Stanton,

Do you think that the whole seratonin transmitter thing is totally wrong regarding depression? I have suffered from depression for at least thirty years. And I've been through therapy, AA and whatever else I could do to self help myself. What a bunch of crap!

Modern antidepressants work for me and although I don't like being a human guinee pig I prefer these pills to that wretched state of mind. Anything is better then that! William Styron describes his depression quite well although he didn't experience depression until he was in his sixties. His book, written in the 80's is called Darkness Visable. Although I've been going through depressions for many years I like Styron's descriptions. Good writing.

Are you a social scientist without even a thought to harmones or brain chemistry. I don't like genetics being used as an excuse for behavior. And I certainly don't buy the twinkie, prozac, maniac defense. I hope you are more openminded then someone who discounts brain chemistry in favor of psychology. I hope you are just trying to cut thru the whole criminal, excuse, and moron team. I agree if that is your intent.

PMS is real, and so is menopause. Do you think that all of our problems stem from our upbringing? If so, why do antidepressants work for me? I can talk until...forever but antidepressants work for me better.

LF

Dear LF:

You seem to want to have me okay your antidepressant use — but there is someone whose position on the matter might cause you even more discomfort — William Styron. Although he was highly committed to believing his depression was a preordained biological disease, he was virulently anti antidepressants (meaning they did nothing at all for him). Basically, his antidote for depression was bed rest. I personally find Styron's memoir of madness, Darkness Visible, a book by a man sadly lacking in insight looking for reasons for his misery.

Whether antidepressants have an effect, how much of an effect, for which people, and with what consequences are debatable questions. Looking only at controlled studies using active placebos (those that are not obviously identifiable as inert by patients), few — if any — differences are found between placebo and antidepressants. Patient and therapist attitudes have been found to be critical to responses to these drugs (as well as to virtually all other classes of psychotropic drugs). The best source for this information is the volume, From Placebo to Panacea: Putting Psychiatric Drugs to the Test, edited by Seymour Fisher and Roger Greenberg.

If you tell me that you find antidepressants helpful to you, I say, "go with what works." If you want to explore the meaning of your life, I say, "look at the literature on antidepressants, examine your beliefs, and approach the sources of your depression openly and critically." Of course, it might be that questioning your antidepressants could harm their efficacy for you. But, tell me, have you not had to vary your doses and brands of antidepressants over the years? I know of virtually no one who has found antidepressants to remain uniformly helpful without significant variations in administration practices — like (forgive me) drug addicts and alcoholics I know who are always looking for the right "titration" to reach the optimal high with the least downside from their drug of choice.

You have grown disillusioned with AA. It was a blind alley ultimately. Why was that? Can one discount AA's version of reality (that alcoholism is a disease) and accept depression is a real disease? Or are the ventures to free oneself of biologically deterministic views of the causes of human behavior and emotion in these two areas related? Do you now feel that the disease of alcoholism was a misdiagnosis for another disease (as Kitty Dukakis claimed John Wallace and his staff at the Edgehill Newport Hospital misdiagnosed her manic-depression)? I don't know the ultimate causes of your problems, but I do believe that one's views of these problems and their sources have personal consequences.

Stanton

Dear Stanton:

I do notice that there is a kind of immunity or tolerance that may be building up over time. I did get very depressed once while still on my medication...

I don't view alcohol addiction as a disease. Alcohol abuse causes diseases. But it's different than depression in that we actually have to do something--from the outside in--like drink too much--and with depression nothing needs to be done. There are people who have had great careers and great lives, or so it would seem, and they can be seriously depressed to the point of not being able to function. I don't claim to thoroughly understand that since I am not yet successful in any career, and I have no children, or as the old saying goes...a pot to....But I do have some good friends. I don't really view depression as a disease either but it can be fatal and although there our outside stresses that can exassperate it (such as drinking alcohol to excess since it is a depressant) essentially it is not as easily controlled as alcohol abuse. I mean we can stop abusing alcohol....

Dear [...]

You came across great. I admire a serious and thoughtful person, trying to come to grips with their lives.

If anyone were to come to me for any advice, I would recommend trying to use their intelligence for job, career, family, and ... those kind of things. I like to consult with people to achieve success. It makes me feel good, and sometimes them.

Stanton

next: Does Childhood Sexual Abuse Lead to Adult Addiction?
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The credibility of Internet addiction has become a legal issue in both civil and criminal courts. The president of the American Academy of Matrimonial Lawyers indicated that there has been a notable rise in the number of divorce cases involving cyberaffairs and online addiction over the past year. Furthermore, the issue of Internet addiction has played a significant role in child custody hearings. Frequently, such Internet abuse leads to neglectful behavior on the part of the custodial parent, often times the mother, leaving the non-custodial parent to fight for full custody. Finally, criminal courts have seen a rise in the number of cases involving sexual misconduct, online pedophilia, online child pornography, and cybersexual addiction. These cases usually evaluate the role of electronic anonymity in the development of deviant, deceptive, or criminal acts.

Dr. Kimberly Young, Founder and President of the Center for Internet Addiction Recovery, has provided forensic consultation in the following ways:

• Conducted psychological evaluations for clients suspected of being addicted to the Internet.
• Provided written affidavits to support the scientific validity of Internet addiction.
• Provided expert testimony to support the scientific validity of Internet addiction.

Dr. Young has testified at a Daubert Hearing held in Wheeling, West Virginia in the case of The State vs. Russell. The trial court is vested with the authority and responsibilities to serve as "gatekeeper" of evidences to screen scientific theories to make sure they are scientifically valid and reliable. The vast majority of scientific theories, usually medical, are typically not challenged as being unreliable and are admissible through judicial notice; however, the newness of Internet addiction may facilitate a Daubert Hearing to determine its scientific validity. The theory was accepted in this case and will be persuasive to other courts.

To contact Dr. Young:

Center for Internet Addiction Recovery
P.O. Box 72
Bradford, PA 16701
814-451-2405 phone
814-368-9560 fax

An article in the Los Angeles Times (1/22/99) explored the new type of Cyber-crime: "Man charged under new cyber-stalking law:"

"A North Hollywood man has become the first perpetrator to be prosecuted under California's new cyber-stalking law. Gary S. Dellapenta, a 50-year-old security guard, has been charged with stalking, computer fraud and solicitation of sexual assault. After his romantic advances were rebuffed by a woman he met at church, he proceeded to post ads in her name on America Online, Hotmail and other Internet sites that described fantasies of being gang-raped. When people responded, he revealed personal information about her, from the address of her apartment to her physical description, her phone number and how to bypass her home security system. Law enforcement officials have predicted that such crimes will proliferate, aided by the decrease in personal privacy and the anonymity of cyberspace."

next: What Makes the Internet Addictive?
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Dear Stanton:

What are your opinions about Smart Recovery? Jack Trimpey's AA Bashing was/is opposed by the Smart Recovery Board, but now there is a ground swell of "Let's give it back to them." What are your opinions about this?

Dick Brockman

Dick:

I'm on the scientific advisory board of SMART, but I welcome all input. You sound well-informed. Tell me where you're at and what you think is going on and your reactions to it.

Stanton

Stanton:

I am here in Texas, Fort Worth, which has been in the heartland of AA country since the beginning. We have the largest Baptist Seminary here and major beliefs that Smart Recovery is probably sinful because it is Ungodly! Albert Ellis is of course an Atheist, ergo REBT can not be abided. Well, not really — we have some enlightened folk here, but the majority are so hard core AA that you can barely talk to them about alternatives to AA without them covering their ears and humming to drown out the anathema. I have been a maverick for many years and was an enthusiastic supporter of Jack's from the beginning and was one of the first Certified Rational Recovery Specialists. We met when he was in our area and he, Lois and I appeared to get along fine. I licensed my agency to be called a Rational Recovery Agency and I was going about giving talks about RR as an alternative to AA for a long time. Then Jack appeared to go off the deep end and do exactly what he criticized AA folks for — saying that the only ones who could help are those who have had the problem and since I am not a recovering anything, I fell out of grace and finally said enough of this Non-Rational Thinking. I was very glad to see SMART Recovery get off the ground and now we carry that banner and have a meeting at our facility weekly.

F.A.C.T.S. is a non-profit agency I started in 1985 with one of my professors, since retired, and we specialize in Family Violence, Anger and Substance Abuse. I am a twenty year retired Air Force Officer, who specialized in Substance Abuse Education and Rehabilitation and Equal Opportunity in the Service. At that time I believed all the propaganda and said the AA was the only way, but was always doubting this. When I retired I went back to school for more Degrees (Social Work) and training and got turned on by REBT and the reasonableness of identifying problems based upon thinking rather than powerlessness, loss of control and higher powers. This whole process fit into our organization with regards to the "Batterers Intervention Programs" and "Anger Control Program" which we have developed. We are again on the outside of some of the approved thinking in these areas, because we are not "Object Relations" oriented, and do not attribute these problems to Unattached or Unbonded childhood experiences. I was trained in this process, especially in Rage Reduction Therapy, by Foster Cline, MD of the Evergreen Associates program in Colorado. In most all these programs people are trying to find the cause or justify the behavior and I find that to be either bullshit or a waste of time. What are we going to do about the behavior? Substance abuse is probably the easiest to measure in that quantities, number of times, and outcomes can be measured, but not by the AA method — a behavioral problem, attributed to a medical disease and cured by a spiritual method!

So anyway! The latest newsletter from SMART Recovery had articles about the abuse we have taken from AAers and Vince Fox's articles about how we should stop being the nice guys and start bashing back. I asked your opinion because I respect you authorship and reasoning and argumentation. I have trained with Albert Ellis in four programs and Michelor Bishop and, although this is my philosophy in general, I can not altogether agree with him and Michelor on the idea that REBT can co-exist with the Twelve Step Approach and that we should be nice guys about the whole affair. The only time I have found acceptance from the Twelve Step Community is if I agree that REBT and Twelve Step can work together. I am a purist in that I can not abide by the Irrational thinking of the Twelve Steps and see how I can agree with them in my therapy. It is rather like you have pointed out in your books and articles, not necessarily in this manner but, if it's bullshit, it's bullshit!

So there you have small input of what I think is going on. I believe that the nice guy approach has not really worked with the Twelve Steppers, although the Criminal Justice System is siding with us more and more and not supporting the AA approach as strongly as in the past. I am frustrated that things are not going as fast as I want them to go. I recognize that this frustration is my making and I can handle that.

I am always looking to learn and improve my mind and do research in these areas. I read a lot and have read several of your works and agree with what you believe. I appreciate your answering me so quickly.

Dick

Dear Dick:

I like the cut of your jib (even if you were in the Air Force)! I hate it when military guys are irrational — I thought that was their primary professional claim — that they see through the bullshit.

Anyhow, I liked the story of your Odyssey very much. You hang out there, do what you think is right, take heat, and roll with the punches. You might actually be doing some good! (Every once in a while, I read something that makes me think psychology works. Like, in the book Fatal Vision, when the defense attorney brings the murderer, Captain MacDonald, to a psychologist for testing, and the guy gets MacDonald to a T! Says he can't comprehend anyone's feelings outside his own, and views any interference with his urges as a personal assault that he feel he can eliminate as he chooses.)

Your experiences with Jack are, of course, fascinating and consistent with those of others. (Have you seen the section on my website where Jack accuses me of being the devil?) I admire your ability to float with the punches and to come out swinging. I admire your nondogmatic, sensible approach to things (I don't even know what "Object Relations" are, but they are obviously bullshit). And you tell me you're making headway within the criminal justice system. I would hope that a guy with a military background could swing a little weight there.

Meanwhile, you may know that my main problem with SMART Recovery is that most human beings in the world are struggling to continue using, and most will continue to do so. So I wish there was a group that dealt with the majority of people — even including those who keep using without much reduction in use, but who could nonetheless still improve their lives and eventually get in a position to ameliorate or eliminate their substance abuse (I'm talking harm reduction).

As for the particular dispute you describe, between the appeasers and the warriors (a la Vincent Fox), my natural disposition is very much, like you, on the side of the latter. It's just laziness and fear of doing battle with those crazy AAers that makes Albert Ellis (whom I know slightly) accept their bullshit (this, from a man whose favorite analytic phrase over the decades has been "bullshit"). But, I found myself agreeing with the accommodators as well — why look for problems when you just are offering to expand the array of services? I can't argue with someone who takes a peaceful approach to reform. And, I might add, sometimes people liken my battling ways to Jack's, and I don't want that as my epitaph.

Keep in touch. Make headway. Get in trouble. These are the words I live by.

Stanton

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Innovative day treatment program for homeless crack addicts makes work and housing dependent upon drug abstinence.

Day Treatment With Abstinence Contingencies and Vouchers

Was developed to treat homeless crack addicts. For the first 2 months, participants must spend 5.5 hours daily in the program, which provides lunch and transportation to and from shelters. Interventions include individual assessment and goal setting, individual and group counseling, multiple psychoeducational groups (for example, didactic groups on community resources, housing, cocaine, and HIV/AIDS prevention; establishing and reviewing personal rehabilitation goals; relapse prevention; weekend planning), and patient-governed community meetings during which patients review contract goals and provide support and encouragement to each other.

Individual counseling occurs once a week, and group therapy sessions are held three times a week. After 2 months of day treatment and at least 2 weeks of abstinence, participants graduate to a 4-month work component that pays wages that can be used to rent inexpensive, drug-free housing. A voucher system also rewards drug-free related social and recreational activities.

This innovative day treatment was compared with treatment consisting of twice-weekly individual counseling and 12-step groups, medical examinations and treatment, and referral to community resources for housing and vocational services. Innovative day treatment followed by work and housing dependent upon drug abstinence had a more positive effect on alcohol use, cocaine use, and days homeless.

References:

Milby, J.B.; Schumacher, J.E.; Raczynski, J.M.; Caldwell, E.; Engle, M.; Michael, M.; and Carr, J. Sufficient conditions for effective treatment of substance abusing homeless. Drug & Alcohol Dependence 43: 39-47, 1996.

Milby, J.B.; Schumacher, J.E.; McNamara, C.; Wallace, D.; McGill, T.; Stange, D.; and Michael, M. Abstinence contingent housing enhances day treatment for homeless cocaine abusers. National Institute on Drug Abuse Research Monograph Series 174, Problems of Drug Dependence: Proceedings of the 58th Annual Scientific Meeting. The College on Problems of Drug Dependence, Inc., 1996.

Source: National Institute of Drug Abuse, "Principles of Drug Addiction Treatment: A Research Based Guide."

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Parents share stories about Nikken sleep systems and Nux Vomica, a homeopathic remedy for treating ADHD.

Natural Alternatives for ADHD

Nikken Sleep Systems

Kim sent us the following information about this......

"My son is using a nikken kenko mattress pad, intellerest magnetic pillow, and magnetic shoe insoles. All of these products are 100% magnetic coverage. They also have a special triangular patent that no one else can copy. The triangular design means that the magnetic energy can travel to every nerve ending. These products are wonderful. And they have given me a new son, one who listens and actually hears you when you talk to him. Also his teachers are very impressed with his change in grades.

If you want to look up these products for yourself, go to http://www.nikken.com/. This will show you all the products available. They also have nutritionals to help.

My son isn't taking the nutritionals because he doesn't need them with the other products he has. But if your interested, one of them is called mental clarity.

Thanks so much for your time, and if you have any questions feel free to e-mail me back at enikken@crosslink.net.

Dean writes......

"I do not have ADD/ADHD nor does my daughter. However, I know many who do. I am writing because I believe I have a treatment that can help. I am a distributor for a company called Nikken. Nikken is a world leader in wellness product research and development.

Have you heard of magnetic therapy? I believe Nikken's sleep systems and other products can provide relief for many with ADD/ADHD symtoms. Please read the attachment, as it contains many positive testimonials from using Nikken products.

There is alot of information about magnetic therapy out there in the form of research and books. Magnetic therapy has been used for thousands of years by early Chinese and even Egyptians. It is real! I've experienced it personally."

Guadalupe from Brussels wrote....

"My ten-years-old son has ADD/ADHD. I bought him a Nikken bed system (pad, pillow, duvet) and in only one month the results are astonishing. His behaviour in general has changed dramatically.

Nux Vomica

This homeopathic remedy has really fired our enthusiasm. We were told by our pharmacist that we could use it for Richard (13 years old, about 10 stone (140lbs) at the time of writing in 1997) in conjunction with Ritalin, with no adverse effect. Nux Vomica is a tree that grows in China, Burma, Thailand and Australia. The fruit contains seeds which are bitter because of the poison, strychnine (no it doesn't work because it kills off the patient!!).

We tried Richard on strength 6, with some really excellent results. In fact, he had a Ritalin holiday over a school half term week, when he had nothing but Nux Vomica, one three times a day, dissolved on the tongue. He was a lot more lively than when on Ritalin, infact more like the old Richard, but without flying off into a stress/tantrum every five minutes. We didn't have one tantrum all week. Now, we do still administer Ritalin, in conjunction with the occasional Nux Vomica tablet, but only when he needs it i.e. sometimes when he's getting too 'high' at school, which is becoming less often these days. We're beginning to wonder if he can infact learn, as he seems to be doing, to do without Ritalin altogether and channel this wonderful extra energy into positive tasks. He seems to be more able to do this now that he's got his self esteem and confidence back to a much higher level.

Other members of our group have recorded similar results with their children and Nux Vomica. Several swear by it. One mum gave it to her two lads who were both awaiting diagnosis, both in their late teens, one of whom was very much a handful. The results were so dramatic, now that they have both been diagnosed, she's not stopping the use of Nux Vomica. Since we told her about Nux, she's been telling us how it's changed her and their lives and she can finally see the light a the end of a long and particularly dark tunnel. Other mums have told us similar stories. Don't get the idea that we are pushing or promoting the use of this remedy, we just told these parents who were particularly desperate and at the end of their tether, about the effect it had had on our Richard and that it might be worth considering as an option.

It is important to note that homeopathic remedies are not intended for long term use and seem to work best with people of certain metabolisms i.e. in harmony with your particular body make up, so that whilst one type of remedy might work well with a small dark haired person, it might not work so well with a large red head and so forth. Also, as with all medications, you should check with your medical practitioner before taking anything not prescribed for you. It may also be of benefit to seek the help of a qualified homeopathic practitioner who may advise alternative teatments. If you are in the UK, we have been advised that The British Homeopathic Association at 15 Clerkenwell Close London, EC1R 0AA, Tel: 020 7566 7800, can provide a national list of medical doctors who have a post-graduate training in homeopathy through the Faculty of Homeopathy (apparently the only recognised training in the UK), as well as details of NHS treatment. Alternatively, The Society of Homeopaths, 2 Artizan Road, Northampton NN1 4HU, Tel: 01604 621400 have a register of non-medically qualified homeopaths.

One last point, the suggested dose of two tablets to be dissolved on the tongue made Richard feel a bit sick so he only has one. Also, don't be put off by the claim on the pack that Nux is just for the treatment of hangovers, it's not!

Ed. Note: Please remember, we do not endorse any treatments and strongly advise you to check with your doctor before using, stopping or changing any treatment.

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male sexual problems

Viagra doesn't preclude psychologists' integral role in the treatment of sexual dysfunction.

Urologists are inundated with inquiries about it. The news media is treating it as the hottest since Prozac.

Viagra, the pharmacological treatment for impotence, went on the market about 2 years ago amid a torrent of publicity. Its manufacturer, Pfizer, Inc., pegs the success rates as high as 80 percent. Men are expected to find the drug far more palatable than the penile implants, vacuum pumps, injections and other standard medical treatments for impotence.

Such is the way that the treatment of impotence is changing. Once thought to be a largely psychological problem, experts have since discovered that diseases such as diabetes or hypertension-or the drugs used to treat them-are often the cause of erectile dysfunction. And while talk therapy was once regarded as the first line of treatment, impotence now appears to be cured by simply popping a pill.

So where does that leave psychologists who have built careers as sex therapists? Has impotence become the domain of urologists and pharmaceutical companies, at the expense of mental health providers?

Practitioners have a variety of answers to those questions. Some say they play an integral, albeit altered role in the treatment of impotence, even in cases of physiological causes. They still conduct psychological screenings to make sure some mental problem, such as anxiety or depression, isn't behind the dysfunction. They work closely with urologists to help patients understand the suspected medical causes for their inability to perform. And they still need to help patients deal with the shame and embarrassment-and the relationship problems-that can accompany their impairment, whether it's organically based or not.

'The current approaches reflect an application of the biopsycho-social paradigm,' says Stewart Cooper, PhD, a Valparaiso University psychology professor who directs the school's counseling center and teaches a course in marital and sex therapy. 'It's a blending of the urological and endrocinological examination, the use of pharmacology and psychotherapy, to resolve issues surrounding sexuality and sexual performance.'

Others worry that medicine has focused on fixing the 'hydraulics' of male sexual dysfunction, at the expense of the personal and relationship problems that so often result in impotence. Leonore Tiefer, PhD, clinical associate professor of psychiatry at Albert Einstein College of Medicine, says the medical field has exaggerated the prevalence of physiologically based erectile disorders, and that organicity is not usually the cause.

'Many people say that unknown percentage of men have organic problems and 100 percent have psychological problems,' she says. 'The point is that they coexist.'

Increasing prevalence?

Urologists estimate that about 30 million American men suffer from erectile dysfunction, and many clinicians believe that number is rising. They say that trend stems from several factors:

- Men's high or exaggerated expectations about their sexual performance.

- The increasing life expectancy, which hikes the population of men who encounter age-related barriers to their erectile functioning. (Studies show that the prevalence of erectile dysfunction triples between the ages of 40 and 70.)

- New and better technology that can be used to diagnose and treat organically based impotence.

'It was once thought to be a largely psychogenic problem,' says Mark Ackerman, PhD, director of health psychology at the VA Medical Center in Atlanta and an assistant professor at the Emory University School of Medicine. 'But recent advances in diagnosis have confirmed that organic factors, such as diabetes or hypertension, confer significant independent risk for erectile dysfunction. The field of medicine now has more tools, like Doppler ultrasound that looks at penile vascular blood flow. The pendulum has now swung in the other direction. Urologists can devote whole practices to the treatment of erectile dysfunction.'

Many psychologists agree that they need to understand the biological risk factors - such as hormonal abnormalities, vascular disorders and neurological problems - that can contribute to impotence.

'I've found I need to have familiarity with fields like urology, endocrinology and geriatrics,' say Rodney Torigoe, PhD, lead psychologist at the U.S. Department of Veterans Affairs (VA) offices in Honolulu. 'Those are things you don't learn in psychology training.'

But none of this precludes psychological treatment as an adjunct, if not integral part of the protocol, psychologists say. Like many medical problems, physical factors that contribute to impotence are often behaviorally based. Smoking, poor diet and lack of exercise all can lead to the vascular problems or diseases that can result in impotence.

And, even medically based factors in impotence can create problems between sexual partners that only psychologists can address.

'Relational therapy is still very important - maybe even more than before,' Ackerman says. 'Even if you fix the penis, you still have the man's psychological reaction to the medical disorder and the problems it can cause in the relationship.'

Many physicians agree with Ackerman's contention. For example, Boston University urologist Irwin Goldstein, MD, in a recent interview published in Urology Times (Vol. 25, No. 10), says he supports the National Institutes of Health standard that 'everybody with impotence needs a psychological evaluation,' conducted by a psychologist.

The technical solution

Many mental health experts lament the medicalization of sexuality as unwarranted and unfair. Tiefer says society's 'pursuit of the perfect penis' focuses more on the man, rather than the couple. Impotence treatment, by centering specifically on a man's ability to engage in intercourse, seems to ignore other aspects of sexuality and slights the woman's satisfaction in a sexual relationship, she says. And it reflects the societal pressure on men to be sexually virile, a standard that can often create performance anxiety in men, she says.

Addressing only the genital component of sexual dysfunction doesn't always guarantee great satisfaction among patients, says David Rowland, PhD, a psychology professor at Valparaiso University and senior associate at Johns Hopkins University. Just because the parts work doesn't mean the men, or their partners, are enjoying sex again, he says.

And the miracle medical cures may not be as miraculous as they sound, notes Leslie R. Schover, PhD, of the Cleveland Clinic Foundation. She notes that Pfizer's own clinical-trial data on Viagra shows that it is most effective for milder forms of erectile problems - such as those that are anxiety-based - and less effective for the more severe forms.

'Viagra is a threat to sex therapy precisely because it is a drug designed to take our 'best customers,'' she says. 'Instead of teaching them new skills that they can use to overcome performance anxiety, it makes them dependent on a pill that costs $10 a pop.'

The most effective treatment for men's sexual dysfunction, Ackerman says, is through closer collaboration between psychologists and urologists. Psychologists who treat men with sexual problems need to better sell their clinical abilities to urologists, Ackerman adds. Health psychologists offer skilled assessment and therapeutic techniques that can not only help urologists pinpoint any psychological or behavioral factors in a patient's sexual dysfunction, but can also help design a treatment plan and aid the patient in complying with the regimen, he says.

'The opportunities for psychologists are plentiful,' he says, 'and they've expanded significantly beyond the role of providing sex therapy.'

This article is from the American Psychological Association.

next: Impotence Related Problems

sexual problems

Impotence and the Partner

Impotence can be very taxing on a relationship. On the one hand, the man may feel that his "loss of manhood" is a subject that he must keep to himself and not share with his partner. He may withdraw emotionally and physically from his partner. The partner may react with feelings of insecurity, self-doubt and may blame him or herself for the sexual difficulties present in the relationship.

The Individual and Society

Society has a tremendous influence on how we view and conduct ourselves. We consider sex to be a very private and intimate act, yet knowledge of the "howtos" and of its pleasure has been communicated to us through word of mouth and through various media such as video and publications. Sex is infused in all cultures. A scent of perfume may arouse sexual feelings. Indeed, it is what we receive through sensory stimuli and fantasies that "turn us on" and in the case of a man, "makes him hard".

Men are pressured from their peers and society to "get it up" and "perform". Any sense that he is unable to do so challenges his sense of manhood and threatens his self-esteem. He may feel guilty that he can no longer perform his function as a man - a "performer" and creator of life - and he may feel that impotence is the first sign that age is creeping up on him.

Impotence and erection weakness is not only a problem for the man but is a problem for the relationship. For example, a man now challenged by his erection weakness may feel embarrassed and ashamed and lose his desire to perform. He may begin to deny his partner any emotional and physical attention and avoid situations where sexual encounters may occur. He may refuse to discuss his difficulties with anyone, especially with his partner. This lack of sexual intimacy between the couple can place great strain on the partner, particularly if the partner is a woman.

A woman may see her partner's erection weakness and absence as a sign that he no longer loves her, finds her attractive or desires her. Her need for understanding and reassurance is not being met and her loving feelings towards her partner are being replaced by feelings of anger, insecurity, self-doubt and even self-blame. Understanding what is happening and knowing that she can support and participate in treatment brings an enormous sense of relief to the partner.

Advice for the Couple

A man's "good piece" doesn't always work at the push of a button. Impotence is an issue that must be worked out between the couple with the full understanding that communication is the most essential step in achieving success towards treatment and recovery. Whereas the man must openly express his feelings and discuss his difficulties, the partner needs to offer sympathy and understanding and reassure that the difficulty is temporary and can be successfully treated. Communication alleviates and prevents any misunderstandings and feelings of unhappiness and isolation.

next: The Psychology of Impotence

Came to believe that a power greater than ourselves could restore us to sanity.

For me, Step Two was the natural progression from Step One. In Step One, I admitted that I could not function as my own higher power. I admitted that my life was a mess because of my own attitude and my own choices.

I could not function as my own higher power. I had to find a higher power greater than my self.

One symptom of my co-dependency had been to let other people function as my higher power. In 1993, I was totally alone. There was not another person to whom I could turn. I had made enemies of just about everyone in my life but a few people, and those few were true friends enough to tell me I needed serious help beyond what they could do.

By grace, I learned that as a higher power, other people do not fit the job's description. People are imperfect, judgmental, given to emotional decisions, and other human traits. I say this compassionately.

I realized, too, for the same reasons, that neither could I function as another person's higher power. I had always been quick to give advice, tell others what they should do, and offer opinions and solutions when no one had asked me. This was yet another manifestation of my co-dependency.

I needed a higher power that was super human. I needed a power higher than myself in whom to trust and believe.

When I came to this realization, I woke up in a sense. All my previous life had been a delusion of my own making. I came to like a person regaining consciousness after being knocked unconscious. All my attempts to deal with life had really been attempts to deny reality and to deny my own powerlessness. Trying to run my own life had been insanity. Somewhere in the back of my mind, I knew I was powerless, but I did not want to admit it, was not ready to admit it, until August 1993.

Once I became humble enough to admit my own powerlessness, once I woke up to reality, then (and only then) was I ready to look outside of my self and seek a power higher than my self. Once I admitted the insanity of trying to play god in my life and in the lives of other people, I was ready to voluntarily undergo whatever change and transformations were necessary within me to achieve sanity and serenity. I willingly turned to God.

next: The Twelve Steps of Co-Dependents Anonymous Step Three

Eating disorders are consuming. They consume the individual in obsessive, negative thinking and behaviors and they consume the individual's relationships with family members, loved ones, and life. This is partially due to the effects of starvation in anorexia. When people are not adequately nourished, they think about food constantly, sometimes even dreaming about it. They also become depressed, isolated, and tired. They avoid relationships because they often feel others pressure them to eat, are physically depleted, and feel compelled to engage in eating disordered behaviors.

Loved ones find eating disorders extremely difficult to understand and accept. Seeing someone you love starve or damage their bodies is stressful, and, often, parents, spouses, and others begin to become intrusive in their efforts to get the person to eat or to stop purging. Soon, the individual may see these loved ones as enemies trying to control her rather than help.

Eating disorders may develop if a person has no other way to speak or represent her feelings. Frequently family dynamics, faulty communication patterns, losses or other stressors such as abuse contributed to negative feelings she could not deal with directly. It is never a simple matter that can be solved by telling the person just to eat. The symptoms have become the individual's way to avoid facing problems more directly or an attempts to feel in control when the rest of one's life feels out of control.

Get help for your relationship by getting help for your eating disorder

Although eating disorders vary in severity from mild to life-threatening, they usually don't go away by themselves. People with eating disorders are often resistant to getting help; after all, it could be seen as a sign of weakness. Loved ones can help break through that by being open to getting help themselves and by examining how they or other family relationships or issues may have contributed. In a family, both fathers and mothers need to be involved in treatment. Too often, we hold mom responsible for everything in families: this challenge needs to be shared.

next: Eating Disorders: Becoming 'the Best Anorexic Ever'
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Everyone experiences the symptoms of anxiety from time to time, caused by any number of things -- changes in our lifestyle, undue stress, tension. These symptoms often reflect a normal response to problems arising in our daily lives. In some cases, however, they may be the symptoms of a psychological or physical illness. The diagnosis of a serious medical problem is not always a simple process.

Because these symptoms are so difficult to assess, both patients and professionals can misdiagnose significant physical or emotional problems. Studies in recent years reveal that a number of physical disorders coexist in patients who have a psychological disorder, and some physical problem may cause 5 to 40 percent of psychological illnesses. In the majority of these cases the health professional fails to make the physical diagnosis.

Nowhere is this confusion more evident and diagnosis more difficult than with panic attacks. If the symptoms of panic are present, there are three possible diagnoses:

1. A physiological disorder is the sole cause of all the symptoms associated with panic. Treatment of the physical problem removes the symptoms.
2. A minor physical problem produces a few symptoms. The individual then becomes introspective and oversensitive to these physical sensations and uses them as a cue to become anxious. His heightened awareness and unnecessary concern will produce an increase in symptoms. If this continues, he can turn an insignificant physical problem into a major psychological distress.
3. There is no physical basis for the symptoms. Some combination of the following will help: education about the problem, reassurance, psychological treatment and medication treatment.

Through a comprehensive evaluation, your physician can determine which, if any, of these physical problems is associated with your symptoms. In most cases, curing the physical illness or adjusting medication will eliminate the symptoms. In some disorders, the symptoms remain as part of a minor disturbance, and you must learn to cope with them.

When a person suffers from anxiety attacks, one of the greatest obstacles to recovery can be the fear that these attacks are the indication of a major physical illness. And in some rare cases that is true. But predominantly, when a person continually worries about physical illness, that kind of worry intensifies or even produces panic attacks. In other words, the less you worry, the healthier you will become. For that reason, I strongly recommend that you adopt the following guidelines if you are experiencing anxiety attacks:

1. Find a physician whom you trust.
2. Explain your symptoms and your worries to him or her.
3. Let your physician conduct any evaluations or examinations necessary to determine the cause of your symptoms.
4. If your primary physician recommends that another medical specialist evaluate your problem, be certain to follow that advice. Make sure that your primary physician receives a report from the specialist.
5. If a physical problem is diagnosed, follow your physician's treatment advice.
6. If your doctor finds no physical cause for your anxiety attacks, use the methods presented in the Panic Attack Self-Help Program to take control of your symptoms. If your symptoms persist, ask your physician or some other source for a referral to a licensed mental health professional who specializes in these disorders.

The most destructive thing you can do when faced with panic attacks is to steadfastly believe that your symptoms mean that you have a serious physical illness, despite continued professional reassurance to the contrary. That is why it is essential that you work with a physician whom you can trust until he or she reaches a diagnosis. No matter how many consultations with other professionals you need, allow one professional to have primary charge of your case and receive all reports. Do not continually jump from doctor to doctor. If you remain fearfully convinced that you have a physical ailment, even when there is a consensus to the contrary among the professionals who have evaluated you, then you can be certain of one thing: your fear is directly contributing to your panic episodes. In Part II you will learn how to control that fear and thereby take control of your symptoms.

Many physiological disorders produce panic-like symptoms. You will find them listed below.

Physiological Disorders with Panic-like Symptoms

Cardiovascular

• Angina pectoris
• Myocardial infarction (recovery from)
• Arrhythmia
• Postural orthostatic hypotension
• Coronary artery disease
• Pulmonary edema
• Heart attack
• Pulmonary embolism
• Heart failure
• Stroke
• Hypertension
• Tachycardia
• Mitral valve prolapse
• Transient ischemic attack
• Mitral stenosis

Respiratory

• Asthma
• Emphysema
• Bronchitis Hypoxia
• Collagen disease Pulmonary fibrosis

Endocrine/hormonal

• Carcinoid tumor
• Pheochromocytoma
• Hyperthyroidism
• Premenstrual syndrome
• Hypoglycemia
• Pregnancy

Neurological/muscular

• Compression neuropathies
• Myasthenia gravis
• GuillainBarr syndrome
• Temporal lobe epilepsy

Aural

• Benign positional vertigo
• Meniere's disease
• Labyrinthitis
• Otitis media
• Mastoiditis

Hematic

• Anemia
• Iron deficiency anemia
• B12 anemia
• Sickle cell anemia
• Folic acid anemia

Drug related

• Alcohol use or withdrawal
• Side effects of many medications
• Illicit drug use
• Stimulant use
• Medication withdrawal

Miscellaneous

• Caffeinism
• Head injury

next: Step 1: Rapid or Irregular Heart Rate
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