Chapter 49 of the book Self-Help Stuff That Works

by Adam Khan

I WAS AT A PUBLICITY SEMINAR recently and the speaker said something very useful. She suggested that when you do a TV interview, you decide beforehand what message you want to communicate to the viewers, and then, no matter what the interviewer asks you, make sure you answer with your message.

Of course you have to acknowledge the question somehow and make the transition to your answer smooth, but, she said, no matter what, you must stay on what you want to say and not get sidetracked by the interviewer.

She was an expert in her field and said this was good advice. Some interviewers are downright hostile. Even if they aren't, they often have a different purpose than you do for being there. So the question becomes: "Whose goal will be achieved? Yours or theirs?" Of course, if your two intentions are not wholly antagonistic, it is possible that both of you can be satisfied.

The same principle operates not only on TV interviews, but in regular life too. The first and most important principle is to know what you want. Know what you want. It doesn't mean you have to step all over everyone to get it. But your wishes are at least as valid as anyone else's, and from your perspective they are more valid than anyone else's. That's the way it ought to be.

So take whatever you get from the world - your circumstances, the people in your life and what they're trying to accomplish - and use it to accomplish your goals.

To do this you have to focus on what you intend to accomplish, and go after it like a hungry lion stalking her prey. No matter what happens, keep trying to accomplish your purpose. It takes some concentration and a little practice. But you'll be able to achieve your goals with more certainty. And you won't be drained as much by things unrelated to your purpose.

Your goals are honorable and valuable. Don't let them get shunted aside by pushy people or less-than-ideal circumstances. Take whatever the world presents to you and use it to accomplish your purpose. No matter what.

Whatever happens, use it to accomplish your purpose.

Scientists have found out some interesting facts about happiness. And much of your happiness is under your influence.
Science of Happiness

Find peace of mind, tranquility in body, and clarity of purpose with this simple method.
Constitutional Right

The questions you ask direct your mind. Asking the right kind of questions makes a big difference.
Why Ask Why?

A simple change in perspective can make you feel better and can also make you more effective at dealing with the situation. Here's one way to change your perspective.
Adventure

What if maximizing your full potential was bad for you?
Be All You Can Be

This is a simple technique for reducing a little of the stress you feel day to day. Its biggest advantage is you can use it while you work.
Rx to Relax

next: Do You Want to Give Up?

Chapter 18 of the book Self-Help Stuff That Works

by Adam Khan

NEGATIVE FEELINGS PLAGUE all of us from time to time. Worry creeps into the mind like an unwelcome in-law, and if something isn't done about it, the worry will stay and eat you out of house and home. Anger strikes, pumping your body full of adrenaline, making it hard to concentrate on your work or speak with a civil tongue. Depression brings feelings of hopelessness and helplessness, darkening and saddening your world like a cold, bleak day in winter.

These are the three faces of negative feelings: Worry, anger, depression. Most negative feelings you ever feel are a shade of anxiety, anger, or sadness. You know these feelings are unpleasant. You know they aren't good for your health. But what can you do to minimize the amount of time you feel them?

First, of course, is to look at the situation causing the negative feelings. If there is a concrete circumstance, a real problem causing the feeling, give it some good hard thought and then do something about it, if you can.

But if there's nothing you can do about it, get involved in something that engages your mind and forget about it. Don't try to stop thinking negatively. Simply try to get absorbed in doing something constructive.

Purposeful activities occupy mind-space, and the more the task engages or takes up your attention, the more mind-space it occupies. Get involved enough in something or do something absorbing enough, and there's no more mind-space left to think about anything else.

What continues a negative emotion is thinking about it. Just as you can distract a crying child and he will forget his skinned knee, you can distract yourself with something so interesting or challenging or important, your mind will stop thinking about the problem, and your negative feelings - now that you're no longer producing them with your thoughts - will dissipate.

Seek escape from unnecessary negative feelings by fleeing into a purpose. It will take your mind off the negative thing, giving you a healthful break from those negative feelings. The side effect is that something purposeful and productive gets done in the meantime. And that will give you something to feel good about.

Relieve negative feelings by turning your attention to purposeful activities.

Find out a useful way to look at the cause of anger, and how much control over your own life this insight can give you:
Argue With Yourself and Win

If worry is a problem for you, or even if you would like to simply worry less even though you don't worry that much, you might like to read this:
The Ocelot Blues

We've been fooled into believing that more material goods
will make us happier than we are now:
We've Been Duped

next: The How of Tao

This page was developed to address issues related to psychotherapy. We hope you find them of interest.

Index:

• To Participants of a Workshop on the Treatment of Bulimia
• The Incorporation of Holistic Principles into a Brief Treatment Framework
• Guiding Principles
• The Contributions of Feminist Therapy
• Old Assumptions and the New Assumptions of O'Hanlon and Davis
• Working with the Body as a Pathway to the Mind
• On Providing Support to Parents who are Also Survivors
• Until We Meet Again

next: To Participants of a Workshop on the Treatment of Bulimia

The potential to communicate on-line opens up whole new possibilities for emotional healing. While some decry the use of technology as an intermediary and claim that the artificial, dehumanizing medium is the "message," there is no doubt that the internet will take on a greater and greater role in the therapy/counseling universe. Why is this? For two reasons. First, in people's busy lives, productivity and efficiency are at a premium. Simply stated, it takes too much time to drive (or worse, take public transportation) to the therapist's office. It will not not be long before people say "Do you remember when we spent an hour in the therapy office and an hour in the car?" Second, the internet gives clients extraordinary choice. Rather than being restricted to their own community, clients can pick therapists from anywhere in the world--language replaces locale as the only barrier.

The availability of internet therapies in different modalities, however, is no guarantee of their effectiveness. Do internet therapies (e-mail, icq/chat, and video) work? How do they compare to traditional face-to-face therapy? Because the use of the internet for this purpose is so new, there is little empirical research on this matter, but we can make an educated guess based upon our understanding of the therapy process.

In Psychotherapy: The Restoration of Voice I identified three parts of the therapy process: discovery, broadening and deepening understanding, and developing a strong therapeutic relationship.

If we use these three processes, discovery, broadening and deepening understanding, and developing a strong therapeutic relationship, as criteria, how do internet therapies stack up against traditional face-to-face therapy.

From this table, you can see that both e-mail and ICQ/Chat are adequate for the discovery part of therapy, but they they are less than ideal beyond this function. E-mail suffers because the therapist is unable to interrupt and ask a question in order to better understand what the client is thinking/feeling at the moment. The therapist can send an e-mail, but he or she has to wait for a reply--a thirty second clarification turns into a day's wait. ICQ/Chat solves the immediacy problem, but the mechanics of typing slows the therapy process to a standstill, and keeps the therapist from attending fully to the client. Internet video shows promise. One question remains to be answered: Will the video technology somehow interfere with the human relationship building process? My guess is that it won't. If it did, people would not laugh and cry at movies; rather they would stare, like my dog Watson, blankly at the screen.

Face-to-face therapy remains the ideal mode of treatment, because it offers the fewest obstacles to a genuine therapeutic relationship. But internet video, with its advantages of time efficiency, and almost unlimited choice of therapists will likely grow in popularity as broadband and fast computers become widely available. It remains to be seen whether this technology will somehow dehumanize the therapy process.

Searching On-Line for a Therapist?

It can be a frustrating experience. But, if you are able to get a sense of who the therapist is through his/her web site, it's a good first step.

Every therapist brings their own philosophy of therapy to their work. But just as importantly, they bring their own "self" through which this philosophy is filtered. That "self" is critical to a good therapy match. Unfortunately, that "self" is rarely revealed in a web site. Yes, credentials and experience are important. But as a therapy consumer, I would also want to know what my therapist is like. What issues is s/he sensitive to? Is s/he bright? How "deep" is s/he? How much world experience does s/he bring to the therapy office as opposed to book knowledge? How realistic is s/he? Is s/he pompous or self important? Will s/he be able to sit with me through my blackest moods? Will s/he be honest with me or hide behind a therapist persona? Does s/he have children? (Perhaps the best way of evaluating a new therapist would be to spend an hour with their children!) Does s/he know what it's really like to raise adolescents? How about stepchildren (if this is relevant)? Does s/he have experience with the death of a loved one? Has s/he had enough pain and loss in their life to really know what I'm talking about?

If a therapist is willing to be revealing, a web site offers people an excellent opportunity to "pre-screen" potential candidates. I think all therapists should put them up. Of course, constructing a site that reveals yourself is risky business. If my therapist had revealed himself in this way, I never would have chosen him (see Dreams, Imagined Dreams: Failed Therapy) Indeed, at most therapist sites, the person is hidden behind a sea of credentials, slick graphics, etc. These sites cry out: "I am professional." But being "professional" does not, by itself, make a good therapist. Good therapy is an endeavor that involves two human beings, and the client will and should over time discover who the therapist is. A good web site can help begin this process.

Certainly, perusing a site is no substitute for a face to face meeting, but it can be an excellent first step in determining whether a good match can be made.

Good luck in your search.

About the author: Dr. Grossman is a clinical psychologist and author of the Voicelessness and Emotional Survival web site.

next: So, You Want to Be a Therapist?

Self-Therapy For People Who ENJOY Learning About Themselves

Therapy is essentially a healthy relationship. Teaching occurs. Emotions are expressed. Ideas are exchanged and examined. But none of these is primary.

What is primary is the relationship between the client and the therapist.

The healthier the relationship, the better the outcome. And the client is half of this important relationship

Which client traits maximize success in therapy? Which traits slow it down?

THE CLIENT'S HUMANITY

The client is a person, not a "label" or a person with a "disease." Clients come to therapy wanting to improve how their life is going.

When they come for the first meeting, therapy is a "fearful hope." The fear is about how they will be treated and the hope is about improving their lives.

If clients are offered respect and kindness, and if they can accept these gifts, they will be successful. If not, they either won't succeed or their success will come very slowly.

RESPECT AND KINDNESS

We could list a lot of the rules about respect, such as those related to confidentiality, keeping the client as the subject rather than the therapist, respecting boundaries, and so forth. (Any therapist who violates these basic rules should be driving a truck.)

What we need to look at most closely, however, is whether the therapist's personality is what the client needs.

For example, I am a rather verbal therapist. I think a few clients I've met couldn't really feel my respect and caring because they needed someone who would let them talk without interruption. (I hope they eventually found a less verbal therapist and did well with them.)

If we assume that the client and the therapist are a good match, the question remains: What can the client do to get maximum benefit from therapy?

WHAT A CLIENT CAN DO TO MAXIMIZE THEIR SUCCESS

A client can help things along by:
1) Telling the full truth.
2) Sharing feelings and degrees of feeling.
3) Understanding the complexity of life's problems.

Before we discuss these traits further I want to make it clear that all clients - those who have all of these traits and those who have none of them - deserve their therapist's respect, caring, time, and energy. Each client deserves the therapist's best.

TELLING THE FULL TRUTH

I like the phrase "brutal honesty." It implies that the truth is more important than social conventions that hide the truth.
The goals of therapy are too important to be hidden due to politeness, embarrassment, or even fear of rejection. The client hires the therapist and pays the bills. Hiding relevant facts until the right time (which may never come) is like holding on to a losing lottery ticket just in case it pays off some day.

SHARING FEELINGS

Therapy is known for valuing the expression of emotion. What is also important is whether the degree of expressed emotion teaches the therapist the relative importance of each issue.

Let's use crying as an example: One client may cry often, but each cry seems to indicate the same degree of emotional pain. This person gets a lot of relief. Another client may cry seldom, but they do mention sadness whenever it is there
and they clearly show whether the sadness is extreme, minor, or in between. This person gets more help at solving problems. (Both expressions of emotion are important but the relief must come first.)

COMPLEXITY

Every client wishes the first therapy meeting could solve everything. Indeed, the first few meetings often do resolve
those problems the client is already prepared to solve.

But the problems that remain after the first few meetings are the difficult ones, because all of the preparation for these changes has to occur during the therapy itself. And this preparation takes time, effort, and the therapy relationship.

People who don't understand this may leave quickly and say: "I tried therapy, but it doesn't work."

They tried getting advice, but they didn't try therapy. Therapy is about the relationship.

Enjoy Your Changes!

Everything here is designed to help you do just that!

next: Why Do We Work So Hard?

Some claim the Alexander Technique can treat depression, stress and chronic pain, but there's little scientific evidence that the Alexander Technique is effective.

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

• Background
• Theory
• Evidence
• Unproven Uses
• Potential Dangers
• Summary
• Resources

Background

The Alexander technique is an educational program that aims to change habitual patterns of movement and posture that are thought to be harmful. Teachers of the Alexander technique guide clients ("students") through various movements using verbal directions and light touch. The goal of these sessions can be to improve coordination and balance, reduce tension, relieve pain, decrease fatigue, improve various medical conditions or promote well-being. Students are encouraged to use what they learn in everyday life. Actors, dancers and athletes use the Alexander technique to improve performance.

F.M. Alexander, an Australian-English actor, developed the Alexander technique. He believed that poor head and neck posture was the cause of his recurrent voice loss. He suggested that people be trained to alter harmful movement patterns and positions.

In 1964, the American Center for the Alexander Technique was founded to provide teaching certification. The certification process generally involves 1,600 hours of training over three years in an approved program. The North American Society of Teachers of the Alexander Technique was established in 1987 to educate the public and to maintain standards for certification of teachers and training courses in the United States. The Alexander technique is taught at wellness centers, through health education programs and by individual teachers.

Theory

Basic beliefs underlying the Alexander technique are that musculoskeletal movements and relationships can directly affect other aspects of health or function and that beneficial movement patterns can be reinforced through repetition. The position of the head and spine is thought to be important in this approach. Many physiologists and behavioral scientists are advocates of musculoskeletal techniques similar to the Alexander technique, although there are few scientific studies of the Alexander technique specifically.

Evidence

Scientists have studied the Alexander technique for the following health problems:

Lung function
A small amount of research reports improved lung function in musicians using the Alexander technique, although these studies are poorly designed and results are mixed. Better evidence is necessary to make any conclusion.

Balance
A small amount of research reports that lessons in the Alexander technique may improve balance in people older than 65 years. However, better-quality evidence is needed before a clear conclusion can be reached.

Temporomandibular joint chronic pain
Evidence is limited, and no firm conclusion can be drawn based on scientific research.

Back pain
Evidence is limited, and no firm conclusion can be drawn based on scientific research.

Parkinson's disease
A small amount of research reports that instruction in the Alexander technique may improve fine and gross movements and reduce depression in patients with Parkinson's disease. However, better evidence is necessary before a clear conclusion can be reached.

Posture in children
Evidence is limited, and no firm conclusion can be drawn based on scientific research. The long-term effects of such instruction in children are not known.

Unproven Uses

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

Potential Dangers

Instruction or practice of the Alexander technique has not been associated with reports of severe complications. However, safety has not been studied systematically. Some practitioners believe that this technique may be less beneficial in people with mental illness or learning disabilities. Safety during pregnancy has not been established scientifically, although the Alexander technique has been used by pregnant women and during delivery without reports of complications.

Do not rely on the Alexander technique alone as an approach to treat medical conditions. Speak with your health care provider if you are considering using the Alexander technique.

Summary

The Alexander technique has been used to address several health issues, but it has not been proven effective for any specific condition. Do not rely on the Alexander technique alone to treat a potentially severe medical condition. Speak with your health care provider if you are considering using the Alexander technique.

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

Resources

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

Selected Scientific Studies: Alexander Technique

Natural Standard reviewed more than 70 articles to prepare the professional monograph from which this version was created.

Some of the more recent studies are listed below:

1. Austin JH, Pullin GS. Improved respiratory function after lessons in the Alexander technique of musculoskeletal education (abstract). Am Rev Respiratory Dis 1984;129(4 pt 2):A275.
2. Austin JH, Ausubel P. Enhanced respiratory muscular function in normal adults after lessons in proprioceptive musculoskeletal education without exercises. Chest 1992;102(2):486-490.
3. Cacciatore TW, Horak FB, Henry SM. Improvement in automatic postural coordination following alexander technique lessons in a person with low back pain. Phys Ther 2005;85(6):565-578.
4. Dennis RJ. Musical performance and respiratory function in wind instrumentalists: effects of the Alexander technique of musculoskeletal education (abstract). Dissertation Abstracts International 1988;48(7):1689a.
5. Dennis J. Alexander technique for chronic asthma. Cochrane Database Syst Rev 2000;(2):CD000995.
6. Dennis RJ. Functional reach improvement in normal older women after Alexander technique instruction. J Gerontol A Biol Sci Med Sci 1999;54(1):M8-11.
7. Ernst E, Canter PH. The Alexander technique: a systematic review of controlled clinical trials. Forsch Komplementarmed Klass Naturheilkd 2003;10(6):325-329.
8. Knebelman S. The Alexander technique in diagnosis & treatment of craniomandibular disorders. Basal Facts 1982;5(1):19-22.
9. Maitland S, Horne R, Burtin M. An exploration of the application of the Alexander technique for people with learning disabilities. Br J Learn Disabil 1996;24:70-76.
10. Nuttall W. The Alexander principle: a consideration of its relevance to early childhood education in England today. Eur Early Child Ed Res J 1999;7(2):87-101.
11. Stallibrass C. An evaluation of the Alexander technique for the management of disability in Parkinson's disease: a preliminary study. Clin Rehabil 1997;11(1):8-12.
12. Stallibrass C, Sissons P, Chalmers C. Randomized controlled trial of the Alexander technique for idiopathic Parkinson's disease. Clin Rehabil 2002;Nov, 16(7):695-708.
13. Valentine ER, Gorton TL, Hudson JA, et al. The effect of lessons in the Alexander technique on music performance in high and low stress situations. Psychol Music 1995;23:129-141.

back to: Alternative Medicine Home ~ Alternative Medicine Treatments

H. drank for thirty years, so much and so frequently that his heart, swimming continuously in alcohol was failing. He was still drinking when he came to see me.

Long ago H. had discovered that no one heard him. Not his parents who were wrapped up in their own worlds, not his siblings, not his friends. Of course they all thought they did, but they didn't. When he turned sixteen, he decided to change his last name to the name of his maternal grandmother. He remembered a few warm times they had spent together.

He had seen many psychiatrists and psychologists in the past. None of them had heard him either. They had all fit him into the their frameworks: he was an alcoholic, a manic-depressive, paranoid, one personality disorder or another, and treated him accordingly. He had tried A.A. but found that too mechanical and regimented for his taste.

When he showed up in my office at Mass. General, I wondered whether I would be able to help him. So many highly credentialed psychiatrists and psychologists had tried and failed. And I wondered how much longer he was going to live. But his story was compelling: he was exceptionally bright, he had a Ph.D. in Anthropology from Princeton, and had taught at a variety of colleges before his emotional problems and drinking had become too severe. So, I decided to give it a try.

In between teaching jobs, H. told me he had bought a sailboat and for a number of years sailed all over the world. He loved long ocean voyages. On the boat he made personal, intimate contact with friends and crew that he had always longed for but could never find elsewhere. There was none of the phoniness of day to day life--people were genuine; on the open ocean game playing quickly disappeared, people relied upon each other for survival.

So, how was I going to help him? From his stories and the way his life had proceeded, I knew he was telling the truth about his family. They had never heard a word he said; not from his earliest days on. And because of his sensitivity to their deafness, his life was tortured. He wanted so much for someone to hear and yet no one would or could. I told him I knew this was true, and that he did not need to convince me any further. The other thing I told him was that because no one had heard him for all of these years, I was certain he had thousands of stories to tell about his life, his disappointments, his wishes, his successes, and I wanted to hear them all. I knew that this would be like a long ocean voyage; that my office was our boat; he was going to tell me everything.

And so he did. He told me about his family, his friends, his ex-wife, his working in some of the fancy restaurants around town as a chef's helper, his drinking, his theories about the world. He gave me books by the Nobel physicist, Richard Feynman, video tapes on chaos theory, anthropology books, scientific papers he had written; I listened, thought, read. Week after week, month after month, he talked and talked and talked. One year into therapy he stopped drinking. He merely said that he didn't feel the need any more. We hardly spent any time talking about it: there were more important things to talk about.

Like his heart. He spent much time in the university libraries research medical journals. He liked to say that he knew as much about his condition, cardiomyopathy, as the leading experts in the field. When he met with his doctor, one of the premier cardiologists in the country, he would discuss all of the latest research. He enjoyed this. Still, the results of his tests were never good. His "ejection fraction" (essentially a measure of the heart's pumping effectiveness) continued to slip. His only hope was a heart transplant.

Two and a half years into therapy, he knew that he was not going to be able to tolerate another Boston winter. As his heart progressively failed he had become fatigued and much more sensitive to the cold. Besides there was a hospital in Florida that had a relatively high success rate with heart transplants, and he thought it would be helpful to live nearby just in case the opportunity arose. The downside, of course, was going to be ending the ocean voyage with me, but he figured we could have contact by telephone if need be. The one thing he asked was that if he did have a transplant that I be in the recovery room when he awoke from surgery. It was not that he wouldn't know where he was (he knew everyone had this experience) it was that he wouldn't know who he was until he saw me. This thought terrified him.

After he moved, we had occasional contact by phone, and when he twice came to Boston he stopped in to see me. By this time I had quit Mass. General and was working out of my home office. The first time he came in he gave me a hug and then moved his chair to within three or four feet of mine. He joked about this: I can hardly see you from there, he said, pointing to where the chair used to be. The second time he came in, I moved the chair closer for him, before he arrived. Each time I saw him he looked a little worse--pasty and weak. He was waiting for a transplant, but there was so much bureaucracy and such a long list of people in need. But he was still hopeful.

A couple months after I last saw H., I got a call from a friend of his. H. was in the hospital in a coma. A neighbor had found him on the floor of his apartment. A day later I received a call that H. had died.

Some of H.'s friends held a memorial service for him down in Florida. A long time friend sent me a sweet note and a photograph of H. at his best: skippering his sailboat. About a month later I received a call from one of H.'s brothers. The family was going to have a memorial service for H. at one of the local hospital chapels. Did I want to come?

At 10:45 I arrived at the hospital and strolled around the grounds for fifteen minutes thinking about H.. Then I went to the chapel. Oddly, when I arrived, a small group of people were filing out the door.

"Is this where the memorial service for H. is?" I asked one of the men who was leaving.

"It just ended."

"I don't understand," I said. "It was supposed to be at 11:00."

"10:30" he said. "Are you Dr. Grossman?" he asked. "I'm Joel, H.'s brother. H. thought very highly of you."

I felt crazy. Could I have gotten the time wrong? I slipped the post-it out of my pocket on which I had written the time Joel had told me. 11:00. "I'm sorry to be late," I said, "But you told me 11:00."

"I don't understand how that could have happened," he said. "Would you like to join us for lunch?"

Suddenly, in my mind, I could picture H. laughing and drawing his chair so close that he could reach out and touch me. "See!" I heard him say. "Didn't I tell you?"

About the author: Dr. Grossman is a clinical psychologist and author of the Voicelessness and Emotional Survival web site.

next: Dreams, Imagined Dreams: Failed Therapy

Detailed information on dietary supplements, what they are and claims made about safety and effectiveness of dietary supplements.

Table of Contents

• What is a dietary supplement?
• What is a new dietary ingredient?
• Are dietary supplements different from foods and drugs?
• What claims can manufacturers make for dietary supplements and drugs?
• How does FDA regulate dietary supplements?
• What information is required on a dietary supplement label?
• Does a label indicate the quality of a dietary supplement product?
• Are dietary supplements standardized?
• What methods are used to evaluate the health benefits and safety of a dietary supplement?
• What are some additional sources of information on dietary supplements?

What is a dietary supplement?

As defined by Congress in the Dietary Supplement Health and Education Act (http://www.fda.gov/opacom/laws/dshea.html#sec3), which became law in 1994, a dietary supplement is a product (other than tobacco) that

• is intended to supplement the diet;

• contains one or more dietary ingredients (including vitamins; minerals; herbs or other botanicals; amino acids; and other substances) or their constituents;

• is intended to be taken by mouth as a pill, capsule, tablet, or liquid; and

• is labeled on the front panel as being a dietary supplement.

What is a new dietary ingredient?

A new dietary ingredient is a dietary ingredient that was not sold in the United States in a dietary supplement before October 15, 1994.

Are dietary supplements different from foods and drugs?

Although dietary supplements are regulated by the U.S. Food and Drug Administration (FDA) as foods, they are regulated differently from other foods and from drugs. Whether a product is classified as a dietary supplement, conventional food, or drug is based on its intended use. Most often, classification as a dietary supplement is determined by the information that the manufacturer provides on the product label or in accompanying literature, although many food and dietary supplement product labels do not include this information.

What claims can manufacturers make for dietary supplements and drugs?

The types of claims that can be made on the labels of dietary supplements and drugs differ. Drug manufacturers may claim that their product will diagnose, cure, mitigate, treat, or prevent a disease. Such claims may not legally be made for dietary supplements.

The label of a dietary supplement or food product may contain one of three types of claims: a health claim, nutrient content claim, or structure/function claim (http://www.cfsan.fda.gov/~dms/hclaims.html). Health claims describe a relationship between a food, food component, or dietary supplement ingredient, and reducing risk of a disease or health-related condition. Nutrient content claims describe the relative amount of a nutrient or dietary substance in a product. A structure/function claim is a statement describing how a product may affect the organs or systems of the body and it can not mention any specific disease. Structure/function claims do not require FDA approval but the manufacturer must provide FDA with the text of the claim within 30 days of putting the product on the market (http://www.cfsan.fda.gov/~dms/ds-labl.html#structure). Product labels containing such claims must also include a disclaimer that reads, "This statement has not been evaluated by the FDA. This product is not intended to diagnose, treat, cure, or prevent any disease."

How does FDA regulate dietary supplements?

In addition to regulating label claims, FDA regulates dietary supplements in other ways. Supplement ingredients sold in the United States before October 15, 1994, are not required to be reviewed by FDA for their safety before they are marketed because they are presumed to be safe based on their history of use by humans. For a new dietary ingredient—one not sold as a dietary supplement before 1994—the manufacturer must notify FDA of its intent to market a dietary supplement containing the new dietary ingredient and provide information on how it determined that reasonable evidence exists for safe human use of the product. FDA can either refuse to allow new ingredients into or remove existing ingredients from the marketplace for safety reasons.

Manufacturers do not have to provide FDA with evidence that dietary supplements are effective or safe; however, they are not permitted to market unsafe or ineffective products. Once a dietary supplement is marketed, FDA has to prove that the product is not safe in order to restrict its use or remove it from the market. In contrast, before being allowed to market a drug product, manufacturers must obtain FDA approval by providing convincing evidence that it is both safe and effective.

The label of a dietary supplement product is required to be truthful and not misleading. If the label does not meet this requirement, FDA may remove the product from the marketplace or take other appropriate actions.

What information is required on a dietary supplement label?

FDA requires that certain information appear on the dietary supplement label:

General information

• Name of product (including the word "supplement" or a statement that the product is a supplement)

• Net quantity of contents

• Name and place of business of manufacturer, packer, or distributor

• Directions for use

Supplement Facts panel

• Serving size, list of dietary ingredients, amount per serving size (by weight), percent of Daily Value (%DV), if established

• If the dietary ingredient is a botanical, the scientific name of the plant or the common or usual name standardized in the reference Herbs of Commerce, 2nd Edition (2000 edition) and the name of the plant part used

• If the dietary ingredient is a proprietary blend (i.e., a blend exclusive to the manufacturer), the total weight of the blend and the components of the blend in order of predominance by weight

Other ingredients

• Nondietary ingredients such as fillers, artificial colors, sweeteners, flavors, or binders; listed by weight in descending order of predominance and by common name or proprietary blend

The label of the supplement may contain a cautionary statement but the lack of a cautionary statement does not mean that no adverse effects are associated with the product. A label for a fictitious botanical product is available at http://vm.cfsan.fda.gov/~acrobat/fdsuppla.pdf.

Does a label indicate the quality of a dietary supplement product?

It is difficult to determine the quality of a dietary supplement product from its label. The degree of quality control depends on the manufacturer, the supplier, and others in the production process.

FDA is authorized to issue Good Manufacturing Practice (GMP) regulations describing conditions under which dietary supplements must be prepared, packed, and stored. FDA published a proposed rule in March 2003 that is intended to ensure that manufacturing practices will result in an unadulterated dietary supplement and that dietary supplements are accurately labeled. Until this proposed rule is finalized, dietary supplements must comply with food GMPs, which are primarily concerned with safety and sanitation rather than dietary supplement quality. Some manufacturers voluntarily follow drug GMPs, which are more rigorous, and some organizations that represent the dietary supplement industry have developed unofficial GMPs.

Are dietary supplements standardized?

Standardization is a process that manufacturers may use to ensure batch-to-batch consistency of their products. In some cases, standardization involves identifying specific chemicals (known as markers) that can be used to manufacture a consistent product. The standardization process can also provide a measure of quality control. .

Dietary supplements are not required to be standardized in the United States. In fact, no legal or regulatory definition exists in the United States for standardization as it applies to dietary supplements. Because of this, the term "standardization" may mean many different things. Some manufacturers use the term standardization incorrectly to refer to uniform manufacturing practices; following a recipe is not sufficient for a product to be called standardized. Therefore, the presence of the word "standardized" on a supplement label does not necessarily indicate product quality.

What methods are used to evaluate the health benefits and safety of a dietary supplement?

Scientists use several approaches to evaluate dietary supplements for their potential health benefits and safety risks, including their history of use and laboratory studies using cell or animal models. Studies involving people (individual case reports, observational studies, and clinical trials) can provide information that is relevant to how dietary supplements are used. Researchers may conduct a systematic review to summarize and evaluate a group of clinical trials that meet certain criteria. A meta-analysis is a review that includes a statistical analysis of data combined from many studies.

What are some additional sources of information on dietary supplements?

Medical libraries are one source of information about dietary supplements. Others include Web-based resources such as PubMed (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?holding=nih) and FDA (http://www.cfsan.fda.gov/~dms/ds-info.html). For general information on botanicals and their use as dietary supplements please see Background Information About Botanical Dietary Supplements (http://ods.od.nih.gov/factsheets/botanicalbackground.asp).

Disclaimer

Reasonable care has been taken in preparing this document and the information provided herein is believed to be accurate. However, this information is not intended to constitute an "authoritative statement" under Food and Drug Administration rules and regulations.

General Safety Advisory

The information in this document does not replace medical advice. Before taking an herb or a botanical, consult a doctor or other health care provider-especially if you have a disease or medical condition, take any medications, are pregnant or nursing, or are planning to have an operation. Before treating a child with an herb or a botanical, consult with a doctor or other health care provider. Like drugs, herbal or botanical preparations have chemical and biological activity. They may have side effects. They may interact with certain medications. These interactions can cause problems and can even be dangerous. If you have any unexpected reactions to an herbal or a botanical preparation, inform your doctor or other health care provider.

Source: Office of Dietary Supplements - National Institutes of Health

next: What's in the Bottle? An Introduction to Dietary Supplements

ADHD is often accompanied by depression for both the child with ADHD and the parents. Learn more.

As most of you know, I began my site on Attention Deficit Disorder in 1995. Over the last several years, I have realized that ADD/ADHD is often accompanied by other issues, and the one I hear most frequently, is Depression.

Often times, with the self-esteem issues and hardships that come with ADHD, Depression appears if it isn't already there and if the ADHD child or adult isn't dealing with depression directly, the stress and chaos in the ADHD household can cause depression to be an issue among other family members.

I also have my own personal battles with depression that stem from a father who felt that verbal abuse and humilation would cure my weight problems, even at 40 years old, an 8 year relationship wrought with domestic violence, verbal and mental abuse as well as the challenges of having an ADHD child.

What Depression Is:

By Deborah Deren - from Wings of Madness Depression website

• Depression is an illness, in the same way that diabetes or heart disease are illnesses.
• Depression is an illness that affects the entire body, not just the mind.
• Depression is an illness that one in five people will suffer during their lifetime.
• Depression is the leading cause of alcoholism, drug abuse and other addictions.
• Depression is an illness that can be successfully treated in more than eighty percent of the people who have it.
• Depression is an equal-opportunity illness - it affects all ages, all races, all economic groups and both genders. Women, however, suffer from depression twice as much as men do.
• At least half of the people suffering from depression do not get proper treatment.
• Untreated depression is the number one cause of suicide.
• Depression is second only to heart disease in causing lost work days in America.

What Depression Is Not:

• Depression is not something to be ashamed of.
• Depression is not the same thing as feeling "blue" or "down."
• Depression is not a character flaw or the sign of a weak personality.
• Depression is not a "mood" someone can "snap out of." (Would you ask someone to "snap out of" diabetes?)
• Depression is not fully recognized as an illness by most health care insurance providers. Most will only pay 50% of treatment costs for out-patient care, as well as limiting the number of visits.

Extensive information on childhood and adult depression at the HealthyPlace.com Depression Community.

next: ADHD Child and School Cooperation
~ adhd library articles
~ all add/adhd articles

Even doctors have trouble differentiating bipolar disorder in children from ADHD and ODD. Here are specific bipolar symptoms to look for.

One of the biggest challenges has been to differentiate children with mania from those with attention deficit hyperactivity disorder (ADHD). Both groups of children present with irritability, hyperactivity and distractibility. So these symptoms are not useful for the diagnosis of mania because they also occur in ADHD. But, elated mood, grandiose behaviors, flight of ideas, decreased need for sleep and hypersexuality occur primarily in mania and are uncommon in ADHD. Below is a brief description of how to recognize these mania-specific symptoms in children.

• Elated children may laugh hysterically and act infectiously happy without any reason at home, school or in church. If someone who did not know them saw their behaviors, they would think the child was on his/her way to Disneyland. Parents and teachers often see this as "Jim Carey-like" behaviors.
• Grandiose behaviors are when children act as if the rules do not pertain to them. For example, they believe they are so smart that they can tell the teacher what to teach, tell other students what to learn and call the school principal to complain about teachers they do not like. Some children are convinced that they can do superhuman deeds (e.g., that they are Superman) without getting seriously hurt, e.g. "flying" out of windows.
• Flight of ideas is when children jump from topic to topic in rapid succession when they talk and not just when a special event has happened.
• Decreased need for sleep is manifested by children who sleep only 4-6 hours and are not tired the next day. These children may stay up playing on the computer and ordering things or rearranging furniture.
• Hypersexuality can occur in children with mania without any evidence of physical or sexual abuse. These children act flirtatious beyond their years, may try to touch the private areas of adults (including teachers), and use explicit sexual language.

In addition, it is most common for children with mania to have multiple cycles during the day from giddy, silly highs to morose, gloomy suicidal depressions. It is very important to recognize these depressed cycles because of the danger of suicide.

From Dr. Demitri Papolos, M.D. and his wife Janice Papolos, authors of the book "The Bipolar Child"

We have interviewed many parents who report that their children seemed different from birth, or that they noticed that something was wrong as early as 18 months. Their babies were often extremely difficult to settle, rarely slept, experienced separation anxiety, and seemed overly responsive to sensory stimulation.

In early childhood, the youngster may appear hyperactive, inattentive, fidgety, easily frustrated and prone to terrible temper tantrums (especially if the word "no" appears in the parental vocabulary). These explosions can go on for prolonged periods of time and the child can become quite aggressive or even violent. (Rarely does the child show this side to the outside world).

A child with bipolar disorder may be bossy, overbearing, extremely oppositional, and have difficulty making transitions. His or her mood can veer from morbid and hopeless to silly, giddy and goofy within very short periods of time. Some children experience social phobia, while others are extremely charismatic and and risk-taking.

If the child is fidgety and inattentive and hyperactive, isn't the correct diagnosis attention-deficit disorder with hyperactivity (ADHD)? Or, if the child is oppositional, wouldn't oppositional-defiant disorder (ODD) be the correct diagnosis?

Several studies have reported that over 80 percent of children who have early-onset bipolar disorder will meet full criteria for ADHD. It is possible that the disorders are co-morbid--appearing together--or that ADHD-like symptoms are a part of the bipolar picture. Also, the ADHD symptoms may simply appear first on the continuum of a developing disorder.

Children with bipolar disorder exhibit much more irritability, labile mood, grandiose behavior, and sleep disturbances-- often accompanied by night terrors (nightmares filled with gore and life-threatening content)--than do children with ADHD.

Because stimulant medications may exacerbate a bipolar disorder and induce an episode or negatively influence the cycling pattern of a bipolar disorder, bipolar disorder should be ruled out first, before a stimulant is prescribed.

Almost all the children in our study of 120 boys and girls diagnosed with bipolar disorder met criteria for oppositional defiant disorder (ODD). Again, the child should be evaluated for a possible bipolar disorder.

So how would a doctor diagnose early-onset bipolar disorder?

The family history is an important clue in the diagnostic process. If the family history reveals mood disorders or alcoholism coming down one or both sides of the family tree, red flags should appear in the mind of the diagnostician. The illness has a strong genetic component, although it can skip a generation.

Many parents are told that the diagnosis cannot be made until the child grows into the upper edges of adolescence--between 16 and 19 years old. The Diagnostic and Statistical Manual of Psychiatry--the DSM-IV--uses the same criteria to diagnose bipolar disorder in children as it does to diagnose the condition in adults, and requires that the manic and depressive episodes last a certain number of days or weeks. But as we already mentioned, the majority of bipolar children experience a much more chronic, irritable course, with many shifts of mood in a day, and often they will not meet the duration criteria of the DSM-IV.

The DSM needs to be updated to reflect what the illness looks like in childhood.

If a child hears voices or sees things, does that mean he or she is schizophrenic?

Absolutely not. Psychotic symptoms such as delusions (fixed, irrational beliefs) and hallucinations (seeing or hearing things not seen or heard by others) can occur during both phases of bipolar disorder. In fact, they are not uncommon. Sometimes the voices and visions are compelling; often they are threatening. Quite a few children report seeing bugs or snakes or say that they see and hear satanic figures.

next: Medication and Therapy for Treating Bipolar Disorder in Children
~ bipolar disorder library
~ all bipolar disorder articles