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Dear Dr. Saltzman,

Thank you so much for providing this opportunity for advice. I'm not sure that I will be able to state my problem very clearly, but I'm going to try. I don't even know what to call it, which is part of the reason I'm writing.

The best way I've come to describe this problem (to myself anyway; I haven't spoken about it to anyone else) is that I have "good" days and "bad" days, and have for as long as I can remember. On good days, I'm a generally normal 23-year-old; I'm able to be myself. I don't worry about what others' opinions are of me, I'm able to speak clearly and without an unbearable amount of fear or stress, and I even think that I look pretty good when I see myself in the mirror. I'm happy. But on bad days, it's just the opposite. People's opinions of me become the only thing that matters. I worry so much about what people are going to think of me that I stutter and can't speak clearly; and if I have to do any sort of public speaking on these days, my voice will shake and I will forget what I'm talking about entirely. I become very easily embarrassed, even around friends and, to a lesser extent, family. I may also start mentally berating myself, but as of late I've been better about stopping myself when this happens, as it seems to make the days that much worse.

I now recognize pretty quickly when I'm having a "bad" day, and have for the last year or so, but I can't seem to do anything about it. All I can do is wait for a new day and hope that it will be a good one. I have many more bad days than good; good days are like an unexpected gift anymore. I wondered for a while if this wasn't caused by diet or exercise or amount of sleep or any number of other variables; but so far, nothing appears to affect it. I can have a bad day when I've had enough sleep and can have a good day when I haven't, and vice versa.

I also went through a three-week period of mild depression a couple of months ago (basically a long string of "bad" days), after an especially embarrassing speech to a small group at work. I started feeling that I would never get over this bad-day problem, and I even had thoughts of suicide (though not of actually carrying outt suicide, at least not at the present time; is that really any different?). After the three weeks, I went back to my normal bad/good, up/down routine, and for no apparent reason.

Any advice you can give will be greatly appreciated.

Thank you again,


23 in Missouri

Dear Shannon--

This is the kind of problem which requires an interview with a trained psychologist who can take a detailed history aimed at creating a treatment plan for what I imagine is some variety of mood disorder. Judging from your letter, treatment would probably consist of weekly psychotherapy meetings, perhaps backed up by some kind of antidepressant medication, but that is only a guess given my ignorance of the depths of your experience. In addition, your suicidal ideation demands the kind of support which I cannot offer via a website, and which requires immediate personal attention. Please make an appointment as soon as possible with the best psychologist you can find.

Be well.

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