Talking to Your Parents, Partner and Other Important People About Sex

teenage sex

If sex was just about orgasms, you could just enjoy it without ever having to talk about it. But there are so many things that come along with sex: pain, messy emotions, awkwardness, confusing feelings, not to mention unwanted pregnancies and sexually transmitted infections (STIs). It's like a 1000-piece model airplane that comes in a box with no instructions...so you're going to have to get some help once in a while.

But sex and sexuality can be really difficult to talk about, so here's a few pointers that might help get you started. Use them only if they make sense to you and to your situation.

Who do you talk to about sex?

Ideally, the first person you try talking to should be someone you trust and feel comfortable with. It doesn't necessarily have to be your sexual partner or a parent. Think of all the people you know: aunts, uncles, cousins, stepparents, godparents, doctors, pharmacists, teachers, guidance counselors, religious leaders, personal friends, family friends. But be careful about confiding in friends who belong to your social circle: they may accidentally (or not so accidentally) let your news slip, even if they promise not to.

If you can't bring yourself to talk about sex with anyone you know, a youth hotline or support group can give you someone who will listen and help, and you won't have to worry about them blabbing to everyone you know. A lot of times, it feels safest to talk to a complete stranger.

After you've talked with someone you trust, they may be able to help you break the subject with more challenging people, like your parents.

Where do you talk?

Choose a private place where you can rant, rave or shed tears without feeling self-conscious. Depending on your personality and what you want to talk about, a private room at home, a park bench, or a quiet restaurant may fit the bill. Avoid having these discussions by phone or by email - cyberhugs just don't cut it when you need the real thing.

What do you say?

You may want to start by telling the person if you're feeling awkward, scared, or ashamed. It prepares your listener for the information to come. Then tell your story as simply and plainly as possible. Don't dwell on too many details or get side-tracked, just be honest and get to the point. This person wants to help you, so they need to know the whole story.

next: How Do You Know When You're Ready for Sex?

APA Reference
Staff, H. (2008, December 27). Talking to Your Parents, Partner and Other Important People About Sex, HealthyPlace. Retrieved on 2024, April 19 from https://www.healthyplace.com/sex/psychology-of-sex/talking-people-about-sex

Last Updated: June 4, 2012

Eating Disorders Prevention: Help for Parents

A Family Guide to Eating Disorders, Part 1: Prevention

How much should you worry if your teenager starts to claim she's not hungry, eliminates foods from her diet, or expresses worry about becoming fat? When does "fussy" or diet-like eating go too far? How can you tell if a person you care about has an eating disorder, and what can you do if you suspect that she does? These are scary questions for parents and concerned others to confront. There is, indeed, a norm in our society that encourages people to value thinness, to diet even when unnecessary, and to be concerned about body size and shape. Under these circumstances, it may be hard to tell what is normal and what is not.

The warning signs of eating disorders can be easily listed, and will be outlined in Part 2 of this Guide. An equally important concern, however, is how to help young people avoid eating problems in the first place.

Self-Esteem is Essential

People who grow up with a strong sense of self-esteem are at much lower risk for developing eating disorders. Children who have been supported in feeling good about themselves - whether their accomplishments are great or small -- are less likely to express whatever dissatisfactions they might experience through dangerous eating behaviors.

And yet, while parents can contribute a great deal to building children's resilience and self-confidence, they do not have complete control over the development of these disorders. Some children are genetically vulnerable to depression or other mood problems, for example, which can affect feelings about self. Some become stressed and self-blaming as parents divorce or fight, despite adult efforts to protect their children from the harmful effects of parental discord. School and peers present stresses and pressures that can wear kids down. So, all parents can do is their best; it is not helpful to blame yourself if your child does develop eating problems. Parents can, however, try to communicate to their children that they are valued no matter what. They can try to listen to and validate their children's thoughts, ideas, and concerns, even if they are not always easy to hear. They can encourage outlets for children where self-confidence can build naturally, such as sports or music. It is critical, however, that these outlets are ones in which your child has genuine interest and experiences enjoyment; pushing a child to excel in an area in which her talents or interests do not lie can do more harm than good!

Role Models, Not Fashion Models

When should you worry about your teenager food habits? When does 'fussy' or diet-like eating go too far? Find here help for parents to prevent eating disorders.The parents' own attitudes and behaviors around eating, food, and body appearance can also serve to prevent eating disorders in children. Many children today witness dieting, compulsive exercise, body dissatisfaction and hatred modeled by parents. Also, well-meaning parents often express concern when children show natural gusto for eating fun or high-fat foods, or when they go through perfectly natural stages that involve some chubbiness. Parents ideally should model a healthy approach toward eating: eating, for the most part, nutritious foods (and not in a sparse or constantly diet-like manner); and fully enjoying occasional treats and social events that involve food. They should model a healthy cynicism toward media images of impossibly thin people and acceptance of a full range of body types. This is challenging, given how much we all are pulled these days by powerful media and outside pressures to be sizes we cannot comfortably be. I suggest families rent Slim Hopes: Advertising & the Obsession with Thinness (Media Education Foundation, 1995, 30 minutes), an excellent and powerful video by media expert Jean Kilbourne. Watch it together and talk about it; this is a useful exercise for boy as well as girl children and their parents, and probably merits repeating as children grow and develop.

In Part 2 of this Guide, we will focus on identifying eating disorders and getting help for the sufferer and for her family.

A Family Guide to Eating Disorders, Part 2: Identification and Treatment

In Part I of this Guide, we focused on strategies for preventing the development of eating disorders in children. In Part 2, we will turn to the warning signs of eating disorders, how to get help, and some Internet resources for families in need.

Signs and Symptoms of Eating Disorders

Here are lists of some of the "red flags" you might notice with eating disorders.

Anorexia Nervosa:

  • Weight loss;
  • Loss of menstruation;
  • Dieting with great determination, even when not overweight;
  • "Fussy" eating -- avoiding all fat, or all animal products, or all sweets, etc.;
  • Avoiding social functions that involve food;
  • Claiming to "feel fat" when overweight is not a reality;
  • Preoccupation with food, calories, nutrition, and/or cooking;
  • Denial of hunger;
  • Excessive exercising, being overly active;
  • Frequent weighing; "Strange" food-related behaviors;
  • Complaints of feeling bloated or nauseated when eating normal amounts;
  • Intermittent episodes of binge eating;
  • Wearing baggy clothes to hide weight loss; and
  • Depression, irritability, compulsive behaviors, and/or poor sleep.

Bulimia Nervosa:

  • Great concern about weight;
  • Dieting followed by eating binges;
  • Frequent overeating, especially when distressed;
  • Binging on high calorie salty or sweet foods;
  • Guilt or shame about eating;
  • Using laxatives and/or vomiting and/or excessive exercising to control weight;
  • Going to the bathroom immediately after meals (to vomit);
  • Disappearing after meals;
  • Secretiveness about binging and/or purging;
  • Feeling out of control;
  • Depression, irritability, anxiety; and
  • Other "binge" behaviors (involving, for example, drinking, shopping, or sex). Getting Help

Many parents or concerned others do not know how to approach a person they're worried about and getting them the help they may need. People can feel very helpless, scared, and, at times, angry when someone they love develops an eating disorder. Help is available, however, and many people and families can grow stronger as a result of seeking help.

If you notice several "red flags," tell the person displaying these behaviors that you are concerned about what you have observed. People with more restrictive (or anorexic) symptoms are much more likely to deny a problem and to resist suggestions that they eat more or see a therapist. The restriction may actually be making them feel "good" in a way, and they may be terrified of losing the "control" they feel they've begun to achieve. It can be helpful to provide information and educational materials, or to suggest that the person see a nutritionist for a consultation.

If denial of the problem persists, and the restricting behavior continues or worsens, younger people may have to be told that they need to see someone for help. They can be given choices: whether they are more comfortable seeing a female or male therapist, for example, or whether they prefer to go alone or with family. With older family members, intervention may not be so simple. In these cases, it may be like dealing with someone who has a drinking problem: you can repeatedly remind the person of your concern and encourage help, you can get help for yourself, but you may not be able to "make" that person change. If you are concerned about imminent dangers to health (as when a person has lost a great deal of weight and looks unwell), bringing a person to a doctor or even a hospital emergency room for evaluation is appropriate.

Individuals who binge and purge are often very distressed about what they are doing and may be afraid of confronting the problem (for example, they may be afraid that they will get fat if they stop purging). They are, however, somewhat more likely to agree to explore options for getting help. In that case, getting educational materials, therapist referral lists, and information about groups can be helpful. It is important to stay as non-judgmental as possible, even if you feel that the person's behavior is "disgusting" or strange.

People are sometimes reluctant to talk to a therapist or counselor. If they are more comfortable starting with a doctor or nutritionist, that's at least a first step. It can be useful, though, to make sure the person understands that feelings, relationship issues, and self-esteem are almost always involved to some extent in these situations and should not be ignored, no matter what course of action the person decides to initially pursue.

next: Obesity in Children and Teens
~ eating disorders library
~ all articles on eating disorders

APA Reference
Staff, H. (2008, December 27). Eating Disorders Prevention: Help for Parents, HealthyPlace. Retrieved on 2024, April 19 from https://www.healthyplace.com/eating-disorders/articles/eating-disorders-prevention-help-for-parents

Last Updated: January 14, 2014

Myth and Meaning

Chapter Three of BirthQuake

alt

"The most painful and difficult part of being middle-aged is that old age and dying are no longer ridiculous abstractions." - Eda Le Shan

As baby boomers progress into middle age, many of us find ourselves struggling with the hard to deny fact that we're not kids anymore. Charles Spezzano in his book, "What To Do Between Birth And Death: The Art of Growing Up," observed: "Most people over twenty-five look like grown-ups--at least on the surface. Most people over the age of twenty-five feel like teenagers inside. This confuses a lot of people."In our case, twenty-five has given way to thirty, forty, and fifty, and yet a significant number of us still feel like teens. What makes growing older particularly difficult for my generation is quite likely the environment in which we came of age. Gail Sheehy reports in "New Passages: Mapping Your Life Across Time," that those born between the ages of 1946 and 1956 experienced the benefits of having had the most privileged and extended period of adolescence of any other generation in history. Those of us born between the years 1956 and 1965, hold the dubious honor of being part of that distinctive class of Americans labeled, "The Me Generation." We are said to have wanted everything: fame, fortune, adventure; and we expected it now! Our images of middle age consisted of such goodies as thickening waistlines, dentures, and wrinkles. We heard, "Never trust anyone over thirty" and "What a drag it is getting old." We, the Boomers, were the ones who counted - the ones with the greatest promise. We were going to usher in the "Brave New World." Is it any wonder that Sheehy quipped, "Who can embrace the larger meaning of life beyond youth when the most important thing in the world is still me?"


continue story below


We were not prepared to become middle aged. Even the term was somehow offensive. We were the largest, the loudest, and the toughest. We were first in all kinds of categories, so how could we possibly be downgraded to the middle? Entering mid-life with the losses we perceived this stage to entail has a lot of us more then a little disoriented. Confronted with aching backs, bad knees, expensive dental work, new rules, new roles, and the dawning awareness that we too are really going to die has left us just a little bit shaken to say the least.

We, who at one time thought we had most of the answers and were very willing to share them, are now discovering more and more questions. And while we've generally become more sensitive to the needs and pain of others, we must also acknowledge that we're not as gifted as we perhaps once thought we were at handling the heartache of others, and even less skilled in dealing with our own.

Often we attempt to talk those we care about out of their painful feelings. If, on the other hand, it's we who are suffering, we tend to focus on the unfortunate aspects of our difficult situations, rather than acknowledge the opportunity those troublesome circumstances or feelings may present. We've generally only given lip service to that tired old cliche about making lemons into lemonade. We've never been particularly good at it anyway. We've been graced with a multitude of choices and a significant amount of control over much of our lives for so long that we've come to see these gifts as entitlements. And while Midlife offers tremendous benefits, it also confronts us with new and unsettling limits and losses that will inevitably (if they haven't already) cause us to experience some degree of suffering. Because suffering is unavoidable, (not because it's good for you) it becomes increasingly important to begin to come to terms with it.

THE STRENGTHENING...

"Those things that hurt, instruct." - Benjamin Franklin

When my daughter was around two years old, and seemingly in perpetual motion whenever her eyes were open, I came down with a very bad case of the flu. My husband was out of town. We had recently moved to the area, so I hadn't yet established a support system, and my family lived five hours away. I was on my own. I could barely move without the room spinning, or needing to vomit. In spite of her mother's incapacitation, my little girl's demands remained constant and her needs immediate. I knew I definitely wasn't equal to the task, and I was also aware that I had no choice but to do what I didn't believe I could do. I was miserable and felt more than a little self-pity. On the afternoon of the second day of my ordeal, a woman I hardly knew called regarding a meeting I was to attend the following week. She noticed that my voice was weak and shaky and asked with concern if I was all right. I told her I was ill and alone with my daughter and having a tough time of it. Her sympathy was comforting, but it was a single comment she made that left the greatest impact. She said, "Things like this are strengthening." I didn't think that she was minimizing my situation, or that she was offering a quick cliche before abandoning me to my own devices. Instead, I felt that she understood, that she herself had been strengthened as a result of experiencing and coping with a difficulty, and that she truly believed that I would be too. I hung up the phone and painfully began to make lunch for my daughter, who was demanding that I pick her up and play our daily lunch game. Her cries grew louder and louder when I refused to comply, and my nausea seemed to increase with each raised decibel. I began repeating silently over and over, "This is strengthening!" "This is strengthening!" "This is strengthening!" While my body remained unmoved, my spirits gradually began to lift.


The next day while lying on the couch with my daughter, it occurred to me that this had been the first time we had simply lain together for most of the day, watching cartoons, telling stories, reading books, and snuggling. I chose to count the blessings of this experience, and to my surprise, I was able to identify more than I would have thought possible. I smiled for the first time in days as I acknowledged that I had indeed been strengthened.

"The giant oak is an acorn that held its ground." - Anonymous

In "Legacy of The Heart: The Spiritual Advantages of a Painful Childhood," Wayne Muller notes that those who've suffered in childhood, while bearing painful scars, invariably exhibit exceptional strengths; including remarkable insight, creativity, and a profound inner wisdom. He challenges such individuals not to perceive themselves as broken and damaged, nor to eliminate parts of themselves, but rather to strive to reawaken that which is wise, whole, and strong within them. In working with victims of childhood trauma, he observed that while still haunted by their past, they also develop an acute sensitivity to others as well as a tendency to seek beauty, love and peace.

" Seen through this lens, family sorrow is not only a painful wound to be endured, analyzed and treated. It may in fact become a seed that gives birth to our spiritual healing and awakening"

It's been my experience that this is often the case with survivors of childhood trauma. While not all such individuals that I've worked with possess the characteristics Muller so respectfully describes, I'm almost always struck by the strength and depth of these people. Each person has brought to therapy unique skills and abilities developed to a significant degree by the very pain they sought to escape.

Muller assures the reader that suffering and pain are not exceptions to the human condition. Instead, they are inevitable threads in the tapestry of life. He cautions not to become trapped by memories of childhood suffering, thus allowing the suffering to become the one thing that is the truest about our lives. He also points out that many of us would prefer to explain our hurt rather than feel it. He advises that we accept the pain we are given and identify the lessons it will inevitably teach if we only look and listen, particularly to the wisdom contained within the depths of our own souls.


continue story below


"The Japanese poet Kenji Miyazawa left us a powerful image of dealing with pain when he said that we must embrace pain and burn it as a fuel for our journey." Matthew Fox

While I don't under any circumstances wish to minimize the pain of another, nor suggest that he or she be grateful for suffering, I do believe that in order to empower another, it's important that the value of all experiences in a person's life be acknowledged. While there are many experiences I would have adamantly refused to struggle with in my own life had I been given the choice, to deny the value of the message in spite of how painful the lesson or unwelcome the messenger, only serves to add insult to injury. If one has no choice but to toil on a particular path, at the very least - claim every available compensation along the way.

"Some part of our being longs to join a small band of our brothers and sisters on a daring and intrepid quest." - Carl Sagan

My friend Victoria phoned the other night. Our friendship has spanned over 15 years, and now since I've moved to South Carolina must reach over a thousand miles. I miss her. She's consistently provided me with comfort and inspiration, and I've long admired her commitment to live her values. What she believes in - is what she acts on. She calmly witnessed and supported Kevin and myself during our difficult period of transition. It appears that she now may be entering her own. I attempt to reassure her over the telephone. I share with her that while the period before we moved away was difficult, I seriously doubted we would have mobilized ourselves to make the necessary changes in our lives without the pain. It's so often easier to remain in a familiar rut than to leave its security and venture out into the unknown.

"New Life comes from decay, from what is undesirable, from a 'stench.'"

- Janice Brewi and Anne Brennan

Suffering has often proven to be a catalyst for growth in my own life. In an attempt to avoid dealing with my childhood agonies, I turned to reading as an escape. It was my discontentment and a desire to flee poverty that prompted me to attend my first college class. Later, it was only after my husband and I had separated for nine months, that I braved Graduate School. Because I myself had experienced despair, I was able to understand and assist others in dealing with their own. It was the numerous mistakes and contradictions in my own character which helped me not to judge the failings of another. The more often I fell, the less likely I was to look down upon someone else who had lost his or her balance. And it was only after surviving again and again the disappointments in my life that I came to understand that it's in each of our nature's to recover. Healing is a natural process.


THE WISDOM BORN OF PAIN

"Wisdom is oft times nearer when we stoop than when we soar." - William Wadsworth

From time to time, Kevin reminds me that when he first met me at the age of 15, in an attempt to engage me in conversation, he asked me what I wanted to be when I grew older. I informed him that my goal was to become wise. He was dumbfounded. "Who was this person and who on earth had as a life long dream to become wise?" he wondered. I did. I still do, and I'm certain that it's been the "wisdom born of pain" that has carried me the farthest in my pursuit of this goal.

The presence of pain saves lives. When my mother was a child, she was playing too close to an open flame. It wasn't until she felt the first stab of pain that she realized that her dress was on fire and cried for help. Had her body failed to register this sensation, she would have quickly become a human torch. Pain tells us when we're in trouble, and hopefully, will keep getting our attention until we do what we need to do to save ourselves.

I'm good at suffering. I think I do it more blatantly than many people I know. I was reading a story to my daughter one morning about a dog named Murphy who died. I began to cry and continued to weep while I read the rest of the book. My daughter thinks I'm strange. It isn't the first time I've burst into tears while reading or watching a movie with her. I was a wreck when she and I saw "The Land Before Time" together. The suffering of others, even some cartoon characters, has always touched me deeply. I remember a blind man who sat outside of Shaws grocery store playing an accordion for donations. Shoppers walked by seemingly oblivious to him. My encounters with this man always left me shaken and profoundly sad. Seventeen years ago, while I was living in California, a white horse came running full speed ahead up to a fence by which I was standing. It startled me and I jumped back. The owner struck the horse in the face. I was enraged by his cruelty, and I cried in sympathy for the horse for days afterwards. I have often wondered how I managed to survive as a psychotherapist with such an acute sensitivity to pain. And then again, perhaps it is this sensitivity that contributed more to my success than any skill I acquired during my years of training.

"I feel her pain and my own pain comes into me, and my own pain grows large and I grasp this pain with my hands, and I open my mouth to this pain, I taste it, I know, and I know why she goes on." Susan Griffin


continue story below


I was trained to remain as objective as possible in my work with clients. Crying in their presence was definitely not considered to be of therapeutic value. For years I would watch people in terrible agony and not shed a tear. My throat would ache and my neck and chest muscles would tighten though. An ancient Chinese belief is that the neck mediates between the thinking mind and the feeling heart. Consequently, when there is difficulty with the neck area, this can often be linked to some kind of withholding or repression of emotional pain. During my early years as a therapist, I constantly had a stiff neck. Eventually, I said to hell with the cool and objective facade I had been taught to project. From time to time (though rarely), I began to permit my own tears to join those of my clients. I don't regret a single moment that I've wept with a client. Maybe it's a rationalization, but I believe that in showing my own pain, I help to validate the feelings of another. My tears are saying, "Yes, it's hard. You're right to cry. It hurts so much that I cry too." As I allowed myself to express my feelings more fully to my clients, the aching in my neck eased significantly.

While discussing compassion in her book, "Living With Chronic Illness", Cheri Register points out that the prefix "com" in Latin means "with". When we experience compassion for another, we feel "with" them and may thus according to Register, "transform a private and often lonely experience into one that is shared." I, personally, would rather be joined in my pain than be silently observed.

I remember being in a group in which a very reserved and private man began to weep. Later, he shared that he was extremely embarrassed by exposing his weakness to us. Joe Melnick, a warm and wonderful therapist who practices in Portland, Maine, turned to him and said, "I hate to cry alone. I always try to do it with someone, and preferably in groups."

I hate suffering, especially my own. I recognize that this may seem like a contradiction to what I have previously maintained regarding the value of suffering, but nevertheless, it's all true for me. I would banish all heartache from the earth if I could. But I can't. No one can. There will always be suffering. And while it can transform, it can also destroy. As a therapist, I've witnessed the destruction that suffering can yield more often than I care to remember. I have also watched strength and wisdom slowly evolve and emerge from the depths of despair. Those times I wish to never forget. Sometimes, the metamorphosis from tragedy to triumph is profound. Other times, discomfort may simply lead to a new insight. The smallest insights, however, can sometimes have a very large effect. One simple example of how this can occur may be found in Regina's story.

 


REGINA REVISITS

"There is in us something wiser then our head." - Schopenhauer

Regina had been referred to me by a former client several years ago for assistance in dealing with panic attacks. Her attacks involved shortness of breath, heart palpitations, dizziness, hot flashes, and tremendous fear that she was going to die. Regina had been a victim of violence as a child, and her abuse as well as her symptoms were addressed in treatment. Our work together had been successful, and I had not seen nor heard from her for at least three years.

When Regina re-contacted me, she informed me that she was beginning to experience anxiety again. While she was able to control her symptoms from developing into a full-blown anxiety attack, she was concerned by the frequency of their reoccurrence.

During our first visit, Regina informed me that she had recently married a wonderful man. They had moved into a spacious new home, and he had an adorable and loving eight- year-old son who visited every other weekend. As Regina continued to update me, it became apparent that her symptoms appeared most often on Friday nights just before her new stepson arrived and got worse as the weekend wore on. She explained that she enjoyed his visits very much and could not imagine why she was experiencing anxiety. She added that she loved her job and seldom dreaded returning on Monday mornings. Further discussion did not appear to render particularly helpful clues.

I decided to do some bodywork with Regina. I asked her to check in with her body and tell me what she was experiencing. With guidance, she was able to identify that her throat felt tight as well as her chest. I played soothing music, asked her to lie down, worked with her to progressively relax her muscles and then, with her permission, placed one hand gently over her chest and one on her throat. For several minutes I held my hands in place and instructed her to patiently wait for a message from her throat and chest. Tears eventually began sliding down her cheeks. She began to grimace and soon was sobbing. When she was able to speak, she informed me that she felt guilty. Her own son was now grown and off to college. She had given birth to him when she was just 16 and had struggled a great deal when he was growing up. She had never felt that she really bonded with him. Their relationship was polite but strained, and their contact was limited to brief telephone conversations and occasional visits. She had grown to love her stepson and felt guilty and sad that she was able to do with and for him what she had not been able to do for her own child. We explored the many complications in her life that she'd struggled with while her son was growing up, and acknowledged the tremendous ways in which she had grown over the years. I pointed out that while it was too late to enjoy her son's childhood, it was not too late to attempt to build a closer relationship with him, nor was it wrong to love and enjoy the new little boy in her life. In fact, I observed that in loving her stepson, she might learn how to express her love to her grown son more effectively. We then reviewed the skills she had learned during our previous work together, not only in symptom management, but also symptom prevention. She agreed to utilize these tools more often than she had during the past year. We scheduled our next appointment for one month later with the understanding that she could contact me for an earlier appointment if the need arose.


continue story below


Regina informed me during our next visit that she had really thought about what I said and remembered a book that she had read to her stepson some time ago. The book was written to a son from a mother and contained the message that no matter how much he drove her crazy or how old he got, she would always love him. She went out and purchased a copy for her grown son and included a heartfelt letter of love and apology to him. Shortly after she mailed them, she received a phone call from her only biological child. The two had a long and loving talk, and he agreed to meet her halfway the following Saturday between the college and her new home in order to spend the day together. After their meeting, Regina felt that she and her son had made significant progress in healing old wounds, and she felt connected to him once again. She also no longer felt guilty about her relationship with her stepson. Regina hadn't experienced her old anxiety symptoms in three weeks, and felt confident that she could deal with them again if or when they recurred. We didn't reschedule, as Regina understood that I was available should she need me in the future. Approximately six months later, I received a note in the mail from her stating that she was doing well and had not been troubled by anxiety since before our last meeting.

For Regina, as with most of us, there was a lesson in her pain. By looking at her anxiety and listening to what it might have to share with her, she was able to recognize feelings she had long repressed regarding her relationship with her son. In acknowledging and accepting her feelings of guilt and regret, she was then able to work toward reconciliation.

"Any major change needs a breakdown." - James Hillman

Whilechange can be a relatively logical, planned, and predictable process, it's all too often heralded by what sociologist Gordon Allport referred to as, "the power of the fait accompli." The power of the fait accompli asserts itself when an event occurs that is out of our control, such as a natural disaster, an illness, loss of a loved one, or loss of a job. Many of our own stories contain the angst of this phenomenon, and many of our stories also represent how pain can eventually lead to possibility. For instance, while reviewing the lives of devoted environmentalists, I noticed that agony often provided the impetus for action. Vice President Al Gore's intense search for "truth" and his deep devotion to environmental issues was deepened after witnessing his son get struck by a car. John Muir launched his career as a naturalist after recovering from an injury that left him temporally blinded and suicidal. Tom Hayden wrote, The Lost Gospel of the Earth as a result of the deep despair he felt on the twentieth anniversary of Earth Day, as he acknowledged that the planet's condition was deteriorating more rapidly than the rate of progress environmentalist were making to protect it.


Gabriele Rico was in serious trouble. Chronic anxiety, panic attacks and physical illness besieged her. Distracted by mothering, writing, teaching, and lecturing - she had successfully repressed much of her pain for years. Little by little however, her old coping techniques were beginning to fail her. The small rumblings of her quake began to build into an ominous roar, which refused to be silenced. Feeling increasingly anxious and overwhelmed, she retreated to a small cabin in the Sierras. The cabin was surrounded by Redwoods and overlooked a stream. It was a beautiful place to rest, to rejuvenate, and to gain much needed perspective. It was here - with no telephone or car, that Gabriele prepared to face her demons. And they came.

Her time in the cabin was often frightening and almost always painful at first. However, as she struggled to stay put, to look and listen and feel, she began to get in touch with the source of her fear and despair. In working through her agony, she utilized the tools of her trade. She wrote. And the more she wrote - the more she understood, and the more empowered she became. Her writing poured out of the deepest and darkest places of her soul during a time which she later described as: "my own terrible downward spiral into crisis." It was in coming to terms with her pain that the book:" Pain and Possibility," began to take shape, and so the wisdom born of Rico's pain is thankfully shared with the rest of us. Pain and Possibility is an outstanding guide that provides the reader with some of the most effective tools I am aware of, in utilizing the written word to discharge, process and work through pain. Rico writes:

"No one is immune to pain, but I know many who let pain fester and take charge of their lives. I know from my own experience that it is possible to discharge that pain and become recharged."

ANGER AS ANCHOR

"All suffering prepares the soul for vision." - Martin Bubar


continue story below


According to Buddhist teachings, the three primary causes of suffering in addition to attachment are anger, ignorance and greed. I once worked with a couple who came to me requesting that I help them fix their troubled relationship. The problem was that neither of them was willing to change their own behavior; each expected me to get the other to change. Not surprisingly, therapy failed, although the couple stayed together.

Years later the husband phoned my office and informed me that his wife was gravely ill and was not expected to live much longer. He told me that she had been asking to see me. I agreed to stop by their home, although I didn't look forward to our meeting, as my own issues regarding death were largely unresolved.

She reached out for my hand when I entered her room and began to cry. I embraced her, said a few words in greeting, and then we sat in silence. Eventually she began to talk. She spoke of many things; her children, her husband, her illness and her fear. I said very little in spite of the words of reassurance that wanted to come flooding out. She needed a compassionate witness, and so I restrained myself and listened loudly. There were many things she confided that day which I'll always remember. However, there was one observation in particular that I feel is important to share with you here. She told me that as she thought about her life, she realized that she'd spent a great deal of it being angry. While she continued to feel that she'd been treated unfairly by others, she had also decided that her anger had eaten away at her soul as malevolently as the cancer was now eating away her body. She deeply regretted all that she now felt had been sacrificed to her indignation. "If only I would have let go of all my resentments a long time ago," she lamented.

I never saw her again. Her husband contacted me approximately three weeks later and informed me that she had died peacefully at home. He calmly informed me of many of the details of her death and then began to cry. I asked him if he was all right, and he replied, "Tammie, do you know what she asked me to do that morning?" "What?" I gently asked. A voice filled with pain but also with what I believe was awe, replied, "She asked me to forgive her for always being so angry."

HOLDING ON

"It's never too late to complete our birth." - Stephen Levine

The Buddha also taught that the more one resists suffering, the more it intensifies. M. Scott Peck, in his best selling book, "The Road Less Traveled: A New Psychology of Love, Traditional Values and Spiritual Growth," maintained that it's the tendency to avoid problems and emotional suffering which is the primary cause of all mental illness. While I'm not certain that I agree with Peck entirely, I am struck by how true this seems in cases of alcoholism, workaholism, relationship addiction, gambling, etc. In fact, I've often been frustrated with how many women who are stuck in destructive relationships suffer day after day because they don't believe they can tolerate the pain involved in letting go of their dream that the loved one will someday change. Catherine was one such individual.

Catherine met her husband when she was fifteen. She married him four years later after breaking up and reuniting with him several times. When I met her, she looked older than her forty-four years. She was depressed, over weight and frightened. Her husband's drinking had escalated to the point where his job was in jeopardy. He had recently completed an inpatient treatment program to address his alcoholism; however, he had resumed drinking three months after his release from the program. He was becoming increasingly ill from the abuse of his body. He was using a great deal of sick time and once again his behavior was erratic, disruptive and abusive. Catherine's own physical health was deteriorating. Her blood pressure was alarmingly high, she had colitis, and experienced increasingly more severe bouts with migraines. While she worried that her husband's addiction to alcohol would kill him, I was concerned that her addiction to him might eventually destroy her.


For several years she had attempted to get him to change. She had participated in ALANON, had attended AA with him when she could get him to join her, and had been in couples counseling and individual counseling twice before. After twenty-five years of begging, ignoring, manipulating, cajoling and seducing - things were only worse. Her children, now grown, were unhappy and bitter. Her finances were precarious, her health poor, and her life seemed to her to be filled with disappointment and futility. She hated her husband, and yet she didn't feel that she could leave him. She had tried twice before only to return. "I couldn't stand it. It hurt so badly. I couldn't sleep or eat or think straight. I thought about him all of the time. It seemed as though I was damned if I left, damned if I stayed. I decided to stay. It was a lot less lonely." But was it? My experience has been that those in unhealthy and distancing relationships seemed to be the loneliest of people. When I shared this observation with her, she agreed that she had been terribly lonely for years, particularly since her children had left home. I informed Catherine that I could do nothing to help her with her husband, and that I would work with her only if she agreed that the focus of our work would be on her, not him. She accepted my condition of treatment.

Catherine's childhood story was similar to those of many other women who've found themselves feeling trapped in unhealthy relationships. She'd been an unhappy child, raised by a depressed mother and an abusive, alcoholic father. She had dreamed of the day that a handsome prince would carry her away, and they would finally live happily ever after. Tragically, her adult life had closely mirrored the life she had lived as a little girl. While the details had changed, she had remained depressed, disappointed, frightened, and still waiting for her happy ending. As a child she had relied upon a rich imagination to help her avoid dealing with her painful feelings. As an adult, she had focused on working on her husband's potential to someday become her prince. Just as when she was a child, it was only her fantasies that she had to hold onto.

Catherine didn't want to revisit her childhood, and I didn't blame her. It had been too painful then. It was too painful now. The closer we looked into her life, the greater our awareness became of how deep her pain was and always had been. It was far safer to worry about her husband than to feel her anger, her sadness, her emptiness, and her shame. Just when her depression threatened to deepen, her husband would rescue her by creating another crisis to which she would have to attend. And so it went. Catherine would peer over and into the deep well of her misery, and then she would run the other way in order to put out another fire that her husband had set. She would run around and around and around. Still, running, while exhausting, can be a lot less scary than standing still.


continue story below


And she suffered greatly on behalf of her man. "For God so loved the world that he gave his only begotten son." God had sacrificed greatly, and we worshipped him for it. Catherine would sacrifice, too, and perhaps someday her husband would acknowledge her self-denial and would beg for her forgiveness. He would then cherish her and make up for all that she had endured on his behalf. Or so she hoped . . .

To leave her husband, she would have to abandon her dreams. She would have to accept that all of the years of agony had failed to produce her happy ending. The pain of facing this bitter reality appeared to be more than she could endure. To suffer a little every single day, but have hope that it might all eventually be worth it, seemed much more appealing than to suffer tremendously and for what? (to save her life.)

For years she stayed with her husband and in therapy with me. First, I hoped that she would leave him. Later, I began to secretly wish she would at least leave me (in peace). And then her oldest son attempted suicide. She spent agonizing days and nights at the hospital, waiting to see if he would live, and then waiting to know if he would sustain permanent brain damage. For months she was caught up in the terrible aftermath (her Quake.)

As her son began to recover, she, too, finally became ready to work through her own denial. Just as she had urged him to fight for his life, she was now prepared to reclaim her own. And step, by sometimes painful, sometimes triumphant step - that's exactly what she did.

I ran into Catherine at the grocery store a few years ago. She looked wonderful! I felt somewhat self-conscious with my hair out of place with my crumbled jeans and oversized shirt, standing beside this sophisticated and well-dressed woman. She had divorced her husband about eight months before finishing her work with me. She informed me that she remained single and lived in a delightfully cozy apartment close by her son and daughter-in-law. She had strengthened her ties to old friends as well as establishing new relationships. She was painting again (she had loved to paint as a young girl) and had joined forces with a group of women who supported each other's efforts to build spirituality into their every-day lives. We chatted and laughed up and down the aisles of the store and stood in line together to check out. As she completed her transaction, and was closing her purse preparing to leave, I asked quietly, "What ever happened to happily ever after?" She smiled impishly and said, "It's here."


LETTING GO

"It's no longer that I can't hang on. It's that I can let go" - Unknown

Judith Viorst, in her wonderful book, "Necessary Losses," addresses one of our very first lessons - life includes loss. James Hillman reflects that at some level growth always includes loss. Loss is a necessary ingredient of both love and growth. We don't experience one without becoming vulnerable to the other. Viorst gently reminds us: "And we cannot become separate people, responsible people, connected people, reflective people without some losing and leaving and letting go."

According to M. Scott Peck, depression is connected to the feeling of loss which come from giving something up that we value greatly. Because loss is an inevitable part of the process of spiritual and mental growth, Peck maintains that depression is basically a normal and healthy occurrence. It fails to be healthy and potentially productive when the giving-up process is interfered with which can result in a prolonged and debilitating depression.

"Suffer the growing pains." - Lillian Hellman

When my husband finished graduate school, although still extremely busy, he was no longer constantly running. All of the sudden there was time to think and feel and look. What he came to see disturbed him. He had worked and sacrificed his entire adult life, and in place of the sense of accomplishment he had expected to feel - there was an emptiness inside of him. He felt hollow and drained. In spite of all that he had gained -- he felt loss. For a time he remained anchored to his disappointment and confusion and struggled to break free. When he was turned loose, he found himself cast adrift in a murky and dark sea of depression. It's frightening to be set adrift, particularly for those who've carefully charted their course, equipped with navigational map and compass. Most attempt desperately to hold on, and furiously fight the currents to regain control. Too often their panic leads them to capsize or upset their boats. We can't always control life's currents, and each of us no matter how hard we may wish otherwise, find ourselves carried away from time to time.


continue story below


I remember when my husband, friends of ours, and I went white water rafting. The guide informed us that if we fell out of the raft, it was not only useless but also dangerous to attempt to swim. We were to simply keep our feet straight ahead of us, our heads together, and allow the rapids to take us along - sort of like a controlled surrender.

Matthew Fox reminds us that we all must undergo the critical process of letting go of guilt, of hurt, of pain, etc. in order to grow spiritually. He council's that, "The choice to wallow in one's pain or in one's guilt is a deliberate choice, as can be the deeper option, which is to let go and move on."

The choice to wallow in one's pain doesn't mean that we get to choose when we suffer and when we don't. We all must suffer. From my perspective, wallowing refers to when we wrap our suffering around ourselves as if it were a cloak and refuse to come out. Kierkegaard said once, "My sadness is my castle." This Danish philosopher may have found himself at home among the relics of his sadness and despair, but for most of us - the land of suffering is a place we must all visit and can even learn from, but by no means is it a place to permanently dwell.

My husband, who's always been level headed, didn't panic in his depression. He floundered, he hurt, and he attempted for a time to hold on to the familiar. And then he let go. When we're small, we need to let go of our parents' hands if we're ever going to learn to walk unsupported. We have to part with our training wheels in order to ride our bikes like the big kids. We have to leave our family home in order to establish our own. Growing up requires over and over again that we let go. Kevin let go of the old dreams that no longer served him. He let go of the guide-wires that had supported and at the same time strangled him. And it was painful letting go. But in letting go, he recognized that as unhappy as he was, he was also now free. Free to re-negotiate the currents and to move forward, away from depression, and towards a more meaningful direction.

"No one ever would have crossed the ocean if they could have gotten off the ship in the storm." Charles F. Kettering

I've often heard people wonder about how things might have been different if they had been spared their painful childhood's, or had been born into a family which offered them more support, love, or opportunities. The premise seems to be that the more good things and the fewer bad things that occur in life, the more successful a person is likely to be. Maybe that's true in general. I only know that when glancing at the lives of the 'successful', I'm struck again and again by how much loss and pain many of these "fortunate" individuals have suffered.

1) At the age of 21, he was told that he only had about two and a half years to live, and that he would gradually lose the use of his body. Eventually only his vital organs such as his heart, his lungs and his brain would function. He was informed that while his mind would work perfectly, he would be trapped inside the body of a "cabbage." He would think and feel but not be able to communicate.

Steven Hawking lived far beyond the short time predicted. Over the years though, his body (with the exception of his vital organs) has failed him. Today, it's little more than his eyes that seem to move -- the rest of him is horribly still. And yet Hawking, with his "cabbage" body, has become one of the greatest physicists of all time. In a movie produced by Erril Morris about Hawking's life entitled, "A Brief History of Time" (the same title as Hawking's book), Hawking reflects on how his illness has effected his work. Before he was diagnosed, he reported that he had been bored with his life.


"There had not seemed to be anything worth doing, but shortly after I came out of hospital, I dreamed I was to be executed. I realized that there were a lot of worthwhile things I could do if I were reprieved..."

Hawking embraced the time that was available to him after his diagnosis and has indicated that he would not have achieved all that he has achieved if he had been able-bodied. His mother agrees, observing that before his illness, he had a number of interests that competed for his time and energy. His disability forced him to "concentrate his mind".

2) She was born with three strikes against her: she was poor, black, and female. When she was three years of age, her father sent her and her four- year- old brother by train from California to Arkansas to live with their grandmother. When she was six, she was taken away from her grandmother to live with her mother. While living with her mother, she was sexually abused by her mother's boyfriend. When she finally told her mother, her perpetrator was murdered shortly after. She believed it was her mother's family who killed him, and she felt responsible for his death. For months she refused to talk to anyone but her brother. While visiting her father, she was stabbed in the side by his girlfriend. By the time she was 17, she was a single parent.

Maya Angelou became an accomplished singer, actress, poet and one of the finest women writers living today.

3) As a child, he was shy, sickly and lonely. Anxiety and fear plagued him. He loved his alcoholic father but was terrified of his violent temper. When he was 11 years of age, his father died. His first-born son, Elliot, died of "cholera infantum". Shortly after his son's death, his mother died. His fourth daughter died when she was four days old. He was forced to place his only sibling in a mental institution, where she remained until her death. His best friend was killed during the war. His daughter, Marjorie, died shortly after giving birth from what was called at the time, puerperal fever. A few short years later, his beloved wife died of a heart attack. His only remaining living son shot himself. Within six years he had lost his daughter, his wife, and his son.

Robert Frost was the first poet ever to be asked to speak at a presidential inauguration and a four- time winner of the Pulitzer Prize.


continue story below


4) He was the first born of four sons. His parents were poor and lived in the ghetto of Philadelphia. His father abandoned the family and his mother was forced to work 12 hours a day as a maid in order to support her children. His little brother died of rheumatic fever.

Much of the early material Bill Cosby used as a comedian was drawn from his difficult childhood in North Philadelphia.

5) At the age of 34, he was arrested for failure to pay his debts after yet another business failure. At 35 he was bankrupt. By the time he was 41, John Audubon had turned his love of painting birds into a lucrative career, and his name would be forever linked to the wildlife he so loved.

6) Her young husband died at the age of 26. Her infant son died just a few weeks after. Within a year, she also lost her mother. Her husband's business associates bankrupted her husband's business. She was poor, she was grieving and she was desperate.

In spite of the many strikes against her, Martha Coston developed, manufactured, and marketed the maritime signal flares, which are used to this day to assist ships in communicating.

7) At the age of 16, her left leg became crippled, leaving her housebound for almost 10 years. Because she was considered unattractive, crippled, and unskilled, her future was thought to be bleak.

Fannie Farmer became a household name with the success of her cookbooks.

8) She was born poor and lost her parents to yellow fever when she was seven- years old. Longing for a home, she married when she was only 14. At 16, she was a mother and a widow.

Sara (Madam C.J.) Walker started a business of her own, and was the first African American woman to become a millionaire.

9) Born a slave, as a child he was worked long hours, fed little, and whipped occasionally. At 17, he was sold to a family who sent him to a slave breaker. The slave breaker repeatedly beat and starved him in order to break his spirit.

Frederick Douglas published the "North Star", became a famous lecturer, and was instrumental in rescuing slaves and abolishing slavery.

10) She was described as a sad and lonely little girl. Her parents had wanted a boy, and she was a disappointment. She developed a number of fears in her childhood. She was afraid of animals, other children, the dark, and so much more. She was called the "Ugly Duckling."

Her mother was cool and distant. Her alcoholic father was her primary source of love and affection. When she was six, her father went to live in a sanitarium in order to deal with his alcoholism. When she was eight, her mother and brother died. She and her younger brother were then sent to live with her grandmother. Her grandmother was a stern and demanding woman. When she was 10, her father died.

She discovered, once she married, that her husband was having an affair with her secretary.

Eleanor Roosevelt has been described as one of the most admired and widely known women of the twentieth century. Her humanitarianism benefited the oppressed, the poor, the suffering, and children

 


11) He was born with a clubfoot to a poor couple in Vermont. His affliction was believed by some to indicate that he was a child of the devil. His father abandoned the family. He was teased relentlessly by his schoolmates. He was a lonely and bitter young boy.

Thaddeus Stevens grew up to be a successful attorney, one of the most powerful members of Congress in American history, and a relentless champion of the rights of African Americans.

12) He was extraordinary. At the age of 23 he completed medical school. At the age of 24, he won the National Tennis Championship. At 25 he was diagnosed with polio and paralyzed from the neck down. He became a professor of clinical psychiatry at the University of California, a Gold Achievement recipient, and has published numerous works. In "Flying Without Wings: Personal Reflections on Being Disabled", Arnold R Beisser shares that when he first stopped struggling and working to overcome his disability, rather than feeling defeated, he finally felt whole again. He experienced a sense of well being, of fullness, and felt at one with himself and the universe. He found that his salvation had not come from hard work, but rather in learning how not to struggle. As Beisser came to accept who and where he was in the moment, without striving to change, he himself was transformed. Beisser wrote:

"Sometimes the fullness I experience here and now is greater than I have ever experienced before..."

13) At the age of 19, John Hockenberry was involved in a car accident that left him paralyzed. He went on to become a successful reporter, winning the Peabody award twice in addition to an Emmy. He's been a national public radio reporter, a middle east correspondent, and a correspondent for ABC's "Day One." In his wonderful book, "Moving Violations: A Memoir," Hockenberry describes his life as a reporter and a paraplegic. Among his observations is that to the outside world, life in a wheelchair meant life without dignity or dreams. To the contrary, Hockenberry found that his disability in many ways enhanced his existence. He also discovered that he was capable of reinventing his life and wrote, "To have invented a way to move without legs was to invent walking. This was a task reserved for Gods, and to perform it was deeply satisfying...I was inventing a new life."


continue story below


The stories of success and triumph, which exist along side of tragedy, are so numerous, that to even attempt to capture a small portion becomes a task that would fill several volumes. Pain and loss don't inevitably preclude success. In fact, they sometimes inspire it.

I am greatly saddened and often frustrated when I encounter individuals who perceive the suffering and loss that they endured in the past as what most defines their life. It's not only a self-defeating attitude; it's often an excuse to hide behind the pain of yesterday, instead of fully facing the responsibility and promise of today.

THE MYTH THAT MORE IS BETTER

"We don't understand the whites, they are always wanting something - always restless - always looking for something. What is it? We don't know. We can't understand them."Native American to Carl Jung

MARCUS

Marcus was drop dead gorgeous. I confess here and now that just looking at him was fascinating - let alone hearing about his privileged life. He spoke of his sailboat, his extravagant condominium in the city, his burgundy BMW, and his oceanfront home. He had a wife who loved him, a son who worshipped him, and a challenging and lucrative career. The man had it all and he was miserable. I called him one of the "wretched rich".

Marcus wanted to be a tour guide. He hated being confined indoors, and was weary of the constant and frantic rushing at work. He longed to be free, but he couldn't afford to keep the beach house, the BMW or the fancy condo on what he would make as a tour guide. Marcus had been miserable for the past ten years at least. When I saw him last, he was still miserable, but he had a bigger boat.

DONALD

Little Donald dreamed about getting bigger. He, like all the other kids, compiled a mental list of what he would do and have. "When I get bigger..." he would often say. He couldn't wait.

He grew up and he got to do and have many of the things that he had hoped for; a big house (for parties), a Harley Davidson, a wife and kids. He had a great time at first, but then he got busier and busier and busier. His big house had a huge yard that took hours to mow. His kids were great, but they were incredibly demanding. He hardly ever found the time to ride his Harley. Donald, like so many of his friends, began to compile a mental list of all that he would do and have when he got older. "When I retire..." he would say. He couldn't wait.

"I want you to know that possessions have made more people unhappy than happy because they define the limits of your life and keep you from the freedom of choice that comes with traveling light upon the earth." Kent Nerburn

"The more you have, the more you want." "The more money you make, the more money you spend." These are extremely familiar sayings used by just about everybody more than once. The words summarize countless all too familiar stories that show up over and over again in the lives of our neighbors, our families and in our own. They are both universal and paradoxical. At a glance, the moral of the stories seems to be that we can never be truly satisfied unless we can stop wanting, and yet to stop wanting appears to be an impossibility for most of us. From this perspective, things look pretty dismal. Perhaps however, as Mihaly Csikszentmihalyi suggests, the problem is not in the wanting, but in the failure to enjoy what we already have. Cierco said long ago that, "To be content with what we possess is the greatest and most secure of riches." Epictetus echoed these words of wisdom stating that, "He is a wise man who does not grieve for the things which he has not, but rejoices for those which he has."


Eventually, most of us learn all too well that having more does not translate into greater health or happiness. A glaring example of this fact can be taken from the status of the United States. We 're one of the most powerful and richest nations in the world, and number one on so many fronts including:

  • We have the highest homicide rate
  • We have more billionaires and more children and elderly living in poverty
  • We die younger (on the average) than citizens of other industrial countries
  • We have the highest incarceration rate in the world
  • We have the largest number of big homes as well as the largest number of homeless
  • We rank first in private consumption and last in savings.

Our children are more likely than those in any other affluent nation to:

  • Live in poverty
  • Die before their first birthday
  • Be abandoned by their fathers
  • Die before they reach their 25th birthday.

And in this land of "Plenty" so much is on the rise:

  • Teenage Suicide
  • Teenage pregnancy
  • The use of antidepressant medications

More of one thing that is desirable can sometimes lead to more of something else that is far less appealing. For example, the more square footage in a house -- the more maintenance required. Also, sometimes more brings less. That same house that requires more maintenance leaves the owner with less free time and money.

One bright and brisk December afternoon, I was visiting Ellen. She was showing me some of the wonderful quilts that she makes. I was particularly taken by a colorful patchwork that had a boat with some words that I didn't understand stitched beneath it. Ellen shared with me that the words in Hebrew meant, "It is enough." She explained that the boat on the quilt represented her husband's boat. "He's always tempted to buy a bigger boat." She hoped that the quilt would remind him that the modest and sea-worthy craft that he possessed was sufficient. I sadly thought about how much suffering could be prevented if only we all knew in our hearts and souls that what we have --"It is enough."

"Who is wealthy? He who is content with what he has." - The Talmud


continue story below


With few exceptions, my generation was raised on television, and many of us were programmed to believe that the 'most' and the 'biggest' is the best. In fact, one of my favorite songs as a child was, "My Dog's Bigger than your Dog." I learned it from a pet food commercial. Not too long ago, PBS aired a program called "Afflunza" which proposed that Americans are suffering from an epidemic of raging consumerism and materialism, leading to symptoms such as record levels of personal debt and bankruptcy, chronic stress, overwork, and broken families. Despite several indicators that Americans are wealthier than ever, (comprising only 5% of the world's population, while consuming 30% of its' resources) our wealth has appeared to have had relatively little impact on our overall well-being. For instance, it's been calculated that while the average American spends six hours a week shopping, the typical American parent spends only 40 minutes per week playing with his or her children. One study found that we spend 40% less time playing with our kids than we did in 1965, and 163 more hours a year working. Also, according to the "index of social health," there's been a 51% decrease in American's overall quality of life.

"It seems all too clear to me that having 'more' materially doesn't necessarily translate into greater happiness or satisfaction. In fact, I whole - heartedly agree with Tom Bender who observed that, "after a point, more becomes a heavy load."

Duane Elgin, in his landmark book, "Voluntary Simplicity," wrote, "Here is a sampling of the definitions of voluntary simplicity that strike a resonant chord with me: a manner of living that is outwardly more simple and inwardly more rich; . . . a deliberate choice to live with less in the belief that more of life will be returned to us in the process; a path toward consciously learning that enable us to touch the world ever more lightly and gently; a paring back of the superficial aspects of our lives so as to allow more time and energy to develop the heartfelt aspects of our lives."

Cecile Andrews, an active player in the voluntary simplicity movement and author of "Circle of Simplicity,"describes voluntary simplicity as: "the examined life. It is looking closely at our lives and asking if they are going in the direction that we choose. It's asking, 'What's important?' When we begin to examine our lives, we see that things are often out of our control, with depression, illness, and violence sky high. Further, the environment is in dire shape. As we continue our examination, we see that things are often out of control, with depression, illness, andviolence sky high. Further, the environment is in dire shape. As we continue our examination, we see that the well being of people and the planet are linked. The lifestyles that are harming us are also harming the planet -- we are working too much, consuming too much, and rushing too much. In many cases, we have lost touch with the things that are important - things like community and a connection to nature."

 


Andrews also points out that simple living doesn't mean giving things up, but rather, giving a quality of life to ourselves that isn't possible when we're overwhelmed with work in order to attain more and more goods which then rob us of our time as we scramble to maintain them. Simple living means a reduction in stress, not in life satisfaction and an increase in time to devote our energy to what really matters. "Living simply gives us a triple cure: it helps us reverse the degradation of the natural world we so love, it frees up scarce resources to help the world's poor, and it promotes joy and fulfillment in our personal lives."

While the simple life appeals to many, 'practical' questions often arise once the matter is considered carefully. One such question is, what would happen to the American economy if we all started living more simply? Wouldn't the United States be in trouble? Andrews responds that there are a number of ways that voluntary simplicity can actually benefit the economy including:

  • More savings for investments and capitol formation

  • A tendency toward economic activity characterized by modernization and sufficiency

  • Reduction of debt, both personal and national

  • Resources used to meet real needs vs. to reinforce overconsumption which leads to both natural resource as well as spiritual depletion

Approximately five years ago a quake hit very successful friends of ours. David and Elaine earned a joint salary that exceeded 100,000 dollars a year. They lived in a big beautiful house on Sebago Lake in Maine, drove two new imported vehicles, spent money without thinking twice, and were in debt. They didn't worry about their maxed out credit cards because of the large paychecks David brought home at the end of the week. There was always enough money to pay the seemingly endless bills the couple accrued. And then one day the bottom fell out. David's company downsized leaving David without a job. David and Elaine were terrified. How would they pay their credit cards, their car payments, and their mortgage? David sought in vain to replace his salary while the couple fell further and further behind. Their American dream quickly became a nightmare. The following year was a painful one for my friends, one that brought significant anxiety, loss, and disillusionment. It also triggered a great deal of soul searching.


continue story below


Today David and Mary live in a Duplex, renting out the other half of their modest home. They share two older model vehicles, and their designer clothing has been replaced for the most part by bargain finds. Are they bitter as a result of all that they've lost? No way! In retrospect, David and Mary share that they've not only given up the luxuries that they used to take for granted, they've given up an enormous amount of stress as well. They no longer have to work long hours to pay for things that they found they never really needed. They both work part-time and have freed themselves up to pursue their passions. Mary has learned to play the guitar and even performs from time to time. David has begun running in marathons and taking pictures, proudly showing off his photo collection of breath-taking nature scenes. Their story is not ultimately one of loss and deprivation - it's a story of discovery and triumph.
When I was a young girl, a man whom I looked up to told me, "the guy with the most toys wins." I have no idea where he is now or how much he's "won." I do know that many of us look up to the wealthiest among us, while at the same time feeling envious and even resentful of them. We place many of our richest on pedestals, while at the same time paying lip service to the teachings of those whose memories stay with us the longest. Ironically, throughout the course of history, our most influential teachers are those who generally claimed the fewest possessions.

In an article first published in 1936, Richard Gregg coined the term voluntary simplicity. One of the issues Gregg addressed in advocating such a lifestyle was how civilizations grow. Gregg wrote:

"In Volume III of Arnold J. Toynbee's Study of History he discusses the growth of civilizations. For some sixty pages he considers what constitutes the growth of civilization, including in that term growth in wisdom as well as in stature. With immense learning he traces the developments of many civilizations, - Egyptian, Sumeric, Minoan, Hellenic, Syriac, Indic, Iranian, Chinese, Babylonic, Mayan, Japanese, etc. After spreading out the evidence, he comes to the conclusion that real growth of a civilization does not consist of increasing command over the physical environment, nor of increasing command over the human environment (i.e. over the nations or civilizations), but that it lies in what he calls 'etherealization'; a development of intangible relationships. He points out that this process involves both a simplification of the apparatus of life and also a transfer of interest and energy from material things to a higher sphere..."

Since the beginning of the Industrial Age our society has mistaken true growth for economic gain. In doing so, we've experienced enormous and in many cases irretrievable losses. At the deepest level, most of us are aware of what we've sacrificed to the "Gods of Economic Growth" and yet amazingly, we so often attempt to fill the current void with more and more material goods. As long as we do so, we fail to experience the degree of personal and spiritual growth that awaits us. Lacking substantive purpose and meaning, many greet the morning with resignation. Reluctantly rising from their beds to make a living, they find themselves deprived of time to enjoy the magnificence of life.

Catherine Leach and her husband read Voluntary Simplicity in the 1980's. In 1990, they moved to the country and made significant changes in their lifestyles, including pursuing more meaningful work. While the couple has by no means been spared challenges, Leach reports that the quality of their lives has been greatly enhanced. She observed: "We are now more connected than ever to what is going on - curious about what's new, what's good and new, what weaknesses we can help correct, and what others are doing to make a better world. We are overworked and underpaid (our choice) but we have discovered a real excitement about the next day and the next decade."


THE MYTH OF HAVING IT ALL

"That child has every toy his father wanted." - Robert E. Whitten

How many times have you gotten the message either inferred or directly that, "You can have it ALL!" What an offer, what a dream, what a promise, and all too often - what a lie!

For years many believed that I had it ALL. And I might have even agreed with them not so long ago. I had a successful private practice, a loving marriage that now spans two decades, a healthy blond haired, blue eyed daughter, a Ph.D., wonderful friends, a close extended family, a cottage on the water to escape to, mutual funds, stocks, an IRA, and plenty of money in the bank.

So how come I wasn't living "happily ever after?" I had more than my young girl fantasies had ever promised. Why wasn't I satisfied? What was wrong with me? Was I just another "spoiled baby boomer?" Did I expect too much? Demand too much?

Or, was it that I had too much? Too many appointments, too many obligations, too many goals, too many roles, too many deadlines, too many plans, too much to maintain, too much to loose . . .

Most parents want their children to have better lives. Ours wanted more money, more opportunities, more security, and more choices for us. We wanted more too, and that's exactly what many of us got - more. More materials, more opportunities, more education, more technology, more stress related disorders, more failed marriages, more latch key children, and more demands. We got, I believe, a whole lot more than most of us bargained for.

We wanted the "good life." I wanted the "good life." I was told in countless ways that it was possible for me to achieve it - if I was smart enough, motivated enough, disciplined enough, willing to work hard enough. If I was "good" enough, it could be mine. And so I did my very best to be and do all of those things. I wanted MINE. As I struggled to achieve, I began to succeed in obtaining and accumulating all of the trappings of the "good life" I had fought so hard for. But with the college degrees came student loans, along with the house came a significant mortgage, significant demands accompanied the private practice, the cottage required regular upkeep, the marriage demanded compromises, the child had seemingly endless needs, with friends came obligations, and along with the "good life" came more and more and more . . . I had a full life. It was so full, that all too often it felt that I would explode.


continue story below


I was becoming a woman of means too. I had the means to do and buy a number of things, and I did them, and bought them, until one day I was surrounded - by THINGS - to have and to hold. I had so much of it ALL that all I needed now was time. I wanted just a little more time please, so that I could do it ALL - with the ALL that I had. It seemed ironic that with the ALL that I'd gained, I couldn't have more of such a small thing, just a wee thing that didn't take up physical space, didn't require maintenance or a mortgage, just a tiny request really - Just a little more time!

One day, in the midst of my plenty, I recognized that I was starving - craving a few totally pointless moments, a period of doing nothing, to just "be" and not "do." How difficult that was to accomplish in spite of ALL that I'd achieved and accumulated. I was surrounded by my ALL.

I had so many CHOICES. Where were they? They were looking me right in the eye and smirking.

"Should I close my practice?" I considered. "And what will become of your clients? How will you get by on just one income? What about those degrees you're still paying on? What will happen to those dreams of yours? How will you pay for your daughter's gymnastic classes, her college, family vacations, and be certain that your financially secure in old age?" the voice demanded.

"Should I stay working?" I wondered. "And how will you give your daughter the quality time she deserves? How will you find time to contribute to your community? When will you ever write your book? How will you manage to stay involved in your daughter's school, connected to your family and friends, keep a journal, and read all of the books that you keep saying you're going to read that aren't work related? Who will tend your garden, keep your bird feeders filled, see that your family's diet is healthy, make dental appointments, see to your daughter's homework, and that your dog has his shots? How will you do all of that and still manage to live a life that doesn't exhaust you?" the voice taunted. "I'll manage. I have so far" I replied. "And is this the life you want for your daughter?" queried the voice. "Absolutely not! I want more for her," I quickly replied. "Maybe you should want less for her," the voice retorted.

Want less? I wanted her to have every opportunity that I had and more. And then it hit me. The "more" had become my problem. I had bought into one of the most popular myths of my generation - that I could have it ALL.

No one can have it all. We each must make choices, it's a fundamental law that none of us escapes. When we choose one path, we forsake another, at least for the time being. We can't do it ALL without making sacrifices.

If a woman chooses to work and parent at the same time, it doesn't necessarily mean that she'll compromise the well being of her child. But she will give up something. In many cases it means giving up time for herself - time to nurture her other relationships, and to develop significant aspects of her inner life. It may not be fair, but it's true.

If a woman chooses not to bear children, it doesn't mean that she's robbing herself of her biological right or forsaking her duty. It does mean that she'll miss certain experiences that many women hold sacred. She can't simply replace them with additional adventures and opportunities, but she can be fulfilled and complete without them.


If a woman chooses to stay at home with her children, it doesn't mean that she'll automatically be a better parent than her working peers are, or that she'll stop growing. It does mean in most cases that she and her children won't be able to spend money as freely as those families who possess two incomes, but she'll have more choices regarding how she spends her time.

If a man decides to abandon the fast track in order to pursue another calling, it doesn't automatically follow that he'll die poor, any more than it guarantees that he'll live happily ever after. It does mean that he's not as likely to possess the financial and material options of his corporate brothers, but he will most likely possess a sense of freedom that most of those he left behind can only hope for in retirement - if they live that long.

There are no simple answers. No perfect path to follow. There is no way to obtain "everything" and give up "nothing." We all understand that intellectually, and yet somehow many of us are still trying to figure out how to get around this fundamental truth.

Lilly Tomlin, the comedian perhaps best known for her portrayal of the precocious little "Edith Ann," quipped, "If I'd known what it would be like to have it all, I might have settled for less."

But I wasn't raised to "settle." My generation which has been touted the largest, most educated, and most advantaged group in the history of the United States, has been born and bred to expect the riches and opportunities we were promised. And we struggle to claim them long after Bob Welch reported in "More to Life Than Having it All," that according to two separate studies published in Psychology Today, we're five times more likely to be divorced as our parents, and ten times more likely than our elders to be depressed. We keep scrambling for more, and more is what we've ultimately gotten, I guess.


continue story below


Who ever it was that said, "You get what you settle for" got my attention, and those words still touch me today. I "got" plenty in my old life, and I settled for more. More stress, and less time; more responsibilities, and less peace of mind; more materials, and less satisfaction; more money for play, and fewer opportunities to enjoy what I had; larger Christmas presents for my daughter, and smaller portions of my energy.

And now, over two years after I made significant changes in my life, I'm still struggling with the trade-offs. There have been far more sacrifices than I would have chosen to make if I was queen of the world, but I'm by no means royalty, so I've learned to barter. And I generally manage to feel that I'm gaining far more than I lost in the deal.

Djohariah Toor informs us in, "The Road by the River," that the Hopi's have a word, Koyaanisqatsi, which means, "a life out of balance." What specifically does it mean to live such a life? Well, I'm not sure I can adequately explain it, but I know with all of my heart that I lived it, and still do. The good news however, is that I've succeeded (I believe) in swinging the pendulum closer to the center. I'm able to invest more in my inner life, my spirit, my relationships, and to live a life that reflects my personal values to a far greater extent than ever before. There's much in my life which still requires fine-tuning, and my professional life has certainly absorbed formidable blows, but my garden is beginning to bloom, my heart feels lighter, and I'm once again discovering anticipation in the mornings.

Charles Spezzano wrote in, "What to do Between Birth and Death," that, "You don't really pay for things with Money. You pay for them with time." I tell myself today (and now believe it), that my time is more valuable than my money. I don't want to spend as much of it as I used to on things that really don't matter much. I have no idea how much of it remains available to me, and I'd rather run out of money in the bank at this point, than out of what ever time I have left. I can't have it ALL, and so I'm negotiating.

My husband, Kevin continues to struggle with his own choices. He's chosen to provide our family with it's only significant source of income. Sometimes I feel saddened when I think of him. One of his best friends, who opted not to have children, enjoys so many more choices than Kevin does. He has a partner that shares the financial burden that Kevin carries alone. His friend goes off on adventures, purchases newer and bigger toys, and relaxes on the weekend, while my sweet husband mows the lawn, attempts to fix a broken appliance (that in his old life he would have had repaired), while contemplating which bill he should pay this week. In our old life, he never would have had to think twice about whom to pay when. The money was always there. Still, today, there's no checking with me to see if he can work late, no wondering what he'll make for dinner tonight after working ten hours, or rushing to pick up our daughter before day care closes. He doesn't need to rush around getting himself and our daughter ready in the morning, and he no longer faces a second shift when he leaves the office for the day. He still misses the financial freedom our previous life-style allowed, how could he not? And he still wonders what it's all for on a bad day. But he's able to focus more closely on his own life, go to bed early if he chooses, and his best friend is waiting for him after a long day who's not as preoccupied as she used to be. One who eagerly awaits him and feels far greater appreciation for him that she ever did before.

Our life is far, far, from perfect. We still catch ourselves longing for that elusive future when we're able to experience greater freedom and more choices. We have less than we used to for sure - less money, less security, and far fewer investments to brighten up our "golden years." But we also have fewer regrets, less guilt, and less tension.

Our larger dreams still all too often overshadow our day to day enjoyment of what we have - our child, our health, our families, our love . . . But we're more apt to catch ourselves now, rather than getting lost far down that road of tomorrow, the one we used to travel on an almost daily basis.


Marilyn Ferguson observed in, "The Aquarian Conspiracy," that, "our problems are often the natural side effects of our success." Kevin and I are clearly experiencing fewer benefits of the conventional "success" that we used to take for granted. Yet, while our shift in life style has presented new challenges, it has also offered solutions to issues that used to weigh heavily on our shoulders each and every day. We have ceased our exhausting struggle to have it ALL, in order to experience and appreciate more fully what we have today, for who knows if it will be there tomorrow.

I sometimes recall my yesterdays when I become discouraged with my today's. Then my mantra was, "hurry, hurry, hurry!" My little girl learned from her parents to move quickly, while reaching out to grab hold as we went speeding by. I recently watched a video of a beautiful, curly haired child playing ballerina, a toddler that used to be mine. As the camera zeroed in on her golden eyes, I realized how often back then her little face was out of focus, as I raced to catch up with my life.

Casey Carlson wrote in Earth Light, "As a professional photographer, I have often used the technique of cropping a picture to focus on the central point or theme of the photograph, to eliminate the extraneous and distracting elements. I had no idea that the technique could be applied to one's possessions with similar success." I too have found that the act of eliminating as many distractions as possible in my own life has served to bring what really matters into far sharper focus.

I'm slowing down now. Getting out of the way as others pass me by, though I still get tempted from time to time. I'm hoping though my resolve will hold - that I'll take the time that I truly understand now is precious. Because no matter what we do, become, or accomplish - the one thing that awaits us all in the end - is the finish line."

ON NET WORTH

"Materialism and a world-fleeing spirituality sustain each other by reacting against one another, leaving us with bloodless spiritual lives and a never-satisfied obsession with things." Thomas Moore


continue story below


Net worth seems to be a popular term these days. According to the Census Bureau, net worth is defined as the value of checking and savings accounts, stocks and bonds, real estate, cars and other various assets (with the exception of jewelry and furniture) minus debt. Well, I don't have a great deal of it, and my sister Terrie has even less. In fact, she has very little of it at this point in her life. She and her husband struggle on a daily basis to make ends meet. So does her lack of net worth make her worth less? Not on your life! Terrie is a cross between Mary Poppins and Elley May Clampett. Children and animals are drawn to her and she to them. Her house, a small and modest ranch, is filled with her own and other people's kids and critters. She doesn't concern herself with stocks and bonds, designer clothes and gourmet fare. Much of her time is devoted to caring for two and four legged creatures, cleaning, baking chocolate chip cookies, and the best pie crust I have ever eaten. Most importantly, perhaps, she is busy creating both simple and yet wonderful moments and memories. While she is four years younger then me and has never been to college, she is truly my greatest role model. I catch myself often attempting to emulate her. Her love of family, her appreciation of nature, her lack of pretense, her ability to acknowledge and give thanks for the little things, have served to make her one of the happiest and most beloved people I know. Net worth? Seems like a pretty flimsy and insignificant little word when I compare it to the riches of my sister's life.

THE MYTH OF HAPPILY EVER AFTER

"The voyage of discovery lies not in seeking new vistas but in having new eyes." - Yeats

Mihaly Csikszentmihalyi maintains that happiness doesn't just happen to us by random chance or as the result of good fortune. Instead, says Csikszentmihalyi, happiness is "...a condition that must be prepared for, cultivated, and defended privately by each person. "

"And they lived happily ever after..." Find me a child anywhere in this country that hasn't heard that line before. To be happy becomes a basic necessity to most of us. "I just want to be happy," I hear again and again. The implication seems to be that the speaker should be congratulated for his/her lack of greed. Happiness isn't all that much to ask for. Happiness should just happen for everybody.

While happiness is truly a gift, it's not simply bestowed upon most of us. Regardless of how magnificent the prize, how beautiful the scenery, or how glorious the adventure, happiness will not automatically result. Happiness requires appreciation for even the smallest of experiences. Happiness has a great deal to do with our expectations. If we expect to feel happy all of the time, then disappointment will follow. We might then search or wait a life- time for whatever it might be that will make us happy. Csikszentmihalyi observes that most of the finest moments of our lives, contrary to modern myth, tend not to be easy and relaxing moments. The finest moments generally occur when we are being challenged by an endeavor that is both difficult and meaningful. Thus, an optimal experience is one which we actively create versus passively encounter. The first time I received straight A's in college was an optimal experience, as was giving birth to my daughter and surviving a white water rafting trip. None of these experiences were easy and yet each was supremely rewarding. I believe that its been the successful completion of difficult and yet worthwhile tasks in my life which have ultimately offered me the greatest satisfaction. In acknowledging the value of trial and triumph, I rejoice in the fact that life holds a multitude of opportunities for each of us to encounter what Maslow has described as "peak" experiences.

Each of us is required to face some level of difficulty. The primary reason that happiness is so difficult to hold onto asserts Csikszentmihalyi, is that we tend to forget that the universe was not designed for the comfort of human beings. When something bad happens to us, we often ask, "why me?" as if we are being unfairly singled out to suffer. Every feeling being on this earth suffers (and not in equal doses). There are no exceptions. Csikszentmihalyi further observes that:

"When people start believing that progress is inevitable and life easy, they may quickly lose courage and determination in the face of the first signs of adversity."


If your expectations are that you will always (or at least ultimately) be rewarded for your efforts; that the extent of your suffering will be directly related to how good or bad you are; that the older you get the more (or less) you will have, etc., you will quickly become disillusioned. If your secret hope is that life will make the most foryou rather than you will make the most of life, then I say your hold on happiness will be tentative and fleeting. If you believe that life is or must be fair, then you will grow bitter. Gail Sheehey describes a survivor as one who "makes the most of what comes and the least of what goes." If we are to live in this world with a sense of gratitude and appreciation, then we had better learn to cut our losses. We must learn to distinguish between when to strive to change our circumstances and when to simply accept what is or what was.

So many of us were raised on fairy tales that implied to us that once a particular event occurred we'd live 'happily ever after.' Consequently many people end up living on what Frederick Edwords referred to as "the deferred payment plan." Those of us who've lived on the deferred payment plan have spent a great deal of our lives waiting. We've told ourselves that we'll be happy when we marry, make enough money, buy our dream house, have a child, when the kids leave home, or that we'll finally be happy when we retire. Sadly, the deferred payment plan often causes us to project a significant amount of ourselves (and our spirits) into the future. Thus, we end up failing to fully appreciate the incredible beauty of our world. Jonathon Swift once wrote a lovely blessing, "may you live all the days of your life." The deferred payment plan makes that very hard to do.

What so many of us fail to recognize is that generally, experiencing happiness is both an active and creative process. We create happiness in part, by what we choose to focus on, appreciate, and expect from our lives. It's been said that love is a verb, and faith is a verb, I'd add that happiness is a verb as well.

Too many of us have been led on a relentless search for happiness and meaning. Along the way, we've constructed a number of fantasies regarding what a happy life would look like. Roy Baumeister, Ph.D. identifies one popular image of the happy life common to many city and suburb dwellers, in his book, "Meanings of Life". Baumeister cites research where individuals were asked what would make them happy. So many city dwellers responded that living on their own farm would make them happy, that the researcher decided to go to the country and interview farmers. Ironically, he found that farmers were not at all a particularly happy group of people.


continue story below


THERE IS NO HAPPILY EVER AFTER. It doesn't come with the right partner, job, award, house, location, child, etc. It comes to you moment by moment, in how you choose to interpret your experiences. During a period of transition, will you dwell on your losses or acknowledge your opportunities? Will you pause and breathe in the crisp fresh air of an autumn day? Will you savor your free moments or attempt to kill time? Will you experience the present fully? You must appreciate the here and now, immerse yourself in today's happenings if you hope to find happiness.

" The basic assumption of the happiness mentality in spite of considerable hard evidence to the contrary -- is that if one lives one's life correctly one will be happy." Gerald May

THE GOOD LIFE: A NEW MYTH AND AN OLD IDEAL

"The dignity of man depends on creating and not on possessing." Theo Spoerri

We baby boomers have fully embraced the idea of "the good life", and though I'm a baby boomer, I'm not at all certain of what that phrase means. What exactlyisit to live the good life? Definitions of the good life would seem to be as different from one another as those whose good life is being described. George Burns, comedian, (now deceased), told us that he had had a good life. Scott and Helen Nearing (homesteaders and social activists) maintained that they had the good life, too. The life of George Burns was vastly different from that of the Nearings, and yet each of their lives have been well lived.

So many of us want the "good life" we've heard so much about, in spite of the fact that it's the pursuit of our culture's particular version of the "good life" with its images of luxury and wealth, that leads us closer each day to the brink of global ecological disaster.

Interestingly, while the notion of the "good life" seems to be deeply implanted in our generation's psyche's, it's origin stems from the dreams of those who came before us, and meant something entirely different from what so many of us have come to yearn for. The world was introduced to the concept of the "good life" by such long gone seekers as William Penn, Thomas Jefferson, Henry David Thoreau and Wendell Barry. And it appears that their vision was very different than our own turned out to be. To them, the "good life" represented a lifestyle based on simplicity; not materialism, on personal freedom; not acquisition, on spiritual, emotional, and interpersonal development; not net-worth. We lament that we too value those things even as we scramble to put large screen televisions with stereo sound, and computers on our tables.

Do I sound harsh? Forgive me please. You see, more than anything else, I'm conducting an argument with myself in your presence. I'm attempting to set myself straight, which typically involves great vigor and drama. It's never been easy for me to change, and that's what I'm trying to do these days. Change my attitude, my perspective, my lifestyle, and my direction. I never did like to walk alone, and so here I am once again attempting to get you to walk along with me. Never mind that I've gotten lost on more than one occasion. Just keep me company.


I've altered my path significantly in the last few years, and I won't tell you that the rewards have been tremendous, (although they often have) or that I don't look longingly at my neighbors life from time to time (is that a new car they have in the garage again? I ask, as we attempt to keep our 1985 model running). One day I'm sitting in my rocker gazing at the crepe Myrtle trees we just planted, feeling a sense of satisfaction and gratitude. The next morning I'm dreaming that my book has been well received, leaving me free of the financial concerns that periodically plague me. I'm feeling good that I'm more available to my daughter one minute, and shooing her away while I attempt to pump out more words on my computer screen the next. You see, I'm far, far from finished and settled into this new life plan of mine. And I still want more, but now I'm settling for less, and striving for different things.

I've decided that a life need not be described as exceptionally happy in order to be good. As a young girl, I dreamed of passion and great adventure. I could not imagine a worthwhile life without them. As an adult approaching 40, I would judge that the life of an individual who often experienced contentment, growth, and love had been a good one.

"The good life, the truly human life is based not on a few great moments but on many, many little ones. It asks of us that we relax in our quest long enough for us to let those moments accumulate and add up to something." Harold Kushner THE MYTH THAT OVER-CONSUMPTION IS HUMAN NATURE

Some days I'm enormously proud to be a member of the human species, on others, I'm ashamed. We've been hard on our environment, on other creatures, and we've been hard on ourselves. American's have been taught by our economic and by many of our social systems that we're insatiable, greedy, and by nature, gluttons. In a Harper's Magazine of Desire by William Leach, Lewis H. Lapham writes that, editorial review of Land


continue story below


" . . . what is so heartening about Leach's book is its argument, entirely persuasive, that consumptionsim is made of a set of attitudes as artificial and deliberately contrived as the movements of a mechanical bird. Prior to 1880 it did not exist in the forms that we now know it, and its corollary behaviors and habits of mind cannot be mistaken for the laws of human nature . . .Between 1890 and 1930 the land of desire replaces the older religions and political ideals that sustained the American people in the century before the Civil War--ideals that embodied the values of thrift, productive labor, the ownership of land, republican government, Christian poverty, and plain speech--and within the span of two generations America becomes synonymous with the culture of acquisition and consumption, with the cult of the new and the belief that money is the alpha and omega of all human existence."

It's not within our nature as a species to behave like a swarm of locusts, devouring everything in our path. Since the dawn of humankind, 99% of our time on this planet was spent as hunter-gatherers. What's led us to engage in such destructive patterns of behavior? Behavior which according to Thomas Berry causes us to burn the very timbers of our life boat. Andrew Bard Schmookler believes it's in part because we've become so disconnected with the grounds of "bodily pleasure." Schmookler explains, "People alienated from a primordial connection with their bodies may indeed be insatiable in their material yearnings." He also asserts that our insatiable appetite for material goods is connected to our insufficient lack of loving contact with others. We've been wounded and alienated by our culture's emphasis on competition, autonomy, independence, and a pathological economy based on growth without limits. Our mass consumption grows as a result of our unfulfilled longings, and we unconsciously attempt to attain materially what can't be bought - community, connection, and meaning.

TAKING OFF THE MASK

"The greatest burden we carry into middle age is the burden of our masks."
- Eda Le Shan

I found much of my own sadness and pain to be connected to a preoccupation with achievement. I wanted to prove to myself, as well as to others, that I was a person of worth. In order to accomplish this, I wore numerous masks. And while each mask was an authentic version of some aspect of myself, it was exhausting never the less, to put them on and take them off as the occasion called for. I might have been feeling exceptionally irritable, but quick - here comes somebody - so I would immediately pull on my soft- spoken, kind and patient mask. Jung describes our persona as:

"...a complicated system of relations between the individual consciousness and society fittingly enough a kind of mask, designed on the one hand to make a definite impression upon others, and on the other, to conceal the true nature of the individual."

We begin to develop our persona in childhood in order to win the approval and assistance of the significant adults in our lives. As we grow older, we create additional and more complex personas. Eventually, the personas become inextricably bound to identity, and we find ourselves asking in midlife, "Who am I without my masks?"

Djohariah Toor observes that it is at midlife that we begin to recognize a split between our feelings and thoughts; between the roles we play and the life we imagine; between the person we are perceived as; and the person we believe ourselves to be; between our mind and body. It becomes increasingly important, advises Toor, that we begin to identify what it is about ourselves that is authentic, and what has become fiction. We must ask ourselves who the real person is "beneath the masks we have worn and the roles we have played. Re-creating the myths of our person-hood and breaking free of the deadness of what we have struggled to conceal about ourselves can be another painful stage of the journey, but ultimately it is a major key in our healing process."


Jung perceived the journey towards the authentic self as a rebirth, and described this fundamental process of midlife transition as, "a long drawn-out process of inner transformation and rebirth into another being. This 'other being' is the other person in ourselves --that larger and greater personality maturing within us, whom we have already met as the inner friend or the soul..."

I believe that the masks I dawned on a daily basis in order to win approval, contributed significantly to my alienation from my authentic self, and ultimately resulted in my being cast adrift from the spiritual aspects of my life. It was through my awareness of this disconnection, and my subsequent attempts to let go of my efforts to win approval from everyone I meet, that I have been led closer toward that which I now seek- a relationship with my authentic self, and union with my spirit. This search brings me nearer to a sense of peace and affiliation with all that is (including the less attractive aspects of myself), have been, and will be.

Anne Morrow Lindbergh once wrote, "Perhaps middle age is, or should be, a period of shedding shells; the shell of ambition, the shell of material accumulations and possessions, the shell of the ego."

INCUBATION

"Man is a stream whose source is hidden." - Emerson

My friend and soul sister, Stephanie, an extremely vibrant and creative woman, shared with me recently that she had been feeling lethargic and uninspired. As she spoke, I began to recall a period not so long ago in my own life. For months after moving to South Carolina, the most unsettling fatigue and desire to hibernate besieged me. While my daughter was in school, I would do a few chores, work on my book, and then be overcome by the need to lie down. I most always succumbed and would sleep sometimes for hours. I would awaken feeling guilty and extremely uneasy. I was sleeping sometimes twelve hours a night and still feeling sluggish. I was also relishing my solitude and avoiding even telephone contact with others. I would be in my apartment for days without leaving except to walk or to sit by the duck pond. Being a therapist, my first thought was that perhaps I was depressed. After all, I had certainly lost enough during the past several months; however, depression didn't quite seem to fit. Initially, for the first month or so, I attributed my strange behavior to exhaustion. I just needed to rest and recover from the emotionally and physically draining experiences I had recently undergone. By late December, this explanation no longer felt comfortable. What was happening to me?


continue story below


Jung may very well have interpreted both my own, and Stephanie's experiences, as relatively common occurrences of mid life - intervals in which one's psychic energy becomes withdrawn from the conscious mind and diverted to the realms of the unconscious. Jung himself encountered these somewhat eerie episodes. He described them as periods in which he often felt "suspended in mid-air." While new heights can be invigorating, most of us can only tolerate being suspended for so long. Still, if we can be patient, if we can open ourselves to the flow of our unconscious, and allow ourselves to drift along with the subterranean currents for a time, then we will most assuredly return eventually to the security of solid ground with greater insight and wisdom.

In retrospect, I believe that my time of slow motion provided me with a tremendous gift. My life had been so active, so frenetic, so goal oriented in the past that I had lost almost complete touch with my inner self. I was able after leaving Maine to undergo an incubation period during those early months following the move. Tillie Olson, author and poet, describes such experiences as providing "that necessary time for renewal, lying fallow, gestation, in the natural cycle of creation." Not since childhood had I experienced this freedom, this quiet time in which I could simply evolve. The most profound period of my quake occurred here - between the normal spaces of my life. This critical stage of my own metamorphosis involved reflection, meditation, a multitude of dreams, reading, writing, soul searching and reclamation. It was a time for me to review my own story as well as to begin to construct a new one.

"When you're in the middle of an earthquake you begin to question, what is it that I really need? What is my real rock?" Jacob Needleman

On March 26, 1872, in Yosemite Valley, John Muir was awakened in the twilight hours of the morning by the violent tremors of the Inyo earthquake. Muir, along with his neighbors, was frightened by the wild motion and rumbling of the quake. And yet, he was also excited, certain that he was about the learn something of tremendous importance.

While neighbors fled to the safety of the lowlands once the heaviest of the shocks subsided, Muir stood his ground -- wide eyed and in wonder. What he soon discovered was that from out of the chaos of the quake, a mountain talus was born.

For months after the initial shock waves, the earth continued to tremor and shift. Muir described this period as a time when"rough places were made smooth, and smooth places rough. But on the whole, by what at first sight seemed pure confusion and ruin, the landscapes were enriched; for gradually every talus, however big the boulders composing it, was covered with grooves and gardens, and made a finely proportioned and ornamental base for the sheer cliffs. Storms of every sort, torrents, earthquakes, cataclysms, convulsions of nature, etc., however mysterious and lawless at first sight they may seem, are only harmonious notes in the song of creation, varied expressions of God's love."

Chapter One - The Quake

Chapter Two - The Haunted

Chapter Three - Myth and Meaning

Chapter Four - Embracing the Spirit

Chapter Eight - The Journey

next:EMBRACING THE SPIRIT Chapter Four

APA Reference
Staff, H. (2008, December 27). Myth and Meaning, HealthyPlace. Retrieved on 2024, April 19 from https://www.healthyplace.com/alternative-mental-health/sageplace/myth-and-meaning

Last Updated: July 21, 2014

Compilation of EMDR Studies

There are more controlled studies on EMDR than on any other method used in the treatment of PTSD (Shapiro, 1995a,b, 1996). A literature review indicated only 6 other controlled clinical outcome studies (excluding drugs) in the entire field of PTSD (Solomon, Gerrity, and Muff, 1992).

The following controlled EMDR studies have been completed:

  1. Boudewyns, Stwertka, Hyer, Albrecht, and Sperr (1993). A pilot study randomly assigned 20 chronic inpatient veterans to EMDR, exposure, and group therapy conditions and found significant positive results from EMDR for self-reported distress levels and therapist assessment. No changes were found in standardized and physiological measures, a result attributed by the authors to insufficient treatment time considering the secondary gains of the subjects who were receiving compensation. Results were considered positive enough to warrant further extensive study, which has been funded by the VA. Preliminary reports of the data (Boudewyns & Hyer, 1996) indicate that EMDR is superior to a group therapy control on both standard psychometrics and physiological measures.

  2. . Carlson, et al. (1998) tested the effect of EMDR on chronic combat veterans suffering from PTSD since the Vietnam War. Within 12 session subjects showed substantial clinical improvement, with a number becoming symptom-free. EMDR proved superior to a biofeedback relaxation control group and to a group receiving routine VA clinical care. Results were independently evaluated on CAPS-1, Mississippi Scale for PTSD, IES, ISQ, PTSD Symptom Scale, Beck Depression Inventory, and STAI.

  3. . Jensen (1994). A controlled study of the EMDR treatment of 25 Vietnam combat veterans suffering from PTSD, as compared to a non-treatment control group, found small but statistically significant differences after two sessions for in-session distress levels, as measured on the SUD Scale, but no differences on the Structured Interview for Post-traumatic Stress Disorder (SI-PTSD), VOC, GAS, and Mississippi Scale for Combat-Related PTSD (M-PTSD; Jensen, 1994). Two psychology interns who had not completed formal EMDR training did this study. Furthermore, the interns reported low fidelity checks of adherence to the EMDR protocol and skill of application, which indicated their inability to make effective use of the method to resolve the therapeutic issues of their subjects.

  4. There are more controlled studies on EMDR than on any other method used in the treatment of PTSD. Here's a list of the studies.Marcus et al. (1996) evaluated sixty-seven individuals diagnosed with PTSD in a controlled study funded by Kaiser Permanente Hospital. EMDR was found superior to standard Kaiser Care which consisted of combinations of individual, and group therapy, as well as medication. An independent evaluator assessed participants on the basis of the Symptom Checklist-90, Beck Depression Inventory, Impact of Event Scale, Modified PTSD Scale, Spielberger State-Trait Anxiety Inventory, and SUD.

  5. Pitman et al. (1996). In a controlled component analysis study of 17 chronic outpatient veterans, using a crossover design, subjects were randomly divided into two EMDR groups, one using eye movement and a control group that used a combination of forced eye fixation, hand taps, and hand waving. Six sessions were administered for a single memory in each condition. Both groups showed significant decreases in self-reported distress, intrusion, and avoidance symptoms.

  6. Renfrey and Spates (1994). A controlled component study of 23 PTSD subjects compared EMDR with eye movements initiated by tracking a clinician's finger, EMDR with eye movements engendered by tracking a light bar, and EMDR using fixed visual attention. All three conditions produced positive changes on the CAPS, SCL-90-R, Impact of Event Scale, and SUD and VOC scales. However, the eye movement conditions were termed "more efficient."

  7. . Rothbaum (1997) the controlled study of rape victims found that, after three EMDR treatment sessions, 90% of the participants no longer met full criteria for PTSD. An independent assessor evaluated these results on the PTSD Symptom Scale, Impact of Event Scale, Beck Depression Inventory, and Dissociative Experience Scale.

  8. Scheck et al. (1998) Sixty females ages 16-25 screened for high-risk behavior and traumatic history were randomly assigned to two session of either EMDR or active listening. There was substantially greater improvement for EMDR as independently assessed on the Beck Depression Inventory, State-Trait Anxiety Inventory, Penn Inventory for Post-Traumatic Stress Disorder, Impact of Event Scale, and Tennessee Self-Concept Scale. Although the treatment was comparatively brief, the EMDR treated participants came within the first standard deviation compared to non-patient norm groups for all five measures.

  9. Shapiro (1989a). The initial controlled study of 22 rape, molestation, and combat victims compared EMDR and a modified flooding procedure that was used as a placebo to control for exposure to the memory and to the attention of the researcher. Positive treatment effects were obtained for the treatment and delayed treatment conditions on SUDs and behavioral indicators, which were independently corroborated at 1- and 3-month follow-up sessions.

  10. Vaughan, Armstrong, et al. (1994). In a controlled comparative study, 36 subjects with PTSD were randomly assigned to treatments of (1) imaginal exposure, (2) applied muscle relaxation, and (3) EMDR. Treatment consisted of four sessions, with 60 and 40 minutes of additional daily homework over a 2- to 3-week period for the image exposure and muscle relaxation groups, respectively, and no additional homework for the EMDR group. All treatments led to significant decreases in PTSD symptoms for subjects in the treatment groups as compared to those on a waiting list, with a greater reduction in the EMDR group, particularly with respect to intrusive symptoms.


  1. D.Wilson, Covi, Foster, and Silver (1996). In a controlled study, 18 subjects suffering from PTSD were randomly assigned to eye movement, hand tap, and exposure-only groups. Significant differences were found using physiological measures (including galvanic skin response, skin temperature, and heart rate) and the SUD Scale. The results revealed, with the eye movement condition only, a one-session desensitization of subject distress and an automatically elicited and seemingly compelled relaxation response, which arose during the eye movement sets.

  2. S.Wilson, Becker, and Tinker (1995). A controlled study randomly assigned 80 trauma subjects (37 diagnosed with PTSD) to treatment or delayed-treatment EMDR conditions and to one of five trained clinicians. Substantial results were found at 30 and 90 days and 12 months post treatment on the State-Trait Anxiety Inventory, PTSD-Interview, Impact of Event Scale, SCL-90-R, and the SUD and VOC scales. Effects were equally large whether or not the subject was diagnosed with PTSD.

Nonrandomized studies involving PTSD symptomatology include:

  1. An analysis of an inpatient veterans' PTSD program (n=100) compared EMDR, biofeedback, and relaxation training and found EMDR to be vastly superior to the other methods on seven of eight measures (Silver, Brooks, & Obenchain, 1995).

  2. A study of Hurricane Andrew survivors found significant differences on the Impact of Event Scale and SUD scales in a comparison of EMDR and non-treatment conditions (Grainger, Levin, Allen-Byrd, Doctor & Lee, in press).

  3. A study of 60 railroad personnel, suffering from high-impact critical incidents, compared a peer counseling debriefing session alone to a debriefing session that included approximately 20 minutes of EMDR (Solomon & Kaufman, 1994). The addition of EMDR produced substantially better scores on the Impact of Event Scale at 2- and 10-month follow-ups.

  4. Research at Yale Psychiatric Clinic conducted by Lazrove et al. (1995) indicated that all symptoms of PTSD were relieved within three sessions for single-trauma victims as independently assessed on standard psychometrics.

  5. Of 445 respondents to a survey of trained clinicians who had treated over 10,000 clients, 76% reported greater positive effects with EMDR than with other methods they had used. Only 4% found fewer positive effects with EMDR (Lipke, 1994).

Recent EMDR Studies

Studies with single trauma victims indicate that after three sessions 84 - 90% of the subjects no longer meet the criteria for PTSD.

The Rothbaum (1997) study found that, after three EMDR sessions, 90% of the participants no longer met full criteria for PTSD. In a test of subjects whose responses to EMDR were reported by Wilson, Becker & Tinker (1995a), it was found that 84% (n=25) of the participants initially diagnosed with PTSD still failed to meet criteria at 15 month follow-up (Wilson, Becker & Tinker, 1997). Similar data were reported by Marcus et al. (1997), Scheck et al. (1998) and by Lazrove et al. (1995) in a recent systematically evaluated case series. While one subject dropped out very early in the study, of the seven subjects who completed treatment (including mothers who had lost their children to drunken drivers), none met PTSD criteria at follow-up.

next: Morning After' Pill Helps Psychotic Depression: Study
~ depression library articles
~ all articles on depression

APA Reference
Gluck, S. (2008, December 27). Compilation of EMDR Studies, HealthyPlace. Retrieved on 2024, April 19 from https://www.healthyplace.com/depression/articles/compilation-of-emdr-studies

Last Updated: June 24, 2016

Cultural Aspects of Eating Disorders

Fatness has traditionally been a greater preoccupation in western societies than in third world countries. Women living in third world countries appear much more content, comfortable and accepted with fuller body shapes.Fatness has traditionally been a greater preoccupation in western societies than in third world countries. Women living in third world countries appear much more content, comfortable and accepted with fuller body shapes. In fact the cultural stereotype of attractiveness within these societies includes a fuller figure. Studies have been done observing women from these societies acculturating into areas in which there is a greater preoccupation on thinness and the results appear disheartening. One study by Furnham & Alibhai (1983) observed Kenyan immigrants who resided in Britain for only four years. These women began adopting the British viewpoint desiring a smaller physique unlike their African peers. Another study by Pumariege (1986) looked at Hispanic women acculturating into a Western society finding that they began adopting the more stringent eating attitudes of the prevailing culture within the same time frame as the previous study (Stice, Schupak-Neuberg, Shaw & Stein, 1994; Wiseman, 1992).

These studies suggest that to fit the given cultural stereotype of attractiveness, women may try to overcome their natural tendency toward a fuller figure. It is apparently hard to "just say no" to society. A study by Bulik (1987) suggests that attempting to become a part of a new culture may encourage one to-over-identify with certain aspects of it. He also suggests that eating disorders might appear in different cultures at various times because of enormous changes which could be occurring within that society (Wiseman, Gray, Mosimann & Ahrens, 1992).

Clinicians sometimes fail to diagnose women of color appropriately. This may be due to the fact that eating disorders have been reported much less among African Americans, Asian Americans and American Indians. Incorrect diagnosis' may also come from the widely accepted false belief that eating disorders only affect middle to upper-middle class white adolescent women (. This oversight reflects a cultural bias and unintended yet prevalent bigotry. These unconscious tinges of prejudice can undermine appropriate treatment (Anderson & Holman, 1997; Grange, Telch & Agras, 1997).

Individuals from other cultures should also not be excluded from the possibility of an eating disorder diagnosis. Westernization has affected Japan. In densely populated urban areas it has been found that Anorexia Nervosa affects 1 in 500. The incidence of Bulimia is markedly higher. In a study be Gandi (1991), anorexia has been found within the American Indian and Indian populations. Five new cases were diagnosed out of 2,500 referrals over a four year period. A study by Nasser (1986) looked at Arab students studying in London and in Cairo. It found that while 22% of the London students had impaired eating 12% of the Cairo students also exhibited difficulties with eating. The interesting part of this study pointed out through diagnostic interviews that 12% of the London group met full criteria for bulimia while none of the Cairo students exhibited bulimic symptoms. These results tend to lead one back to the theory of cultural stereotypes and the over-identification which may occur when attempting to acculturate into a new society. No culture appears immune to the possibility of eating disorders. Research seems to point toward more incidences of eating disorders in westernized societies as well as societies experiencing enormous changes (Grange, Telch & Agras, 1997; Wiseman, Gray, Mosimann & Ahrens, 1992).

Fatness has traditionally been a greater preoccupation in western societies than in third world countries. Women living in third world countries appear much more content, comfortable and accepted with fuller body shapes.Middle-aged women as well as children can also develop eating disorders. For the most part the development of these disorders appears linked to the cultural standards. A study by Rodin (1985) states that in women over the age of 62 the second greatest concern for them are changes in their body weight. Another study by Sontag (1972) focuses on the "double standard of aging" and reveals how aging women in Western society consider themselves less attractive or desirable and become fixated on their bodies. The scariest statistics of all are those surrounding 8-13 year old girls. Children as young as 5 have expressed concerns about their body image (Feldman et al., 1988; Terwilliger, 1987). Children have also been found to have negative attitudes regarding obese individuals (Harris & Smith, 1982; Strauss, Smith, Frame & Forehand, 1985), dislike an obese body build (Kirkpatrick & Sanders, 1978; Lerner & Gellert, 1969; Stager & Burke, 1982), express a fear of becoming obese (Feldman et al., 1988; Stein, 1986; Terwilliger, 1987), and do not like to play with fat children (Strauss et al., 1985).

A real tragedy and some of the scariest statistics of all are those surrounding 8-10 year old girls and boys and are presented in a study by Shapiro, Newcomb & Leob (1997). Their research indicates these children at this young age have internalized a sociocultural value regarding thinness on a personal level. Boys as well as girls reported very similar perceived social pressures. The study goes on to state that these children have demonstrated an ability to reduce their anxiety about becoming fat by implementing early weight control behaviors. From this study 10% to 29% of boys and 13% to 41% of girls reported using dieting, diet foods or exercise to lose weight. One concern cited involved the possibility of using more extreme measures, such as vomiting or using medication if the earlier methods fail or the pressure to be thin intensifies.

In a study by Davies & Rurnham (1986) conducted with 11-13 year old girls, one half of the girls wanted to lose weight and were concerned about their stomachs and thighs. Of these girls only 4% were actually overweight but 45% considered themselves as fat and wanted to be thinner and 37% had already tried dieting. At this tender age girls apparently have equated success and popularity with thinness, potentially planting the seeds for the development of an eating disorder.

next: Eating Disorders: Being Jewish in a Barbie World
~ eating disorders library
~ all articles on eating disorders

APA Reference
Gluck, S. (2008, December 27). Cultural Aspects of Eating Disorders, HealthyPlace. Retrieved on 2024, April 19 from https://www.healthyplace.com/eating-disorders/articles/cultural-aspects-of-eating-disorders

Last Updated: January 14, 2014

The Power of Social Support in Coping With Depression

Social support is a key ingredient in dealing with emotional pain that goes along with chronic unremitting anxiety and depression.

My definition of a man is this: a being who can get used to anything."
Dostoyevsky

The title of my book is When Going Through Hell - Don't Stop! What do I mean by hell? I define it as "relentless physical or emotional pain that appears to have no end." This was my experience of living with chronic, unremitting anxiety and depression.

I found that the best way to cope with such intense discomfort was to live my life one day at a time. Whenever I contemplated the prospect of dealing with my pain over the long term, I became overwhelmed. But if I could reduce my life to a single 24-hour segment of time-that was something I could handle. If I could tread water (or, being in hell, tread fire) each day, then perhaps I could survive my ordeal.

Working together, my therapist and I created what I called "my daily survival plan for living in hell." The central idea was simple-to develop coping strategies that would get me through the day, hour by hour, minute by minute. Because I was fighting a war on two fronts, I had to devise and employ techniques that would deal with both the depression and the anxiety. I used my coping strategies to create four categories of support, which I have summarized on the following pages. These categories are: physical support, mental/emotional support, spiritual support, and most importantly, people support.

What follows is a brief outline of my daily survival plan. I have rewritten it in the second person so that you can adapt it to your individual needs. Remember, the goal is to identify coping strategies that will keep you safe and get you through each day until the pattern of the depression shifts.

A. People Support

Social support is a key ingredient in dealing with emotional pain that goes along with chronic unremitting anxiety and depression.Social support is a key ingredient in dealing with emotional pain. Find a way to structure your daily routine so that you will be around people much of the time. If there is a day treatment program in your area, some form of group therapy, or depression support groups at your local hospital, attend them. Don't be embarrassed about asking for help from family members or friends. You are suffering from an illness, not a personal weakness or defect in character.

My own sense of connection with people gave me a reason not to harm myself. I did not want to afflict my friends and family with the anguish that would result from my self-imposed departure. A lifeguard at the pool where I swam, agreed with my thinking. "Other people are a good reason to stay alive," she affirmed.

Support is critical in helping people to cope with all kinds of extreme circumstances. Survivor researcher, Julius Siegal, emphasizes that communication among prisoners of war provides a lifeline for their survival. And for those who are prisoners of their inner wars, support is equally crucial. In chronicling his own depressive episode, novelist Andrew Solomon wrote:

Recovery depends enormously on support. The depressives I've met who have done the best were cushioned with love. Nothing taught me more about the love of my father and my friends than my own depression.

B. Physical Support

The second aspect of your daily survival plan consists of finding ways to nurture your physical body. Here are some suggestions.

  • Exercise: Research has shown that regular exercise can improve mood in cases of mild to moderate depression. Exercise is one of the best ways to elevate and stabilize mood as well as improve overall physical health. Pick an activity that you might enjoy, even if it is as simple as walking around the block, and engage in it as often as you can (three to four times a week is ideal).

  • Diet and Nutrition: Eat a diet that is high in complex carbohydrates and protein, avoiding foods such as simple sugars that can cause emotional ups and downs. Try to stay away from foods that have chemical additives or preservatives that may create ups and downs for chemically sensitive individuals.

  • Sleep: Adopt a regular sleep schedule to get your body into a routine. If you have trouble getting to sleep or suffer from insomnia, there are behavioral techniques as well as medication that can help you to sleep. The book "No More Sleepless Nights" by Peter Hauri is a good resource.

  • Medication: Take your antidepressant medication as prescribed. Check with your health care professional before making any changes in dosage. Be patient and give the medicine enough time to work.


C. Mental/Emotional Support

Every thought and feeling produces a neurochemical change in your brain. Although you may not always be able to control the painful symptoms of depression and anxiety, you can influence the way you think and feel about those symptoms.

  • Monitoring self-talk. Monitoring one's self-talk is an integral strategy of cognitive-behavioral therapy, a talk therapy widely used in treating depression. You may wish to work with a therapist who specializes in cognitive therapy. He or she can help you to replace thoughts of catastrophe and doom with affirmations that encourage you to apply present-moment coping strategies. For example, the statement "My depression will never get better" can be replaced by the affirmation "Nothing stays the same forever" or "This, too, will pass." Switching from negative to positive self-talk is a process that may have to practiced once, twice, sometimes ten times a day. Since the depressed brain tends to see life through dark-colored glasses, monitoring one's inner dialogue provides a lifeline to healing.

  • Keep a mood diary. One of the survival techniques I used to stay alive in my hell was to keep track of my anxiety and depression on a day-to-day basis. To this end, I created a daily mood scale. Somehow, the simple act of observing and recording moods gave me a sense of control over them. I also used the mood diary to track my reactions to pharmaceutical drugs and to record daily thoughts and feelings. Here is the scale that I used. Feel free to adapt it to your own needs.

Daily Mood Scale

Score 1-10
Depression
Score 1-10
Anxiety
8 -10
despair, suicidal feelings,
8 - 10
out-of-control behavior, hitting, rhyming voices
6 - 7
at the edge, feeling really bad
6 - 7
strong agitation, pacing
5
definite malaise, insomnia
5
moderate worry, physical agitation
3 - 4
depression slightly stronger
3 - 4
mild fear and worry
1 - 2
minorly depressed mood
1 - 2
slight fear and worry
0
absence of symptoms
0
absence of symptoms

Clearly the goal is to be on the low end of the scale. The lower the number, the fewer the symptoms.

  • Be compassionate with yourself. As part of one's emotional self-care, it is important to release the toxic feelings of blame, guilt or shame that are so often felt by a person who is depressed. Try to remember that depression is an illness, like diabetes or heart disease. It is not caused by a personal weakness or a defect in character. It is not your fault that you have this disorder."

    Once again you can turn to the affirmation process. Whenever you start to judge yourself for being depressed you can repeat, "It's not my fault that I am unwell. I am actually a powerful person residing inside a very sick body. I am taking good care of myself and will continue to do so until I get well."

  • Focus on the little things. In the middle of my episode I asked my therapist, if all I am doing is trying to survive from day to day, how do I find any quality to my life?"

    "The quality is in the little things," she replied.

    Whether it is a kind word from a friend, a sunny day, a beautiful sunset, or an unexpected break from the pain, see if you can take in and appreciate these small moments of grace. Having such moments is akin to making deposits into an "emotional bank account." When the dark periods return, you can draw upon these stored memories and affirm that life can still be beautiful, if only for an instant.

    Above all, no matter how bad things seem, remember that nothing stays the same forever. Change is the only constant in the universe. One of the most powerful thoughts you can hold is the simple affirmation "This too, will pass."

D. Spiritual Support

If you believe in God, a Higher Power, or any benevolent spiritual presence, now is the time to make use of your faith. Attending a form of worship with other people can bring both spiritual and social support. If you have a spiritual advisor (rabbi, priest, minister, etc.), talk with that person as often as possible. Put your name on any prayer support list(s) you know of. Don't be bashful about asking others to pray for you. (A list of twenty-four hour telephone prayer ministries in provided for you in my section on prayer.) The universe longs to help you in your time of need.

Because of the disabling nature of depression, you may not be able to implement all of the strategies that I have presented. That is okay. Just do the best you can. Do not underestimate the power of intention. Your earnest desire to get well is a powerful force that can draw unexpected help and support to you-even when you are severely limited by a depressive illness.

Click to buy: Healing From DepressionThis page was adapted from the book, "Healing from Depression: 12 Weeks to a Better Mood: A Body, Mind, and Spirit Recovery Program", by Douglas Bloch, M.A.

Bloch is an author, teacher and counselor who writes and speaks on the topics of psychology, healing and spirituality. He earned his B.A. in Psychology from New York University and an M.A. in Counseling from the University of Oregon.

Bloch is the author of ten books, including the inspirational self-help trilogy Words That Heal: Affirmations and Meditations for Daily Living; Listening to Your Inner Voice; and I Am With You Always, as well as the parenting book, Positive Self-Talk for Children.

next: Coping With Loss: Bereavement and Grief
~ depression library articles
~ all articles on depression

APA Reference
Staff, H. (2008, December 26). The Power of Social Support in Coping With Depression, HealthyPlace. Retrieved on 2024, April 19 from https://www.healthyplace.com/depression/articles/power-of-social-support-in-coping-with-depression

Last Updated: June 24, 2016

Articles on Eating Disorders and Others

anorexia.and.bulimia

Eating Disorders: Anorexia Nervosa -- Articles on Anorexia

USA Gymnastics Online: Technique: Striking the Balance -- Very nice article on the correlation between sports and eating disorders. In the beginning talks about Christy Henrich, a gymnast that lost her battle with anorexia.

Science

Anorexic Men More Depressed Than Peers -- Men who suffer from eating disorders have higher rates of depression, anxiety disorders and alcohol abuse than their peers do, study findings suggest.

Anorexia -- Short article covering the basics of anorexia through the characteristics of a sufferer.

.society.

Is Women's Self-Esteem Tied to a Dress Size? -- We're not supposed to hate models because they are beautiful. But what do you feel when you see a young, beautiful woman on television or in an advertisement? Appreciation? Envy? Despair?

The Media and Body Image -- There's no such thing as a "perfect look." Yet magazines, TV shows and commercials could lead you to think otherwise.

next: Compulsive Exercising
~ all peace, love and hope articles
~ eating disorders library
~ all articles on eating disorders

APA Reference
Staff, H. (2008, December 26). Articles on Eating Disorders and Others, HealthyPlace. Retrieved on 2024, April 19 from https://www.healthyplace.com/eating-disorders/articles/articles-on-eating-disorders-and-others

Last Updated: April 18, 2016

Center for Internet Addiction Recovery Sitemap

Whether it's cybersexual addiction, online gaming addiction or other forms of internet addiction, you'll find comprehensive info here.

Introduction

Resources on the Psychology of Cyberspace

Articles

Articles on Treatment of Internet Addiction

Legal Articles

General Interest Articles

Dealing with Online Auction Addiction and Obsessive Online Trading

IA Tests

Cyberwidows Help Center



next: What is Internet Addiction (IA)?
~ all articles on addictions
~ addictions community homepage

APA Reference
Gluck, S. (2008, December 26). Center for Internet Addiction Recovery Sitemap, HealthyPlace. Retrieved on 2024, April 19 from https://www.healthyplace.com/addictions/center-for-internet-addiction-recovery/center-for-internet-addiction-recovery

Last Updated: June 24, 2016

Mood Disorders as Physical Illnesses

A Primer on Depression and Bipolar Disorder

II. MOOD DISORDERS AS PHYSICAL ILLNESSES

In this essay we will explore the nature of depression and bipolar disorder as physical illnesses of an organ of the body, known as the brain, which manifest themselves through mental symptoms (see definition on p. 8) in the magnificently complex set of internal experiences we call our mind. I will touch briefly on causes, symptoms, treatment, suicide, impact on family and friends; my focus will be primarily on understanding these aspects of the problem. In addition, I will touch on the issues of self-help and support groups, stigma, public policy, and hope for the future. But the reader must be aware that what I write here is unabashedly devoted to the treatment of the physical aspects of depression and bipolar disorder. The process of healing one's psyche (i.e. one's internal feelings about oneself and the world) after successful medication moves the brain's physiology into the normal range is barely mentioned; it is discussed in my companion essay "Depression and Spiritual Growth" (see Bibliography). Both aspects of the recovery/rebuilding process are critical for sustained growth and wellness of victims of these illnesses.

A. Causes

hp-bipolar-388The ultimate causes of depression and bipolar disorder are not yet known. But over the years a number of hypotheses, theories, or ``models'' have been advanced as possible explanations of these illnesses; some of them have proven to be much more useful in treating the illnesses than others. Some of the earliest work was done by Sigmund Freud, who tried to fit the mood disorders into the framework of ``psychoanalysis'', the talk-therapy technique he invented to treat mental illness. He had some success treating some patients with mild to moderate depression, less success with people who were severely depressed, and essentially no success with people who suffered from bipolar disorder. The latter illness he called a ``psychosis'', i.e. a very severe, and possibly permanent, mental disorder in his scheme of things. The fact that Freud, one of the most brilliant, creative, and insightful of the talk-therapists of all time, got such poor results treating the severe mood disorders is very significant. It is strong evidence that he was using the wrong therapeutic approach; that these illnesses in their most severe forms don't respond to manipulation of our thoughts, but require more direct medical intervention.

Freud's picture of the causes of the mood disorders is quite fanciful and misleading in the light of modern knowledge. But his pioneering methods were essentially the only therapeutic procedures available until the development of useful psychiatric medications starting in the 1950's and onward. Since that time there has been a rapid increase in the number of medications that can be used to treat depression and bipolar disorder effectively. Today, therapy using these medications has largely displaced psychoanalysis for the severe mood disorders. Even though methods based on a psychopharmacological model are often preferred today, results are usually obtained if treatment with medication is combined with one of the modern forms of talk-therapy (usually quite different from Freudian psychoanalysis). Once medication permits the brain to function again within the normal range, it is necessary for almost all victims to go through a carefully-guided, and extensive, period of healing and rebuilding. The fruits of these efforts are frequently stupendous; the victim finds him/herself feeling well, sometimes for the very first time in their lives!

Our basic picture of brain function today is that cognition, memory, and our moods all result from constant passing back and forth of electrical impulses through the extremely complex network of nerve cells that permeates the brain. There is a large body of convincing experimental evidence that this picture is correct, and recently a great deal of theoretical work has allowed researchers to begin to simulate the behavior of this network with computers. If the message-passing process, neurotransmission, is broken, interrupted, diverted to the wrong place, then the transmission of information from one point in the brain to another where it is needed, fails.

In some cases this loss may be inconsequential; in others it may cause a massive failure of the system: loss of memory, misinterpretation of reality or inability to perceive reality, or inappropriate mood. The crucial nexus in the message passing process occurs in a small gap, the synapse, between the extremities of nerve cells, which do not quite touch. The ``firing'' of one cell excites a complex biochemical and biophysical reaction in the synapse, and chemical messengers flood across the synapse from the exciting cell to the receiving cell. The receiving cell, in turn, passes the message on by initiating the same process at the next synapse. If anything goes wrong with this mechanism, if a nerve doesn't fire, if the chemical soup in the synapse is not exactly right, if the receiving cell doesn't respond correctly to the chemical messengers, then message transmission is disrupted. Depending on where and how the interruption occurs, we will experience one or more incorrect psychic phenomena in our minds; if the errors become large, we experience mental illness. In summary, in this model, we say that one suffers from ``mental illness'' when a definite set of physical/chemical disorders in the physical organ we call the brain causes us to experience abnormal and undesirable behavior of the complex phenomenon (which includes awareness, mood, abstract reasoning, thinking, ...) which we call our mind.


The appropriateness of the title of this section now becomes apparent, and we shall henceforth adopt the model that major mental illness results from one or more serious defects in the neurotransmission process (and perhaps other brain processes as well, not yet fully understood). Indeed, in the case of schizophrenia and the major dementias (e.g. Alzheimer's) there is a great deal of evidence that over a period of time the brain suffers severe damage and/or deterioration internally, again the result of (unknown) physical mechanisms. In other words, we will view the mentally ill brain as being, in a sense, ``broken''. And the job of the physician and patient is to repair or overcome, if possible, the damage.

At the present time this is best done using specific medications, which have been carefully tested and validated, to relieve the symptoms of the various mental illnesses. The ultimate cause of these failures of brain function is not yet known. Some research strongly indicates that the problem is genetic; that it is programmed into the DNA of our bodies at birth, an unfortunate inheritance from our parents. That, if true, has a sinister ring because it means some of us are ``doomed'' to the disease no matter who we are, or what we do. On the other hand it would also mean that at some point in the future in may be possible to eliminate the problem at or before birth, using rapidly progressing recombinant DNA techniques. Or it may be that the brain can be damaged by physical or chemical influences from its environment. The jury is still out on these questions.

One important conclusion to be drawn on the basis of the biological model of mental illness described above is that mental illness is not the result of a failure of will, or of the desire to be well. Countless mentally ill people have had to suffer both the ravages of the disease, and the scorn of an uncomprehending society, a doubly cruel injury. One of my strongest hopes for the future is that all people who have CMI, and society at large, can learn that mental illness is illness in the ordinary medical sense, and deserves to be treated with as much respect and compassion as any other illness. Indeed, a workable metaphor for bipolar disorder is that in many ways it is a condition something like diabetes. That is, the illness can cause major disability, or even death (through suicide), and it may well be permanent in many cases. But at the same time, it responds well to medication, and if the victim takes his/her medication faithfully, he/she can lead an essentially normal life. I have known several courageous diabetics who manage to lead productive and satisfying lives; and I know an increasing number of courageous people who have CMI who do so also.

Up to this point I have focused almost exclusively on chronic, often severe, depression, resulting from fundamentally biological causes. But all of us are all too familiar with another kind of depression. To illustrate, suppose you struggle through traffic one morning, and have a minor accident which does several hundred dollars of damage to your car; you arrive at work, and your boss throws a fit because you are late (again!) and fires you on the spot; you go back home, and on the kitchen table find a brief note from your spouse saying that he/she is leaving you, and has run off with the next door neighbor. Unless you are very unusual, by this time you will be depressed. The depression may be fairly severe, and it may last for a substantial time: days, perhaps even weeks. But in the end, this kind of depression will usually lift by itself, and will normally respond very well to talk therapy and/or medication. Three characteristics of this kind of depression are that: (1) it is caused by events outside of you, i.e. that it is a (reasonable!) response to unfavorable conditions in your reality; (2) it is the result of a loss, or the perception of loss (if no loss actually occurred); and (3) it is temporary (imagine a reversal of the causative events, or the interjection of a new positive event -- say winning the jackpot in the lottery). I will refer to this type of depression as "psychogenic'' to reflect the fact that its origins result from psychic activity in our brains stimulated by outside events. I am sure that doctors would object to such a term (their term "exogenous'' is, if anything, worse), but I will use it anyway as a metaphor to suggest the characteristic depressive response to unfavorable outside events.

In contrast, I will refer to the kind of depression I have been talking about earlier (plus bipolar disorder) as "biogenic'' to stress that it is a result of biological/biochemical/biophysical malfunction in our brains, independent (almost) of outside events. (Doctors would probably prefer the word "endogenous'', but I'm not a doctor so I'm exempt.) A characteristic of this kind of depression is that it is usually chronic: it has existed for months or years (in some cases a lifetime), and can exist for an arbitrarily long time into the future, regardless of outside events. Of course, it is almost never ``either-or''. In most serious depressions both causes can be implicated. Typically a psychogenic event will trigger a much more serious biogenic response in the brain. A good example is my move to Illinois in 1985; the combination of loss of friends and familiar environs, plus the stresses associated with a new job and making new friends, provided a trigger to drop me into the major depression that had been lurking about, waiting for me to fall in, for years. To make an analogy: when you get to the edge of a cliff, and then suddenly slip on a marble and fall over the edge, the marble was only the trigger for the disaster; it is the depth of the fall from the top of the cliff to its bottom that does you in.

In the name ``bipolar disorder'' also known as bipolar affective disorder, ``bipolar'' means that the victim can swing ``up'' and ``down'' between mania and depression; ``affective disorder'' means mood disorder. Depression is now often called unipolar mood disorder or unipolar depression, which means the victim goes only from normal moods to depression, goes only ``down''. The ``bipolar'' and ``unipolar'' designations have the advantage of being linguistically neutral, emphasizing the fact that the victim has a ``disorder'', i.e. illness, rather than that he/she is ``manic'' and/or ``depressed''. This is a fine linguistic point perhaps, but an important one, especially when most people in society don't distinguish between the words ``manic'' and ``maniac''. In any event, remember that all these terms are only metaphors (as are all the terms of medical science); use them when they are useful, but don't feel bound to them in the face of a more complex reality.

next: Treatment of Depression and Bipolar Disorder
~ back to Manic Depression Primer homepage
~ bipolar disorder library
~ all bipolar disorder articles

APA Reference
Staff, H. (2008, December 26). Mood Disorders as Physical Illnesses, HealthyPlace. Retrieved on 2024, April 19 from https://www.healthyplace.com/bipolar-disorder/articles/causes-of-bipolar-disorder

Last Updated: March 28, 2017

Why and by Whom the American Alcoholism Treatment Industry is Under Siege

In this barn-burner, Stanton stands alone in protecting the likes of Alan Marlatt, Peter Nathan, Bill Miller et al. from the onslaughts of John Wallace in his war on the "Anti-Traditionalists." One in a series of exchanges between Peele and Wallace, this is an important historical document. For example, it recounts how Peter Nathan, Barbara McCrady, and Richard Longabaugh's chapter on treatment in the Sixth Special Report to Congress was rewritten by Wallace. But it is also tremendously important for predicting and evaluating current developments in treatment and treatment evaluation. Of course, shortly after the article appeared, and despite Wallace's claims for its remarkable treatment success, the Edgehill-Newport clinic closed because insurers refused to pay its bills as a result of Stanton's articles. Since this time, however, Longabaugh now sides with Enoch Gordis in saying that current treatments (including the 12-step variety Wallace practiced at E-N) are great!

Moreover, in this forward-looking document, Stanton describes the concept of harm reduction by indicating that severely dependent alcoholics who may not abstain can still show improvement. And, in light of Gordis, Longabaugh, et al.'s tap dancing on the results of Project MATCH, do consider Gordis's quote, cited in this article, that "To determine whether a treatment accomplishes anything, we have to know how similar patients who have not received the treatment fare. Perhaps untreated patients do just as well. This would mean that the treatment does not influence outcome at all...."

Journal of Psychoactive Drugs, 22(1):1-13

Morristown, New Jersey

Abstract

addiction-articles-137-healthyplaceConventional disease-based inpatient alcoholism treatment is under attack in the United States and internationally because it accomplishes little beyond simple counseling and is less effective than other life-skill-oriented therapies. Nonetheless, disease-model adherents retain a stranglehold on American alcoholism treatment and attack all "nontraditionalists" who question their approaches. One such attack by Wallace (1989) is discussed. In addition, Wallace's claim that his treatment program at Edgehill Newport as well as other private treatment centers have remission rates ten times as high as those found for typical hospital treatments is examined critically. Finally, the group of researchers who question at least some elements of the standard wisdom about alcoholism and addiction is found to include nearly every major research figure in the field.

Keywords: alcoholism, controlled drinking, disease model, remission, treatment, outcome

In his response to my article in this journal (Peele 1988), John Wallace (1989: 270) casts himself as an upholder of scrupulous science and an open-mindedness toward critics as long as they do not perform "marginal scholarship, ideology masquerading as science, and faulty experiments." However, in his articles titled "The Attack of the Anti-Traditionalist Lobby" and "The Forces of Disunity," Wallace (1987a: 39; 1987c: 23) addressed his Professional Counselor readers about other concerns:

Obviously, it is in the interests of alcoholism counselors to pay greater attention to the politics of alcoholism and to appreciate the inroads the "Anti-Traditionalist" lobby already has made into universities, research centers, academic journals, and large government agencies ....

These forces of disunity tried first to divide the alcoholism field over the issue of controlled drinking, and then through various attacks upon sobriety, on the disease model of alcoholism . . . on the concepts, principles, and activities of Alcoholics Anonymous. Now it appears that the target has become the still emerging and fragile comprehensive system of alcoholism treatment services.

Among the members of the antitraditionalist lobby (in addition to me) Wallace named in his Professional Counselor articles are Alan Marlatt (Director of the Addictive Behaviors Research Laboratory at the University of Washington), William Miller (Professor of Psychology and Psychiatry and Director of Clinical Training at the University of New Mexico), Peter Nathan (Director of the Rutgers Center of Alcohol Studies), Martha Sanchez-Craig (Senior Scientist at the Ontario Addiction Research Foundation), and Nick Heather (Director of the Australian National Drug and Alcohol Research Centre). Wallace (1987b: 25) declared that his intention was to "scrutinize more closely the activities of this group and to take steps to ensure they do no harm." The following are some quotes from this group that Wallace (1987a; 1987b) criticized:

Given that the only clear, significant overall difference between residential and nonresidential programs is in the cost of treatment, it would seem prudent for public and private third-party payers to enact policy that de-emphasizes the hospitalization model of care where it is nonessential and encourages the use of less expensive but equally effective alternatives—(Miller & Hester 1986b: 803)

[The behavior of alcoholics results from their belief] that craving and loss of control are inevitable components of alcoholism rather than simply [from] the pharmacologic impact of alcohol. The realization grows that what we think and what we believe in and what we are convinced of is much more important in determining our own behavior than [is] a narrow physiologic response—(Nathan 1985: 171-172)

[Alcoholics Anonymous] preaches a doctrine of total redemption, teetotaling forever. And many a former alcoholic believes that a single drink will send him on the short, slippery slope to alcoholic hell. It's true that for some alcoholics who have been uncontrolled drinkers for many years and whose health has deteriorated, the option of moderation is no longer workable. However, the resolution never to have a drink again is not always a cure-all. The vast majority of alcoholics who try to abstain eventually return to the bottle or to another addiction—(Peele 1985: 39)

A radical alternative to development of surreptitious methods of early identification [of drinking problems to be treated] is to provide treatment services that would appeal to persons with less severe problems and to rely upon them to identify themselves. If those presenting for treatment were willing volunteers rather than apprehended "deniers," there might be better outcomes —(Sanchez-Craig 1986: 598)

However, the critics of traditional treatments of alcoholism include more powerful and influential objectors than me or any of the other researchers Wallace quoted. Consider the following statement from Enoch Gordis (1987: 582), director of the National Institute on Alcohol Abuse and Alcoholism (NIAAA):

Yet in the case of alcoholism, our whole treatment system, with its innumerable therapies, armies of therapists, large and expensive programs, endless conferences and public relations activities is founded on hunch, not evidence, and not on science... ...Contemporary treatment for alcoholism owes its existence more to historical processes than to science...

After all [many feel], we have provided many of our treatments for years. We really are confident that the treatment approaches are sound... Yet, the history of medicine demonstrates repeatedly that unevaluated treatment, no matter how compassionately administered, is frequently useless and wasteful and sometimes dangerous or harmful.

Wallace vigorously defends the disease model of alcoholism, but he is wrong on the evidence. This article addresses this evidence in three major areas: (1) controlled-drinking outcomes, (2) the outcomes of standard disease treatments for alcoholics, and (3) how well the perspectives of major researchers jibe with the disease model.


Controlled-Drinking Outcomes for Alcoholics

The Incidence of Controlled Drinking in Treated Alcoholics

In his rejoinder to my article, Wallace (1989) reviewed the controlled-drinking research reported by Foy, Nunn and Rychtarik (1984), a longer follow-up of this study by Rychtarik and colleagues (1987a), and my description of this research. Foy, Nunn and Rychtarik (1984) found better outcomes at six months for a group of severely dependent veterans treated with a goal of abstinence compared with those given controlled-drinking training. These differences were not significant at the end of a year, and at a follow-up of from five to six years reported by Rychtarik and colleagues (1987a: 106), "results showed no significant differences between groups on any dependent [outcome] measure." Moreover, at the longer follow-up, 18.4% of all subjects were controlled drinkers ("no days of greater than 3.6 oz. of absolute ethanol consumption" and "no record of drinking-related negative consequences" over the prior six months), while 20.4% were abstaining.

Fewer than 10% of the subjects in the Foy-Rychtarik experiment engaged in abstinence or controlled drinking throughout the study follow-up period. Instead, the subjects frequently shifted among abstinence, problem drinking, and moderate drinking categories; Wallace (1989) devoted an entire page to reproducing a table from Rychtarik and colleagues (1987a) that shows just this. Rychtarik and colleagues (1987a: 107) characterized the data presented in this table as being essentially similar to that in the Rand reports (Polich, Armor & Braiker 1980; Armor, Polich & Stambul 1978) and that of Helzer and colleagues (1985) "in demonstrating the marked instability of individuals' drinking patterns." Ironically, this instability—which Wallace cited as a sign of the lack of impact of controlled-drinking training—undercuts the lurid imagery he has used to describe the dangers of controlled-drinking training (Wallace 1987b: 25-26): ". . . when thousands of lives and so much human tragedy is [sic] at stake .... we must not forget that it is the duty of members of the various professions to defend the public against quackery."

When Wallace (1989: 263) claimed that I implied that the 18% of treated alcoholics who ended the experiment six years later drinking in a controlled fashion were from the group who received training in controlled drinking, a "conclusion [which] would indeed be wrong, but I believe it is the one Peele is hoping his readers will draw," he is barking up the wrong tree. I am mainly concerned with how people come to grips with their drinking problems on their own over the course of their lives; not with justifying any brand of therapy. As a result, for me, alcoholics who are trained to abstain but who become controlled drinkers are far more interesting than those who are trained to become controlled drinkers and who do so.

In 1987 I reviewed the history of such controlled-drinking outcomes (Peele 1987c) in an article titled "Why Do Controlled Drinking Outcomes Vary by Investigator, by Country and by Era?" In that article, I summarized the following research results reported in standard treatment programs that did not train controlled drinkers: Pokorney, Miller & Cleveland (1968) found that 23% of alcoholics were drinking in a moderate manner one year after being discharged from the hospital; Schuckit and Winokur (1972) reported that 24% of women alcoholics were moderate drinkers two years after discharge from the hospital; Anderson and Ray (1977) reported that 44% of alcoholics drank non-excessively during the year after undergoing inpatient treatment.

More recently, the Journal of Studies on Alcohol published a Swedish study (Nordström & Berglund 1987) in which "social drinking was twice as common as abstinence" (21 subjects were social drinkers and 11 abstainers) among 70 hospitalized alcohol-dependent male subjects in a good social-adjustment condition who were followed up two decades after their hospitalization. When combined with 35 randomly selected poor-adjustment patients, the overall controlled-drinking percentage for the entire hospitalized group in the Swedish study was 21% (compared to 14% abstaining).

In a follow-up study of 57 married alcoholics 16 years after treatment in a Scottish hospital, McCabe (1986) found almost the same percentages who were controlled drinkers (20%) and abstainers (14.5%). It is interesting that such high controlled-drinking outcomes prevailed in studies that followed up treated alcoholics approximately two decades after their hospitalization. In these studies, alcoholics became more likely to moderate their drinking over time, some after several years of abstaining. Moreover, Nordström and Berglund (1987: 102) found that "5 of 11 abstainers, but only 4 of 21 social drinkers, had relapses at least one year [after achieving] . . . the final type of successful drinking pattern."

Level of Alcohol Dependence and Controlled Drinking

The Foy-Rychtarik study found no relationship between level of alcohol dependence and controlled-drinking versus abstinence outcomes at five to six years. Regarding this assertion on my part, Wallace (1989: 264) stated, "It is important that results of this study concerning alcohol dependence be reported because they directly contradict Peele," whereupon he quoted once again the one-year results of Foy, Nunn and Rychtarik (1984) that "preliminary findings" indicated "dependence appears to have played a key role" in moderation versus abstinence outcomes. In their longer report of the five- to six-year follow-up study, Rychtarik and colleagues stated (1987b: 28) that "the Foy et al. (1984) study found that the degree of dependence was predictive of ability to drink in a controlled/reduced fashion in the first year following treatment. The results of the regression analysis on 5 -6 year data failed to replicate this finding."

Ironically, although Wallace has been criticizing the Rand reports for more than a decade, it is the Rand research that first provided a scientific basis for the idea that more dependent alcoholics are less likely (but not completely unlikely) to moderate their drinking than less severely dependent drinkers. However, the entire relationship between level of alcohol dependence and the ability to reduce drinking has been questioned by a series of increasingly sophisticated psychological analyses. Wallace (1989) pointed out that Orford, Oppenheimer and Edwards' (1976) British group found controlled-drinking outcomes were more likely for alcoholics with fewer dependence symptoms at intake. It is therefore extremely interesting that Orford designed a treatment experiment specifically for the purpose of comparing whether controlled drinking was more closely related to level of alcohol dependence or to one's "personal persuasion" that one could achieve controlled drinking.

In this study with 46 subjects, Orford and Keddie (1986: 495) reported that "no support was found for the dependence hypothesis: . . . there was no relationship between level of dependence/severity and the type of drinking outcome (ABST or CD)." Instead, they found that the patients' "persuasion" that one type of outcome was more achievable was more important in determining outcome. Another study, reported at the same time as the Orford and Keddie research by another British group, replicated these findings with a larger group (126) of subjects. Elal-Lawrence, Slade and Dewey (1986: 46) did not find a relationship between severity of drinking problems and outcome type, but "that alcoholism treatment outcome is most closely associated with the patients' own cognitive and attitudinal orientation, past behavioral expectations, the experience of abstinence and the freedom of having his or her own goal choice .... This may be the time to act with caution before reaching another . . . conclusion that only the less severely dependent problem drinkers can learn to control their drinking."


Changing Criteria for Controlled-Drinking Outcome—The Helzer Study

The main purpose of my 1987 article on controlled drinking was not to discount reported differences in controlled drinking versus abstinence outcomes, but to understand these differences across time, across countries, and across investigators. I concluded that definitions of alcoholic remission and relapse change according to cultural and political climates. Wallace (1989) called me to task for not mentioning in my article Edwards' (1985) critique of Davies' (1962) study reporting significant numbers of controlled drinkers in a hospital treatment population (although I didn't mention the Davies article either). In my 1987 article on controlled-drinking outcomes, I discussed Edwards' and Davies' findings along with almost 100 other conflicting reports of controlled-drinking outcomes in terms of how the criteria for what comprises moderate drinking vary by era and by country.

Both Wallace and I made a great deal of the study by Helzer and colleagues (1985). Wallace (1987b: 24) originally characterized the results of this study as follows: "Only 1.6 percent [of alcoholic patients] appeared able to meet criteria for 'moderate drinking.' More than 98% of the males in the Helzer study were unable to sustain moderate drinking patterns when moderate was defined most liberally as up to six drinks per day" (actually, this result applied to males and females combined in the study). Wallace implied here that alcoholics in the study were attempting to moderate their drinking, but they were not. When asked by the researchers, most claimed that it was impossible for alcoholics to resume moderate drinking and the hospital regimen assuredly discouraged them from believing they could do so.

As I pointed out, the 1.6% moderate drinking figure needs to be augmented by considering the 4.6% of alcoholics who drank moderately, but did so for only up to 30 of 36 of the previous months, while abstaining the rest of the time. In his response, Wallace (1989: 264) first declared, "Peele was apparently distressed that I did not mention that an additional 4.6 percent were mostly abstinent (with occasional drinking)," as though I were oversensitive in thinking that such a provocative outcome group should be "mentioned" in a discussion of this study. On the next page, however, Wallace conceded that "with regard to the . . . group of 4.6 percent occasional but moderate drinkers . . . Peele could have a point." The point is that slightly over 6% of a very severely alcoholic group became moderate or light drinkers. The larger group in this study in which I was interested, however, was the 12% who drank more than "six drinks per day," but who had that many drinks no more than four times in any one month during the previous three years. In his response, Wallace (1989: 264) labeled this a group who "were drinking heavily but denying alcohol-related medical, legal, and social problems." But Helzer and colleagues (1985) found no indication of any such problems for this 12% despite having checked hospital and police records and questioning collaterals, and their interpretation that this group is "denying" problems is an a priori one that reflects the political climate of the times.

Wallace (1989: 264-265) described his fundamental objection to this group: ". . . alcoholics who are drinking in excess of seven or more drinks [this should read "drank seven or more drinks" or" in excess of six drinks"] per day on four or more days in any one month are engaging in at risk drinking whether or not they are denying present medical, legal or social problems .... Peele, however, is obviously distressed that Helzer and colleagues would 'disqualify from remission' any alcoholic who 'got drunk four times in any one month in a three year period.' Personally, I do not believe it is acceptable for anybody, let alone an alcoholic, to get drunk four times in any one month." In his article, Wallace (1989: 267) repeated two insinuating questions from his earlier articles: "Is it possible that Dr. Peele would not mind a moderately 'stoned' American population at all? Furthermore, is it possible that Dr. Peele finds something inherently wrong and unappealing about sober consciousness?"

Here Wallace accused me of being too permissive because I recognize that most alcoholics will continue to drink and many people seek experiences of intoxication. At the same time, disease theorists consider me hopelessly moralistic because I maintain the best antidote to addiction is for a society to refuse to accept addictive misbehavior as an excuse for itself (Peele 1989). Indeed, in a response to my article "Ain't Misbehavin': Addiction Has Become An All-Purpose Excuse" in The Sciences, Wallace (1990) wrote a letter to the editor accusing me of being a "law and order" zealot who wants to punish addicts. What confuses Wallace is my acceptance that people will drink but my intolerance for crime, violence, and other misbehaviors associated with substance abuse that are now frequently excused as being an uncontrollable result of addiction (as when drunk drivers use an alcoholism defense after killing or maiming another driver).

Value issues aside, the question in the Helzer study (1985) is whether or not people who drink more than six drinks at a time a few times a month are actively alcoholic. In particular, if they were formerly alcoholics, could this amount of drinking, however heavy one considers it to be by one's personal standards, represent an improvement in their drinking behavior? In the Rand study (Polich, Armor & Braiker 1980: v), for example, the median level of drinking at intake was 17 drinks per day. Is it important to note whether a person who once drank 17 drinks per day later drank seven drinks or more only as many as four times during any one month in the previous three years? If one believes that "once an alcoholic always an alcoholic," the only question to ask is whether the person has stopped drinking entirely or, in an almost unachievable standard of moderate drinking, if they drink without ever getting drunk.

Improvement Versus Perfection in Treatment Outcomes

In progressively restricting what is called controlled drinking, important clinical details have been increasingly missed, such as the substantial reduction in drinking levels and drinking problems that some people undergo over the course of their lives even though they do not abstain. I used the Tennant (1986: 1489) editorial in the Journal of the American Medical Association to make this point: 'There are now ample epidemiological outcome data to call for other goals in treatment of alcoholism in addition to continuous abstinence." I also reported on Gottheil and colleagues' (1982: 564) study of hospitalized alcoholics that found between a third and over half "engaged in some degree of moderate drinking" and that those who were classified as moderate drinkers "did significantly and consistently better than nonremitters at subsequent follow-up assessments." Furthermore, the Gottheil group declared that "if the definition of successful remission is restricted to abstinence, the treatment centers cannot be considered especially effective and would be difficult to justify from cost-benefit analyses."

It would seem to be worthwhile to know that nonabstaining alcoholics can still do "significantly and consistently better" on various outcome measures than active alcoholics, rather than to rush to lump them—based on their occasional drunkenness—with the most abandoned, out-of-control alcoholics. I want to illustrate this difference in perspective with what I consider to be one of the most intriguing outcome studies ever conducted in the alcoholism field. Goodwin, Crane and Guze (1971) classified 93 ex-felons as "unequivocal alcoholics" and followed their course for eight years after prison, during which time only two were-treated for alcoholism. These researchers classified 38 of the ex-felons as being in remission, although only seven of them were abstinent, indicating a nonabstinence remission rate of a third.

Among the continuing drinkers in remission, l7 were categorized as moderate drinkers (drinking regularly while "rarely getting intoxicated"). But more fascinating were the remaining men that these researchers placed in the remission group—eight continued to get drunk regularly on weekends, while another six switched from spirits to beer and still "drank almost daily and sometimes excessively." Clearly, Wallace would not consider these men to be in remission. Yet Goodwin, Crane and Guze categorized them thus because these men, who had previously been imprisoned, now no longer got drunk publicly, did not commit crimes or other antisocial acts when intoxicated, and stayed out of jail. In other words, Goodwin and colleagues saw a significant overall improvement in the drinkers' lives as sufficient grounds for declaring that they were no longer alcoholics.


Evaluating Treatment Outcomes

What Is the Standard Remission Rate for Alcoholism Treatment?

When he is confronted with poor remission rates in hospital programs, Wallace blames poor treatment methods, while claiming that his and other private treatment programs use far superior methods. For example, Rychtarik and colleagues (1987a) found that only four percent of their patients abstained continuously over the five- to six-year follow-up period. Wallace (1989) predictably attributed these results to the futility of the behavioral methods utilized in the study, which he contrasted with the results of therapy at Edgehill Newport and comparable treatment centers. Rychtarik and colleagues (1987b: 29), on the other hand, claimed that "the long-term effects of the present broad-spectrum behavioral treatment program do not appear to vary much from the results of more traditional treatment for chronic alcoholics."

In reviewing the Edwards group's finding that treated alcoholics and those given a single session of advice had equally good outcomes (Edwards et al. 1977), Wallace (1989: 268) concluded that "by American standards of outcome, the British were not giving particularly good advice or good treatment" since "90% of the men had drunk again" within a relatively short time period. What are the standard abstinence and/or remission rates following American treatment programs? We have seen that Wallace disparages Rychtarik and colleagues' discovery of four percent continuous abstinence over five to six years. He has consistently deprecated the Rand report's finding (for NIAAA treatment centers) that only seven percent of men abstained throughout the course of the study's four-year follow-up. But other researchers Wallace has cited favorably have revealed similar results.

For example, Vaillant (1983) found that 95% of his hospital and Alcoholics Anonymous (AA) treatment group resumed alcoholic drinking at some point during an eight-year follow-up; overall their outcomes were no different than comparable groups of alcoholics who went totally untreated. Helzer and colleagues' (1985) research showed even more disturbing results for hospital alcoholism treatment. While they announced that their results discounted the value of controlled-drinking therapy, they evaluated hospital treatment that certainly did not practice controlled-drinking therapy. And, of the four hospital treatment settings studied (Helzer et al. 1985: 1670), "the alcohol-unit inpatients . . . fare[d] the worst. Only 7 percent survived and recovered from their alcoholism, by either maintaining abstinence or controlling their drinking" [emphasis added]. Featuring as the main finding in this study that only 1.6% of patients became moderate drinkers and therefore controlled-drinking therapy is useless, but that nonetheless over 90% of those receiving standard alcoholism treatment died or were still alcoholic, is like congratulating oneself on performing a successful operation while the patient has died.

Comparing Wallace's Claims for Alcoholism Treatment With Others' Results

Wallace and colleagues (1988) reported a successful remission rate for treated alcoholics of almost 10 times that revealed by Helzer and colleagues (1985). If Wallace genuinely believes that successful treatment methods that can create high abstinence rates have been devised and are readily available, are the alcoholism ward studied by Helzer and colleagues and Vaillant's hospital (Cambridge Hospital) liable for medical malpractice claims? What remission rates have Wallace and other private centers claimedand what have they demonstrated? Wallace (1989) called me most to task for my statement that "although well-controlled studies typically find few alcoholics who abstain for several years following treatment, Wallace and representatives of many other treatment centers often report successful outcomes in the neighborhood of 90 percent" and for my saying these claims are not reported in legitimate refereed journals.

Actually, Wallace and colleagues (1988) claimed a two-thirds (66%) remission rate for socially stable patients without coexisting drug problems at Edgehill Newport, as defined by continuous abstinence for six months following treatment. I apologize for associating Wallace with reported success rates even higher than the one he claims. Nonetheless, I maintain that—in contrast to well-controlled studies of hospitalized alcoholics that typically find fewer than 10% of alcoholics have abstained throughout varying follow-up periods after treatment—Wallace speaks for a group of private treatment centers that claim substantially higher abstinence rates, from 60% to 90%. These claims are invalidated by close scrutiny of the research methods used by the treatment personnel investigating their own patients and they are misleading and detrimental to realistic evaluation of alcoholism treatment.

Wallace has been quite concerned, understandably, to defend the success of expensive private treatment centers like Edgehill Newport against detractors of such programs, of which I am not the first. I repeat from my original article a quote that appeared in a Journal of the American Medical Association editorial (Tennant 1986: 1489): "The serious problem of alcoholism has been lost in the competitive hype among alcoholism treatment centers. Any sophisticated critic using statistical analysis to measure treatment effectiveness is appalled by the display of a media or sports star claiming cure thanks to a specific treatment center's help—which proclaims 80% to 90% cure rates."

For example, in a recent article in a national magazine, The Public Interest, Madsen (1989) wrote: "Treatment programs based on AA principles, such as the Betty Ford Center, the Navy Alcohol Recovery Program, and the Employee Assistance Programs, have recovery rates up to 85%." Madsen's article was an attack on Fingarette's (1988) book Heavy Drinking: The Myth of Alcoholism as a Disease; indeed, Madsen (1988) has written an entire pamphlet attacking this book. Yet, although he assails Fingarette's scientific credentials in both his publications, Madsen nowhere refers to a single piece of research that supports his claims about the effectiveness of AA-type programs. In fact, Miller and Hester (1986a) reported that the only controlled investigations of AA as a treatment modality have found it to be inferior for general populations not only to other kinds of treatment, but also to receiving no treatment!

Wallace (1987c) specifically addressed Miller and Hester's (1986b) claim that inpatient treatment is no more effective and considerably more expensive than less intensive alternatives, along with Edwards and colleagues' (1977) demonstration that an advice session was as good as hospital care in producing remission from alcoholism—remember that Wallace also lauds Edwards (1985) for attacking controlled-drinking outcomes. But there are more, many more, assaults on inpatient treatment effectiveness. For example, the U.S. Congress, through its Office of Technology Assessment, declared that "controlled studies have typically found no differences in outcome according to intensity or duration of treatment" (Saxe, Dougherty & Esty 1983: 4).


The prestigious journal Science, which has published a number of pieces that support disease models of alcoholism, published an article in 1987 that asked "Is alcoholism treatment effective?" and concluded that the best predictor of outcome is the type of patient who enters treatment, rather than the intensiveness of the treatment (Holden 1987). This article referred to Miller and Hester's work and also to Helen Annis, a researcher at the Ontario Addiction Research Foundation (ARF). ARF has for some time de-emphasized hospital treatment, preferring even to deal with detoxification in a social, rather than a medical, setting. Indeed, Annis and other researchers have reported that withdrawal is less severe when carried out in a non-medical setting (Peele 1987b).

As a result, the Canadian national health system generally does not pay for hospital care for alcoholism . Private treatment centers in Canada have thus actively begun marketing their services in America. This difference between the American and the Canadian systems is reflected even more strongly in Britain. Wallace (1989) labeled as "inappropriate" Britain's decision to de-emphasize inpatient treatment, a decision I quoted Robin Murray as saying was based on the British having found the benefits of such treatment to be "marginal." Murray and colleagues (1986: 2) commented on the sources of this difference between Britain and the United States: "It is perhaps worth noting that whether or not alcoholism is considered a disease, and how much treatment is offered, has no bearing on the remuneration of British doctors."

How Well Does Wallace Support His Claims for His Treatment Program?

As one can see from the range of negative findings about alcoholism treatment (particularly hospital treatment) both within the United States and internationally, the value and especially the cost-effectiveness of such treatment are under severe attack. For example, Medicare has attempted to impose a limitation on payment for hospital treatment for alcoholism, creating a battle that has continued to rage for more than five years and that has yet to be resolved. If one takes seriously assertions like those by Madsen (1989) and Wallace (1987c) that AA is tremendously effective, how then can the costs of inpatient treatment—which range from $5,000 to $35,000 a month—be justified? Indeed, what about Vaillant's (1983) report that his patients did no better than untreated comparison groups, or the untreated remission rate reported by Goodwin, Crane and Guze (1971) of 40% over eight years for alcoholic ex-felons?

Thus, some importance was attached to the document to which Wallace (1989) alluded in his rebuttal: the Sixth Special Report to the U.S. Congress on Alcohol and Health (Wallace 1987d), in which he made his claims about the efficacy of private treatment and his own Edgehill Newport program. Actually, the treatment chapter in this report was originally assigned to—and a first draft written by— Peter Nathan (Director of the Rutgers Center of Alcohol Studies), Barbara McCrady (Clinical Director, Rutgers Center of Alcohol Studies), and Richard Longabaugh (Director of Evaluation at Butler Hospital in Providence, Rhode Island). Nathan and colleagues found that inpatient treatment produced no greater benefits than did outpatient treatment and that intensive alcoholism treatment was not cost-effective. NIAAA asked Wallace to revise this draft, which he did by softening its major points and eliminating a number of references and key conclusions by the original authors, after which Nathan, McCrady, and Longabaugh withdrew their names from the document (Miller 1987).

Wallace (1989) mentioned specifically two studies in his rebuttal to my article that he likewise emphasized in the Sixth Special Report. The first is a 1979 study of inpatient treatment by Patton conducted at Hazelden, which reported a continuous abstinence rate of over 60% at one year following treatment. Wallace (1989: 260) indicated that he does not fully trust these results, and he revised the remission figure in this study to a more defensible "lower bound of 50%." He then cited his own published account of a 66% continuous abstinence rate six months after treatment at his Edgehill Newport program (Wallace et al. 1988). Longabaugh (1988), an outcome researcher who was originally asked to write the treatment outcome chapter for the Sixth Special Report, discussed the results from these studies along with the general conclusions of the Wallace authored Sixth Special Report at a conference titled "Evaluating Recovery Outcomes."

Longabaugh began by noting that the number of beds in private alcoholism treatment centers quintupled between 1978 and 1984. At the same time, he pointed out, there was no evidence to support the effectiveness of these for-profit units. Longabaugh (1988: 22-23) quoted Miller and Hester (1986b: 801-802): "Although uncontrolled studies have yielded inconsistent findings regarding the relationship between intensity and outcome of treatment, the picture that emerges from controlled research is quite consistent. No study to date has produced convincing evidence that treatment in residential settings is more effective than outpatient treatment. To the contrary, every study has reported either no statistically significant differences between treatment settings or differences favoring less intensive settings." He indicated that this result contrasted with the conclusions of the Wallace chapter in the Sixth Special Report, which claimed that the high relapse rate observed in the majority of the treatment programs studied made it impossible to generalize about comparative cost-effectiveness.

Longabaugh described two studies from the Sixth Special Report regarding programs that produce a 50% or higher abstinence rate, and how they differed from public programs that reported far poorer outcomes. Longabaugh (1988) indicated that "the problem in making comparisons is to use a common yardstick," and he described how "one study claiming that over 60% of patients were abstinent one year after treatment in fact had a known success rate of 27.8% when the sample was subjected to more careful and accurate examination." The study to which Longabaugh referred is the Hazelden follow-up study (Patton 1979), which is the one outcome study other than at his own treatment center that Wallace (1989: 260) described favorably. Longabaugh (1988) revised the 61% success rate reported in this study further downward—beyond the 50% at which Wallace himself placed it—based on information Patton reported on the exclusion of various groups in this research. For example, in calculating the program's success rate, the original investigators eliminated from the baseline treatment group (or denominator) patients who stayed less than five days in treatment and others who had relapsed and returned for treatment during the follow-up period. Hazelden's announced policy is that relapse and repeat treatment is an acceptable natural consequence of the disease of alcoholism that must be reimbursed by insurers.

Longabaugh (1988) concluded that it was impossible to evaluate results from "for-profit, free-standing programs with better-prognosis patients because there have been no results [based on controlled-comparison research] reported to date for those kind of treatment programs." He further noted that NIAAA has received no applications to conduct such research. Instead, the only outcome studies that can be expected from such programs "are single-program studies of doubtful value."

Longabaugh (1988) then reviewed Wallace and colleagues' (1988) study, which found that 66% of patients in the program had been continuously sober at follow-up. However, as Longabaugh noted:

. . the program report was limited to treatment of socially stable patients who were judged to have restorative potential; they had been transferred from detoxification to rehabilitation, indicating that it was expected they would participate fully in a rehabilitation program; they were married and living with a spouse with no plans to separate; they had sufficient resources to pay for treatment; they were asked to participate in the study in the third week of treatment, after any dropouts would have been removed from the sample; they had been "regularly discharged from the program" with no accounting of patients who were not "regularly'' discharged.

Longabaugh finally raised the question, "Was this population representative of the population they were treating? We don't know the answer .... More important, this treatment for this group is not compared with any alternative. It is not compared with a hospital program, an outpatient program, with AA, or no treatment whatsoever .... any other intervention [might be as effective with such a group], perhaps even including no intervention at all."


In evaluating Wallace's results, Longabaugh emphasized the layer after layer of qualification applied to patients before they were included in the study. This is how Wallace (1989: 260), on the other hand, characterized his research: "This study met reasonable standards of clinical research: . . . patients were randomly [emphasis added] selected from a pool of socially stable patients ...." The word "randomly" is key in Wallace's description here, because random selection is such a necessary step in making statistical deductions about a sample. The so-called random nature of Wallace's study takes on one further wrinkle. On the nationally televised ABC program "Nightline," Wallace, Chad Emrick, and others discussed the effectiveness of alcoholism treatment with host Dr. Timothy Johnson. The following is an excerpt from the program "Alcoholism Treatment Controversy" (ABC News 1989: 2,4):

Joe Bergantio, ABC News: Last year alone, 51,000 alcoholics opted for treatment in an inpatient program, at a cost of about $500 million health care dollars. Earlier this month, Kitty Dukakis decided to do the same .... The average cost of outpatient treatment for alcoholics is about $1,200. For a month-long inpatient program, it's $10,000. An increasing number of doctors are asking if inpatient care is worth the difference.

Dr. Thomas McLellan, Veterans Administration Hospital: Well, it's a fact that most people can do as well in an outpatient program as in an inpatient program.

John Wallace, Edgehill Newport: To say that outpatient treatment was just as effective as inpatient treatment is absurd.

Chad Emrick, Outpatient Treatment Center Director: Well, I have been reviewing the treatment outcome literature . . . for over 20 years now, and there have been a number of studies where patients with alcohol problems have been randomly assigned to either inpatient treatment or outpatient care . . . and the vast majority of these studies have failed to find any differences in outcome.... And when differences have been observed,oftentimes the differences seem to favor the less intensive treatment [emphasis added] ....

John Wallace:...I certainly don't agree with Dr. Emrick. I know his work and I respect his work, but . . . I believe that there's quite a different interpretation of the literature cited by Dr. Emrick .... What I think it shows is ... in the vast majority of these studies, the relapse rates were so high—whether they were treated as outpatient or whether they were treated as inpatient—that what these studies showed was that outpatient (in these particular programs) was equally ineffective to inpatient in these particular programs.

Dr. Johnson: Okay. If they're equally ineffective, as you put it . . .

Dr. Wallace: That's right.

Dr. Johnson:... then why waste money up-front with an intensive program? . . .

Dr. Wallace: Because there are other intensive inpatient programs like Edgehill Newport that show a dramatically higher recovery rate. In our latest randomly assigned [emphasis added] study of socially stable alcoholics treated in a middle-class alcoholism treatment program, 66% of our people are continuously abstinent from both alcohol and drugs, our alcoholics, socially stable alcoholics, at six months following treatment.

Note that the phrase "randomly assigned" was used by both Emrick and Wallace, but with entirely different meanings. Wallace apparently meant randomly selected from among his patients for follow-up—although, as Longabaugh showed, there are so many exclusionary principles involved in selecting this group that it is impossible to say in what way this so-called randomly selected group is related to the general pool of patients at Edgehill Newport. Emrick uses "randomly assigned" in its conventional research sense to mean patients who were randomly assigned to one treatment or another and whose outcomes were then compared with one another. But there is no random assignment of patients to any treatment groups in Wallace's research, and all receive the standard Edgehill Newport program.

To reiterate how important the creation of a comparison group is for drawing any conclusions about a treatment, consider Vaillant's (1983: 283-284) experience: "It seemed perfectly clear that . . . by inexorably moving patients from dependence upon the general hospital into the treatment system of AA, I was working for the most exciting alcohol program in the world. But then came the rub. Fueled by our enthusiasm, I and the director . . . tried to prove our efficacy. Our clinic followed up our first 100 detoxification patients .... [and found] compelling evidence that the results of our treatment were no better than the natural history of the disease." In other words, it was only after follow-up and comparison with nontreatment groups of comparably severe alcoholics that Vaillant could get a clear vision of his results, which were that his treatment added little or nothing to the long-run prognosis for his patients. As NIAAA director Enoch Gordis (1987: 582) declared: "To determine whether a treatment accomplishes anything, we have to know how similar patients who have not received the treatment fare. Perhaps untreated patients do just as well. This would mean that the treatment does not influence outcome at all ...."

What Does Wallace's Treatment Consist Of?

Wallace (1989), asserting that I do not understand modern alcoholism treatment as practiced at Edgehill Newport and other private treatment centers, listed the techniques he uses at Edgehill Newport; oddly, many are psychological and behavioral techniques he otherwise seems to disparage. In addition, Wallace (1989: 268) averred, "I do not argue that we must confront the alcoholic and demand abstinence, as Peele claims." Yet, first-person accounts of Edgehill Newport's program do not describe cognitive-behavioral or other therapy techniques. Instead, they concentrate exclusively on the program's commitment to the disease theory and the need for abstinence and on the conversion experiences patients undergo. Wallace (1990) himself described the didactic emphasis of his treatment program: "At Edgehill Newport, the disease model— including genetic, neurochemical, behavioral and cultural factors—is taught to patients ...."


One account of the Edgehill Newport program and of how a patient came to it for treatment was included in a New York Times Magazine article (Franks 1985) titled "A New Attack on Alcoholism." The article began with a sweeping generalization: "The myth that alcoholism is always psychologically caused is giving way to a realization that it is, in large measure, biologically determined." Franks is clearly indebted to Wallace, whose name and program were mentioned in highly positive terms, while the article recounted a range of speculative biological research about alcoholism. Yet, all Franks (1985: 65) had to say about treatment approaches engendered by the new biological discoveries was contained in a single paragraph: "Most treatment programs are now designed to attack the illness on all fronts, and to lead alcoholics out of their shame and isolation and into a scientific and cognitive structure within which they can understand what has happened to them. Sometimes daily doses of Antabuse [a therapy Miller and Hester found was ineffective] are prescribed .... Dr. [Kenneth] Blum is currently testing a psychoactive agent which raises brain endorphin levels. Some treatment programs use an experimental machine which purports to stimulate electrically the production of endorphins and other euphoriants."

Franks (1985: 48) described a single case of alcoholism treatment in a sidebar titled "The Story of 'James B'." Franks knew James B as the father of a good friend.

If James B had denied his problem, so had we. He had been depressed over the death of his wife and the loss of his architectural business .... at last we had gathered into a crisis intervention team and surprised him.... Dr. Nicholas Pace ... who helped refine the crisis intervention technique, had advised us to use reason, histrionics, and even threats to strip James B of his defenses and deliver him to a treatment center....

"We think your disease is alcoholism...."

"That' s preposterous ! My problems have nothing to do with alcohol." . . . Coached about the new science of alcohol and the liver, we tried to convince James B that there was no shame in being an alcoholic.

"Look, can 't you understand?" James B said. 'I'm sick, yes; depressed, yes; getting old, yes. But that's all." . . .

After 14 hours of this scenario, some of us began to question whether he really was an alcoholic.... Then he let spill a few words. "Geez, if I couldn't go down to the pub for a few, I think I'd go nuts." "Aaah," Isabel said. "You just admitted it." . . .

That very night, we drove him to the Edgehill treatment center in Newport.

The sidebar ended by reporting that James B had accepted that he was a "diseased" alcoholic. Despite appearing in an article about biological discoveries and cures for alcoholism, everything mentioned is as old as AA and, even earlier, temperance and the Washingtonians. This diagnosis was conducted by nonprofessionals during a grueling 14-hour marathon session. Furthermore, the diagnosis was so shaky that it depended finally on James B's casual mention that he counted on his visits to the pub. Contrast this lay diagnostic process with the extremely stringent diagnosis of alcoholism called for by Madsen (1988: 11), an ardent disease-model and AA proponent: "I do not believe that we have a single study of alcoholism in which it can be demonstrated that every subject is clearly alcoholic. This can have catastrophic results [emphasis added] for the conclusions of such studies.... This over-diagnosis is due to inexperienced or too eager researchers, sloppy diagnosis, and a lack of responsibility. . . . Alcoholism is classifiable by valid scientists who have had adequate field experience."

Madsen sees catastrophe resulting from misdiagnosing problem drinkers as alcoholics. One reason may have to do with controlled drinking, which Madsen (1988: 25) thinks is impossible for true alcoholics, but is rather simple for other problem drinkers: "Any third-rate counselor should be able to help a non-addicted drinker moderate his or her drinking." If one accepts Madsen's argument that moderation is so readily accomplished by non-addicted drinkers, then it is essential to distinguish between the non-addicted alcohol abuser and the addicted (or alcoholic) one. Wallace and colleagues (1988: 248) provided a description of the diagnostic criteria they used to classify alcoholics: patients "met NCA [National Council on Alcoholism] criteria for the diagnosis of alcoholism, and/or had drug abuse/dependence diagnoses, required inpatient care, and had restorative potential."

It seems that perhaps everyone who is admitted to Edgehill Newport would qualify for the outcome study, and therefore Edgehill admissions policies are quite relevant to this research. One wonders, for example, if the James B case is typical of the subject population in Wallace and colleagues' (1988) study. Furthermore, are any of those who apply or who are referred for treatment in Wallace's program referred to more appropriate, non-disease treatments because they are non-addicted drinkers? Edgehill Newport admissions policies received national attention when Kitty Dukakis was admitted to the hospital. In press conferences and interviews, Kitty and Michael Dukakis (and many collaterals) reported that Mrs. Dukakis only began having drinking problems following her husband's defeat for the presidency, when she had had, according to Michael Dukakis, too much to drink on two or three occasions.

These reports prompted a great deal of media speculation, as well as interviews with alcoholism experts, about whether Kitty Dukakis was an alcoholic. Many treatment professionals and Kitty Dukakis herself explained that her prior dependence on amphetamines was the basis for her diagnosis of alcoholism. This claim received so much attention that Goodwin (1989: 398) discussed it in the pages of the Journal of Studies on Alcohol: "Kitty Dukakis, checking in for alcoholism treatment, opened up a perennial question: Does one drug dependence lead to another? It was amazing how many authorities said yes, absolutely. If Mrs. Dukakis was hooked on diet pills at one time in her life, she was likely to become hooked on something else, like alcohol. There is almost no evidence for this."

One is reminded of Madsen's insistence that those treating a person for alcoholism must establish that the person is an "addicted drinker" or else face the possibility of "catastrophic" misdiagnosis. Furthermore, one must judge whether or not the patient population on which Wallace and colleagues (1988) reported their results has the same degree of alcohol dependence as found among the highly dependent subjects in other studies, such as the Rand report. It may not make much sense, therefore, to compare the abstinence rates of those at Edgehill Newport with studies of hospitals whose outcomes Wallace denigrates.

In light of his research, let us review Wallace's (1987c: 26) demands: ". . . we must insist that researchers in the treatment field give us research that is every bit as adequate and unbiased as research in other areas of alcohol studies." In his rejoinder to me, Wallace (1989: 259, 267) declared: "It is concluded that marginal scholarship, partial and/or inaccurate representations of research, and inappropriate generalizations do not constitute the basis for drawing reliable and valid conclusions about alcoholism treatment" and that good science and treatment require "(1) an insistence on fairness; (2) attention to scientific method and data; (3) healthy skepticism; and (4) reasonable caution."


A Whole Different Perspective

Wallace's and My Different Backgrounds and Perspectives

That alcoholism treatment is under siege is obvious. In the last paragraph of the third part of his "Waging the War for Wellness" series, Wallace (1987c: 27) issued a clarion call to alcoholism professionals: "We must recognize and resist the various tactics and strategies of the Anti-traditionalist lobby to divide us. We must stand shoulder to shoulder in solidarity. Otherwise, alone and divided we will be weak and easy targets for those who do not want to pay for alcoholism services [emphasis added]." Throughout his rebuttal of my article, Wallace (1989: 270) adopted a tone of injured innocence: "Despite Peele's efforts to discredit me by unjustly accusing me of intolerance and wishes to persecute, my convictions about the necessity for competent science to guide clinical practice remain intact." Wallace paints me as the persecutor. Yet the point of view he espouses is by far the dominant one in the United States. At the same time, as Miller and Hester (1986a: 122) indicated: "The list of elements that are typically included in alcoholism treatment in the United States . . . all lack adequate scientific evidence of effectiveness."

Whenever investigators question any tenets of the American treatment system, they are liable to be vilified. One well-known case was the Rand research. In 1976, Wallace participated in the NCA's press conference assailing the first Rand report: "I find the Rand conclusions of no practical beneficial consequences for treatment and rehabilitation." Others, like Samuel Guze, felt differently (Armor, Polich & Stambul 1978: 220-221): "Alcoholism and Treatment, a Rand report . . . is interesting, provocative, and important. The authors are obviously well-informed, competent, and sophisticated. They appear to recognize and appreciate the complex issues that their report covers .... What the data do demonstrate is that remission is possible for many alcoholics and that many of these are able to drink normally for extended periods. These points deserve emphasis, because they offer encouragement to patients, to their families, and to relevant professionals."

More than a decade later, Wallace (1987b: 24) was still attacking this report and its four-year follow-up and anyone who took them to indicate moderation of drinking problems was a real possibility, "Considering the scientific inadequacies of the first Rand report and the actual data from the second...." Others feel differently, including Mendelson and Mello (1985: 346-347), editors of the Journal of Studies on Alcohol and themselves preeminent alcoholism researchers: "Despite the gradually accumulating data base [on controlled-drinking outcomes], the 1976 publication of . . . the Rand Report was responded to with outrage by many self-appointed spokesmen for the alcoholism treatment community .... When this data base was followed again after four years, there were no significant differences in relapse rates between alcohol abstainers and non-problem drinkers .... [The Rand study] was evaluated with the most sophisticated procedures available ...." Whatever Mendelson and Mello's opinions, virtually no one in the United States (although not around the world) practices controlled-drinking therapy for alcoholics, and the practical applications of the Rand reports and of much other research, such as the techniques cited by Miller and Hester (1986a), are negligible. That is the power of the current alcoholism treatment establishment, which NIAAA director Gordis (1987) noted when he said, "Contemporary treatment for alcoholism owes its existence more to historical processes than to science ...."

My own work in the alcoholism field includes a number of critical summaries of views of alcoholism and other drug addictions and their treatment and prevention. Wallace (1989) referred to one of these articles, "The Implications and Limitations of Genetic Models of Alcoholism and Other Addictions" (Peele 1986), that cast doubt on genetic claims about alcoholism. Recently, another of my articles (Peele 1987a) received the 1989 Mark Keller Award for the best article in the Journal of Studies on Alcohol for the years 1987-1988. I also address addiction and alcoholism professionals at conferences, such as the 1988 [DHHS] Secretary's National Conference on Alcohol Abuse and Alcoholism, where I debated with James Milam whether or not alcoholism is a disease. In this sense, some important venues have answered Wallace's (1989: 259) question—"Can Stanton Peele's Opinions Be Taken Seriously?"—in the affirmative.

Nonetheless, my role in the alcoholism field is that of an outsider. When I name research professionals (mainly physicians)—such as Enoch Gordis, Donald Goodwin, Samuel Guze, Jack Mendelson, Nancy Mello, George Vaillant, John Helzer, Lee Robins, Forest Tennant, Robin Murray, and Griffith Edwards—to support my positions, and when I asked in my original article in this journal (Peele 1988) whether Wallace considered these mainstream figures to be anti-traditionalists, I was being ironic. I meant through this device to illustrate how poorly conventional wisdom does at explaining the results and views of the most prominent of alcoholism researchers. For example, the Goodwin, Crane and Guze(1971) article that described remission among former convicts who continued to drink could never be published today in the aftermath of the furor created around the Rand reports.

I described alcoholism treatment in Great Britain in my original article as a way of showing that the supposed biological basis of alcoholism and of its medical treatment does not travel well across the Atlantic. I do not understand Wallace's (1989) reasoning in his response to my quotes of Robin Murray's negative findings on genetic causation as well as his statement that British psychiatry finds that the disease approach to alcoholism does more harm than good. Wallace seemed to be saying that this is a slap at British and American researchers who study biological sources of alcoholism. My point was that the defection of almost the whole of a nation from the disease model does not support Wallace's (1989: 269) view that "in the future, I think that the type of arguments mounted by Peele against biological factors in alcoholism and in favor of controlled drinking will be dismissed readily as prescientific or even as ascientific."

In a major speech (Newman 1989), Wallace indicated where he thinks alcoholism treatment based on modern neuroscientific discoveries is headed. In the first place, he does not find them inconsistent with AA and "spiritual" recovery: "I think behavior affects neurochemistry. When you get in AA you get in touch with your good molecules." Here is how Wallace describes the future: "Treatment is going to be transformed over the next ten years. There will be a lot more so-called New Age initiatives, including body massage, meditation, and attention to diet."

That the British are going in the opposite direction from this country is clear in the description put forward in the pro-disease trade publication, the U.S. Journal of Drug and Alcohol Dependence (Zimmerman 1988: 7):

The ten men and women who live at the Thomybauk recovery home in Edinburgh have all had trouble with alcohol, but don't call them alcoholics or suggest that they have a disease.

They're problem drinkers. They developed a dependence on alcohol. They aren't being treated for alcoholism but are trying to learn to deal with personal problems in a way that avoids getting drunk. If they want to try to drink again and control it, their counselors at Thomybauk wouldn't object.

Thomybauk would be considered a novel, if not dangerous, course of treatment for alcoholism in the United States, where the traditional disease concept of alcoholism makes total abstinence the widely accepted goal of treatment. In England and Scotland, and Mach of the rest of the world, it's the other way around [emphasis added]. The majority of medical and psychiatric practitioners frown on the idea that persons who have once lost control of their drinking must, above all, avoid a "first drink" if they expect to sustain their recovery. In the eyes of these doctors, it is insisting on abstinence that may jeopardize alcoholic recovery. They prefer to work with a concept of alcohol dependence which has varying degrees of severity and may leave the door open for a return to social drinking by some patients.


Wallace (1989: 266) particularly objected to my citing data from Robins and Helzer regarding returned Vietnam veteran heroin addicts: "For the record, I have personally long admired the work of these researchers. My admiration is not diminished by their careful, forthright, and fascinating study of heroin use and addiction among Vietnam Veterans. Helzer and Robins' discussions of their findings on the possible use of narcotics by previously addicted soldiers without readdiction is a model of restraint .... One does not come away from reading Helzer and Robins' work with the feeling that opiate or other drug use has been sanctioned or encouraged. I am of the opinion, however, that the same cannot be said of Peele's work."

Here is what Robins and colleagues (1980) found: (1) "Heroin use progresses to daily or regular use no more often than use of amphetamines or marijuana" (p. 216); (2) "Of those men who were addicted in the first year back. . . of those treated, 47 percent were addicted in the second period; of those not treated, 17 percent were addicted" (p. 221); and (3) "Half of the men who had been addicted in Vietnam used heroin on their return, but only one-eighth became re-addicted to heroin. Even when heroin was used frequently, that is, more than once a week for a considerable period of time, only one-half of those who used it frequently became re-addicted" (pp. 222-223). These data undermine the foundation of the beliefs on which Wallace bases his entire model of addiction and addiction treatment. Given his respect for these researchers and their work, what does Wallace make of these findings? Where in his writings or work does he make use of them?

Robins and colleagues (1980: 230) tried to deal with their "uncomfortable" results in the last paragraph of their article, which was subtitled "How Our Study Changed Our View of Heroin": "Certainly our results are different from what we expected in a number of ways. It is uncomfortable presenting results that differ so much from clinical experience with addicts in treatment. But one should not too readily assume that differences are entirely due to our special sample. After all, when veterans used heroin in the United States, only one in six came to treatment."

The Robins group's research suggests a model of addiction as something other than a lifetime disease. The exploration of normal human development out of addiction is especially crucial today because of the rapid expansion of the application of the disease concept, not only to people with milder drinking problems, but—in treatment centers such as Hazelden and CompCare and others—to labeling and treating (including hospitalizing) those suffering from such diseases as "codependence" and addictions to sex, gambling, overeating, and shopping. This madness must be exposed for what it is.

Acknowledgments

The author is grateful to Chad Emrick, Richard Longabaugh, and Archie Brodsky for their input.

References

ABC News. 1989. Alcoholism treatment controversy. "Nightline" transcript February 27. New York: ABC News.

Anderson W. & Ray, O. 1977. Abstainers, non-destructive drinkers and relapsers: One year after a four-week inpatient group-oriented alcoholism treatment program. In: Seixas, F. (Ed.) Currents in Alcoholism Vol.2. New York: Grune & Stratton.

Armor, D.J., Polich, J.M. & Stambul, H.B. 1978. Alcoholism and Treatment. New York: John Wiley & Sons.

Davies, D.L. 1962. Normal drinking in recovered addicts. Quarterly Journal of Studies on Alcohol Vol. 23: 94-104.

Edwards, G. 1985. A later follow-up of a classic case series: D.L Davies's 1962 report and its significance for the present. Journal of Studies on Alcohol Vol. 46: 181-190.

Edwards, G.; Orford. J.; Egert, S.; Guthrie, S.; Hawker, A.; Hensman, C.; Mitcheson, M.; Oppenheimer, E. & Taylor, C. 1977. Alcoholism: A controlled trial of "treatment" and "advice." Journal of Studies on Alcohol Vol. 38: 1004-1031.

Elal-Lawrence, G.; Slade, P.D. & Dewey, M.E. 1986. Predictors of outcome type in treated problem drinkers. Journal of Studies on Alcohol Vol. 47: 41-47.

Fingarette, H. 1988. Heavy Drinking: The Myth of Alcoholism as a Disease. Berkeley: University of California Press.

Foy, D.W.; Nunn, L.B. & Rychtarik, R.G. 1984. Broad-spectrum behavior treatment for chronic alcoholics: Effects of training controlled drinking skills. Journal of Consulting and Clinical Psychology Vol. 52: 218-230

Franks, L. 1985. A new attack on alcoholism. New York Times Magazine October 20: 47-50ff.

Goodwin, D.W. 1989. The gene for alcoholism. Journal of Studies on Alcohol Vol. 50: 397-398.

Goodwin, D.W.; Crane, J.B. & Guze, S.B.1971. Felons who drink: An 8-year follow-up. Quarterly Journal of Studies on Alcohol Vol. 32: 136-147.

Gordis, E. 1987. Accessible and affordable health care for alcoholism and related problems: Strategies for cost containment. Journal of Studies on Alcohol Vol. 48: 579-585.

Gottheil, E.; Thornton, C.C.; Skoloda, T.E. & Alterman, A.L. 1982. Follow-up of abstinent and nonabstinent alcoholics. American Journal of Psychiatry Vol. 139: 560-565.

Helzer, J.E.; Robins, L.N.; Taylor, J.R.; Carey, K.; Miller, R.H.; Combs-Orme, T. & Farmer, A. 1985. The extent of long-term moderate drinking among alcoholics discharged from medical and psychiatric treatment facilities. New England Journal of Medicine Vol. 312: 1678-1682.

Holden, C.1987. Is alcoholism treatment effective? Science Vol. 236: 2022.

Longabaugh, R. 1988. Optimizing the cost-effectiveness of treatment. Paper presented at Conference on Evaluating Recovery Outcomes, Program on Alcohol Issues. University of California, San Diego, February 4-6.

Madsen, W. 1989. Thin thinking about heavy drinking. The Public Interest Spring: 112-118.

Madsen, W. 1988. Defending the Disease Theory: From Facts to Fingarette. Akron, Ohio: Wilson, Brown.

McCabe, R.J.R. 1986. Alcohol-dependent individuals sixteen years on. Alcohol & Alcoholism Vol. 21: 85-91.

Mendelson, J.H. & Mello, N.K. 1985. Alcohol Use and Abuse in America. Boston: Little, Brown.

Miller, W.R. 1987. Behavioral alcohol treatment research advances: Barriers to utilization. Advances in Behavior Research and Therapy Vol. 9: 145-167.

Miller, W.R. & Hester, R.K. 1986a. The effectiveness of alcoholism treatment: What research reveals. In: Miller, W.R. & Heather, N.K. (Eds.) Treating Addictive Behaviors: Processes of Change. New York: Plenum.

Miller, W.R. & Hester, R.K. 1986b. Inpatient alcoholism treatment: Who benefits? American Psychologist Vol. 41: 794-805.

Murray, R.M.; Gurling, H.M.D.; Bernadt, M.W. & Clifford, C.A. 1986. Economics, occupation and genes: A British perspective. Paper presented at the American Psychopathological Association. New York, March.

Nathan, P. 1985. Alcoholism: A cognitive social learning approach. Journal of Substance Abuse Treatment Vol. 2: 169-173.

Newman, S. 1989. Alcoholism researcher cites group of causes. U.S. Journal of Drug and Alcohol Dependence September 7.

Orford, J. & Keddie, A. 1986. Abstinence or controlled drinking. British Journal of Addiction Vol. 81: 495-504.

Orford, J., Oppenheimer, E. & Edwards, G.1976. Abstinence or control: The outcome for excessive drinkers two years after consultation. Behavior Research and Therapy Vol. 14: 409-418.

Patton, M. 1979. Validity and Reliability of Hazelden Treatment Follow-Up Data. Center City, Minnesota: Hazelden.

Peele, S. 1989. Ain't misbehavin': Addiction has become an all-purpose excuse. The Sciences July/August: 14-21.

Peele, S. 1988. Can we treat away our alcohol and drug problems or is the current treatment binge doing more harm than good? Journal of Psychoactive Drugs Vol. 20(4): 375-383.

Peele, S. 1987a. The limitations of control-of-supply models for explaining and preventing alcoholism and drug addiction. Journal of Studies on Alcohol Vol. 48: 61-77.

Peele, S. 1987b. What does addiction have to do with level of consumption? Journal of Studies on Alcohol Vol. 48: 84-89.

Peele, S. 1987c. Why do controlled-Drinking outcomes vary by country, by investigator and by era?: Cultural conceptions of relapse and remission in alcoholism. Drug and Alcohol Dependence Vol.20: 173-201.

Peele, S. 1986. The implications and limitations of genetic models of alcoholism and other addictions. Journal of Studies on Alcohol Vol. 47: 63-73.

Peele, S. 1985. Change without pain. American Health January/February: 36-39.

Pokorney, A.D.; Miller, B.A. & Cleveland, S.E. 1968. Response to treatment of alcoholism: A follow-up study. Quarterly Journal of Studies on Alcohol Vol. 29: 364-381.

Polich, J.M.; Armor, D.J. & Braiker, H.B. 1980. The Course of Alcoholism: Four Years After Treatment. Santa Monica, California: Rand Corporation.

Robins, L.N.; Helzer, I.E.; Hesselbrock, M. & Wish, E. 1980. Vietnam veterans three years after Vietnam: How our study changed our view of heroin. In: Brill, L. & Winick, C. (Eds.) The Yearbook of Substance Use and Abuse. Vol. 2. New York: Human Sciences Press.

Rychtarik, R.G.; Foy, D.W.; Scott, T.; Lokey, L. & Prue, D.M. 1987a. Five- to six-year follow-up of broad-spectrum behavioral treatment for alcoholism: Effects of training controlled drinking skills. Journal of Consulting and Clinical Psychology Vol. 55: 106-108.

Rychtarik, R.G.; Foy, D.W.; Scott, T.; Lokey, L. & Prue, D.M. 1987b. Five- to six-year follow-up of broad-spectrum behavioral treatment for alcoholism: Effects of training controlled drinking skills, extended version to accompany JCC brief report. Jackson, Mississippi: University of Mississippi Medical Center.

Sanchez-Craig, M. 1986. The hitchhiker's guide to alcohol treatment British Journal of Addiction Vol. 82: 597-600.

Saxe, L.; Dougherty, D. & Esty, J. 1983. The Effectiveness and Costs of Alcoholism Treatment. Washington, D.C.: U.S. GPO.

Schuckit, M.A. & Winokur, G.A.1972. A short-term follow-up of women alcoholics. Diseases of the Nervous System Vol. 33: 672-678.

Tennant, F.S. 1986. Disulfiram will reduce medical complications but not cure alcoholism. Journal of the American Medical Association Vol. 256:1489.

Vaillant, G.E. 1983. The Natural History of Alcoholism. Cambridge, Massachusetts: Harvard University Press.

Wallace, J. 1990. Response to Peele (1989). The Sciences January/February: 11-12.

Wallace, J. 1989. Can Stanton Peele's opinions be taken seriously? Journal of Psychoactive Drugs Vol. 21 (2): 259-271.

Wallace, J. 1987a. The attack of the "Anti-Traditionalist" lobby. Professional Counselor January/February: 21-24ff.

Wallace, J. 1987b. The attack upon the disease model. Professional Counselor March/April: 21-27.

Wallace, J. 1987c. The forces of disunity. Professional Counselor May/June: 23-27.

Wallace, J. 1987d. Chapter VII. Treatment Sixth Special Report to the U.S. Congress on Alcohol and Health from the Secretary of Health and Human Services. Rockville, Maryland: DHHS.

Wallace, J.; McNeill, D.; Gilfillan, D.; MacLeary, K. & Fanella, F.1988. I. Six-month treatment outcomes in socially stable alcoholics: Abstinence rates. Journal of Substance Abuse Treatment Vol. 5: 247-252.

Zimmerman, R. 1988. Britons balk at U.S. treatment methods. U.S. Journal of Drug and Alcohol Dependence January: 7, 18.

next: Why Aren't You On Bill Moyers' 5-Part Series On Alcoholism/Addiction On PBS?
~ all Stanton Peele articles
~ addictions library articles
~ all addictions articles

APA Reference
Staff, H. (2008, December 26). Why and by Whom the American Alcoholism Treatment Industry is Under Siege, HealthyPlace. Retrieved on 2024, April 19 from https://www.healthyplace.com/addictions/articles/why-and-by-whom-the-american-alcoholism-treatment-industry-is-under-siege

Last Updated: June 28, 2016