Parents of children with eating disorders have a difficult and frightening job. Recent research by Pamela Carlton, MD, indicates that they often feel overwhelmed and confused when their critically ill child is hospitalized. They may not understand the severity of the threat to their child's health, and they are often anxious about their own ability to care for their child after discharge.

"Parents are extraordinarily frustrated that they can't get their kid to eat," says Carlton, a staff physician at Lucile Packard Children's Hospital's eating disorders program. "We've found that, although we're taking care of their kids, they're not learning what they can do in the hospital and at home to help their children."

Carlton is spearheading a new effort to teach parents the how and why of the medical, psychiatric and nutritional treatment their child will receive as an inpatient of Lucile Packard Children's Hospital's Comprehensive Eating Disorders Program. The eating disorders staff will also help parents manage their child's condition at home after discharge and will organize weekly support groups for parents of children with eating disorders, a first for the area. The support groups will be led by a social worker and may invite occasional speakers to address common parental questions.

The plan sprang from two focus groups Carlton conducted a year ago, as well as a recent survey of 97 families of Packard Children's Hospital eating disorder inpatients. She asked the parents of children who had been hospitalized for anorexia, bulimia and other eating disorders to list concerns they had about their child's disorder and its treatment.

"What was very interesting to us," says Carlton, "was that hospitalization was the first time the parents realized how sick their kids actually were. We want parents to realize how serious the situation is and why we are taking it seriously. They may think, 'She seemed fine when I brought her into the clinic, so it can't really be that bad.'"

Carlton also found that parents are often confused about the rationale and enactment of their child's treatment plan. Participants of the focus groups were unanimous in their desire to have more information about all aspects of their child's disease and treatment, and both groups asked to stay behind after the session to compare notes with each other about their experiences.

"One thing that really frustrates parents is that they have no idea how to feed their child at home," says Carlton. "They're looking at the nutritional guidelines and asking 'What does this mean? What is a serving?'"

As part of the new education campaign, every parent will receive a binder of information about eating disorders and the types of treatment their child can expect to receive. After reviewing the information, the parents will meet weekly with Carlton for two hours to discuss the material.

Parents will learn, for example, that children who are less than 75 percent of their ideal body weight, or whose hearts beat less than 50 times each minute, have a drastically increased risk of sudden cardiac death even though they may look fine. They will be instructed to watch out for subtle danger signs, including fainting and blue hands or feet, which may signal a medical emergency.

And they will meet Anna, an alternate personality evoked in an essay by a recovering patient describing how it feels to be 'inhabited' by an eating disorder. Finally, the binder includes basic information about food groups and menus for balanced, nutritionally complete meals to feed their child.

In addition to the written information and the weekly question and answer sessions, Carlton hopes to set up a resource room for parents at the eating disorder program's new home at El Camino Hospital. When completed, the room will likely offer educational materials for check-out and computer terminals with lists of suggested reputable websites about eating disorders. Carlton plans to evaluate the effectiveness of the new educational program by surveying parents upon admission and again when their child is discharged. "If their knowledge and comfort levels about eating disorders and their treatment don't increase, then we'll adjust the program to better meet their needs," she says.

next: How Do I Help Someone With an Eating Disorder?
~ eating disorders library
~ all articles on eating disorders

teenage sex

As teens, many struggle with issues of self esteem - the degree to which we appreciate our own worth and importance. The way we regard ourselves is dependent on many factors, and recognizing them is the first step to overcoming obstacles.

Self-esteem involves how much a person values herself and appreciates her own worth and importance. For example, a teen with healthy self-esteem is able to feel good about her character and her qualities and take pride in her abilities, skills, and accomplishments. Self-esteem is the result of comparing how we'd like to be and what we'd like to accomplish with how we actually see ourselves.

Everyone experiences problems with self-esteem at certain times in their lives - especially teens who are still figuring out who they are and where they fit into the world. How a teen feels about herself can be related to many different factors, such as her environment, her body image, her expectations of herself, and her experiences. For example, if a person has had problems in her family, has had to deal with difficult relationships, or sets unrealistic standards for herself, this can lead to low self-esteem.

Recognizing that you can improve your self-esteem is a great first step in doing so. Learning what can hurt self-esteem and what can build it is also important. Then, with a little effort, a person can really improve the way she feels about herself.

Constant criticism can harm self-esteem - and it doesn't always come from others! Some teens have an "inner critic," a voice inside that seems to find fault with everything they do - and self-esteem obviously has a hard time growing in such an environment. Some people have modeled their inner critic's voice after a critical parent or teacher whose acceptance was important to them. The good news is that this inner critic can be retrained, and because it now belongs to you, you can be the one to decide that the inner critic will only give constructive feedback from now on.

It may help to pinpoint any unrealistic expectations that may be affecting your self-esteem. Do you wish you were thinner? Smarter? More popular? A better athlete? Although it's easy for teens to feel a little inadequate physically, socially, or intellectually, it's also important to recognize what you can change and what you can't, and to aim for accomplishments rather than perfection. You may wish to be a star athlete, but it may be more realistic to set your sights on improving your game in specific ways this season. If you are thinking about your shortcomings, try to start thinking about other positive aspects of yourself that outweigh them. Maybe you're not the tallest person in your class and maybe you're not class valedictorian, but you're awesome at volleyball or painting or playing the guitar. Remember - each person excels at different things and your talents are constantly developing.

How to Improve Your Self-Esteem

If you want to improve your self-esteem, there are some steps you can take to start empowering yourself:

• Remember that self-esteem involves much more than liking your appearance. Because of rapid changes in growth and appearance, teens often fall into the trap of believing their entire self-esteem hinges on how they look. Don't miss the inner beauty that's more than skin deep in yourself and in others.
• Think about what you're good at and what you enjoy, and build on those abilities. Take pride in new skills you develop and talents you have. Share what you can do with others.
• Exercise! You'll relieve stress, and be healthier and happier.
• Try to stop thinking negative thoughts about yourself. When you catch yourself being too critical, counter it by saying something positive about yourself.
• Take pride in your opinions and ideas - and don't be afraid to voice them.
• Each day, write down three things about yourself that make you happy.
• Set goals. Think about what you'd like to accomplish, then make a plan for how to do it. Stick with your plan and keep track of your progress. If you realize that you're unhappy with something about yourself that you can change, then start today. If it's something you can't change (like your height), then start to work toward loving yourself the way you are.
• Beware the perfectionist! Are you expecting the impossible? It's good to aim high, but your goals for yourself should be within reach.
• Make a contribution. Tutor a classmate who's having trouble, help clean up your neighborhood, participate in a walk-a-thon for a good cause, the list goes on. Feeling like you're making a difference can do wonders to improve self-esteem.
• Have fun - enjoy spending time with the people you care about and doing the things you love.

It's never too late to build or improve self-esteem. In some cases, a teen may need the help of a mental health professional, like a therapist or psychologist, to help heal emotional hurt and build healthy, positive self-esteem. A therapist can help a teen to learn to love herself and realize that her differences make her unique.

So, what's the payoff? Self-esteem plays a role in almost everything you do - teens with high self-esteem do better in school and enjoy it more and find it easier to make friends. They tend to have better relationships with peers and adults, feel happier, find it easier to deal with mistakes, disappointments, and failures, and are more likely to stick with something until they succeed. Improving self-esteem takes work, but the payoff is feeling good about yourself and your accomplishments.

next: Difference Between Sex and Love

"All of us who are happy have the intention of being happy. It seems to me that intention is the key."
- Janet Jantzen

1) Responsibility
2) Deliberate Intent
3) Acceptance
4) Beliefs
5) Gratitude
6) This Moment
7) Honesty
8) Perspective

2) Make Happiness A Deliberate Intention

How often do you base whether you'll be happy or not, on the circumstances and conditions in your life? "When this happens, I'll be happy. When I get this house, car, relationship, job, this problem is solved, have self esteem, get out of this marriage (the list is endless) ... thenI'll be happy."

What if your happiness was...
More important than changing?
More important than getting what you want?
More important than making more money?
More important than being healthy?
More important than having friends?
More important than being respected?
More important than having the right career?
More important than being in a great relationship?

What if you could be happy while pursuing the things you want? Whose to say you can't? Is there any reason you can't experience joy while creating the life you want?

What we focus on becomes larger in our lives. If you focus on feeling happy, you will feel happier. Consider this. If you don't have to use unhappiness to motivate yourself to accomplish something, you could pursue your desires while being happy. You could feel good, right here, right now. It's all about setting the intention to feel good at the top of your list. To understand this more fully, I recommend you read Emotional Options by Mandy Evans.

One of the surprising and amazing results of deliberately making happiness important in your life, is how much more effective you will be at creating what you want!

next: 8 Ways To Happiness: Acceptance

"Most folks are about as happy as they make up their minds to be."
- Abraham Lincoln

So if happiness is so important to us, and its what everyone seeks, then why aren't there any classes on how to be happy? No society, past or present, has put any emphasis on teaching people to experience what we all yearn for. You'd think with the magnitude of the role happiness plays in our lives, that there would be some type of education on the subject. Ever seen "A Study in Happiness" offered at school? No, of course not.

I've racked my brain trying to figure out why we don't teach people about how to help themselves feel good, and I think it comes down to one reason. Society, as a whole, has some pretty big misconceptions about what it means to be happy. We have passed down from generation to generation the belief that happiness, or unhappiness, can be attributed to external causes. We've been told that other people and the circumstances make us happy or unhappy. That our happiness is outside ourselves. Here's what Richard Evans has to say about happiness and society.

"The Pursuit of Happiness"

There are some fine distinctions to be found in the now immortal phrase, "Life, liberty, and the pursuit of happiness." Life is eternal; liberty, an inalienable right, but with happiness - we are offered only the right to pursue it! We can give a man his liberty but not so his happiness. We can help, but ultimately he has to help himself to happiness. This all men have in common, we are searching for happiness. No one wants to be unhappy; no one deliberately sets out to try to make a muddle of his life.

Among the many misconceptions concerning this thing so much pursued are these: (One) That money makes happiness. False. It may help or it may hinder. Some men have sold their happiness, but no one was ever able to buy it. (Two) That pleasure is the same as happiness. False. You can wear yourself ragged in pursuit of pleasure and still wake up in dull despair. (Three) That fame brings happiness. False. The record eloquently indicates otherwise. (Four) That happiness must be found in far places. False again. We carry it with us.

If there were no reasonable chance of finding happiness, we had just as well ring down the curtain on time and eternity, for happiness is properly the chief business and ultimate aim of life. "Men are, that they might have joy." But there is no point in pursuing it where it never was and never will be found. No one ever over took anything -- including happiness -- by pursuing it on the wrong road. If we want it, we had better look for it where it is."

Since society believes happiness comes from things and events, it's focus is on classes that help you get things and events. The most important lessons are left up to you to sort out. Who am I? What do I believe? How can I be happy?

next: Using Unhappiness As Motivation

What are the signs and symptoms of child physical, sexual and emotional abuse and the risks for anxiety, depression and substance abuse? Read more.

The statistics on physical child abuse are alarming. It is estimated hundreds of thousands of children are physically abused each year by a parent or close relative. Thousands die. For those who survive, the emotional trauma remains long after the external bruises have healed. Communities and the courts recognize that these emotional "hidden bruises" can be treated. Early recognition and treatment are important to minimize the long term effect of physical abuse.

Children who have been abused may display:

• feelings of sadness or other symptoms of depression
• a poor self-image
• sexual acting out
• inability to trust or love others
• aggressive, disruptive, and sometimes illegal behavior
• anger and rage
• self-destructive or self-abusive behavior, suicidal thoughts
• passive or withdrawn behavior
• fear of entering into new relationships or activities
• anxiety and fears
• school problems or failure
• flashbacks, nightmares
• drug abuse and alcohol abuse

Often the severe emotional damage to abused children does not surface until adolescence or later when many abused children become abusing parents. An adult who was abused as a child often has trouble establishing intimate personal relationships. These men and women may have trouble with physical closeness, touching, intimacy, and trust as adults. They are also at higher risk for anxiety, depression, substance abuse, medical illness, and problems at school or work.

Without proper treatment, physically abused children can be damaged for life. Early identification and treatment are important to minimize the long-term consequences of abuse. Child and adolescent psychiatrists provide comprehensive evaluation and care for children who have been abused. The family can be helped to learn new ways of support and communicating with one another. Through treatment, the abused child begins to regain a sense of self-confidence and trust.

Physical abuse is not the only kind of child abuse. Many children are victims of neglect, or sexual abuse, or emotional abuse. In all kinds of child abuse, the child and the family can benefit from the comprehensive evaluation and care of a child and adolescent psychiatrist.

For the most comprehensive information about Depression and Treatment, visit our Depression Community Center at HealthyPlace.com.

next: Common Symptoms in Adult Survivors of Childhood Sexual Abuse
~ all abuse library articles

Excerpts from the Archives of the Narcissism List Part 15

1. Money and the Narcissist
2. Treating Your Narcissist
3. Forgetting My Self
4. What to Tell Your Narcissist?
5. Narcissists Hate Happy People
6. Sexual Abuse
7. Punishing Evil
8. Psychology

1. Money and the Narcissist

Money stands for love in the narcissist's emotional vocabulary. Having been deprived of love early on in his childhood, the narcissist constantly seeks for love substitutes. To him, money is THE love substitute. All the qualities of the Narcissist are manifest in his relationship with money, and in his attitude towards it. Due to his sense of entitlement - he feels that he is entitled to other people's money. His grandiosity leads him to believe that he should have, or does have more money than he actually has. This leads to reckless spending, to pathological gambling, to substance abuse, or to compulsive shopping. Their magical thinking leads narcissists to irresponsible and short-sighted behavior, the results of which they believe themselves to be immune from. So, they descend to debt, they commit financial crimes, they hassle people, including their closest relatives. Their fantasies lead them to believe in financial (fabricated) "facts" (achievements) - incommensurate with their talents, qualifications, jobs, and resources. They pretend to be richer than they are, or capable of becoming rich, if they so resolve. They have a love-hate ambivalent relationship with money. They are mean, stingy, and calculating with their own money - and spendthrift with OPM (other people's money). They live lavishly, well above their means. The often go bankrupt and ruin their businesses. Reality very rarely matches their grandiose fantasies. Nowhere is the grandiosity gap more evident than where money is involved.

2. Treating Your Narcissist

Treat them as you would children. This is so CLEAR and so endearing. It fosters in many the wish to protect the narcissist from his own delusions or to violently shake him into submission for his own good. The narcissist is like that wide eyed, hands up, Jewish kid in the famous holocaust photograph, his clothes concealing a load of food weightier than he, his fate sealed, his gaze accepting and far. A Nazi SS soldier is pointing a gun at him. It is all in sepia colours and the bustle of everyday death is muted in the background.

3. Forgetting My Self

I HAD amnesia of myself. I knew next to nothing about who I was, what I did, how I felt. Then, life shattering events handed me the answers. Then I went looking for a label for what I learned about myself.

• I knew nothing.
• I discovered that I knew nothing.
• I studied myself.
• I labeled my findings.

Are labels self fulfilling prophecies? I think that yes, to some extent. This risk DEFINITELY exists. I try to avoid it by interacting with other narcissists and especially with victims of narcissists. I FORCE myself to be as un-narcissistic as I can: help people, empathize, deny selfishness, avoid grandiosity (and I do face temptations).

It is not working. I act out. I lash at the new "Sam". Maybe it is my narcissism fighting the last battle. Maybe I am administering the coup de grace.

And maybe not. Maybe my new found philanthropy is another narcissistic ploy.

The worst part is when you are no longer able to tell the healthy from the sick, your self from your invented self, your will from the dynamics of your disorder.

4. What to Tell Your Narcissist?

I would tell him that we are all shaped in our early childhood by people: parents, teachers, other adults, our peers. It is a delicate job of fine tuning. Very often it is incomplete or wrongly done. As children, we defend ourselves against the incompetence (and, sometimes, the abuse) of our elders. We are individuals, so we each adopt (often unconsciously) a different defense mechanism. One of these self-defense mechanisms is called "narcissism". It is the choice not to seek love and acceptance from - and not to give them to - those incapable or unwilling to provide it. Instead, we construct an imaginary "self". It is everything that we are not, as children. It is omnipotent, omniscient, immune, grandiose, fantastic and ideal. We direct our love at this creation. But deep inside, we know that it is our invention. We need others to inform us constantly and persuasively that it is not MERELY our invention, that it has an existence all of its own, independent of us. This is why we look for "narcissistic supply": attention, adoration, admiration, applause, approval, affirmation, fame, power, sex, etc.

5. Narcissists Hate Happy People

Narcissists HATE happiness and joy and ebullience and vivaciousness and, in short, life itself.

The roots of this bizarre propensity can be traced to a few psychological dynamics which operate concurrently (it is very confusing to be a narcissist):

First, there is pathological envy.

The Narcissist is constantly envious of other people: their successes, their property, their character, their education, their children, their ideas, the fact that they can feel, their good mood, their past, their future, their present, their spouses, their mistresses or lovers, their location...

Almost ANYTHING can be the trigger of a bout of biting, acidulous envy. But there is nothing which reminds narcissists of the totality of their envious experiences than happiness. They lash out at happy people out of their own deprivation.

Then there is narcissistic hurt.

The narcissist regards himself as the center of the world and life of those around him. He is the source of all emotions, responsible for all developments, positive and negative alike, the axis, the prime cause, the only cause, the mover, the shaker, the broker, the pillar, the fount, forever indispensable. It is therefore a bitter and sharp rebuke to this grandiose fantasy to see someone else happy. It confronts the narcissist with the reality outside the realm of his fantasies. It painfully serves to illustrate to him that he is but one of many causes, phenomena, triggers, and catalysts. That there are things happening outside the orbit and remit of his control, or initiative.

Moreover, the narcissist uses projective identification. He feels bad through other people, his proxies. He induces unhappiness and gloom in others to enable him to experience his own misery. Inevitably, he attributes the source of such sadness either to himself - or to the "pathology" of the sad person.

The narcissist often says to people he made unhappy:

"You are constantly depressed, you should really see a therapist".

The narcissist - in an effort to maintain the depressive state until it serves its cathartic purposes - strives to perpetuate it by sowing constant reminders of its existence. "You look sad/bad/pale today. Is anything wrong? Can I help you? Things haven't been going so well, ah?".

Last but not least is the exaggerated fear of losing control.

The narcissist feels that he controls his human environment mostly by manipulation and mainly by emotional extortion and distortion. This is not far from reality. The narcissist suppresses any sign of emotional autonomy. He feels threatened and belittled by an emotion fostered not by him, nor by his actions directly or indirectly. Counteracting someone else's happiness is the narcissist's way of reminding everyone: I am here, I am omnipotent, you are at my mercy, and you will feel happy only when I tell you to.

And the victims of the narcissist?

We hate the perpetrator of abuse also because he made us hate ourselves. Trying to avert the ultimate act of self-hatred, trying to avoid self liquidation, we "kill" ourselves symbolically by denying ourselves, our thoughts, our feelings. It is an act of magic, a ritual of exorcism, a transubstantiation, a black eucharist of hate. By denying our selves we deny our only possible savior, our only feasible solution and absolution: our selves. We thus hope to avoid confronting the unthinkable, feeling the impossible, committing the irreversible. But, inevitably, it backfires. We feel rage, helplessness, self-contempt, weakness and the temptation of requiting our misery once and for all.

The victims of the narcissist are, thus, unhappy people to start with.

6. Sexual Abuse

Sexual abuse can be interpreted as an extreme form of projective identification, a primitive defense mechanism. The abuser gets in touch with his weaker, needier, younger, immature, dependent, helpless part - the part that he derides, hates and fears - by having sex with a child. A child is weak, and needy, and young, and immature, and dependent, and helpless. Having sex with a child is a mode of communication. The abuser connects to these areas in himself that he abhors, holds in contempt, loathes, and is terrified of, the fault lines of his precariously balanced personality.

The child is forced to play these parts - neediness, dependence, helplessness - by the abuser. The sexual act is an act of auto-erotic narcissism (especially between a parent and his off-spring), an act of having intercourse with one's self. But it also an act of cruel subjugation and submission, a sadistic act of humiliation. The abuser symbollically humbles these parts in himself that he hates, through the agency of the abused child. Sex is to the abuser an instrument of dominance, a transformation of extreme aggression directed at the abuser's self but through a child.

The more "stereotypical" the child - the more "valuable" (appealing) it is to the abuser. If not helpless, needy, weak, dependent, and submissive - the child loses his or her value and function.

7. Punishing Evil

As far as abuse is concerned, there is no relative morality, or mitigating circumstances.
Abusers are NEVER right. They should ALWAYS be punished and severely.
YOU are never to blame. You are not responsible, not even partly.
We do not punish evil people. We punish evil deeds.
We do not lock people up ONLY when they are evil. We more often lock them up when they are dangerous.
You should start not by learning to love.
You should start by learning to HATE.
Learn to hate properly, unabashedly, openly. Flaunt it.

You will then be able to love yourself - but not before.

To my mind, the OVERRIDING emotion is GRIEF because it is a spectrum and one colour in the spectrum is shame. But it is not terribly important as long as you are capable of feeling them all.

8. Psychology

Psychology is lacking in philosophical rigour because it was established by charlatans and by medical doctors (medicine being a heuristic, taxonomic, exegetic-diagnostic, descriptive, phenomenological, and statistical discipline). Not much of a pedigree.

Psychology was founded as the "mechanics" and "dynamics" of the psyche. As physics became more interested in describing the world rather than in explaining it - psychology acquired the added legitimacy to seek similar goals.

Hence the prevailing emphasis on symptoms, signs, and behaviours, and the shift away from scientifically suspect "models" and "theories" (however poetic).

In future, instead of nine criteria one would have to possess two to qualify as a veritable PD. It is progress - but of the horizontal kind.

And to do this we must get rid of the LANGUAGE of psychology because it limits our ability to say anything new, or profoundly fundamental. It IS descriptive and phenomenological. It will not allow for anything else. What is depression if not a list of OUTSIDE correlations, pairs of behaviors/observations? And isn't PTSD another DSM category derived through the same faulty tools?

A clear cut delineation, a line of demarcation, a scientifically rigorous taxonomy is NOT possible even if we employ totally extraneous tools such as "symptoms", "signs", "behaviors", "presenting symptoms", etc. The scalpel is much too thick, the grains much too coarse. We need much more refined analytic AND synthetic tools.

next: Excerpts from the Archives of the Narcissism List Part 16

Interview with Dr. Anthony Spina, founder and president of Knowledge Resources

Anthony C. Spina, Ph.D. has over 25 years business, industry, and education experience in both internal and external consulting. He has broad professional experience in multiple disciplines, such as organizational effectiveness, research, market analysis, training, change management, information technology, and marketing.

He is the founder and president of Knowledge Resources, an organization focused on facilitating transitioning processes for both individuals and organizations attempting to meet the challenges and demands of constantly changing, complex environments. Dr. Spina considers himself a social critic and management philosopher passionately concerned about the societal impact of technology on the way we live and work.

Tammie: What attracted you personally to the voluntary simplicity movement?

Dr. Spina: Approximately fifteen years ago, I started to become very much aware of my lifestyle and of those oround me (friends, neighbors, relatives, co-workers, etc). I continually heard and witnessed how hectic everyone's lives were and how they wanted to get out of the rat race. Compared to living conditions 30-40 years ago, there appeared to be a paradox. We have the most labor saving devices now in society than ever before in history. In the 1980's, all the business journals reported that the problem of the 90's was going to be how to fill up all our leisure time. They predicted a 35-hour work week and that the fastest growing industry would be the leisure marketplace. Needless to say something quite different is in place.

More recently, I stumbled upon the simplicity movement while performing the literature review for my dissertation. Actually, I discovered it during the concept stage and delved deeper into the phenomenon in the initial stages of my research. I was looking into the literature associated with quality of life issues and happiness. The volume of information was sufficient for several lifetimes of research. The topic of simplicity stirred up great curiosity in me and I decided to seek out the potential relationship between this trend and what I was observing in my everyday life. That's when I began reading more of the publications associated with simplicity and my interest grew exponentially into the meaning and processes behind this trend.

Tammie: You indicated in your wonderful article, "Research Shows New Aspects of Voluntary Simplicity" that in all the cases that you studied of individuals who "downshifted" or made significant moves to simplify their lives, there existed a "wake up" call or a triggering event. Were there common themes related to the kinds of events or realizations that served as an impetus for change in the people that you studied? And if so, what were they?

Dr. Spina: Bare in mind that my research was qualitative. If perhaps, I had performed a quantitative study and surveyed thousands of people, then maybe I would have seen a pattern. However, in my research, there were no common, easily identified "triggers." Each was very unique and common to the individual's situation and circumstances. These included events such as divorce, witnessing a tragic event, a vacation in the wilderness, or job loss, to name a few. But we all experience these events in our lives and yet the majority of us do not make major transitions. The "trigger" alone is not enough. The stage has to be set to allow the individual to hear the "signal" when the trigger is fired and take us above the "noise" level.

Tammie: What, specifically, are you referring to when you talk about the "noise" level?

Dr. Spina: The word "noise" was inspired and borrowed from the field of Communication and Information Theory. In layman's terms, recall the time before cable when you had to adjust the rabbit ears on top of your TV to tune in the station, thus resulting in a clear picture and sound. The snow and static, where the "noise" and the picture & sound represented the message which contained information. The greater the noise, the weaker the signal. When the message is unintelligible, information is not transmitted and all meaning is lost.

Using this metaphor to amplify (no pun intended) my research findings, the meaning(s) in our daily living is often drowned out by the noise we experience. This "noise," enabled by many of our modern technologies, takes the form of over-work, the glut of information, consumerism/materialism, mass advertising, and the TV & personal computers. Included in this last category are the cell phones, beepers, laptops, pagers, FAX machines, etc. which blur the line between our work space and personal lives. The signal must emerge from all this noise and can only occur if one is ready and pre-disposed to begin adjusting the "rabbit ears" (I couldn't resist) of our lives to make it happen.

Tammie: Thanks. That's a terrific analogy. You also reported that each participant in your study appeared to experience a process that involved three stages: (1) Pre-transition, (2) Trigger or motivation, and (3) Post-Transition. Would you mind elaborating on these stages just a bit?

Dr. Spina: The pre-transition state is what I observed as a set of conditions or circumstances which had significantly deteriorated the quality of living. It's an awareness state. "I know something is wrong. I am not finding my present life situation to be meaningful, enjoyable, or worthy of being sustained. I am not sure what it is I am searching for, but this isn't it anymore." This is typically the state of mind of one in this pre-transition state. Once again, many of us feel this way from time to time, but when it becomes sustained and there is this mental affirmation that it just won't do anymore. the stage is set. The "noise" level in our lives has become saturated. All that is needed is something to tip the scales, which leads to the next stage.

The trigger or motivation stage is what caused these individuals to reclaim meaning in their lives. It can be what we typically refer to as the "last straw," but more likely, it's something totally more remote. For example, one of my research participants recalled being on a vacation trip which involved a day long kayak trip in which they were only able to take along the bare essentials for life. This event raised their awareness of the excesses in their normal lives. Now this doesn't appear on the surface to be such a mind-blowing event, but coupled with their existing quality of life, this is all it took to send them into the next stage.

Once the participant recognized what is truly important in their lives, the source of noise is easily identified and minimized as necessary. This is what I referred to as the post-transition stage. Here is where the signal or meaning levels are turned up high and the person is now pursuing the lifestyle that was absent from his or her daily living previously. It may involve a geographic move, a divorce, a change of jobs, or all of the above. The most revealing observation I made was that this new direction was really not new at all. It was what these people were all about since their youth, but over the years, the noise, often assisted by our high-tech society, dimmed out.

Tammie: You've explored how technology has served as a trigger or motivator in leading some people to downshift and you offer a very important perspective that I'm hoping you might share.

Dr. Spina: When I began my research, I was seeking a connection between this movement and technology, particularly, information-related technologies. I admitted that my researcher bias was looking to indict technology as the negative motivator.

My first observation was quite the contrary. Several downshifters use technology to help simplify. The most obvious example is using the computer to tele-work or tele-commute, thus working from home, either full or part-time. This allows for more flexible scheduling in one's life and a better balance between work and family. This, of course, assumes the nature of your passion and work allow for this arrangement. Others use email to connect with distance friends and family, as well as other simplicity advocates forming online communities of interest. Personally, having been a technocrat most of my life, I prefer face-to-face encounters over the electronic ones. Yet, look at what's facilitating this dialogue right now and witness the audience that may be exposed to this discussion.

Tammie: You pointed out that the Kellogg company reduced work hours to six hours a day during the depression in order to preserve jobs, and as a result the quality of life for these workers improved significantly. There have been a number of studies it seems that indicate that there's a very definite relationship between fewer work hours and quality of life and yet for the most part, most Americans just keep working longer and harder these days it seems. Why is that from your perspective?

Dr. Spina: Work was identified as one of the greatest examples of "noise." The work-spend-consume-work- spend-consume cycle is ruling the majority of American society. For many, who we are is defined by what we do and what we have. We have a multiplicity of identities. Kenneth Gergen, in his book, The Saturated Self, calls this "multiphrenia." If we need to identify ourselves externally, we will easily sink into the noise levels. In order to buy all those nice accoutrements, we will need to work more to obtain the money to pay for those purchases. The market will gladly accommodate this desire. Advertising and its associated media target just this situation and we respond.

Members of the Voluntary Simplicity (VS) movement transition from an externally identified self to an internally identified self. This is where all the meaning, the signal, resides. It takes courage to do this, because by placing less emphasis on material possessions, one has to identify one's self by what's inside. How many know what that is, since we have been brainwashed to rely on external things for this answer? For those, the majority, who have not come to this realization, they will have to continue to define themselves externally. This means more money, which in turn means more work.

There are many other factors that contribute to overwork, related to economics, globalization, advances in technology, the transforming to a service economy, single parent families, etc. All the people in my research were affected by these conditions as well. Therefore, I have offered my opinion from a more micro level.

Tammie: Your definition of simplicity, "living life to its fullest (by each person's own standards) without harm to the planet or the society," is a wonderful one. How have you applied this definition to your own life?

Dr. Spina: I struggle with this daily. Personally, I have been through the first and second stages of VS, or what I am now calling Intentional Conscious Living (ICL). Almost four years ago, I left my corporate career for more meaningful work. I watch my purchases of material things much more closely than ever before and have become more environmentally aware. I no longer rely on external appearances for my identity, for who "I am." The other members of my family are not necessarily in concert with my new found direction. That has caused conflict and limits on how fast and how deep I can move in the direction of simplification. So I am still executing the third stage of post-transition quality of life. I am certain the path is correct, but uncertain of the challenges ahead. Nevertheless, the "signal" is strong and the meaning is becoming more clear daily. The dependence on money (more than is really necessary) is the most difficult challenge in the face of mortgages, college tuition, etc. All of these can be overcome as is evidenced in the simplicity literature.

Tammie: You've also asserted that perhaps we need a new defining term to describe what we're currently referring to as "the simple living movement" and you've suggested "intentional conscious Living" as an alternative. How might "intentional conscious living" more accurately define this movement?

Dr. Spina: I believe that if VS'ers truly wish to share the experience, meaning, and satisfaction of their newly-found quality of life, the focus should not be on frugality alone or being a tightwad. What I said before, is that many people define themselves by what "they have" and "how they look." If you were to appeal to these folks and encourage them to give these possessions up, you are in reality asking them to give up part of themselves. ICL is not giving up anything. It's getting something back that has been lost. This is the message that needs to be conveyed. Now it may involve, less spending, more environmental awareness, different purchasing options, but this should be an effect not the inspiration for the transition.

When I approach people with the term simplicity, they respond with fear and apprehension. They tell me, "I like spending money and will work hard to get it. I enjoy a day at the mall. I like to have nice things." It is not for me to judge these people as being uninformed or unenlightened. However, if these same people tell me they are unhappy, hate their work, need more time, feel stressed, have little energy for relationships, and wish things were simpler; then they need to live a life that is more mindful, more conscious, more intentional. This is the first message they should hear, not start downsizing!

Tammie: That's a really important point that you've made, and I agree with you. Tom Bender once wrote when addressing the tendency of so many Americans towards overconsumption that, "after awhile more becomes a heavy load." I'm wondering how you would respond to Bender's statement.

Dr. Spina: I think I may have already answered this question. The more toys we have the more attention and maintenance they require, not to mention more time for the additional work needed to earn the additional money to buy "more." So the burden of "more" is hidden in the process to acquire "more." It is a process that is enabled by technology in the form of television and new media advertising. It's what keeps the economy going. It's the whole consumption issue and why it's in place.

Tammie: What advice would you offer someone who's seriously considering simplifying his or her Life?

Dr. Spina: The participants in my study all took their cue from reading two books, "Voluntary Simplicity", by Duane Elgin; and, "Your Money or Your Life", by Joe Dominquez and Vicki Robin. These two works seem to represent the bible of the VS movement. I would also highly recommend that they attend a Simplicity Study Circle or begin one themselves. I recommend the latter and encourage them to read Cecile Andrew's book, "The Circle of Simplicity."

The reason to start one from scratch is based on the original intent of study circles. That is, people coming together to solve a common problem. Then, if downsizing is the goal, the more common themes of VS can be explored. If the issues are focused on more meaningful and conscious living, the group might start on a different footing. This will insure that folks won't be scared away by thinking they have to give up their homes to enjoy life. I also encourage people to "talk it up." You will be surprised to find out how many of us feel the same way but are apprehensive to speak up because we thing we are alone with these thoughts.

You can read Dr. Spina's article, "Research Shows New Aspects of Voluntary Simplicity" in the January-March 1999 issue of the Simple Living Network Newsletter. All correspondence can be directed to Dr. Spina at Knowledge Resources, 19 Norman Lane, Succasunna, NJ 07876 E-Mail: drspina@usa.net

next: Interviews: GRAYWOLF: On Psychotherapy, Consciusness, Healing and Change...

A short story of a woman healing from a bad marriage and physical and emotional abuse.

This is the story about a single woman, a book and a range of mountains. The woman is myself, Molly Turner, fresh out of a women's hostel where I'd spent almost two years getting over a bad marriage to a man who was a victim of drink and drugs.

To my amazement, one morning in 1996, I woke up in the hostel, battered and bruised, again. That much was familiar. But I only learned later that my good friend, Michelle James and her man had pulled me out of being a punching bag for the last time. The hostel had taken me in, thank God, and there I lived until I was able to get some kind of perspective back into my life, pretty much for the first time ever. So that's a sketch of my life. More later.

Before I tell you about the book that helped me so much, you have to understand that living and loving a man who beats on you every day of your life is so exhausting. Mentally, physically and emotionally, I was shattered and broken in so many ways. For hours on end, I'd sit and stare, until someone would come up to me and talk. To describe this in another way, there were no words in my thoughts, just a dumb numbing blank. A complete nothingness.

Unless you've been there, it's hard to explain it. But it always hurts, like the deepest loss imaginable, but you never know quite what it is that's gone.

So when my friend Michelle gave me a book on Sacred Mountains, I was pleased to get it. It looked great, but why? Why mountains? I don't climb. Never have. And I don't plan to. Even now.

"Just read it", Michelle told me, with the smile I've learned to recognize as deep wisdom. Michelle has a habit of doing just the right thing at the right time. "Read it, and let it move you."

So I looked at the pictures, and then began to read a book that literally lifted me away from blank voids and numbing wordlessness, onto a pathway that's given me great things in my life. The book is "Sacred Mountains: Ancient Wisdom and Modern Meanings". The man I have to thank is the author, Adrian Cooper.

Slowly, I began to read about these beautiful peaks and summits that I'd never visited, but which formed new scenes in my mind - in a mind more used to being kicked and punched and shouted at, at any time of the day or night. Even being woken up and finding myself used as a punch bag, to this. Breathtaking ice walls. Glistening, golden rock and hill sides with pure air and green grass.

And poetry. Poetry, a subject I loved at school, but which I'd never studied since I was too small to be of interest to any one. But now I was reading the translated words of Chinese poets telling me about journeys through the clouds. Native Americans telling me about places which are a precious refuge. Africans too, loving their high pathways.

I was beginning to see why Michelle had bought the book for me. I was facing up to some huge mountains in my life. All kinds of recovery. And physical healing was only a part of it. There was a lot of emotional healing I needed too. And Adrian Cooper's book was the guide manual that Michelle wanted me to study to get me through it. Like a 'Life Skills 101' course!

But there is more than poetry in Sacred Mountains. There are women, and men too, from the 1990s, who have been through grief and anxiety and pain, but who also went out to their local mountains and watched and listened, patiently. Patiently learning from these beautiful places. Learning to be patiently at one with the wild. Patiently wild.

So I followed their example. When I was half way through the book, and unable to put it down, and unable to stop thinking about it, Michelle and Ken drove me out to the Sierra Nevada's, a four hour drive away from the city (San Francisco). My feet and legs were still aching from the past, so walking wasn't the best idea. But we drove up toward the Mariposa Grove so I could get out and look down the Yosemite Valley. Learning my first lesson on watching the summits patiently.

To my shame, I broke down and cried. I cried and cried, while Michelle held me like the good friend she is. It was so overwhelmingly beautiful. It was soul-changingly beautiful. It was huge and ancient. And forgotten. But it had to be watched patiently. Nothing there could be rushed. To rush is an insult to the mountains. So always be patient. It's worth it in the end.

How can we possibly be cruel to anyone when there is beauty of this kind on the same planet we share? How could anyone ignore children when there is the need to show them mountains, and rare pathways, and glaciers, and glorious skies. Skies that change so fast toward the end of day you can't imagine the designs you'll see next. Patiently learning to act as a humble, blessed witness to the greatest show on earth. Thousands of feet high, clouds arching above mountain peaks that warm to their touch. And all the time, even when you don't know it, they're lighting fires in your mind.

And yes, I cried again on the way back too. Like a child on the back seat, leaning my head on Michelle's shoulder, sobbing for the beauty I had been shown - by a good friend and a truly great author.

Over the next weeks I finished Adrian Cooper's book and started on his next. And Michelle and Ken took me out to the Sierras every weekend. When my feet and legs got better, our hikes got longer. And what discoveries we made! Don't expect this story to turn into a geography lesson, because I don't remember all the place names. But I also don't think the names matter too much. It's their mystery that left their mark the most. Pure beauty. Honesty. Honest places - rugged, broken with the millennia, but proud to share what they have. Ready to risk being seen in their broken but mighty grandeur.

We discovered water falls that seemed to come down at us from heaven. And the people we met. Smiling hikers from all over the world led to this place by the power of these ancient mountains. Travelers who'd saved for years on end to be here, some of them on once-in-a-life-time visits. Golden Wedding Anniversaries. A need to be here, all of which I can understand now.

If I'd been shown this story before I'd read Adrian Cooper's book, I'm not sure it would have interested me. At that time, mountains, and so much else, had next to no meaning in any part of my life. Punch bags don't often take an interest in their environment, believe me! But now things are different.

We all have our mountains to climb. And that's what the book proved to me. Some of the women who tell their stories in "Sacred Mountains: Ancient Wisdom and Modern Meanings," have lived in situations beyond despair. Men have lived with grief too. So many reasons to travel to these peaks, but they all found healing when they got themselves out to the mountains, learning to watch and listen to their teaching patiently. Always, the secret is patience. So now I understand mountains aren't the exclusive preserve of mountaineers. Mountains are ours. They can be teachers to us all. Everyone. Especially the battered and bruised. All the victims of life can come to these mighty masters of time and find what they need.

So this is the story I wanted to share, about one woman, a miraculous book, and some equally miraculous mountains. And Michelle. As you may have guessed, I've had a lot of help to put this story together. So thank you again Michelle, Ken, Matthew, Gwen, Artie and Laura, you were there when I needed you most.

Lots of love to you all,

Molly Turner

next:Desiderada

Did you know that bad things that have happened to you in your life can cause or worsen psychiatric symptoms? There is more and more research that is confirming the strong connection between traumatic life events and psychiatric symptoms. If you feel this is true for you, medications may help you be able to do some work on this issue (you can decide about that) but there are other things you will need to do. Begin with the following.

1. When you are traumatized, you lose control of your life. You may feel like you still don't have any control over your life. You have to take back that control by being in charge of every aspect of your life. Others, including your spouse, family members, friends and health care professionals will try to tell you what to do. Before you do it, think about it carefully. Do you feel that it is the best thing for you to do right now? If not, you should not do it. It is important that you make decisions about your own life.

2. Talk to one or more people about what happened to you. Make sure it is a person or people who understand that what happened to you is serious and that describing it over and over again to another person is part of the healing process. It should not be a person who says something like: "That wasn't so bad." "You should just forget about it." "Forgive and forget." or "You think that's bad, let me tell you what happened to me." You will know when you have described it enough, because you won't feel like doing it anymore. Writing about it in your journal also helps a lot.

3. You may not feel close to anyone. You may feel like there is no one you can trust. Begin now to develop close relationships with another person. Think about the person in your life that you like best. Invite them to do something fun with you. If that feels good, make a plan to do something else together at another time--maybe the following week. Keep doing this until you feel close to this person. Then, without giving up on that person, start developing a closer relationship with another person. Keep doing this until you have close relationships with at least five people. Support groups and peer support centers are good places to meet people.

4. If you possibly can, work with a counselor or join a group for people who have been traumatized.

5. Develop a Wellness Recovery Action Plan so you can do what you need to stay well, and so you can effectively respond to symptoms whenever they come up.

Read the self-help book on relieving the effects of trauma that I wrote with Maxine Harris.

next: Developing Your Post-Crisis Plan
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Article discussing relationship between body image and shame in women.

by Brené Brown, Ph.D., L.M.S.W. author of I Thought It Was Just Me

We often want to believe that shame is reserved for the unfortunate few who have survived terrible traumas, but this is not true. Shame is something we all experience. And, while it feels like shame hides in our darkest corners, it actually tends to lurk in all of the familiar places. After interviewing over 400 women across the US, I learned that there are twelve areas that are particularly vulnerable for women: appearance and body image, motherhood, family, parenting, money and work, mental and physical health (including addiction), aging, sex, religion, surviving trauma, speaking out and being labeled or stereotyped.

Interestingly, there are no absolutely universal shame triggers. The issues and situations that I find shaming may not even come up on another woman's radar. This is because the messages and expectations that drive shame come from a unique combination of places including our families of origin, our own beliefs, the media and our culture. One place where women find themselves surrounded by unattainable and conflicting expectations is body image.

While some of us might have quieted the tapes about "not being smart enough" or "not being good enough" -- it seems that almost all women continue to wage battle with looking "beautiful, cool, sexy, stylish, young and thin enough." With more than 90% of the participants experiencing shame about their bodies, body image is the one issue that comes closest to being a "universal trigger." In fact, body shame is so powerful and often so deeply rooted in our psyches that it actually affects why and how we feel shame in many of the other categories, including sexuality, motherhood, parenting, health, aging and a woman's ability to speak out with confidence.

Our body image is how we think and feel about our bodies. It is the mental picture we have of our physical bodies. Unfortunately, our pictures, thoughts and feelings may have little to do with our actual appearance. It is our image of what our bodies are, often held up to our image of what they should be.

While we normally talk about body image as a general reflection of what we look like, we can't ignore the specifics -- the body parts that come together to create this image. If we work from the understanding that women most often experience shame when we become trapped in a web of layered, conflicting and competing expectations of who, what and how we should be, we can't ignore that there are social-community expectations for every single, tiny part of us -- literally from our heads to our toes. I'm going to list our body parts because I think they are important: head, hair, neck, face, ears, skin, nose, eyes, lips, chin, teeth, shoulders, back, breasts, waist, hips, stomach, abdomen, buttocks, vulva, anus, arms, wrists, hands, fingers, fingernails, thighs, knees, calves, ankles, feet, toes, body hair, body fluids, pimples, scars, freckles, stretch marks and moles.

I bet if you look at each of these areas, you have specific body part images for each one -- not to mention a mental list of what you'd like it to look like and what you'd hate to have a specific part look like.

When our very own bodies fill us with shame and feelings of worthlessness, we jeopardize the connection we have with ourselves (our authenticity) and the connection we have with the important people in our lives. Consider the woman who stays quiet in public out of the fear that her stained and crooked teeth will make people question the value of her contributions. Or the women who told me that "the one thing she hates about being fat" is the constant pressure to be nice to people. She explained, "If you're bitchy, they might make a cruel remark about your weight." The research participants also spoke often about how body shame either kept them from enjoying sex or pushed them into having it when they didn't really want to but were desperate for some type of physical validation of worthiness.

There were also many women who talked about the shame of having their bodies betray them. These were women who spoke about physical illness, mental illness and infertility. We often conceptualize "body image" too narrowly -- it's about more than wanting to be thin and attractive. When we begin to blame and hate our bodies for failing to live up to our expectations, we start splitting ourselves in parts and move away from our wholeness.

We can't talk about shame and body image without talking about the pregnant body. Has any body image been more exploited in the past few years? Don't get me wrong. I'm all for exploring the wonders of the pregnant body and removing the stigma and shame of the pregnant belly. But let's not replace that with one more airbrushed, computer-generated, shame-inducing image for women to not be able to live up to. Movie stars who gain fifteen pounds and have their stretch marks airbrushed for their "Look! I'm human too!" portraits do not represent the realities that most of us face while pregnant.

Parenting is also a shame category affected by body image. As an admittedly vulnerable, imperfect parent, I'm not one to jump on the "blame parents for everything -- especially the mothers" bandwagon. Having said that, I will tell you what I found in my research. Shame creates shame. Parents have a tremendous amount of influence on their children's body image development, and girls are still being shamed by their parents -- primarily their mothers -- about their weight.

When it comes to parenting and body image, I find that parents fall along a continuum. On one side of the continuum, there are parents who are keenly aware that they are the most influential role models in their children's lives. They work diligently to model positive body image behaviors (self-acceptance, acceptance of others, no emphasis placed on the unattainable or ideal, focusing on health rather than weight, deconstructing media messages, etc.).

On the other side of the continuum are parents who love their children just as much as their counterparts, but are so determined to spare their daughters the pain of being overweight or unattractive (and their sons the pain of being weak) that they will do anything to steer their children toward achievement of the ideal -- including belittling and shaming them. Many of these parents struggle with their own body images and process their shame by shaming.

Last, there are the folks in the middle, who really do nothing to counter the negative body-image issues but also don't shame their children. Unfortunately, due to societal pressures and the media, most of these kids do not appear to develop strong shame resilience skills around body image. There just doesn't appear to be any room for neutrality on this issue -- you are either actively working to help your children develop a positive self-concept or, by default, you are sacrificing them to the media- and society-driven expectations.

Power, Courage and Resilience

As you can see, what we think, hate, loathe and question about our bodies reaches much further and affects far more than our appearance alone. The long reach of body shame can impact how we live and love. If we are willing to examine the messages and practice empathy around body image and appearance, we can start to develop shame resilience. We can never become completely resistant to shame; however, we can develop the resilience we need to recognize shame, move through it constructively and grow from our experiences.

Across the interviews, women with high levels of shame resilience shared four things in common. I refer to these factors as the four elements of shame resilience. The four elements of shame resilience are the heart of my work. If we are going to confront the shame we feel about our bodies, it is imperative that we start by exploring our vulnerabilities. What is important to us? We must look at each body part and explore our expectations and the sources of these expectations. While it often painful to acknowledge our secret goals and expectations, it is the first step to building shame resilience. We have to know and explicitly identify what's important and why. I believe there is even power in writing it down.

Next, we need to develop critical awareness about these expectations and their importance to us. One way to develop critical awareness is to run our expectations through a reality-check. I use this list of questions in my work:

• Where do the expectations about my body come from?
• How realistic are my expectations?
• Can I be all these things all of the time?
• Can all of these characteristics exist in one person?
• Do the expectations conflict with each other?
• Am I describing who I want to be or who others want me to be?
• What are my fears?

We must also find the courage to share our stories and experiences. We must reach out to others and speak our shame. If we feed shame the secrecy and silence it craves -- if we keep the struggles with our bodies buried inside -- the shame will fester and grow. We must learn to reach out to one another with empathy and understanding. If, in a diverse sample of women ages 18 - 80, over 90% of the women struggled with body image, it is clear not one of us is alone. There is a tremendous amount of freedom that comes with identifying and naming common experiences and fears -- this is the foundation of shame resilience.

Copyright © 2007 Brené Brown

About Brené Brown, Ph.D., L.M.S.W., is an educator, writer, and nationally renowned lecturer, as well as a member of the research faculty at the University of Houston Graduate College of Social Work, where she recently completed a six-year study of shame and its impact on women. She lives in Houston, Texas, with her husband and two children.

She is the author of I Thought It Was Just Me: Women Reclaiming Power and Courage in a Culture of Shame. Published by Gotham Books. February 2007;$26.00US/$32.50CAN; 978-1-592-40263-2.

For more information, please visit http://www.brenebrown.com/.

next: Articles: The Magic of Appreciation