Namenda: Alzheimer's Medication

Namenda is a medication used in the treatment of Alzheimer's Disease. Detailed info on usage, dosage, side-effects of Namenda.

Brand Name: Namenda
Generic Name: Memantine hydrochloride

Namenda (memantine hydrochloride) is medication used in treatment of Alzheimer's Disease. Detailed info on uses, dosage and side-effects of Namenda below.

Contents:

Description
Pharmacology
Indications and Usage
Contraindications
Precautions
Drug Interactions
Adverse Reactions
Overdose
Dosage
Supplied
Patient Instructions

Namenda Patient Information (in plain English)

Description

Namenda® (memantine hydrochloride) is an orally active NMDA receptor antagonist. The chemical name for memantine hydrochloride is 1-amino-3,5-dimethyladamantane hydrochloride with the following structural formula:

Source: Forest Laboratories, U.S. distributor or Namenda.

Namenda Structure

The molecular formula is C 12 H 21 N·HCl and the molecular weight is 215.76.

Memantine HCl occurs as a fine white to off-white powder and is soluble in water. Namenda is available as tablets or as an oral solution. Namenda is available for oral administration as capsule-shaped, film-coated tablets containing 5 mg and 10 mg of memantine hydrochloride. The tablets also contain the following inactive ingredients: microcrystalline cellulose, lactose monohydrate, colloidal silicon dioxide, talc and magnesium stearate. In addition the following inactive ingredients are also present as components of the film coat: hypromellose, triacetin, titanium dioxide, FD&C yellow #6 and FD&C blue #2 (5 mg tablets), iron oxide black (10 mg tablets). Namenda oral solution contains memantine hydrochloride in a strength equivalent to 2 mg of memantine hydrochloride in each mL. The oral solution also contains the following inactive ingredients: sorbitol solution (70%), methyl paraben, propylparaben, propylene glycol, glycerin, natural peppermint flavor #104, citric acid, sodium citrate, and purified water.

Clinical Pharmacology

Mechanism of Action and Pharmacodynamics

Persistent activation of central nervous system N-methyl-D-aspartate (NMDA) receptors by the excitatory amino acid glutamate has been hypothesized to contribute to the symptomatology of Alzheimer's disease. Memantine is postulated to exert its therapeutic effect through its action as a low to moderate affinity uncompetitive (open-channel) NMDA receptor antagonist which binds preferentially to the NMDA receptor-operated cation channels. There is no evidence that memantine prevents or slows neurodegeneration in patients with Alzheimer's disease.

Memantine showed low to negligible affinity for GABA, benzodiazepine, dopamine, adrenergic, histamine and glycine receptors and for voltage-dependent Ca 2+ , Na + or K + channels. Memantine also showed antagonistic effects at the 5HT 3 receptor with a potency similar to that for the NMDA receptor and blocked nicotinic acetylcholine receptors with one-sixth to one-tenth the potency.

In vitro studies have shown that memantine does not affect the reversible inhibition of acetylcholinesterase by donepezil, galantamine, or tacrine.

Pharmacokinetics

Memantine is well absorbed after oral administration and has linear pharmacokinetics over the therapeutic dose range. It is excreted predominantly in the urine, unchanged, and has a terminal elimination half life of about 60-80 hours.

Absorption and Distribution

Following oral administration memantine is highly absorbed with peak concentrations reached in about 3-7 hours. Food has no effect on the absorption of memantine. The mean volume of distribution of memantine is 9-11 L/kg and the plasma protein binding is low (45%).

Metabolism and Elimination

Memantine undergoes partial hepatic metabolism. About 48% of administered drug is excreted unchanged in urine; the remainder is converted primarily to three polar metabolites which possess minimal NMDA receptor antagonistic activity: the N-glucuronide conjugate, 6-hydroxy memantine, and 1-nitroso-deaminated memantine. A total of 74% of the administered dose is excreted as the sum of the parent drug and the N-glucuronide conjugate. The hepatic microsomal CYP450 enzyme system does not play a significant role in the metabolism of memantine. Memantine has a terminal elimination half-life of about 60-80 hours. Renal clearance involves active tubular secretion moderated by pH dependent tubular reabsorption.

Special Populations

Renal Impairment: Memantine pharmacokinetics were evaluated following single oral administration of 20 mg memantine HCl in 8 subjects with mild renal impairment (creatinine clearance, CLcr, >50 - 80 mL/min), 8 subjects with moderate renal impairment (CLcr 30 - 49 mL/min), 7 subjects with severe renal impairment (CLcr 5 - 29 mL/min) and 8 healthy subjects (CLcr > 80 mL/min) matched as closely as possible by age, weight and gender to the subjects with renal impairment. Mean AUC 0-(infinity) increased by 4%, 60%, and 115% in subjects with mild, moderate, and severe renal impairment, respectively, compared to healthy subjects. The terminal elimination half-life increased by 18%, 41%, and 95% in subjects with mild, moderate, and severe renal impairment, respectively, compared to healthy subjects.

No dosage adjustment is recommended for patients with mild and moderate renal impairment. Dosage should be reduced in patients with severe renal impairment (See DOSAGE AND ADMINISTRATION ).

Elderly: The pharmacokinetics of Namenda in young and elderly subjects are similar.

Gender: Following multiple dose administration of Namenda 20 mg b.i.d., females had about 45% higher exposure than males, but there was no difference in exposure when body weight was taken into account.

Drug-Drug Interactions

Substrates of Microsomal Enzymes: In vitro studies indicated that at concentrations exceeding those associated with efficacy, memantine does not induce the cytochrome P450 isozymes CYP1A2, CYP2C9, CYP2E1 and CYP3A4/5. In addition, in vitro studies have shown that memantine produces minimal inhibition of CYP450 enzymes CYP1A2, CYP2A6, CYP2C9, CYP2D6, CYP2E1, and CYP3A4. These data indicate that no pharmacokinetic interactions with drugs metabolized by these enzymes are expected.

Inhibitors of Microsomal Enzymes: Since memantine undergoes minimal metabolism, with the majority of the dose excreted unchanged in urine, an interaction between memantine and drugs that are inhibitors of CYP450 enzymes is unlikely. Coadministration of Namenda with the AChE inhibitor donepezil HCl does not affect the pharmacokinetics of either compound.

Drugs Eliminated via Renal Mechanisms: Memantine is eliminated in part by tubular secretion. In vivo studies have shown that multiple doses of the diuretic hydrochlorothiazide/triamterene (HCTZ/TA) did not affect the AUC of memantine at steady state. Memantine did not affect the bioavailability of TA, and decreased AUC and C max of HCTZ by about 20%. Coadministration of memantine with the antihyperglycemic drug Glucovance® (glyburide and metformin HCl) did not affect the pharmacokinetics of memantine, metformin and glyburide. Memantine did not modify the serum glucose lowering effects of Glucovance®, indicating the absence of a pharmacodynamic interaction.

Drugs that make the urine alkaline: The clearance of memantine was reduced by about 80% under alkaline urine conditions at pH 8. Therefore, alterations of urine pH towards the alkaline state may lead to an accumulation of the drug with a possible increase in adverse effects. Drugs that alkalinize the urine (e.g. carbonic anhydrase inhibitors, sodium bicarbonate) would be expected to reduce renal elimination of memantine.

Drugs highly bound to plasma proteins: Because the plasma protein binding of memantine is low (45%), an interaction with drugs that are highly bound to plasma proteins, such as warfarin and digoxin, is unlikely.


 


CLINICAL TRIALS

The effectiveness of Namenda (memantine hydrochloride) as a treatment for patients with moderate to severe Alzheimer's disease was demonstrated in 2 randomized, double-blind, placebo-controlled clinical studies (Studies 1 and 2) conducted in the United States that assessed both cognitive function and day to day function. The mean age of patients participating in these two trials was 76 with a range of 50-93 years. Approximately 66% of patients were female and 91% of patients were Caucasian.

A third study (Study 3), carried out in Latvia, enrolled patients with severe dementia, but did not assess cognitive function as a planned endpoint.

Study Outcome Measures: In each U.S. study, the effectiveness of Namenda was determined using both an instrument designed to evaluate overall function through caregiver-related assessment, and an instrument that measures cognition. Both studies showed that patients on Namenda experienced significant improvement on both measures compared to placebo.

Day-to-day function was assessed in both studies using the modified Alzheimer's disease Cooperative Study - Activities of Daily Living inventory (ADCS-ADL). The ADCS-ADL consists of a comprehensive battery of ADL questions used to measure the functional capabilities of patients. Each ADL item is rated from the highest level of independent performance to complete loss. The investigator performs the inventory by interviewing a caregiver familiar with the behavior of the patient. A subset of 19 items, including ratings of the patient's ability to eat, dress, bathe, telephone, travel, shop, and perform other household chores has been validated for the assessment of patients with moderate to severe dementia. This is the modified ADCS-ADL, which has a scoring range of 0 to 54, with the lower scores indicating greater functional impairment.

The ability of Namenda to improve cognitive performance was assessed in both studies with the Severe Impairment Battery (SIB), a multi-item instrument that has been validated for the evaluation of cognitive function in patients with moderate to severe dementia. The SIB examines selected aspects of cognitive performance, including elements of attention, orientation, language, memory, visuospatial ability, construction, praxis, and social interaction. The SIB scoring range is from 0 to 100, with lower scores indicating greater cognitive impairment.

Study 1 (Twenty-Eight-Week Study)

In a study of 28 weeks duration, 252 patients with moderate to severe probable Alzheimer's disease (diagnosed by DSM-IV and NINCDS-ADRDA criteria, with Mini-Mental State Examination scores >/=3 and !--=14 and Global Deterioration Scale Stages 5-6) were randomized to Namenda or placebo. For patients randomized to Namenda, treatment was initiated at 5 mg once daily and increased weekly by 5 mg/dayin divided doses to a dose of 20 mg/day (10 mg twice a day).

Effects on the ADCS-ADL:

Figure 1 shows the time course for the change from baseline in the ADCS-ADL score for patients in the two treatment groups completing the 28 weeks of the study. At 28 weeks of treatment, the mean difference in the ADCS-ADL change scores for the Namenda-treated patients compared to the patients on placebo was 3.4 units. Using an analysis based on all patients and carrying their last study observation forward (LOCF analysis), Namenda treatment was statistically significantly superior to placebo.

Namenda Figure 1

Figure 1: Time course of the change from baseline in ADCS-ADL score for patients completing 28 weeks of treatment.

Figure 2 shows the cumulative percentages of patients from each of the treatment groups who had attained at least the change in the ADCS-ADL shown on the X axis.

The curves show that both patients assigned to Namenda and placebo have a wide range of responses and generally show deterioration (a negative change in ADCS-ADL compared to baseline), but that the Namenda group is more likely to show a smaller decline or an improvement. (In a cumulative distribution display, a curve for an effective treatment would be shifted to the left of the curve for placebo, while an ineffective or deleterious treatment would be superimposed upon or shifted to the right of the curve for placebo.)

Namenda Figure 2

Figure 2: Cumulative percentage of patients completing 28 weeks of double-blind treatment with specified changes from baseline in ADCS-ADL scores.

Effects on the SIB: Figure 3 shows the time course for the change from baseline in SIB score for the two treatment groups over the 28 weeks of the study. At 28 weeks of treatment, the mean difference in the SIB change scores for the Namenda-treated patients compared to the patients on placebo was 5.7 units. Using an LOCF analysis, Namenda treatment was statistically significantly superior to placebo.

Namenda Figure 3

Figure 3: Time course of the change from baseline in SIB score for patients completing 28 weeks of treatment.

Figure 4 shows the cumulative percentages of patients from each treatment group who had attained at least the measure of change in SIB score shown on the X axis.

The curves show that both patients assigned to Namenda and placebo have a wide range of responses and generally show deterioration, but that the Namenda group is more likely to show a smaller decline or an improvement.

Namenda Figure 4

Figure 4: Cumulative percentage of patients completing 28 weeks of double-blind treatment with specified changes from baseline in SIB scores.

Study 2 (Twenty-Four-Week Study) In a study of 24 weeks duration, 404 patients with moderate to severe probable Alzheimer's disease (diagnosed by NINCDS-ADRDA criteria, with Mini-Mental State Examination scores ≥ 5 and ≤ 14) who had been treated with donepezil for at least 6 months and who had been on a stable dose of donepezil for the last 3 months were randomized to Namenda or placebo while still receiving donepezil. For patients randomized to Namenda, treatment was initiated at 5 mg once daily and increased weekly by 5 mg/day in divided doses to a dose of 20 mg/day (10 mg twice a day).

Effects on the ADCS-ADL: Figure 5 shows the time course for the change from baseline in the ADCS-ADL score for the two treatment groups over the 24 weeks of the study. At 24 weeks of treatment, the mean difference in the ADCS-ADL change scores for the Namenda/donepezil treated patients (combination therapy) compared to the patients on placebo/donepezil (monotherapy) was 1.6 units. Using an LOCF analysis, Namenda/donepezil treatment was statistically significantly superior to placebo/donepezil.

Namenda Figure 5

Figure 5: Time course of the change from baseline in ADCS-ADL score for patients completing 24 weeks of treatment.

Figure 6 shows the cumulative percentages of patients from each of the treatment groups who had attained at least the measure of improvement in the ADCS-ADL shown on the X axis.

The curves show that both patients assigned to Namenda/donepezil and placebo/donepezil have a wide range of responses and generally show deterioration, but that the Namenda/donepezil group is more likely to show a smaller decline or an improvement.

Namenda Figure 6

Figure 6: Cumulative percentage of patients completing 24 weeks of double-blind treatment with specified changes from baseline in ADCS-ADL scores.

Effects on the SIB: Figure 7 shows the time course for the change from baseline in SIB score for the two treatment groups over the 24 weeks of the study. At 24 weeks of treatment, the mean difference in the SIB change scores for the Namenda/donepezil-treated patients compared to the patients on placebo/donepezil was 3.3 units. Using an LOCF analysis, Namenda/donepezil treatment was statistically significantly superior to placebo/donepezil.

Namenda Figure 7

Figure 7: Time course of the change from baseline in SIB score for patients completing 24 weeks of treatment.

Figure 8 shows the cumulative percentages of patients from each treatment group who had attained at least the measure of improvement in SIB score shown on the X axis.

The curves show that both patients assigned to Namenda/donepezil and placebo/donepezil have a wide range of responses, but that the Namenda/donepezil group is more likely to show an improvement or a smaller decline.

Namenda Figure 8

Figure 8: Cumulative percentage of patients completing 24 weeks of double-blind treatment with specified changes from baseline in SIB scores.

Study 3 (Twelve-Week Study) In a double-blind study of 12 weeks duration, conducted in nursing homes in Latvia, 166 patients with dementia according to DSM-III-R, a Mini-Mental State Examination score of <10, and Global Deterioration Scale staging of 5 to 7 were randomized to either Namenda or placebo. For patients randomized to Namenda, treatment was initiated at 5 mg once daily and increased to 10 mg once daily after 1 week. The primary efficacy measures were the care dependency subscale of the Behavioral Rating Scale for Geriatric Patients (BGP), a measure of day-to-day function, and a Clinical Global Impression of Change (CGI-C), a measure of overall clinical effect. No valid measure of cognitive function was used in this study. A statistically significant treatment difference at 12 weeks that favored Namenda over placebo was seen on both primary efficacy measures. Because the patients entered were a mixture of Alzheimer's disease and vascular dementia, an attempt was made to distinguish the two groups and all patients were later designated as having either vascular dementia or Alzheimer's disease, based on their scores on the Hachinski Ischemic Scale at study entry. Only about 50% of the patients had computerized tomography of the brain. For the subset designated as having Alzheimer's disease, a statistically significant treatment effect favoring Namenda over placebo at 12 weeks was seen on both the BGP and CGI-C.

Indications and Usage

Namenda (memantine hydrochloride) is indicated for the treatment of moderate to severe dementia of the Alzheimer's type.

Contraindications

Namenda (memantine hydrochloride) is contraindicated in patients with known hypersensitivity to memantine hydrochloride or to any excipients used in the formulation.

Precautions

Information for Patients and Caregivers: Caregivers should be instructed in the recommended administration (twice per day for doses above 5 mg) and dose escalation (minimum interval of one week between dose increases).

Neurological Conditions Seizures:

Namenda has not been systematically evaluated in patients with a seizure disorder. In clinical trials of Namenda, seizures occurred in 0.2% of patients treated with Namenda and 0.5% of patients treated with placebo.

Genitourinary Conditions

Conditions that raise urine pH may decrease the urinary elimination of memantine resulting in increased plasma levels of memantine.

Special Populations

Hepatic Impairment

Namenda undergoes partial hepatic metabolism, with about 48% of administered dose excreted in urine as unchanged drug or as the sum of parent drug and the N-glucuronide conjugate (74%). The pharmacokinetics of memantine in patients with hepatic impairment have not been investigated, but would be expected to be only modestly affected.

Renal Impairment

No dosage adjustment is needed in patients with mild or moderate renal impairment. A dosage reduction is recommended in patients with severe renal impairment (see CLINICAL PHARMACOLOGY and DOSAGE AND ADMINISTRATION ).

Drug-Drug Interactions

N-methyl-D-aspartate (NMDA) antagonists: The combined use of Namenda with other NMDA antagonists (amantadine, ketamine, and dextromethorphan) has not been systematically evaluated and such use should be approached with caution.

Effects of Namenda on substrates of microsomal enzymes: In vitro studies conducted with marker substrates of CYP450 enzymes (CYP1A2, -2A6, -2C9, -2D6, -2E1, -3A4) showed minimal inhibition of these enzymes by memantine. In addition, in vitro studies indicate that at concentrations exceeding those associated with efficacy, memantine does not induce the cytochrome P450 isozymes CYP1A2, CYP2C9, CYP2E1 and CYP3A4/5. No pharmacokinetic interactions with drugs metabolized by these enzymes are expected.

Effects of inhibitors and/or substrates of microsomal enzymes on Namenda: Memantine is predominantly renally eliminated, and drugs that are substrates and/or inhibitors of the CYP450 system are not expected to alter the metabolism of memantine.

Acetylcholinesterase (AChE) inhibitors: Coadministration of Namenda with the AChE inhibitor donepezil HCl did not affect the pharmacokinetics of either compound. In a 24-week controlled clinical study in patients with moderate to severe Alzheimer's disease, the adverse event profile observed with a combination of memantine and donepezil was similar to that of donepezil alone.

Drugs eliminated via renal mechanisms: Because memantine is eliminated in part by tubular secretion, coadministration of drugs that use the same renal cationic system, including hydrochlorothiazide (HCTZ), triamterene (TA), metformin, cimetidine, ranitidine, quinidine, and nicotine, could potentially result in altered plasma levels of both agents. However, coadministration of Namenda and HCTZ/TA did not affect the bioavailability of either memantine or TA, and the bioavailability of HCTZ decreased by 20%. In addition, coadministration of memantine with the antihyperglycemic drug Glucovance® (glyburide and metformin HCl) did not affect the pharmacokinetics of memantine, metformin and glyburide. Furthermore, memantine did not modify the serum glucose lowering effect of Glucovance®.

Drugs that make the urine alkaline: The clearance of memantine was reduced by about 80% under alkaline urine conditions at pH 8. Therefore, alterations of urine pH towards the alkaline condition may lead to an accumulation of the drug with a possible increase in adverse effects. Urine pH is altered by diet, drugs (e.g. carbonic anhydrase inhibitors, sodium bicarbonate) and clinical state of the patient (e.g. renal tubular acidosis or severe infections of the urinary tract). Hence, memantine should be used with caution under these conditions.

Carcinogenesis, Mutagenesis and Impairment of Fertility

There was no evidence of carcinogenicity in a 113-week oral study in mice at doses up to 40 mg/kg/day (10 times the maximum recommended human dose [MRHD] on a mg/m 2 basis). There was also no evidence of carcinogenicity in rats orally dosed at up to 40 mg/kg/day for 71 weeks followed by 20 mg/kg/day (20 and 10 times the MRHD on a mg/m 2 basis, respectively) through 128 weeks.

Memantine produced no evidence of genotoxic potential when evaluated in the in vitro S. typhimurium or E. coli reverse mutation assay, an in vitro chromosomal aberration test in human lymphocytes, an in vivo cytogenetics assay for chromosome damage in rats, and the in vivo mouse micronucleus assay. The results were equivocal in an in vitro gene mutation assay using Chinese hamster V79 cells.

No impairment of fertility or reproductive performance was seen in rats administered up to 18 mg/kg/day (9 times the MRHD on a mg/m 2 basis) orally from 14 days prior to mating through gestation and lactation in females, or for 60 days prior to mating in males.

Pregnancy

Pregnancy Category B: Memantine given orally to pregnant rats and pregnant rabbits during the period of organogenesis was not teratogenic up to the highest doses tested (18 mg/kg/day in rats and 30 mg/kg/day in rabbits, which are 9 and 30 times, respectively, the maximum recommended human dose [MRHD] on a mg/m 2 basis).

Slight maternal toxicity, decreased pup weights and an increased incidence of non-ossified cervical vertebrae were seen at an oral dose of 18 mg/kg/day in a study in which rats were given oral memantine beginning pre-mating and continuing through the postpartum period. Slight maternal toxicity and decreased pup weights were also seen at this dose in a study in which rats were treated from day 15 of gestation through the post-partum period. The no-effect dose for these effects was 6 mg/kg, which is 3 times the MRHD on a mg/m 2 basis.

There are no adequate and well-controlled studies of memantine in pregnant women. Memantine should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.

Nursing Mothers

It is not known whether memantine is excreted in human breast milk. Because many drugs are excreted in human milk, caution should be exercised when memantine is administered to a nursing mother.

Pediatric Use

There are no adequate and well-controlled trials documenting the safety and efficacy of memantine in any illness occurring in children.

Adverse Reactions

The experience described in this section derives from studies in patients with Alzheimer's disease and vascular dementia.

Adverse Events Leading to Discontinuation: In placebo-controlled trials in which dementia patients received doses of Namenda up to 20 mg/day, the likelihood of discontinuation because of an adverse event was the same in the Namenda group as in the placebo group. No individual adverse event was associated with the discontinuation of treatment in 1% or more of Namenda-treated patients and at a rate greater than placebo.

Adverse Events Reported in Controlled Trials: The reported adverse events in Namenda (memantine hydrochloride) trials reflect experience gained under closely monitored conditions in a highly selected patient population. In actual practice or in other clinical trials, these frequency estimates may not apply, as the conditions of use, reporting behavior and the types of patients treated may differ. Table 1 lists treatment-emergent signs and symptoms that were reported in at least 2% of patients in placebo-controlled dementia trials and for which the rate of occurrence was greater for patients treated with Namenda than for those treated with placebo. No adverse event occurred at a frequency of at least 5% and twice the placebo rate.

Table 1: Adverse Events Reported in Controlled Clinical Trials in at Least 2% of Patients Receiving Namenda and at a Higher Frequency than Placebo-treated Patients.
Body System
Adverse Event
Placebo
(N = 922)
%
Namenda
(N = 940)
%
Body as a Whole
Fatigue
1 2
Pain
1 3
Cardiovascular System
Hypertension
2 4
Central and Peripheral Nervous System
Dizziness
5 7
Headache
3 6
Gastrointestinal System
Constipation
3 5
Vomiting
2 3
Musculoskeletal System
Back pain
2 3
Psychiatric Disorders
Confusion
5 6
Somnolence
2 3
Hallucination
2 3
Respiratory System
Coughing
3 4
Dyspnea
1 2

Other adverse events occurring with an incidence of at least 2% in Namenda-treated patients but at a greater or equal rate on placebo were agitation, fall, inflicted injury, urinary incontinence, diarrhea, bronchitis, insomnia, urinary tract infection, influenza-like symptoms, abnormal gait, depression, upper respiratory tract infection, anxiety, peripheral edema, nausea, anorexia, and arthralgia.

The overall profile of adverse events and the incidence rates for individual adverse events in the subpopulation of patients with moderate to severe Alzheimer's disease were not different from the profile and incidence rates described above for the overall dementia population.

Vital Sign Changes: Namenda and placebo groups were compared with respect to (1) mean change from baseline in vital signs (pulse, systolic blood pressure, diastolic blood pressure, and weight) and (2) the incidence of patients meeting criteria for potentially clinically significant changes from baseline in these variables. There were no clinically important changes in vital signs in patients treated with Namenda. A comparison of supine and standing vital sign measures for Namenda and placebo in elderly normal subjects indicated that Namenda treatment is not associated with orthostatic changes.

Laboratory Changes: Namenda and placebo groups were compared with respect to (1) mean change from baseline in various serum chemistry, hematology, and urinalysis variables and (2) the incidence of patients meeting criteria for potentially clinically significant changes from baseline in these variables. These analyses revealed no clinically important changes in laboratory test parameters associated with Namenda treatment.

ECG Changes: Namenda and placebo groups were compared with respect to (1) mean change from baseline in various ECG parameters and (2) the incidence of patients meeting criteria for potentially clinically significant changes from baseline in these variables. These analyses revealed no clinically important changes in ECG parameters associated with Namenda treatment.

Other Adverse Events Observed During Clinical Trials

Namenda has been administered to approximately 1350 patients with dementia, of whom more than 1200 received the maximum recommended dose of 20 mg/day. Patients received Namenda treatment for periods of up to 884 days, with 862 patients receiving at least 24 weeks of treatment and 387 patients receiving 48 weeks or more of treatment.

Treatment emergent signs and symptoms that occurred during 8 controlled clinical trials and 4 open-label trials were recorded as adverse events by the clinical investigators using terminology of their own choosing. To provide an overall estimate of the proportion of individuals having similar types of events, the events were grouped into a smaller number of standardized categories using WHO terminology, and event frequencies were calculated across all studies.

All adverse events occurring in at least two patients are included, except for those already listed in Table 1, WHO terms too general to be informative, minor symptoms or events unlikely to be drug-caused, e.g., because they are common in the study population. Events are classified by body system and listed using the following definitions: frequent adverse events - those occurring in at least 1/100 patients; infrequent adverse events - those occurring in 1/100 to 1/1000 patients. These adverse events are not necessarily related to Namenda treatment and in most cases were observed at a similar frequency in placebo-treated patients in the controlled studies.

Body as a Whole: Frequent: syncope. Infrequent: hypothermia, allergic reaction.

Cardiovascular System: Frequent: cardiac failure. Infrequent: angina pectoris, bradycardia, myocardial infarction, thrombophlebitis, atrial fibrillation, hypotension, cardiac arrest, postural hypotension, pulmonary embolism, pulmonary edema.

Central and Peripheral Nervous System: Frequent: transient ischemic attack, cerebrovascular accident, vertigo, ataxia, hypokinesia. Infrequent: paresthesia, convulsions, extrapyramidal disorder, hypertonia, tremor, aphasia, hypoesthesia, abnormal coordination, hemiplegia, hyperkinesia, involuntary muscle contractions, stupor, cerebral hemorrhage, neuralgia, ptosis, neuropathy.

Gastrointestinal System: Infrequent: gastroenteritis, diverticulitis, gastrointestinal hemorrhage, melena, esophageal ulceration.

Hemic and Lymphatic Disorders: Frequent: anemia. Infrequent: leukopenia.

Metabolic and Nutritional Disorders: Frequent: increased alkaline e phosphatase, decreased weight. Infrequent: dehydration, hyponatremia, aggravated diabetes mellitus.

Psychiatric Disorders: Frequent: aggressive reaction. Infrequent: delusion, personality disorder, emotional lability, nervousness, sleep disorder, libido increased, psychosis, amnesia, apathy, paranoid reaction, thinking abnormal, crying abnormal, appetite increased, paroniria, delirium, depersonalization, neurosis, suicide attempt.

Respiratory System: Frequent: pneumonia. Infrequent: apnea, asthma, hemoptysis.

Skin and Appendages: Frequent: rash. Infrequent: skin ulceration, pruritus, cellulitis, eczema, dermatitis, erythematous rash, alopecia, urticaria.

Special Senses: Frequent: cataract, conjunctivitis. Infrequent: macula lutea degeneration, decreased visual acuity, decreased hearing, tinnitus, blepharitis, blurred vision, corneal opacity, glaucoma, conjunctival hemorrhage, eye pain, retinal hemorrhage, xerophthalmia, diplopia, abnormal lacrimation, myopia, retinal detachment.

Urinary System: Frequent: frequent micturition. Infrequent: dysuria, hematuria, urinary retention.

Events Reported Subsequent to the Marketing of Namenda, both US and Ex-US

Although no causal relationship to memantine treatment has been found, the following adverse events have been reported to be temporally associated with memantine treatment and are not described elsewhere in labeling: atrioventricular block, bone fracture, carpal tunnel syndrome, cerebral infarction, chest pain, claudication, colitis, dyskinesia, dysphagia, gastritis, gastroesophageal reflux, grand mal convulsions, intracranial hemorrhage, hepatic failure, hyperlipidemia, hypoglycemia, ileus, impotence, malaise, neuroleptic malignant syndrome, acute pancreatitis, aspiration pneumonia, acute renal failure, prolonged QT interval, restlessness, Stevens-Johnson syndrome, sudden death, supraventricular tachycardia, tachycardia, tardive dyskinesia, and thrombocytopenia.

ANIMAL TOXICOLOGY

Memantine induced neuronal lesions (vacuolation and necrosis) in the multipolar and pyramidal cells in cortical layers III and IV of the posterior cingulate and retrosplenial neocortices in rats, similar to those which are known to occur in rodents administered other NMDA receptor antagonists. Lesions were seen after a single dose of memantine. In a study in which rats were given daily oral doses of memantine for 14 days, the no-effect dose for neuronal necrosis was 6 times the maximum recommended human dose on a mg/m 2 basis. The potential for induction of central neuronal vacuolation and necrosis by NMDA receptor antagonists in humans is unknown.

DRUG ABUSE AND DEPENDENCE

Controlled Substance Class: Memantine HCl is not a controlled substance.

Physical and Psychological Dependence: Memantine HCl is a low to moderate affinity uncompetitive NMDA antagonist that did not produce any evidence of drug-seeking behavior or withdrawal symptoms upon discontinuation in 2,504 patients who participated in clinical trials at therapeutic doses. Post marketing data, outside the U.S., retrospectively collected, has provided no evidence of drug abuse or dependence.

Overdose

Because strategies for the management of overdose are continually evolving, it is advisable to contact a poison control center to determine the latest recommendations for the management of an overdose of any drug.

As in any cases of overdose, general supportive measures should be utilized, and treatment should be symptomatic. Elimination of memantine can be enhanced by acidification of urine. In a documented case of an overdosage with up to 400 mg of memantine, the patient experienced restlessness, psychosis, visual hallucinations, somnolence, stupor and loss of consciousness. The patient recovered without permanent sequelae.

Dosage and Administration

The dosage of Namenda (memantine hydrochloride) shown to be effective in controlled clinical trials is 20 mg/day.

The recommended starting dose of Namenda is 5 mg once daily. The recommended target dose is 20 mg/day. The dose should be increased in 5 mg increments to 10 mg/day (5 mg twice a day), 15 mg/day (5 mg and 10 mg as separate doses), and 20 mg/day (10 mg twice a day). The minimum recommended interval between dose increases is one week.

Namenda can be taken with or without food.

Patients/caregivers should be instructed on how to use the Namenda Oral Solution dosing device. They should be made aware of the patient instruction sheet that is enclosed with the product. Patients/caregivers should be instructed to address any questions on the usage of the solution to their physician or pharmacist.

Doses in Special Populations

A target dose of 5 mg BID is recommended in patients with severe renal impairment (creatinine clearance of 5 - 29 mL/min based on the Cockroft-Gault equation):

For males: CLcr = [140-age (years)] · Weight (kg)/[72 · serum creatinine (mg/dL)]

For females: CLcr = 0.85 · [140-age (years)] · Weight (kg)/[72 · serum creatinine (mg/dL)]

How Supplied

5 mg Tablet:

Bottle of 60 NDC #0456-3205-60
10 × 10 Unit Dose NDC #0456-3205-63

The capsule-shaped, film-coated tablets are tan, with the strength (5) debossed on one side and FL on the other.

10 mg Tablet:

Bottle of 60 NDC #0456-3210-60
10 × 10 Unit Dose NDC #0456-3210-63

The capsule-shaped, film-coated tablets are gray, with the strength (10) debossed on one side and FL on the other.

Titration Pak:

PVC/Aluminum Blister package containing 49 tablets. 28 × 5 mg and 21 × 10 mg tablets. NDC #0456-3200-14

The 5 mg capsule-shaped, film-coated tablets are tan, with the strength (5) debossed on one side and FL on the other. The 10 mg capsule-shaped, film-coated tablets are gray, with the strength (10) debossed on one side and FL on the other.

Oral Solution:

The dosage recommendations for oral solution are the same as those for tablets. The oral solution is clear, alcohol-free, sugar-free, and peppermint flavored.

2 mg/mL Oral Solution (10 mg = 5 mL)
12 fl. oz. (360 mL) bottle NDC #0456-3202-12

Store at 25°C (77°F); excursions permitted to 15-30°C (59-86°F) [see USP Controlled Room Temperature].

Forest Pharmaceuticals, Inc.
Subsidiary of Forest Laboratories, Inc.
St. Louis, MO 63045
Licensed from Merz Pharmaceuticals GmbH

PATIENT INSTRUCTIONS FOR NAMENDA® Oral Solution

Follow the directions below to use your Namenda® Oral Solution dosing device.

IMPORTANT: Read these instructions before using Namenda® Oral Solution.

 

Patient Instructions For Nameda 1
  1. Remove oral dosing syringe along with the green cap and plastic tube from its protective plastic bag. Attach the tube to the green cap if it isn't already attached.
Patient Instructions For Nameda 2
  1. The bottle comes with a child- resistant cap. Open it by pushing down on the cap while turning the cap counter-clockwise (to the left). Remove the unscrewed cap. Carefully remove the seal from the bottle and discard.
Patient Instructions For Nameda 3
  1. Insert the plastic tube fully into the bottle and screw the green cap tightly onto the bottle by turning the cap clockwise (to the right).
Patient Instructions For Nameda 4
  1. The green cap has an attached lid which is to be used for sealing the product in between doses. Keeping the bottle upright on the table, remove the lid to uncover the opening on the top of the cap. With the plunger fully depressed, insert the tip of syringe firmly into the opening in the cap.
Patient Instructions For Nameda 5
  1. While holding the syringe, gently pull the plunger of the syringe up to draw medicine into the syringe.
Patient Instructions For Nameda 6
  1. Remove the syringe from the opening of the cap. Invert the syringe (point tip upwards) and slowly press the plunger to a level that pushes out any large air bubbles that may be present. Keep the plunger in this position. Do not worry about a few tiny bubbles. This will not affect your dose in any way.
Patient Instructions For Nameda 7
  1. Re-insert the tip of the syringe into the opening of the cap. While holding the syringe, continue to gently pull out the plunger until the bottom of the black ring of the plunger reaches the appropriate mark on the syringe that corresponds to the dose prescribed.
Patient Instructions For Nameda 8
  1. Remove the syringe from the bottle and swallow the Oral Solution directly from the syringe. Do not mix with any other liquid.
Patient Instructions For Nameda 9
  1. After use, reseal the bottle by snapping the attached lid closed.
Patient Instructions For Nameda 10
  1. Rinse the empty syringe by inserting the open end of the syringe into a glass of water, pulling the plunger out to draw in water, and pushing the plunger in to remove the water. Repeat several times. Allow the syringe to air dry.

IMPORTANT: The information in this monograph is not intended to cover all possible uses, directions, precautions, drug interactions or adverse effects. This information is generalized and is not intended as specific medical advice. If you have questions about the medicines you are taking or would like more information, check with your doctor, pharmacist, or nurse. Last updated 4/07.

Source: Forest Laboratories, U.S. distributor of Namenda.

Namenda Patient Information (in plain English)

back to: Psychiatric Medications Pharmacology Homepage

APA Reference
Staff, H. (2008, December 27). Namenda: Alzheimer's Medication, HealthyPlace. Retrieved on 2024, October 7 from https://www.healthyplace.com/alzheimers/medications/namenda-alzheimers-medication

Last Updated: February 26, 2016

Buying Is Only a Click (Oops!) Away

Is online shopping addictive? It can be. So are auction sites. There's even a term for it: "ebay addiction."

Spending thousands of dollars used to take some effort. You had to get dressed. Get out of the house. Make eye contact. Count change. It could take days. Weeks, even.

But getting and spending are easier online, and the membrane between impulse and purchase has grown thinner. Web sites draw surfers toward the shoals of indebtedness, offering novelty, speed, convenience, bargains, unlimited hours, coupons, new deals daily, limited sales tax and helpful suggestions from other shoppers. Simply click on Buy Now, and pay later.

As the credit card bills of history's biggest, most touted holiday E-commerce season are coming due and accruing double-digit interest, Internet surfers are shopping before breakfast, shopping alone and picking up an extra book or three -- causing some of them to wind up hiding the resulting credit card bills from their spouses. How did these people get hooked? What is so compelling about the Internet marketplace?

Although online shopping still amounts to only a tiny fraction of all retail sales -- 1 percent of consumer sales, according to Joseph Vause, vice president for electronic commerce at Visa USA -- it is expected to match the current catalogue and mail-order share of the market by 2003. And with 99 percent of Internet sales conducted with plastic, compared with 20 percent of conventional sales, the potential to run up a credit card bill is significantly higher.

The temptation to spend money online can be even harder to resist when a Web surfer taps into the excitement of an auction.

"Ebay is definitely addictive!" Jane Brasovan of The Woodlands, Tex., said via e-mail. She estimated that she had bought 1,500 to 2,000 items, most of them antiques and dolls, on the Ebay auction site.

"I am trying to stop this addictive cycle at the present time," she continued, "as I've spent far too much money and now have a houseful of 'things' that I would probably be better off without!"

In a phone interview, she added: "It's hard to stop. I've tried stopping, but I don't do too well. You get kind of carried away, bidding on something, and when somebody outbids you, you get mad because they outbid you. You go in and bid and know darned well you shouldn't. Sometimes you feel like saying, 'You're not going to get that if I can't get it.' " Ms. Brasovan said she had spent up to six or seven hours at a stretch on the Ebay site.

Allison Ector, editor and publisher of Covert Shoppers Anonymous, an online compendium of Web bargains, figures that she spends $800 a month online, far more than she used to spend when driving to stores near her home in West Chester, Pa.

"It's just clicking buttons," she said, "and it's easy to say, 'Well, I'll worry about this next month when I get the bill.' " She has found herself playing an economies-of-scale game with shipping and handling charges. "When I get to the end of that shopping cart transaction, I've often hit the Back button, gone back and purchased more things, to make it cost effective," she said.

It may be hard to find online shopaholics who have become so hooked on new-media marketing that they have resorted to pilfering from their children's college funds or have moved back to their parents'.

But there are many people, particularly at the auction sites, who find themselves powerless in the face of items for sale online.

Debbie Lunden, who collects McCoy kitchenware from the 1940's and 1950's, signs on to Ebay once a day to see what is being auctioned.

"For years I had been looking for a teapot," said Ms. Lunden, director of the McKean County Planning Commission in Pennsylvania. "I knew there had to be one." In October, she found one, and the closing bids were due at 5 A.M.

"I set the alarm and was up at 4:45 in the morning, thinking, 'That gives me 15 minutes to get connected,' " she said. She panicked when she discovered that her husband had packed away the laptop, but she got online in time to buy the teapot, plus a creamer and sugar bowl, for $97, including shipping -- "a real buy," she said. Ms. Lunden lives in Bradford, Pa., population about 9,600, where the shopping possibilities are limited.

"It was something I really had to have," she said of the teapot. "I'm not a person to get up in the middle of the night, but I had to because that's when the bidding was. I had to make a sacrifice, and it was worth it."




"I'm totally addicted to just surfing thousands of items on Ebay," Gib Bergman, a cook in Sutersville, Pa., wrote via e-mail. Bergman, a shopper who has bid on scores of items, including knives, Beanie Babies and Elvis memorabilia, at Ebay, continued: "And it is so easy to spend money that you don't have just laying around. It's worse than being an alcoholic -- an obsessive gambler is more like it."

"I'm pretty much an addict," Bergman added. His wife, Helen, used to be able to restrain him from buying, he said, but no more. "I used to go to flea markets," he said. "You'd see stuff and she'd say, 'That's too much,' but here I'm here by myself. I'll put a bid in on something and later say to her, 'Guess what I got?' It's just like a candy store -- it is very addictive." In 10 years of conventional shopping he could never have acquired the number of Elvis items he has been able to buy via Ebay, he said.

Experts on credit and commerce readily recognize the seductions of E-commerce. Kimberly S. Young, founder of the Center for Online Addiction in Bradford, Pa., said the auction sites were exciting -- shopping as entertainment.

"When you're the winner, that's reinforcing," she said. "For that moment, you're engaged, it gives you a favorable high. You're completely absorbed in this, and it's kind of an escape mechanism. You start to think, 'What else do I need?' "

Sometimes clicking fingers take over where the brain leaves off, said Wayne S. DeSarbo, a marketing professor at Pennsylvania State University. "There's so little time to think about what you're doing and rationalize it," he said. "As the result of just a few keystrokes, you're done and gone. For the compulsive shopper, this would provide a quick and easy fix from the stress and anxiety of everyday life. It's a temporary high one gets from shopping.

There's little time for rationalization."

Bill Furmanski, a spokesman for the National Foundation for Consumer Credit, said it could be easier to buy impulsively online than off. "In the mall, it's easier to recommend that you put an item down and walk away, and see if you still need it at the end of your trip, to ease the impulse purchases you make," he said. "On the Internet, it's not as easy. Maybe you should sign off first, and it will still be there when you sign back on."

Splurges online appear to differ from splurges off line. People watching the Home Shopping Network might end up with many lifetime supplies of cubic zirconia and Ginzu knives. But wired shoppers talk sheepishly of their "Amazon problems": a tendency to spend more at Amazon.com than they had budgeted for books, software and CD's, items that are, if you rationalize carefully, inherently useful for self-improvement.

Many aspects of the Internet encourage impulsive or compulsive buying.

"You're alone, and kind of nobody sees what you're doing," said the founder of Spenders Anonymous, a support group in Minneapolis, speaking on the condition of anonymity, "and when you're into your addiction, you want it that way." For shy people, an Internet auction provides welcome anonymity.

"For a lot of people that are shy -- not the competitive people who go to auction houses and compete with real people -- it's a much safer domain," said Dr. Young, who is an assistant professor of psychology at the University of Pittsburgh at Bradford. "It's anonymous, it's private, and there is a sense of winning."

The Internet can also empower shoppers, said Austan Goolsbee, an assistant professor of economics at the University of Chicago, giving them the benefits of haggling and comparison shopping without making them take the chance of offending anyone face to face.

"You would feel kind of self-conscious asking someone at an airline to run through 100 scenarios for a flight you want to take," he said, so travelers can fiddle with schedules or destination cities more easily online. "And where you're comparison shopping, it oftentimes makes people feel a little bad for walking out of the store." But no Web site is going to call a person rude for heading elsewhere for a better bargain.

Offering power to the consumer can be the Internet's most effective way to lure buyers.

"Consumers are now in control, and it is so compelling" said Donna Hoffman, a professor of marketing at Vanderbilt University. "It's not the lack of sales tax, not the convenience, not the potential economic savings, that makes online shopping attractive. It's just the chance to be in control.

The balance of power between business and the consumer has shifted radically. If you're the business, you're no longer in 100 percent control."

Electronic shoppers want convenience, and they want it now. Where they can get it, they're willing to pay for it, plus shipping and handling.

"The modern analogy is the minibar in your hotel room," said Jerry Kaplan, a co-founder of Onsale.com, a discount retailer. "Would you usually pay $2 for a Diet Coke? Absolutely not. But in the minibar in the hotel room, you're more likely to go for it. Here you have people sitting at a computer all day, and a lot of sales take place. They're discretionary purchases due to convenience, where you've eliminated the cost of physically going out and shopping."

Source: NY Times



next: Is the Internet Addictive?
~ all center for online addiction articles
~ all articles on addictions

APA Reference
Staff, H. (2008, December 27). Buying Is Only a Click (Oops!) Away, HealthyPlace. Retrieved on 2024, October 7 from https://www.healthyplace.com/addictions/center-for-internet-addiction-recovery/online-shopping-addiction-ebay-addiction

Last Updated: June 24, 2016

What Makes the Internet Addictive: Potential Explanations for Pathological Internet Use

Kimberly S. Young
University of Pittsburgh at Bradford

Paper presented at the 105th annual conference of the
American Psychological Association, August 15, 1997, Chicago, IL.

ABSTRACT

Research has identified pathological Internet use (PIU) which has been associated with significant social, psychological, and occupational impairment. Prior research in the addictions field has explored the addictive qualities sustaining drug and alcohol addictions, pathological gambling, and even video game addiction. However, there exists little explanation for what makes computer-mediated communication (CMC) habit forming to the determent of one's personal well being. Therefore, this exploratory study classified 396 cases of dependent Internet users (Dependents) based upon an adapted version of the criteria for Pathological Gambling defined by the DSM-IV (APA, 19950. Qualatative analyses attempted to identify the psychological reinforcement underlying CMC. Results suggested that information protocols were the least addictive functions and that interactive aspects of the Internet such as chat rooms were highly addictive, creating an atmosphere for Dependents to seek out companionship, sexual excitement, and alter identities. Implications for assessment and treatment are discussed.

What Makes the Internet Addictive: Potential Explanations for Pathological Internet Use.

Methodology

  • Subjects
  • Materials
  • Procedures

Results

  • Demographic Data
  • Addictive Applications
  • Social Support
  • Sexual Fulfillment
  • Creating A Persona
  • Unlocked Personalities
  • Recognition And Power

Discussion

References

What Makes the Internet Addictive:

Potential Explanations for Pathological Internet Use.

While many believe the term addiction should only be applied to cases involving the ingestion of a drug (e.g., Walker, 1989; Rachlin, 1990), similar criteria have been applied to a number of problem behaviors such as eating disorders (Lacey, 1993; Lesieur & Blume, 1993), pathological gambling (Mobilia, 1993; Griffiths, 1991 and 1990), computer addiction (Shotton, 1991) and video game addiction (Keepers, 1990). Today, among a small but growing body of research, the term addiction has extended into the psychiatric lexicon that identifies problematic Internet use associated with significant social, psychological, and occupational impairment (Brenner, 1996; Egger, 1996; Griffiths, 1997; Morahn-Martin, 1997; Thompson, 1996; Scherer, 1997; Young, 1996).

Young (1996) initiated telephone surveys to formally study pathological Internet use (PIU) based upon modified criteria of Pathological Gambling defined in the DSM-IV (American Psychiatric Association, 1995). Case studies showed that Dependents classified used the Internet an average of thirty-eight hours per week for non-academic or non-employment related 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 non-addicts in this study who used the Internet an average of eight hours per week with no significant consequences reported.

Subsequent research on PIU based upon a self report determination of addiction were conducted utilizing on-line survey methods. Brenner (1996) received 185 responses in one month to his on-line survey regarding behavior patterns associated with the Internet. His survey showed that 17% used the Internet more than 40 hours per week, 58% said that others had complained about their excessive net usage, and 46% indicated getting less than 4 hours of sleep per night due to late night log ins. Egger (1996) received 450 responses to his on-line survey. Self-professed addicts in this study often looked forward their next net session, felt nervous when off-line, lied about their on-line use, easily lost track of time, and felt the Internet caused problems in their jobs, finances, and socially. Steve Thompson (1996) developed the "McSurvey" which yielded 104 valid responses. Among respondents to his on-line survey, 72% felt addicted and 33% felt their Internet usage had a negative effect on their lives. Surveys conducted on college campuses (Morhan-Martin, 1997; Scherer, 1997) also supported that students suffered significant academic and relationships impairment due to excessive and uncontrolled Internet usage. Formal Computer/Internet addiction treatment centers have even been established at such clinical settings as Proctor Hospital in Peoria, Illinois and Harvard affiliate McLean Hospital in response to the serious impairment caused by PIU.




Despite the increased awareness that PIU is a legitimate concern, little is understood about what makes computer-mediated communication (CMC) habit forming and often times "addictive." Therefore, using case studies collected as part of Young's original 1996 study, this paper discusses the potential explanations of PIU and offers implications for future evaluation and treatment.

METHODOLOGY

Subjects

Participants were volunteers who respondent to: (a) nationally and internationally dispersed newspaper advertisements, (b) flyers posted among local college campuses, (c) postings on electronic support groups geared towards Internet addiction (e.g., the Internet Addiction Support Group, the Webaholics Support Group), and (d) those who searched for keywords "Internet addiction" on popular Web search engines (e.g., Yahoo). For a detailed discussion of the self-selection bias inherent in this methodology and limitations of these research findings, please refer to my paper entitled "Internet Addiction: The Emergence of a New CLinical Disorder."

Materials

An exploratory survey consisting of both open-ended and closed-ended questions was constructed for this study that could be administered by telephone interview or electronic collection. The survey administered a Diagnostic Questionnaire (DQ) containing the eight-item classification list. Subjects were then asked such qustions as : (a) how long they have used the Internet, (b) how many hours per week they estimated spending on-line, (c) what types of applications they most utilized, (d) what made these particular applications attractive, (e) what problems, if any, did their Internet use cause in their lives, and (f) to rate any noted problems in terms of mild, moderate, or severe impairment. Lastly, demosgraphic information from each subject such as age, gender, highest educational level achieved, and vocational background were also gathered..

Procedures

Telephone respondents were administered the survey verbally at an arranged interview time. The survey was replicated electronically and existed as a World-Wide-Web (WWW) page implemented on a UNIX-based server which captured the answers into a text file. Electronic answers 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. A total of 605 surveys in a three month period were collected with 596 valid responses that were classifed from the DQ as 396 Dependents and 100 Non-Dependents. Approximately 55% of the respondents replied via electronic survey method and 45% via telephone survey method. The qualitative data gathered were then subjected to content analysis to identify the range of characteristics, behaviors and attitudes found.

RESULTS

Demographic Data

Means, standard deviations, percentages, and coding schemes were utilized to analyze data. The sample of Dependents included 157 males and 239 females. Mean ages were 29 for males, and 43 for females. Mean educational background was 15.5 years. Vocational background was classified as 42% none (i.e., homemaker, disabled, retired, students), 11% blue-collar employment, 39% non-tech white collar employment, and 8% high-tech white collar employment.

Addictive Applications

The Internet itself is a term which represents different types of functions that are accessible on-line. Therefore, before discussing addictive nature of the Internet, one must examine the types of applications being used. When Dependents were asked "What applications do you most utilize on the Internet?", 35% indicated chat rooms, 28% MUDs, 15% News groups, 13% E-mail, 7% WWW, and 2% Information Protocols (e.g., gopher, ftp, etc.,). Upon examination, traditional information protocols and Web pages were the least utilized among Dependents compared to over 90% of respondents who became addicted to the two way communication functions: chat rooms, MUDs, news groups, or e-mail. This makes the case that the database searches, while interesting and often times time-consuming, are not the actual reasons Dependents become addicted to the Internet.

Chat rooms and MUDs were the two most utilized mediums which both allow multiple on-line users to simultaneously communicate in real time; similar to having a telephone conversation except in the form of typed messages. Over 1,000 users can occupy a single virtual area. Text scrolls quickly up the screen with answers, questions, or comments to one another. Privatized messages are another available option which allow only a single user to read a message sent.

Multi-User Dungeons, more commonly known as MUDs, differ from chat rooms as these are an electronic spin off of the old Dungeon and Dragons games where players take on character roles. There are literally hundreds of different MUDs ranging in themes from space battles to medieval duels. In order to log into a MUD, a user creates a character name, Hercules for example, who fights battles, duels other players, kills monsters, saves maidens or buys weapons in a make believe role playing game. MUDs can be social in a similar fashion as in chat room, but typically all dialogue is communicated while "in character."




When asked about the main attractions of using these direct dialogue features, 86% of Dependents reported anonymity, 63% accessibility, 58% security, and 37% ease of use. Young (1996) previously noted that "clear differences exist among the specific Internet applications utilized between Dependents and Non-Dependents. Non-Dependents predominantly used those aspects of the Internet which allow them to gather information and to maintain pre-existing relationships through electronic communication. However, Dependents predominantly used those aspects of the Internet which allow them to meet, socialize, and exchange ideas with new people through highly interactive mediums." Consistent with these findings, content analysis classified three major areas of reinforcement pertaining to these two way communication features: social support, sexual fulfillment, and creating a persona. Each of these will be discussed in more depth.

Social Support

Social support can be formed on the basis of a group of people who engage in regular computer-mediated communication with one another for an extended period of time. With routine visits to a particular group (i.e., a specific chat area, MUD, or news group), a high degree of familiarity among other group members is established forming a sense of community. Like all communities, the Cyberspace culture has its own set of values, standards, language, signs, and artifacts and individual users adapt to the current norms of the group. CMC creates the opportunity to disregard normal conventions about privacy (e.g., by posting personal messages to public bulletin boards), and the removal of time and space separations between work and play, office and home, all communicate and reinforce the norms associated with this subculture beyond all boundaries (Kielser et al, 1984).

Once membership into a particular group has been established, a Dependent relies upon the conversation exchange for companionship, advice, understanding, and even romance. Rheingold (1996) explained that the ways in which people use CMC always will be rooted in human needs, not hardware and software and states how "words on a screen are quite capable of moving one to laughter or tears, of evoking anger or compassion, of creating a community from a collection of strangers." The ability to create virtual communities that leave the physical world behind such that well known, fixed, and visual people no longer exist form a meeting of the minds living in a purely text-based society.

Despite that such interactions are purely text-based conversations, the exchange of words empower a deep psychological meaning as intimate bonds are quickly formed among on-line users. In Cyberspace, social convention of rules of politeness are gone, allowing personal questions about a person's marital status, age, or weight to be asked upon an initial virtual meeting. The immediacy of such open and personal information about oneself fosters intimacy among others in the community. Upon a first meeting, an on-line user can tell a complete stranger about his personal life - leaving him feeling close. Through this immediate exchange of personal information, one can easily become involved in the life of others who they have never met - almost like watching a soap opera and thinking of the characters as real people.

As they become more involved in the virtual group, Dependents were able to take more emotional risks by voicing controversial opinions about religion, abortion, or other value laden issues. In real life, Dependents were unable to express these opinions to their closest confidants or even their spouses. However, in Cyberspace, they felt free to express such opinions without fear of rejection, confrontation, or judgment since the presence of others was less readily available and their own identities were well masked. For example, a priest who was active and well respected in his parish disagreed with aspects of the Catholic faith such as not allowing women to be priests and mandatory celibacy. Yet, he would never voice his reservations about the Catholic faith publicly to his congregation. He kept his views to himself until he discovered the "alt.recovery.catholicism" discussion group for former Catholics, where he openly voiced his opinions without fear of retribution. Beyond the airing of deep rooted feelings, the Internet allows the exchange of positive and negative feedback elicited from a quorum of other users. Those who shared his views comforted the priest, and those who challenged him provided a dialogue to debate such issues without revealing his vocation or identity.

The formation of such virtual arenas create a group dynamic of social support to answer a deep and compelling need in people whose real lives are interpersonally impoverished. In particular, life circumstances such as home bound caretakers, the disabled, retired individuals, and homemakers limit access to others. In these cases, individuals are more likely to use the Internet as an alternative to develop such social foundations that are lacking in their immediate environments. Furthermore, the need for social support may be higher in our society due to the disintegration of traditional community-based neighborhoods and the growing rate of divorce, remarriage, and relocation. Lastly, individuals with a prior history of psychiatric illness may be more reliant upon CMC to satisfy social support needs. For example, Young (1997) found that moderate to severe rates of depression co-exist with pathological Internet use. It is plausible that depressives who suffer from low self-esteem, a fear of rejection, and a higher need for approval use the Internet in order to overcome these real life interpersonal difficulties through such social community building generated through CMC.

Sexual Fulfillment

Erotic fantasies can be played out such that people can engage in novel sexual acts commonly known as Cybersex. Chat areas with titles such as "MarriedM4Affair" "The Gay Parade" "Family Time" "SubM4F" or "Swingers" are designed to encourage on-line users to engage explicitly in erotic chat. There are hundreds of sexually explicit rooms entailing submission, dominance, incest, fetishes, and homosexual fantasies. These rooms are easily available on-line, with a little experimentation of various channels to select from, an on-line user can review such titles and with a click of a button be inside one of these rooms. Furthermore, erotic handles can be created to express the type of sexual fantasy being sought such as "Ass Master" "Golden Shower" "M 4 hot phone" "daddy's girl" or "Whips & Chains."




Using CMC for Cybersex was perceived as the ultimate safe sex method to fulfill sexual urges without fear of disease such as AIDS or herpes. Further, Cybersex allowed Dependents to explore the mental and subsequent physical stimulation of acting out forbidden erotic fantasies such as S&M, incest, or urination. Unlike 900 numbers which can be traced or risking being seen at an adult bookstore, Dependents viewed Cybersex to be completely anonymous and unable to be traced. They felt free to carry out illicit sexual impulses and were able to act in ways that differed from real life conduct without fear of repercussion. In general, de-individuation among users or "the process whereby submergence in a group produces anonymity and a loss of identity, and consequent weakening of social norms and constraints" (e.g., Zimbardo, 1969) facilitated such sexually uninhibited behavior among Dependents. The ability to enter into a bodiless state of communication enabled users to explore altered sexual states of being which fostered emotions that were new and richly exciting. Such uninhibited behavior is not necessarily an inevitable consequence of visual anonymity, but depends upon the nature of the group and the individual personality of the on-line user.

Finally, for those Dependents who felt unattractive or maintained few dating opportunities, it was perceived easier to "pick up" another person through Cybersex than in real life. As one Dependent who used the handle "The Stud" explained "I am a 49 year old balding overweight man. But I tell young ladies in Cyberspace that I am 23, muscular, blonde hair and blue eyes. Otherwise, I know that they aren't going to want to have sex with an old, fat guy."

Recognition and Power

Personas allow individuals to virtually obtain recognition and achieve power most saliently through the creation of MUD characters. Character forces exist which consist of ranking creating the illusion of leadership roles and subordinates. MUD players begin at the lowest rank and move to the next highest rank by collecting points, strength, powers, and weaponry within the game. Dependents desire to become more potent in their characters which leads to recognition as a powerful leader among subordinate players.

Dependents closely identified with their characters such that they personally experienced this sense of recognition, gaining self esteem with each virtual encounter. Turkle (1995) states how "the virtual reality becomes not so much an alternative as a parallel life." That is, an on-line player can project an altered identity and act "in character" amongst other on-line players also acting "in character." Indeed, Dependents experience a meshing of boundaries between the virtual role and self. In particular, MUDders blur the distinctions of their own personality and the personality of their character. By reconstructing oneself, a MUDder is able to develop personal attributes not displayed in daily life. A weak man can become strong, a fearful man can become courageous (Turkle, 1995).

For example, Mark admitted, "All I do is play MUDs. I was on it 24 hours a day, every day, for a solid week. My grades fell because I skipped all my classes, never slept, and certainly never studied. But I didn't care. All that mattered to me was MUDding." Socially, Mark had not dated much on campus and didn't participate in any social clubs. He was from a small town and had never traveled much outside of it. This 19 year old college sophomore immediately made it clear why he played MUDs, as he constructed a life that was more expansive than his own. Through MUDding, Mark was able to learn about European culture, command troops, and even marry a female player named "Heron" - the ceremony of course took place by the captain of one of the sea vessels.

Turkle (1995) describes a MUD as a kind of Rorschach Ink Blot in that players can project a fantasy. But unlike a Rorschach, it does not stay on the page. Virtually, Mark had achieved a position of ultimate status as "Lazarus" in the game Mega Wars. He lead the war in several attacks as Admiral of the Empire. Troops from the Coalition feared Lazarus and made that clear. Mark said "I had become a legend as I was the best leader most had seen." Achieving a powerful position bolstered his self esteem as he earned recognition by becoming a legend in this MUD. However, upon return to his real life, Mark was still an awkward sophomore with low grades, few friends, and no date on Saturday night.

DISCUSSION

These findings suggest that information protocols are the least utilized among Dependent on-line users while two way interactive functions such as chat rooms and Multi-user Dungeons are the most utilized. This study also showed that anonymous interactive functions afford Dependents a mechanism to seek out social support and sexual fulfillment directly. Furthermore , the cultivation of new personas through the creation of fictitious handles inspired Dependents to discover repressed personality traits and heighten their experience of recognition and power. The mood states derived from such on-line stimulation ranged from reduced loneliness, improved self-esteem, and euphoria which acted as positive reinforcement for excessive Internet use.

CMC was able to comfort Dependents who were able to replicate the unmet need of confidential social support. However, on-line relationships often times are not integrated into real life situations due to the limitations of geographic disbursement among users. As Turkle (1995) notes "computers offer the illusion of companionship without the demands of friendship." Therefore, the temporary support fix available through the Internet does not succeed the long lasting commitment formed among real life maintenance of interpersonal relationships. Furthermore, as Young (1996) noted, impairment to relationships in the form of social withdrawal, marital discord, and divorce were the leading consequence of PIU. Therefore, while Dependents maintained satisfying on-line relationships, these highly interfere with proper socialization of real life relationships. Finally, while the ability to create on-line personas provide users with a safe outlet to achieve unmet psychological needs, the mental absorption into a new character role negatively impacted real life interpersonal and familial functioning.

Young (1997) found that 83% of addicts had utilized such technology for less than one year, concluding that new comers were more vulnerable to developing PIU. In a recent survey conducted by IntelliQuest, an Austin-based research firm, Snider (1997) reported that an estimated 11.7 million plan to venture on-line within the next year. With the rapid expansion of the Internet into new marketplaces, mental health practitioners and academicians should direct more attention into the development of effective treatment protocols to handle the increased risk of PIU among the growing population of Cyberspace inhabitants.

Future research should examine accurate diagnosis of PIU and develop a uniform set of clinical criteria, such as the modified DSM-IV criteria introduced in prior research (Young, 1996). Effective evaluation of each diagnosed case should include a review of prior psychiatric and addiction history to examine the overlay of a dual diagnosis. The treatment protocol should emphasis the primary psychiatric symptoms if present because effective management of a primary psychiatric condition may indirectly correct PIU. Clinical assessment should also include the extent of use, specific on-line functions being utilized, level of impairment, current social support, interpersonal skills, and family dynamics to help determine what unmet psychological needs are being fulfilled through CMC. Lastly, a behavioral modification protocol should be implemented that best assists patients to achieve those psychological needs being met through CMC in real life.

next: Hooked Online




REFERENCES

American Psychiatric Association. (1995). Diagnostic and Statistical Manual of Mental Disorders. (4th ed.). Washington, DC: Author.

Brenner, V. (1996). An initial report on the on-line assessment of Internet addiction: The first 30 days of the Internet usage survey. http://www.ccsnet.com/prep/pap/pap8b/638b012p.txt

Busch, T. (1995). Gender differences in self-efficacy and attitudes toward computers. Journal of Educational Computing Research, 12, 147-158.

Egger, O. (1996). Internet and addiction. http://www.ifap.bepr.ethz.ch/~egger/ibq/iddres.htm

Freud, S. (1933/1964). New introductory lectures on psychoanalysis. In J. Strachey (Ed.), The standard edition of the complete psychological works of Sigmund Freud (Vol. 23). London: Hogarth.

Griffiths, M. (1997). Does Internet and computer addiction exist? Some case evidence. Paper presented at the 105th annual meeting of the American Psychological Association, August 18, 1997. Chicago, IL.

Griffiths, M. (1991). Amusement machine playing in childhood and adolescence: a comparative analysis of video game and fruit machines. Journal of Adolescence, 14, 53-73.

Griffiths, M. (1990). The cognitive psychology of gambling. Journal of Gambling Studies, 6, 31 - 42.

Keepers, G. A. (1990). Pathological preoccupation with video games. Journal of the American Academy of Child and Adolescent Psychiatry, 29, 49-50.

Kiesler, S., Siegal, J., & McGuir, T. (1985). Social psychological aspects of computer-mediated communication. American Psychologist, 39, 1123-1134.

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

Lesieur, H. R. & Blume, S. B. (1993). Pathological Gambling, Eating Disorders, and the psychoactive substance use disorders. Journal of Addictive Diseases, 12(3), 89 -102.

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

Morahn-Martin, J. (1997). Incidence and correlates of pathological Internet use. Paper presented at the 105th annual meeting of the American Psychological Association, August 18, 1997. Chicago, IL.

Rachlin, H. (1990). Why do people gamble and keep gambling despite heavy losses? Psychological Science, 1, 294-297.

Rheingold, H. A slice of life in my virtual community. http://europa.cs.mun.ca/cs2801/b104_20.html.

Scherer, K., (1997). College life online: Healthy and unhealhty Internet use. Journal of College Life and Development. (38), 655-665.

Shotton, M. (1991). The costs and benefits of "computer addiction." Behaviour and Information Technology, 10, 219-230.

Snider, M. (1997). Growing on-line population making Internet "mass media." USA Today, February 18, 1997

Thompson, S. (1996). Internet Addiction McSurvey results. http://cac.psu.edu/~sjt112/mcnair/journal.html

Turkle, S. (1995). Life on the Screen: Identity in the age of the Internet. New York, NY: Simon & Schuster.

Walker, M. B. (1989). Some problems with the concept of "gambling addiction": should theories of addiction be generalized to include excessive gambling? Journal of Gambling Behavior, 5, 179 - 200.

Walters, G. D. (1992). Drug-seeking behavior: Disease or lifestyle? Professional Psychology: Research and Practice, 23(2), 139-145.

Walters, G. D. (1996). Addiction and identity: exploring the possibility of a relationship. Psychology of Addictive Behaviors, 10, 9-17.

Weissman, M. M. & Payle, E. S. (1974). The depressed woman: A study of social relationships (Evanston: University of Chicago Press).

Young, K. S. (1996). Internet addiction: the emergence of a new clinical disorder. Poster presented at the 104th Annual Convention of the American Psychological Association in Toronto, Canada, August 16, 1996.

Young, K. S. (1997). The relationship between depression and pathological Internet use. Proceedings and abstracts of the Annual Meeting of the Eastern Psychological Association, Volume 68, Washington, DC, April 10, 1997.

Zimbardo, P. (1969). The human choice: Individuation, reason and order versus deindividuation, impulse and chaos. In W.J. Arnold and D. Levine (eds.), Lincoln, Nebraska: University of Nebraska Press.



next:   Hooked Online
~ all center for online addiction articles
~ all articles on addictions

APA Reference
Staff, H. (2008, December 27). What Makes the Internet Addictive: Potential Explanations for Pathological Internet Use, HealthyPlace. Retrieved on 2024, October 7 from https://www.healthyplace.com/addictions/center-for-internet-addiction-recovery/what-makes-the-internet-addictive-potencial

Last Updated: October 6, 2015

Think Strong

Chapter 27 of the book Self-Help Stuff That Works

by Adam Khan

SOME PEOPLE ARE EMOTIONALLY stronger than others. They can take a lot of stress and strain without falling apart, while others collapse into a whimpering heap at the smallest things.

The main difference between an emotionally weak person and an emotionally strong person is what they think when things go wrong. When troubles come along, the weak one is in the habit of thinking: "This is more than I can stand." A tough one thinks: "I can handle this."

It doesn't matter what specific words a person puts to the two different kinds of thinking. But the thoughts that make people weak are feeble and impotent: "I can't take it, it's too overwhelming, it's too much to bear, I can't stand it, I'm not up to this, I'm not emotionally ready for this," etc.

The thoughts that make you strong are capable and resolute: "I can take it, everything is going to work out, I'll get through it, maybe there's a lesson in it for me, adversity builds character, I'm tough, people have been through worse, if I try I can find an advantage in all this, when this is over I'll be wiser," etc.

To become stronger, change your thoughts. It's as simple and uncomplicated as that. There's nothing to it but to do it. Start saying something different to yourself during tough times. When you feel stress, coach yourself, "Come on, [your name here], you can handle this. When this is over, you might even be a stronger person because of it." Think strong thoughts and you will be tougher, braver, and more resilient. Just like that.

The stronger thoughts are truer than the weak thoughts. You can take it. Human beings, including you, can withstand a tremendous amount of strain without cracking, as any cursory perusal of war stories, survival accounts, and reports of disasters demonstrate.

These kinds of thoughts won't be habitual at first, of course. The way you think is as much a habit as the way you tie your shoes. But keep deliberately thinking stronger, and after awhile it will become habitual. Eventually, you'll wonder how you ever thought differently.


 


Would you like to be stronger? Would you like to have more emotional calm during the stressful times? Would you like to stand as a pillar of strength when those about you are crumbling? Sure you would. This is the way. Change your thoughts. Make them stronger. Don't think you can do it? That's the first thought to change.

Think thoughts that give you strength and make you tough.

In some cases, a feeling of certainty can help. But there are many more circumstances where it is better to feel uncertain. Strange but true.
Blind Spots

When some people get smacked around by life, they give in and let life run them over. But some people have a fighting spirit. What's the difference between these two and why does it make a difference? Find out here.
Fighting Spirit

Learn how to prevent yourself from falling into the common traps we are all prone to because of the structure of the human brain:
Thoughtical Illusions

Would you like to stand as a pillar of strength during difficult times? There is a way. It takes some discipline but it is very simple.
Pillar of Strength

next: Where to Tap

APA Reference
Staff, H. (2008, December 27). Think Strong, HealthyPlace. Retrieved on 2024, October 7 from https://www.healthyplace.com/self-help/self-help-stuff-that-works/think-strong

Last Updated: March 31, 2016

Internet Addiction Books

Books written by Internet addiction expert, Dr. Kimberly Young on a variety of subjects pertaining to Internet addiction.

Breaking Free of the Web: Catholics and Internet Addiction

The ultimate guide for Catholics who seek to break the addiction of the Internet. It offers methods of healing that are therapeutically sound and rooted in faith. It includes how-to measures and real-life scenarios about people struggling to kick their Internet addiction, in addition to spiritual exercises and prayers that will guide Internet addicts through the difficult journey of health.

Caught in the Net

In Caught in the Net, Kimberly Young shares the results of her three-year study of Internet abuse. Often using the words of the Internet addicts themselves, she presents the stories of dozens of lives that were shattered by an overwhelming compulsion to surf the Net, play MUD games, or chat with distant and invisible neighbors in the timeless limbo of cyberspace.

Tangled in the Web: Understanding Cybersex from Fantasy to Addiction

Tangled in the Web offers a critical look at Cybersex fantasy and its potential for addiction, and provides a comprehensive plan for recovery to help individuals hooked on adult chat rooms, online pornography, web cam sex, or a Cyberaffair. Couples dealing with online infidelity will also learn how to save their relationships with a seven-step plan to rebuild commitment and regain intimacy. Families will learn how to encourage a cybersex-addicted loved one to seek treatment and finally, therapists will learn how to work with clients who suffer from Cybersexual-Addiction.

Internet Addiction E-Books

Breaking the Denial: Confronting a Loved One Addicted to the Internet
Why would a parent use the Internet to the point it causes pain for their children? Why would a spouse jeopardize a marriage for pictures on a computer screen? Initially, Internet users will rationalize that people are unable to become addicted to a machine.

Understanding Compulsive Online Gambling and Treatment for Addicts
Online casinos have sprung up practically overnight into a multimillion-dollar business, attracting a large number of gamblers worldwide. Compulsive gambling has been around for decades, but now access and opportunity are even greater with the invention of Internet gambling, bringing with it a new form of addictive behavior.

Infidelity Online: A Guide to Rebuilding your Relationship after an Online Affair
This exclusive guide and interactive workbook is specially designed to help you and your partner rebuild your relationship after a cyberaffair. The guide provides you with proven techniques to help save your relationship from virtual adultery.

When Gaming Becomes an Obsession
This booklet helps parents understand the warning signs and risk factors associated with obsessive gaming and provides specific advice on how to deal with a son or daughter's gaming addiction.

Getting Web Sober: Help for Cybersex Addicts and their Loved Ones
This exclusive step-by-step guide is specially designed to help you and loved ones recover from cybersexual addiction. Leveraging proven recovery techniques, this invaluable book will help and serve as a useful clinical guide for therapists.

A Therapist's Guide to Assess and Treat Internet Addiction
This comprehensive book outlines the symptoms and risk factors associated with Internet addiction. You will learn how to integrate traditional recovery strategies with specialized technique unique to this client population and step-by-step recovery strategies for effective treatment planning.

Managing Employee Internet Abuse: Strategies to Stop Internet Abuse in the Workplace
Does your company worry about employees who surf the Internet? Does your company fear the damage created by employees who abuse the Internet such as lost productivity, information security breeches, and liability in discrimination lawsuits initiated by harassing worker email? Each year, corporations lose billions because of employee Internet misuse but are unsure how best to combat the problem.



next: Caught in the Net
~ all center for online addiction articles
~ all articles on addictions

APA Reference
Staff, H. (2008, December 27). Internet Addiction Books, HealthyPlace. Retrieved on 2024, October 7 from https://www.healthyplace.com/addictions/center-for-internet-addiction-recovery/internet-addiction-books

Last Updated: June 24, 2016

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

teenage sex

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

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

Who do you talk to about sex?

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

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

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

Where do you talk?

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

What do you say?

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

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

APA Reference
Staff, H. (2008, December 27). Talking to Your Parents, Partner and Other Important People About Sex, HealthyPlace. Retrieved on 2024, October 7 from https://www.healthyplace.com/sex/psychology-of-sex/talking-people-about-sex

Last Updated: June 4, 2012

Eating Disorders Prevention: Help for Parents

A Family Guide to Eating Disorders, Part 1: Prevention

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

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

Self-Esteem is Essential

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

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

Role Models, Not Fashion Models

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

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

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

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

Signs and Symptoms of Eating Disorders

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

Anorexia Nervosa:

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

Bulimia Nervosa:

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

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

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

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

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

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

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

APA Reference
Staff, H. (2008, December 27). Eating Disorders Prevention: Help for Parents, HealthyPlace. Retrieved on 2024, October 7 from https://www.healthyplace.com/eating-disorders/articles/eating-disorders-prevention-help-for-parents

Last Updated: January 14, 2014

Myth and Meaning

Chapter Three of BirthQuake

alt

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

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


continue story below


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

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

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

THE STRENGTHENING...

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

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


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

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

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

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

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

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


continue story below


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

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

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

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

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

- Janice Brewi and Anne Brennan

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


THE WISDOM BORN OF PAIN

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

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

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

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

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


continue story below


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

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

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

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

 


REGINA REVISITS

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

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

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

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

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


continue story below


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

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

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

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


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

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

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

ANGER AS ANCHOR

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


continue story below


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

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

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

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

HOLDING ON

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

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

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


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

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

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


continue story below


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

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

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

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

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


LETTING GO

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

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

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

"Suffer the growing pains." - Lillian Hellman

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


continue story below


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

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

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

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

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

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

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

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


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

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

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

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

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

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


continue story below


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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

 


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

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

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

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

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


continue story below


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

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

THE MYTH THAT MORE IS BETTER

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

MARCUS

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

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

DONALD

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

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

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

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


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

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

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

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

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

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

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

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

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


continue story below


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

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

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

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

 


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

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

  • More savings for investments and capitol formation

  • A tendency toward economic activity characterized by modernization and sufficiency

  • Reduction of debt, both personal and national

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

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


continue story below


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

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

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

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

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


THE MYTH OF HAVING IT ALL

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

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

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

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

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

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

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


continue story below


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

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

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

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

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

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

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

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

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


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

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

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

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

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


continue story below


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

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

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

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

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

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

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


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

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

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

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

ON NET WORTH

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


continue story below


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

THE MYTH OF HAPPILY EVER AFTER

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

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

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

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

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

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


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

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

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

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


continue story below


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

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

THE GOOD LIFE: A NEW MYTH AND AN OLD IDEAL

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

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

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

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

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


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

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

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

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


continue story below


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

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

TAKING OFF THE MASK

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

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

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

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

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


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

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

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

INCUBATION

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

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


continue story below


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

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

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

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

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

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

Chapter One - The Quake

Chapter Two - The Haunted

Chapter Three - Myth and Meaning

Chapter Four - Embracing the Spirit

Chapter Eight - The Journey

next:EMBRACING THE SPIRIT Chapter Four

APA Reference
Staff, H. (2008, December 27). Myth and Meaning, HealthyPlace. Retrieved on 2024, October 7 from https://www.healthyplace.com/alternative-mental-health/sageplace/myth-and-meaning

Last Updated: July 21, 2014

Compilation of EMDR Studies

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

The following controlled EMDR studies have been completed:

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

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

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

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

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

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

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

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

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

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


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

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

Nonrandomized studies involving PTSD symptomatology include:

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

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

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

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

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

Recent EMDR Studies

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

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

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

APA Reference
Gluck, S. (2008, December 27). Compilation of EMDR Studies, HealthyPlace. Retrieved on 2024, October 7 from https://www.healthyplace.com/depression/articles/compilation-of-emdr-studies

Last Updated: June 24, 2016

Cultural Aspects of Eating Disorders

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

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

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

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

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

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

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

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

APA Reference
Gluck, S. (2008, December 27). Cultural Aspects of Eating Disorders, HealthyPlace. Retrieved on 2024, October 7 from https://www.healthyplace.com/eating-disorders/articles/cultural-aspects-of-eating-disorders

Last Updated: January 14, 2014