• Watch the video on Narcissist and the Internet

To the narcissist, the Internet is an alluring and irresistible combination of playground and hunting grounds, the gathering place of numerous potential sources of narcissistic supply, a world where false identities are the norm and mind games the bon ton.And it is beyond the reach of the law, the pale of social norms, the strictures of civilized conduct.

The somatic finds cyber-sex and cyber-relationships aplenty. The cerebral claims false accomplishments, fake skills, erudition and talents. Both, if minimally communicative, end up at the instantly gratifying epicenter of a cult of fans, followers, stalkers, erotomaniacs, denigrators, and plain nuts. The constant attention and attendant quasi-celebrity feed and sustain their grandiose fantasies and inflated self-image.

The Internet is an extension of the real-life Narcissistic Pathological Space but without its risks, injuries, and disappointments. In the virtual universe of the Web, the narcissist vanishes and reappears with ease, often adopting a myriad aliases and nicknames. He (or she) can thus fend off criticism, abuse, disagreement, and disapproval effectively and in real time - and, simultaneously, preserve the precarious balance of his infantile personality. Narcissists are, therefore, prone to Internet addiction.

The positive characteristics of the Net are largely lost on the narcissist. He is not keen on expanding his horizons, fostering true relationships, or getting in real contact with other people. The narcissist is forever the provincial because he filters everything through the narrow lens of his addiction. He measures others - and idealizes or devalues them - according to one criterion only: how useful they might be as sources of narcissistic supply.

The Internet is an egalitarian medium where people are judged by the consistency and quality of their contributions rather than by the content or bombast of their claims. But the narcissist is driven to distracting discomfiture by a lack of clear and commonly accepted hierarchy (with himself at the pinnacle). He fervently and aggressively tries to impose the "natural order" - either by monopolizing the interaction or, if that fails, by becoming a major disruptive influence.

 

But the Internet may also be the closest many narcissists get to psychodynamic therapy. Because it is still largely text-based, the Web is populated by disembodied entities. By interacting with these intermittent, unpredictable, ultimately unknowable, ephemeral, and ethereal voices - the narcissist is compelled to project unto them his own experiences, fears, hopes, and prejudices.

Transference (and counter-transference) are quite common on the Net and the narcissist's defence mechanisms - notably projection and projective identification - are frequently aroused. The therapeutic process is set in motion by the - unbridled, uncensored, and brutally honest - reactions to the narcissist's repertory of antics, pretensions, delusions, and fantasies.

The narcissist - ever the intimidating bully - is not accustomed to such resistance. Initially, it may heighten and sharpen his paranoia and lead him to compensate by extending and deepening his grandiosity. Some narcissists withdraw altogether, reverting to the schizoid posture. Others become openly antisocial and seek to subvert, sabotage, and destroy the online sources of their frustration. A few retreat and confine themselves to the company of adoring sycophants and unquestioning groupies.

But a long exposure to the culture of the Net - irreverent, skeptical, and populist - usually exerts a beneficial effect even on the staunchest and most rigid narcissist. Far less convinced of his own superiority and infallibility, the online narcissist mellows and begins - hesitantly - to listen to others and to collaborate with them.

 

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next: Abusing the Narcissist

Getting Off The Rollercoaster

If we consider the Mind as both the instrument of perception and thought, and that perceptions and interpretations require some previous experience or knowledge, the ability to perceive is then an acquired or learnt ability always linked to our personal history.

Our lives are therefore based around a multitude of relational factors which form the frameworks and viewpoints in order for us to interpret or make sense of the world. Naturally, this helps us to function in the world.

Ideally, perceptions should build upon each other to develop into the maturity of adult discernment. The catch is that the perceptions of childhood, (which form the foundation of our thinking) do not naturally or by themselves have the benefit of adult discernment. Only from the ongoing exposure to love, generosity, compassion, positive support and values from parental care does the childhood experience overcome the potential for these immature perceptions to corrupt or undermine the thinking later on in adult life.

I once had an extended visit at a friends house. He led his active life, and allowed me to have full run of the house. I noticed he had a Hi-Fi in the living room but it was not connected or wired up. Upon deciding to listen to some music, I went about connecting all the various modules and connecting the right cables to the right sockets. I finished by plugging in all the electrical power cables except the radio... I just left the power plug draped near the power board. Everything worked and enjoyed the music.

About a week later, my friends son came over for a visit. He decided he'd like to listen to the radio. He noticed the power cable wasn't plugged in so he plugged it in. My friend was amazed and delighted that his son had got his Hi-Fi working and showered him with praise as this proud Father acknowledged his sons cleverness and technical aptitude.

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I said nothing. However, later on I found myself slightly put out as I felt a sense of injustice that the recognition was not coming to me.

Very, very strange I thought to myself. Never was there any intention to seek praise... I just got the thing going one day so I could listen to music. But when this show of overwhelming appreciation became manifest, I felt like I was missing out, and I now seemed to be after something that I originally had not intention of obtaining.

I paced back and forth, the mental wheels were rapidly spinning. Ahhh!... I now started to grasp that two things were happening inside me, and it is very much worth our while to discuss it here. The things I were feeling were...

• A sense of injustice.
• A sense for a need of recognition of my ability.

INJUSTICE - RECOGNITION. I had tapped into the beginnings of some important understandings
Many years ago, I might have spoken up to make sure that the recognition came my way as well as the need to set the record straight. I probably would have burned inside until I spoke up. Fortunately those days are long gone, but still lingering was a residual part of my old thinking rearing it's ugly head.

The perception of...

"Hey You!, you didn't acknowledge my ability!... you're the cause of my grief!"

...is not accurately defined in the false belief that an external object (a person) is the cause of my disharmony.

This injustice is in me, just as this need for recognition of ability is in me. Does this mean that people can expect injustice or unjust behaviour from me as a common aspect to my personality? I thought about this very intensely and come up with "No". I know this doesn't equate with my real nature, yet something was not sitting quiet right within me. The more I pursued it the more confusing it became. Such confusion is the opposite of what should be attained through successful self inquiry. I had to initiate a change of tack and began to focus on the 'Recognition' aspect.

More pacing and squeezing of my chin. Slowly an understanding began to filter into my consciousness. The want for recognition was the PRIMARY ISSUE. I had become confused by focusing on a secondary feeling of 'Injustice'. Obviously, for an injustice to be present, something had to make it so. The perceived 'Incorrect Recognition' was the injustice. The 'Recognition' aspect was at the root of this injustice. I was now getting closer to the real issue. This is where the use of "I" came into it. For you and I both, this is an extremely valuable understanding to possess.

You might say that I am just seeking approval, and essentially I would agree with these thoughts, but if it was simply a matter of seeking approval, it would then have to said... "of what?". The notion of approval would once again go back to... "My abilities and best efforts." Once again, the root of the experience contains a direct identification back to me. This is what you should remember as you engage in self inquiry. The correct understanding will not be ambiguous as in the case "seeking approval" for there can always be another question that can go beyond that point. The words "I", "ME" or "MY", or the undisputable sense of the person in question, must always be included in the final analysis.

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Suddenly an awesome stillness came over me. A very powerful sense of being deeply connected to a truth about myself. Now I began to see why the injustice was so prominent. This lack of recognition has actually been such a regular feature in my life that a secondary perception of injustice continues to be falsely validated and hence distorted over the years. I am therefore much more likely to see or perceive injustices around me and in various other situations.

Upon the revelation of RECOGNITION, I now see that throughout my life, I have not given recognition to others. The very reason I have written this book is because my life had essentially collapsed, and I had come to the understanding that the only way out was to become more aware of my surroundings, my family, my friends, my job, my life. As far as personal relationships go, the loved one would leave primarily through my lack of attentiveness... my lack of awareness.

MY thinking, MY behavioUr, had been clearly mirrored back to me. This phenomenon is a remarkable and natural aspect of possessing human consciousness in the physical world. We can only ever know and understand the world through our perceptions. What is seen to be out there is simply a reflection of what's within.

For me I can see it all so very clearly, without agitation, without objection. I bow to the truth. So profound was this awakening for me that I actually felt physically different. I can also describe it as if a major shift had occurred. A shift of 'what' I can't actually put a name to, but somehow the word 'shift' seems to be appropriate.

Here I must point out where careful attention is required not to confuse all the qualities that are inside as primary. eg: All though this sense of injustice is in me, since it is of a secondary nature, I am happy to say that I am not a person who treats people unfairly or unjustly.

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You to must identify the primary and secondary qualities and re-align your perceptions correctly and without imposing judgment upon yourself. Always love and respect yourself, as well as your discoveries during self inquiry.

Now to deal fully and finally with the RECOGNITION aspect, for this is what this chapter is all about.

The Saying is... "What is seen to be out there is actually in you." This is the mirror action of life.

Going through this example brings us to one important question. How do we know that our perceptions are correct or false? This question is extremely sensitive and full of vulnerability's if precise answers are expected by anyone other than yourself, but the understanding which I myself cling to is...

Through my perceptions and understandings:

• Is my life progressing?
• Have the various stages in my life be a steeping stone to other new stages?
• Do I leave each stage accepting of what is left behind?

or

• Do I seem stuck in re-occurring situations whether they be financial, vocational, personal?
• Do the same sorts of people re-emerge into my life and bring the same sorts of situations and dramas?

If you tend to answer yes to the first group and "no" to the second group of questions, then it would seem that progress and growth are a healthy part of your life and your perceptions would have to said to be working in a positive way for you.

If the case is the opposite of the above, then this is an indicator to consider implementing change. The key to bringing about real change lies in exploring the domain of the Inner World... taking the Inner Journey to your deep self.

The major aspect of being human is consciousness. We have self-awareness. That is... we are the animal that has awoken itself to the fact that we are animal. In that awakening, we remain animal no longer since we have ascended into the realm of perceptions, understandings and realisations. However, there is a subtle trap in possessing conscious awareness, for it can bring about false perceptions if the experiences that one accumulates are not fully understood through contemplation. This subtle trap can keep us locked in the region above the animal, yet below the stage of human development where a higher and clearer consciousness brings freedom, and liberates the creative potential.

The freedom I talk of is the freedom to know, love and understand yourself to such a degree that fears dramatically reduce their stranglehold over us and the good life we try to implement. Also, in this freedom, I have personally found that the yearning and clinging aspects of myself have essentially diminished. I still have desires, dreams and goals, but the aching yearning to love and be loved has dissolved into the awareness that I am that love which I have been yearning for and seeking externally for so many years of my life.

This does not mean that I don't need people, or that I don't wish to have a life long partner, on the contrary, having found and realised my inner love... my inner self, I am finally in a position to be free enough to start living and to start loving in a refined way.

In the years before my path of self discovery, I longed to love and longed to be loved, but now I see that this longing is an indicator that the inner love has not yet been realised. Sure you may appreciate that things that I talk of, and that they sit perfectly well with you on intellectual level, but until you have realised from experience your inner love by the path of inner work, there will always be that restlessness and yearning.

When you finally realise your inner love, you will know without a shadow of a doubt that you have reached that state.

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Difference between Delusion and Mis-perception

To come to an understanding that your thinking and perceptions are limiting positive progress does not mean that your life is based on total ignorance and false values. It is more likely indicating incomplete or immature understandings. In the process of self discovery, new understandings and Self-Knowledge will become a lamp on your path. When the lamp of Self-Knowledge is lit, it can never be extinguished for the fuel that keeps it lit is an enlightened understanding of the truth and the ability to recognise the truth. Having cultivated refined intuition, is to possess the mechanism that recognises the inner truth.

Delusion on the other hand is a chronic state where suffering is habitual, and the potential for positive growth and progress become very very limited. Within delusion, anger is also present for the existence of false notions reflected in new life experiences are then falsely validated to then become more chronic and distorted perceptions. Life is seen to be bitter, cruel and without compassion. Deluded thinking usually has a negative, (perhaps destructive) impact on other people as well.

"Where Do I Start?"

Your must amplify your intuition. If you already consider yourself an intuitive person yet still see a need for change, then your intuition is not being allowed to surface in the area of your life where you are stuck..

If you have a belief in God, then pray for assistance and believe that such assistance will manifest. If you don't believe in God, then believe in yourself and the fighting spirit of human nature to rise above, and be intolerant of ignorance... especially the ignorance of the Self.

Now take a look at that last paragraph. Each is written to inspire and uplift different people with different beliefs and perceptions. Hopefully, each person would find the essence of inspiration to cultivate the qualities of faith and courage, and ultimately bring about the restoration of integration, harmony and peace for the journey ahead. If uplifting inspiration is the case, then where can we say this quality comes from? This Will to carry on comes about from a deep inner experience... not from this book, or even some other place. From Within.

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Important to note is that this particular example of a positively motivating inner experience is in-consequential to the debate of Gods existence or non-existence. The inner experience, where it is known to have come from within, has to be acknowledged as the all powerful motivator that drives the human being forward through difficult times. This is the essence of the Human Spirit. This is being Spiritual.

No two people will have exactly the same perceptions on life for we are all viewing the world from our own unique viewpoint.

Just as each of our eyes are separated by a small distance, the image that the left eye sees is not the same as the right eye. What is seen from each viewpoint is slightly different; it cannot be the same. Amazingly, it is the brain that integrates these different images to expand the visual perception by giving us 3D vision. In the same way, the individual perceptions of peoples can be integrated into the common consciousness of mankind to enable a clearer and more accurately defined view of the world. In writing this book, I am contributing to the world, the understandings which have had a positive and uplifting effect in my life.

Developing Intuition.

Developing Intuition requires careful attention in the early days of the seeker. Your goal will be found in the form of "A Silent Knowledge, devoid of questions".

The surfacing of your intuition does not come in the form of words or images. It is deep and serene ( don't confuse this with some fanciful state of mystic bliss).

When an intuitive response manifests, you will not be plagued by rationalisations and questions, for those are the products of mental and logical processes. The Silent Knowledge is from your deep spiritual self... the True Self, and it is beyond all the drama and confusion.

It would also helpful to consider the Mind as the means to bring forth into the world, the offering that the True Self puts forward in guiding you through your daily life.

If the True Self is the driver of a car, then the Mind is the steering wheel responding to the direction of the driver to then allow the car, (the physical body) to go in the required direction. Obviously, amid our everyday activities there is a sort of auto-pilot which effectively gets us through our journey day-in day-out. It is when we enter unfamiliar ground or require a course correction that the auto-pilot needs to be over-ridden and control handed back for to the driver... the True Self.

We need to confidently be able to tune into and listen to the Wordless Knowledge.

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All this philosophy and theory is not meant to point a judgemental finger at anyone, but is a call to awaken to the notion that there is always a higher truth to be found that can ease you through your trials. This higher truth will stop you from carrying any unnecessary burdens amid the true difficulties that must be passed through, and guide you in confidence in your everyday life.

The road to freedom and enlightenment is the way to gain a life where progress is the significant attribute of your life. Here, it is important to have a clear understanding of the use of the word enlightenment. Often it is used in a spiritual context associated with the mystic religions, or of the final union of the individual soul with God, (sometimes known as Nirvana or Samadhi.) But in our daily life amid the demands of family and work etc, can still be beautifully enhanced by the application of a love for truth and Self Knowledge enabling a life devoid of confusion and conflict. The degree of enlightenment brought about by activating awareness philosophy can only enrich your life.

To change the values we live by in an enormous task, but by seeing and concentrating on the benefits that such efforts can deliver will bring you to a realisation that you can be your main source of energy and drive in your quest to become new.

TENACITY ..."The ability to HANG ON", will help bring the transformation to your lifestyle as your thinking shifts it's attitude by mirroring new and good things for you.

FAITH ..."The certainty that exists without the support of concrete evidence", will be the first of many new characteristics to start you on your way and give you a goal to believe in.

LOVE... "Of self and others", to bring you a freedom to break loose of any restrictions that try to tie you to the past. When we do a good thing, we can be sure that a good thing will be returned to us, so to keep on acting to the goodness and truth within will see the changes we long for begin to become real and permanent in our lives.

To become aware of the causes of problems or pain in your life, is to have taken the first steps in altering these unwelcome aspects. If you want good people in your life, then your thinking has to mirror those qualities so that other people can then see them and be attracted to them. If you want people to be aware of your love, your needs, your hopes, then your thinking must demonstrate an equal awareness in your own nature. If you want trusting and sincere people to be a part of your life, then these qualities must also be evident in yourself. If you want truthful people in your life, then you must consistently live by the truth.

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After such a change is made, the mirror action of Life will help to bring such aspects into our life to enjoy always.

If we compromise our values and our own inner truth, we will compromise the quality of the life we have gained, and lose the freedom to live in Truth, Peace and Love.

Second best thinking will bring you second best situations and people. By being willing to live to your truest self, and by believing you have a right to the best in every aspect that life has to offer, then the good that you have always sought after will be sure to come to you.

All that has been discussed so far is about the aspects of our nature that might indicate a need for change and growth, but it is also vital to acknowledge that the love that you see in others... the goodness that you see in others and within the world, can only ever be appreciated by yourself because that quality is alive within you. Don't think that life will only mirror a persons inadequacies; life will also allow your beauty to manifest. The goodness that you see as being 'out there' is actually 'Within You'.

CONTEMPLATION:

My mirror was clouded with confusion...

and the blurred image I was looking at was NOT what I thought it was.

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next: Getting Off the Roller Coaster A Good Way to Love.

Watch a video on Narcissism, Substance Abuse, and Reckless Behaviours

Pathological narcissism is an addiction to narcissistic supply, the narcissist's drug of choice. It is, therefore, not surprising that other addictive and reckless behaviours - workaholism, alcoholism, drug abuse, pathological gambling, compulsory shopping, or reckless driving - piggyback on this primary dependence.

The narcissist - like other types of addicts - derives pleasure from these exploits. But they also sustain and enhance his grandiose fantasies as "unique", "superior", "entitled", and "chosen". They place him above the laws and pressures of the mundane and away from the humiliating and sobering demands of reality. They render him the centre of attention - but also place him in "splendid isolation" from the madding and inferior crowd.

Such compulsory and wild pursuits provide a psychological exoskeleton. They are a substitute to quotidian existence. They afford the narcissist with an agenda, with timetables, goals, and faux achievements. The narcissist - the adrenaline junkie - feels that he is in control, alert, excited, and vital. He does not regard his condition as dependence. The narcissist firmly believes that he is in charge of his addiction, that he can quit at will and on short notice.

The narcissist denies his cravings for fear of "losing face" and subverting the flawless, perfect, immaculate, and omnipotent image he projects. When caught red handed, the narcissist underestimates, rationalizes, or intellectualizes his addictive and reckless behaviours - converting them into an integral part of his grandiose and fantastic False Self.

Thus, a drug abusing narcissist may claim to be conducting first hand research for the benefit of humanity - or that his substance abuse results in enhanced creativity and productivity. The dependence of some narcissists becomes a way of life: busy corporate executives, race car drivers, or professional gamblers come to mind.

The narcissist's addictive behaviours take his mind off his inherent limitations, inevitable failures, painful and much-feared rejections, and the grandiosity gap - the abyss between the image he projects (the False Self) and the injurious truth. They relieve his anxiety and resolve the tension between his unrealistic expectations and inflated self-image - and his incommensurate achievements, position, status, recognition, intelligence, wealth, and physique.

 

Thus, there is no point in treating the dependence and recklessness of the narcissist without first treating the underlying personality disorder. The narcissist's addictions serve deeply ingrained emotional needs. They intermesh seamlessly with the pathological structure of his disorganized personality, with his character faults, and primitive defence mechanisms.

Techniques such as "12 steps" may prove more efficacious in treating the narcissist's grandiosity, rigidity, sense of entitlement, exploitativeness, and lack of empathy. This is because - as opposed to traditional treatment modalities - the emphasis is on tackling the narcissist's psychological makeup, rather than on behaviour modification.

The narcissist's overwhelming need to feel omnipotent and superior can be co-opted in the therapeutic process. Overcoming an addictive behaviour can be - truthfully - presented by the therapist as a rare and impressive feat, worthy of the narcissist's unique mettle.

Narcissists fall for these transparent pitches surprisingly often. But this approach can backfire. Should the narcissist relapse - an almost certain occurrence - he will feel ashamed to admit his fallibility, need for emotional sustenance, and impotence. He is likely to avoid treatment altogether and convince himself that now, having succeeded once to get rid of his addiction, he is self-sufficient and omniscient.

 

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next: The Cyber Narcissist

Detailed information on paying for alternative treatments, alternative remedies for mental health conditions.

On this page

1. What is CAM?
2. How do patients pay for CAM treatments delivered by a practitioner?
3. How can I find out if there are any laws in my state about insurance coverage of a CAM modality (treatment) that I am interested in?
4. I have health insurance. If I am interested in obtaining treatment from a CAM practitioner, what financial questions should I ask?
5. What financial questions should I ask the practitioner?
6. What about CAM insurance coverage that may be offered through employers?
7. Does NCCAM have a list of insurance companies that cover CAM?
8. My insurer has asked me for evidence, from scientific and medical literature, about the use of a CAM treatment. Can NCCAM provide this information?
9. My insurance company has denied my claim for CAM treatment. Is there anything I can do?
10. Are there laws to help me keep my health insurance if I lose or change jobs? Do these laws apply to CAM treatments?
11. What are tax-exempt accounts for medical expenses? How might they help me?
12. Does the Federal Government have resources that might help me financially with my health-related expenses?
13. Are CAM services deductible on my income tax?
14. Can you suggest any other resources?
15. Resources

Consumers of health care, including complementary and alternative medicine (CAM), often have questions about the financial aspects of obtaining treatment. This fact sheet addresses a number of frequently asked questions about consumer financial issues in CAM and includes resources for further information.

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1. What is CAM?

CAM, as defined by the National Center for Complementary and Alternative Medicine (NCCAM), is a group of diverse medical and health care systems, practices, and products that are not presently considered part of conventional medicine. ¹Complementary medicine is used together with conventional medicine. Alternative medicine is used in place of conventional medicine. To find out more about these terms, consult the NCCAM fact sheet "What Is Complementary and Alternative Medicine?" (See "Resources.")

NCCAM is the Federal Government's lead agency for research on CAM. NCCAM is dedicated to exploring CAM healing practices in the context of rigorous science, training CAM researchers, and disseminating authoritative information to the public and professionals.

¹Conventional medicine is medicine as practiced by holders of M.D. (medical doctor) or D.O. (doctor of osteopathy) degrees and by allied health professionals, such as physical therapists, psychologists, and registered nurses. Other terms for conventional medicine include allopathy; Western, mainstream, orthodox, and regular medicine; and biomedicine. Some conventional medical practitioners are also practitioners of CAM.

2. How do patients pay for CAM treatments delivered by a practitioner?

In CAM, as in conventional medicine, there are two primary ways people pay for care.

• Out-of-pocket payment. Most consumers must pay for CAM practitioner services and CAM therapeutic products themselves.

• Insurance. Some health plans offer some coverage of CAM. Such coverage tends to be very limited, however, and varies considerably from state to state.

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3. How can I find out if there are any laws in my state about insurance coverage of a CAM modality (treatment) that I am interested in?

There is no one central resource that collects this information for all the states. Some resources that may be helpful include:

• If you are seeking CAM treatment from a practitioner, there is likely to be one or more national professional associations for practitioners of that treatment--for example, associations for chiropractors. Many of these organizations monitor insurance coverage and reimbursement for their specialty. You can locate organizations by trying an Internet search or asking a reference librarian for assistance.

• Each of the 50 states, as well as the District of Columbia and the four U.S. territories, has an agency that regulates the insurance industry in that state, enforces insurance laws, and assists consumers. This agency is often called the office of the state insurance commissioner (see "Resources"). The services that this office provides vary by state, but each handles consumer inquiries. Your commissioner's office may be able to inform you of any requirements in your state for insurance coverage of a specific CAM modality.

4. I have health insurance. If I am interested in obtaining treatment from a CAM practitioner, what financial questions should I ask?

First, you need to be informed about your health insurance plan. Does it offer any coverage of CAM treatments? If so, what are the requirements and limits--for example, does the plan limit the conditions it will cover, require that CAM services be delivered by specific practitioners (such as a licensed medical doctor or a practitioner in the company's network), or cover only services that the plan determines to be medically necessary? Read your plan carefully, including the limits and exclusions. You may also want to check with the insurance company before you seek treatment.

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Here are some questions to ask your insurer:

• Does this care need to be preauthorized or preapproved?

• Do I need a referral from my primary care provider? ²

• What services, tests, or other costs will be covered?

• How many visits are covered and over what period of time?

• Is there a copayment?

• Will the therapy be covered for any condition or only for certain conditions?

• Will any additional costs (for example, laboratory tests, dietary supplements, equipment, or supplies) be covered?

• Will I need to see a practitioner in your network? If so, can you provide me with a list of practitioners in my area?

• If I use a practitioner who is not part of your network, do you provide any coverage? Are there any additional out-of-pocket costs?

• Are there any dollar or calendar limits to my coverage?

It will help you if you keep organized records about all interactions with your insurance company. Keep copies of letters, bills, and claims. Make notes about calls, including the date, time, customer service representative's name, and what you were told. If you are not satisfied with a representative's explanations, ask to speak to someone else.

²If the insurance company requires you to have a referral, be sure to obtain it and take it with you to the practitioner. It is also a good idea to keep a copy for your records.

 

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5. What financial questions should I ask the practitioner?

Here are some questions to ask the practitioner or his office staff:

• Do you accept my health insurance?

• Do I file the claim forms, or do you (the provider) take care of that?

• What is the cost for an initial appointment?

• How many treatments will I need?

• How much will each treatment cost?

• Can I receive treatment for a trial period to see if the therapy works for me before I commit to a full course?

• Will there be any additional costs?

It can also be useful to ask which insurance plans the practitioner accepts, in case you become interested in changing plans at some point (for example, through a change of employment).

If you do not have insurance coverage for treatment, and paying the full fee each time would be difficult for you, you might ask:

• Can your office arrange a payment plan so that my costs are spread out over a longer period of time?

• Do you offer a sliding-scale fee? (A sliding-scale fee adjusts charges based on a patient's income and ability to pay.)

For more information on seeking treatment from a practitioner, consult the NCCAM fact sheet "Selecting a Complementary and Alternative Medicine (CAM) Practitioner." (See "Resources.")

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6. What about CAM insurance coverage that may be offered through employers?

If CAM coverage is offered, it is usually one of the following types:

• Higher deductibles. A deductible is a total dollar amount that the consumer must pay before the insurer begins making payments for treatments. Under this type of policy, CAM coverage is offered, but the consumer pays a higher deductible.

• Policy riders. A rider is an amendment to an insurance policy that may change coverage in some way (such as increasing or decreasing benefits). You may be able to purchase a rider that adds or expands coverage in the area of CAM.

• A contracted network of providers. Some insurers work with a group of CAM providers who agree to offer services to group members at a rate lower than that offered to nonmembers. You pay out of pocket for treatment, but at a discounted rate.

Employers negotiate with insurance companies for plan rates and services. This is done on a periodic basis (usually annually). You may wish to let your company's benefits administrator know about any coverage preferences you have. If your company offers more than one plan, evaluate carefully what each one offers, so you can pick the plan that best meets your needs.

The Agency for Healthcare Research and Quality (AHRQ), a Federal agency, has helpful publications about choosing and using a health insurance plan (see "Resources").

7. Does NCCAM have a list of insurance companies that cover CAM?

As a medical research organization, NCCAM does not collect this kind of information and, therefore, does not have a list of companies that cover CAM. The following suggestions may be helpful:

• Talk to your family members, friends, and coworkers about their experiences with insurance companies and plans.

• Check what your state insurance commissioner's office (see Question 3) has to offer. Many provide consumer publications, such as summaries of basic information about the health insurance companies operating in the state and/or ratings of those companies. Note that commissioners' offices do not provide recommendations or advice on specific companies.

• An insurance broker (an agent who sells policies for a variety of companies) may also be a resource.

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8. My insurer has asked me for evidence, from scientific and medical literature, about the use of a CAM treatment. Can NCCAM provide this information?

The NCCAM Clearinghouse can help you find information from the scientific and medical literature on CAM. They use databases of peer-reviewed scientific and medical journals, such as CAM on PubMed (see "Resources"). If you do not have access to the Internet, the Clearinghouse can send information to you.

9. My insurance company has denied my claim for CAM treatment. Is there anything I can do?

As discussed in Question 3, make sure you know your policy--including what it is, and is not, supposed to cover. Check whether there has been a coding ³ error, either by the practitioner's office or by the insurance company; compare the codes on the practitioner's bill with the codes on the document you received from the insurance company. If you think your insurer made a mistake processing your claim, you can request a review from the company. Also, the insurance company should have an appeal procedure and provide a copy of it with your policy. It may be helpful to discuss with your practitioner whether she can do anything on your behalf, such as writing a letter. If you have taken these steps and the problem is not resolved, contact your state insurance commissioner's office, which has consumer complaint procedures.

³Health care providers and insurance companies use a standard set of codes in billing for medical services.

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10. Are there laws to help me keep my health insurance if I lose or change jobs? Do these laws apply to CAM treatments?

If you currently have an insurance plan that includes any CAM coverage, the following laws may be of interest to you.

The Health Insurance Portability and Accountability Act (HIPAA) of 1996 offers limited protections for many employed Americans. HIPAA protects health insurance coverage for workers and their families if the worker changes or loses his job. The law:

• Limits the ability of insurance companies to refuse coverage based on preexisting conditions.

• Prevents group health plans from denying or charging more for coverage because of past or present poor health.

• Assures renewal of coverage, regardless of any health conditions of people covered under the policy.

• Guarantees certain small-business employers, and certain people who lose job-related coverage, the right to buy health insurance.

The Centers for Medicare & Medicaid Services (see "Resources") can provide you with general information on the Federal HIPAA program. Note that individual states may have specific laws related to HIPAA requirements; if you need more information on HIPAA in your state, contact your state insurance commissioner's office.

Another Federal law that may help you is the Consolidated Omnibus Budget Reconciliation Act (COBRA) of 1985. COBRA continuation coverage gives you the chance to buy and maintain your current group health coverage for a defined period of time if you are laid off or have your work hours reduced below the level for receiving benefits. The length of continuation coverage depends on the reason for your loss of group coverage. COBRA generally covers health plans of businesses with 20 or more employees, employee organizations, and state or local governments. You must meet certain application deadlines and other conditions, such as payment schedules, to maintain coverage under COBRA. COBRA also can help you avoid a gap in coverage if you change jobs and are not immediately eligible for coverage in your new company.

For more information about COBRA, contact your nearest office of the Pension and Welfare Benefits Administration of the Department of Labor (see "Resources"). Your state may also have a law that requires insurers to continue group plan coverage to individuals who lose their medical coverage for various reasons. Check with your state insurance commissioner's office.

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11. What are tax-exempt accounts for medical expenses?

How might they help me? A flexible spending arrangement (FSA; sometimes called a Flexible Spending Account) is a benefit provided by some employers that offers a way to help pay for out-of-pocket medical expenses, while reducing the employee's taxable income. With FSAs for health-related expenses, you choose an amount of pre-tax dollars to be set aside from your paycheck each pay period. This money is then available to reimburse certain health-related expenses that are not paid any other way, such as by insurance. You may need to supply documentation from a physician or other health care provider that the treatment is medically necessary. Note that the IRS does not allow the same expense(s) to be both reimbursed through an FSA and claimed as a tax deduction (see Question 13).

Another type of tax-exempt benefit for health-related expenses is a health savings account (HSA). Set up by Congress in December 2003, HSAs allow some individuals who participate in a high-deductible health plan to save money in a tax-free account. If you are eligible, you can use these savings to pay for your future medical expenses or those of your spouse or dependents.

The IRS has publications with more information about FSAs and HSAs. The Department of the Treasury also has a direct link to information about HSAs on its Web site. See "Resources" below for details.

12. Does the Federal Government have resources that might help me financially with my health-related expenses?

Currently, Federal health assistance programs are not set up to assist with CAM expenses specifically. They are intended to provide either direct support (direct payments) or indirect support (such as housing or child care credits, medical care at public clinics, or other social services) to people whom the Government determines to be in need. Examples include people who:

• Have a low income and limited resources.

• Do not have other medical insurance.

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  Have a disability.

• Are part of a population that has difficulty accessing medical care.

• Are at least 65 years of age.

• Have served in the military.

There are Federal databases on the Internet that can introduce you to these programs. GovBenefits (www.govbenefits.gov) provides an overview and a self-test to help you identify whether any benefits are appropriate for your needs. FirstGov (www.firstgov.gov) has information on various health-related programs such as Medicare and Medicaid. FirstGov also has a database with information on benefits for seniors, www.firstgov.gov/Topics/Seniors.

The Social Security Administration (see "Resources") has two programs that pay benefits to people with disabilities:

• Social Security Disability Insurance (SSDI) pays benefits to disabled workers who have paid into Social Security through payroll deductions and to certain family members.

• Supplemental Security Income (SSI) pays benefits to people who are elderly or disabled and have low incomes.

The Department of Veterans Affairs (see "Resources") may be able to help with health care costs if you or a family member served in the Armed Forces. Certain CAM treatments may be covered, such as chiropractic and acupuncture.

The Health Resources and Services Administration (HRSA, see "Resources") has several programs:

• While this program is not CAM-specific, the Hill-Burton program requires health care facilities (usually hospitals and clinics) that received certain Federal funding to provide a specific amount of health care to needy persons free or at reduced cost. Eligibility is determined by income and family size, using the Federal poverty guidelines.

• Through its Bureau of Primary Health Care (BPHC), HRSA funds community and migrant health care centers that treat people with limited access to medical services. Depending on the needs of the community, CAM care may be integrated with conventional care at these centers.

• Through the national "Insure Kids Now!" initiative, each state has a program to make health insurance available to infants, children, and teens in working families.

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The Centers for Medicare & Medicaid Services (see "Resources"), formerly the Health Care Financing Administration, administers the Medicare and Medicaid programs:

• Medicare is insurance for older persons and persons with disabilities. As of 2002, it includes some limited coverage of chiropractic services. Other CAM insurance coverage is under consideration.

• Medicaid, a joint Federal-state program, is for people who need financial assistance for medical expenses. States may choose to provide optional Medicaid health care services, which could include CAM, in addition to required Medicaid services.

Also available through the Centers for Medicare & Medicaid Services is the State Children's Health Insurance Program, which expands health coverage to uninsured children in working families that earn too much for Medicaid but too little to afford private coverage.

The Federal Government also provides states and communities with various funds to assist needy persons, including for medical care. To find out more about these benefits and whether you are eligible, contact your state or local department of social services. These departments are listed in the "Government" section of your phone book.

Some persons have inquired whether they can receive CAM treatments or financial assistance for treatments from NCCAM. Given its mission of research, training, and disseminating information, NCCAM does not provide financial assistance or treatment to consumers. As part of its research, NCCAM does conduct clinical trials of some CAM treatments (to find out more, go to nccam.nih.gov/clinicaltrials, or contact the NCCAM Clearinghouse; see "Resources").

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13. Are CAM services deductible on my income tax?

As of 2002, the IRS allows a limited number of deductibles for CAM services and products (see "Resources"). Top

14. Can you suggest any other resources?

If treatment (whether CAM or conventional) for a disease or condition creates a financial crisis for you and your family, you may wish to try the following for more information:

• If you receive care at a hospital or clinic, that facility may have a social worker or patient advocate who can advise you.

• You may also find it helpful to contact nonprofit organizations that work on your disease or medical condition (try an Internet search or check directories at your local library).

15.Resources

Web sites for the resources below are given where available, but you may also call or write for information.

NCCAM Clearinghouse

Toll-free in the U.S.: 1-888-644-6226
International: 301-519-3153
TTY (for deaf or hard-of-hearing callers): 1-866-464-3615

E-mail: info@nccam.nih.gov
Web site: www.nccam.nih.gov
Address: NCCAM Clearinghouse,
P.O. Box 7923,
Gaithersburg, MD 20898-7923
Fax: 1-866-464-3616
Fax-on-Demand service: 1-888-644-6226

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Agency for Healthcare Research and Quality (AHRQ)

AHRQ conducts research on health care outcomes, quality, cost, use, and access. AHRQ's publications for consumers, including "Choosing and Using a Health Plan" and "Checkup on Health Insurance Choices," are located at www.ahrq.gov/consumer/index.html#plans .

Toll-free in the U.S.: 1-800-358-9295
TTY (for deaf and hard-of-hearing callers): 1-888-586-6340
Web site: www.ahrq.gov
E-mail: info@ahrq.gov

CAM on PubMed

CAM on PubMed, a database developed jointly by NCCAM and the National Library of Medicine, offers citations to (and in most cases, breif summaries of) articles on CAM in scientically based, peer-reviewed journals. CAM on PubMed also links to many publisher Web sites, which may offer the full text of articles.

Web site: www.nlm.nih.gov/nccam/camonpubmed.html

Centers for Medicare & Medicaid Services (CMS)

CMS, formerly the Health Care Financing Administration, administers the Medicare and Medicaid programs. Contact the above to be referred to your nearest regional office. CMS has publications on these programs, including the HIPAA law.

Toll-free in the U.S.: 1-877-267-2323
Web site: www.cms.hhs.gov

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Department of Labor (DOL)

The DOL has informational pamphlets and other materials concerning Federal health care laws, including the HIPAA and COBRA laws.

The DOL Pension and Welfare Benefits Administration Web site has many publications. Go to www.dol.gov/pwba or call the toll-free number below.

Toll-free in the U.S.: 1-866-4-USA-DOL (1-866-487-2365)
TTY (for deaf or hard-of-hearing callers): 1-877-889-5627
Web site: www.dol.gov

Department of the Treasury

The Department's Office of Public Affairs has information on HSAs, including press releases and links to other resources. A representative can be reached 24 hours a day by calling 202-622-2960. Questions can also be submitted by e-mail to HSAinfo@do.treas.gov.

Telephone: 202-622-2000
Web site: www.ustreas.gov

Department of Veterans Affairs (VA)

The VA is responsible for providing Federal benefits to veterans of the Armed Forces and their dependents. With regard to CAM, as of 2002, coverage decisions for chiropractic were being made on a regional basis, and there had been some coverage of acupuncture in the preceding few years. For more information, contact your local VA health facility, or the Tricare Military Health System at www.tricare.osd.mil.

Toll-free in the U.S.: 1-877-222-8387
TTY (for deaf or hard-of-hearing callers): 1-800-829-4833
Web site: www.va.gov/health_benefits

Health Resources and Services Administration (HRSA)

Contact HRSA for more information about its programs and a referral to your nearest HRSA field office.

• For information about the Hill-Burton program, you can go to www.hrsa.gov/osp/dfcr/obtain/obtain.htm or call 1-800-638-0742.

• For information about or referrals to HRSA's community and migrant health centers, and other BPHC-funded centers, you can go to www.ask.hrsa.gov/pc.

• HRSA administers the "Insure Kids Now!" campaign. To be referred to the program in your state, go to www.insurekidsnow.gov/states.htm or call toll-free 1-877-543-7669.

Toll-free in the U.S.: 1-888-ASK-HRSA (1-888-275-4772)
Web site: www.hrsa.gov
E-mail: ask@hrsa.gov

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Insurance Commissioners' Offices

To locate the insurance commissioner's office for your state (or for D.C. or the U.S. Territories):
(1) If you have access to the Internet, go to www.consumeraction.gov/insurance.shtml.
(2) If you don't have access to the Internet, consult the "State Government" section of your phone book or inquire with directory assistance. Note that the insurance commissioner or regulator's office can have different names in different states, such as the [Name of State] Insurance Administration (or Division or Department). Each office has a toll-free consumer assistance number.

Internal Revenue Service (IRS)

The IRS is the nation's tax collection agency. Publications include:

• "Introduction to Cafeteria Plans," which includes a chapter on FSAs. This document is online at:
  www.irs.gov/pub/irs-utl/intro_to_cafeteria_plans_doc.pdf.

• Publication 553, "Highlights of 2003 Tax Changes," which was revised in January 2004 and includes information on HSAs. This document is online at www.irs.gov/pub/irs-pdf/p553.pdf.

• Publication 502, "Medical and Dental Expenses," on tax deductions for medical costs. This document is online at www.irs.gov/pub/irs-pdf/p502.pdf. As of 2003, potentially deductible costs include some CAM therapies such as acupuncture, chiropractic, and osteopathy.

Toll-free in the U.S.: 1-800-829-1040
Web site: www.irs.ustreas.gov

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Social Security Administration (SSA)

The SSA administers benefits under two programs, the Social Security Disability Insurance (SSDI) Program and the Supplemental Security Income (SSI) Program.

Toll-free in the U.S.: 1-800-772-1213
TTY (for deaf or hard-of-hearing callers): 1-800-325-0778
Web site: www.ssa.gov

NCCAM has provided this material for your information. It is not intended to substitute for the medical expertise and advice of your primary health care provider. We encourage you to discuss any decisions about treatment or care with your health care provider. The mention of any product, service, or therapy in this information is not an endorsement by NCCAM.

next: Important Information About Herbal Treatments

In: Peele, S., with Brodsky, A. (1975), Love and Addiction. New York: Taplinger.

© 1975 Stanton Peele and Archie Brodsky.
Reprinted with permission from Taplinger Publishing Co., Inc.

A. Responses to Morphine and a Placebo

In the Lasagna experiment, patients were given injections of an allegedly pain-killing drug which was sometimes morphine and sometimes a placebo. The drugs were administered under double-blind conditions; that is, neither the patients nor the technicians who administered the drugs knew which was which. Depending on the sequence of administration of the two drugs, which was varied in several ways, between 30 and 40 percent of the patients found the placebo as adequate as the morphine. Those who believed in the efficacy of the placebo also were somewhat more likely to obtain relief from the morphine itself. The average percentage of times relief was obtained from morphine by those who never responded to the placebo was 61 percent, while for those who did accept the placebo at least once, it was 78 percent.

B. Shared Action of Chemically Distinct Substances

In grouping barbiturates, alcohol, and opiates into one category, we depart, of course, from a strictly pharmacological approach to drugs. Since these three kinds of drugs have different chemical structures, a pharmacological model cannot explain the fundamental similarities in people's reactions to them. Consequently, many biologically oriented researchers have attempted to discount such similarities. Foremost among these scientists is Abraham Wikler (see Appendix F), whose position may have ideological overtones. It is consistent, for instance, with the importance he gives physiological habituation in his reinforcement model of addiction, and with the conservative public position he has maintained on such issues as marijuana. However, nowhere have pharmacologists been able to demonstrate a link between the particular chemical structures of the major depressants and the unique addictive properties that Wikler believes each of them has. In any case, there are other biochemical researchers who claim, as do Virginia Davis and Michael Walsh, that "Because of the resemblance of symptoms occurring on withdrawal of either alcohol or the opiates, it seems possible that the addictions may be similar and that the real distinctions between the two drugs could be only the length of time and dosage required for development of dependence."

Generalizing from Davis and Walsh's argument, differences in the effects of many drugs are perhaps more quantitative than qualitative. Marijuana, for instance, would have small potential for addiction simply because it is too mild a sedative to engage fully a person's consciousness in the manner of heroin or alcohol. Even these quantitative distinctions may not always be intrinsic to the drugs in question, but may be strongly influenced by the dosage strengths and methods of administration that are characteristically employed with these drugs in a given culture. The Bushmen and Hottentots may have reacted violently to smoking tobacco because they swallowed the smoke rather than exhaling it. Coffee and tea may be prepared in milder concentrations in present-day America than in nineteenth-century England. Smoking a cigarette may provide a small and gradual infusion of nicotine, compared to the amount of heroin one gets from injecting a strong dose directly into the bloodstream. These circumstantial differences are not inconsiderable, and should not be mistaken for categorical differences between substances which in important respects operate similarly.

C. Effects of Expectations and Setting on Reactions to a Drug

Subjects in the Schachter and Singer study received an injection of the stimulant epinephrine (adrenalin), which was presented to them as an "experimental vitamin." Half of the subjects were told what to expect from the injection (i.e., generalized arousal); the other half were kept in the dark about these "side effects" of the supposed vitamin. Then each subject was left in a room with another person—a stooge paid by the experimenter to act in a specified way. Half the subjects in each of the original two groups were exposed, individually, to a stooge who acted as though he were euphoric, joking and throwing paper around, and half were put in with a stooge who took offense at the experiment and stalked out in anger. The result was that uninformed subjects—those who had not been told what their physiological reaction to the injection was going to be—picked up the mood set by the stooge, while informed subjects did not. That is, if the subject experienced an effect from the drug, but didn't know why he was feeling that way, he became very suggestible. Seeing the stooge react to the experiment in a certain way served to explain for the subject why he himself was physiologically aroused—i.e., that he was angry, or that he was euphoric. On the other hand, if the subject could link his physiological state with the injection, then he had no need to look around him for an emotional explanation for his arousal. Another group of subjects, who were grossly misinformed about what the injection would do to them, were even more suggestible than were uninformed subjects.

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To investigate what happens generally when people mislabel the drug they take, or anticipate effects that actually are characteristic of a different kind of drug, Cedric Wilson and Pamela Huby gave subjects three classes of drugs: stimulants, depressants, and tranquilizers. "When the subjects guessed correctly which drug they had received," reported Wilson and Huby, "they responded to it vigorously. When they guessed incorrectly, the effects of the drug were partially or completely inhibited."

D. Comparison of Health Hazards of Commonly Used Drugs with Those of Heroin

The major health hazards of tobacco are in the areas of lung cancer, emphysema, chronic bronchitis, and heart disease. Coffee, according to Marjorie Baldwin's article "Caffeine on Trial," is being implicated in heart disease, diabetes, hypoglycemia, and stomach acidity. In addition, recent research has concentrated on the increased incidence of birth defects and increased risks in pregnancy with both of these drugs, as well as with aspirin. The U.S. Public Health Service has reported that smoking on the part of mothers is an important contributor to the high rate of fetal mortality in this country. Lissy Jarvik and her colleagues, investigating chromosomal damage from LSD (see Appendix E), find that long-time aspirin users and "coffee or Coca-Cola addicts" run similar risks of genetic damage and congenital abnormality in their offspring, and women who take aspirin daily are now being observed to show a higher than normal rate of irregularities in pregnancy and childbirth.

While American society has been slow in recognizing the deleterious consequences of these familiar drugs, it has from the outset exaggerated those of heroin. Along with the myths of addiction after one shot (for which only a psychological explanation is possible) and unlimited tolerance, heroin is thought to lead to physical degeneration and death. But the experience of lifetime users in favorable social climates has shown that heroin is as viable a habit to maintain as any other, and medical research has not isolated any ill effects on health from heroin use alone. The main cause of illness and death among street addicts is contamination from unhealthy conditions of administration, such as dirty hypodermic needles. The addict's lifestyle also contributes in many ways to his high mortality rate. Charles Winick has concluded, "Opiates usually are harmless, but they are taken under unsatisfactory conditions. Malnutrition caused by loss of appetite probably is the most serious complication of opiate addiction."

The physical danger that heroin is most widely believed to present for its users is that of death by overdose. Constituting perhaps the most persistent misapprehension about the drug, "heroin overdoses" have vastly increased in recent years while the average heroin content in doses available on the street has been shrinking. Citing an investigation by Dr. Milton Helpern, New York City's Chief Medical Examiner, Edward Brecher shows that so-called deaths by OD could not possibly result from that cause. The best current guess is that deaths attributed to overdosing are actually due to the use of heroin in combination with another depressant, such as alcohol or a barbiturate.

The information presented here is not intended as an argument favoring the use of heroin. In fact, it is true that heroin offers the most sure and complete chance for eradicating one's consciousness, which is the basic element in an addiction. The premise of this book is that addiction as a way of life is psychologically unhealthy both in its causes and consequences, and the values which the book is meant to encourage run directly counter to those of a drugged or otherwise artificially supported existence. The exculpatory data on heroin, together with the evidence of ill effects from cigarettes and coffee, are offered in support of the proposition that a culture's—our culture's—estimate of the physical as well as psychological hazards of different drugs is an expression of its overall attitude toward those drugs. What must be dealt with is our society's need to condemn heroin from every possible angle, regardless of the facts, even while that society is so strongly susceptible to heroin and other forms of addiction.

E. LSD Research

Sidney Cohen's study was based on a survey of 44 LSD researchers who, among them, had collected data on 5000 individuals who had been given LSD or mescaline on a total of 25,000 occasions. These subjects, broken down into "normal" experimental volunteers and patients undergoing psychotherapy, showed the following rates of complications associated with hallucinogenic trips: attempted suicides—0 per 1000 for normal subjects, 1.2 per 1000 for psychiatric patients; psychotic reactions lasting longer than 48 hours (roughly the duration of a trip)—less than 1 per 1000 for normal subjects, less than 2 per 1000 for psychiatric patients.

The refutation of the Maimon Cohen study on chromosomal breakage caused by LSD focused on the fact that the study employed human leukocytes (white blood cells) cultured artificially in a test tube (in vitro), rather than in the living organism (in vivo). Under these conditions, where the cells cannot easily rid themselves of toxins, many chemicals cause increased chromosomal breakage. These include aspirin, benzene, caffeine, antibiotics, and even more innocuous substances, such as water that has not been twice distilled. Subsequent in vivo studies of users of pure and illicit LSD, along with further in vitro studies with proper controls, showed that there is no special danger with LSD. Reporting that caffeine doubles breakage rates just as LSD does, Jarvik and her colleagues note that any substance introduced into the body in sufficient quantity during gestation can cause congenital abnormality.

F. Conditioning Models of Addiction

A major line of thought in addiction research—the conditioned learning approach of Abraham Wikler and the animal experimenters at the University of Michigan (see Appendix B)—is explicitly concerned with the psychological rewards and punishments associated with drug use. The chief limitation of this theorizing and research, however, is that it takes withdrawal distress for granted and assumes that the relief of withdrawal pain is invariably the addict's primary reinforcement for taking an opiate past the period of initial involvement with the drug. Other rewards (such as those provided by environmental stimuli) are considered, but only as secondary reinforcements that are linked to the relief of withdrawal.

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The mechanistic character of conditioning theories is associated with their origins in the observation of laboratory animals. Human consciousness entails a greater complexity of response to drugs, and withdrawal, than animals are capable of. Only animals respond to drugs in a predictable way, and only animals (especially encaged animals) respond uniformly to the onset of withdrawal by renewing their dosage of a drug. For a conditioning theory to explain the behavior of human addicts, as well as nonaddicted drug users, it must take into account the various social and personal reinforcements— ego-gratification, social approval, security, self-consistency, sensory stimulation, etc.—that motivate human beings in their drug-taking as in other activities.

Recognizing the limitations of animal-based hypotheses, Alfred Lindesmith has proposed a variation of conditioning theory which adds to it an important cognitive dimension. In Addiction and Opiates, Lindesmith argues that addiction occurs only when the addict understands that physiological habituation to morphine or heroin has taken place, and that only another dose of the drug will protect him from withdrawal. Despite Lindesmith's insistence that addiction is a conscious, human phenomenon, his theory is just as narrowly based on physical dependence and withdrawal as all-purpose reinforcers as are other conditioning models. It posits only one kind of cognition (i.e., the awareness of an association between withdrawal and taking an opiate) as influencing the psychological process of conditioning, rather than allowing for the range of cognitions of which human beings are capable. Lindesmith notes marginally that hospital patients who know that they have received morphine, and who are knowingly withdrawn from the drug, still do not usually become addicted. This is because they think of themselves as patients, not addicts. Lindesmith fails to draw what seems a reasonable inference from this observation: that self-image is always a factor to be considered in the addiction process.

G. Physiological and Psychological Mechanisms of Addiction

The publication in Science of a study by Louise Lowney and her colleagues on the binding of opiate molecules in the brains of mice, which is part of an ongoing line of research in that area, has convinced many people that a breakthrough has been achieved in understanding addiction physiologically. But for every study of this sort that reaches the public eye, there is also one like Psychology Today's report on Richard Drawbaugh and Harbans Lal's work with morphine-addicted rats who had been conditioned to accept the ringing of a bell (together with a placebo injection) in place of morphine. Lal and Drawbaugh found that the morphine antagonist naloxone, which is presumed to counteract the effects of morphine chemically, inhibited the effects of the conditioned stimulus (the bell) as well as those of morphine itself. Clearly, the antagonist was working at something besides a chemical level.

Chemical reactions in the brain can, of course, be observed whenever a psychoactive drug is introduced. The existence of such reactions, and the fact that all psychological processes ultimately take the form of neural and chemical processes, should not be used to beg the questions raised by the impressive array of research, observations, and subjective reports that testify to the variability of human reactions to drugs.

next: Mother Asks For Help For Her Daughter
~ all Stanton Peele articles
~ addictions library articles
~ all addictions articles

References

Baldwin, Marjorie V. "Caffeine on Trial." Life and Health (October 1973): 10-13.

Brecher, Edward M. Licit and Illicit Drugs. Mount Vernon, N.Y.: Consumers Union, 1972.

Cohen, Maimon M.; Marinello, Michelle J.; and Back, Nathan. "Chromosomal Damage in Human Leukocytes Induced by Lysergic Acid Diethylamide." Science 155 (1967): 1417-1419.

Cohen, Sidney. "Lysergic Acid Diethylamide: Side Effects and Complications." Journal of Nervous and Mental Disease 130 (1960): 30-40.

Davis, Virginia E., and Walsh, Michael J. "Alcohol, Amines, and Alkaloids: A Possible Biochemical Basis for Alcohol Addiction." Science 167 (1970): 1005-1007.

Dishotsky, Norman I.; Loughman, William D.; Mogar, Robert E.; and Lipscomb, Wendell R. "LSD and Genetic Damage." Science 172 (1971): 431-440.

Drawbaugh, Richard, and Lal, Harbans. "Reversal by Narcotic Antagonist of a Narcotic Action Elicited by a Conditioned Stimulus." Nature 247 (1974): 65-67.

Jarvik, Lissy F.; Kato, Takashi; Saunders, Barbara; and Moralishvili, Emelia. "LSD and Human Chromosomes." In Psychopharmacology: A Review of Progress 1957-1967 edited by Daniel H. Efron, pp. 1247-1252. Washington, D.C.: Public Health Service Document No. 1836; HEW, 1968.

Lasagna, Louis; Mosteller, Frederick; von Felsinger, John M.; and Beecher, Henry K. "A Study of the Placebo Response." American Journal of Medicine 16 (1954): 770-779.

Lindesmith, Alfred R. Addiction and Opiates. Chicago: Aldine, 1968.

Lowney, Louise I.; Schulz, Karin; Lowery, Patricia J.; and Goldstein, Avram. "Partial Purification of an Opiate Receptor from Mouse Brain." Science 183 (1974): 749-753.

Schachter, Stanley, and Singer, Jerome E. "Cognitive, Social, and Physiological Determinants of Emotional State." Psychological Review 69 (1962): 379-399.

Wikler, Abraham. "Some Implications of Conditioning Theory for Problems of Drug Abuse." In Drug Abuse: Data and Debate, edited by Paul L. Blachly, pp. 104-113. Springfield, Ill.: Charles C Thomas, 1970.

Wilson, Cedric W. M., and Huby, Pamela, M. "An Assessment of the Responses to Drugs Acting on the Central Nervous System." Clinical Pharmacology and Therapeutics 2 (1961): 174-186.

 

Increased levels of depression are associated with those who become addicted to the Internet.

Kimberly S. Young and Robert C. Rodgers

Ed. Note: This paper was published in CyberPsychology & Behavior, 1(1), 25-28, 1998

ABSTRACT

Prior research has utilized the Zung Depression Inventory (ZDI) and found that moderate to severe rates of depression coexist with pathological Internet use.¹ Although the ZDI was utilized for its expediency with on-line administration, its limitations include poor normative data and less frequent clinical use. Therefore, this study utilized the Beck Depression Inventory (BDI), which has more accurate norms and frequent usage among dual diagnostic patient populations. An on-line survey administered on a World Wide Web site utilized the BDI as part of a larger study. A total of 312 surveys was collected with 259 valid profiles from addicted users, which again supported significant levels of depression to be associated with pathological Internet use. This article discusses how a treatment protocol should emphasis the primary psychiatric condition if related to a subsequent impulse control problem such as pathological Internet use. Effective management of psychiatric symptoms may indirectly correct pathological Internet use.

PRIOR RESEARCH HAS IDENTIFIED the existence of addictive Internet use, which has been associated with significant social, psychological, and occupational impairment.² Addicts in this study used the Internet an average of 38 hr per week for nonacademic or nonemployment purposes, which caused detrimental effects such as poor grade performance among students, discord among couples, and reduced work performance among employees. This is compared to nonaddicts who used the Internet an average of 8 hr per week with no significant consequences reported. Predominantly, the interactive capabilities of the Internet such as chat rooms or on-line games were seen to be the most addictive. This type of behavioral impulse control failure, which does not involve an intoxicant, was seen as most akin to pathological gambling. Therefore, a formal term utilized in this article is pathological Internet use (PIU) to refer to cases of addictive Internet use.

Research in the addictions field has shown that psychiatric illnesses such as depression are often associated with alcoholism³ and drug addiction.⁴ Further, research has shown that other addictive behaviors overlap with depression-for example, eating disorders⁵'⁶ and pathological gambling.⁷-⁹ Although the concept of Internet addiction has gained credibility among mental health professionals both in academic and clinical realms, little research has been conducted to examine if similar underlying psychiatric illnesses may contribute to such Internet abuse.¹

Therefore, the objective of this study was to assess depression and compare such results to other established dual diagnostic populations. Young¹ utilized the Zung Depression Inventory¹⁰ (ZDI), which suggested that increased levels of depression are associated with moderate to severe levels of PIU. However, the ZDI yields limited clinical utility; therefore, this study used the Beck Depression Invento#¹ (BDI) because it is a more psychometrically and clinically valid instrument to further investigate the effects of depression on PIU. Finally, this study also attempted to increase its sample size from the previous examination (N -99) to improve generalizability of results.

METHOD

Subjects

Subjects were self-selected active Internet users who responded to postings on electronic support groups and those who searched for the keywords Internet or addiction on popular Web search engines (e.g., Yahoo).

Materials

An on-line survey was constructed for this study. The survey exists as a World Wide Web (WWW) page (located at http: / /www.pitt. edu/ ksy/survey.html) implemented on a UNIX-based server that captures the answers into a text file. The on-line survey administered a structured diagnostic questionnaire that modified the DSM-IV criteria for pathological gambling'² to classify subjects as addicted or nonaddicted, followed by administration of the BDI, the Sixteen Personality Factor Inventory,¹⁵ and Zuckerman's Sensation Seeking Scale,¹³ as part of a larger study. Finally, demographic information was also gathered.

Procedures

The WWW location of the survey was submitted to several popular search engines available to assist on-line users in finding Web pages of interest. On-line users entering keyword searches for Internet or addiction would find the survey and have the option to follow the link to the survey in order to fill it out. Additionally, a brief description of the study along with the WWW address of the survey was advertised on prominent electronic support groups geared toward Internet addiction (e.g., the Internet Addiction Support Group and the Web-aholics Support Group). Answers to the survey were sent in a text file directly to the principal investigator's electronic mailbox for analysis. Respondents who answered "yes" to five or more of the criteria were classified as addicted Internet users for inclusion in this study.

RESULTS

A total of 312 surveys were collected, resulting in 259 valid geographically dispersed profiles from addicted users. The sample included 130 males with a mean age of 31 and 129 females with a mean age of 33. Educational background was as follows: 30% had a high school degree or less, 38% had an associate's or bachelor's degree, 10% had a master's degree or doctorate, and 22% were still in school. Of the subjects, 15% had no vocational background (e.g., homemaker or retired), 31% were students₁ 6% were blue-collar workers (e.g., factor worker or auto mechanic), 22% were nontech white-collar workers (e.g., school teacher or bank teller), and 26% were high-tech white-collar workers (e.g., computer scientist or systems analyst).

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Occupational type appears to be a determinant in the level of Internet usage in this study. These results suggest that nontech or high-tech white-collar workers are more likely to become addicted to the Internet than are blue-collar workers. White-collar employment may offer wider access to the Internet and greater salary potential, making the purchase of a home computer more affordable compared to those in blue-collar types of employment, which may explain these results.

Results from the BDI were a mean of 11.2 (SD 13.9), indicating mild to moderate levels of depression compared to normative data. Prior research showed that analysis of the ZDI provided a mean of 38.56 (SD = 10.24), also indicating mild to moderate levels of depression when compared to normal populations.~ Therefore, the BDI yielded similar results as the prior work suggesting that depression is a significant factor in the development of PIU.

DEPRESSION AND INTERNET ADDICTION DISCUSSION

As noted with other addictive disorders, our findings suggest that increased levels of depression are associated with those who become addicted to the Internet. This suggests that clinical depression is significantly associated with increased levels of personal Internet use. These results should be interpreted with caution, however, as self-selected sample biases exist in this study coupled with the questionable accuracy of on-line responses.

This study suggests that accurate assessment of depression and PIU can improve early detection, especially when one is masked by primary symptoms of the other diagnosis. It is likely that low self-esteem, poor motivation, fear of rejection, and the need for approval associated with depressives contribute to increased Internet use, as prior research indicated that the interactive capabilities available on the Internet were found to be most addictive.² It is plausible that depressives are drawn to electronic communication because of the anonymous cover granted to them by talking with others through fictitious handles, which helps them overcome real-life interpersonal difficulties. Kiesler et al.¹⁴ found that computer-mediated communication weakens social influence by the absence of such nonverbal behavior as talking in the head set, speaking loudly, staring, touching, and gesturing. Therefore, the disappearance of facial expression, voice inflection, and eye contact makes electronic communication less threatening, thereby helping the depressive to overcome the initial awkwardness and intimidation in meeting and speaking with others. This anonymous two-way talk also helps depressives feel comfortable sharing ideas with others thanks to the personal control over the level of their communication, as they have time to plan, contemplate, and edit comments before sending an electronic message. Therefore, the treatment protocol should emphasize the primary psychiatric condition, if related to a subsequent impulse control problem, as addictive Internet use. Effective management of such psychiatric symptoms may indirectly correct PIU.

Based on the findings, it is concluded that evaluation of suspected cases of PIU should in-dude assessment for depression. These results, however, do not clearly indicate whether depression preceded the development of such Internet abuse or if it was a consequence. Young² showed that withdrawal from significant real-life relationships is a consequence of PIU. Therefore, the possibility exists that increased levels of social isolation subsequent to excessive time spent in front of a computer may result in increased depression rather than be a cause of such Internet overuse. Therefore, further experimentation with a more comprehensive level of analysis is necessary to examine cause and effect. Data collection should also include patients in treatment to eliminate the methodological limitations of an on-line survey and to improve the clinical utility of the information gathered. Finally, although it is unclear how PIU compares to other established addictions, future research should investigate if clinical depression is an etiologic factor in the development of any addictive syndrome, be it alcohol, gambling, or the Internet.

next:Researchers Find Sad, Lonely World in Cyberspace
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REFERENCES

1. Young, K.S. (1997, April 11). Leoels of depression and addiction underlying pathological Internet use. Poster presented at the annual meeting of the Eastern Psychological Association, Washington, DC.

2. Young, K.S. (1996, August 10). Internet addiction: The emergence of a new clinical disorder. Paper presented at the 104th annual meeting of the American Psycho-logical Association, Toronto.

3. Capuzzi, D., & Lecoq, L.L. (1983). Social and personal determination of adolescent use and abuse of alcohol and marijuana. Personnel and Guidance Journal, 62, 199-205.

4. Cox, W.M. (1985). Personality correlates of substance abuse. In M. Galizio & S.A. Maisto (Eds.), Determinants of substance abuse: Biological, psychological, and environmental factors (pp.209-246). New York: Plenum.

5. Lacey, H.J. (1993). Self-damaging and addictive behavior in bulimia nervosa: A catchment area study. British Journal of Psychiatry, 163, 190-194.

6. Lesieur, H.R., & Blume, S.B. ~993). Pathological gambling, eating disorders, and the psychoactive substance use disorders. Journal of Addictive Diseases, 12(3), 89-102.

7. Blaszczynski, A., McConaghy, N., & Frankova, A. (1991). Sensation seeking and pathological gambling. British Journal of Addiction, 81, 113-117.

8. Criffiths, M. (1990). The cognitive psychology of gambling. Journal of Gambling Studies, 6, 31~2.

9. Mobilia, P. (1993). Gambling as a rational addiction. Journal of Gambling Studies, 9(2), 121-151.

10. Zung, W.K. (1965). Self-rating depression scale. New York; Springer-Verlag.

11. Beck, A.T., Ward, C.M., Mendeleson, M., Mock, J.F., & Erbaugh, J.K. (1961). An inventory for measuring depression. Archives of General Psychiatry, 4, 5~-571.

12. American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author.

13. Zuckerman, M. (1979). Sensation seeking behavior: Beyond the optimal level of arousal. Hillsdale, NJ: Erlbaum.

14. Kiesler, S., Siegal, I., & McGuire, T.W. (1984). Social psychological aspects of computer-mediated communication. American Psychologist, 39(10), 1123~134.

15. Cattell, R. (1975). Sixteen Personality Factor Inventory. The Institute of Personality and Ability, Inc., Champaign, IL

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Are you a black person in a blue funk that just won't go away?

Do the things that once gave you pleasure now seem uninspiring, and are you sleeping and eating a lot more or a lot less than is normal for you? If the answer to these questions is "Yes," you may be depressed. But you are not alone. About 17 million people a year suffer from depression, mental health experts say.

And if you are an average black person in America, you are more likely than an average white person to suffer depression.

You don't have to remain depressed, however. Dr. Freda Lewis-Hall, a psychiatrist who has worked extensively in the African-American community says not nearly enough blacks who are depressed seek professional help. "Most either believe that depression, or the "blues," is a necessary condition of life and must be endured, or they fear being labeled as insane and therefore do no seek professional help," says Dr. Lewis-Hall.

In addition to dramatic changes in sleeping and eating patterns, Dr. Lewis-Hall says symptoms of clinical depression include "changes in energy level, so that there is a lack of energy; not enjoying things that were previously enjoyed, like you've gone to church every Sunday, but for weeks you can't get up and go to church. You just feel so depressed."

A survey by the National Mental Health Association revealed that only one-third of all persons with major depression ever seek treatment. According to the study, African-Americans and persons over 65 years old are the least likely to seek professional help for depression.

Dr. Lewis-Hall, who is a clinical research physician at U.S. Medical Operations and is director of the Women's Health Center at Eli Lilly and Company, stresses that most depression cases are treatable. "In fact, more than 80% of people with clinical depression can successfully recover and resume normal, happy and productive lives," Dr. Lewis-Hall stated in a paper on clinical depression in the African-American community.

Dr. Lewis-Hall said the medical community could not say in every case precisely what caused depression but had identified certain factors that could either cause depression directly or predispose a person to be depressed.

"What we believe is that, number one...depression seems to run in families, and so we know that there is some predisposition, some genetic piece to it," she said. "The other piece of it is what happens in the environment. And there are certain things that we recognize as risk factors for the development of depression, and they include things like having been a victim of abuse, or violence, poverty, chronic or serious illnesses - cancer, heart disease, diabetes. We think that people with chronic illnesses have systems that are likely to develop other illness, that there is an actual change in the physiology of the person that actually leads to the development of depression."

Dr. Lewis-Hall adds that not everybody that gets diabetes also gets depression. Not everybody that's hospitalized for very serious illness gets clinical depression. "One would think that if you went into a population of people with cancer everybody would have depression, because having cancer is a depressing thing. But the reality is that only (20-35%) percent of them actually go on to develop this medical illness that we call depression. They may be sad at some point after hearing the diagnosis or after going through the treatment, but to actually develop (depression), not everybody does it."

Nonetheless, the 20-35% percent rate of depression among persons with serious or chronic illness is likely to account for a larger portion of the black population than the white population, since African-Americans suffer conditions such as high blood pressure, heart disease, diabetes and lupus at a significantly higher rate than whites.

Additionally, some mental health experts believe that the stresses of racism and the attendant social undervaluing of the victims of racism lead to low self-esteem among those persons. Therefore, the stress of encountering racism and the low self-esteem caused by it are thought to be contributors to depression in some African-Americans, Dr. Lewis-Hall said.

To improve their chances of overcoming depression, African-Americans who are afflicted- and their friends and families - need to recognize the cultural norms and myths in the African-American community that contribute to depression and the tendency to live with it untreated, Dr. Lewis-Hall said. And sufferers need to seek professional help for their depression, she said.

Citing her own experience as an African-American and a mental health expert diagnosing and treating depression in African-Americans during an Urban Corps assignment in Washington, D.C., Dr. Lewis-Hall said "the stigma continues to be great." The relative isolation of African-Americans from the U.S. information mainstream has prevented them from being full beneficiaries of the aggressive public education campaign on depression that has been carried on in the media in recent years, Dr. Lewis-Hall said.

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That campaign has helped white Americans and many other non-African members of U.S. society to improve their attitudes and approaches to depression, while African-Americans mostly have been left behind, still clinging to unhealthy beliefs about depression and the stigma of insanity.

"We don't often have an opportunity to hear depression described as the medical illness that it is," she said. "If we look at the exposure of African-Americans to things that we recognize as risk factors in developing depression, (we see that) we get exposed to those more often. What we don't think is that there is a genetic predisposition on the part of African-Americans to be depressed."

Significantly, the risk factors that predispose many African-Americans to depression frequently affect another visible group of persons in the U.S. - immigrants. Because immigrants tend to be poorer than the mainstream population, and because many of them also experience racism and are often undervalued as persons, they too experience high levels of depression.

Some immigrants feel isolation and hopelessness and slide progressively into depression under the weight of language barriers, cultural differences, poverty, racism and generally being undervalued.

"There have been number of studies that have been shown that immigrants to this country, and to other countries, are clearly at risk for the development of depression and other mental illnesses. That is because immigration is one of the toughest of all stressers," Dr. Lewis-Hall said.

The stress of immigration "includes loss of people that you love because you usually leave them behind. It changes your entire perspective. It changes everything. It changes where you live, where you work, who you socialize with. And as much as many cultures are pliable in accepting people who have immigrated there ... immigration still is an enormous stresser unto itself," she said.

next: How Do Hispanics Experience Depression?
~ depression library articles
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• Basics #1: Your Needs and Wants
• Basics #2: Your Natural Feelings
• Basics #3: Unnatural Feelings
• Clear Communication: #1
• Clear Communication: #2
• Guidelines For Emotional Health
• Success

 

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Oncologist shares experiences of treating cancer patients and learns that cancer is a journey that also provides opportunities for healing and transformation.

As a medical oncologist, I have been honored to serve as physician, guide, and friend to thousands of individuals with cancer and their loved ones. Many heroic people have inspired and taught me a great deal about living courageously in the face of great challenges, and the unknown.

Through this process, I have come to understand the experience of cancer as a journey -- filled with ups and downs, periods of calm and tumult, and extraordinary opportunities for healing and transformation. I have also seen, again and again, what powerful roles the mind, heart, and spirit can play in impacting every individual's journey through cancer.

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It is normal and common to feel overwhelmed by a cancer diagnosis, as anyone who has been through this experience can attest. Unfortunately, it is not yet normal or common for individuals and families to receive skillful, coherent, and comprehensive help in navigating the mental, emotional, and spiritual aspects of cancer. For many, this is a painful and tragically missed opportunity. But it doesn't have to be so.

Over many years of running an integrative cancer center, I was repeatedly asked: "Doctor, in addition to radiation, chemotherapy, and surgery, what else can I do to help myself? What should I eat? What vitamins should I take? What alternative therapies should I use?" And, "How can I deal with the mental, emotional, and spiritual challenges I am encountering?"

In searching for meaningful and practical answers, I saw an important pattern. I recognized that all questions and concerns encountered by patients and their loved ones fall into one of seven distinct, but inter-related domains of inquiry and exploration. I call these The Seven Levels of Healing® and describe them in detail in The Journey Through Cancer: Healing and Transforming the Whole Person. They are a powerful guide for navigating all aspects of the cancer journey, including the mental, emotional, and spiritual -- as well as physical -- ones.

The Seven Levels are briefly summarized below, along with some practical suggestions for using them right away:

Level One:Education and Information. Understanding your medical care is important to achieving the best outcome. Feeling clear and confident about your care helps put your mind at ease and enhances your ability to enter the deeper dimensions of healing. Find an experienced oncologist whom you trust, and who answers your questions fully. Don't make hasty decisions. Make decisions based on knowledge and understanding, not on fear.

Level Two:Connection with Others. This is a powerful component of healing. Family members can only do so much. Seek additional support from friends, clergy, and self-help organizations. Join a support group. Talk with others who have navigated the journey though cancer and found positive solutions.

Level Three:The Body as Garden. Conventional treatments remain the foundation of leading-edge cancer care. However, taking an active role in caring for your body also includes good nutrition, exercise, massage, relaxation, and other complementary therapies. These can nourish and strengthen the body, soothe and calm the mind, and invigorate the heart and spirit.

Level Four: Emotional Healing. Cancer can be an emotional roller-coaster. Everyone involved can experience feelings of fear, anger, depression, and doubt -- as well as gratitude and love. Keep a journal to explore and release your innermost feelings. Work with a counselor or therapist. Don't neglect your emotional self.

Level Five: The Nature of Mind. Mental anxiety is often another part of cancer. The mind can work for or against you, depending on your focus. To avoid feeling overwhelmed, examine your thoughts and beliefs and see if they are serving you. When fear and doubt are replaced with clarity and understanding, anxiety often diminishes. Ask yourself, "What are the blessings in my life? What am I truly grateful for?"

Level Six: Life Assessment. It is very empowering to discover the deepest meaning and purpose of your life, especially in the face of cancer. Answering three important questions can help clarify your priorities and liberate enormous time, energy, and resources for healing:

• What is the meaning and purpose of my life?
• What are my most important goals for the coming year?
• How do I want to be remembered by those whom I love?

Level Seven: The Nature of Spirit. There is no better time than now to fully honor and embrace your spiritual essence. It is the source not only of the love, joy, and fulfillment that we all seek, but physical healing as well. Explore this through meditation, reflection, prayer, time in nature, and sharing with loved ones. Remember that your body needs love and care, but your mind, heart, and spirit need and deserve these as well.

Copyright © 2006 Jeremy R. Geffen

Jeremy R. Geffen, MD, FACP, is a board-certified medical oncologist, a Fellow of the American College of Physicians, and a renowned pioneer in integrative medicine and oncology. He is founder of Geffen Visions International (www.geffenvisions.com) and Director of Integrative Oncology for P4 Healthcare and Caring4Cancer.com. He is also author of the highly acclaimed book The Journey Through Cancer: Healing and Transforming the Whole Person (Three River Press, 2006) and audio program The Seven Levels of Healing®.

In 1994, he founded the Geffen Cancer Center and Research Institute in Vero Beach, FL, which he directed until 2003. It was one of the first cancer centers in the United States explicitly designed to provide a working model of truly holistic, comprehensive cancer care for the twenty-first century. Dr. Geffen lectures widely and offers seminars and retreats on the multidimensional aspects of medicine, wellness, and life. He also advises organizations on integrative programs for medicine and healing.

next: Articles: Kenosha

• About Change
• About Shame
• Clients and Success in Therapy
• Depression: What To Do About It
• Discipline
• False Memories and Responsibility
• Feeling Like You Belong
• Getting Enough Attention
• Growing Up Emotionally
• Handling Criticism
• Healing From Sexual Abuse: A Strategy
• How Does Abuse Happen?
• How To Have A Lousy Sex Life
• How To Talk About Feelings
• Life's Craziest Beliefs
• Living With Alcoholics
• Loneliness
• Natural Anger
• Perfectionism
• Personal Freedom
• Problems With Anger
• Quitting Addictions
• Sexual Abuse In Childhood
• Shame: What You Can Do About It
• Subconscious Life Scripts
• Were You Loved As A Child?
• What To Tell A Therapist
• Who Is The Real You?
• Who's Healthy?

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