problems. I believe boredom and tedium are added to the list as they only intensify the hopelessness. (Its own special kind of suffering.)
Some will choose to ‘self medicate’ with alcohol or drugs. They want something more, and find they only create more burdens (not less.) Some will become hopelessly addicted, never finding relief from their burdens, but only increasing them. Suicide very often is seen as the only way out.
But Jesus will never condemn (leave that to the Pharisees) but instead offers a sort of amnesty to the burnt-out and the burdened. “Come to me, all of you who are weary and carry heavy burdens, and I will give you rest.” Jesus did not say, “Get away from me, I am holy and you are not.” Rather, He makes himself to be the solution to all those who life has overwhelmed. He wants our burdens and takes on our weariness. He wants us. He wants to give us peace and rest.
He invites us to exchange whatever burdens us for the yoke of discipleship.
An easy trade, especially since we are so desperate. Some have evaluated Jesus’ offer and made the transaction–piling up our burdens at His feet. We might be a little hesitant about the “my yoke” part, but will quickly find that discipleship can’t be compared to the weight we once carried for so long.
The non-demands of biblical disciplehip are easy—“For my yoke is easy to bear, and the burden I give you is light.”Following Jesus becomes the best way to live.
29 He gives power to the weak and strength to the powerless. 30 Even youths will become weak and tired, and young men will fall in exhaustion. 31 But those who trust in the Lord will find new strength. They will soar high on wings like eagles. They will run and not grow weary. They will walk and not faint.
Do you know someone who seems like he or she has “lost touch” with reality? Does this person talk about “hearing voices” no one else can? Does he or she see or feel things no one else can? Does this person believe things that aren’t true?
Sometimes people with these symptoms have schizophrenia, a serious illness.
What is schizophrenia?
Schizophrenia is a serious brain illness. Many people with schizophrenia are disabled by their symptoms.
People with schizophrenia may hear voices other people don’t hear. They may think other people are trying to hurt them. Sometimes they don’t make any sense when they talk. The disorder makes it hard for them to keep a job or take care of themselves.
Who gets schizophrenia?
Anyone can develop schizophrenia. It affects men and women equally in all ethnic groups. Teens can also develop schizophrenia. In rare cases, children have the illness too.
When does it start?
Symptoms of schizophrenia usually start between ages 16 and 30. Men often develop symptoms at a younger age than women. People usually do not get schizophrenia after age 45.
What causes schizophrenia?
Several factors may contribute to schizophrenia, including:
Genes, because the illness runs in families
The environment, such as viruses and nutrition problems before birth
Different brain structure and brain chemistry.
Scientists have learned a lot about schizophrenia. They are identifying genes and parts of the brain that may play a role in the illness. Some experts think the illness begins before birth but doesn’t show up until years later. With more study, researchers may be able to predict who will develop schizophrenia.
What are the symptoms of schizophrenia?
Schizophrenia symptoms range from mild to severe. There are three main types of symptoms.
1. Positive symptoms refer to a distortion of a person’s normal thinking and functioning. They are “psychotic” behaviors. People with these symptoms are sometimes unable to tell what’s real from what is imagined. Positive symptoms include:
Hallucinations: when a person sees, hears, smells, or feels things that no one else can. “Hearing voices” is common for people with schizophrenia. People who hear voices may hear them for a long time before family or friends notice a problem.
Delusions: when a person believes things that are not true. For example, a person may believe that people on the radio and television are talking directly to him or her. Sometimes people believe that they are in danger-that other people are trying to hurt them.
Thought disorders: ways of thinking that are not usual or helpful. People with thought disorders may have trouble organizing their thoughts. Sometimes a person will stop talking in the middle of a thought. And some people make up words that have no meaning.
Movement disorders: may appear as agitated body movements. A person with a movement disorder may repeat certain motions over and over. In the other extreme, a person may stop moving or talking for a while, a rare condition called “catatonia.”
2. Negative symptoms refer to difficulty showing emotions or functioning normally. When a person with schizophrenia has negative symptoms, it may look like depression. People with negative symptoms may:
Talk in a dull voice
Show no facial expression, like a smile or frown
Have trouble having fun
Have trouble planning and sticking with an activity, like grocery shopping
Talk very little to other people, even when they need to.
3. Cognitive symptoms are not easy to see, but they can make it hard for people to have a job or take care of themselves. Cognitive symptoms include:
Trouble using information to make decisions
Problems using information immediately after learning it