The information in this booklet is from studies designed to find out how people who experience psychiatric symptoms deal with these symptoms and help themselves feel better. The researcher and the study participants are people who have been told that they have a psychiatric or mental illness. Not all of these ideas work for everyone--use the ones that feel right to you. If something doesn't sound right to you, skip over it. However, try not to dismiss anything before you have considered it.

The opinions expressed herein are those of the author and are not necessarily those of the Center for Mental Health Services.

Have you been told that you have a psychiatric or mental illness like depression, bipolar disorder or manic depression, schizophrenia, borderline personality disorder, obsessive-compulsive disorder, dissociative disorder, post traumatic stress disorder or an anxiety disorder?

___ yes ___ no

Or do feelings or experiences like those that follow make you feel miserable, unsafe and get in the way of doing the things you want to do?

• feeling like your life is hopeless and you are worthless
• wanting to end your life
• thinking you are so great that you are world famous, or that you can do supernatural things
• feeling anxious
• being afraid of common things like going outdoors or indoors, or being seen in certain places
• feeling like something bad is going to happen and being afraid of everything
• being very "shaky", nervous, continually upset and irritable
• having a hard time controlling your behavior
• being unable to sit still
• doing things over and over again--finding it very hard to stop doing things like washing your hands, counting everything or collecting things you don't need
• doing unusual things like wearing winter clothes in the summer and summer clothes in the winter
• believing things like the television or radio are talking to you or that the smoke alarms or digital clocks in public buildings are taking pictures of you
• saying things over and over that don't make any sense
• hearing voices in your head
• seeing things you know aren't really there
• feeling like everyone is against you or out to get you
• feeling out of touch with the world
• periods of time go by when you don't know what has happened or how the time has passed--you don't remember being there but others say you were
• feeling unconnected to your body
• having a hard time keeping your mind on what you are doing
• a sudden or gradual decrease or increase in your ability to think, focus, make decisions and understand things
• feeling like cutting or hurting your body
• feeling like you are a "fake"

___ yes ___ no

If you answered yes to either or both of these questions, this booklet is filled with helpful information and things you can do to feel better.

First, remember, you are not alone. Most people experience feelings or experiences like these at some time in their life. Some of them get help and treatment from health care providers. Other people try to get through it on their own. Some people don't tell anyone what they are experiencing because they are afraid others will not understand and will blame them or treat them badly. Other people share what they are experiencing with friends, family members or co-workers. Sometimes these feelings and experiences are so severe that others know you have are having them even though you have not told them. No matter what your situation is, these feelings and experiences are very hard to live with. They keep you from doing what you want to do with your life, doing things you have to do for yourself and others, and doing things that are rewarding and enjoyable.

As you begin to work on helping yourself to feel better, there are some important things to keep in mind.

1. You will feel better. You will feel happy again. The disturbing experiences and feelings you've had or are having are temporary. This may be hard to believe but it's true. No one knows how long these symptoms will last. But there are lots of things you can do to relieve them and make them go away. You will want help from others including health care providers, family members and friends in relieving your symptoms, and for on-going help in staying well.
2. The best time to address these feelings and experiences is now, before they get any worse.
3. These feelings and experiences are not your fault.
4. When you have these kinds of feelings and experiences, it is hard to think clearly and make good decisions. If possible, don't make any major decisions--like whether to get a job or change jobs, move, or leave a partner or friend--until you feel better.
5. These feelings and experiences do not mean that you are not smart or are less important or valuable than other people.
6. Sometimes people who have these kinds of feelings and experiences are treated badly by people who don't understand. If that happens to you, talk to your friends about it (if you don't have any friends, or only have a few, read the section of this booklet on making new friends. Try to stay away from people who treat you badly. Spend time with upbeat, positive people, people who are nice to you, and who like you just the way you are.
7. Listen to the concerns and feedback from your friends, family members and health care providers who are trying to be helpful.
8. These feelings and experiences do not take away your basic personal rights, like your right to:
   • ask for what you want, to say yes or no, and to change your mind.
   • make mistakes.
   • follow your own values, standards and spiritual beliefs.
   • express all of your feelings, both positive or negative, and to be afraid.
   • determine what is important to you and to make your own decisions based on what you want and need.
   • have the friends and interests of your choice.
   • be uniquely yourself and to allow yourself to change and grow.
   • your own need for personal space and time
   • be safe.
   • be playful and frivolous.
   • be treated with dignity, compassion and respect at all times.
   • know the side effects of recommended medications.
   • to refuse medications and treatments that are unacceptable to you for any reason.

   You may be told that the following things are not normal. They are normal. These kinds of things happen to everyone and are part of being human.

   • getting angry when you are provoked
   • expressing emotion when you are happy, sad or excited
   • forgetting things
   • feeling tired and discouraged sometimes
   • wanting to make your own decisions about your treatment and life.
9. It's up to you to take responsibility for your behavior and for getting better. You are the only one who can help yourself feel better. However, you can reach out for help from others.

What to do if these feelings and experiences feel overwhelming

If any of the following apply to you, or your feelings and experiences feel overwhelming, do some things to help yourself right away.

• You feel absolutely hopeless and/or worthless.
• You feel like life is not worth living anymore.
• You think a lot about dying, have thoughts of suicide or have planned how you will kill yourself
• You are taking lots of risks that are endangering your life and/or the lives of others.
• You feel like hurting yourself, hurting others, destroying property or committing a crime .

Things you need to do:

• Arrange an appointment with your doctor, a health care worker or a mental health agency. If your symptoms make you a danger to yourself or someone else, insist on immediate care and treatment--a family member or friend may need to do this for you if your symptoms are too severe. If you are taking medicines and you think it would be helpful, ask for a medicine check.
• Ask a friend or family member to stay with you until you feel better -- talk, play cards, watch a funny video together, listen to music, etc..
• Call someone you really like and talk to them about how you are feeling.
• Do something simple that you really enjoy, like "getting lost" in a good book, staring at a beautiful picture, playing with your pet or brushing your hair.
• Write anything you want to in a notebook or on scraps of paper.

You will find other ideas in the next section, Things you can do right away to help yourself feel better. As you learn what helps you to feel better, and take action quickly, you will find that you will spend more and more time feeling well and less time feeling badly.

Sometimes when you feel this bad, you may feel like doing things that are dangerous, frightening to others, or things that will be embarrassing to you or others. Keep in mind that no matter how bad you feel, you are still responsible for your own behavior.

If you possibly can, see a physician or a health care worker you like and trust. These feelings and experiences can be caused or worsened by medical illnesses that you don't know you have--like thyroid problems or diabetes. The sooner you get help, the sooner you will feel better. Insist on help with figuring out what to do about any feelings or experiences that are making you uncomfortable or keeping you from doing the things you want or need to do. If you feel it is necessary, ask to be sent to someone else who knows more about treating these kinds of issues.

Doctors and health care workers can tell you about possible things they can do for you or you can do for yourself that will help you feel better. When you go to see them, take a complete listing of all medicines and anything else you may be using to help yourself feel better, and a list of unusual, uncomfortable or painful physical or emotional symptoms--even if they don't seem important to you. Also describe any difficult issues in your life--both things that are going on now and things that have happened in the past--that may be affecting the way you feel. This will help the doctor give you the best possible advice on what you can do to help yourself. It's always easier to go to the doctor if you take along a good friend. This person can help you remember what the doctor suggests, and could take notes if you want them to.

Your doctor or health care worker is providing you with a service, just like the person who installs your telephone or fixes your car. The only difference is they have experience and expertise in dealing with health issues. Your doctor or health care worker should:

• listen carefully to everything you say and answer your questions.
• be hopeful and encouraging.
• plan your treatment based on what you want and need.
• teach you how to help yourself.
• know about and be willing to try new or different ways of helping you feel better.
• be willing to talk with other health care professionals, your family members and friends about your problems and what can be done about them, if want them to.

Your health care rights include the right to:

• decide for yourself treatments that are acceptable to you and those that are not.
• a second opinion without being penalized.
• change health care workers--this right may be limited by some health care plans.
• have the person or people of your choice be with you when you are seeing your doctor or other health care worker.

Your health care worker may suggest that one or several medicines would help you feel better. Find the answers to the following questions to help you decide whether or not you want to take this medicine, and so that you have important information about the medicine. You can get this information by asking your health care worker or pharmacist, looking it up in a book on medications in the library, or by searching for it on the internet.

• What is the common name, product name, product category and suggested dosage level of this medicine?
• How does the medicine work?
• What does the physician expect it to do? How long will it take to do that?
• How well has this medicine worked for other people?
• What are the possible dangers of taking this medicine?
• What are the possible long and short term side effects of taking this medicine? Is there any way to reduce the risk of experiencing these side effects?
• Are there any dietary or life restrictions (such as no driving) when using this medicine?
• How are medicine levels in my blood checked? What tests will be needed before taking this medicine and while taking the medicine? 
• How would I know if the dose should be changed or the medicine stopped?
• How much does it cost? Are there any programs that would help me cover some or all of the costs of this medications? Is there a less expensive medication that I could use instead?

If your symptoms are so bad that you can't understand this information, ask a family member or friend to learn about the medication and to discuss with you whether or not this is a good medicine for you to take.

If you decide to use psychiatric medicine or medicines, they must be managed very carefully to get the best possible results and to avoid serious problems. To do this:

• use these medicines exactly as the doctor and pharmacist has suggested.
• report any side effects to your doctor.
• tell your doctor about any times that you have not been able to take your medicine for any reason so the doctor can tell you what to do--do not double the next dose unless the doctor tells you to.
• avoid the use of alcohol or illegal drugs (if you are addicted to them, ask your doctor for help).
• pay close attention to lifestyle issues that cannot be corrected by medications, such as stress, chaos, poor diet (including excessive use of sugar, salt and caffeine), lack of exercise, light, rest, and smoking.

Things you can do right away to help yourself feel better

1. Tell a good friend or family member how you feel. Telling someone else who has had the same or similar experiences or feelings is very helpful because they can best understand how you are feeling. Ask them if they have some time to listen to you. Tell them not to interrupt with any advice, criticism or judgments. Tell them that after you get done talking you can discuss what to do about the situation, but that first, just talking with no interruptions will help you feel better.
2. If you have a counselor you feel comfortable with, tell her or him how you are feeling and ask for their advice and support. If you don't have a counselor and would like to see someone professionally, contact your local mental health agency (The phone number can be found in the yellow pages of your phone book under Mental Health Services.) Sliding scale fees and free services are often available.
3. In order to deal most effectively with the way you feel and to decide what you are going to do about it, learn about what you are experiencing. This will allow you to make good decisions about all parts of your life like: your treatment; how and where you are going to live; who you are going to live with; how you will get and spend money; your close relationships; and parenting issues. To do this, read pamphlets you may find in your doctor's office or health care facility; review related books, articles, video and audio tapes (the library is often a good source of these resources); talk to others who have had similar experiences and to health care professionals; search the Internet; and attend support groups, workshops or lectures. If you are having such a hard time that you cannot do this, ask a family member or friend to do it with you or for you.
4. Get some exercise. Any movement, even slow movement, will help you feel better--climb the stairs, take a walk, sweep the floor.
5. Spend at least one half hour outdoors every day, even if it is cloudy or rainy.
6. Let as much light into your home or work place as possible--roll up the shades, turn on the lights.
7. Eat healthy food. Avoid sugar, caffeine (coffee, tea, chocolate, soda), alcohol and heavily salted foods. If you don't feel like cooking, ask a family member or friend to cook for you, order take out, or have a healthy frozen dinner.
8. Every day, do something you really enjoy, something that makes you feel good--like working in your garden, watching a funny video, playing with a small child or your pet, buying yourself a treat like a new CD or a magazine, reading a good book or watching a ball game. It may be a creative activity like working on a knitting, crocheting, or woodworking project, painting a picture, or playing a musical instrument. Keep the things you need for these activities on hand so they will be available when you need them.
9. Relax! Sit down in a comfortable chair, loosen any tight clothing and take several deep breaths. Starting with your toes, focus your attention on each part of your body and let it relax. When you have relaxed your whole body, notice how it feels. Then focus your attention for a few minutes on a favorite scene, like a warm day in spring or a walk at the ocean, before returning to your other activities.

1. If you are having trouble sleeping, try some of the following suggestions:
   • before going to bed:
     • avoid heavy meals, strenuous activity, caffeine and nicotine
     • read a calming book
     • take a warm bath
     • drink a glass of warm milk, eat some turkey and/or drink a cup of chamomile tea
   • listen to soothing music after you lie down
   • eat foods high in calcium like dairy products and leafy green vegetables
   • avoid alcohol--it will help you get to sleep but may cause you to awaken early
   • avoid sleeping late in the morning and long naps during the day

2. Ask a family member or friend to take over some or all of the things you need to do for several days--like taking care of children, household chores and work-related tasks--so you have time to do the things you need to take care of yourself.

3. Keep your life as simple as possible. If it doesn't really need to be done, don't do it. Learn that it is alright to say "no" if you can't or don't want to do something, but don't avoid responsibilities like taking good care of yourself and your children. Get help with these responsibilities if you need it.
4. Avoid nasty or negative people who make you feel bad or irritated. Do not allow yourself to be hurt physically or emotionally in any way. If you are being beaten, sexually abused, screamed at or suffering other forms of abuse, ask your health care provider or a crisis counselor to help you figure out how you can get away from whoever is abusing you or how you can make the other person or people stop abusing you.
5. Work on changing your negative thoughts to positive ones. Everyone has negative thoughts that they have learned, usually when they were young. When you are feeling badly, these negative thoughts can make you feel worse. For instance, if you find yourself thinking, "I will never feel better," try saying, "I feel fine," instead. Other common negative thoughts and positive responses:
   

   No one likes me.	Many people like me.
   I am worthless.	I am a valuable person.
   I'm a loser.	I'm a winner.
   I can't do anything right.	I do many things right.

   Repeat the positive responses over and over. Every time you have the negative thought, replace it with the positive one.

Things To Do When You Are Feeling Better

When you are feeling better, make plans using the ideas in the previous section.

Things you can do right away to help yourself feel better, that will help you keep yourself well. Include simple lists of:

• to remind yourself of things you need to do every day, like getting a half hour of exercise and eating three healthy meals;
• to remind yourself of things that may not need to be done every day, but if you miss them they will cause stress in your life, like bathing, buying food, paying bills or cleaning your home.
• of events or situations that, if they come up, may make you feel worse, like a fight with a family member, health care provider or social worker, or loss of your job;
  • and a list of things to do (relax, talk to a friend, play your guitar) if these things happen so you won't start feeling badly.
• of early warning signs that you are starting to feel worse, like always feeling tired, sleeping too much, overeating, dropping things and losing things;
  • and a list of things to do (get more rest, take some time off, arrange an appointment with your counselor) to help yourself feel better.
• of signs that things are getting much worse, like you are feeling very depressed, you can't get out of bed in the morning or you feel negative about everything;
  • and a list of things to do that will help you feel better quickly (get someone to stay with you, spend extra time doing things you enjoy, contact your doctor).
• of information that can be used by others if you become unable to take care of yourself or keep yourself safe such as :
  • signs that indicate you need their help
  • who you want to help you (give copies of this list to each of these people)
  • the names of your doctor, counselor and pharmacist
  • any medications you are taking
  • things that others can do that would help you feel better or keep you safe
  • things you do not want others to do or that might make you feel worse

Key to successful recovery: family members and close friends

One of the most effective ways to improve the way you feel is reaching out to a very good friend, family member, or health care professional, either telling them how you are feeling or sharing an activity with them. If you feel that there is no one you can turn to when you are having a hard time, you may need to work on finding some new friends.

GOOD FRIENDS ARE PEOPLE WHO HELP YOU FEEL GOOD ABOUT YOURSELF.

Here are some ways you could meet people with whom you may become friends. You may not be able to do these things until you feel better.

• Attend a support group. Support groups are a great way to make new friends. It could be a group for people who have similar health issues. You can ask your doctor or other health care professional to help you find one, or check support group listings in the newspaper.
• Go to events in your community like fairs and concerts.
• Join a special interest club. They are often free. They are usually listed in the newspaper. You will meet people with whom you already share a common interest. It might be a group that is focused on hiking, bird watching, stamp collecting, cooking, music, literature, sports, etc..
• Take a course. Adult education programs, community colleges, universities and parks and recreation services offer a wide variety of courses that will help you meet people while learning something new or refreshing your skills. Another benefit is that you will learn something interesting that might open the doors to a new career, or a career change.
• Volunteer. Offer to assist a school, hospital or organization in your community.

Things To Do When You Are Feeling Better

When you are feeling better, make plans using the ideas in the previous section.

Things you can do right away to help yourself feel better, that will help you keep yourself well. Include simple lists of:

• to remind yourself of things you need to do every day, like getting a half hour of exercise and eating three healthy meals;
• to remind yourself of things that may not need to be done every day, but if you miss them they will cause stress in your life, like bathing, buying food, paying bills or cleaning your home.
• of events or situations that, if they come up, may make you feel worse, like a fight with a family member, health care provider or social worker, or loss of your job;
  • and a list of things to do (relax, talk to a friend, play your guitar) if these things happen so you won't start feeling badly.
• of early warning signs that you are starting to feel worse, like always feeling tired, sleeping too much, overeating, dropping things and losing things;
  • and a list of things to do (get more rest, take some time off, arrange an appointment with your counselor) to help yourself feel better.
• of signs that things are getting much worse, like you are feeling very depressed, you can't get out of bed in the morning or you feel negative about everything;
  • and a list of things to do that will help you feel better quickly (get someone to stay with you, spend extra time doing things you enjoy, contact your doctor).
• of information that can be used by others if you become unable to take care of yourself or keep yourself safe such as :
  • signs that indicate you need their help
  • who you want to help you (give copies of this list to each of these people)
  • the names of your doctor, counselor and pharmacist
  • any medications you are taking
  • things that others can do that would help you feel better or keep you safe
  • things you do not want others to do or that might make you feel worse

Key to successful recovery: family members and close friends

One of the most effective ways to improve the way you feel is reaching out to a very good friend, family member, or health care professional, either telling them how you are feeling or sharing an activity with them. If you feel that there is no one you can turn to when you are having a hard time, you may need to work on finding some new friends.

GOOD FRIENDS ARE PEOPLE WHO HELP YOU FEEL GOOD ABOUT YOURSELF.

Here are some ways you could meet people with whom you may become friends. You may not be able to do these things until you feel better.

• Attend a support group. Support groups are a great way to make new friends. It could be a group for people who have similar health issues. You can ask your doctor or other health care professional to help you find one, or check support group listings in the newspaper.
• Go to events in your community like fairs and concerts.
• Join a special interest club. They are often free. They are usually listed in the newspaper. You will meet people with whom you already share a common interest. It might be a group that is focused on hiking, bird watching, stamp collecting, cooking, music, literature, sports, etc..
• Take a course. Adult education programs, community colleges, universities and parks and recreation services offer a wide variety of courses that will help you meet people while learning something new or refreshing your skills. Another benefit is that you will learn something interesting that might open the doors to a new career, or a career change.
• Volunteer. Offer to assist a school, hospital or organization in your community.

next: Taking Back Control of Your Life
~ back to Mental Health Recovery homepage
~ depression library articles
~ all articles on depression

In the past few decades researchers have focused on eating disorders, the causes of these disorders and how the treatment of eating disorders. However, it has mainly been in the last decade that researchers have started looking at eating disorders in children, the reasons why these disorders are developing at such a young age, and the best recovery program for these young people. To understand this growing problem it is necessary to ask a few important questions:

1. Is there a relationship between family context and parental input and eating disorders?
2. What effect do mothers who suffer or have suffered from an eating disorder have on their children and specifically their daughters' eating patterns?
3. What is the best way to treat children with eating disorders?

Types of Childhood Eating Disorders

In an article focusing on an overall description of eating disorders in children, by Bryant-Waugh and Lask (1995), they claim that in childhood there appears to be some variants on the two most common eating disorders found in adults, anorexia nervosa and bulimia nervosa. These disorders include selective eating, food avoidance emotional disorder, and pervasive refusal syndrome. Because so many of the children do not fit all of the requirements for anorexia nervosa, bulimia nervosa, and eating disorder not otherwise specified, they created a general definition which includes all eating disorders, "a disorder of childhood in which there is an excessive preoccupation with weight or shape, and/or food intake, and accompanied by grossly inadequate, irregular or chaotic food intake" (Byant-Waugh and Lask, 1995). Furthermore they created a more practical diagnostic criteria for childhood onset anorexia nervosa as: (a) determined food avoidance, (b) a failure to maintain the steady weight gain expected for age, or actual weight loss, and (c) overconcern with weight and shape. Other common features include self-induced vomiting, laxative abuse, excessive exercising, distorted body image, and morbid preoccupation with energy intake. Physical findings include dehydration, electrolyte imbalance, hypothermia, poor peripheral circulation and even circulatory failure, cardiac arrythmias, hepatic steatosis, and ovarian and uterine regression (Bryant-Waugh and Lask, 1995).

Causes and Predictors of Eating Disorders in Children

Eating disorders in children, like in adults, are generally viewed as a multi-determined syndrome with a variety of interacting factors, biological, psychological, familial and socio-cultural. It is important to recognize that each factor plays a role in predisposing, precipitating, or perpetuating the problem.

In a study by Marchi and Cohen (1990) maladaptive eating patterns were traced longitudinally in a large, random sample of children. They were interested in finding whether or not certain eating and digestive problems in early childhood were predictive of symptoms of bulimia nervosa and anorexia nervosa in adolescence. Six eating behaviors were assessed by maternal interview at ages 1 through 10, ages 9 through 18, and 2.5 years later when they were 12 through 20 years old. The behaviors measured included (1) meals unpleasant; (2) struggle over eating; (3) amount eaten; (4) picky eater; (5) speed of eating (6) interest in food. Also data on pica (eating dirt, laundry starch, paint, or other nonfood material), data on digestive problems, and food avoidance were measured.

The findings revealed that children showing problems in early childhood are definitely at an increased risk of showing parallel problems in later childhood and adolescence. An interesting finding was that pica in early childhood was related to elevated, extreme, and diagnosable problems of bulimia nervosa. Also, picky eating in early childhood was a predictive factor for bulimic symptoms in the 12-20 year olds. Digestive problems in early childhood were predictive of elevated symptoms of anorexia nervosa. Furthermore, diagnosable levels of anorexia and bulimia nervosa were presaged by elevated symptoms of these disorders 2 years earlier, suggesting an insidious onset and an opportunity for secondary prevention. This research would be even more helpful in predicting adolescent onset of eating disorders if they had traced the origins and development of these abnormal eating patterns in children and then further examined alternative contributors to these behaviors.

Family Context of Eating Disorders

There has been considerable speculation regarding familial contributors to the pathogenesis of anorexia nervosa. Sometimes family dysfunction has proved a popular area for consideration for eating disorders in children. Often times parents fail to encourage self-expression, and the family is based on a rigid homeostatic system, governed by strict rules that are challenged by the child's emerging adolescence.

A study by Edmunds and Hill (1999) looked at the potential for undernutrition and links with eating disorders to the issue of dieting in children. Much debate centers around the dangers and benefits of dieting in children and adolescents. In one aspect dieting at an early age is central to eating disorders and has a strong association with extreme weight control and unhealthy behaviors. On the other hand, childhood dieting has the character of a healthy method of weight control for children who are overweight or obese. Especially important for children is the family context of eating and particularly the influence of parents. A question arises concerning whether highly restrained children receive and perceive parental control over their child's food intake. Edmunds and Hill (1999) looked at four hundred and two children with a mean age of 12 years old. The children completed a questionnaire composed of questions from the Dutch Eating Behavior Questionnaire and questions concerning parental control of eating by Johnson and Birch. They also measured the children's body weight and height and completed a pictorial scale assessing body shape preferences and the Self-Perception Profile for Children.

The research findings suggested that 12-year-old dieters are serious in their nutritional intentions. Highly restrained children reported greater parental control of their eating. Also, dieting and fasting were reported by nearly three times as many 12-year-old girls, showing that girls and boys differ in their experiences of food and eating. However, boys were more likely to be nurtured with food by parents than were girls. Though this study did show a relationship between parental control over eating and restrained children, there were several limitations. The data was collected from one age group in only one geographical area. Also the study was solely from the children's point of view, so more parental research would be helpful. This study does point to the fact that children and parents are both in desperate need for advice about eating, weight, and dieting.

A study also focusing on parental factors and eating disorders in children by Smolak, Levine, and Schermer (1999), examined the relative contributions of mother's and father's direct comments about child's weight and modeling of weight concerns through their own behavior on child's body esteem, weight-related concerns, and weight loss attempts. This study emerged because of the expressed concern about the rates of dieting, body dissatisfaction, and negative attitudes about body fat among elementary school children. In the long run early practices of dieting and excessive exercising to lose weight may be associated with the development of chronic body image problems, weight cycling, eating disorders, and obesity. Parents play a detrimental role when they create an environment which emphasizes thinness and dieting or excessive exercise as a way to attain the desired body. Specifically, parents may comment on the child's weight or body shape and this tends to become more common as the children get older.

The study consisted of 299 fourth graders and 253 fifth graders. Surveys were mailed to the parents and were returned by 131 mothers and 89 fathers. The children's questionnaire consisted of items from the Body Esteem Scale, weight loss attempts questions, and how much they were concerned with their weight. The parents' questionnaire addressed issues such as attitudes concerning their own weight and shape, and their attitudes about their child's weight and shape. The results from the questionnaires found that parental comments concerning the child's weight were moderately correlated with weight loss attempts and body esteem in both boys and girls. Daughter's concern about being or getting too fat was related to mother's complaints about her own weight as well as mother's comments about daughter's weight. Daughter's concern about being fat was also correlated with father's concern about his own thinness. For sons, only father's comments on son's weight was significantly correlated with concerns about fat. The data also indicated that mothers have a somewhat greater effect on their children's attitudes and behaviors than do fathers, especially for daughters. This study had several limitations including the relatively young age of the sample, the consistency of the findings, and the lack of a measure of body weight and shape of the children. However, despite these limitations, the data suggests that parents may certainly contribute to children's and especially girls', fears of being fat, dissatisfaction, and weight loss attempts.

Eating Disordered Mothers and Their Children

Mothers tend to have greater effects on their children's eating patterns and self image of themselves, especially for girls. The psychiatric disorders of parents may influence their child rearing methods and may contribute to a risk factor for the development of disorders in their children. Mothers with eating disorders may have a difficult time feeding their infants and young children and will further effect the child's eating behaviors over the years. Often the family environment will be less cohesive, more conflicted, and less supportive.

In a study by Agras, Hammer, and McNicholas (1999) 216 newborns and their parents were recruited for a study from birth to 5 years of age of the offspring of eating disordered and non-eating disordered mothers. The mothers were asked to complete the Eating Disorders Inventory, looking at Body Dissatisfaction, Bulimia, and Drive for Thinness. They also completed a questionnaire which measured hunger, dietary restraint, and disinhibition, as well as a questionnaire concerning purging, weight loss attempts, and binge eating. Data on infant feeding behaviors were collected in the laboratory at 2 and 4 weeks of age using a suckometer; 24 hour infant intake was assessed at 4 weeks of age using a sensitive electronic weighing scale; and for 3 days each month infant feeding practices were collected using the Infant Feeding Report by the mothers. Also infant heights and weights were obtained in the laboratory at 2 and 4 weeks, 6 months, and at 6-month intervals thereafter. Data on aspects of the mother-child relationships were collected annually by questionnaire from the mother on the child's birthday from 2 to 5 years of age.

The findings from this study suggest that mothers with eating disorders and their children, particularly their daughters, interact differently that non-eating disordered mothers and their children in the areas of feeding, food uses, and weight concerns. The daughters of eating disordered mothers appeared to have a greater avidity for feeding early in their development. Eating disordered mothers also noted more difficulty weaning their daughters from the bottle. These findings may be due in part to the mother's attitudes and behaviors associated with her eating disorder. The report of higher rates of vomiting in the daughters of the eating disordered mothers is interesting to highlight given that vomiting is so frequently found as a symptomatic behavior associated with eating disorders. Beginning at 2 years of age, the eating disordered mother expressed a much greater concern over their daughter's weight that they did for their sons or as compared to non-eating disordered mothers. Finally, eating disordered mothers perceived their children to have greater negative affectivity that do non-eating disordered mothers. Limitations to this study include the overall rate of the past and present eating disorders found in this study was high, compared with community sample rates, the study should also follow these children into the early school years to determine whether the interactions in this study do in fact lead to eating disorders in children.

Lunt, Carosella, and Yager (1989) also conducted a study focusing on mothers with anorexia nervosa and instead of looking at young children, this study observed the mothers' of adolescent daughters. However, before the study even started, the researchers had a difficult time finding potentially suitable mothers because they refused to participate, fearing deleterious effects of the interviews on their relationship with their daughters. The researchers felt that adolescent daughters of women with anorexia nervosa might be expected to have some trouble in dealing with their own maturational processes, tendencies to deny problems, and possibly an increased likelihood of developing eating disorders.

Only three anorexic mothers and their adolescent daughters agreed to be interviewed. The results of the interviews showed that all three mothers avoided talking about their illnesses with their daughters and tended to minimize its effects on their relationships with their daughters. A tendency on the part of both the mothers and daughters to minimize and deny problems was found. Some of the daughters tended to closely watch their mother's food intake and worry about their mother's physical health. All three daughters felt that they and their mothers were very close, more like good friends. This may be because while the mothers were ill the daughters treated them more like peers or some role reversal may have occurred. Also, none of the daughters reported any fears of developing anorexia nervosa nor any fears of adolescence or maturity. It is important to note that all of the daughters were at least six years old before their mothers developed anorexia nervosa. By this age much of their basic personalities had developed when their mothers were not ill. It can be concluded that having a mother who has had anorexia does not necessarily predict that the daughter will have major psychological problems later in life. However, in future studies it is important to look at anorexic mothers when their children are infants, the father's role, and the influence of a quality marriage.

Treatment of Childhood Eating Disorders

In order to treat children who have developed eating disorders it is important for the physician to determine the severity and the pattern of the eating disorder. Eating disorders can be divided into two categories: Early of Mild Stage and Established or Moderate Stage.

According to Kreipe (1995) patients in the mild or early stage include those who have 1) mildly distorted body image; 2) weight 90% or less of average height; 3) no symptoms or signs of excessive weight loss, but who use potentially harmful weight control methods or exhibit a strong drive to lose weight. The first stage of treatment for these patients is to establish a weight goal. Ideally a nutritionist should be involved in the evaluation and treatment of children at this stage. Also diet journals can be used to evaluate nutrition. Re-evaluation by the physician within one to two months ensures healthy treatment.

Kreipe's recommended approach to established or moderated eating disorders includes the additional services of professionals who have experience in treating eating disorders. Specialists in adolescent medicine, nutrition, psychiatry, and psychology each have a role in the treatment. These patients have 1) definitely distorted body image; 2)weight goal less than 85% of average weight for height associated with a refusal to gain weight; 3) symptoms or signs of excessive weight loss associated with a denial of the problem; or 4) use of an unhealthy means to lose weight. The first step is to establish a structure to daily activities that ensures adequate caloric intake and limits expenditure of calories. The daily structure should include eating three meals a day, increasing caloric intake, and possibly limiting physical activity. It is important that the patients and parents receive ongoing medical, nutritional, and mental health counseling throughout the treatment. The emphasis of the team approach helps the children and the parents realize that they are not alone in their struggle.

Hospitalization, according to Kreipe should only be suggested if the child has severe malnutrition, dehydration, electrolyte disturbances, ECG abnormalities, physiologic instability, arrested growth and development, acute food refusal, uncontrollable binging and purging, acute medical complications of malnutrition, acute psychiatric emergencies, and comorbid diagnosis that interferes with the treatment of the eating disorder. Adequate preparation for inpatient treatment can prevent some negative perceptions regarding hospitalization. Having direct reinforcement from both the physician and parents of the purpose of the hospitalization as well as the specific goals and objectives of the treatment can maximize the therapeutic impact.

CONCLUSIONS

Recent research on childhood eating disorders reveal that these disorders, which are very similar to anorexia nervosa and bulimia nervosa in adolescents and adults, do in fact exist and have multiple causes as well as available therapy. Research has found that observing eating patterns in young children is an important predictor of problems later in life. It is important to realize that parents play a huge role in children's self-perceptions of themselves. Parental behavior such as comments and modeling at a young age can lead to disorders later in life. Similarly, a mother who has or has had an eating disorder may rear daughters in such a way that they have a high avidity for feeding early in life, which may pose a serious risk for the later development of an eating disorder. Although having a mother who has an eating disorder does not predict the later development of a disorder by the daughter, clinicians should still assess the children of patients with anorexia nervosa to institute preventive interventions, facilitate early case finding, and offer treatment where needed. Furthermore, the treatment that is available tries to focus on the larger issues associated with weight loss in order to help patients complete treatment and maintain a healthy lifestyle in a culture of thinness. Future research should focus on more longitudinal studies where both the family and the child are observed from infancy to late adolescence, focusing attention on eating patterns of the entire family, attitude toward eating within the family, and how the children develop over time in different family structures and social environments.

References

Agras S., Hammer L., McNicholas F. (1999). A prospective study of the influence of eating-disordered mothers on their children. International Journal of Eating Disorders, 25(3), 253-62.

Bryant-Waugh R., Lask B. (1995). Eating Disorders in Children. Journal of Child Psychology and Psychiatry and Allied Disciplines 36 (3), 191-202.

Edmunds H., Hill AJ. (1999). Dieting and the family context of eating in young adolescent children. International Journal of Eating Disorders 25(4), 435-40.

Kreipe RE. (1995). Eating disorders among children and adolescents. Pediatrics in Review, 16(10), 370-9.

Lunt P., Carosella N., Yager J. (1989) Daughters whose mothers have anorexia nervosa: a pilot study of three adolescents. Psychiatric Medicine, 7(3), 101-10.

Marchi M., Cohen P. (1990). Early childhood eating behaviors and adolescent eating disorders. Journal of the American Academy of Child and Adolescent Psychiatry, 29(1), 112-7.

Smolak L., Levine MP., Schermer R. (1999). Parental input and weight concerns among elementary school children. International Journal of Eating Disorders, 25(3), 263-

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Getting Off The Rollercoaster

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

"What is a thought ?"

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

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

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

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

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

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

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

or

"It was too good to be true",

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

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

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

FINDING YOUR TALENT:

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

CREATIONS OF THE EGO:

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

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

KNOWLEDGE WITHIN:

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

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

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

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

We are now Co creating with God.

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

EQUALITY FOR ALL PEOPLE IN ALL THINGS:

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

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

THE VARIOUS NATURES OF CREATIONS:

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

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

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

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

CREATIVITY AND "THE NOW":

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

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

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

ENJOYING THE CREATIONS OF OTHERS:

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

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

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

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

CONTEMPLATION:

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

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next: Getting Off the Roller Coaster The Peaceful Balance.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

4 New Ways to Relieve Pain

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

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

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

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

Electrical Field Stimulation

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

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

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

Prolotherapy

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

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

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

Intramuscular Stimulation (IMS)

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

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

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

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

Source: Alternative Medicine

back to: Complimentary and Alternative Medicine

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

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

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

Background

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

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

Theory

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

Evidence

Scientists have studied guided imagery for the following health problems:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Unproven Uses

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

Potential Dangers

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

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

Summary

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

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

Resources

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

Selected Scientific Studies: Guided Imagery

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

Some of the more recent studies are listed below:

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

back to: Alternative Medicine Home ~ Alternative Medicine Treatments

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

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

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

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

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

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

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

next: Taking Antidepressants
~ back to Living with Depression homepage
~ depression library articles
~ all articles on depression

• Watch the video on Acquired Situational Narcissism

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

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

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

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

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

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

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

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

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

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

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

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

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

next: The Narcissist's Reality Substitutes

Perhaps the best brief summary of Diseasing of America.

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

Ilana Mercer
Vancouver, Canada

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

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

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

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

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

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

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

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

One esteemed addiction researcher, Stanton Peele, is different.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

It is plain stupid.

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

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

• Watch the video on Narcissism Misdiagnosed as General Anxiety Disorder

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

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

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

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

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

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

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

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

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

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

Bibliography

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

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

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

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

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

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

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

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

next: Acquired Situational Narcissism