Father-Daughter Relationships

I feel that the childhood relationships you had with the parent of the opposite sex has had the most influence on the adult you. How you feel about yourself as a woman goes back to how your Daddy treated his Little Girl.

Did he listen to what you had to say?
Did he respect your opinions and welcome your contributions to the conversation?
Did he ever ask you for input regarding family issues?
Did he treat women in general like second-class citizens?
Did he respect your mother and show her affection?
Was your mother his equal partner?
Did he participate in family functions or did his work come first?
Was he active in your school activities, or was he an absentee father?
Did he keep his promises, or did you often wait by the window for him after the last guest left your party and the ice cream had melted?
Was he aggressive or abusive to you or your mother?

Look at the relationships that you have had with other men. Do you gravitate to men like your father? Are they usually kind and loving men, or are they uncaring or abusive? Daughters need to know that the first man in their life loved them unconditionally, as every man in her life thereafter will be patterned after her first love --- good, bad, or indifferent.

I hope that you were fortunate enough to have a father who enriched your life. If he made you feel like his beautiful princess and also valued you as an intelligent and independent individual, then I'm fairly certain that your relationships with the men in your life have been positive experiences. If, on the other hand, you lived with a father who discounted you and made you feel miserable, or you had an absentee father who was not a part of your life, then it's likely that you have picked the same kind of men as an adult. One would think that living with an alcoholic, abusive, or inattentive, emotionally unavailable father would make you more aware and thus more cautious and selective. Unfortunately, this is the opposite of the established patterns. Surprisingly enough, you tend to choose the same man as your father, regardless of his positive or negative affect on your life.

The psychology behind this phenomenon is really quite interesting: being treated in an abusive way as a child diminishes your self-worth and thus your expectations of yourself and the way others should treat you. You forget that you deserve choices in your life, and tend to accept whatever circumstances befall you. Moreover, as most abusive, aggressive men prefer women they can easily dominate, your diminished self-image makes you a target for abuse. A vicious cycle of reduced self-worth and abusive relationships ensues because abusive treatment only enforces the poor self-esteem. Women will marry or live with an abusive man like 'Dear Old Dad ' or seek our a man whom they can never trust to be there for them. Incredibly, when they finally find the courage to leave him, more often than not they will become involved with another man just like him!

I have counseled many young women who, as adults, still wanted to have a father/daughter relationship with their absentee father and continued to try to reconnect with a man who had left little more than tire tracks on the paths of their lives. One woman actually wanted her father to walk her down the aisle, and she was afraid to ask him. She was afraid that he would say no, or even worse that he would say yes, and not show up. Like daughters of alcoholic and abusive fathers, they still cling to the possibility of a normal relationship, but continue to seek out the same type of man.

Breaking the pattern is essential if you are ever to enjoy a healthy relationship with the opposite sex.

First you must acknowledge that you have the problem. Work on building your self-esteem and give up the role of victim. Now you must identify the traits that are predominant in the men that you choose.

Is the individual power hungry?
Does he need to be in control at all times?
Does he have an inflated ego?
Does he make promises only to break them?
Is he jealous?
Is he possessive? Is he aware of your needs?
Does he discount your opinions?
Does he want to change your hair, clothes, personality, etc.?
Does he need to be right most of the time?
Is he there for his family and friends when they need him?
Does he embarrass you in public or does he ignore you?
Does he discount your feelings?
Has he ever abused you --- psychologically, verbally, or physically?
Is he quick to say, "You made me do that," or "It won't happen again?"
Do you trust him with your heart?

Any of these can be red flags, and now you may be aware of others. If you love this individual and you both want to work on the relationship, I suggest couple's counseling. With a clear perspective and information from an impartial therapist, you may decide that you are willing to overlook some of his negative behavior. If you are certain that you cannot live with the imperfections of this individual --- even if some of the traits are seemingly benign ---- do not count on changing them after you have made a final commitment. Ask that 'little girl' inside of you," Did my Father change?" Find an opposite type and give him a chance. You will finally be on your way to establishing new patterns of behavior.

I'm Here For You,
by Dr. Beverly Block

Unsung Heroes

By MEERA DEVI DARAN
Today’s dads are no longer removed from their children’s upbringing – they actually seek happiness in fatherhood.

Are fathers, through no fault of their own, sometimes made to feel inferior next to mothers? The notion that mothers are natural caregivers, to the extent of being biologically-engineered for it, continues to prevail much to the chagrin of fathers.

Certainly the ability to give birth (and lactate!) is an unparalleled feat, but when fathers are demoted as secondary parents due to biological shortcomings, you have to wonder if all the flak they receive is justified.

Admittedly, from the time a baby is born, fathers are relegated to the sidelines, where they can only watch and fret. It is this paternal detachment, which supposedly continues throughout the developmental process of children, that is frequently used against fathers to question the degree of their involvement in families.


Dr Goh Chee Leong

These are not random rumblings of discontent either; in fact, early psychology theorists like Sigmund Freud and John Bowlby laid much of the groundwork for the dad-bashing that we have now become accustomed to.

In the United States, Father’s Day has increasingly become a no-holds-barred assault on fathers, with talk of the deadbeat dad – he who abandons his family and shirks all responsibility – dominating the headlines.

With so much resentment and negativity surrounding the issue, harsh remarks have been made about fathers and the role they play; last year, a prominent US magazine went so far as to ask if fathers, as a collective, have done enough to deserve a Father’s Day at all.

Ironically enough, Mother’s Day is often celebrated in less punishing terms, with past sins and wrongdoings more readily set aside. At the end of the day, mums emerge unscathed as saint-like creatures that can do no wrong.

“While mothers are often seen as nurturers who play a pivotal role in the healthy development of their children, the role of fathers is often reduced to mere breadwinner,” said Lee Wee Min, executive director of Focus on the Family Malaysia, with noticeable regret.

“In certain cultures, fathers are seldom encouraged to spend time with their children and are often perceived as cold disciplinarians,” he says.

Nevertheless, the decline of a classically patriarchal system, as well as emerging gender benders have contributed to a changed landscape for fatherhood over the years.

Where once a father was looked upon as the authoritative head of the family who had responsibilities and obligations to fulfil, the modern-day dad is far more approachable and involved in the lives of his children; he seeks actual happiness in fatherhood.

Counselling psychologist Johana Johari, who runs her own private practice in Kuala Lumpur, is firm in her beliefs about paternal involvement in Malaysian families.

“Our traditional definitions of how fathers should behave have certainly changed; we are increasingly exposed and educated as parents now. But our parenting styles must adapt to new belief systems so that we can break the vicious cycle of fathers doing unto their children what their fathers did unto them.”

Johana Johari

The 43-year-old principal of MY Confidential, a nationwide network of private counsellors in Malaysia, spoke at length about the roles of fathers that are often discounted. “Fathers are instrumental role models for their children, especially sons, who need a male adult to emulate. A daughter, on the other hand, learns how to communicate and establish healthy relationships with men as a result of the interactions with her father,” she explains.

“Fathers can do many things for their children that mothers cannot, and vice versa. Both parents are definitely essential in complementing each other.”

Director of HELP University College’s Centre for Psychology Dr Goh Chee Leong echoed her sentiments. “There is enough research in developmental psychology to suggest that fathers contribute significantly to the emotional wellbeing of a child and the development of their character, their ambitions, their sense of morals and their perception of responsibility,” he says.

“The bottom line is this: for a child to develop in a balanced and healthy manner, they need a home environment that is secure, happy, stimulating and loving. Fathers have an equal responsibility in shaping this environment. With more practice, there is no reason to believe that fathers have a lower capacity for love, care and nurturing,” he explains.

Even science has come to the defence of fathers recently; a study on the effects of hormonal changes during newfound fatherhood by Psychology Today, a respected US journal on clinical psychology, has shown that men may be a lot more similar to women after all, as fathers were found to have high levels of prolactin (a hormone associated with lactating mothers) towards the end of a partner’s pregnancy.

In a redefined understanding of masculinity and fatherhood, it was also established that fathers experience testosterone reduction and elevated levels of estrogen 30 days before birth, a condition that continues to last up to 12 weeks. The study offers pioneering evidence that to nurture is part of man’s nature after all.

So all is fine and well then?

Not quite, the roles of fathers in separated families or in the aftermath of a divorce are still sketchy at best.

US statistics claiming that more than half of divorced fathers lose contact with their kids within a few years are alarming, but Johana is quick to point out that in her line of work, parents usually make an effort to maintain normalcy and lessen the impact of divorce on their children.

“From my observations, it is the mother that usually plays an important role in determining the father’s involvement after divorce; but the bond cannot be completely erased regardless of whether the split is an amicable one or not. You can be an ex-husband, but never an ex-father,” she says succinctly.

Considering that there is a prevalent bias in society for maternal custody of children after divorce, Johana argues that credit should be given where credit is due. “I have worked with many single fathers who continue to fight for custody of their children without remarrying, but you don’t hear about these stories very often,” she says.

We may not have an existing movement to champion fathers’ rights in Malaysia, such as that of the controversial superhero protesters known as Fathers 4 Justice in Britain, but lest we forget, all fathers will be regarded as heroes in their own right this Father’s Day.

Dr Goh offers one last piece of advice: “What is important is that we focus on the kind of fathers we know we should be, rather than the type of fathers society thinks we are.”


Tuesday June 10, 2008

Chronic Fatigue Syndrome

Definition
Chronic fatigue syndrome (CFS) is a complicated disorder characterized by extreme fatigue that doesn't improve with bed rest and may worsen with physical or mental activity.

Chronic fatigue syndrome may occur after an infection, such as a cold or viral illness. The onset can be during or shortly after a time of great stress, or chronic fatigue syndrome come on gradually without a clear starting point or obvious cause.

Women are diagnosed with chronic fatigue syndrome far more often than men are. However, it's unclear whether chronic fatigue syndrome affects women more frequently or if women report it more often than men do.

Treatment for chronic fatigue syndrome focuses on a combination of approaches to relieve signs and symptoms.

Symptoms
Chronic fatigue syndrome is a flu-like condition that can drain your energy and, sometimes, last for years. People previously healthy and full of energy may experience a variety of signs and symptoms.

People with chronic fatigue syndrome exhibit signs and symptoms similar to those of most common viral infections. Unlike flu (influenza) symptoms, which usually subside in a few days or weeks, the signs and symptoms of CFS can last much longer. They may come and go frequently with no identifiable pattern.

Primary signs and symptoms
In addition to persistent fatigue, not caused by other known medical conditions, chronic fatigue syndrome has eight possible primary signs and symptoms. Chronic fatigue syndrome symptoms include:

Loss of memory or concentration
Sore throat
Painful and mildly enlarged lymph nodes in your neck or armpits
Unexplained muscle soreness
Pain that moves from one joint to another without swelling or redness
Headache of a new type, pattern or severity
Sleep disturbance
Extreme exhaustion lasting more than 24 hours after physical or mental exercise

According to the International Chronic Fatigue Syndrome Study Group — a group of scientists, researchers and doctors brought together by the Centers for Disease Control and Prevention (CDC) to determine a standard method for defining and diagnosing chronic fatigue syndrome — a person meets the diagnostic criteria of chronic fatigue syndrome when unexplained persistent fatigue occurs for six months or more along with at least four of the eight primary signs and symptoms.

Additional signs and symptoms
In addition, people with chronic fatigue syndrome have reported other various signs and symptoms that aren't part of the official definition. These include:

Abdominal pain
Allergies or sensitivities to foods, alcohol, odors, chemicals, medications or noise
Bloating
Chest pain
Chronic cough
Diarrhea
Dizziness, balance problems or fainting
Dry mouth
Earache
Irregular heartbeat
Jaw pain
Morning stiffness
Nausea
Chills and night sweats
Psychological problems, such as depression, irritability, anxiety disorders and panic attacks
Shortness of breath
Tingling sensations
Visual disturbances, such as blurring, sensitivity to light, eye pain and dry eyes
Weight loss or gain

If you have chronic fatigue syndrome, your symptoms may peak and become stable early on, and then come and go over time. Some people go on to recover completely, while others grow progressively worse.

Causes
Of all chronic illnesses, chronic fatigue syndrome is one of the most mysterious. Unlike definite infections, it has no clear cause. Several possible causes have been proposed, including:

Depression
Iron deficiency anemia
Low blood sugar (hypoglycemia)
History of allergies
Virus infection, such as Epstein-Barr virus or human herpesvirus 6
Dysfunction in the immune system
Changes in the levels of hormones produced in the hypothalamus, pituitary glands or adrenal glands
Mild, chronic low blood pressure (hypotension)

The cause of chronic fatigue syndrome may be an inflammation of the pathways of the nervous system as a response to an autoimmune process, but with nothing measurable in the blood as in other autoimmune diseases, such as rheumatoid arthritis and lupus. Chronic fatigue syndrome may also occur when a viral illness is complicated by a dysfunctional immune system. Some people with CFS may have a low blood pressure disorder that triggers the fainting reflex.

In many cases, however, no serious underlying infection or disease is proved to specifically cause chronic fatigue syndrome. Lack of medical knowledge and understanding of CFS has made determining and describing the characteristics of the condition difficult.

Risk factors
Women are diagnosed with chronic fatigue syndrome two to four times as often as men, but sex isn't a proven risk factor for this condition. It may be that women are simply more likely than men are to report their symptoms to their doctor.

The condition is most common in people in their 40s and 50s, but it can affect people of all ages.

Because the cause of the condition is unknown, doctors have yet to determine and confirm definite risk factors for the disease.

When to seek medical advice
Fatigue can be a symptom of many illnesses, such as infections or psychological disorders. In general, see your doctor if you have persistent or excessive fatigue. Severe fatigue that prevents you from fully participating in activities at home, work or school may be a symptom of an underlying medical problem.

Tests and diagnosis
A diagnosis of chronic fatigue syndrome is based on exclusion. This means that before arriving at a diagnosis, a doctor has ruled out any other disease or condition that may be causing your fatigue and related symptoms.

In general, doctors find it difficult to diagnose chronic fatigue syndrome because it has some of the same signs and symptoms as many other diseases. There's no diagnostic or laboratory procedure to confirm the presence of chronic fatigue syndrome.

Doctors exclude certain conditions before considering a diagnosis of chronic fatigue syndrome. These include:

Having an active, identifiable medical condition that often results in fatigue, such as low levels of thyroid hormones (hypothyroidism) or sleep apnea
Using medicines that may cause fatigue
Having a relapse of a previously treated illness that can result in fatigue, such as cancer
Having had a past or current diagnosis of a major depressive disorder or other psychiatric illness, such as schizophrenia or an eating disorder
Abusing alcohol or another substance
Being severely obese, as defined by a body mass index (BMI) of 45 or greater

Over time, be alert to any new cues that might indicate that the problem is caused by something other than chronic fatigue syndrome. When other diseases or conditions are excluded, your doctor may then determine if your illness meets the CFS-specific criteria.

Complications
Possible complications of chronic fatigue syndrome include:

Depression, related both to symptoms and lack of diagnosis
Side effects and adverse reactions related to medication treatments
Side effects and adverse reactions associated with lack of activity (deconditioning)
Social isolation caused by fatigue
Lifestyle restrictions
Missing work

Treatments and drugs
There's no specific chronic fatigue syndrome treatment. In general, doctors aim to relieve signs and symptoms by using a combination of treatments, which may include:

Moderating daily activity.
Your doctor may encourage you to slow down and to avoid excessive physical and psychological stress. However, too much rest can make you weaker, worsening your long-term symptoms. Your goal should be to maintain a moderate level of daily activity and gently increase your stamina over time.

Gradual but steady exercise.
Often with the help of a physical therapist, you may be advised to begin an exercise program that slowly becomes more challenging. Research has proved that gradually increasing exercise can improve the symptoms of chronic fatigue syndrome. In one study, 70 percent of participants with CFS reported feeling better after completing a supervised program of graduated exercise.

Cognitive behavior therapy.
This treatment, often used in combination with graduated exercise, also has been found to improve the symptoms of chronic fatigue syndrome. In cognitive behavior therapy, you work with a mental health professional to identify negative beliefs and behaviors that might be delaying your recovery and replace them with healthy, positive ones.

Treatment of depression.
If you're depressed, medications, such as tricyclic antidepressants and selective serotonin reuptake inhibitors (SSRIs), may help. Antidepressants may also help improve sleep and relieve pain. Tricyclic antidepressants include amitriptyline (Limbitrol, a multi-ingredient drug that contains amitriptyline), desipramine (Norpramin) and nortriptyline (Aventyl, Pamelor). SSRIs include fluoxetine (Prozac, Sarafem), paroxetine (Paxil), sertraline (Zoloft) and bupropion (Wellbutrin).

Treatment of existing pain.
Acetaminophen (Tylenol, others) and nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin and ibuprofen (Advil, Motrin, others), may be helpful to reduce pain and fever.

Treatment of allergy-like symptoms.
Antihistamines, such as fexofenadine (Allegra) and cetirizine (Zyrtec), and decongestants that contain pseudoephedrine (Sudafed) may relieve allergy-like symptoms such as runny nose.

Treatment of low blood pressure (hypotension).
The drugs fludrocortisone (Florinef), atenolol (Tenormin) and midodrine (ProAmatine, Orvaten) may be useful for certain people with chronic fatigue syndrome.

Treatment for problems of the nervous system.
Symptoms such as dizziness and extreme skin tenderness can sometimes be relieved by clonazepam (Klonopin). Your doctor may prescribe medications such as lorazepam (Ativan) and alprazolam (Xanax) to relieve symptoms of anxiety.

Experimental therapies
Research aimed at finding new treatments for chronic fatigue syndrome has included studies of the following medications:

Methylphenidate (Ritalin, Concerta).
This psychostimulant appears to boost and balance levels of the brain chemicals called neurotransmitters. It's commonly used to treat attention-deficit/hyperactivity disorder (ADHD). One study found that methylphenidate improved fatigue and concentration in some people with chronic fatigue syndrome.

D-ribose.
Also called ribose, this form of sugar is an essential energy source for your cells. Scientists believe that impaired cellular metabolism — some kind of disorder in the way your cells do their work — may play a role in chronic fatigue syndrome. Some research has found that natural D-ribose supplements may significantly improve the symptoms of chronic fatigue syndrome, with particular benefit in study participants' energy level and overall well-being.

Acupuncture.
Acupuncture has been studied as a treatment for the symptoms of fibromyalgia, a disease that is considered similar to CFS and is also characterized by fatigue and muscle soreness. In one clinical trial, half the participants received acupuncture, while the other half received a placebo treatment. Those treated with acupuncture experienced a significant improvement in their symptoms — especially fatigue and anxiety — compared with the nonacupuncture group.

Corticosteroids.
Some studies have found that oral hydrocortisone may improve symptoms of chronic fatigue syndrome, while other studies have found no benefit.

Immune globulins and interferons.
These medications are used to boost your immune system's ability to fight infection. Studies have not found them to be consistently effective in treating chronic fatigue syndrome, and participants have experienced severe side effects.

Antiviral drugs, such as acyclovir.
The possible connection between chronic fatigue syndrome and Epstein-Barr virus led researchers to test whether powerful antiviral medications could improve the symptoms of chronic fatigue syndrome. This approach has not been found effective, and the connection between Epstein-Barr virus and chronic fatigue syndrome has since been disproved.

Cholinesterase (ko-lin-ES-tur-ase) inhibitors, such as galantamine.
These drugs improve the effectiveness of acetylcholine, a chemical messenger that is believed to be important for memory, thought and judgment. Galantamine is used in the treatment of Alzheimer's disease, but has not been found beneficial for chronic fatigue syndrome.

Prevention
Because the cause of chronic fatigue syndrome remains unknown, there's no known way to prevent the illness from occurring. Be aware of the symptoms and signs of chronic fatigue syndrome and seek the help of your doctor to manage them if they occur.

Lifestyle and home remedies
Learning how to manage fatigue can help you improve your level of functioning and your quality of life despite your symptoms. You may work with a rehabilitation medicine specialist who can teach you how to plan activities to take advantage of times when you usually feel better.

These important self-care steps can help you to maintain good general health:

Reduce stress.
Develop a plan to avoid or limit overexertion and emotional stress. Allow yourself time each day to relax. That may mean learning how to say no without guilt. If possible, don't change your routine totally. People who quit work or drop all activity tend to do worse than those who remain active.

Get enough sleep.
Getting sufficient sleep is essential. In addition to allotting enough time for sleep, practice good sleep habits, such as going to bed and getting up at the same time each day and limiting daytime napping.

Exercise regularly.
You may need to start slow and build up gradually. But exercising regularly often improves symptoms. Many people find exercises such as walking, swimming, biking and water aerobics to be helpful. A physical therapist may help you develop a home-exercise program. Stretching, good posture and relaxation exercises also can be helpful.

Pace yourself.
Keep your activity on an even level. If you do too much on your good days, you may have more bad days.

Maintain a healthy lifestyle.
Try to eat a balanced diet, drink plenty of fluids, limit your caffeine intake, stop smoking, get adequate rest and exercise regularly. Find a hobby or career that's enjoyable and fulfilling for you.

Coping and support
The experience of chronic fatigue syndrome varies from person to person. For many people, however, the symptoms are more bothersome early in the course of the illness and then gradually decrease. Some people recover completely with time. Emotional support and counseling may help you and your loved ones deal with the uncertainties and restrictions of chronic fatigue syndrome.

You may find it therapeutic to join a support group and meet other people with chronic fatigue syndrome. Support groups aren't for everyone, and you may find that a support group adds to your stress rather than relieves it. Experiment and use your own judgment to determine what's best for you.

Alternative medicine
Some makers of various dietary supplements and herbal remedies claim these substances have potential benefits for people with chronic fatigue syndrome, but the effectiveness of these substances for treating the condition hasn't been proved in controlled studies. Though a product may be of "natural" origin, that doesn't ensure its safety. Dietary supplements and herbal preparations can have potentially harmful side effects and may dangerously interfere or interact with prescription medications.

Some complementary therapies can benefit people with chronic fatigue syndrome by reducing anxiety and promoting a sense of well-being. These include deep-breathing and muscle-relaxation techniques, massage and healing touch, and movement therapies such as stretching, yoga and tai chi.

Talk to your doctor before using any unprescribed remedy or new complementary therapy.

Source: MayoClinic.com

Grieving

Background
For many years, people with terminal illnesses were an embarrassment for doctors. Someone who could not be cured was evidence of the doctors' fallibility, and as a result the doctors regularly shunned the dying with the excuse that there was nothing more that could be done (and that there was plenty of other demand on the doctors' time).
Elizabeth Kübler-Ross was a doctor in Switzerland who railed against this unkindness and spent a lot of time with dying people, both comforting and studying them. She wrote a book, called 'On Death and Dying' which included a cycle of emotional states that is often referred to (but not exclusively called) the Grief Cycle.
In the ensuing years, it was noticed that this emotional cycle was not exclusive just to the terminally ill, but also other people who were affected by bad news, such as losing their jobs or otherwise being negatively affected by change. The important factor is not that the change is good or bad, but that they perceive it as a significantly negative event.

The Grief Cycle
The Grief Cycle can be shown as in the chart below, indicating the roller-coaster ride of activity and passivity as the person wriggles and turns in their desperate efforts to avoid the change.



The initial state before the cycle is received is stable, at least in terms of the subsequent reaction on hearing the bad news. Compared with the ups and downs to come, even if there is some variation, this is indeed a stable state.
And then, into the calm of this relative paradise, a bombshell bursts...

Shock stage: Initial paralysis at hearing the bad news.
Denial stage: Trying to avoid the inevitable.
Anger stage: Frustrated outpouring of bottled-up emotion.
Bargaining stage: Seeking in vain for a way out.
Depression stage: Final realization of the inevitable.
Testing stage: Seeking realistic solutions.
Acceptance stage: Finally finding the way forward.

Sticking and cycling
Getting stuck
A common problem with the above cycle is that people get stuck in one phase. Thus a person may become stuck in denial, never moving on from the position of not accepting the inevitable future. When it happens, they still keep on denying it, such as the person who has lost their job still going into the city only to sit on a park bench all day.

Getting stuck in denial is common in 'cool' cultures (such as in Britain, particularly Southern England) where expressing anger is not acceptable. The person may feel that anger, but may then repress it, bottling it up inside.

Likewise, a person may be stuck in permanent anger (which is itself a form of flight from reality) or repeated bargaining. It is more difficult to get stuck in active states than in passivity, and getting stuck in depression is perhaps a more common ailment.

Going in cycles
Another trap is that when a person moves on to the next phase, they have not completed an earlier phase and so move backwards in cyclic loops that repeat previous emotion and actions. Thus, for example, a person that finds bargaining not to be working, may go back into anger or denial.

Cycling is itself a form of avoidance of the inevitable, and going backwards in time may seem to be a way of extending the time before the perceived bad thing happens.

Source:

Elisabeth Kübler-Ross, On Death and Dying, Macmillan, NY, 1969.

Stress - The No.1 Killer

Description of Stress

Without stress, life would be dull and unexciting. Stress adds flavor, challenge and opportunity to life. Too much stress, however, can seriously affect your physical and mental well-being. A major challenge in today's stress-filled world is to make the stress in your life work for you instead of against you.
During a stressful situation, the brain signals the release of stress hormones. These chemical substances trigger a series of responses that gives the body extra energy: blood-sugar levels rise, the heartbeat speeds up and blood pressure increases. The muscles tense for action. The blood supply is diverted away from the gut to the extremities to help the body deal with the situation at hand.

Stress is with us all the time. It comes from mental or emotional activity, as well as physical activity. It is unique and personal to each of us. So personal, in fact, that what may be relaxing to one person may be stressful to another. For example, if you are an executive who likes to keep busy all the time, "taking it easy" at the beach on a beautiful day may feel extremely frustrating, nonproductive and upsetting. You may be emotionally distressed from "doing nothing."

Too much emotional stress can cause physical illness, such as high blood pressure, ulcers or even heart disease. Physical stress from work or exercise is not likely to cause such ailments.

The important issue is learning how our bodies respond to these demands. When stress becomes prolonged or particularly frustrating, it can become harmful - causing distress or "bad stress." Recognizing the early signs of distress and then doing something about them can make an important difference in the quality of your life and may actually influence your survival.

Stress and Disease

Because the stress response couples physiological and emotional responses, it seems probable that stress can translate frustration into physical illness, but the precise mechanisms by which this occurs are not known. In some situations, as with tension headaches or upset stomachs, the connections appear fairly clear. On the other hand, both headaches and bellyaches can occur with no emotional provocation whatsoever.

The chain of causation is even less clear when it comes to more chronic and serious conditions, such as heart disease, hypertension, diabetes and cancer. The list of diseases linked to stress is almost endless, and includes asthma, allergies, rheumatoid arthritis, ulcers, ulcerative colitis and migraine headaches, among many others.

An important distinction that needs to be made. Any of these chronic illnesses can be made harder to bear by a stress-laden situation or an emotionally inadequate response on the part of the patient. On the other hand, it is no longer possible to credit older theories that specific emotional experiences or reactions actually cause these various diseases. On the whole, it seems most likely that stress plays a non-specific role in disease by throwing off the body's natural ability to heal itself.

Self Care

When stress occurs, it is important to recognize and deal with it. Here are some suggestions for ways to handle stress. As you begin to understand more about how stress affects you as an individual, you will come up with your own ideas on how to ease the tension.

Try physical activity. When you are nervous, angry or upset, release the pressure through exercise or physical activity. Running, walking, playing tennis or working in your garden, are just some of the activities you might try. Physical exercise will relieve that "up tight" feeling, relax you, and turn the frowns into smiles. Remember, your body and your mind work together.

Share your stress. It helps to talk to someone about your concerns and worries. Perhaps a friend, family member, teacher or counselor, can help you see your problem in a different light. If you feel your problem is serious, you might seek professional help from a psychologist, psychiatrist or social worker. Knowing when to ask for help may help to avoid more serious problems later.

Know your limits. If a problem is beyond your control and cannot be changed at the moment, don't fight the situation. Learn to accept what is for now, until such time when you can change it.

Take care of yourself. You are special. Get enough rest and eat well. If you are irritable and tense from lack of sleep, or if you are not eating correctly, you will have less ability to deal with stressful situations. If stress repeatedly keeps you from sleeping, you should ask your doctor for help.

Make time for fun. Schedule time for both work and recreation. Play can be just as important to your well-being as work; you need a break from your daily routine to just relax and have fun.

Be a participant. One way to keep from getting bored, sad, and lonely is to go where it's all happening. Sitting alone can make you feel frustrated. Instead of feeling sorry for yourself, get involved. Offer your services to a neighborhood or volunteer organizations. Help yourself by helping other people. Get involved in the world and the people around you, and you will find they will be attracted to you. You're on your way to making new friends and enjoying new activities.

Check off your tasks. Trying to take care of everything at once can seem overwhelming, and as a result, you may not accomplish anything. Instead, make a list of what tasks you have to do and do them one at a time, checking them off as they're completed. Give priority to the most important ones and do those first.

Must you always be right? Do other people upset you - particularly when they don't do things your way? Try cooperation instead of confrontation; it's better than fighting and always being "right." A little give and take on both sides will reduce the strain and make you both feel more comfortable.

It's OK to cry. A good cry can be a healthy way to bring relief to your anxiety, and it might even prevent a headache or other physical consequence. Take some deep breaths; they also release tension.

Create a quiet scene. You can't always get away, but you can "dream the impossible dream." A quiet country scene, painted mentally or on canvas, can take you out of the turmoil of a stressful situation. Change the scene by reading a good book or playing beautiful music to create a sense of peace and tranquillity.

Avoid self-medication. Although you can use drugs to relieve stress temporarily, drugs do not remove the conditions that caused the stress in the first place. Drugs, in fact, may be habit-forming and create more stress than they relieve. They should be taken only on the advice of your doctor.

The best strategy for avoiding stress is to learn how to relax. Unfortunately, many people try to relax at the same pace that they lead the rest of their lives. For a while, tune out your worries about time, productivity, and "doing it right." You will find satisfaction in just being, without striving. Find activities that give you pleasure and that are good for your mental and physical well-being. Forget about always winning and focus on relaxation, enjoyment, and health. Be good to yourself.

Source: www.healthscout.com

Depression

Depressive illnesses often interfere with normal functioning and cause pain and suffering not only to those who have a disorder, but also to those who care about them. Serious depression can destroy family life as well as the life of the ill person. But much of this suffering is unnecessary.

Most people with a depressive illness do not seek treatment, although the great majority even those whose depression is extremely severe can be helped. Thanks to years of fruitful research, there are now medications and psychosocial therapies such as cognitive/behavioral, "talk" or interpersonal that ease the pain of depression.

Unfortunately, many people do not recognize that depression is a treatable illness. If you feel that you or someone you care about is one of the many undiagnosed depressed people in this country, the information presented here may help you take the steps that may save your own or someone else's life.

WHAT IS A DEPRESSIVE DISORDER?

A depressive disorder is an illness that involves the body, mood, and thoughts. It affects the way a person eats and sleeps, the way one feels about oneself, and the way one thinks about things. A depressive disorder is not the same as a passing blue mood. It is not a sign of personal weakness or a condition that can be willed or wished away. People with a depressive illness cannot merely "pull themselves together" and get better. Without treatment, symptoms can last for weeks, months, or years. Appropriate treatment, however, can help most people who suffer from depression.

TYPES OF DEPRESSION

Depressive disorders come in different forms, just as is the case with other illnesses such as heart disease. This pamphlet briefly describes three of the most common types of depressive disorders. However, within these types there are variations in the number of symptoms, their severity, and persistence.

Major depression is manifested by a combination of symptoms (see symptom list) that interfere with the ability to work, study, sleep, eat, and enjoy once pleasurable activities. Such a disabling episode of depression may occur only once but more commonly occurs several times in a lifetime.

A less severe type of depression, dysthymia, involves long-term, chronic symptoms that do not disable, but keep one from functioning well or from feeling good. Many people with dysthymia also experience major depressive episodes at some time in their lives.

Another type of depression is bipolar disorder, also called manic-depressive illness. Not nearly as prevalent as other forms of depressive disorders, bipolar disorder is characterized by cycling mood changes: severe highs (mania) and lows (depression). Sometimes the mood switches are dramatic and rapid, but most often they are gradual. When in the depressed cycle, an individual can have any or all of the symptoms of a depressive disorder. When in the manic cycle, the individual may be overactive, overtalkative, and have a great deal of energy. Mania often affects thinking, judgment, and social behavior in ways that cause serious problems and embarrassment. For example, the individual in a manic phase may feel elated, full of grand schemes that might range from unwise business decisions to romantic sprees. Mania, left untreated, may worsen to a psychotic state.

SYMPTOMS OF DEPRESSION AND MANIA

Not everyone who is depressed or manic experiences every symptom. Some people experience a few symptoms, some many. Severity of symptoms varies with individuals and also varies over time.

Depression
Persistent sad, anxious, or "empty" mood
Feelings of hopelessness, pessimism
Feelings of guilt, worthlessness, helplessness
Loss of interest or pleasure in hobbies and activities that were once enjoyed, including sex
Decreased energy, fatigue, being "slowed down"
Difficulty concentrating, remembering, making decisions
Insomnia, early-morning awakening, or oversleeping
Appetite and/or weight loss or overeating and weight gain
Thoughts of death or suicide; suicide attempts
Restlessness, irritability
Persistent physical symptoms that do not respond to treatment, such as headaches, digestive disorders, and chronic pain
Mania
Abnormal or excessive elation
Unusual irritability
Decreased need for sleep
Grandiose notions
Increased talking
Racing thoughts
Increased sexual desire
Markedly increased energy
Poor judgment
Inappropriate social behavior

CAUSES OF DEPRESSION

Some types of depression run in families, suggesting that a biological vulnerability can be inherited. This seems to be the case with bipolar disorder. Studies of families in which members of each generation develop bipolar disorder found that those with the illness have a somewhat different genetic makeup than those who do not get ill. However, the reverse is not true: Not everybody with the genetic makeup that causes vulnerability to bipolar disorder will have the illness. Apparently additional factors, possibly stresses at home, work, or school, are involved in its onset.

In some families, major depression also seems to occur generation after generation. However, it can also occur in people who have no family history of depression. Whether inherited or not, major depressive disorder is often associated with changes in brain structures or brain function.

People who have low self-esteem, who consistently view themselves and the world with pessimism or who are readily overwhelmed by stress, are prone to depression. Whether this represents a psychological predisposition or an early form of the illness is not clear.

In recent years, researchers have shown that physical changes in the body can be accompanied by mental changes as well. Medical illnesses such as stroke, a heart attack, cancer, Parkinson's disease, and hormonal disorders can cause depressive illness, making the sick person apathetic and unwilling to care for his or her physical needs, thus prolonging the recovery period. Also, a serious loss, difficult relationship, financial problem, or any stressful (unwelcome or even desired) change in life patterns can trigger a depressive episode. Very often, a combination of genetic, psychological, and environmental factors is involved in the onset of a depressive disorder. Later episodes of illness typically are precipitated by only mild stresses, or none at all.

Depression in Women
Women experience depression about twice as often as men.1 Many hormonal factors may contribute to the increased rate of depression in women particularly such factors as menstrual cycle changes, pregnancy, miscarriage, postpartum period, pre-menopause, and menopause. Many women also face additional stresses such as responsibilities both at work and home, single parenthood, and caring for children and for aging parents.

A recent NIMH study showed that in the case of severe premenstrual syndrome (PMS), women with a preexisting vulnerability to PMS experienced relief from mood and physical symptoms when their sex hormones were suppressed. Shortly after the hormones were re-introduced, they again developed symptoms of PMS. Women without a history of PMS reported no effects of the hormonal manipulation.6,7

Many women are also particularly vulnerable after the birth of a baby. The hormonal and physical changes, as well as the added responsibility of a new life, can be factors that lead to postpartum depression in some women. While transient "blues" are common in new mothers, a full-blown depressive episode is not a normal occurrence and requires active intervention. Treatment by a sympathetic physician and the family's emotional support for the new mother are prime considerations in aiding her to recover her physical and mental well-being and her ability to care for and enjoy the infant.

Depression in Men
Although men are less likely to suffer from depression than women, 6 million men in the United States are affected by the illness. Men are less likely to admit to depression, and doctors are less likely to suspect it. The rate of suicide in men is four times that of women, though more women attempt it. In fact, after age 70, the rate of men's suicide rises, reaching a peak after age 85.

Depression can also affect the physical health in men differently from women. A new study shows that, although depression is associated with an increased risk of coronary heart disease in both men and women, only men suffer a high death rate.2

Men's depression is often masked by alcohol or drugs, or by the socially acceptable habit of working excessively long hours. Depression typically shows up in men not as feeling hopeless and helpless, but as being irritable, angry, and discouraged; hence, depression may be difficult to recognize as such in men. Even if a man realizes that he is depressed, he may be less willing than a woman to seek help. Encouragement and support from concerned family members can make a difference. In the workplace, employee assistance professionals or worksite mental health programs can be of assistance in helping men understand and accept depression as a real illness that needs treatment.

PSYCHOTHERAPIES
Many forms of psychotherapy, including some short-term (10-20 week) therapies, can help depressed individuals. "Talking" therapies help patients gain insight into and resolve their problems through verbal exchange with the therapist, sometimes combined with "homework" assignments between sessions. "Behavioral" therapists help patients learn how to obtain more satisfaction and rewards through their own actions and how to unlearn the behavioral patterns that contribute to or result from their depression.

Two of the short-term psychotherapies that research has shown helpful for some forms of depression are interpersonal and cognitive/behavioral therapies. Interpersonal therapists focus on the patient's disturbed personal relationships that both cause and exacerbate (or increase) the depression. Cognitive/behavioral therapists help patients change the negative styles of thinking and behaving often associated with depression.

Psychodynamic therapies, which are sometimes used to treat depressed persons, focus on resolving the patient's conflicted feelings. These therapies are often reserved until the depressive symptoms are significantly improved. In general, severe depressive illnesses, particularly those that are recurrent, will require medication (or ECT under special conditions) along with, or preceding, psychotherapy for the best outcome.

HOW TO HELP YOURSELF IF YOU ARE DEPRESSED

Depressive disorders make one feel exhausted, worthless, helpless, and hopeless. Such negative thoughts and feelings make some people feel like giving up. It is important to realize that these negative views are part of the depression and typically do not accurately reflect the actual circumstances. Negative thinking fades as treatment begins to take effect. In the meantime:

- Set realistic goals in light of the depression and assume a reasonable amount of responsibility.
- Break large tasks into small ones, set some priorities, and do what you can as you can.
- Try to be with other people and to confide in someone; it is usually better than being alone and secretive.
- Participate in activities that may make you feel better.
- Mild exercise, going to a movie, a ballgame, or participating in religious, social, or other activities may help.
- Expect your mood to improve gradually, not immediately. Feeling better takes time.
- It is advisable to postpone important decisions until the depression has lifted. Before deciding to make a significant transition change jobs, get married or divorced discuss it with others who know you well and have a more objective view of your situation.
- People rarely "snap out of" a depression. But they can feel a little better day-by-day.
- Remember, positive thinking will replace the negative thinking that is part of the depression and will disappear as your depression responds to treatment.
- Let your family and friends help you.

How Family and Friends Can Help the Depressed Person
The most important thing anyone can do for the depressed person is to help him or her get an appropriate diagnosis and treatment. This may involve encouraging the individual to stay with treatment until symptoms begin to abate (several weeks), or to seek different treatment if no improvement occurs. On occasion, it may require making an appointment and accompanying the depressed person to the doctor. It may also mean monitoring whether the depressed person is taking medication. The depressed person should be encouraged to obey the doctor's orders about the use of alcoholic products while on medication. The second most important thing is to offer emotional support. This involves understanding, patience, affection, and encouragement. Engage the depressed person in conversation and listen carefully. Do not disparage feelings expressed, but point out realities and offer hope. Do not ignore remarks about suicide. Report them to the depressed person's therapist. Invite the depressed person for walks, outings, to the movies, and other activities. Be gently insistent if your invitation is refused. Encourage participation in some activities that once gave pleasure, such as hobbies, sports, religious or cultural activities, but do not push the depressed person to undertake too much too soon. The depressed person needs diversion and company, but too many demands can increase feelings of failure.

Do not accuse the depressed person of faking illness or of laziness, or expect him or her "to snap out of it." Eventually, with treatment, most people do get better. Keep that in mind, and keep reassuring the depressed person that, with time and help, he or she will feel better.

Source:
This brochure is a new version of the 1994 edition of Plain Talk About Depression and was written by Margaret Strock, Public Information and Communications Branch, National Institute of Mental Health (NIMH). Expert assistance was provided by Raymond DePaulo, MD, Johns Hopkins School of Medicine; Ellen Frank, MD, University of Pittsburgh School of Medicine; Jerrold F. Rosenbaum, MD, Massachusetts General Hospital; Matthew V. Rudorfer, MD, and Clarissa K. Wittenberg, NIMH staff members. Lisa D. Alberts, NIMH staff member, provided editorial assistance.

NIH Publication No. 00-3561
Printed 2000

Fritz Perls - Gestalt Therapy