Parents need to be aware of men who describe themselves as boylovers who believe sex between an adult man and a boy is perfectly fine. They engage in child sexual exploitation which can begin on internet. The beliefs of ManBoyLove are spelled out in this document.

Editor Note: The Boylove Manifesto is a German document that was written in 1997 by TPKA jay_h. It was a declaration of boylove, boylovers, and of the point of view of boylovers on their right to exist and the rights that should be afforded to boys. It does not represent the views of Dr. Faulkner or Debbie Mahoney from the child protection group, SafeGuarding Our Children-United Mothers (SOC-UM).

Who Are We?

Boylove is a worldwide phenomenon that does not recognize the boundaries of gender, race, nationality, age, religious beliefs or philosophy. Boylove describes a special kind of relationship between human males. Boylove has always been with us, exists among us today and will always continue to exist.

A boylover is commonly referred to as a "pedophile". Since boylovers can only speak for themselves, the feminists viewpoint cannot be expressed as part of this document. For the same reason you will not find a treatment about the love of women to boys, nor the love of men to girls as part of this discussion. The aim of this document is to explain the love between human males.

As boylovers we distance ourselves from the current discussion about "child sexual abuse". We are not willing to participate in a confrontational discussion that does not even take into account the variety of sexual relationships between various age groups.

This document represents the views of the author. The stereotype boylover does not exist. There are as many different opinions among boylovers, as there are men who love and admire boys.

Who Should Read This Document?

This document was written for all boylovers, their friends, their boyfriends and their girlfriends. Further, it was conceived for those children who have been, or may someday be confronted with this subject. It is aimed at parents, counselors, teachers and everyone whose life is touched, privately or professionally, by children. Hopefully, it will be read by some who deal with children, youths and boylovers as part of a therapy program. Finally, this document is a resource for those who may have kept an open mind and are genuinely interested in learning more about the difficult subject of "boylove".

This document hopes to assist the reader in shaping his or her own opinion. While we are not hoping to gain any supporters for our opinions, we would like to be afforded the opportunity to submit our point-of-view to the current debate.

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Why Was This Document Published?

The discourse about sexual contacts between different age groups, particularly those that take place between children and adults, has reached a dead-end. The parties on either side of the argument are no longer on speaking terms. Those who have taken it upon themselves to protect every boy from every boylover place the blame squarely on the boylover. To further their cause, these people do not bother to separate fiction and hearsay from the alleged facts. Their doctrine still nourishes from several centuries filled with repressive sexual standards. When child sexuality became taboo, the thought spread through our collective conscience that a child is simply not a sexual being. Sigmund Freud ventured past this taboo. Since that time, the attempt has been made to restrict the newly discovered sexuality of children by means of legislation. The imbalance of power which governes the relationship between adults and children was swiftly expanded to include the subject of sexuality. The adult members of our society mandate how a child is to cope with his or her own sexuality.

The attempt to employ restricions and punishment as a means of child rearing often causes the child to experience serious conflicts. While may traumatise the child, it will certainly do nothing to further his or her natural development in the future. The discrepancy between the desire a child may experience and the restrictions placed upon these desires by society harms the natural and healthy development of his or her own sexuality. As a result, these children will suffer from some psychological damage even as adults.

This document presents the opposing point of view. At the same time, it attempts to liberate children and adults from many false premises which govern our relationships and our sexuality. In view of the social and cultural position of a boylover, an attempt will be made to present his fundamental ethics - particularly the rights of the boy and the boylover's responsibilities.

What Is Boylove?

It is not possible to reduce or limit boylove by focusing only on the sexual aspects of an intergenerational relationship. Human sexuality plays the same part in a boylove relationship as it undoubtedly does in any relationship between human beings. Therefore it may not not be present, only slightly present, or explicitly present in any given relationship. A relationship that is based on sexual contact alone is not really part of boylove, because this term includes far more than that.

A boylover desires a friendly and close relationship with a boy. This relationship will not necessarily include any sexual intimacy, nor will it necessarily exclude it. A boylover's fascination focuses primarily on the "boyish" and "childish" traits that are particular to any boy. The physical traits of the boy and the boylover's sexual desires, which may or may not be present, are quite secondary to that fascination. A boylover will go to great lengths to protect a boy from negative influences, or any physical and emotional harm. Further, a boylover will not resort to threats nor will he show any signs of aggressive or even violent behavior as part of a relationship.

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The Boylove Relationship?

In most cases is the attraction between the boylover and the boy is mutual. The boy is drawn to an adult who takes him seriously and treats him respectfully. The boylove relationship is void of the demeaning power struggles and restrictions which are customarily are part of any child/adult relationship. In a boylove relationship, the boy is afforded the chance to experience himself as a person. A person who may have and express his own opinion, without running the risk of having it cast aside as unqualified, or even "childish". His spirit, as well as his body, are seen as a whole. Not as something that is still in the process - a developmental stage on the way to adulthood.

A child is commonly viewed as someone who needs to grow up in order to become a person. Society applies adult standards in order to shape and mould the child. Personality traits that may be considered undesirable or inconvenient, are often removed in the process of child rearing and education.

As part of a boylove relationship the older partner accepts and nourishes the spirit of the child. The boylover doesn't try to apply adult standards of behaviour in order force the boy's spirit to fit the mould. The boy experiences this acceptance of his own unique character as something very special and pleasant. He feels free to develop and grow, because his partner treasures his personality and takes it seriously.

Although the adult partner is always in a position to exercise power over the child, the boylover tries to avoid any power struggles within the relationship. However, the boylover must be aware of the fact that an imbalance of power is present in any adult/child relationship. Therefore a situation may arise where he may need to raise this topic with his partner.

What Are The Rights Of The Boy?

First and foremost it is the right of the boy to develop his personality and his sexuality freely. This rule must govern every boylove relationship and it does. Any physical or psychological pressure inherently infringes upon this precious right. Further, any restrictions that may interfere with the development of his personality, or those that may prohibit him from experiencing his sexuality without restraints, may also be considered an infringement of his rights. It is the boylovers responsibility to shape the relationship in order to comply to the wishes and needs of the boy. It is also his responsibility to ask questions and listen carefully. Most importantly, the boylover must not interfere with the autonomous development of the boy.

The boy has the right to be protected against physical or psychological abuse. It should also be considered a form of abuse when a boy is prohibited from exercising his rights to experience a loving relationship, or if he is not allowed to experience and develop his own sexuality. The rights of the boy should be respected in this regard, too.

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What Are Our Demands?

We demand the freedom of individual sexuality for boys and for boylovers.

We demand that current standards of sexuality are reconsidered. These standards infringe upon basic human rights, because they prohibit children and those who love them from even thinking about engaging in any sexual intimacy.

We demand that any medical, psychological or religious notions which are preconceived against child sexuality, be exempted from a discussion about new sexual standards.

We demand that children as well as boylovers be included in the current debate concerning sexuality between children and adults. At this point, the "experts" are people who have gained their knowledge about intergenerational relationships from books and statistics. It sounds incredible: there are people who are defending the best interests of an age group and they haven't even bothered to ask members of this age group if this representation is desirable, or in their best interests.

We demand our freedom of speech in the media. The internet is being targeted as the forum for boylovers. We demand to be held to the same standards as every other participant in the internet: if there is nothing illegal being published on a "boylove site" then this site may not be shut down, or censored at will.

We demand a forum for open communication between boylovers. A forum that is entirely free from repression. This discourse, support and a sense of community is important. It is a place to discuss sexual ethics and a forum that will be reached by boylovers from around the globe.

We demand that society reconsiders the status of the child. This is our most important demand. Since children are not granted their own personality, and since they are not being taken seriously, there are "experts" who may represent their "best interests". And as long as we allow this representation to take place, children will be denied their right to develop their own personality, as well as their own sexuality.

next: Self-injury Not Limited to Teens
~ all abuse library articles

Part 5: The Creation of an Overeater -- Mary's Story

What follows is a synthesis of many overeaters' stories to convey the nature of the secret-keeping strategy commonly used by people who overeat and/or binge. This one is selected to show the complexity of what goes into creating and maintaining an inner secret.

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Four year old Mary sits cross legged on the gold-braided living room rug looking up at the TV. Behind her on the big, brown couch sits her father reading the newspaper. He grunts and shakes the paper.

She hears the sharp rustle and cringes, but stays seated on the floor. He slams the paper down on the wooden coffee table. Her hands tremble, and her heart pounds. She breathes short, fast gasps. She sits very still, trying to become invisible.

He growls softly, deep in his throat. Her body stiffens as she stares at the TV, focusing her eyes, ears, heart and soul on the screen. She hears a thud as he jumps awkwardly to his feet. She keeps watching TV, trying to get inside the set, the story, the figures on the screen.

He kicks the couch. She hears the wooden legs scrape against the floor. Her body tight and unmoving, she tries to be as hard and still as the floor. The colors on the TV screen seem to become more vivid to her. She tries to pour her entire being into the screen, making the pictures and sounds her whole world.

He roars at the walls. "Nothing gets done around here. What kind of mess is this?" Mary's eyes glaze. Her heart beats faster. Her mind is totally absorbed in a soap commercial. Her body attempts to retreat into a numb calm. She ignores the pounding of her heart.

From the coffee table, her father picks up a small box of crayons and throws it across the room. She breathes deeply and stares at the Bugs Bunny cartoon now playing. She is oblivious to all but the cartoon. She has achieved invisibility and nonexistence.

He bellows, "Nobody does a damn thing around here!" and sweeps an end table with his hand, sending a lamp and ashtray flying. She has lost awareness of her body, the floor, the room, sounds, sights, smells. To Mary now, only Bugs Bunny exists. Her father lurches around the room, mumbling unintelligibly. In the cartoon Bugs Bunny steals a carrot. Mary laughs.

Her father whirls at her. "What's so funny, you lazy good-for-nothing brat, making a mess everywhere and laughing at me!" She looks up, dazed. She doesn't know what he is talking about. She is so removed she doesn't know who or what he is.

"Answer me, you worthless, no-good!"

He picks her up and throws her across the room. She crashes into the wall. She may feel terror and pain. She may cry out, "No, Daddy, please," or, "I'll be good," or "I didn't do anything," or "I'm sorry."

She may say and feel nothing. She may remain dazed and feel body pain later. She may not remember this happened. She may remember the events but not the feelings. She may remember body and emotional feelings, but not the event. Lack of memory or partial memory shields her from the unendurable knowledge that she lives with a dangerous person. This person can explode at any time, frighten her, hurt her for no understandable reason, and she can do nothing to stop him or protect herself.

All she can do is blank her felt existence out of existence. For a while, Mary does not exist to herself.

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Part 5: Discussion of Mary's Story

Mary found a way to protect herself as best she could from unavoidable and intolerable fear and pain. Her pain comes from more than the physical event.

Emotionally, it is intolerable for Mary to know that her father can and will terrorize her at any time and that her mother will not or cannot protect her. The people she depends on for daily caretaking and protection are dangerous to her. She cannot bear to live with that knowledge and so she finds a way to know as little as possible about her true situation.

If Mary can blot these painful experiences from her awareness she will be able to fearlessly love and trust her father. She can also depend on her mother to care for her, and she can experience herself living in a safe world.

This has more to do with overeating than many people realize. A child has few self-protective resources. If an inescapable, painful, fearsome or humiliating situation exists, creative, strong children can put themselves into a trance. In this way, they can dull the horror of their experience.

Children can divide their minds into pieces so that they are not present as a whole person during extreme torment. Different fragments carry different parts of the experience so the children do not have to know or remember the episodes in their entirety. In this way, they make their experience manageable. Mary saved herself from having to tolerate through knowledge or memory what is intolerable.

Part 5: Mary Grows Up -- Early Stages of Becoming an Overeater

As Mary gets older she may not be able to put herself in a trance as easily as she could as a child. Actual events and emotional memories may approach awareness levels. She may reach for food to help her maintain oblivion. If food works, and it does for many people, she will continue to use eating to help her achieve the trance state she feels is necessary for her survival.

Throughout her life, she may feel body pain and emotional tremors without connecting them to any outside incident. She may sometimes attribute these feelings to physical illness or minor accidents. Gradually she will accept these feelings as "the way she is."

Eventually she may be certain she has these feelings because she is "bad" or "worthless." She may feel "special" in her feelings of terrible faults and therefore feel she deserves special attention in the form of punishment or abandonment.

Mary may feel the physical and emotional feelings she experienced during the abuse she experienced as a child without connecting those feelings to her history. Like many people who overeat or binge, she may not remember sections of her childhood. Her memory blanks may be so thorough, she will not know she does not remember.

Part 5: Mary Grows Up -- Adult Stages of Being an Overeater

Observing the adult Mary who chronically overeats and binges, we notice seemingly inexplicable traits. She has limited and odd childhood memories. She cannot remember the old living room, but she does remember the TV. She doesn't want her children playing with crayons. She continually tries to please her father with gifts and attention. She is angry at her mother most of the time.

She will not have furniture with wooden legs in her home. She refuses to be in a room with any man, including her husband, while he is reading a newspaper. She is afraid to laugh in public. She has many secrets. She may steal little sweets in the grocery store or in social settings when she thinks others are not looking. She will refuse to attend violent movies. Yet she may have sadism/masochism fantasies, perhaps secret, perhaps acted out.

She may blank out at times. On careful observation we might notice that these mental blanks occur when someone around her has body, facial or verbal mannerisms similar to her father.

She has deep bouts of sorrow and loneliness where no one can cheer her up. She feels alone, ugly, bad, scared and is the worst person in the world to herself. She gets angry and sad when people will not change rules or behavior for her. If they do change to accommodate her wishes, she will be briefly grateful but will feel the changes are not enough. She surprises people by not remembering them or their kindness. She doesn't remember needing people.

She overeats regularly. Sometimes she vomits on purpose. When she feels familiar despair she will binge.

Mary is trapped in the overeater's prison. Mary exercises. She reads diet books. She doesn't understand why she can't stop overeating. She believes she overeats and feels bad because she is bad. She is certain that if she stopped overeating her life would be fine, and she would be happy and a good person. She feels humiliated and helpless because she can't stop.

Mary is not curious about her feelings. Her main concern is stopping her feelings, not understanding them. Her lack of curiosity and her insistence on making food her main point of focus are crucial in maintaining her ignorance about herself.

As long as her secrets remain unknown to herself, Mary will continue to feel she is in constant danger. Because she is oblivious to the torture and heartbreak she experienced in her past, she has not learned to recognize and avoid abuse in her present. She may allow abusive people in her life, even invite them, because she doesn't know she has more power than she did as a child. For her, abuse is more than familiar. Abuse feels like home.

Part 5: The Way Out

Someday Mary might become curious about herself. If she does she might begin her triumphant journey.

Triumph actually begins with defeat. Once Mary knows that everything she has tried has failed, she may open herself to something new. This is usually the reason people seek 12-step programs, meditation, support groups, friendly and comforting religious programs and/or professional psychological help.

Their pain, fear and despair is so intense that they are willing to reach out to something unknown and perhaps frightening rather than continue their way of life.

Overeaters also look for help when they feel they have no other choice. Sometimes the overeating itself is no longer effective in blocking their feelings. They feel overwhelmed with anxiety. They are alone with their secret without knowing what it is.

This devastating feeling reduces all choices to one: meet your true self at last. The possibility of freedom lies is changing direction, reaching out to unfamiliar resources, examining your inner life.

What follows is a series of secret discovering questions, preparatory activities and action steps to start you on your triumphant journey. Answer the questions. Begin to discover your secrets. Learn how to build the inner strength and knowledge base that will equip you to discard the overeating way of life.

Bon Voyage!

end of part 5

next: Part Six: Twenty Inner Secret Discovery Questions
~ all triumphant journey articles
~ eating disorders library
~ all articles on eating disorders

by Kay (pseudonym) presented with author's permission
by Joanna Poppink, M.F.T.

(Only names have been changed to protect the privacy of family members) Followed by author's correspondence with Joanna Poppink, L.M.F.T.

Dear Joanna,

I am writing in the hopes of saving my sister Janet. Janet has always been one of my best friends, and my other sister Wilma and I are certain Janet will die if she doesn't t get help.

Janet is 36 years old and has been suffering from Anorexia Nervosa since the age of 16. She has been in an out of treatment and hospitals over the years. It has been about one year since her last 5-month stay at XX (a well known eating disorder treatment center). Since her release last April, she has had 4 hospitalizations and three seizures all caused by her eating disorder.

Janet insists on living in her studio apartment in the city while most of the family is in the suburbs. She comes out to the suburbs often, but despite our efforts to keep her to stay with us she insists on going back to her apartment, and has even called cabs to take her back home.

She can no longer drive because of her seizures and has been on disability for the last year and a half. Janet is also an alcoholic and often turns to binge drinking to escape her problems. On one occasion we picked her up at an El stop bombed drunk. She does not remember the incident.

Janet admits that she drinks to escape her depression. It s a non-ending cycle and I m convinced she will die soon if something drastic doesn't change.

Janet is the middle daughter of three girls. Wilma is 37, and I am 33. In everyone's eyes, Janet is an outgoing person with a bubbly personality. Janet was the lead in many plays in high school. She was an honor student in high school with practically a perfect straight A report card. She was the 2nd runner up in our town beauty pageant at the age of 20.

Janet is a people pleaser. She would do anything to help a friend, relative or stranger. She just can t seem to help herself.

I believe God has saved her time and time again. All of her seizures occurred when she was either around family, or in public. They could just as well have happened while she was alone in her apartment, which is where she spends most of her time these days. When we picked her up, drunk, at the El stop, we found her because she called dad from a payphone. She doesn't remember the incident or the phone call.

My five year old son Chris and Janet have a special bond. Janet lived with us for the first few years of Chris's life. Chris knows Janet is sick because she doesn't t eat. He recently overheard my cries and conversation with my husband in which I stated that I didn't want Janet to die. He pretty much went hysterical crying, "I don t want Auntie Janety to die."

How do you explain Anorexia to a 5 year old? Janet has often said that she doesn't t want to live, but is going on for her nieces and nephew.

Janet loves children. Her first job out of college was teaching preschoolers at a Montessori school. Janet has told me, "The kids love me for me." If only she could love herself the same way.

She has had several bad relationships over the years. The most recent one was with a married lawyer who was getting divorced. This scum was at my house on Thanksgiving a couple of years ago and even held my baby daughter, which now makes me sick to my stomach. He used Janet for very selfish reasons and then Janet found out that his wife was pregnant again. This put Janet over the edge and back in the hospital. Still though, he tracked her down in the hospital and continued to call her.

Because Janet is so sick and has no self-esteem, she immediately got her hopes up and started the relationship back up. Once she was out of the hospital; the relationship resumed and consisted only of lunchtime visits to her apartment for sex. He is now out of the picture because we told his wife.

I have every crazy story you can imagine about the abnormal behavior of a severe anorexic. These memories go back at least 15 years. Janet and I lived together right after I got out of college. This was after her first in-patient stay at a treatment center in Illinois. Janet has specific foods that are okay for her to eat. This list consists of vegetables, diet soda, a morning bagel if you are feeling thin that day, pickles, olives, and pretzels.

She has shared with me every thought that goes through her mind. Nothing I could say helped her. She usually denied that she still had a problem. I've even gone as far as going through the garbage even after it was outside in the trash can to prove to Janet that her anorexia/bulimia was no secret. I found wrappers of all the food she ate during a binge.

We had fights on a regular basis that would end up in tears and hugs. Tough love has never been my expertise. She was staying at our house recently and I asked her to try a little chicken breast on her salad. She did put it on and ate it, but later threw it up. She admitted to me that she threw it up, and broke down in tears saying she had to do it because she ate a lot at mom and dad's the last weekend and gained a few pounds and was freaking out about it.

She also told me in tears that she couldn't t be alone. Sure enough, two days later she demanded going back to her apartment. Her cycle now is to eat when she's visiting us out in the suburbs, and then she starves for 3-5 days.

Her body is so messed up. Among many of her problems is severe osteoporosis. Recent test showed her bones to be as frail as those of a 98 year-old woman. She had to have all her teeth drilled down to just nubs, and have caps put on all of her them because her teeth deteriorated so much due to vomiting. Her blond hair was once healthy. Now, it is thin and sparse.

She started in therapy after her release from the hospital last April at WW, a well-known eating disorder center here. I tried to get her there for the past ten years! I was very hopeful. That didn't last because it required her to go in for weigh-ins and stick to certain commitments.

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Janet's story is that she didn't t like the therapist. She said that therapist blamed everything on family issues. Janet simply couldn't stick to the expectations of the program. Janet somehow got her way out of that one.

Janet has been seeing a therapist off and on for several years who does not specialize in anorexia. She says, "He makes me feel better." She s very encouraged by the fact that he recently started reading up on anorexia to learn more about it! Wow, after years of seeing her, he's now reading up on it! Shouldn't we feel so good?

God forbid my parents would ever get cancer, I m sure Janet would just love it if we sent them to a doctor who started reading up on it. She doesn't listen to me when we say that she needs to be going to someone who understands her problem. Making her feel good is indeed a good thing, but a doctor needs to help you make progress toward recovery and this therapist is not doing that.

But I think Janet sees his concern for her, and she sees that he really likes her which is what Janet longs for in any relationship. It s all part of anorexia. She is a people pleaser but continues to damage herself.

Joanna, my parents are at a loss of what to do. My retired father has spent $110,000 of his savings from Janet's most recent stay in the hospital last year. He has hired a lawyer to fight the insurance companies denial of the claims.

Anorexia is NOT just a mental disease I have no doubt Janet would be dead if she didn't t get into that hospital. She would have died because her body stopped working. Isn't that physical? The 200 pages of documentation from doctors, hospitals, and therapists verify this.

We cannot afford for her to go back into in-patient treatment. Her Cobra ends in June. She is applying for social security, but if she doesn't get it, any more hospitalizations will be devastating for my parents. My mother works mostly so they have health insurance. I know what a terrible position it is to have to put money into consideration to save a life, but it's reality.

My dad can t get out of his mind one of her recent seizure episodes where she was laying on the ground and fighting the paramedics in complete hysteria screaming, "Dad, I don't want to die."

I bought Janet the new book by Tracy Gold entitled Room to Grow- An Appetite for Life. Janet read it and is convinced that Tracy went through everything she is! When asking her how Tracey got through it, Janet replied, "She met her husband." Janet doesn't realize this needs to come from within her.

I want to continue my efforts in finding her more help.

Sincerely,

Kay

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Dear Kay,

Your letter is moving and heartbreaking. I admire your stamina and dedication as you attempt to help your sister and your family. Your question, how do you explain anorexia to a five year old? lingers in my soul.

I wish you every success in finding the quality treatment your sister needs and the support you and your family need. Please take care of yourself.

Best wishes and peace, peace, peace

Joanna

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Dear Kay,

Your letter describing your sister's situation is a most valuable description of what agony anorexia can bring to the individual suffering from the illness and the entire family.

I think many people would benefit from hearing this story. Would you be willing to have your letter be posted on my website?

Please let me know. You can be as public or as anonymous as you wish. I believe your story needs to be told and you tell it clearly and well. Truth, pain and love pour from every sentence.

Best wishes and peace, peace, peace.

Joanna

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Dear Joanna,

Yes, Joanna, you can post my letter. The comfort of knowing that it could help someone makes me feel better. I do not care if my email address is attached.

I appreciate your response, and on behalf of everyone you have helped and are helping right now, THANK YOU. I truly believe that 5-10 years from now, the horrors of Anorexia will be much better known and treatment will be accessible and covered by insurance for in-patient treatment for the necessary period of time it takes to help a person. In the meantime, I'm afraid my sister will become a statistic.

If you have any unique suggestions as to how we can get Janet help, please let me know. I know that our distance disables our ability to become a client of yours. I know it really takes the right therapy and commitment of the patient to beat the disease. Janet has lived with this so long, I just don't see her making the change in her lifestyle. It's horrible for me to say that, but it's how I feel. She needs to be forced, and that goes against a lot of the recommendations of doctors for someone with anorexia. She's an adult and she needs to make the change. I just don't know if I can live with the consequences.

Thank you again for your quick response. God bless you.

Attached is a picture of my beautiful sister and my two great kids who adore her more than candy or life itself.

Sincerely,

Kay

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Dear Kay,

Thank you for the picture. What beautiful people. For reasons of privacy, legal permissions, etc. I doubt if I could post the picture with your writings. But I wish I could. Your sister and your children are so very lovely. And their beauty is part of the problem in this culture. Even with all the eating disorder awareness and distorted body image publicity moving through our society, it is still difficult for most people to believe or understand that a person can look this good according to current standards of beauty and be in danger of losing her life from an eating disorder.

You wrote: "If you have any unique suggestions as to how we can get Janet help, please let me know. ?... She's an adult and she needs to make the change. I just don't know if I can live with the consequences."

Here's my attempt to respond. You are exhausted from doing everything you possibly can for Janet. Your request is for help for Janet. You write about time, money, energy, heartache, rescue missions all directed at Janet.

But... you and your family are suffering terribly. I'm especially concerned with your sentence, " I just don't know if I can live with the consequences." Not only are there people in your life who love you and whom you love, but you also have young children. You have a five year old who is worried about Aunt Janet dying. Must he also worry about his mother dying?

I invite you to make a major energy direction shift. Tough love sounds like it's behaving harshly to the sick person. But really, it's behaving with love, care and practical day-to-day wisdom as you actively honor and cherish what you honor and cherish.

If you put your own mental, spiritual and physical well being first, you will find that you get more sleep, find more reason to smile, have more positive experiences to share with your children, build health and confidence in yourself and those near to you. The tough love part emerges when your sister discovers that you are putting your energy into health and not her illness.

The aspect of this that confuses people is the issue of support. You want to support your sister. You do not want to support her illness. How to be clear on the difference can be a great challenge. You can offer her love, friendship, normal sharing of activities, and encouragement in terms of health promoting activities. She needs to be responsible for the consequences of her actions, especially the actions that come from acting out her illness.

I also suggest that you explore the possibility of attending al-anon meetings. There you will find people working to create healthy lives despite loving a person with a self-destructive behavior pattern. The meetings can be very helpful for people who love someone with a serious eating disorder. And, of course, you completely qualify because Janet's problems include drinking alcohol to excess.

You say that Janet doesn't remember certain events in her life. Perhaps this is due to alcoholic blackouts or some kind of chemical disruption in her system. But it also could relate to a form of a dissociative illness. Has she been tested for such an illness?

The DES test is a simple pen and paper instrument that can give an indication of whether dissociative experiences are part of her complex diagnosis.

You can go to the website: http://www.issd.org/ The International Society for the Study of Dissociation. Under "online resource for the public" you'll see a number of resources that may be helpful including "treatment guidelines" and useful links.

Also, The Sidran Institute, http://www.sidran.org/ concerns itself with traumatic stress education and advocacy and may have some useful information for you and your sister. Actually Sidran was created by a woman whose sister suffers from a serious and debilitating traumatic stress disorder.

That's all I can think of from this distance, Kay. You may have heard all this before. If you haven't and I've been intrusive with my remarks, please forgive me and let my comments go. If you have heard this before and are open to these thoughts, then my comments may help reinforce what you are already considering.

About posting your letter:

Do you want to keep all the names as they are? If we use your real name then we are also revealing the identity of your sister and other family members. Do you want that? I think the power of your letter will remain unchanged if you use different names, but the choice is yours.

If we include your e-mail, you will get letters. I have no doubt about that. Do you want that correspondence?

My personal suggestion is that you do not leave contact information. You are under enough stress, and the letters can be triggering.

Best wishes, Kay. And yes, people do die from illnesses similar to what your sister is experiencing. But please remember, people also find recovery and live.

Peace, peace, peace

Joanna

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Dear Joanna,

Thank you so much for your help. Your words have given me strength, hope, and next steps. The time you took to respond to me way out here in Illinois shows that you are indeed an incredible person.

Yes, you can post my letter and my e-mail. Please change the names.

Sincerely,

Kay

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presented with author's permission by Joanna Poppink, M.F.T.

Names of family members and eating disorder treatment programs have been changed to protect and respect the privacy of family members.

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Vitamin A is essential to good vision. Vitamin A also plays a role in Alzheimer's Disease, HIV, and Inflammatory Bowel Disease (IBD). Learn about the usage, dosage, side-effects of vitamin A.

• Overview
• Uses
• Dietary Sources
• Available Forms
• How to Take It
• Precautions
• Possible Interactions
• Supporting Research

Overview

Vitamin A is very important for maintaining good vision. In fact, the first sign of a vitamin A deficiency is often night blindness. Vitamin A also contributes to the maintenance of healthy skin and mucous membranes that line the nose, sinuses, and mouth. Research has shown that this nutrient is necessary for proper immune system function, growth, bone formation, reproduction, and wound healing. Animal studies also suggest that it provides some protection from toxic chemicals such as dioxins. (Dioxins are released into the air from combustion processes such as commercial waste incineration and burning fuels like wood, coal or oil. These chemicals can also be found in cigarette smoke.)

The liver can store up to a year's supply of vitamin A. However, these stores become depleted when a person is sick or has an infection. Research suggests that parasitic infections such as intestinal worms may deplete the body's vitamin A stores and interfere with its absorption.

Vitamin A is a fat-soluble vitamin derived primarily from animal-based foods. However, the body can also make vitamin A from beta-carotene, a fat-soluble nutrient found in dark green leafy vegetables and the more brightly colored fruits and vegetables such as carrots, sweet potatoes, and cantaloupe.

 

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Vitamin A Uses

Acne, Psoriasis, and other Skin disorders

Topical and oral preparations containing retinoids (synthetic form of vitamin A) are helpful in clearing up acne and psoriasis and have shown promise for treating other skin disorders such as rosacea, premature aging from the sun, and warts. These are given by prescription.

Eye Disorders

A number of vision disorders involving the retina and cornea are associated with vitamin A deficiencies. Night blindness, for example, and xerophthalmia (characterized by dry eyes) improve with vitamin A supplementation. A large, population-based study conducted in Australia showed that vitamin A had a protective effect against cataracts.

Wounds and Burns

The body needs vitamin A, along with several other nutrients, in order to form new tissue and skin. The body's levels of vitamin A are low immediately after burn injuries, for example. Supplementation with beta-carotene helps the body replenish vitamin A stores, strengthen the immune system, relieve oxidative stress caused by the injury, and aid the body in forming new tissue.

Immune System

Research has shown that vitamin A boosts the immune system by stimulating white blood cell function and increasing the activity of antibodies (proteins that attach to foreign proteins, microorganisms, or toxins in order to neutralize them). Vitamin A deficiency may be associated with increased risk of infection and infections tend to deplete the body's stores of vitamin A.

Vitamin A deficiency, for example, is common among children in many developing countries who are prone to infections, which often results in life-threatening diarrhea. Low levels of vitamin A are also particularly severe among children infected with the human immunodeficiency virus (HIV). Some studies suggest that vitamin A supplements may reduce the risk of death in children infected with HIV. Your doctor will determine whether vitamin A (in addition to standard treatment) is necessary and appropriate.

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Measles

People, particularly children, who are deficient in vitamin A are more likely to develop infections (including measles). Vitamin A deficiencies also cause such infections to be more severe, even fatal. Vitamin A supplements reduce the severity and complications of measles in children. Vitamin A also reduces the risk of death in infants with this disease (especially in those who have low levels of the vitamin). In areas of the world where vitamin A deficiency is widespread or where at least 1% of those with measles die, the World Health Organization recommends giving high doses of vitamin A supplements to children with the infection.

Intestinal Parasites

There is evidence that roundworms such as Ascaris deplete vitamin A stores in people, particularly children, leaving them less able to fight off infections. At the same time, it appears that low vitamin A levels can make a person more susceptible to intestinal parasites. There is not enough scientific evidence at this point, however, to suggest that taking vitamin A supplements helps prevent or treat intestinal parasites. More research is underway.

Osteoporosis

An appropriate balance of vitamin A -- not too much and not too little -- is necessary for normal bone development. Low levels of vitamin A may contribute to the development of bone loss or osteoporosis. On the other hand moderately high doses of vitamin A (exceeding 1,500 mcg or 5,000 IU per day) may lead to bone loss. Therefore, for prevention or treatment of osteoporosis, it is best to obtain vitamin A from food sources and not to eat more than the recommended dietary allowance (RDA).

Inflammatory Bowel Disease (IBD)

Many people with IBD (both ulcerative colitis and Crohn's disease) have vitamin and mineral deficiencies, including vitamin A. Further research is needed to determine whether supplementation with vitamin A or other individual vitamins or minerals may help treat the symptoms of IBD. In the meantime, healthcare practitioners often recommend a multivitamin to people with this condition.

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Bone Marrow Disorders

Results from a carefully conducted 7-year clinical study suggest that a modest dose of vitamin A (together with chemotherapy) may help improve survival time in patients with certain bone marrow disorders such as chronic myelogenous leukemia (CML; considered a myeloproliferative disorder). Research suggests that retinoids such as vitamin A have antitumor effects against juvenile CML (which accounts for 3% to 5% of cases of leukemia in children), as well as certain cancer cells grown in the laboratory.

Cancer

Vitamin A, beta-carotene, and other carotenoids from foods may be associated with decreased risk of certain cancers (such as breast, colon, esophageal, and cervical). In addition, some laboratory studies suggest that vitamin A and carotenoids may help fight against certain types of cancer in test tubes. However, there is no proof that these supplements can help prevent or treat cancer in people. In fact, some evidence suggests that beta-carotene and, possibly, vitamin A may put people at increased risk of lung cancer, particularly smokers.

Preliminary evidence suggests that a topical form of vitamin A, applied to the cervix (the opening to the uterus) with sponges or cervical caps shows promise for the treatment of cervical cancer. Also, women with HIV who are deficient in vitamin A may be at greater risk for cervical cancer (a common occurrence in women with HIV) than those with normal levels of this vitamin. More research is needed before conclusions can be drawn about use of vitamin A to treat or prevent cervical cancer or cervical dysplasia (a precancerous change to the cervix).

Similarly, use of retinoids (a synthetic form of vitamin A) for skin cancer is currently under scientific investigation. Vitamin A and beta-carotene levels in the blood tend to be lower in people with certain types of skin cancer. However, results of studies evaluating higher amounts of natural forms of vitamin A or beta-carotene for skin cancer have been mixed.

Tuberculosis

Although early studies showed no improvement in children who took vitamin A with standard treatment for tuberculosis (TB), a very recent study found that this vitamin (together with zinc) may enhance the effects of certain TB drugs. These changes were demonstrated just two months after starting the vitamin A. More research is warranted. Until then, your doctor will determine if the addition of vitamin A is appropriate and safe.

Peritonitis

Although the effects of vitamin A on peritonitis have not been studied in people, animal studies suggest that this vitamin may prove to be useful in combination with antibiotic therapy for the treatment of this condition.

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Osteoarthritis

Vitamin A plays an important role in bone formation and also acts as an antioxidant, so some researchers believe that it may help reduce symptoms of osteoarthritis. No studies have investigated this possibility, however.

Food Poisoning

Animal studies suggest that rats who are deficient in vitamin A are more likely to become infected with Salmonella (one type of bacteria that can cause food poisoning). Also, rats infected with Salmonella tend to eliminate the bacteria from their bodies faster when treated with vitamin Athan with placebo. They also gain more weight and have a better immune response than placebo-treated rats. How this ultimately relates to people is not known at this time, however.

Vitamin A and Alzheimer's Disease

Preliminary studies suggest that levels of vitamin A and its precursor, beta-carotene, may be significantly lower in people with Alzheimer's compared to healthy individuals, but the effects of supplementation have not been studied.

Miscarriage

Vitamin A and beta-carotene levels tend to be lower in women who have miscarried. These nutrients are generally found in prenatal vitamins. Your doctor or nutritionist can advise you about the appropriate amount to look for in a vitamin. The amount of vitamin A taken should not exceed the recommendation of your healthcare provider because too much vitamin A can lead to birth defects.

Human Immunodeficiency Virus (HIV)

Vitamin A deficiency is fairly common in those with HIV. In addition, pregnant women who have HIV are more likely to transmit the virus to their unborn child if their zinc levels are low compared to HIV-positive women with normal zinc levels. Although more research is needed, vitamin A supplements may delay the progression of HIV to Acquired Immunodeficiency Syndrome (AIDS), diminish symptoms of HIV and AIDS such as diarrhea, and help to prevent the transmission of the virus from mother to child.

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Other

Additional conditions for which vitamin A may prove useful include ulcers (crater like lesion of the skin or mucosal membranes) of the cornea, stomach or small intestines (called peptic ulcer), and legs (often due to poor circulation or collection of fluid, called stasis ulcer). Gingivitis (inflammation of the gums) is another condition for which vitamin A may prove useful. Much more research is needed in each of these areas.

 

 

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Vitamin A Dietary Sources

Vitamin A, in the form of retinyl palmitate, is found in beef, calf, chicken liver; eggs, and fish liver oils as well as dairy products including whole milk, whole milk yogurt, whole milk cottage cheese, butter, and cheese.

Vitamin A can also be produced in the body from beta-carotene and other carotenoids (fat-soluble nutrients found in fruits and vegetables). Most dark-green leafy vegetables and deep yellow/orange vegetables and fruits (sweet potatoes, carrots, pumpkin and other winter squashes, cantaloupe, apricots, peaches,and mangoes) contain substantial amounts of beta-carotene. By eating these beta-carotene rich foods, a person can increase their supply of vitamin A.

 

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Vitamin A Available Forms

Vitamin A supplements are available as either retinol or retinyl palmitate. All forms of vitamin A are readily absorbed by the body.

Tablets or capsules are available in 10,000 IU, 25,000 IU, and 50,000 IU doses. A healthcare provider can help determine the appropriate dosage of vitamin A. Most multivitamins contain the recommended dietary allowance (RDA) for vitamin A (see How To Take It).

In many cases, taking beta-carotene (a building block of vitamin A, is a safer alternative to taking vitamin A. Unlike vitamin A, beta-carotene does not build up in the body, so it can be taken in larger amounts without the same risk. This makes it a better alternative for children, adults with liver or kidney disease, and pregnant women in particular.

 

 

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How to Take Vitamin A

Vitamin A is a fat-soluble vitamin and is absorbed along with fat in the diet. Foods or supplements containing vitamin A should be taken during or shortly after a meal.

Therapeutic doses have ranged as high as 50,000 IU for adults. However, any high dose therapy (more than 25,000 IU for an adult or 10,000 IU for a child) should be closely monitored by a healthcare professional. The effect of such high doses on children is not known.

Daily dietary intakes for vitamin A are listed below.

Pediatric

• Infants birth to 6 months: 400 mcg or 1,333 IU of retinol (AI)
• Infants 7 to 12 months: 500 mcg or 1,667 IU of retinol (AI)
• Children 1 to 3 years: 300 mcg or 1,000 IU of retinol (RDA)
• Children 4 to 8 years: 400 mcg or 1,333 IU of retinol (RDA)
• Children 9 to 13 years: 600 mcg or 2,000 IU of retinol (RDA)
• Males 14 to 18 years: 900 mcg or 3,000 IU of retinol (RDA)
• Females 14 to 18 years: 700 mcg or 2,333 IU of retinol (RDA)

Adult

• Males 19 years and older: 900 mcg or 3,000 IU of retinol (RDA)
• Females 19 years and older: 700 mcg or 2,333 IU of retinol (RDA)
• Pregnant females 14 to 18 years: 750 mcg or 2,500 IU of retinol (RDA)
• Pregnant females 19 years and older: 770 mcg or 2,567 IU of retinol (RDA)
• Breastfeeding females 14 to 18 years: 1,200 mcg or 4,000 IU of retinol (RDA)
• Breastfeeding females 19 years and older: 1,300 mcg or 4,333 IU of retinol (RDA)

 

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Precautions

Because of the potential for side effects and interactions with medications, dietary supplements should be taken only under the supervision of a knowledgeable healthcare provider.

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An excess of vitamin A taken during pregnancy can cause birth defects in the fetus. Because all prenatal vitamins contain some vitamin A, taking any more during pregnancy can pose potential danger to the fetus.

Too much vitamin A is toxic to the body and can cause liver failure, even death. Some of the symptoms of vitamin A toxicity are lasting headache, fatigue, muscle and joint pain, dry skin and lips, dry or irritated eyes, nausea or diarrhea, and hair loss. While it is unlikely that one could get toxic amounts of vitamin A from food sources alone, it is quite possible to do so with supplements. Consuming more than 25,000 IU of vitamin A per day (adults) and 10,000 IU per day (children) from either food or supplements or both is known to be toxic. For those 19 and older, the tolerable upper limit for vitamin A consumption has been set at 10,000 IU per day. Clearly, it is important to take vitamin A supplements only under the careful supervision of a knowledgeable healthcare provider.

While low levels of vitamin A may contribute to the development of bone loss or osteoporosis, doses exceeding 1,500 mcg or 5,000 IU per day may lead to bone loss. Therefore, for prevention or treatment of osteoporosis, it is best to obtain vitamin A from food sources and not to eat more than the recommended dietary allowance (RDA).

Both vitamin A and beta-carotene may increase triglycerides (fatty deposits in the body that rise after eating) and even increase risk of death from heart disease, particularly in smokers.

Vitamin A is found in many different types of vitamin formulas. For example, supplements that say "wellness formula," "immune system formula," "cold formula," "eye health formula," "healthy skin formula," or "acne formula," all tend to contain vitamin A. Those who take a variety of different formulas could therefore put themselves at risk for vitamin A toxicity.

Vitamin A supplements should not be taken while using any vitamin A - derived drugs, such as isotretinoin and tretinoin.

In addition, synthetic vitamin A can cause birth defects. For this reason, this type of vitamin A should not be used by pregnant women or women who are trying to become pregnant.

 

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Possible Interactions

If you are currently being treated with any of the following medications, you should not use vitamin A without first talking to your healthcare provider.

Antacids

One study suggests that the combination of vitamin A and antacids may be more effective than antacids alone in healing ulcers.

Birth Control Medications

Birth control medications increase the levels of vitamin A in women. Therefore, it may not be appropriate for women taking birth control medications to take vitamin A supplements. Again, this is something that should be discussed with a knowledgeable healthcare provider.

Blood thinning Medications, Anticoagulants

Long-term use of vitamin A or use of high doses may lead to an increased risk of bleeding for those taking blood-thinning medications, particularly warfarin. People taking this medication should notify a doctor before taking vitamin A supplements.

Cholesterol-lowering Medications

The cholesterol-lowering medications cholestyramine and colestipol (both known as bile acid sequestrants), may reduce the body's ability to absorb vitamin A.

Another class of cholesterol-lowering medications called HMG-CoA reductase inhibitors or statins (including atorvastatin, fluvastatin, and lovastatin, among others) may actually increase vitamin A levels in the blood.

Doxorubicin

Test tube studies suggest that vitamin A may enhance the action of doxorubicin, a medication used for cancer. Much more research is needed, however, to know whether this has any practical application for people.

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Neomycin

This antibiotic may reduce vitamin A absorption, especially when delivered in large doses.

Omeprazole

Omeprazole (used for gastroesophageal reflux disease or "heart burn") may influence the absorption and effectiveness of beta-carotene supplements. It is not known whether this medication affects the absorption of beta-carotene from foods.

Weight Loss Products

Orlistat, a medication used for weight loss and olestra, a substance added to certain food products, are both intended to bind to fat and prevent the absorption of fat and the associated calories. Because of their effects on fat, orlistat and olestra may also prevent the absorption of fat-soluble vitamins such as vitamin A. Given this concern and possibility, the Food and Drug Administration (FDA) now requires that vitamin A and other fat soluble vitamins (namely, D, E, and K) be added to food products containing olestra. How well vitamin A from such food products is absorbed and used by the body is not clear. In addition, physicians who prescribe orlistat add a multivitamin with fat soluble vitamins to the regimen.

Alcohol

Alcohol can enhance the toxic effects of vitamin A, presumably through its adverse effects on the liver. It is unwise to take vitamin A if you drink regularly.

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Supporting Research

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Carman JA, Pond L, Nashold F, Wassom DL, Hayes CE. Immunity to Trichinella spiralis infection in vitamin A-deficient mice. J Exp Med. 1992;175(1):111-120.

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Segasothy M, Phillips PA. Vegetarian diet: panacea for modern lifestyle diseases? QJM. 1999;92(9):531-544.

Semba RD. Vitamin A, immunity and infection. Clin Infect Dis. 1994;19:489 - 499.

Simsek M, Naziroglu M, Simsek H, Cay M, Aksakal M, Kumru S. Blood plasma levels of lipoperoxides, glutathione peroxidase, beta carotene, vitamin A and E in women with habitual abortion. Cell Biochem Funct. 1998;16(4):227-231.

Smith MA, Parkinson DR, Cheson BD, Friedman MA. Retinoids in cancer therapy. J Clin Oncol. 1992;10(5):839-864.

Smith W, Mitchell P, Webb K, Leeder SR. Dietary antioxidants and age-related maculopathy: the Blue Mountains Eye Study. Ophthalmology. 1999;106(4):761-767.

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Stratton SP, Dorr RT, Alberts DS. The state-of - the art in chemoprevention of skin cancer. Eur J Cancer. 2000;36(10):1292-1297.

Sturniolo GC, Mestriner C, Lecis PE, et al. Altered plasma and mucosal concentrations of trace elements and antioxidants in active ulcerative colitis. Scand J Gastroenterol. 1998;33(6):644-649.

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Thornquist MD, Kristal AR, Patterson RE, et al. Olestra consumption does not predict serum concentrations of carotenoids and fat-soluble vitamins in free-living humans: early results from the sentinel site of the olestra post-marketing surveillance study. J Nutr. 2000;130(7):1711-1718.

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Step Two is about coming to believe in a power greater than ourselves. Here is an inventory of the beliefs I have come to hold regarding the Higher Power of my recovery, whom I choose to call God.

God is actively working in my life, for the benefit of myself and others with whom I interact.

God has a purpose and design for my life.

God is moving and shaping all events in my life toward that design and purpose.

God actively communicates with me through the people and circumstances in my life.

God wills for good stuff to come to me through other people.

God wills for good stuff to come to other people through me.

God provides exactly what I need at exactly the moment I need it.

God provides exactly what I want at exactly the moment it will best benefit me or someone in my life.

God provides grace for my imperfections, mistakes, and poor choices.

God instructs me by, and wants me to learn from my imperfections, mistakes, and poor choices.

God is ever present in my heart, but I must consciously seek to commune with God.

God works in my life in many mysterious, miraculous ways that I, as yet, cannot comprehend.

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next: A Power Greater

Pregnant women who take antidepressants known as selective serotonin reuptake inhibitors (SSRIs) may be at higher risk of premature delivery, a new study says.

SSRIs include the popular antidepressants fluoxetine (brand name Prozac), paroxetine (Paxil) and .

However, the news is by no means all bad. On the plus side, researchers found no link between SSRIs and birth defects or developmental delays.

"Our results offer some reassurance and some cause for concern," says Dr. Greg Simon, lead author of the study and an associate investigator and psychiatrist at Group Health Cooperative's Center for Health Studies in Seattle. "The reassurance is SSRIs are not associated with any risk of birth defects or malformations. The concern is that SSRIs appear to be associated with an increased risk of premature delivery."

The study appears in the December issue of the American Journal of Psychiatry.

Researchers examined the medical records of 185 women and their babies who took antidepressants during pregnancy and 185 women and their babies who were treated for depression during pregnancy but did not take any drugs for the condition.

Women taking antidepressants were twice as likely to give birth prematurely. About 10 percent of women who took SSRIs at any time during their pregnancy gave birth before 36 weeks, the standard definition of premature labor, compared to only 5 percent of women who didn't take SSRIs.

The women on SSRIs gave birth, on average, a week earlier than those not exposed to these drugs.

"While this risk of premature delivery is low, the findings affect a large population of women," Simon says.

So what's a woman to do?

"Each woman has to consider her own situation and decide what to do," Simon says. "A woman who has severe depression while not using this drug would probably continue to take it. But a woman who has relatively mild depression might choose to stop using it during pregnancy."

Women are more than twice as likely to suffer depression as men, according to the American Psychological Association. And women are most likely to be depressed during their childbearing years, from about ages 20 to 50.

Dr. Milton Anderson, a psychiatrist at the Oschner Clinic Foundation in New Orleans, says the danger of depression to a mother and child should not be underestimated.

Depressed women often don't sleep well, eat well or get the medical care they need. Pregnant women who try to commit suicide can severely damage their baby, Anderson adds.

"Severe depression is toxic to mothers and babies," Anderson says.

While premature delivery is of concern, he believes the more crucial finding is that SSRIs are otherwise safe.

"The bigger importance of the study is the reassurance that there wasn't an increased rate of fetal abnormalities of birth defects," Anderson says. "We worry about that with any drug during pregnancy."

Given the new research, Anderson says he would recommend that women who have serious depression -- a lifelong history, recurrent suicide attempts -- remain on the medicine. Women who have milder depression -- perhaps a single bout and who've been in remission for six months or more -- should slowly come off antidepressants.

Either way, he'd make the decision with the woman and her obstetrician.

"We would like to have pregnant women off any and all medicine during the pregnancy," he says. "But in those moms who have severe depression or who are at risk of severe depression, this looks like a relatively manageable risk of early delivery."

The study found the older generation of medicines called tricyclic antidepressants, which include imipramine and amitriptyline, had no effect on the risk of premature delivery.

Researchers did not look at some of the newest antidepressants on the market, including Wellbutrin, Effexor and Remeron.

HealthScout News - Dec. 10, 2002

next: Mood Disorders and the Reproductive Cycle
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Dr. Frank Lawlis, author of The ADD Answer, says there are better, healthier options for treating your child's ADD than ADHD medications.

The following is an excerpt from chapter five of The ADD Answer: How to Help Your Child Now by Dr. Frank Lawlis and published by Viking.

Medical students are often warned that "sometimes the treatment can be worse than the disease." I sincerely believe that is often the case when children with ADD are given medication to control their ADHD symptoms.

ADD - ADHD medications are most often prescribed by family physicians — not by a pediatric psychiatrist — which makes me very suspicious. How much understanding do such physicians have of these very potent drugs? My personal and professional opinion is that they should be used very cautiously and only on a short-term basis with specific goals in mind. Most experienced school counselors concede that such medication loses most of its effectiveness by the teenage years anyway, so medications are not a long-term solution for ADD.

Healthier Options To ADHD Medications

There are better and healthier options for treating your child's ADD, beginning with a strong family environment and a focus on healthy behaviors and goals, as we have discussed already, and including a range of approaches to stimulate the brain and focus the child's attention naturally, which will be discussed in subsequent chapters. I base my understanding of medication on years of experience in working with children and on years of working and researching ADD. Although I have had training in psychopharmacology, I always seek recommendations from referring physicians in matters related to medication. I also want to be very clear that I do not have any direct responsibilities for issuing prescriptions or for making the necessary laboratory assessments critical to any drug protocol, especially with children. However, I consult with a group of medical experts when devising medication strategies.

Let us be fair with doctors. There is an old saying credited to Abraham Maslow, a famous psychologist: "If the only tool that you have is a hammer, everything looks like a nail." Physicians nowadays are asked to evaluate and treat hundreds of childhood problems, and most feel that the only tools they have are drugs. Doctors also rarely observe the daily behavior of the child who is being treated. They usually have to rely on the observations and opinions of parents and teachers — not only as a basis for diagnosis but also for evaluating the results. Too often the only feedback the doctor receives on medication is that the parent no longer brings the child in to see him. If the physician doesn't hear anything more, he assumes the medication worked properly. But in truth, it could be that the parents simply looked elsewhere for help, or gave up.

The Circular Firing Squad

Too often when a child has ADD, everyone responsible for helping him is shooting in the dark. Doctors often don't get good follow-up information. Parents get frustrated and make decisions without adequate professional input. Instead of circling the wagons against ADD, we form a circular firing squad and shoot at one another.

Typically, parents, physicians, and teachers find themselves at odds over a child's treatment. Parents are often bewildered about what to do to help and protect their child. School administrators, understandably, are most concerned about the learning environment for all of their students. Too often, busy physicians treat the symptoms, not the child.

That is madness. But it is understandable madness and it is prevalent. We are a pill-popping, quick-fix society. School administrators are under pressure themselves to get classrooms under control. Few physicians are trained adequately to deal with ADD children. I have attended medical conferences on ADD in which the doctors on the dais obviously had no clue about the long-term adverse effects of medicating children. It is a very serious business, especially when dealing with any drugs that affect a child's neurological system.

Until recently, no studies systemically examined the long-term effects of ADHD drugs on children, such as Ritalin and amphetamines (Dexedrine and Adderall). Some of the side effects of these drugs can be profound. They can be a greater threat to a child's health than most, if not all, ADD symptoms. Certainly they can cause psychosis, including manic and schizophrenic episodes ...

Unfortunately some physicians typically do not stop medicating when psychotic symptoms appear. Instead, they may slap on another diagnosis, of depression or antisocial personality, and then treat this diagnosis by adding antidepressants, mood stabilizers, or neuroleptics (commonly used for epilepsy) to the treatment mix. It is not unusual for children to be taking as many as five different medications, all based on adult prescriptions. Meds upon meds is madness upon madness ...

The side effects are not restricted to psychiatric problems. Stimulants excite the whole body, not only the brain. Stimulating medications also affect the cardiovascular system. One of the side effects of Ritalin is that it boosts the activity of the heart and the cardiovascular systems so that they develop beyond what is considered normal. There is also some danger of liver damage from medications used to treat ADD and side effects. Sleep and appetite problems resulting from medication are also of concern ...

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Parents need to understand the potential dangers of medications used to treat ADD. Although only 50 percent of children with ADD can be helped through drug therapy, the ones who respond to drug treatment face the following side effects:

• nervousness
• insomnia
• confusion
• depression
• agitation
• irritability
• stunted growth and development

Other side effects, in a lower rate of incidence, include:

• exacerbation of behavior symptoms (hyperactivity)
• hypersensitivity reactions (allergy-type reactions to environmental agents)
• anorexia (eating disorder)
• nausea
• dizziness
• heart palpitations (heart rate fluctuations)
• headaches
• dyskinesia (movement-of-the-body problems)
• drowsiness
• hypertension (high blood pressure)
• tachycardia (rapid, racing heartbeat)
• angina (heart pain)
• arrhythmia (heart rate changes)
• abdominal pain
• lowered threshold for seizures

Source: Excerpt from chapter five of The ADD Answer: How to Help Your Child Now. August 2005. For more, go to http://www.franklawlis.com/

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next: Switching to Strattera from Another ADHD Medication
~ adhd library articles
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Treatment of Depression in Children

There is no cookbook technique. Treatment must be tailored to the needs and schedule of the child and his family. Generally, with mild to moderate depression, one first tries psychotherapy and then adds an antidepressant if the therapy has not produced enough improvement. If it is a severe depression, or there is serious acting out, one may start medication at the beginning of the treatment.

It is important that parents find a child psychiatrist to evaluate and treat their depressed child. A child psychiatrist is a medical doctor who has received special training in diagnosing and treating psychiatric disorders in children. Other doctors, including family doctors and pediatricians may have taken a course in child psychiatry, but a great majority are not experts in the field.

Psychotherapy

A variety of psychotherapeutic techniques have been shown to be effective. There is some suggestion that cognitive-behavioral therapy may work faster. Cognitive therapy helps the individual examine and correct negative thought patterns and erroneous negative assumptions about himself. Behaviorally, it encourages the individual to use positive coping behaviors instead of giving up or avoiding situations. After therapy is over, children may benefit from scheduled or "as-needed" booster sessions.

Many feel that family therapy can speed recovery and help prevent relapse. There are different styles of family therapy.

Antidepressant Medication

SSRIs (Selective Serotonin Reuptake Inhibitors -- Prozac, , Lexapro, etc.) have brightened the outlook for the medication treatment of child and teenage depression. The side effects are not as annoying as those of the older medications. These medications are somewhat less toxic in overdosage. Some studies have shown that the SSRIs are better than placebo for depression. As compared to adults, adolescents are a bit more likely to become agitated or to develop a mania while they are taking an SSRI. These medications can decrease libido in both adolescents and adults. The doctor should warn parents about the symptoms of mania, especially if there is a family history of Bipolar Disorder. If the child has had a manic episode in the past, some doctors suggest adding a mood stabilizer such as Lithium or Depakote. In addition, parents should know about the potential for an increase in suicidal thoughts and behaviors.

Most studies suggest that the older, tricyclic antidepressant medications (Amitriptyline, Imipramine Desipramine) are no better than placebo in the treatment of depression. Still, some doctors have seen individual children and adolescents who have responded well. Tricyclic antidepressants can be an effective treatment for ADHD. Since there is a small risk of heart rhythm changes in children on these medications, doctors usually follow EKGs. The usefulness of blood tricyclic levels is being debated.

Important Note: Bipolar disorder must be ruled out before a child is prescribed antidepressants for depression or stimulants, as these can trigger mania.

Stopping Antidepressant Medications

The decision about when to stop antidepressant medication can be complex. If the depressive episodes are recurrent or severe, one may consider longer term maintenance pharmacotherapy. If the depression was milder, the family wishes the child to be off medications, or there are side effects, one may consider stopping the medication several months or a year after the symptoms are gone. If there have been several recurrences, one might then talk to the patient and family about longer term maintenance. Exercise, a balanced diet (at least three meals per day) and a regular sleep schedule are desirable. If there is a seasonal component, a light box or light visor may be helpful.

Other Considerations

Some individuals have only one episode of depression, but often depression becomes a recurrent condition. Thus, the child and family should become educated about the early warning symptoms of depression so that they can get right back in to the doctor. It is also useful to discuss the child's particular "early warning signs" with the primary care doctor. Sometimes the psychiatrist or therapist will schedule booster sessions in advance and other times, leave the door open for the child or family to schedule one or two sessions.

If there are residual social skills problems, a social skills group through the school or other agency can help. Scouts and church youth groups can be enormously helpful. If parents and child consent, the doctor will sometimes involve a scout leader or clergy.

It's also important to treat comorbid psychiatric disorders such as anxiety and ADHD. Since a young person who has had a depression is more vulnerable to drug abuse, one should start out early with preventative measures. The primary care doctor can be a partner in monitoring for relapse, substance abuse and social skills problems during and after the psychiatric treatment.

next: Advice: 'It's Hard For Parents To Understand'
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~ all articles on depression

Every human that has ever existed has had happiness as their ultimate goal in life. Pretty bold and presumptuous statement, huh? When you put the emphasis on "ultimate", I think you'll find the statement is true.

It's the odd ways in which we pursue happiness that makes us question the validity of this idea. What about the guy that works at a job he hates for his family? Is his goal to be happy? Again, I think the answer is "yes."

"What is the purpose or meaning of your life? Is your life for you to be happy, or would you prefer your life be for something else? Would that make you happy? Whatsoever you seek, you seek the cessation of unhappiness and the satisfaction of happiness.

Even those people who would be willing to die to save another do it for happiness. The idea of seeing themselves as loving another so much that they'd sacrifice themselves, makes them happy.

You do all that you do for happiness."

- Bruce Di Marsico

Your core motivation to be happy is surrounded by layers of other desires. Like an onion, you must first peel away the layers to reach the core. Let's look at an example.

I want a car.
Why do you want that?
So I can get to work.
Why do you want that?
So I can earn enough money for a house.
Why do you want that?
So I can have a place I call my own.
Why do you want that?
So I can feel free to do with it what I will.
Why do you want that?
Because when I feel free, I feel happy.

"Many men go fishing all of their lives without knowing that it is not fish they are after."

Henry David Thoreau

Happiness does not always appear to be an obvious goal because of the intermediate goals we believe are necessary to achieve happiness. But in the end, we do what we do to feel good.

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Some say the "will to survive" is the strongest desire of all men, but even this I question. What about suicide? What about people with a fatal disease who are in a lot of pain and want to die? These people want to end their lives. If the will to survive was our highest motivation above all else, it would seem people would want to live, no matter what.

So what DO these people want? To end their pain. From this one can only conclude that the desire to feel good is even stronger than the desire to stay alive.

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And he said unto them...

"If a man told God that he wanted most of all to help the
suffering world, no matter the price to himself, and God
answered and told him what he must do, should the man
do as he is told?"

"Of course, Master!" cried the many.
"It should be pleasure for him to suffer the tortures of
hell itself, should God ask it!"

"No matter what those tortures, nor how difficult the task?"

"Honor to be hanged, glory to be nailed to a tree and burned,
if so be that God has asked," said they.

"And what would you do," the Master said unto the
multitude, "if God spoke directly to your face and said...

'I command that you be happy in the world, as long
as you live.' What would you do then?"

And the multitude was silent, not a voice, not a sound
was heard upon the hillsides, across the valleys
where they stood.

-Illusions by Richard Bach

next: Society and Happiness

Bipolar relapse explained plus signs and symptoms of a bipolar relapse for those diagnosed with bipolar disorder and their families and friends.

A relapse is said to occur when the symptoms of bipolar disorder worsen or when previous bipolar symptoms return. Many people have experienced one or more relapses of their illness. After a relapse, you may still experience persistent symptoms-which is different from worsening symptoms.

Before a relapse happens, people often experience changes in their symptoms or in some aspect of their behavior, thoughts or feelings. These changes are called warning signs and they are indications that a bipolar relapse may be imminent.

Signs of a Bipolar Episode

• Feeling more tense or nervous**
• Feeling that people are talking about me**
• Having more trouble sleeping**
• Change in level of activity**
• Having more trouble concentrating**
• Losing interest in things I usually like doing
• Seeing friends less
• Enjoying things less
• Feeling more depressed (or suddenly grandiose)
• Eating less
• Having more religious ideas
• Preoccupied with one or two ideas
• Having trouble making sense when talking
• Feeling like I was forgetting things more
• Feeling worthless
• Feeling like I was going crazy
• Hearing voices or seeing things
• Feeling that someone else was controlling me
• Feeling badly for no apparent reason
• Stopped caring how I looked
• Having more nightmares or bad dreams
• Feeling more angry over little things
• Thinking about hurting myself
• Feeling more aggressive or pushy
• Feeling too excited or overactive
• Having trouble relating to family
• Having frequent aches and pains
• Drinking more alcohol
• Using more drugs (uppers, downers, LSD, marijuana)
• Thinking about hurting someone else

** Universal Warning Signs

These signs are different for everyone. It is important to work out which signs may be relevant to you and have a plan of what to do should any of these signs of a bipolar relapse appear.

Sources:

• McFarlane, W., Terkelson, K., "New Approaches to Families Living with Schizophrenia." Institute, 62nd Annual Ortho-Psychiatric Meeting, N.Y., 1985.
• Inner North Brisbane Mental Health Service, Warning Signs of A Possible Relapse

next: Bipolar Disorder FAQs
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