Getting Off The Rollercoaster

All creations originate as a thought. What was once a concept for someone, now becomes discernible reality to another. To ponder the implications of that sentence are incredible. Ask yourself...

"What is a thought ?"

How does one define the source of all definitions. How do you put into words, that which gives birth to words. Through consciousness, an individual is able to experience or feel a need for something... and then understand a way in which it is able to be brought into reality.

When we talk of creativity, we might immediately tend to think of a painting, a sculpture, or perhaps a piece of music, but these are only examples of refined creativity. All of us have resourcefulness and innovation, so to say that "I'm not a creative person", is only to compare yourself to other people whose creations expand outside their own immediate world.

Sometimes we can be resentful of an apparent lack of talent in a some area, and then allow this thinking to dominate the conception of our overall abilities. Through unawareness, we assume that no talent in one area shall hold true for all others. However, for every path in Life, there is a talent appropriate to serve that particular need. When we discover the talent that resides within us, we can be sure that we will find the same joy and fulfilment that others have found throughout the many and varied walks in life.

To talk of the talent of Mozart or the talent of Mother Theresa, would eventually bring you to a common quality that each in their own way have found. When someone's talent is uncovered, they will be found to be doing what they know is good and what makes them feel good. They are free in the use of the energies that propel their wants as they do what comes easily and instinctively. When any such task is then completed, the feeling of contentment and satisfaction is the universal characteristic that serves in the continuation of expressive desires.

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Through my training in Electronics, I have obtained all the understandings of Color Television to such a degree that I am now able to repair them, yet I still marvel at this invention and its theory of operation. It never ceases to be a source of delight and wonder that someone could conceptualise such a device and bring it into reality. When I look at a city skyscraper in the making, I see ingenuity unlimited. I see skill, wisdom, and talent. I see the tools employed to do all the various jobs. I hear an electric drill whining away and think of it's motor driven by a strange mysterious force called electricity. I think of someone trying to understand how a mysterious magnetic field would have to be employed to make such a device spin at high speed. I imagine the joy of the Architects at seeing their creation grow before their very eyes. What started out as someone's dream, has now been given the ability to be touched by the hand of another. When someone designs a car and oversees all aspects of its production, that person will then see their dream unfold before their very eyes. Eventually, they will end up sitting inside their own dream. In all these examples, what began as a seed in the mind of one, becomes available for the discernment of another.

In the early days of my songwriting development, I would get immense pleasure from each of my new creations, however, there was a time when the flow of exciting new material would stop. I began to get anxious and very concerned that my days as a composer were limited. The enthusiasm and joy of my early efforts was replaced by a quietly disheartening concern as time passed by without any new songs. Thoughts such as ...

"I'll never be able to write again."

or

"It was too good to be true",

...would very often enter my mind. Fortunately I was graced with more inspirations and many more songs, and it taught me that one's creativity ebbs and flows. I ponder these particular thoughts and see also how my life has its own Ebb and Flow.

The energy I put into my music can be enormous, and very rarely will I write a song in a flash. Though the mechanics of putting pen to paper as the energy expresses itself seem to make the song appear in no time, the thoughts that are dwelling in me require a kind of "slow to moderate" temperature setting to be used. This cooking process of my musical creations is all very strange; sometimes my creative thoughts are working on a subject without me even realising it. An event in the past can be a trigger to a way of thinking so discreet, that another prompt from some other related part of the original event will make the creation gel and a song will then be born.

From this I now recognise that we have many types of experiences and we can learn from all of them. For a time, things happen inside us as we unconsciously consolidate events which have come our way. Afterwards, we then find we are able to explain our feelings so as to express them knowledgeably. It like our batteries are on charge or something is cooking. For myself, this process works in all areas of my life, and especially where I have an output that I want to be shared. Instinctively, I feel it will be the same for you.

FINDING YOUR TALENT:

To be able to find peace in yourself with regard to talent, you must understand what aspect of your nature you know is good, and then go about bringing this goodness to other people. To begin believing that you have talent and great creativity, will then liberate the state of mind to allow these jewels to be revealed. You will affirm your creativity just as you are affirming your goodness and Love. By calling on these qualities within, you then allow your creativity to come forth through your positive attitude.

CREATIONS OF THE EGO:

Since being creative requires effort, conditioned thinking through a fear of the necessary energy, can easily be seen as causing the death of countless wonderful ideas. When negative thinking is allowed to continue whenever creative thoughts are born, the ability to be expressive through the creative process is suppressed as the energies that were available to the development of ideas, become lost, or get redirected into other areas. When creative urges are withheld from evolving, a way of thinking is then formulated which sees oneself as being a non creative person.

Sometimes we say that "It is too hard!" and indeed, many times things are "Too hard", but even as we say these words, we let something very valuable go unnoticed. When we kill an idea by thinking like this, we have become a victim of Ego thinking. We never said it was impossible, we only said it was "Too Hard". We were unthinking in the words that formulated in our minds and allowed a fear to guide our wants, our energies, and our happiness. It was a fear of effort. It was subtle and quite nonchalant, but it was a fear. It was the Ego acting upon a situation by wanting to make things go easy for us. Remember once again... Ego will think for the situation of the moment and give us options to keep things uncomplicated for us. It does not consider future reward from effort. It has no patience, and it would be happy to let us sleep for the rest of our lives.

KNOWLEDGE WITHIN:

Through the ongoing process of learning and employing our acquired knowledge, we are able to bring into our lives the products of our thinking. By this understanding, we can now see that all actions are creations, since all creations originate as thoughts. The action of doing mirrors our thinking, so it is now open to us that we create our own life. Through our behaviour modelled on our thinking, we can, and do bring about the things that are a part of our life. Even fear based ways of thinking still have the ability to create, and it is through this that we are able to appreciate how we can create our own problems; negative situations; or even chaos. When we act from Love based thinking, our thoughts, and therefore our creations, bring good things into our lives as well as the lives of others. Since the fruits of our efforts originated through thoughts which centred from Love, we allow the creative outputs of other Love based thinking people to infiltrate and inspire our own Life even more.

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When we act in Love in all things, our Love based way of thinking follows the direction of our True Self and we bring forth great changes and opportunities into our life. We are CREATING a new life for ourselves and others who will be a part of this new life. People will see good things come into our life and respond by wanting to know how it is that we have such things. Our Love will now open up doors for us that would otherwise have stayed closed. The reason they were closed is revealed by an understanding that we had nothing to offer those who were behind such doors before, and they in turn, had nothing to offer us. What we would've found while we were slaves of Ego thinking would not have interested us one bit.

Goodness is throughout the world, and when we have something good to contribute, the world eagerly opens its arms to the good things we have to give. To those who want good things, the world is also just as eager to give. Affirm an abundant and prosperous life for yourself. The truest Love knows no limits.

By having the want to be a part of good things, you naturally encounter others who also know of and seek out good things. Our Good thoughts create good opportunities and we then become a part of the true creation process. We become equal creators with God since we are both motivated by Love. We both work for the good of humankind, we both work for the highest good, and we have justifiable pride in our accomplishments.

We are now Co creating with God.

When we see our Spiritual link with life, it affects all aspects of our life. Our True Self is then able to work for us in a truly integrated way. We will then allow all such aspects to mirror our life. We have re-Created our life through the creation of a new unity, and it is this new unity that will bring us a new Peace.

EQUALITY FOR ALL PEOPLE IN ALL THINGS:

Since we are equal with all things in creation, all creations originating from our thoughts are equal in magnificence to any singular creation that has ever been or ever will be. Regardless of whether the creation is tangible or abstract, complex or simple, subtle or striking. To open our minds to the possibility of limitless horizons is in itself another great creation. Through the stillness of Love we are able to listen to our thoughts and know that some how, we will find a way to bring about the ideas that feel good and true for us. Our efforts will even have an ability to go on and inspire creativity in others.

Good creativity does not restrict itself to the fine arts, but is more precisely defined by the goodness it gives firstly to yourself and then of course to others. To be able to share your goodness and Love based ideas with another person is to know that your creative abilities are fully functioning. Creativity is universal in its output. There are no border lines, there are only horizons; so if you wish to travel beyond those horizons, you can do so by expanding your knowledge through learning.

THE VARIOUS NATURES OF CREATIONS:

Some creations are abstract such as Music. You do not have the creation totally at your disposal as you do with a painting. To experience music you have to add the dimension of time, and it is the soul which takes in the quality of the creation. When you look at a painting, you have the entire concept delivered to you at once. Though we are able to study it in detail later on, when we first look at a picture, we know exactly what it is all about. Once again our soul takes in the quality of the creation but this time, it has a physical manifestation of canvas and paint. Books are like songs since they unfold and tell us a story, but it's complexity is increased since a book is complete and fully available to us, yet we need to take time to read it through.

When a musical instrument is played live, each instant that passes is pure newness. There is nothing of what was or what of is to come as in the case of a book. The creation is fully enjoyed by being in "THE NOW". When people share a meal together, they partake in the unfolding of the efforts and talents of the person who created the meal. Here it is our body that enjoys the creation. It is tangible, and we needed time to enjoy it. If the meal was a romantic dinner for two, then an added feeling of contentment at the soul level would also exist.

Creations can take any form by being Abstract or Physical, and the enjoyment can also be Abstract or Physical. To lead an inspirational life is Abstract in the giving and receiving, as seeds of creativity are laid everywhere you go. By developing your own Love, you are then able to give a gift so precious, that it far surpasses the greatest creation that has ever taken a form in the physical. When we create a life of Love for another by our own example, we create freedom and peace for other people. To be able to create happiness for someone who is sad is a great thing. To be able to teach someone how to create a good life for themselves is a wonderful thing. When one shares their new knowledge for the good of others so they are able to pass this ability on, it then demonstrates how thoughts themselves are tremendous creations.

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Any talk of creations and creating is not complete without the mention of bringing children into the world. Of all the greatness that exists in the previously mentioned examples, to bring a child into your life and nurture it with Love and caring, is in my mind an incredible achievement for any individual. To remember that children are but clay in the hands of the potter, we then find ourselves with an awesome ability to mould children into any shape at all. When we employ the design based on Love and also add our own way of Loving in this moulding process, we know we are part of the creation process of A LIFE. It is a life modelled in Love which allows our own Love to continue even after our time here has passed. By devoting our efforts to raising a child in Love, we give a gift to the world... we have created a Life from the Goodness of Life for the Glory of Life.

CREATIVITY AND "THE NOW":

Through understanding the value of expressing your creativity, it is clear that the goodness you give, shall come back to you in goodness from other things. But to be efficiently creative on a regular basis, we need to return to the concept of "THE NOW". Your creativity can only exist in the present, and when we dwell on past or future events to much, we have in essence missed a lovely visitor who came to call on us. When we create, we are one with our thoughts as we conceive. We are developing newness, and to do this properly, we need to have at hand the full use of our abilities.

When we project out of the present, we are living out a pre-formulated series of events that has no room for growth. What was, will always be and therefore can never be modified or altered. All we end up doing is going around in circles to re-invent the wheel.

In the present, we have at our disposal "Peace" as our greatest asset and from this state of well being, we have an enormous potential for variety to then help us in the process of creating. With clear vision and good intent, we can be sure that the concept that was seeded in our minds, will allow us to bring forth our desires into reality.

ENJOYING THE CREATIONS OF OTHERS:

I once heard Music described as "The Flower of Feeling". I also think of it as a fruit of the Soul, but for some people, it is food for the Soul. As mankind came out of the swamps and lit the first camp fires, perhaps the primitive percussion music of sticks and logs became the primeval language. For myself, I feel that through music, man connected with the spiritual essence, since music can speak in ways that spoken language cannot express, and though he may not have known it, it might have been the first form of prayer. Even today as we listen to an instrumental piece or even a song in another language, a quality of feeling still manages to be understood by our heart and soul. Our minds are able to set the scene in a most perfect way, and through that peace, we are able to drift away with the notes to become part of the creation.

Since music is a form of communication, we can use this concept to try and understand what might have been the motive of writing a piece of music. Through calling on our awareness, we can then ponder the efforts and talents that have gone into all the various productions of music. We can ask why is it that the given title was used. We can go with the flow and feeling in the tune and listen to the passion in the words. Every now and then, try to go deeper that your daily routine might allow...take time out to unwind. If you are musical, let the talent of others nurture your own talent so as to produce that "Fruit of the Soul". If you are not musically gifted, then let that "Fruit" be "Food" for your own soul.

Music can be used as a very powerful tool to bring you peace. Listen to gentle music if you don't already, and get into the soul behind the creation. When you bring peace to yourself through such actions, you have actually created Peace for yourself; Yes!...you have Created, and such a creation is priceless.

Allow your own creativity to be enhanced by the creations of others. Look deeper into the work so that the meaning and motivation in the work may enable you to find an inspiration for your own creativity. There are very few people who are able to claim total originality, so to admit inspiration from another source only highlights your own awareness, and also gives a deserving credit to that other persons abilities and efforts.

CONTEMPLATION:

Your Love and it's fruits,
will be your greatest Creation.

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next: Getting Off the Roller Coaster The Peaceful Balance.

Specialized clinics combine traditional and alternative therapies for treating fibromyalgia and chronic pain. Discover new ways to overcome pain.

Open the newspaper or flip on the TV and you'll see accolades for doctors' many miraculous abilities. They can separate conjoined twins, reattach severed limbs, and shuffle organs between patients like peas in a shell game. But sit down with someone whose body is racked with the pain of osteoarthritis, migraines, or fibromyalgia, and the shortcomings of traditional medicine become blindingly clear. The humbling fact is that at least 50 million Americans live in chronic pain, and the vast majority are pretty much at its mercy. The hallmarks of daily life—work, sleep, raising families—become enormous challenges, and as if that's not enough, most pain patients also grapple with depression. "Chronic pain can swallow you up and steal your identity," says Penny Cowan, founder and executive director of the American Chronic Pain Association in Rocklin, California. "So many of us base who we are on what we do, on our abilities. When that is taken away, you become an un-person." Unfortunately, chronic pain patients have traditionally been the Achilles' heels of Western medicine. They're hard to diagnose—pain is by its nature subjective, and can't be located on an X-ray or under a microscope—and conventional treatments are fraught with risk. And painkillers like nonsteroidal anti-inflammatories, opioids, and morphine come packaged with a slew of side effects as well as some addictive properties, which can be more disruptive than the pain itself. No wonder pain sufferers are often perceived as "difficult": Who wouldn't get cranky under such frustrating circumstances?

The uneasy relationship many chronic pain patients have with doctors is driving them into the arms of alternative healers. In fact, pain is the number one reason people use alternative medicine, according to the Journal of the American Medical Association. Some therapies, such as acupuncture, biofeedback, and massage, are scientifically proven to reduce certain types of pain, while others, like reiki and meditation, can help a person get a handle on the emotional demons that chronic pain unleashes.

But while it's tempting to paint a two-dimensional picture—conventional medicine bad, alternative medicine good—it's also dangerously simplistic. A naturopath who tells a patient her pain will vanish with the right combination of supplements is just as irresponsible as a doctor who dashes off a prescription for opiates before running out the door. If ever there was a condition that calls for a truce between the two schools of thought, it's chronic pain.

Enter James Dillard, a specialist in integrative pain management and the author of The Chronic Pain Solution. Trained first as an acupuncturist and chiropractor and only later as a physician, Dillard believes an integrative approach is especially important for people who struggle with chronic pain. "Because they suffer on so many levels—physically, emotionally, and psychosocially—you can't treat chronic pain with a single therapy," he says. "You have to have a compassionate, healing relationship with the whole person."

That's precisely what patients can expect at the Center for Health and Healing at Beth Israel Medical Center in Manhattan, one of several integrative pain clinics across the country, where Dillard practiced until recently. (He has since taken a position at Columbia University School of Medicine.) There, in serene feng-shuied offices high above the Midtown bustle, general practitioners, internists, and psychotherapists share space and information with acupuncturists, aromatherapists, and reflexologists. And the payoff is more than just feel-good reassurance. "By using conventional pain tools judiciously and adding complementary therapies," Dillard says, "you can lower drug dosages, reduce side effects, and often bring down medical costs."

Dillard's patients run the gamut from Upper East Side matrons to Lower East Side artists, and at the core of his approach is an open mind. "You don't have to wear robes, chant, or drink wheatgrass juice," he says. "Just take conventional medicine and shove it a little to the left."

Or shove alternative medicine to the right. In fact, Dillard often leans heavily on prescription drugs in the early stages of treatment. "Sometimes they're absolutely necessary just to get people going again and give them hope that they can feel better," he says. Once the pain has receded from center stage, Dillards brings up complementary pain management tools, such as acupuncture, chiropractic, meditation, and biofeedback. By covering all the bases—calming the mind, stretching the muscles, soothing inflammation, and manipulating the skeleton—Dillard hopes to begin addressing pain at its roots instead of just muffling its voice with painkillers.

Below are stories of three of Dillard's patients, all of whom suffered years of torment before finally getting a grip on their pain. By the time they got to the Center for Health and Healing, some had already begun to experience relief by way of alternative therapies they'd found on their own. In all cases, Dillard added some essential ingredients to the mix, and sent his patients on their way with tools for weathering the inevitable storms that chronic pain can stir up. Even the integrative approach is no easy fix—but for some it's clearly the best chance medicine has to offer.

In 1995, Fred Kramer, a 44-year-old registered nurse, was in a minor auto accident from which he walked away unhurt. Or so he thought. The next morning, his left shoulder was in such pain that he could barely move his arm, so he tossed back a couple of Motrin, put on an ice pack, and called in sick. After a couple of days on the couch, however, he grew impatient and hauled himself back to work, still in pain.
Two months after the accident, the searing pain had put an end to all but the mildest activities. On a friend's suggestion, Kramer saw an orthopedic surgeon, who sent him home with the pat advice to "give it time." But in the end, time became Kramer's biggest enemy.

A year after the accident, a coworker casually suggested Kramer's injury might be myofascial pain syndrome (MPS). Often accompanying another injury, MPS results when muscles lock themselves into place to protect a part of the body from injury, forming a shield of sorts. Over time the tension slows circulation to the muscles. Without sufficient blood, the cells become starved for oxygen, and strained nerves send the brain increasingly loud pain signals. As the muscles tighten, so do the surrounding sheaths of tissue, called fasciae. Unless the muscles are coaxed back into relaxing soon after the injury, the initial problem can spiral into greater levels of pain and continuing loss of mobility.

Kramer, relieved to have an actual diagnosis, began chiropractic treatments that he hoped would unlock his tight muscles. They helped, but not enough, and by this time he had become seriously depressed. "I never felt like myself," he says. "The pain gnawed at me every day. I was functioning, but only doing what I had to do to survive."

Then, as he puts it, the events of September 11, 2001, knocked the self-pity right out of him. "That experience lit a fire under me," he says. He began seeing a physical therapist, who used trigger point therapy to goad his frozen muscles into melting back into position. Trigger points are knots of muscle tissue caused by long-standing tension that can send waves of pain into neighboring muscles. A therapist will use his or her fingers to put deep, steady pressure on a point for several minutes at a time. In addition to these sessions, the therapist helped Kramer rebuild the shoulder's strength and mobility.

Last fall, after seeing James Dillard's PBS special on pain titled Chronic Pain Relief, Kramer made an appointment at the Center for Health and Healing. To get the chi flowing to the shoulder, Dillard suggested he add acupuncture to his regimen. He also recommended omega-3 fatty acid supplements, which are known for their anti-inflammatory properties as well as their ability to combat the blues.

Today Kramer is nearly pain-free for the first time in eight years. Instead of singling out a specific alternative treatment, he credits them all.

"So many doctors told me I could have this pain for the rest of my life," he says. "Thank God I'm finally starting to see the light at the end of the tunnel."

Meredith Powers. t 40, Meredith Powers blends in easily with the 20-something students at a café near a Manhattan university. Only her red-rimmed eyes, nervous energy, and habit of holding herself closely, as if cradling a delicate sculpture, reveal her history of chronic pain.

As a competitive swimmer throughout high school and into college, Powers was not one to be sidelined by pain. When the gnawing sensation in her shoulders first got her attention, she simply kept going. But eventually she had to shelve her swimsuit for good, and her pain went away. A year later it was back, though she's hard-pressed to say why. Maybe it was the typing, driving, or holding a book to read—all things she can no longer do comfortably. Six years later, she's still struggling to get a handle on her suffering. "I can't do anything with my shoulders or arms," she says. "I'm in agony."

Powers began her search for relief with conventional care, but results of MRIs, X-rays, and blood work all came back normal. Her case befuddled every doctor she called on. Her default diagnosis was tendonitis, but when the standard treatments for that ailment didn't work—rest, ice, and anti-inflammatories—she became very depressed.

On a doctor's suggestion, Powers got herself to the Center for Health and Healing, where Dillard decided to try a shotgun approach. He started with acupuncture to reduce the inflammation and later added chiropractic adjustments to open up the shoulder joint.

He also sensed that Powers would benefit from a more mind/body type of therapy and recommended hypnotherapy. A clinically proven way to reduce blood pressure, lower heart rate, and decrease stress hormones, hypnotherapy works by guiding a person into a trancelike state where he or she becomes highly receptive to the power of suggestion.

Powers responded well. More important, the hypnotherapy warmed her to the idea of using a variety of mind/body practices to fight her pain. Last year she had her first real breakthrough when treated with reiki, a form of energy healing that originated in Japan.

"Reiki reduced my anxiety, lessened my pain, and improved my mood," she says. Powers has since added daily meditation and self-guided imagery to her routine.

"I'm learning that my pain isn't something I'm going to fix," she says. "But reiki has given me my first real hope that I can get through it."

4 New Ways to Relieve Pain

If alternative medicine standbys like acupuncture, biofeedback, and massage don't ease your pain, there are some new options that might. Some use modern technology; others require nothing more than a little sugar water and a few needles. They're not yet backed by stacks of scientific studies, but many practitioners report using them on their patients with great success. Low-Level Laser Therapy (also known as cold laser therapy)

What it is: Low-level lasers emit a specific wavelength of light that penetrates several inches below the skin, where it decreases inflammation and muscle spasms and increases blood flow and production of ATP, the body's all-purpose energy molecule. According to Robert Bonakdar, a physician and director of pain management at the Scripps Center for Integrative Medicine in La Jolla, California, low-level lasers provide more than just pain relief. "They actually help the tissue heal," he says.

What it's good for: Low-level laser therapy was recently approved by the FDA for a wide range of conditions, including arthritis, carpal tunnel syndrome, muscle and joint pain, and muscle spasms.

Where to find it: Bonakdar uses one of the most common types of low-level laser therapy, called the SportLaser. To find the nearest physician with a SportLaser, look on www.sportlaser.com. However, other types of low-level lasers exist; to learn more about the therapy, visit www.laser.nu.

Electrical Field Stimulation

What it is: The ancestor of the field is static magnet therapy, in which magnets worn on the body are said to promote healing through a variety of possible mechanisms, including increasing blood flow and balancing the body's energy patterns. But in the latest version, a number of devices deliver actual electric current or pulses of electromagnetic energy. Transcutaneous electrical nerve stimulation, or TENS, has been in use for a while. One of the newer additions is the BioniCare Bio-1000, which sends microelectric currents into arthritic knee joints, reducing pain and possibly even spurring production of new cartilage. "I think it's going to be pretty revolutionary for people with osteoarthritis in their knees," Bonakdar says. He's also excited about a machine made by Magnatherm that generates pulses of electromagnetic energy to heat the tissue.

What it's good for: The Bio-1000 is the first noninvasive, nondrug treatment approved by the FDA to treat arthritis of the knee, and the company is currently developing machines to treat arthritis in other areas of the body, too. The Magnatherm device is good for chronic pain in hard-to-treat areas, such as the lower back and pelvis, Bonakdar says, as well as for specific types of pain such as tendonitis and bursitis.

Where to find it: To find a physician with access to BioniCare Bio-1000, you'll have to call the company at 866.246.5633. The same is true for the Magnatherm device; the number is 800.432.8003.

Prolotherapy

What it is: This simple therapy involves the injection of a concentrated solution—usually dextrose—into an aching joint. The sugar water is thought to set off an inflammatory response, which can jump-start the body's own healing process. Once popular among orthopedic surgeons, prolotherapy fell out of favor with the advent of surgical techniques. But according to Chris Centeno, a physician and director of the Centeno Clinic, in Westminster, Colorado, many studies have shown it to be effective.

What it's good for: Injured or aging tendons and ligaments, particularly in small, gliding joints like the jaw, wrist, elbow, knee, and ankle.

Where to find it: Most major cities have at least a few prolotherapy practitioners. To find one, go to the website of the American Association of Orthopaedic Medicine: www.aaomed.org.

Intramuscular Stimulation (IMS)

What it is: Intramuscular stimulation is not for the faint of heart: A practitioner inserts acupuncture needles from one-half to two inches deep to reach what are known as muscle motor points, or areas where nerves are concentrated in the muscle. The needle pokes a tiny hole in the muscle membrane, triggering the muscle to contract and eventually release.

What it's good for: IMS is used to treat chronic soft tissue pain caused by muscles that have permanently shortened after an injury or repeated stress. According to Centeno, IMS is an effective last resort for those who have exhausted other options.

"Our average IMS patient has struck out with chiropractic, physical therapy, massage, and acupuncture," he says. "The results in this population are amazing."

Where to find it: Although intramuscular stimulation has been around for decades and is common in Canada and Europe, just a handful of trained practitioners exist in the United States, and more than half of them work at Centeno's clinic (www.centenoclinic.com). The others can be located on www.istop.org. It's important to find a qualified practitioner, Centeno points out, since inserting needles that deep requires extensive training.

Source: Alternative Medicine

back to: Complimentary and Alternative Medicine

Learn about guided imagery, an alternative treatment for depression, anxiety, insomnia, bulimia and other mental health - health conditions.

Before engaging in any complementary medical technique, you should be aware that many of these techniques have not been evaluated in scientific studies. Often, only limited information is available about their safety and effectiveness. Each state and each discipline has its own rules about whether practitioners are required to be professionally licensed. If you plan to visit a practitioner, it is recommended that you choose one who is licensed by a recognized national organization and who abides by the organization's standards. It is always best to speak with your primary health care provider before starting any new therapeutic technique.

1. Background
2. Theory
3. Evidence
4. Unproven Uses
5. Potential Dangers
6. Summary
7. Resources

Background

Historically, imagery has been used by many cultural groups, including the Navajos, ancient Egyptians, Greeks and Chinese. Imagery has also been used in religions such as Hinduism and Judaism. The term "guided imagery" refers to a number of different techniques, including visualization; direct suggestion using imagery, metaphor and storytelling; fantasy and game playing; dream interpretation; drawing; and active imagination.

Therapeutic guided imagery is believed to allow patients to enter a relaxed state and focus attention on images associated with issues they are confronting. Experienced guided imagery practitioners may use an interactive, objective guiding style with the aim to encourage patients to tap into latent inner resources and find solutions to problems. Guided imagery is a meditative relaxation technique sometimes used with biofeedback. Books and audiotapes are available as well as interactive guided imagery groups, classes, workshops and seminars.

Theory

It is proposed that the mind can affect the body when visualized images evoke sensory memory, strong emotions or fantasy. Imagery has been said to cause many types of changes in the body, including alterations in breathing, heart rate, blood pressure, metabolism, cholesterol levels and functions of the gastrointestinal system, immune system and endocrine system. A goal of guided imagery is to use the senses of touch, smell, sight and sound to achieve a tranquil state that may help reduce or eliminate physical symptoms.

Evidence

Scientists have studied guided imagery for the following health problems:

Headache
Initial research suggests that guided imagery may provide added benefits when used at the same time as standard medical care for migraine or tension headache. Some studies show that relaxation therapies, including use of guided imagery, may be as effective or more effective in reducing the frequency of migraine headaches than are modest doses of a beta-blockade medication. Other study results disagree. Further study is needed to make a strong conclusion.

Cancer
Some studies suggest that guided imagery techniques (such as relaxation and imagery training tapes) may improve quality of life and sense of comfort (mood, depression) in cancer patients. Further research is needed to confirm these results.

HIV
Initial evidence suggests that occasional use of guided imagery techniques may improve quality of life in people with HIV. Additional research would be helpful.

Anxiety and wound healing after surgery
Initial evidence suggests that guided imagery relaxation audiotapes may reduce postoperative anxiety, improve healing and relieve stress. This research is preliminary, and more study is needed before a recommendation can be made.

Anxiety and depression in multiple sclerosis
There is early research that the use of imagery may reduce anxiety but not depression or physical symptoms in patients with multiple sclerosis. Additional research would be helpful in this area.

Memory
Preliminary research suggests that guided imagery of short duration may improve working memory performance. Further research is needed before a firm conclusion can be drawn.

Congestive heart failure
A small preliminary study reports that guided imagery is of no benefit in congestive heart failure.

Fibromyalgia
Initial research suggests possible reductions in pain and improvements in functioning.

Upper respiratory tract infections
Preliminary research in children suggests that stress management and relaxation with guided imagery may reduce the duration of symptoms due to upper respiratory tract infections. Additional research is needed to confirm these results.

Bulimia nervosa
Evidence from preliminary research suggests that guided imagery may be an effective treatment for bulimia nervosa, at least in the short-term. Further study is needed before firm conclusions can be drawn.

Insomnia
Preliminary research supports the value of combined drug therapy and relaxation training in the treatment of insomnia. Further research is necessary to make a firm recommendation.

Juvenile rheumatoid arthritis
Cognitive-behavioral interventions for pain may be an effective adjunct to standard pharmacologic interventions for pain in patients with juvenile rheumatoid arthritis. Further research is needed to confirm these results.

Pain
Significantly lower postoperative pain ratings and shorter hospital stays in children, less abdominal pain and less pain from laparoscopic surgery have been associated with guided imagery practice. Preliminary research also suggests guided imagery may help in reducing cancer pain. Further research is needed to confirm these results.

Osteoarthritis
Preliminary research suggests a reduction in pain and mobility difficulties in patients with osteoarthritis. Further research is needed before a firm conclusion can be drawn.

Relaxation in chronic obstructive pulmonary disease
A small study reports increased relaxation outcomes in people with chronic obstructive pulmonary disease (emphysema or chronic bronchitis) who use guided imagery techniques. Additional research is needed to confirm these results.

Unproven Uses

Guided imagery has been suggested for many other uses, based on tradition or on scientific theories. However, these uses have not been thoroughly studied in humans, and there is limited scientific evidence about safety or effectiveness. Some of these suggested uses are for conditions that are potentially life-threatening. Consult with a health care provider before using guided imagery for any use.

Potential Dangers

Guided imagery has not been associated with severe adverse effects in the available scientific literature. In theory, excessive inward focusing may cause pre-existing psychological problems or personality disorders to surface. Guided imagery is usually intended to supplement medical care, not to replace it, and guided imagery should not be relied on as the sole therapy for a medical problem. Contact a qualified health care provider if your mental or physical health is unstable or fragile.

Never use guided imagery techniques while driving or doing any other activity that requires strict attention. Be careful if you have any physical symptoms that can be brought about by stress, anxiety or emotional upset because imagery may trigger these symptoms. If you feel unusually anxious while practicing guided imagery, or if you have a history of trauma or abuse, speak with a qualified health care provider before practicing guided imagery.

Summary

Guided imagery has been suggested for many different health conditions. Although guided imagery has not been proven effective for any specific condition, research is early and is not definitive. Do not rely on guided imagery alone to treat potentially dangerous medical conditions. Speak with your health care provider if you are considering guided imagery therapy.

The information in this monograph was prepared by the professional staff at Natural Standard, based on thorough systematic review of scientific evidence. The material was reviewed by the Faculty of the Harvard Medical School with final editing approved by Natural Standard.

Resources

1. Natural Standard: An organization that produces scientifically based reviews of complementary and alternative medicine (CAM) topics
2. National Center for Complementary and Alternative Medicine (NCCAM): A division of the U.S. Department of Health & Human Services dedicated to research

Selected Scientific Studies: Guided Imagery

Natural Standard reviewed more than 270 articles to prepare the professional monograph from which this version was created.

Some of the more recent studies are listed below:

1. Ackerman CJ, Turkoski B. Using guided imagery to reduce pain and anxiety. Home Healthc Nurse 2000;Sep, 18(8):524-530;quiz, 531.
2. Afari N, Eisenberg DM, Herrell R, et al. Use of alternative treatments by chronic fatigue syndrome discordant twins. 1096-2190 2000;Mar 21, 2(2):97-103.
3. Ahsen A. Imagery treatment of alcoholism and drug abuse: a new methodology for treatment and research. J Mental Imagery 1993;17(3-4):1-60.
4. Antall GF, Kresevic D. The use of guided imagery to manage pain in an elderly orthopaedic population. Orthop Nurs 2004;23(5):335-340.
5. Baider L, Peretz T, Hadani PE, et al. Psychological intervention in cancer patients: a randomized study. Gen Hosp Psychiatry 2001;Sep-Oct, 23(5):272-277.
6. Baird CL, Sands L. A pilot study of the effectiveness of guided imagery with progressive muscle relaxation to reduce chronic pain and mobility difficulties of osteoarthritis. Pain Manag Nurs 2004;5(3):97-104.
7. Ball TM, Shapiro DE, Monheim CJ, et al. A pilot study of the use of guided imagery for the treatment of recurrent abdominal pain in children. Clin Pediatr (Phila) 2003;Jul-Aug, 42(6):527-532.
8. Barak N, Ishai R, Lev-Ran E. [Biofeedback treatment of irritable bowel syndrome]. Harefuah 1999;Aug, 137(3-4):105-107, 175.
9. Baumann RJ. Behavioral treatment of migraine in children and adolescents. Paediatr Drugs 2002;4(9):555-561.
10. Brown-Saltzman K. Replenishing the spirit by meditative prayer and guided imagery. Semin Oncol Nurs 1997;Nov, 13(4):255-259.
11. Burke BK. Wellness in the healing ministry. Health Prog 1993;Sep, 74(7):34-37.
12. Burns DS. The effect of the bonny method of guided imagery and music on the mood and life quality of cancer patients. J Music Ther 2001;Spring, 38(1):51-65.
13. Castes M, Hagel I, Palenque M, et al. Immunological changes associated with clnical improvement of asthmatic children subjected to psychosocial intervention. Brain Behav Immun 1999;Mar, 13(1):1-13.
14. Collins JA, Rice VH. Effects of relaxation intervention in phase II cardiac rehabilitation: replication and extension. Heart Lung 1997;Jan-Feb, 26(1):31-44.
15. Crow S, Banks D. Guided imagery: a tool to guide the way for the nursing home patient. Adv Mind Body Med 2004;20(4):4-7.
16. Dennis CL. Preventing postpartum depression: part II. A critical review of nonbiological interventions. Can J Psychiatry 2004;49(8):526-538.
17. Esplen MJ, Garfinkel PE. Guided imagery treatment to promote self-soothing in bulimia nervosa: a theoretical rationale. J Psychother Pract Res 1998;Spring, 7(2):102-118.
18. Esplen MJ, Garfinkel PE, Olmsted M, et al. A randomized controlled trial of guided imagery in bulimia nervosa. Psychol Med 1998;Nov, 28(6):1347-1357.
19. Fors EA, Sexton H, Gotestam KG. The effect of guided imagery and amitriptyline on daily fibromyalgia pain: a prospective, randomized, controlled trial. J Psychiatr Res 2002;May-Jun, 36(3):179-187.
20. Gaston-Johansson F, Fall-Dickson JM, Nanda J, et al. The effectiveness of the comprehensive coping strategy program on clinical outcomes in breast cancer autologous bone marrow transplantation. Cancer Nurs 2000;Aug, 23(4):227-285.
21. Gimbel MA. Yoga, meditation, and imagery: clinical applications. Nurse Pract Forum 1998;Dec, 9(4):243-255.
22. Groer M, Ohnesorge C. Menstrual-cycle lengthening and reduction in premenstrual distress through guided imagery. J Holist Nurs 1993;11(3):286-294.
23. Gruzelier JH. A review of the impact of hypnosis, relaxation, guided imagery and individual differences on aspects of immunity and health. Stress 2002;Jun, 5(2):147-163.
24. Halpin LS, Speir AM, CapoBianco P, et al. Guided imagery in cardiac surgery. Outcomes Manag 2002;Jul-Sep, 6(3):132-137.
25. Hernandez NE, Kolb S. Effects of relaxation on anxiety in primary caregivers of chronically ill children. Pediatr Nurs 1998;Jan-Feb, 24(1):51-56.
26. Hewson-Bower B, Drummond PD. Psychological treatment for recurrent symptoms of colds and flu in children. J Psychosom Res 2001;Jul, 51(1):369-377.
27. Holden-Lund C. Effects of relaxation with guided imagery on surgical stress and wound healing. Res Nurs Health 1988;Aug, 11(4):235-244.
28. Hosaka T, Sugiyama Y, Tokuda Y, et al. Persistent effects of a structured psychiatric intervention on breast cancer patients' emotions. Psychiatric Clin Neurosci 2000;Oct, 54(5):559-563.
29. Hudetz JA, Hudetz AG, Klayman J. Relationship between relaxation by guided imagery and performance of working memory. Psychol Rep 2000;Feb, 86(1):15-20.
30. Hudetz JA, Hudetz AG, Reddy DM. Effect of relaxation on working memory and the Bispectral Index of the EEG. Psychol Rep 2004;95(1):53-70.
31. Ilacqua GE. Migraine headaches: coping efficacy of guided imagery training. Headache 1994;Feb, 34(2):99-102.
32. Johnstone S. Guided imagery: a strategy for improving relationships and human interactions. Aust J Holist Nurs 2000;Apr, 7(1):36-40.
33. Kaluza G, Strempel I. Effects of self-relaxation methods and visual imagery on IOP in patients with open-angle glaucoma. Ophthalmologica 1995;209(3):122-128.
34. Klaus L, Beniaminovitz A, Choi L, et al. Pilot study of guided imagery use in patients with severe heart failure. Am J Cardiol 2000;86(1):101-104.
35. Kolcaba K, Fox C. The effects of guided imagery on comfort of women with early stage breast cancer undergoing radiation therapy. Oncol Nurs Forum 1999;26(1):67-72.
36. Kvale JK, Romick P. Using imagery for role transition of midwifery students. J Midwifery Womens Health 2000;Jul-Aug, 45(4):337-342.
37. Kwekkeboom KL, Kneip J, Pearson L. A pilot study to predict success with guided imagery for cancer pain. Pain Manag Nurs 2003;4(3):112-123.
38. Lambert SA. The effects of hypnosis/guided imagery on the postoperative course of children. J Dev Behav Pediatr 1996;Oct, 17(5):307-310.
39. Laurion S, Fetzer SJ. The effect of two nursing interventions on the postoperative outcomes of gynecologic laparascopic patients. J Perianesth Nurs 2003;Aug, 18(4):254-261.
40. Lecky C. Are relaxation techniques effective in relief of chronic pain? Work. 1999;13(3):249-256.
41. Lewandowski WA. Patterning of pain and power with guided imagery. Nurs Sci Q 2004;17(3):233-241.
42. Louie SW. The effects of guided imagery relaxation in people with COPD. Occup Ther Int 2004;11(3):145-159.
43. Maguire BL. The effects of imagery on attitudes and moods in multiple sclerosis patients. Altern Ther Health Med 1996;2(5):75-79.
44. Mannix LK, Chandurkar RS, Rybicki LA, et al. Effect of guided imagery on quality of life for patients with chronic tension-type headache. Headache 1999;39(5):326-334.
45. Manyande A, Berg S, Gettins D, et al. Preoperative rehearsal of active coping imagery influences subjective and hormonal responses to abdominal surgery. Psychosom Med 1995;Mar-Apr, 57(2):177-182.
46. Marks IM, O'Dwyer AM, Meehan O, et al. Subjective imagery in obsessive-compulsive disorder before and after exposure therapy: pilot randomised controlled trial. Br J Psychiatry 2000;176:387-391.
47. Marr J. The use of the Bonny Method of Guided Imagery and Music in spiritual growth. J Pastoral Care 2001;Winter, 55(4):397-406.
48. McKinney CH, Antoni MH, Kumar M, et al. Effects of guided imagery and music (GIM) therapy on mood and cortisol in healthy adults. Health Psychol 1997;Jul, 16(4):390-400.
49. Mehl-Madrona L. Complementary medicine treatment of uterine fibroids: a pilot study. Altern Ther Health Med 2002;Mar-Apr, 8(2):34-6, 38-40, 42, 44-46.
50. Moody LE, Fraser M, Yarandi H. Effects of guided imagery in patients with chronic bronchitis and emphysema. Clin Nurs Res 1993;2(4):478-486.
51. Moody LE, Webb M, Cheung R, et al. A focus group for caregivers of hospice patients with severe dyspnea. Am J Palliat Care 2004;21(2):121-130.
52. Moore RJ, Spiegel D. Uses of guided imagery for pain control by african-american and white women with metastatic breast cancer. 1096-2190 2000;Mar 21, 2(2):115-126.
53. Murray LL, Heather Ray A. A comparison of relaxation training an syntax stimulation for chronic nonfluent aphasia. J Commun Disord 2001;Jan-Apr, 34(1-2):87-113.
54. Norred CL. Minimizing preoperative anxiety with alternative caring-healing therapies. AORN J 2000;Nov, 72(5):838-840, 842-843.
55. Ott MJ. Imagine the possibilities: guided imagery with toddlers and pre-schoolers. Pediatr Nurs 1996;Jan-Feb, 22(1):34-38.
56. Peeke PM, Frishett S. The role of complementary and alternative therapies in women's mental health. Prim Care 2002;Mar, 29(1):183-197, viii.
57. Rees BL. An exploratory study of the effectiveness of a relaxation with guided imagery protocol. J Holist Nurs 1993;Sep, 11(3):271-276.
58. Rees BL. Effect of relaxation with guided imagery on anxiety, depression, and self-esteem in primiparas. J Holist Nurs 1995;Sep, 13(3):255-267.
59. Rosen RC, Lewin DS, Goldberg L, et al. Psychophysiological insomnia: combined effects of pharmacotherapy and relaxation-based treatments. 1389-9457 2000;Oct 1, 1(4):279-288.
60. Rossman ML. Interactive Guided Imagery as a way to access patient strengths during cancer treatment. Integr Cancer Ther 2002;Jun, 1(2):162-165.
61. Rusy LM, Weisman SJ. Complementary therapies for acute pediatric pain management. Pediatr Clin North Am 2000;Jun, 47(3):589-599.
62. Sloman R. Relaxation and imagery for anxiety and depression control in community patients with advanced cancer. Cancer Nurs 2002;Dec, 25(6):432-435.
63. Sloman R. Relaxation and the relief of cancer pain. Nurs Clin North Am 1995;Dec, 30(4):697-709.
64. Speck BJ. The effect of guided imagery upon first semester nursing students performing their first injections. J Nurs Educ 1990;Oct, 29(8):346-350.
65. Spiegel D, Moore R. Imagery and hypnosis in the treatment of cancer patients. Oncology (Huntingt) 1997;Aug, 11(8):1179-1189; discussion, 1189-1195.
66. Stevensen C . Non-pharmacological aspects of acute pain management. Complement Ther Nurs Midwifery 1995;Jun, 1(3):77-84.
67. Thompson MB, Coppens NM. The effects of guided imagery on anxiety levels and movement of clients undergoing magnetic resonance imaging. Holist Nurs Pract 1994;Jan, 8(2):59-69.
68. Troesch LM, Rodehaver CB, Delaney EA, et al. The influence of guided imagery on chemotherapy-related nausea and vomiting. Oncol Nurs Forum 1993;20(8):1179-1185.
69. Turkoski B, Lance B. The use of guided imagery with anticipatory grief. Home Healthc Nurse 1996;Nov, 14(11):878-888.
70. Tusek D, Church JM, Fazio VW. Guided imagery as a coping strategy for perioperative patients. AORN J 1997;Oct, 66(4):644-649.
71. Tusek DL, Church JM, Strong SA, et al. Guided imagery: a significant advance in the care of patients undergoing elective colorectal surgery. Dis Colon Rectum 1997;40(2):172-178.
72. Tusek DL, Cwynar RE. Strategies for implementing a guided imagery program to enhance patient experience. AACN Clin Issues 2000;Feb, 11(1):68-76.
73. Wachelka D, Katz RC. Reducing test anxiety and improving academic self-esteem in high school and college students with learning disabilities. J Behav Ther Exp Psychiatry 1999;Sep, 30(3):191-198.
74. Walco GA, Ilowite NT. Cognitive-behavioral intervention for juvenile primary fibromyalgia syndrome. J Rheumatol 1992;Oct, 19(10):1617-1619.
75. Walco GA, Varni JW, Ilowite NT. Cognitive-behavioral pain management in children with juvenile rheumatoid arthritis. Pediatrics 1992;Jun, 89(6 Pt 1):1075-1079.
76. Walker JA. Emotional and psychological preoperative preparation in adults. Br J Nurs 2002;Apr 25-May 8, 11(8):567-575.
77. Walker LG, Heys SD, Walker MB, et al. Psychological factors can predict the response to primary chemotherapy in patients with locally advanced breast cancer. Eur J Cancer 1999;Dec, 35(13):1783-1788.
78. Weber S. The effects of relaxation exercises on anxiety levels in psychiatric inpatients. J Holist Nurs 1996;Sep, 14(3):196-205.
79. Wichowski HC, Kubsch SM. Increasing diabetic self-care through guided imagery. Complement Ther Nurs Midwifery 1999;Dec, 5(6):159-163.
80. Wills L, Garcia J. Parasomnias: epidemiology and management. CNS Drugs 2002;16(12):803-810.
81. Wynd CA. Personal power imagery and relaxation techniques used in smoking cessation programs. Am J Health Promot 1992;6(3):184-189.
82. Yip KS. The relief of a caregiver's burden through guided imagery, role-playing, humor, and paradoxical intervention. Am J Psychother 2003;57(1):109-121.
83. Zachariae R, Oster H, Bjerring P, et al. Effects of psychologic intervention on psoriasis: a preliminary report. J Am Acad Dermatol 1996;Jun, 34(6):1008-1015.

back to: Alternative Medicine Home ~ Alternative Medicine Treatments

My psychiatric hospital stays were not what I expected. They were unpleasant, in that being in a psychiatric ward is almost like being in jail. You are not free to come and go, the windows all have tough screens or even bars on them. You aren't allowed to have anything not approved by your doctor or the ward staff. Visitors can only come two-hours a day and, even then, only a pre-approved list of people can visit. You are not allowed any rest during the day, as activities are planned all the time.

In short, I can't recommend it as a vacation destination.

However, my stay was pleasant in that I didn't experience any of the expected "horror stories" such as in One Flew Over The Cuckoo's Nest. The ward staff was pleasant (but firm, very firm!). Everyone did their best to make a bad situation as comfortable as possible.

Bottom line is, if you or someone you know, has to check in to a psychiatric ward, don't be afraid to do it. It won't be fun, but it will be what you need. And it's not as bad as popular media depictions may lead you to believe.

My later inpatient stays were each followed by a few weeks in a "partial hospitalization" program. Even though you live at home, you spend 6-hours a day in intensive group therapy. In many ways, it's more intense than being an inpatient because the pace and depth of the therapy is much more advanced. I emerged with a true grasp of exactly how erroneous my thinking was, how distorted my perception of the world.

next: Types of Depression
~ back to Living with Depression homepage
~ depression library articles
~ all articles on depression

In the vast majority of cases, the prognosis for depression is good. Of course, this is true only when someone is in treatment for depression. Untreated depression usually doesn't go away by itself, and often gets worse with time. And remember, untreated depression can be terminal, since it is the leading cause, by far, of suicide. Depression is a very serious illness which demands treatment--but those who take the difficult step of getting treated for it, will usually recover.

next: Taking Antidepressants
~ back to Living with Depression homepage
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• Watch the video on Acquired Situational Narcissism

The Narcissistic Personality Disorder (NPD) is a systemic, all-pervasive condition, very much like pregnancy: either you have it or you don't.Once you have it, you have it day and night, it is an inseparable part of the personality, a recurrent set of behavior patterns.

Recent research (1996) by Roningstam and others, however, shows that there is a condition which might be called "Transient or Temporary or Short Term Narcissism" as opposed to the full-fledged version. Even prior to their discovery, "Reactive Narcissistic Regression" was well known: people regress to a transient narcissistic phase in response to a major life crisis which threatens their mental composure.

Reactive or transient narcissism may also be triggered by medical or organic conditions. Brain injuries, for instance, have been known to induce narcissistic and antisocial traits and behaviors.

But can narcissism be acquired or learned? Can it be provoked by certain, well-defined, situations?

Robert B. Millman, professor of psychiatry at New York Hospital - Cornell Medical School thinks it can. He proposes to reverse the accepted chronology. According to him, pathological narcissism can be induced in adulthood by celebrity, wealth, and fame.

The "victims" - billionaire tycoons, movie stars, renowned authors, politicians, and other authority figures - develop grandiose fantasies, lose their erstwhile ability to empathize, react with rage to slights, both real and imagined and, in general, act like textbook narcissists.

But is the occurrence of Acquired Situational Narcissism (ASN) inevitable and universal - or are only certain people prone to it?

It is likely that ASN is merely an amplification of earlier narcissistic conduct, traits, style, and tendencies. Celebrities with ASN already had a narcissistic personality and have acquired it long before it "erupted". Being famous, powerful, or rich only "legitimized" and conferred immunity from social sanction on the unbridled manifestation of a pre-existing disorder. Indeed, narcissists tend to gravitate to professions and settings which guarantee fame, celebrity, power, and wealth.

As Millman correctly notes, the celebrity's life is abnormal. The adulation is often justified and plentiful, the feedback biased and filtered, the criticism muted and belated, social control either lacking or excessive and vitriolic. Such vicissitudinal existence is not conducive to mental health even in the most balanced person.

The confluence of a person's narcissistic predisposition and his pathological life circumstances gives rise to ASN. Acquired Situational Narcissism borrows elements from both the classic Narcissistic Personality Disorder - ingrained and all-pervasive - and from Transient or Reactive Narcissism.

Celebrities are, therefore, unlikely to "heal" once their fame or wealth or might are gone. Instead, their basic narcissism merely changes form. It continues unabated, as insidious as ever - but modified by life's ups and downs.

In a way, all narcissistic disturbances are acquired. Patients acquire their pathological narcissism from abusive or overbearing parents, from peers, and from role models. Narcissism is a defense mechanism designed to fend off hurt and danger brought on by circumstances - such as celebrity - beyond the person's control.

Social expectations play a role as well. Celebrities try to conform to the stereotype of a creative but spoiled, self-centered, monomaniacal, and emotive individual. A tacit trade takes place. We offer the famous and the powerful all the Narcissistic Supply they crave - and they, in turn, act the consummate, fascinating albeit repulsive, narcissists.

next: The Narcissist's Reality Substitutes

Perhaps the best brief summary of Diseasing of America.

North Shore (Vancouver) News, June 7, 1999
Reprinted with permission of North Shore News.

Ilana Mercer
Vancouver, Canada

An anti-drug rally held in Abbotsford last week and fronted by former heavy weight boxer George Chuvalo and federal MP Randy White sported the usual confused rhetoric about drugs and addiction.

It was a mixture of demands and accusations to government; the tone resembling an ideological hangover from the days of the Temperance Movement and the Prohibition, topped with a dose of AA scare tactics.

Incidentally, the misconceptions about addiction unite social conservatives and liberals alike. Both factions seem to feel it is the humane thing to describe what is essentially a problem of behaviour, as a disease, even though it is not.

Liberals as much as conservatives, support coercive means of treatment. All are oblivious to the stupidity of forcing an occasional user to confess to a life-long debilitating "disease." All are blind to the violation of liberty and the futility of forcing someone into rehab.

In a radio interview, MP Randy White expressed his well-meaning support for the disease conception of addiction.

Asked to explain why proponents of the disease model of addiction refuse to address the fact that drug addiction involves choices, values and preferences, he refused to do so.

"Have you not made a mistake ever?" he admonished the host.

As if embarking on a life of drugs was about one unfortunate glitch. The dangers of gathering more and more behaviours under the disease label is not something about which politicians or health-care specialists care to think, despite the scary ramifications for a society already committed to "morality lite" and to diminished personal responsibility.

One esteemed addiction researcher, Stanton Peele, is different.

In his book Diseasing of America, Peele states that the disease conceptions of misbehaviour are bad science, and morally and intellectually sloppy.

"Once we treat alcoholism and addiction as diseases," writes Peele, "we cannot rule out that anything people do but shouldn't is a disease, from crime to excessive sexuality to procrastination."

The application of the medical disease model to addictions was developed to "remove the stigma from these behaviours."

There is, however, no genetic marker for alcoholism or drug addiction. Still, the misconception that these behaviours are linked to a genetic vulnerability is aired repeatedly by the media, all in the absence of evidence.

The rationale for using the disease model to describe addiction, even though it is intellectually dishonest, is that medical treatment is effective. This is also untrue.

An overview of controlled studies indicates that "treated patients do not fare better than untreated people with the same problems."

The evaluation of one program for heroin addiction, for instance, showed a recidivism rate of 90% soon after treatment. This is because a behavioural problem cannot be remedied by medical intervention. Addicts are cured when they decide to give up the habit.

Most cigarette smokers who quit give up cold turkey with no help, and there is no indication treatment for smokers is any more effective than no treatment.

The disease conception of addiction is a means of separating the behaviour from the person.

Much like the flu, drugs are said to "get a hold" of you, to use Mr. Chuvalo's words when describing his son. But an honest look is always more productive than a clouded one, and an honest look at drug-use means we cannot separate it from a person's values, strengths or lack thereof.

Once someone becomes involved with drugs, we explain everything they do by saying it was because of the drug, neglecting in the process of this circular argument to note that the source of the addiction is the person and not the drug.

Heroin addicts are highly disposed to having social problems even before they become addicted. And good predictors of future drug use are truancy and smoking behaviour, indicating that certain people by virtue of their personality characteristics or social circumstances are more at risk than others. If you fail to hold the kid who goes astray responsible for his actions — then you cannot praise the kid who doesn't. That's the logic of diminished responsibilities all round.

Once again the myths about drug use in the general population come from what Dr. Peele calls "extremely self-dramatizing addicts who report for treatment, and who in turn are extremely attractive to the media." Which calls into question the wisdom of using video footage such as was used during the rally, in which a heroin addict, described in positive personal terms, tells about his life.

This portrays the addict as a hero, and separates the addict from his behaviour with the protective rampart of a disease label.

Indeed, there are activist groups downtown campaigning for respect for the addict, pointing towards the degree of confusion in our thinking. Because the more undeserved respect addicts get, the more events they attend as "witnesses," the more they will stay addicts and the more addiction will be glamorized.

Positive reinforcement increases rather than extinguishes behaviour. Pavlov's dog could tell you that.

Unfortunately, the various accelerated programs school kids are exposed to year in and year out are breeding out of them the protective effects of personal responsibility, and the healthy disdain for addicts.

They are taught by mouthpieces of the activist industry that "It" can happen to anyone, that they have little control and that once "diagnosed" as an addict always an addict.

This sets in motion — where there is already some drug use — a self-defeating cycle of abstinence and relapse, not to mention an overall rise in drug-related involvement.

All in all, most teens and college students outgrow their occasional binges and turn into responsible adults. For doing what teens and college students do as a rite of passage, youngsters do not deserve to be labelled diseased.

It is plain stupid.

The paranoia of the temperance and the prohibition era, which has culminated in AA disease dogma, needs to be replaced with an emphasis on personal, parental, and community power.

next: The Conflict Between Public Health Goals and the Temperance Mentality
~ all Stanton Peele articles
~ addictions library articles
~ all addictions articles

• Watch the video on Narcissism Misdiagnosed as General Anxiety Disorder

Anxiety Disorders - and especially Generalised Anxiety Disorder (GAD) - are often misdiagnosed as Narcissistic Personality Disorder (NPD).

Anxiety is uncontrollable and excessive apprehension. Anxiety disorders usually come replete with obsessive thoughts, compulsive and ritualistic acts, restlessness, fatigue, irritability, difficulty concentrating, and somatic manifestations (such as an increased heart rate, sweating, or, in Panic Attacks, chest pains).

By definition, narcissists are anxious for social approval or attention (Narcissistic Supply). The narcissist cannot control this need and the attendant anxiety because he requires external feedback to regulate his labile sense of self-worth. This dependence makes most narcissists irritable. They fly into rages and have a very low threshold of frustration.

Like patients who suffer from Panic Attacks and Social Phobia (another anxiety disorder), narcissists are terrified of being embarrassed or criticised in public. Consequently, most narcissists fail to function well in various settings (social, occupational, romantic, etc.).

Many narcissists develop obsessions and compulsions. Like sufferers of GAD, narcissists are perfectionists and preoccupied with the quality of their performance and the level of their competence. As the Diagnostic and Statistical Manual (DSM-IV-TR, p. 473) puts it, GAD patients (especially children):

"...(A)re typically overzealous in seeking approval and require excessive reassurance about their performance and their other worries."

This could apply equally well to narcissists. Both classes of patients are paralysed by the fear of being judged as imperfect or lacking. Narcissists as well as patients with anxiety disorders constantly fail to measure up to an inner, harsh, and sadistic critic and a grandiose, inflated self-image.

The narcissistic solution is to avoid comparison and competition altogether and to demand special treatment. The narcissist's sense of entitlement is incommensurate with the narcissist's true accomplishments. He withdraws from the rat race because he does not deem his opponents, colleagues, or peers worthy of his efforts.

As opposed to narcissists, patients with Anxiety Disorders are invested in their work and their profession. To be exact, they are over-invested. Their preoccupation with perfection is counter-productive and, ironically, renders them underachievers.

It is easy to mistake the presenting symptoms of certain anxiety disorders with pathological narcissism. Both types of patients are worried about social approbation and seek it actively. Both present a haughty or impervious facade to the world. Both are dysfunctional and weighed down by a history of personal failure on the job and in the family. But the narcissist is ego-dystonic: he is proud and happy of who he is. The anxious patient is distressed and is looking for help and a way out of his or her predicament. Hence the differential diagnosis.

Bibliography

Goldman, Howard G. - Review of General Psychiatry, 4th ed. - London, Prentice-Hall International, 1995 - pp. 279-282

Gelder, Michael et al., eds. - Oxford Textbook of Psychiatry, 3rd ed. - London, Oxford University Press, 2000 - pp. 160-169

Klein, Melanie - The Writings of Melanie Klein - Ed. Roger Money-Kyrle - 4 vols. - New York, Free Press - 1964-75

Kernberg O. - Borderline Conditions and Pathological Narcissism - New York, Jason Aronson, 1975

Millon, Theodore (and Roger D. Davis, contributor) - Disorders of Personality: DSM IV and Beyond - 2nd ed. - New York, John Wiley and Sons, 1995

Millon, Theodore - Personality Disorders in Modern Life - New York, John Wiley and Sons, 2000

Schwartz, Lester - Narcissistic Personality Disorders - A Clinical Discussion - Journal of Am. Psychoanalytic Association - 22 (1974): 292-305

Vaknin, Sam - Malignant Self Love - Narcissism Revisited, 6th revised impression - Skopje and Prague, Narcissus Publications, 2005

next: Acquired Situational Narcissism

• Watch the video on Asperger Disorder and Narcissism

Asperger's Disorder is often misdiagnosed as Narcissistic Personality Disorder (NPD), though evident as early as age 3 (while pathological narcissism cannot be safely diagnosed prior to early adolescence).

In both cases, the patient is self-centered and engrossed in a narrow range of interests and activities. Social and occupational interactions are severely hampered and conversational skills (the give and take of verbal intercourse) are primitive. The Asperger's patient body language - eye to eye gaze, body posture, facial expressions - is constricted and artificial, akin to the narcissist's. Nonverbal cues are virtually absent and their interpretation in others lacking.

Yet, the gulf between Asperger's and pathological narcissism is vast.

The narcissist switches between social agility and social impairment voluntarily. His social dysfunctioning is the outcome of conscious haughtiness and the reluctance to invest scarce mental energy in cultivating relationships with inferior and unworthy others. When confronted with potential Sources of Narcissistic Supply, however, the narcissist easily regains his social skills, his charm, and his gregariousness.

Many narcissists reach the highest rungs of their community, church, firm, or voluntary organization. Most of the time, they function flawlessly - though the inevitable blowups and the grating extortion of Narcissistic Supply usually put an end to the narcissist's career and social liaisons.

The Asperger's patient often wants to be accepted socially, to have friends, to marry, to be sexually active, and to sire offspring. He just doesn't have a clue how to go about it. His affect is limited. His initiative - for instance, to share his experiences with nearest and dearest or to engage in foreplay - is thwarted. His ability to divulge his emotions stilted. He is incapable or reciprocating and is largely unaware of the wishes, needs, and feelings of his interlocutors or counterparties.

Inevitably, Asperger's patients are perceived by others to be cold, eccentric, insensitive, indifferent, repulsive, exploitative or emotionally-absent. To avoid the pain of rejection, they confine themselves to solitary activities - but, unlike the schizoid, not by choice. They limit their world to a single topic, hobby, or person and dive in with the greatest, all-consuming intensity, excluding all other matters and everyone else. It is a form of hurt-control and pain regulation.

Thus, while the narcissist avoids pain by excluding, devaluing, and discarding others - the Asperger's patient achieves the same result by withdrawing and by passionately incorporating in his universe only one or two people and one or two subjects of interest. Both narcissists and Asperger's patients are prone to react with depression to perceived slights and injuries - but Asperger's patients are far more at risk of self-harm and suicide.

The use of language is another differentiating factor.

The narcissist is a skilled communicator. He uses language as an instrument to obtain Narcissistic Supply or as a weapon to obliterate his "enemies" and discarded sources with. Cerebral narcissists derive Narcissistic Supply from the consummate use they make of their innate verbosity.

Not so the Asperger's patient. He is equally verbose at times (and taciturn on other occasions) but his topics are few and, thus, tediously repetitive. He is unlikely to obey conversational rules and etiquette (for instance, to let others speak in turn). Nor is the Asperger's patient able to decipher nonverbal cues and gestures or to monitor his own misbehavior on such occasions. Narcissists are similarly inconsiderate - but only towards those who cannot possibly serve as Sources of Narcissistic Supply.

next: Misdiagnosing Narcissism - Generalised Anxiety Disorder (GAD)

It is important to keep in mind that the person with Alzheimer's Disease needs to be treated with dignity and respect.

Make sure you explain the person's cultural or religious background, and any rules and customs, to anyone from a different background so that they can behave accordingly. These may include:

• respectful forms of address
• what they can eat
• religious observances, such as prayer and festivals
• particular clothing or jewelry that they (or those in their presence) should or should not wear
• any forms of touch or gestures that are considered disrespectful
• ways of undressing
• ways of dressing the hair
• how they wash or use the toilet.

Acting with courtesy

Many people with Alzheimer's have a fragile sense of self-worth; it's especially important that people continue to treat them with courtesy, however advanced their Alzheimer's.

• Be kind and reassuring to the person you're caring for without talking down to them.
• Never talk over their head as if they are not there - especially if you're talking about them. Include them in conversations.
• Avoid scolding or criticizing them - this will make them feel small.
• Look for the meaning behind their words, even if they don't seem to be making much sense. Whatever the person is saying, they are usually trying to communicate with you about how they feel.
• Try to imagine how you would like to be spoken to if you were in their position.

Respecting privacy and Alzheimer's

• Try to make sure that the person's right to privacy is respected.
• Suggest to other people that they should always knock on the person's bedroom door before entering.
• If they need help with intimate personal activities, such as washing or using the toilet, do this sensitively and make sure the door is kept closed if other people are around.

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Offer simple choices and Alzheimer's

• Make sure that, whenever possible, you inform and consult the person about matters that concern them. Give them every opportunity to make their own choices.
• Always explain what you are doing and why. You may be able to judge the person's reaction from their expression and body language.
• People with Alzheimer's can find choice confusing, so keep it simple. Phrase questions so that they only need a 'yes' or 'no' answer, such as 'Would you like to wear your blue jumper today?' rather than 'Which jumper would you like to wear today?'

Expressing feelings and Alzheimer's

Alzheimer's affects people's thinking, reasoning and memory, but the person's feelings remain intact. A person with Alzheimer's will probably be sad or upset at times. In the earlier stages, the person may want to talk about their anxieties and the problems they are experiencing.

• Try to understand how the person feels.
• Make time to offer them support, rather than ignoring them or 'jollying them along'.
• Don't brush their worries aside, however painful they may be. Listen and show them that you are there for them.

Tips for making the person feel good about themselves

• Avoid situations in which the person is bound to fail, as this can be humiliating. Look for tasks they can still manage and activities they enjoy.
• Give them plenty of encouragement. Let them do things at their own pace and in their own way.
• Do things with them, rather than for them, to help them retain their independence.
• Break activities down into small steps so that they feel a sense of achievement, even if they can only manage part of a task.
• Our self respect is often bound up with the way we look. Encourage the person to take a pride in their appearance, and compliment them on how they look.

Sources:

• UK Alzheimer's Society - Carers' Advice Sheet 524

next: Respect and Caring for Someone with Alzheimer'