(and Victims of Physical Abuse, Verbal Abuse, Sexual Abuse)

I know, too well, how you are feeling. Maybe you are a friend of the victim; maybe you are a family member; perhaps you are simply in the next office down the hall. No matter what your relationship to this person, you feel helpless. You feel like you have to stand by and just be a silent witness to the assault.

You want to be able to yank your loved one right out of that awful situation. You want to (at the very least) lock the abuser in a room full of hungry tigers. You see her being hurt by the person who promised to love, honor, and cherish her. You may see bruises, and yet she doesn't leave. You know there must be something you can do, yet you haven't the first clue what it is.

I have to tell you, there is so much you can't do. What you can't do is this: you can't yank her out. You can't explain to her how much better off she will be without him around to berate and abuse. You can't convince her that there is a happier place for her, away from his accusations. You can't make her understand that no matter how many times he apologizes it will happen again and again and again, and it will probably get worse (it could even go from verbal abuse to physical abuse). You can't stop the abuse. You can't talk to the abuser and make him see the error of his ways. Right now, all she hears are his words of apology, because she so desperately wants to believe that there is something she can do to make it right, to make it work, to make him stop.

However, what you can do is much more important. You can be her friend. You can offer a place to stay if it's possible; you can help set up a "secret phrase," and respond instantly to that phrase. You can be the ounce of sanity in the insane world. You can be the one who listens and sympathizes. You can be the one she turns to when he does it again and again and again. You can keep a change of clothes for her and any children, in the event that it does turn "uglier." Sometimes, just knowing there is an avenue of escape makes leaving easier. You can be that avenue.

I know this is hard on you. I have been in both shoes. I have friends right now who are in abusive relationships, and even knowing what I went through, they simply do not see where they are themselves. I don't know when or even if they will ever realize what a predicament they are in, but if and/or when they do, I will be there.

There comes a point in most of these abusive relationships where the victim simply wakes up to reality. Sometimes, the very realization is enough to send her away. Sometimes it takes more. It may be a major thing, such as a trip to the emergency room (where there was no physical violence, physical abuse before), or it may a very small thing, such as a meal carefully prepared being dumped unceremoniously into the garbage because "I don't like it.". There is no way to gauge what will do it. The only thing I can tell you is be patient. Time is the only constant here.

Show her this website. Let her know that there are others, many others, who have been right where she is now. I wish I could give you a "magic wand" to wave, but I can't. All I can do is tell you that God works in a mysterious way, and we all know that He only gives us what He knows we can handle. It takes a very strong woman to put up with what she's going through. weakness is not the issue here. Just be her friend, and be patient.

next: Have an Escape Plan to Get Away From Domestic Violence
~ all Break Free! articles
~ all abuse library articles
~ all articles on abuse issues

MUST HAVES for People Who Self-Injure or a Loved One Who Does (Self-Harm, Self-Mutilation)

Bodily Harm: The Breakthrough Healing Program for Self-Injurers
By Jennifer Kingsonbloom, Karen Conterio, Wendy Lader
buy the book 

Reader Comment:
"This book is a must have to school counselors, especially those who work with middle school girls. The book provides insight and how to be helpful to the student that is in crisis."

A Bright Red Scream
by Marilee Strong
buy the book 

Reader Comment:
"The book is extremely well written and researched and the case studies sited enable the reader to identify - whether you are or were a self-injurer yourself or know someone who is."

Cutting: Understanding and Overcoming Self-Mutilation
by Steven Levenkron
buy the book 

Reader Comment:
This book is about people who cut and has ways to help cutters overcome their addiction to cutting as a means of escape and find better alternatives to this destructive lifestyle.

Suicide, Self-Injury, and Violence in the Schools: Assessment, Prevention, and Intervention Strategies
By: Gerald A. Juhnke, Paul Granello, Darcy Haag
buy the book 

Description: The first book of its kind to address suicide, self-injury, and violence in school settings.

Stopping the Pain: A Workbook for Teens Who Cut & Self-Injure By: Lawrence E. Shapiro
buy the book 

Customer Comment: "I got this product for my 15 year old daughter.Her social worker loved the book and my daughter liked it."

Skin Game: A Memoir
by Caroline Kettlewell
buy the book 

Reader Comment:
"I could not put this book down. It doesn't focus as much on the cutting as I thought it would when I bought it, but it paints a very real portrait of a 'cutter'."

See My Pain! Creative Strategies and Activities for Helping Young People Who Self-Injure
By Susan Bowman, Kaye Randall
buy the book 

Reader Comment:
"This activity book was a great resource! I used it for a group processing course and was able to get some awesome handouts that you are able to reproduce."

Bodies under Siege: Self-mutilation and Body Modification in Culture and Psychiatry
By Armando R. Favazza
buy the book 

Reader Comment:
"Many people look at this book to be designed solely for sufferers...it isn't. As it states, it discusses Self-Mutilation and Body Modification in Culture and Psychiatry."

Treating Self-Injury: A Practical Guide
By Barent W. Walsh 
buy the book 

Reader Comment:
"This book contains case studies of real-life situations with a variety and diversity of ages, genders, and backgrounds."

Stanton Peele is not your mainstream psychologist. Read his viewpoints on alcoholism, addictions and addiction treatment.

Stanton Peele is a licensed psychologist, attorney and the author of numerous books and articles on the subject of alcoholism, addiction and treatment. He has pioneered, among other things, the idea that addiction occurs with a range of experiences, and the "harm reduction" approach to addiction.

Despite research and a general belief in the addictions treatment field that alcoholism and addictions are medically/biologically based diseases, Dr. Peele does not view addictions as medical problems but as "problems of life" that most people overcome and that the failure to do so is the exception rather than the rule.

Dr. Peele has won numerous awards for his contribution to the field of alcoholism including the Alfred R. Lindesmith Award for achievement in the Field of Scholarship, from the Drug Policy Foundation and the Rutgers Center of Alcohol Studies Mark Keller Award for Alcohol Studies for his article "The limitations of control-of-supply models for explaining and preventing alcoholism and drug addiction."

Contents:

• Stanton Peele's Approach
• Denial - of Reality and of Freedom - in Addiction Research and Treatment
• Bad Advice for Lindsay Lohan
• Addiction: The Analgesic Experience
• A Brief History of the National Council on Alcoholism through Pictures
• Addiction to Get Rich Quick Schemes
• Can I Ever Get Off Methadone
• Can My Son's Marijuana Use Be Therapeutic
• Diseasing of America - 6. What Is Addiction, and How Do People Get It
• Drug and Alcohol Policy
• Genetic Models
• How Do I Get My Boyfriend to Quit Drugs / Drinking
• How Do I Help a Friend in a Hospital for Drug Treatment and a Suicide Attempt
• I Was Surprised That My Inmate Husband Is a Pot Smoker
• John Allen of the NIAAA's Response to Stanton Peele's Article on Project MATCH in the Sciences
• Journal Articles and Book Chapters
• Love and Addiction - Appendix
• Mother Asks For Help for Her Daughter
• My Husband Is Continuously Losing Jobs and Has No Desire to Do Anything But Sit and Drink
• Palm eBooks
• Presentations
• Reducing Harms from Youth Drinking
• Should I Turn My Father over to His Military Superiors
• Stanton, Have You Been Bought
• Stop Making Excuses for Drug Addiction
• The Conflict between Public Health Goals and the Temperance Mentality
• The Road to Hell
• What Do I Do when I Find an Adoptive Baby has Special Problems Possibly Related to Her Mother's Drug Use
• What Do You Think of Methadone Treatment, and Is It Good for Me
• What Do You Think of SMART Recovery
• What Is Your Attitude towards Audrey Kishline's "Accident"
• Why Are So Many Indians Alcoholics
• Why Do Controlled Drinking Outcomes Vary by Investigator, by Country and by Era
• Why Do You Slight Benjamin Rush's Discovery that Alcoholism Is a Disease
• Book - Addiction Proof Your Child
• Book - The Meaning of Addiction
• Stanton Peele's Bookshop

To understand more about Stanton Peele and his approach to alcoholism and other addictions: Read Stanton Peele's blog

next: Stanton Peele's Approach
~ addictions library articles
~ all addictions articles

Depression in later life frequently coexists with other medical illnesses and disabilities. In addition, advancing age is often accompanied by loss of key social support systems due to the death of a spouse or siblings, retirement, and/or relocation of residence. Because of their change in circumstances and the fact that they're expected to slow down, doctors and family may miss the diagnosis of depression in elderly people, delaying effective treatment. As a result, many seniors find themselves having to cope with symptoms that could otherwise be easily treated.

Depression tends to last longer in elderly adults. It also increases their risk of death. Studies of nursing home patients with physical illnesses have shown that the presence of depression substantially increased the likelihood of death from those illnesses. Depression also has been associated with increased risk of death following a heart attack. For that reason, making sure that an elderly person you are concerned about is evaluated and treated is important, even if the depression is mild.

Depression in the elderly is more likely to lead to suicide. The risk of suicide is a serious concern among elderly patients with depression. Elderly white men are at greatest risk, with suicide rates in people ages 80 to 84 more than twice that of the general population. The National Institute of Mental Health considers depression in people age 65 and older to be a major public health problem.

(The National Hopeline Network 1-800-SUICIDE provides access to trained telephone counselors, 24 hours a day, 7 days a week)

Risk Factors

Factors that increase the risk of depression in the elderly include: Being female, unmarried (especially if widowed), stressful life events, and lack of a supportive social network. Having physical conditions like stroke, cancer and dementia further increase that risk. While depression may be an effect of certain health problems, it can also increase a person's risk of developing other illnesses -- primarily those affecting the immune system, like infections.

The following risk factors for depression are often seen in the elderly:

• Certain medicines or combination of medicines
• Other illnesses
• Living alone, social isolation
• Recent bereavement
• Presence of chronic or severe pain
• Damage to body image (from amputation, cancer surgery, or heart attack)
• Fear of death
• Previous history of depression
• Family history of major depressive disorder
• Past suicide attempt(s)
• Substance abuse

Depression Treatment in Elderly

There are several treatment options available for depression. In many cases, a combination of the following treatments is most successful.

Antidepressant Medicines

Many antidepressant medicines are available to treat depression. Most of the available antidepressants are believed to be equally effective in elderly adults, but the risk of side effects or potential reactions with other medicines must be carefully considered. For example, certain older types of antidepressants -- such as amitriptyline and imipramine -- can be sedating and cause a sudden drop in blood pressure when a person stands up, which can lead to falls and fractures. However, there are other antidepressants which do not cause those types of problems.

Antidepressants may take longer to start working in older people than they do in younger people. Since elderly people are more sensitive to medicines, doctors may prescribe lower doses at first. Another factor may be forgetting (or not wanting) to take their medicine. Many elderly patients are taking lots of drugs, which can lead to increased complications and side effects. In general, the length of treatment for depression in the elderly is longer then it is in younger patients.

Psychotherapy

Most depressed people find that support from family and friends, involvement in self-help and support groups, and psychotherapy are very helpful.

Psychotherapy is a method of treatment that relies on a unique relationship between a therapist and his or her patient. The goal of psychotherapy is to discuss issues and problems in order to eliminate or control troubling and painful symptoms, helping the patient return to normal functioning. It also can be used to help a person overcome a specific problem or to stimulate overall emotional growth and healing. In regularly scheduled sessions, usually 45 to 50 minutes in length, a patient works with a psychiatrist or other therapist to identify, learn to manage, and ultimately overcome, emotional and behavioral problems.

Psychotherapy is especially beneficial for those patients who prefer not to take medicine, as well as for those not suitable for treatment with drugs because of side effects, interactions with other medicines, or other medical illnesses. The use of psychotherapy in older adults is especially beneficial because of the broad range of functional and social consequences of depression in this age group. Many doctors recommend the use of psychotherapy in combination with antidepressant medicines.

Electroconvulsive Therapy (ECT)

Electroconvulsive therapy (ECT) plays an important role in the treatment of depression in older adults. ECT is a medical treatment performed only by highly skilled health care professionals, including doctors and nurses, under the direct supervision of a psychiatrist (a medical doctor trained in the diagnosis and treatment of mental illnesses).

Prior to ECT treatment, a patient will receive general anesthesia and a muscle relaxant. ECT, when done correctly, causes the patient to have a seizure. The muscle relaxant is given to prevent this. Electrodes are placed on the patient's scalp and finely controlled electric impulses are applied, which causes brief seizure activity in the brain. The patients' muscles are relaxed, so the seizure they experience will usually be limited to slight movement of the hands and feet. Patients are carefully monitored while being treatment. The patient awakens minutes later, does not remember the treatment or events surrounding the treatment, and is often confused. This confusion typically lasts for only short periods of time. ECT is given up to three times a week for two to four weeks. In most cases, ECT is used only when medications or psychotherapy have not been effective, cannot be tolerated, or (in life-threatening cases) will not help the patient quickly enough.

Other Problems Affect Treatment of Depression in the Elderly

The stigma attached to mental illness and psychiatric treatment is even more powerful among the elderly and is often shared by members of the patient's family, friends, and neighbors. This stigma can keep elderly patients from seeking treatment. In addition, depressed older people may not report their depression because they believe there is no hope for help. This sense of helplessness is a characteristic of the disease itself.

Elderly people may also not be willing to take their medicines because of side effects or cost. In addition, having certain other illnesses at the same time as depression can interfere with the effectiveness of antidepressant medicines.

Alcoholism and abuse of other substances may interfere with effective treatment, and unhappy life events -- including the death of family or friends, poverty, and isolation -- may also affect the patient's motivation to continue with treatment.

Medicines Which Can Cause Depression

All medicines have side effects, but some medicines can cause or worsen depression symptoms. Among the commonly used medicines that can create such problems are:

• Some pain medicines (codeine, darvon)
• Some drugs for high blood pressure (clonidine, reserpine)
• Hormones (estrogen, progesterone, cortisol, prednisone, anabolic steroids)
• Some heart medications (digitalis, propanalol)
• Anticancer agents (cycloserine, tamoxifen, Nolvadex, Velban, Oncovin)
• Some drugs for Parkinson's disease (levadopa, bromocriptine)
• Some drugs for arthritis (indomethacin)
• Some tranquilizers/antianxiety drugs (, Halcion)
• Alcohol

next: Exercise Works in Treating Elderly Depression
~ depression library articles
~ all articles on depression

Breakdown of suicide statistics - completed suicides, number of suicide deaths, suicide rate among children and attempted suicides.

Completed Suicides in the U.S. - 1999

• Suicide was the 11th leading cause of death in the United States.
• It was the 8th leading cause of death for males, and 19th leading cause of death for females.
• The total number of suicide deaths was 29,199
• The 1999 age-adjusted rate** was 10.7/100,000, or 0.01%.
  • 1.3% of total deaths were from suicide. By contrast, 30.3% were from diseases of the heart, 23% were from malignant neoplasms (cancer), and 7% from cerebrovascular disease (stroke), the three leading causes.
  • Suicide outnumbered homicides (16,899) by 5 to 3.
  • There were twice as many deaths due to suicide than deaths due to HIV/AIDS (14,802).
  • There were almost exactly the same number of suicides by firearm (16,889) as homicides (16,599).
• Suicide by firearms was the most common method for both men and women, accounting for 57% of all suicides.
• More men than women die by suicide.
  • The gender ratio is 4:1.
  • 72% of all suicides are committed by white men.
  • 79% of all firearm suicides are committed by white men.
• Among the highest rates (when categorized by gender and race) are suicide deaths for white men over 85, who had a rate of 59/100,000.
• Suicide was the 3rd leading cause of death among young people 15 to 24 years of age, following unintentional injuries and homicide. The rate was 10.3/100,000, or .01%.

  • The suicide rate among children ages 10-14 was 1.2/100,000, or 192 deaths among 19,608,000 children in this age group.

    The 1999 gender ratio for this age group was 4:1 (males: females).

  • The suicide rate among adolescents aged 15-19 was 8.2/100,000, or 1,615 deaths among 19,594,000 adolescents in this age group.

    The 1999 gender ratio for this age group was 5:1 (males: females).

    Among young people 20 to 24 years of age the suicide rate was 12.7/100,000, or 2,285 deaths among 17,594,000 people in this age group.

    * The 1999 gender ratio for this age group was 6:1 (males: females).

Attempted Suicides in the U.S. - 1999

No annual national data on attempted suicide are available; reliable scientific research, however, has found that:

• There are an estimated 8-25 attempted suicides to one completion; the ratio is higher in women and youth and lower in men and the elderly
• More women than men report a history of attempted suicide, with a gender ratio of 3:1
• The strongest risk factors for attempted suicide in adults are depression, alcohol abuse, cocaine use, and separation or divorce
• The strongest risk factors for attempted suicide in youth are depression, alcohol or other drug use disorder, and aggressive or disruptive behaviors

Source: National Instititute of Mental Health

The National Hopeline Network 1-800-SUICIDE provides access to trained telephone counselors, 24 hours a day, 7 days a week.

Or for a crisis center in your area, visit the National Suicide Prevention Lifeline.

next: Suicide FAQ
~ depression library articles
~ all articles on depression

Diagnostic Criteria for Muscle Dysmorphia

• Preoccupation with the idea that one's body is not sufficiently lean and muscular. Characteristic associated behaviors include long hours of lifting weights and excessive attention to diet.

• The preoccupation is manifested by at least two of the following four criteria:
  • The individual frequently gives up important social, occupational, or recreational activities because of a compulsive need to maintain his or her workout and diet schedule.
  • The individual avoids situations where his or her body is exposed to others, or endures such situations only with marked distress or intense anxiety.
  • The preoccupation about the inadequacy of body size or musculature causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
  • The individual continues to work out, diet, or use ergogenic (Performance-enhancing) substances despite knowledge of adverse physical or psychological consequences.
• The primary focus of the preoccupation and behaviors is on being too small or inadequately muscular, as distinguished from fear of being fat as in anorexia nervosa, or a primary preoccupation only with other aspects of appearance as in other forms of body dysmorphic disorder.

Diagnostic Criteria for Anorexia Nervosa (for men)

• Refusal to maintain body weight at or above a minimally normal weight for age and height (e.g., weight loss leading to maintenance of body weight less that 85% if that expected; or failure to make expected weight gain during period of growth, leading to body weight less than 85% of that expected).
• Intense fear of gaining weight or becoming fat, even though underweight.
• Disturbance in the way in which one's body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or denial of the seriousness of the current low body weight.

Diagnostic Criteria for Bulimia Nervosa

• Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following:
  • Eating in discrete period of time (e.g., within an 2-hour period), an amount of food that is definitely larger than most people would eat during a similar period of time and under similar circumstances
  • A sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating)
• Recurrent inappropriate compensatory behavior in order to prevent weight gain, such as self-induced vomiting misuse of laxatives, diuretics, enemas, or other medications; fasting, or excessive exercise.
• The binge eating and inappropriate compensatory behaviors both occur, on average, at least twice a week for 3 months. Self-evaluation is unduly influenced by body shape and weight. The disturbance does not occur exclusively during episodes of Anorexia Nervosa.

Diagnostic Criteria for Binge-Eating Disorder

• Recurrent episodes of binge eating. An episode of binge-eating is characterized by both of the following:
  • Eating, in a discrete period of time (e.g., within any 2 hour period), an amount of food that is definitely larger than most people would eat in a similar period of time under similar circumstances.
  • A sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating)
• The binge-eating episodes are associated with three (or more) of the following:
  • Eating much more rapidly than normal
  • Eating until feeling uncomfortably full
  • Eating large amounts of food when not feeling physically hungry
  • Eating alone because of being embarrassed by how much one is eating
  • Feeling disgusted with oneself, depressed, or very guilty after overeating
  • Marked distress regarding binge eating is present.
• The binge eating occurs, on average, at least 2 days a week for 6 months.
• The binge eating is not associated with the regular use of inappropriate compensatory behaviors (e.g., purging, fasting, excessive exercise) and does not occur exclusively during the course of Anorexia Nervosa or Bulimia Nervosa.

Diagnostic Criteria for Body Dysmorphic Disorder

• Preoccupation with an imagined defect in appearance. If a slight physical anomaly is present, the person's concern is markedly excessive.
• The preoccupation causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
• The preoccupation is not better accounted for by another mental disorder (e.g., dissatisfaction with body shape and size in Anorexia Nervosa).

next: Eating Disorders: Muscle Dysmorphia in Men
~ eating disorders library
~ all articles on eating disorders

Your thoughts about recovering from depression can prevent you from living a great life, even if you have depression.

A friend once remarked I was a wonderful role model for how to live a great life despite suffering from depression. At the time, I was unable to see the value in that since, the ultimate goal is to be depression free - isn't it? Suffering from depression means we're flawed, right? It means there's something wrong with my life in which case, what is there to be proud of?

After several trips out of depression and then descending into the pit of despair over-and-over again, I began to wonder whether or not I'd ever be completely free of depression and, more importantly, whether or not it really matters.

Nowadays I'm able to see that:

Suffering / not suffering from depression is not what's important, but how I respond to what occurs in my life (including depression) is.

Given that 75% of depression sufferers cycle back into depression at some point, it makes more sense to learn to enjoy your life despite depression rather than endlessly waiting for this wonderful time when you will never be depressed again.

The common model of depression and cure is based on an overly simplistic 2 phase model where:

• Phase I - You're Depressed or
• Phase II - You're Not Depressed

The ultimate aim is to get from I to II and stay there. Then you can live happily ever after.

There's a major flaw with this type of thinking however: How do you know when it is time to live happily ever after? How do you know for certain you are completely free of depression?

THE REALITY IS WE CAN NEVER GUARANTEE THAT WE ARE OR WILL BE DEPRESSION FREE.

Given this, I've devised a new strategy based on the following 3 phase model.

• Phase I - Depressed
• Phase II - Period of Remission
• Phase III - Depression Free

At first sight, this might appear discouraging. The thought of living your whole life with the spectre of depression is not a happy one. But I believe that the 3-phase model actually increases your chances of becoming Depression free.

Notice how Phase II and Phase III look the same. Even, if you never get to Phase III, you can still have a wonderful life.

Finding yourself at phase I is a backward experience if you're living according to the 2-stage model. While you are depression free, you feel successful and positive. Slipping back into depression makes you feel you've failed again and thus adds to your depression.

However, finding yourself at Phase I in the 3-stage model is a positive experience. You have an opportunity to learn some more and move another step closer to being depression free in phase III. All you need to do is learn to handle the depression differently.

Model 1 is outcome driven. Model 2 is process driven. And that difference is important.

THE KEY is to enjoy the process of your life as you work towards the outcome of being depression free - instead of waiting for the outcome before you can enjoy the process!

Gillian Pearce is a Personal and Business Coach and creator of the '7 Steps to a Depression Free Life - A Self-Help Guide'. Coaching Program. This article is taken from her Self Help Guide.

next: Where to Get Help For Depression
~ depression library articles
~ all articles on depression

Things to consider to help you cope with a family member who has bipolar disorder or another mental illness.

Supporting Someone with Bipolar - For Family and Friends

• No one is to blame and you cannot cure a mental disorder for a family member.
• Despite medication compliance, episodes may occur. It may take some time to find the right medications and dosages. Additionally, the symptoms of the disorder may change over time, requiring medication adjustments.
• Despite your efforts, the symptoms may get worse.
• Separate the person from the disorder. Love the person, hate the disorder and separate the medication side effects from the disorder/person.
• It is NOT okay for you to neglect your needs. Take care of yourself, ensuring you have a rich and fulfilling life. Do not shoulder the whole responsibility for your family member. You may have to assess your emotional commitment.
• There is nothing to be ashamed of if someone in your family has a neurological chemical brain disorder.
• It is natural to experience many strong emotions such as denial, grief, guilt, fear, anger, sadness, hurt, and confusion. Healing occurs with acceptance and understanding. Allow your affected family member and other family members to go through their grieving processes at their own pace. This is also true for you.
• You may have to re-evaluate your expectations. Your family member's successes may be experienced differently from others. However, recognizing that a person has limited capabilities should not mean that you should expect nothing of them. It is important to set boundaries and set clear limits.
• Do not be afraid to ask if your family member is contemplating suicide. Remember that suicide attempts are a cry for help. Often the individual is trying to escape from the consequences of the disorder, and they feel hopeless. Their thinking and judgment at this time may be impaired; they may not understand that they are seeing the world through the symptoms of their disorder. Do not put up a barrier to open communication.
• Remember that irritability and unusual behavior can be a symptom of the disorder; do not take it personally.
• Forgive yourself and others sense of humor.
• Allow your family member the dignity to make his or her own choices; do not patronize, but encourage.

Recognize Pending Episodes

To minimize the effects of mania and depression and the consequences, it is important to identify pending episodes. Early recognition can prevent severe impairment in social and occupational functioning. Potential harm to relationships and the family unit can be minimized. Recognizing and treating episodes in their early stages can allow individuals to lead a healthy, productive life.

Even though your family member may be medicated, prescription drugs may not eliminate all episodes of mania or depression. You can help your family member by recognizing marked changes in their behavior.

Factors that could exacerbate a pending episode may be related to the environment, stress, or an unhealthy lifestyle.

An increase or change in usage of mood altering substances through the use of stimulants and depressants such as caffeine, smoking, alcohol, prescription drug abuse, and illegal narcotics may also indicate a problem exists.

Please do not judge your family member; it is common to abuse these substances in an attempt to decrease the effects of the disorder. However, the use of these substances will defeat the purpose of the prescribed medications, decreasing their effectiveness, and potentially create an unwanted mood swing.

What To Do in a Crisis

Listen
Let the person unload despair and ventilate anger. If given the opportunity to do this, he will feel better. This is a cry for help.

Be sympathetic
A non-judgmental, patient, calm acceptance of the situation will get you faster results.

Do not hesitate to ask if they are feeling suicidal; you are not putting ideas in his head; you are doing a good thing for him. You are showing him you are concerned, that you take him seriously and that it is okay for him to share his pain with you.

Do not trivialize his problems. Simply talking about how he is feeling will give him relief from loneliness and pent-up feelings. It will confirm a feeling of being understood.

Assess the situation
There are three criteria to 95% of all suicidal people: PLAN, MEANS, and TIME SET

PLAN - Has he thought about how he would accomplish his goal?

MEANS - Does he have the ability to carry through his plan?

TIME SET - Has he thought about when he would do it?

Know when to get help. Don't go it alone if he has taken an overdose, ask what and how much and contact your local poison control center. If the poison control center indicates medical assistance is required, either transport him to your nearest hospital, or call for an ambulance.

If there is a possibility he is manic, point out the fact that he may be having an episode by using examples of how his current behavior has changed. Ask him if he has been taking his medication as prescribed.

Encourage him to seek professional help. Remember that when someone is feeling manic, they are often unaware that there is anything wrong; they may react in a defensive way towards you. Let them know you are concerned. If you suspect he is delusional or is hallucinating, please contact your nearest hospital.

Common Concerns and Reactions of Siblings

The following are some of the common thoughts and reactions that occur when a sibling has been diagnosed with a mental illness. By understanding these thoughts, you or the sibling may be better able to assess and deal with these issues.

• Siblings of the diagnosed family member are affected in their relationships within the family and friends; their own thoughts and self-image may be affected.
• The healthy sibling may try to escape physically and/or emotionally from the family. They may place boundaries or barriers to separate from the family or from friends.
• The healthy sibling may take sides within the family. He may feel obligated to be a mediator, however, his own feelings may be in conflict.
• Healthy children may feel preferential treatment is given to the affected family member.
• Healthy children may adopt a more serious disposition and approach to life.
• Healthy children may feel inadequate with their ability to handle crisis situations; include them in discussions about suicide prevention and intervention. The healthy sibling may mature at an earlier age and feel that they "lost" their childhood compensating for their affected sibling's shortcomings.
• Siblings may experience concern anticipating extended care of their family member, even though this may not be realistic.
• They may worry that they could be or might become like the affected family member.
• They also could have concerns about whether they should have children or not. Will their children be affected with the disorder?
• Healthy children may overcompensate to prove their mental health and stability, or to show that they are normal.
• Healthy children will likely feel anger and resentment at the affected sibling and feel guilty that they were not diagnosed with the disorder.
• Embarrassment and feelings of shame for the family may be experienced after diagnosis of mental illness in the family.
• Healthy children may experience grief over the change in their brother or sister.
• They may experience difficulty in establishing and maintaining a healthy relationship with their affected sibling.
• Healthy siblings may also have feelings of disagreement with diagnosis, not realizing that they are in denial. 

Family Matters

Monitor Behavior

• Monitor behavior without being intrusive. Be discreet. Individuals who are experiencing symptoms of mania will probably deny that there is anything wrong with them. People in depression will often isolate from the family. They need to know you still love them.
• Monitor any reckless or endangering activity.
• Pay attention to any extravagant expenditures or excessive shopping sprees. This could indicate a potential manic episode.
• Listen carefully to word choices to determine an impending episode. If you notice rapid speech, this could be hypomania. It is important to acknowledge the symptoms you see and confront the family member with how they are feeling to find out if there is a problem, or if it is just a normal fluctuation in mood.

Maintain a Close Relationship

• Tell your family member how much you love them and mean it. Give them a hug when they need one.
• Treat your family member with dignity and respect.
• Include your family member at family gatherings and outings. However, recognize that sometimes your family member may not feel able to attend because of symptoms associated with the disorder or their medications.
• If your family member does not live at home, contact them by telephone on a regular basis.
• Offer assistance. If they do not have transportation, offer to go shopping with them or to help do their laundry. Prepare frozen dinners that can be re-heated.

next: Dealing with Anger and Guilt After A Suicide
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women and sex

Because men are allowed to express themselves sexually from an early age, it gives them more confidence in the sexual arena. But the trugh is that they let their guard down here makes them more vulnerable than ever.

Women should be aware that men are particularly vulnerable to rejection before, during, and after sex. Sex opens men up to rejection and sexual rejects are often seen as personal rejections.

Their defenses are down and they are at risk. They are like a turtle without a shell-easily punctured and hurt. In addition, men often don't distinguish between the rejection of them sexually and the rejection of them as a whole person.

But will they act hurt when they are rejected? Probably not. That is not an acceptable emotion for men in our society. They are more likely to act mad or sullen, or merely withdraw. Their defensive reaction to the injury is detached, distant, or critical in keeping with society's expectations of men. Often the reaction is, "I'm gone; I'm out of here."

Does this mean women should have sex with men whenever or wherever the men wish, just to avoid wounding them in their vulnerable state?

Of course not.

But it does mean they should be aware that men are particularly vulnerable before, during, and after sex. This is not the time to launch into a ten minute dissertation of what is wrong with his sexual technique.

next: Men's Sexual Fantasies

Self-Therapy For People Who ENJOY Learning About Themselves

Sometimes we want to be helpful to an adult friend who is feeling bad. How can we offer such personal help to a friend? How can we guard against damaging our relationship with them in the process?

THREE GUIDING PRINCIPLES:

1. Do you really WANT to help?
2. Are you willing to ONLY LISTEN unless they specifically ask for more?
3. Can you pay attention to their EMOTIONS instead of their problem?

Don't Think For Them

Giving advice or offering explanations and interpretations without being asked is insulting. It implies that you think your friend can't think for themselves.)

Don't Invite More Emotion Than You Can Handle

Even if it is clearly asked for, don't invite emotional release unless you can stay with your friend while they experience their feelings. (Don't say "maybe you need a good cry" unless you are willing to sit through the tears!)

Don't Get Lost In The Problem

Your friend will be telling you about some problem that has lots of emotion attached to it. Pay attention to the emotion, not the problem.

If they are sad, show that you care about how bad it feels. If they are angry, help them to talk it out (without either agreeing or disagreeing). If they are scared, comfort them physically (if that's appropriate) or with your words. If they are feeling guilty, ask them to think about whether they might be angry instead.

REMEMBER WHY THEY CAME TO YOU

If they had wanted a preacher, a therapist, or a parent they could have gone to one. They came to you because they wanted a friend!

BEING A FRIEND

Two things can help when we feel bad, love and therapy. Therapists offer therapy, friends offer love. A true friend is someone who plays with us, enjoys us, and is there for us.

A MAP OF THE PITFALLS

Some people always seem to be feeling bad. Think about each of your friendships, and ask yourself this question: "Do we usually just have fun, without talking about some problem?" If the answer is "no," your friend is not asking you to be a friend, they are asking you to be a counselor or an advisor of some sort. The potential "pitfalls" in such a relationship are too numerous to mention. Either back out of this friendship cautiously or insist that it change into something you can both count on to be enjoyable.

"You look bad today, do you want to talk?" "What's wrong with you lately? Is everything OK?" If you often say things like this to your friends, you aren't offering friendship, you are offering a "helping relationship" which evidently you need more than your friend! Prove your competence in some other way. Let your friends be.

AGITATION

"Agitation" is a special rhythmic kind of wriggling. We all do it sometimes. We might tap a pencil against our desks, or move our legs up and down repeatedly.

PERSISTENT agitation is a sign of extreme emotion and confusion. If the person you are trying to help agitates constantly ask them to stop it if they can so you can concentrate. If they keep agitating even after you've asked them to stop a few times, stop talking about the problem! (Invite them for a quiet walk or something.) This person has so much going on "down deep" that they can't even hear you well.

And if all of that emotion and confusion did come up, it would definitely be way too much for you to handle in a friendship.

WHEN YOUR HELP DOESN'T HELP

When your love and caring isn't enough, don't be afraid to say so.

Remember that you can't really help unless you want to, and you can't possibly want to if you are being overused or if you are running out of time or energy. Simply say: "I don't think I can help you anymore with this," If they ask you where they can turn now, tell them all you know about resources in your community. If they don't ask, tell them anyway if their level of pain is compelling.

Tell them about this neat self-therapy program you saw on the Internet! Tell them that your friend "Tony" would be happy to suggest a course of self-therapy for them if they'd just ask.

next: Peace on Earth