Friday, November 17, 2023

Are You Supporting Terrorism?


(Photo from Der Spiegel.)

I didn't want to post this because it would offend some people, but I can't sit back and watch hysterical Americans - mostly uninformed young people - make fools of themselves by supporting HAMAS and calling for the genocide of the Jewish people.

If you support HAMAS, you are supporting terrorism, whether you understand that or not. HAMAS is no different than ISIS, Al Qaeda, the Taliban, Hezbollah, or any other Islamic terrorist group. The goal of all of these groups is to establish a worldwide Islamic caliphate (theocracy), eliminate non-Muslims who refuse to convert, and rule the world. If that sounds fun and romantic to you, I suggest you move to Iran or Afghanistan and experience it first-hand. Too many Americans believe the propaganda and neglect to do their homework. I have talked to Muslims who support the caliphate and believe me, the level of hatred they expound is terrifying. If you think the world is messed up now, just imagine what it would be like under those circumstances. Believe me, you would not survive or want to live under those conditions. Americans have no clue what goes on in other countries and don't appreciate what they have here. If you hate America, please leave. We will easily survive without you. America is the last bastion of individual freedom in the world, and that is quickly eroding because of people who don't appreciate how blessed they are to live in the USA. Do you see millions of people trying to invade any other country? Of course not. Our borders are flooded by illegals because these people want a better life than the one they have back home. Supporting any person, group, political party, or organization that wants to undermine and destroy America is an act of complete insanity. And insane people belong in padded cells where they can't hurt themselves or other people.

Israel is a country that is under attack on all sides by people who hate it. Every day that it survives is a day to celebrate. Israelis just want to survive and live their lives. They are not trying to rule the world and impose their beliefs on others.

It's also important to note that some Arabs and Arab countries helped the Nazis slaughter Jews during World War II. This alone should be a big RED FLAG to people who ignore history. And, do you see any country in the Middle East offering to take in the Palestinians? Of course not, because they don't want HAMAS or any other terrorist group in their own countries. And Palestinians are not innocent bystanders. It's a badge of honor when a Palestinian son or daughter becomes a jihadist and dies a martyr. So, spare me your crocodile tears and misguided support of HAMAS.

PEACE is a luxury the world can't afford right now. There are too many bad people trying to run the world and destroy all of us. It's impossible to negotiate with or appease terrorists, just like it was impossible to do that with Hitler and the Nazis. Ultimately, everyone dies when evil isn't confronted and defeated. Satan destroys his own.

Sorry if I offended you, but c'est la vie. We can't tolerate this crap anymore. It's too important.

Dawn Pisturino

November 17, 2023

Copyright 2023 Dawn Pisturino. All Rights Reserved.

Saturday, October 28, 2023

Season of the Witch


Halloween witches are traditionally portrayed as old, ugly hags with stringy gray hair, long, warty noses, pointy fingernails, and clawed hands. They ride broomsticks, collect black cats, owls, rats, and other animals as familiars and pets, and cast maleficent spells on unsuspecting people. They exude malignant, negative energy wherever they go. They are evil beings who seek to do harm to others.

However, "witches" have served various purposes throughout history, from natural healers, midwives, oracles, spell casters, matchmakers, advisors to kings, devil worshipers, and evil conjurors. There is no single definition for "witch" since wise women have played significant roles through the centuries, and good witches have existed alongside bad ones.

When Gerald Gardner published The Meaning of Witchcraft in 1959, modern Wicca was born, which seeks to bring the natural and mystical worlds together in a positive and life-affirming form. Do no harm is the primary Wiccan motto, although traditionally expressed as "An' ye harm none, do what ye will." A far cry from the ugly Halloween crone!

Samhain (Halloween) is the most important festival in the Wiccan year, for it marks the end of the year's life cycle when the veil between life and death is at its most fragile. This is the night the dead are remembered and invited to partake in the festivities. As the old year ends, the new year begins. Celebrants look forward to new possibilities, more abundant harvests, and a happier and more fulfilled life.

As you sip your pumpkin spice latte and indulge in delectable chocolates and pastries this Halloween, remember it is a holiday that encompasses many layers of meaning. For some, it is "a night of frolic," as the Sanderson sisters would say (Disney's Hocus Pocus). It is a night of hope for others, looking forward to a new year. While there may be mischief makers and people with evil interests on the prowl, this is true every night of the year. The evening news reminds us every night.

So, take advantage of the holiday season and start partying heartily!


Dawn Pisturino

October 28, 2023

Copyright 2023 Dawn Pisturino. All Rights Reserved.

Sunday, September 17, 2023

The Ethics of Autonomy (Self-Determination)


One of the ethical issues that came up frequently in our behavioral health unit was the issue of autonomy (Greek: self-law). If somebody wanted to die, did they have the right to die? Specifically, several older people on our unit underwent dialysis three times a week. They got tired of it, quit going, and decided they wanted to die. People interpreted this as a suicidal gesture, forcing them to be admitted involuntarily to our behavioral health unit.

The question arose: Did these people have the mental capacity to make this decision? One woman had a history of psychosis. Was she mentally competent to decide to quit dialysis? After her evaluation, the psychiatrist determined that the woman was not mentally competent to make this decision. The woman was held in our unit under Title 36 (involuntary commitment with all legal rights temporarily suspended) and forced to go to dialysis. Her daughter became her legal guardian, so the woman lost all legal rights to quit going to dialysis. The woman was unhappy with her life. Other people forced her to undergo a medical treatment she did not want.

Most of the nurses on the unit believed the woman had the right to quit dialysis if she no longer wanted it. Using the reasoning appropriate to Kohlberg’s Stages 5 and 6 of moral development, the psychiatrist was following the ethical code of her profession – do no harm – and protecting her professional license. The people who sent the patient to our unit were concerned about her well-being and did what they felt was right. The nurses advocated for the patient’s civil rights – autonomy and self-determination. Even if the patient had a history of psychosis, she had a right to stop treatment that was making her life unhappy. On the medical floor, if a patient deemed mentally competent decides to quit dialysis and die, nobody questions it. Their rights are not legally taken away because they chose to die. They designate themselves a “Do Not Resuscitate,” put their affairs in order, and let Mother Nature take its course. It’s a moral dilemma, dependent on the law, mental health vs. medical rights, and personal moral judgment.

If you were in this situation, what would you choose? What are your thoughts?

Dawn Pisturino

September 18, 2023

Copyright 2023 Dawn Pisturino. All Rights Reserved.

Wednesday, August 2, 2023

Book Review: "Re-Create and Celebrate" by Cindy Georgakas


Re-Create and Celebrate by Cindy Georgakas (2023). Available on

I did not want to read another self-help book. I studied yoga, meditation, breathwork, herbalism, alternative medicine, New Age modalities, and authentic spiritual practices for years. I did a deep dive into Hinduism, Buddhism, and Islam. Plus, fifteen years of mental health experience had taught me the evidence-based practices of mental health care. As the saying goes, “There is nothing new under the sun,” what could Cindy teach me?

Cindy is a warm, good-hearted, and sincere woman who strives to share her life experiences and knowledge with others. Always positive and encouraging, she never approaches people with arrogance or condescension in her voice and attitude. She freely admits her mistakes. Unlike some people on the Internet, Cindy is a role model who can be trusted and admired.

Pushed to the breaking point by a difficult personal situation, I needed renewal and support. A little voice kept telling me to order Cindy’s book. I finally did it, and I’m glad I did.

From the very first word, Cindy’s book reminded me of concepts I had not thought about for years. Her soothing voice spoke to me, calmed me down, and cleared away my turbulent thoughts and emotions. Her presence helped me make an important decision I had been avoiding. Reading her book taught me that no matter what we know or think we know, we sometimes need a nudge from a caring human being to set us back on the right track.

No matter where you are on your quest for self-improvement, Cindy’s book is a valuable guide to help you get where you want to be. I highly recommend it, based on my own experience.


Have a blessed day!

Dawn Pisturino

August 2, 2023

Copyright 2023 Dawn Pisturino. All Rights Reserved.

Friday, May 12, 2023

National Albuterol Shortage


My husband has had asthma his whole life and depends on respiratory drugs like albuterol to keep himself healthy. Right now, there's a national shortage, and I've already been informed by two different pharmacies that they can't get it and don't know when they will get it. Luckily, he has lots of Hispanic friends who willingly pick up medication for him when they travel to Mexico. We keep a backup supply for times like this. But, I'm scared for the people who don't have that option. They will end up in the hospital unnecessarily or die. This is a disgraceful example of what's happening in our medical/pharmaceutical system. And real people are suffering as a result.

Dawn Pisturino
May 12, 2023
Copyright 2023 Dawn Pisturino. All Rights Reserved.

Monday, March 20, 2023

Adjustment Disorder and Internet Gaming Disorder


The final project for my Online Digital Obsessions class asked us to create a fictitious patient with an electronic addiction, adopt the role of a college counselor, and create a treatment plan for this patient's therapeutic intervention. In the end, we were required to predict the challenges and outcomes for this patient. At this time, there is no official diagnosis, "Internet Gaming Disorder." The proposed diagnosis was referred for further study by the American Psychiatric Association. However, it is expected to be adopted in the future. Playing video games is only a problem when it becomes the dominant interest in somebody's life and undermines their normal functioning in day-to-day living.

Adjustment Disorder and Internet Gaming Disorder

by Dawn Pisturino

Thomas Edison State University


       Jeremy Reed is an 18-year-old Caucasian male who was referred to counseling by his academic advisor for depression.  He says that adjusting to university life has been difficult, and he has been feeling increasingly depressed.  He began playing World of Warcraft on his computer to relieve stress and cope with his depressed feelings.  He became so involved in the game that he began neglecting his homework, and his grades are suffering.  His academic advisor referred him to counseling so he does not lose his full-ride scholarship to the university. 

       The client says that playing World of Warcraft makes him “feel good,” and he does not want to stop.  He has made new friends and become a “top player.”  He admits to feeling more depressed and irritable when he is not playing the game.  I explain to Jeremy—who is a biology major—that he feels good when he plays World of Warcraft because the activity activates the reward system in his brain and stimulates the release of dopamine.  The more he activates this system, however, the more he craves the gratifying pleasure produced by the game.  He needs to spend more hours playing the game to reach that same level of pleasure and craves playing the game when he is not able to do so.  Playing the game has become more important to him than his academic performance, so he is neglecting his schoolwork and falling behind.  As he loses control over his impulse to play, I explain, his life will spiral more and more out of control.  He is at great risk for not sleeping and eating, neglecting his hygiene, alienating his roommate, and losing his scholarship and admission to the university if he does not reduce his game playing and start improving his academic performance.  Jeremy agrees that this is true but also states that he does not want to completely give up playing the game (Gros et al., 2020, pp. 2-4; Tavormina & Tavormina, 2017, pp. 422-424).

Clinical Assessment

       For this assessment, I am using the Therapist Clinical Assessment/Psychosocial Assessment tools used routinely at Flagstaff Medical Center Behavioral Health Unit in Flagstaff, Arizona, and the PHQ-9 questionnaire because I am familiar with these forms.  The PHQ-9 is used to screen clients for symptoms of depression and has a proven track record of accuracy and reliability.  Clients who fill out the form are scored based on their responses.  Scores equal to or greater than 10 can indicate a depressive disorder (American Psychological Association, 2020, para. 1-2).

       The client, Jeremy Reed, presents as withdrawn with a flat affect and a disheveled appearance.  His thought processes are linear and logical with organized thinking.  He is alert and oriented.  His speech is coherent and clear, but he is delayed in his responses.  His psychomotor activity appears normal, but he makes poor eye contact.  His thought content is realistic, but he exhibits poor insight into his excessive video game activity even though his memory and judgment are within normal limits.  He denies hearing voices, having hallucinations, or experiencing extreme mood swings.

       Jeremy denies any current suicidal and homicidal ideation.  He denies any actual self-harm or harm to others.  He denies any thoughts of suicide/homicide in the past or making any gestures or threats of violence against others.

       The client denies any history of sexual, verbal, emotional, or physical abuse.  He does not recall witnessing any extreme acts of violence.  He reports that his parents argue sometimes but always resolve their differences amicably.  He is an only child and has no half-siblings or step-siblings.

       Jeremy confirms that he is a healthy heterosexual male with little sexual experience.  He is currently single and not sexually active.  Although he would like to have a girlfriend, he believes it would interfere even more with his studies.

       The client says he is a nominal Protestant and only attends church at Christmas and Easter.  He has experimented with yoga and meditation in the past to live a healthier lifestyle.  He does not routinely pray or engage in spiritual practices.

       Jeremy currently lives on campus in a dorm and has no housing needs.  He is unemployed at the moment but worked part-time at Burger King in high school.  He is studying biology and plans a career as a biologist.  Since he has a full-ride scholarship to the university, his parents help out with his expenses.  He says he does not want to lose his scholarship or disappoint his parents.

       The client has no military experience and no legal difficulties.  He has never been arrested or suspended from school. As far as he knows, his developmental history was normal.

       Jeremy says he played basketball in high school and still enjoys playing when he can find the time and other players.  He has no significant medical history, no known allergies, and takes no prescribed medications. The client appears well-nourished and physically fit.  His tonsils were removed at age 10.  He broke his arm when he fell off his bike at age 12.  He is already registered with the university’s student health services.  Currently, he reports staying up late playing video games, feeling tired the next day, and eating too much junk food.  He says he lacks the motivation and concentration to study.

       The client denies any mental health history.  He states that his depression and anxiety began a couple of months ago when he began his freshman year of college.  This is his first time living away from home, and he is having trouble adjusting to university life, living with a roommate, and being away from his family.  He is carrying a full load of credits and feels stressed out and overwhelmed by all the homework, expectations, and pressure.

       Jeremy believes his paternal grandfather was a heavy smoker and alcohol drinker.  His father drinks alcohol occasionally, mostly on holidays.  His mother takes Vistaril occasionally for anxiety.  He admits to trying cannabis twice but did not like it.  He denies all other substance use except alcohol, which he uses occasionally on the weekends.  His only source of caffeine is Coca-Cola.

       The client states that his main form of recreation right now is playing Internet video games, i.e., World of Warcraft.  He wants to cut back and resume his studying, but he derives a lot of satisfaction from the game and does not want to stop playing the game completely.  He admits that he loses track of time while on the game.  He is not fully motivated to quit.

       Jeremy describes his strengths as being goal-oriented and a good student.  He is strongly motivated to complete his college degree and start work as a biologist.  He describes his weaknesses as being too introverted and serious.  He believes he has poor coping skills when it comes to stress.  He wants help overcoming his depression and anxiety but says he is not interested in taking medication.  Although he does not see playing video games as a serious problem, he admits that it has already affected his grades and academic standing.  His PHQ-9 score is 13, with 4 boxes checked in the gray areas.  His score indicates moderate depression that is making it difficult for him to function at his normal baseline (American Psychological Association, 2020, para. 1-3).

Probable Diagnoses and Treatment Plan

Probable Diagnoses

Problem #1 – Adjustment Disorder with Mixed Anxiety and Depressed Mood (ICD Code   F43.23) ( ICD-10 Coded, 2022, para. 1)          

       Adjustment disorder occurs when a person is faced with a stressful life situation, such as going away to school.  Jeremy describes having a difficult time adjusting to university life and

being away from home.  He has no prior history of depression, anxiety, or other mental health issues.  His symptoms appeared less than three months ago after arriving on campus for his freshman year, meeting the DSM-V criteria.  He reports increasing depression and anxiety that are affecting his ability to cope with his new situation.  If Jeremy agrees with the assessment and treatment plan, his prognosis looks good. (American Psychiatric Association, 2015, pp. 120-121; Kenardy, 2014, para. 1-3; Mayo Clinic, 2023, para. 1-13).

Problem #2 – Internet Gaming Disorder (no ICD code until ICD-11) ( Petry et al., 2015, pp. 1,7)

       Internet gaming disorder (IGD) appears in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-V) in Section III under the heading of “Conditions for Further Study.”  The DSM-V provides criteria for IGD that closely align with the criteria for other addictive disorders, like substance use disorder and gambling disorder.  Clients who meet at least five of the criteria could be considered suffering from or at high risk for Internet gaming disorder (Petry et al., 2015, pp. 1-5).

       Jeremy has been playing Internet video games to relieve stress, anxiety, and depression.  He has been spending increasing amounts of time playing video games and spending less time sleeping and studying.  As a result, his academic performance has declined, and he risks losing his full-ride scholarship.  Currently, Jeremy meets six of the criteria on the DSM-V list of criteria: preoccupation, tolerance, neglecting other activities, escapism, and risking losing his

educational opportunities.  He has only been playing for a couple of months and is not fully motivated to quit, even though he recognizes that he needs to make some changes in his life.  If

he agrees with the assessment and treatment plan, however, his prognosis looks good (Petry et al., 2015, pp. 2-3).                                           

Treatment Plan

Goals and Objective

       Jeremy’s primary concern is protecting his full-ride scholarship and earning his biology degree.  His second goal is to learn new coping skills to deal with his depression, anxiety, and stress.  His third goal is to achieve more balance in his life between studying and recreation.  His fourth goal is to reduce his time playing video games and participate in more physical activities, like basketball.  Overall, the client’s objective is to return to his normal baseline status before going away to college.  He wants the same self-confidence and control over his life that he had before.  He wants to regain his motivation and commitment to studying and succeeding in school.  He wants a positive outcome that will help him grow as a person and mature into adulthood.

Action Plan

       Psychotherapy is the primary evidence-based treatment for both adjustment disorder and Internet gaming disorder (IGD).  The client will benefit from weekly psychotherapy sessions to discuss how and why leaving home and starting college has made such a huge impact on his well-being, including his use of video games to relieve stress.  If psychotherapy is insufficient to stabilize the client, a course of medication may be helpful.  The client, however, is unwilling to try medication at this time (American Psychiatric Association, 2015, pp. 63, 121; Gros et al.,

2020, p. 15; Kenardy, 2014, para. 4, 6-7, 10; Mayo Clinic, 2023, para. 22-23; Petry et al., 2015, p. 6; Tavormina & Tavormina, 2017, p. 424; Torres-Rodriguez et al., 2017, pp. 1003, 1005-1006, 1010-1011).


       Cognitive behavioral therapy (CBT) is effective in helping clients to recognize and re-frame harmful patterns of thought and behavior.  The client will be referred to a therapist who is proficient in CBT since it has been proven successful in treating both adjustment disorder and IGD.  I will encourage the client to continue seeing me on a weekly basis at the clinic for one-to-one motivational and support counseling and provide him with opportunities to participate in clinical workshops that will help him to learn new skills in stress management, anger management, relaxation activities, mindfulness and resilience training, and goal-focused solutions.  With Jeremy’s cooperation, we will devise a schedule that maps out times for study, recreation, and playing video games that supports his class schedule and enhances his goals and objective.  I will suggest that he join a campus support group for new students.  I will refer him to mental health peer support services for monitoring and help.  If the client requires medication, I will refer him to a psychiatrist or psychiatric nurse practitioner for evaluation and prescriptions. 

I will get consent from the client to speak to his parents, make them aware of the situation, and offer them support.  Since Jeremy is in a vulnerable age group, he needs intense support to get through this temporary setback.  Otherwise, this could turn into an ongoing issue (American Psychiatric Association, 2015, pp. 63, 121; Gros et al., 2020, p. 15; Kenardy, 2014, para. 4, 6-7, 10; Mayo Clinic, 2023, para. 22-23; Petry et al., 2015, p. 6; Tavormina & Tavormina, 2017, p. 424; Torres-Rodriguez et al., 2017, pp. 1003, 1005-1006, 1010-1011).


       Since Jeremy is highly motivated to protect his full-ride scholarship and complete his degree, his prognosis is good as long as he follows the treatment plan.  Challenges include ongoing depression, anxiety, and stress that may undermine his motivation, time constraints due to carrying a full load, and relapsing on playing video games.  I will provide him with literature and books that will help him to understand the biological, neurological, and psychological nature of his problems.  This may pique his interest as a biology student and keep him involved in his

therapy.  I will suggest that he drop any extra credits that he is taking.  The client will be given positive encouragement and reinforcement to stick to his goals.  I will work with his assigned peer support person to monitor his progress and participation.


       Eighteen-year-old Jeremy Reed was referred to my office for depression, anxiety, and excessive playing of video games by his academic advisor.  Jeremy’s symptoms began when he moved into the campus dorm to start his freshman year of college a few months ago.  Since then, he has been spending more time playing video games and less time studying.  His academic performance has suffered, putting his full-ride scholarship at risk.

       This client is positive for symptoms of adjustment disorder and Internet gaming disorder.  His age makes him a high risk for long-term mental health issues, including suicide, if he does not participate in treatment.  If he cannot control, reduce, or eliminate his video game activity, he will continue to decline academically, which will impact other areas of his life (Kenardy, 2014, para. 2).


American Psychiatric Association. (2015). Understanding mental disorders: Your guide to

       dsm-5. Washington: American Psychiatric Publishing.

American Psychological Association. (2020). Patient health questionnaire. American

       psychological association. Retrieved from


Gros, L., Debue, N., Lete, J., van de Leemput, C. (2020). Video game addiction and emotional

       states: Possible confusion between pleasure and happiness. Frontiers in psychology.

       doi: 10.3389/fpsyg.2019.02894.

ICD-10 Coded. (2022). ICD-10-cm code f43.23. ICD-10 coded. Retrieved from

Kenardy, J. (2014). Treatment guidance for common mental health disorders: Adjustment

       disorder. Australian psychological society inpsych 2014, 36(5). Retrieved from

Mayo Staff Writers. (2023). Adjustment disorders. Mayo clinic. Retrieved from


Petry, N.M., Rehbein, F., Ko, C., O’Brien, C.P. (2015). Internet gaming disorder in the dsm-5.

       Current psychiatry reports, 17(72). doi: 10.1007/s11920-015-0610-0.

Tavormina, M.G.M., Tavormina, R. (2017). Playing with video games: Going to a new

       addiction. Psychiatria danubina, 29(3), 422-426.

Torres-Rodriguez, A., Griffiths, M.D., Carbonell, X. (2017). The treatment of internet gaming

       disorder: A brief overview of the pipatic program. International journal of mental health

       addiction. doi: 10.1007/s11469-017-9825-0.  

February 19, 2023

Copyright 2023 Dawn Pisturino. All Rights Reserved.








Friday, February 17, 2023

Electronic Addictions, Las Vegas Style


(Photo from Unsplash)

Electronic Addictions, Las Vegas Style

When people go into a casino, they are mesmerized by the colors, bright lights, and dinging bells of slot machines that, nowadays, look suspiciously like video games. In fact, the video game craze has influenced what kinds of games casinos offer to their customers. The live-action table games are slowly being replaced with interactive video games. Not only is this cost-effective for casinos, but machines can be manipulated to take more of the customer’s money.

But why are people so attracted to the Las Vegas type of bells and whistles that they find in casinos, amusement parks, and video arcades? Why are they mesmerized by these same effects on their video games, computers, and smartphones? Are consumers being trained to use electronic devices like toys – and not just tools for business and communication?

According to an article posted on the Psychology Today website, “the typical American spends about 1460 hours per year on their smartphone” (Brooks, 2019, para. 2). The author attributes this behavior to the variable ratio reinforcement schedule, a conditioning process that draws users over and over again to their electronic devices, and in particular, video games. With the right psychological rewards in place, users can quickly become hooked (Brooks, 2019, para. 3).

In a variable ratio reinforcement schedule, rewards are delivered randomly so that the electronic device user has to use the device more and more in order to get the psychological reward. If the user stops using the device, he gets no reward. But if he keeps going, the reward will eventually be delivered, hooking the user even more (Brooks, 2019, para. 4-5).

Why does this happen? Dopamine is released by the brain when the reward system is activated. A random reward reinforces the reward system further, leading the electronic device user to unconsciously look for the stimulus that delivers the reward (Brooks, 2019, para. 7).

The anticipation and expectation of reward entice the device user to keep using the device and receiving the reward once more . . . over and over again . . . until the user has lost control over his own impulses. Unless the user has strong sales resistance and self-discipline, he may find himself glued to his device, drawn there like a bee to honey. This is why the diagnosis of impulse control has become so pertinent to the abuse and overuse of electronic devices (Brooks, 2019, para. 8).


Brooks, M. (2019). The “vegas effect” of our screens. Psychology Today. Retrieved from


Dawn Pisturino

January 7, 2023

Copyright 2023 Dawn Pisturino. All Rights Reserved.