Read about "Trauma Bonding" and the Psychology of Torture here.

Read about Traumas as Social Interactions here. 

Abusers exploit, lie, insult, demean, ignore (the "silent treatment"), manipulate, and control.

There are a million ways to abuse. To love too much is to abuse. It is tantamount to treating someone as an extension, an object, or an instrument of gratification. To be over-protective, not to respect privacy, to be brutally honest, with a sadistic sense of humor, or consistently tactless - is to abuse.

To expect too much, to denigrate, to ignore - are all modes of abuse. There is physical abuse, verbal abuse, psychological abuse, sexual abuse. The list is long. Most abusers abuse surreptitiously. They are "stealth abusers". You have to actually live with one in order to witness the abuse.

There are three important categories of abuse:

Overt Abuse

The open and explicit abuse of another person. Threatening, coercing, beating, lying, berating, demeaning, chastising, insulting, humiliating, exploiting, ignoring ("silent treatment"), devaluing, unceremoniously discarding, verbal abuse, physical abuse and sexual abuse are all forms of overt abuse.

Covert or Controlling Abuse

Abuse is almost entirely about control. It is often a primitive and immature reaction to life circumstances in which the abuser (usually in his childhood) was rendered helpless. It is about re-exerting one's identity, re-establishing predictability, mastering the environment - human and physical.

The bulk of abusive behaviors can be traced to this panicky reaction to the remote potential for loss of control. Many abusers are hypochondriacs (and difficult patients) because they are afraid to lose control over their body, its looks and its proper functioning. They are obsessive-compulsive in an effort to subdue their physical habitat and render it foreseeable. They stalk people and harass them as a means of "being in touch" - another form of control.

To the abuser, nothing exists outside himself. Meaningful others are extensions, internal, assimilated, objects - not external ones. Thus, losing control over a significant other - is equivalent to losing control of a limb, or of one's brain. It is terrifying.

Independent or disobedient people evoke in the abuser the realization that something is wrong with his worldview, that he is not the centre of the world or its cause and that he cannot control what, to him, are internal representations.

To the abuser, losing control means going insane. Because other people are mere elements in the abuser's mind - being unable to manipulate them literally means losing it (his mind). Imagine, if you suddenly were to find out that you cannot manipulate your memories or control your thoughts ... Nightmarish!

In his frantic efforts to maintain control or re-assert it, the abuser resorts to a myriad of fiendishly inventive stratagems and mechanisms. Here is a partial list:

Unpredictability

The abuser acts unpredictably, capriciously, inconsistently and irrationally. This serves to render others dependent upon the next twist and turn of the abuser, his next inexplicable whim, upon his next outburst, denial, or smile.

Tip

Refuse to accept such behavior. Demand reasonably predictable and rational actions and reactions. Insist on respect for your boundaries, predilections, preferences, and priorities.

Disproportional Reactions

One of the favorite tools of manipulation in the abuser's arsenal is the disproportionality of his reactions. He reacts with supreme rage to the slightest slight. Or he would punish severely for what he perceives to be an offence against him, no matter how minor. Or, he would throw a temper tantrum over any discord or disagreement, however gently and considerately expressed. Or, he would act inordinately attentive, charming and tempting (even over-sexed, if need be).

This ever-shifting code of conduct and the unusually harsh and arbitrarily applied penalties are Neediness and dependence on the source of "justice" meted and judgment passed - on the abuser - are thus guaranteed. premeditated. The victims are kept in the dark.

Tip

Demand a just and proportional treatment. Reject or ignore unjust and capricious behavior.

If you are up to the inevitable confrontation, react in kind. Let him taste some of his own medicine.

Dehumanization and Objectification (Abuse)

People have a need to believe in the empathic skills and basic good-heartedness of others. By dehumanizing and objectifying people - the abuser attacks the very foundations human interaction. This is the "alien" aspect of abusers - they may be excellent imitations of fully formed adults but they are emotionally absent and immature.

Abuse is so horrid, so repulsive, so phantasmagoric - that people recoil in terror. It is then, with their defenses absolutely down, that they are the most susceptible and vulnerable to the abuser's control. Physical, psychological, verbal and sexual abuse are all forms of dehumanization and objectification.

Tip

Never show your abuser that you are afraid of him. Do not negotiate with bullies. They are insatiable. Do not succumb to blackmail.

If things get rough- disengage, involve law enforcement officers, friends and colleagues, or threaten him (legally).

Do not keep your abuse a secret. Secrecy is the abuser's weapon.

Never give him a second chance. React with your full arsenal to the first transgression.

Abuse of Information

From the first moments of an encounter with another person, the abuser is on the prowl. He collects information. The more he knows about his potential victim - the better able he is to coerce, manipulate, charm, extort or convert it "to the cause". The abuser does not hesitate to misuse the information he gleaned, regardless of its intimate nature or the circumstances in which he obtained it. This is a powerful tool in his armory.

Tip

Be guarded. Don't be too forthcoming in a first or casual meeting. Gather intelligence.

Be yourself. Don't misrepresent your wishes, boundaries, preferences, priorities, and red lines.

Do not behave inconsistently. Do not go back on your word. Be firm and resolute.

Impossible Situations

The abuser engineers impossible, dangerous, unpredictable, unprecedented, or highly specific situations in which he is sorely needed. The abuser makes sure that his knowledge, his skills, his connections, or his traits are the only ones applicable and the most useful in the situations that he, himself, wrought. The generates his own indispensability. abuser

Tip

Stay away from such quagmires. Scrutinize every offer and suggestion, no matter how innocuous.

Prepare backup plans. Keep others informed of your whereabouts and appraised of your situation.

Be vigilant and doubting. Do not be gullible and suggestible. Better safe than sorry.

Control by Proxy

If all else fails, the abuser recruits friends, colleagues, mates, family members, the authorities, institutions, neighbours, the media, teachers - in short, third parties - to do his bidding. He uses these them to cajole, coerce, threaten, stalk, offer, retreat, tempt, convince, harass, communicate and otherwise manipulate his target. He controls these unaware instruments exactly as he plans to control his ultimate prey. He employs the same mechanisms and devices. And he dumps his props unceremoniously when the job is done.

Another form of control by proxy is to engineer situations in which abuse is inflicted upon another person. Such carefully crafted scenarios of embarrassment and humiliation provoke social sanctions (condemnation, opprobrium, or even physical punishment) against the victim. Society, or a social group become the instruments of the abuser.

Tip

Often the abuser's proxies re unaware of their role. Expose him. Inform them. Demonstrate to them how they are being abused, misused, and plain used by the abuser.

Trap your abuser. Treat him as he treats you. Involve others. Bring it into the open. Nothing like sunshine to disinfest abuse.

Ambient Abuse

The fostering, propagation and enhancement of an atmosphere of fear, intimidation, instability, unpredictability and irritation. There are no acts of traceable explicit abuse, nor any manipulative settings of control. Yet, the irksome feeling remains, a disagreeable foreboding, a premonition, a bad omen. This is sometimes called "gaslighting".

In the long term, such an environment erodes the victim's sense of self-worth and self-esteem. Self-confidence is shaken badly. Often, the victims adopts a paranoid or schizoid stance and thus renders himself or herself exposed even more to criticism and judgment. The roles are thus reversed: the victim is considered mentally deranged and the abuser - the suffering soul.

Tip

Run! Get away! Ambient abuse often develops to overt and violent abuse.

You don't owe anyone an explanation - but you owe yourself a life. Bail out.

Some philosophers say that our life is meaningless because it has a prescribed end. This is a strange assertion: is a movie rendered meaningless because of its finiteness? Some things acquire a meaning precisely because they are finite: consider academic studies, for instance. It would seem that meaningfulness does not depend upon matters temporary.

We all share the belief that we derive meaning from external sources. Something bigger than us - and outside us - bestows meaning upon our lives: God, the State, a social institution, an historical cause.

Yet, this belief is misplaced and mistaken. If such an external source of meaning were to depend upon us for its definition (hence, for its meaning) - how could we derive meaning from it? A cyclical argument ensues. We can never derive meaning from that whose very meaning (or definition) is dependent on us. The defined cannot define the definer. To use the defined as part of its own definition (by the vice of its inclusion in the definer) is the very definition of a tautology, the gravest of logical fallacies.

On the other hand: if such an external source of meaning were NOT dependent on us for its definition or meaning - again it would have been of no use in our quest for meaning and definition. That which is absolutely independent of us - is absolutely free of any interaction with us because such an interaction would inevitably have constituted a part of its definition or meaning. And that, which is devoid of any interaction with us - cannot be known to us. We know about something by interacting with it. The very exchange of information - through the senses - is an interaction.

Thus, either we serve as part of the definition or the meaning of an external source - or we do not. In the first case, it cannot constitute a part of our own definition or meaning. In the second case, it cannot be known to us and, therefore, cannot be discussed at all. Put differently: no meaning can be derived from an external source.

Despite the above said, people derive meaning almost exclusively from external sources. If a sufficient number of questions is asked, we will always reach an external source of meaning. People believe in God and in a divine plan, an order inspired by Him and manifest in both the inanimate and the animate universe. Their lives acquire meaning by realizing the roles assigned to them by this Supreme Being. They are defined by the degree with which they adhere to this divine design. Others relegate the same functions to the Universe (to Nature). It is perceived by them to be a grand, perfected, design, or mechanism. Humans fit into this mechanism and have roles to play in it. It is the degree of their fulfilment of these roles which characterizes them, provides their lives with meaning and defines them.

Other people attach the same endowments of meaning and definition to human society, to Mankind, to a given culture or civilization, to specific human institutions (the Church, the State, the Army), or to an ideology. These human constructs allocate roles to individuals. These roles define the individuals and infuse their lives with meaning. By becoming part of a bigger (external) whole - people acquire a sense of purposefulness, which is confused with meaningfulness. Similarly, individuals confuse their functions, mistaking them for their own definitions. In other words: people become defined by their functions and through them. They find meaning in their striving to attain goals.

Perhaps the biggest and most powerful fallacy of all is teleology. Again, meaning is derived from an external source: the future. People adopt goals, make plans to achieve them and then turn these into the raisons d'etre of their lives. They believe that their acts can influence the future in a manner conducive to the achievement of their pre-set goals. They believe, in other words, that they are possessed of free will and of the ability to exercise it in a manner commensurate with the attainment of their goals in accordance with their set plans. Furthermore, they believe that there is a physical, unequivocal, monovalent interaction between their free will and the world.

This is not the place to review the mountainous literature pertaining to these (near eternal) questions: is there such a thing as free will or is the world deterministic? Is there causality or just coincidence and correlation? Suffice it to say that the answers are far from being clear-cut. To base one's notions of meaningfulness and definition on any of them would be a rather risky act, at least philosophically.

But, can we derive meaning from an inner source? After all, we all "emotionally, intuitively, know" what is meaning and that it exists. If we ignore the evolutionary explanation (a false sense of meaning was instilled in us by Nature because it is conducive to survival and it motivates us to successfully prevail in hostile environments) - it follows that it must have a source somewhere. If the source is internal - it cannot be universal and it must be idiosyncratic. Each one of us has a different inner environment. No two humans are alike. A meaning that springs forth from a unique inner source - must be equally unique and specific to each and every individual. Each person, therefore, is bound to have a different definition and a different meaning. This may not be true on the biological level. We all act in order to maintain life and increase bodily pleasures. But it should definitely hold true on the psychological and spiritual levels. On those levels, we all form our own narratives. Some of them are derived from external sources of meaning - but all of them rely heavily on inner sources of meaning. The answer to the last in a chain of questions will always be: "Because it makes me feel good".

In the absence of an external, indisputable, source of meaning - no rating and no hierarchy of actions are possible. An act is preferable to another (using any criterion of preference) only if there is an outside source of judgement or of comparison.

Paradoxically, it is much easier to prioritize acts with the use of an inner source of meaning and definition. The pleasure principle ("what gives me more pleasure") is an efficient (inner-sourced) rating mechanism. To this eminently and impeccably workable criterion, we usually attach another, external, one (ethical and moral, for instance). The inner criterion is really ours and is a credible and reliable judge of real and relevant preferences. The external criterion is nothing but a defence mechanism embedded in us by an external source of meaning. It comes to defend the external source from the inevitable discovery that it is meaningless.

next: What is Abuse?

The Mechanisms That Make A Depressive

Why do some people stay "blue" and "down" for a long time after something bad happens to them, whereas others snap out of it quickly? Why do some people frequently fall into a blue funk whereas others suffer sad moods only infrequently?

Chapter 3 presented the general framework for the understanding of depression. Now this chapter proceeds to discuss why a particular person is more predisposed to depression than are other people who are closer to "normal".

Figure 3 presents an overview of the depression system. It shows the main elements that influence whether a person is sad or happy at a given moment, and whether one does or does not descend into the prolonged gloom of depression. Starting at the left, these numbered elements are as follows: 1) Experiences in childhood, both the general pattern of childhood as well as traumatic experiences, if any. 2) The person's adult history: the recent experiences have the greatest weight. 3) The actual conditions of the individual's present life--relationships with people as well as such objective factors as health, job, finances, and so on. 4) The person's habitual mental states, plus her view of the world and herself. This includes her goals, hopes, values, demands upon herself, and ideas about herself, including whether she is effective or ineffective and important or unimportant. 5) Physical influences such as whether she is tired or rested, and anti-depression drugs she is taking, if any. 6) The machinery of thought which processes the material coming in from the other elements and produces an evaluation of how the person stands with respect to the hypothetical situation taken for comparison. (7) A sense of helplessness.

Figure 3

The main lines of influence from one element-set to another are also shown in Figure 3. The question we ask is: how may a person, alone or with a counselor, alter these elements or their effects to produce fewer negative self-comparisons and a greater sense of competence--hence less sadness--and by that means pull the person out of depression?

Now we proceed in greater detail, considering the elements within these various element-sets and how they influence one another. Those who want still more details on the relationships between these various elements may wish to consult Appendix A, where all these specific ideas are linked graphically.

The Normal Person

A few definitions to start with: A "normal" person is someone who has never suffered from serious depression, and whom we have little reason to think will suffer serious depression in the future. A "depressed" person is someone now suffering from serious depression. A "depressive" is someone who is now depressed or in the past has suffered serious depression, and is subject to depression again unless it is prevented. A depressive who is not now depressed is like an alcoholic who does not now drink, that is, he is a person with a dangerous propensity that requires careful control.

A normal person has "realistic" expectations, goals, values, and beliefs that "normally" keep him feeling good. That is, the normal person's view of the world and himself interacts with his actual state in such a way that the comparisons he makes between actual and hypothetical are usually positive, on balance. Normal people may also have a higher tolerance for negative self- comparisons when they do occur, compared to depressives.

Bad fortune may befall the normal person--perhaps death in the family, injury, marriage breakdown, money problems, loss of job, or a disaster to the community. The person's actual situation then is worse than before, and the comparison between actual and benchmark-hypothetical becomes more negative than before. The unfortunate event must be understood and interpreted in the context of the person's entire life situation. The normal person eventually perceives and interprets the event without distorting it or misinterpreting it to make it seem more terrible or permanent than it really is. And the normal person may suffer less pain and "accept" the event more easily than the depressive.

What then happens? There are several possibilities including: a) Circumstances may change of themselves. Bad health may improve or the individual may purposely alter the circumstances--find a new job, or another spouse or friend. b) The person may "get used to" his health disability or being without the loved one. That is, the person's expectations may change. This affects the hypothetical situation to which he compares his actual situation. And after the expectations of the normal person change in response to the change in circumstances, the hypothetical-comparison state again comes into balance with the actual state in such fashion that the comparison is not negative, and sadness no longer occurs. c) The normal person's goals may change. A basketball player who aimed to make the college team may suffer a spinal injury and be confined to a wheelchair. A "healthy" person's reaction is, after a time, to shift his goal to being a star on the wheelchair basketball team. This restores the balance between the hypothetical state and the actual state, and removes sadness.

David Hume, as great as any philosopher who ever lived, as well as a person of cheerful "normal" temperament, describes how he reacted when his first great book had a very disappointing reception:

I had always entertained a notion that my want of success in publishing the Treatise of Human Nature, had proceeded more from the manner than the matter, and that I had been guilty of a very usual indiscretion, in going to the press too early. I therefore cast the first part of that work anew in the Enquiry concerning Human Understanding, which was published while I was at Turin. But this piece was at first little more successful than the Treatise of Human Nature. On my return from Italy, I had the Mortification to find all England in a ferment, on account of Dr. Middleton's Free Enquiry, while my performance was entirely overlooked and neglected. A new edition, which had been published at London of my Essays, moral and political, met not with a much better reception.

Such is the force of natural temper, that these disappointments made little or no impression on me.(1)

"Normal" people do not, however, respond to misfortune by adapting so readily that their spirits are unaffected. A study that compared paraplegic accident victims to persons who had not suffered paralysis from accident found that the paraplegics remained less happy than the uninjured persons months after the accident2 Normal people may be flexible in adapting their thinking to their circumstances, but they are not perfectly flexible.

The Depressive

The depressive differs from the normal person in having a propensity for prolonged sadness; this is the stripped-down minimum definition of a depressive. This propensity, caused by some mental baggage or biochemical scar carried over from the past, interacts with contemporary events to maintain a state of negative self-comparison.

Much of this Part II is devoted to describing this special mental baggage of the depressive. In preview, here are several important cases:

1) The depressive may, because of her intellectual or emotional training in childhood, misinterpret actual current conditions in a negative direction so that the comparison between actual and hypothetical is perennially negative, or so that after a bit of bad fortune the return to a balanced or positive comparison is much slower than for a person who is not a depressive.

2) The depressive may have a view of the world, herself, and her obligations such that her actual conditions will necessarily always be below the hypothetical. An example is a person whose talents are not extraordinary but who was brought up to believe that her talents are such that she ought to win a Nobel prize. Hence, all her life she will feel a failure, her actual state below the hypothetical, and she will therefore be depressed.

3) The depressive may have a mental quirk which forces all comparisons to be seen as negative even if his actual conditions compare well with his counterfactual condition. For example, he may believe that all people are basically sinful, as Bertrand Russell was afflicted in his youth. Or the perennial negative self-comparison may be caused by biochemical factors to be discussed shortly.

4) The depressive may feel more acute pain from a given negative self-comparison than does the normal person. For example, the depressive might have memories of severe punishment in childhood each time his performance fell below the parental norm. Those memories of the pain from childhood punishment may intensify the pain of negative self-comparisons later on.

5) Still another difference between depressives and non- depressives is that depressives-- almost invariably while they are depressed, and in many cases also when they are not depressed--have a conviction of personal worthlessness and incompetence and lack of self esteem. This sense of worthlessness is general and persistent in depression, compared to the specific and transient sense of worthlessness everyone experiences from time to time. The person who is not depressed says, "I did badly on the job this month." The depressed person says, "I always do badly on jobs," and he thinks that he will continue to do badly in the future. The depressed person's "I'm no good" judgment seems permanent and refers to all of him, whereas the "I did badly" of the nondepressed person is temporary and refers to one part of him alone. This is an example of over generalizing, which is typical of many depressives and a source of much pain and sadness.

Perhaps depressives tend to over generalize as a general habit, and to be more absolutistic in their judgments than do normal people in most of their thinking. Or perhaps depressives confine these damaging habits of thought to self-evaluative areas of their life, which cause depression. Whichever is the case, these habitual modes of inflexible thinking can cause prolonged sadness and depression.(3)

Habitual Negative Self-Comparisons Produce A Sense of Worthlessness

A single negative self-comparison does not imply a general sense of worthlessness and lack of self-esteem. A single negative self-comparison is like a single frame of a movie that is in your consciousness at a single moment, whereas a lack of self-esteem is like an entire movie full of negative self- comparisons. In addition to the specific negative self- comparison impressions you receive from each of the movie's frames, you also take away a general impression from the movie as a whole--personal worthlessness. And when later reflecting on the movie, you may at a given moment remember either a single frame or your general impression of the movie as a whole, and both the specific and the general views give you the impression of worthlessness.

A depressive reviews so many thoughts of individual negative self-comparisons that she develops the general impression of lack of personal value--worthlessness--which reinforces the individual negative self-comparisons. The never-ending flow of neg-comps also contributes to the sense that the person is helpless to stop the flow, and causes the person to lose hope that the painful neg-comps will ever cease. The general impression of worthlessness then combines with a sense of helplessness to cause sadness. The relationship between negative self-comparisons, lack of self esteem, and sadness may be diagrammed as in Figure 4.

Self-Evaluation and Your "Life Report"

Put the above discussion another way: At any given moment you have in your mind something like a school report card -- call it your `Life Report' -- with grades on it for a variety of "subjects." You write the grades for yourself, though taking into account how other people judge you, of course, to a greater or lesser degree. The "subjects" include both life conditions, such as the condition of your love life or marriage, and activities, such as your professional achievements and your behavior toward your granduncle.

Another category of `subjects' on the Life Report are future occurrences that matter to you and which are related to your `success' or `failure'-- on the job, in your relationships with others, even religious experiences. These are marked "High hope" or "Low hope".

The "subjects" are marked "important" (e.g. professional achievement) or "unimportant" (e.g. behavior toward granduncle). Again, other people's judgments influence you, but probably less so than in their judgments about how you are doing in specific activities.

The over-all state of your Life Report - the larger proportion of those "important" matters that are of your own doing are marked positive or negative--constitutes your self- esteem or "self image." If there are many important matters marked "bad," the composite constitutes low self-esteem and a poor self-image of yourself.

Then along comes some unpleasant event, minor or major, that leads to a negative self-comparison between, on the one hand, what you think about yourself in light of the event, and on the other hand, the standard which you take as your benchmark for comparison. The consequent sadness will be only temporary when the event is not seen as all-important or is surrounded by a lot of other negative indications: the effects of the death of a loved one upon a person with generally high self-esteem is such an example. But if your Life Report is predominantly negative in the categories marked "important," then any negative event will be reinforced by the overall sense of worthlessness, and will in turn contribute to your feeling worthless. This gives extra strength to each particular negative self-comparison. And when (or if) the thought of that particular negative self-comparison leaves you, the generalized negative self-comparison of being worthless keeps you feeling sad. When that state continues for a time, we call it depression.

When talking of his own depressed thoughts, Tolstoy put the matter this way: "[Like drops of ink always falling on one place they ran together into one big blot." (4)

How does one happen to have a negative Life Report? These are possible contributing factors, a) one's childhood training and upbringing, b) one's present life situation, including the recent past and the expected future, and c) an innate predisposition to react fearfully or otherwise negatively toward events. The last of these possibilities is pure speculation; no evidence has yet been shown for its existence.

The role of the present is straightforward: It provides evidence that you interpret about how well you are doing with various matters, and how well you can hope to do in the future.

The past has a multiple role: It provided--and still provides--evidence about how well you usually do on some matters.(5) But it also taught you methods --sound or unsound--to interpret and evaluate the evidence that the world provides to you about your activities and life condition. And, perhaps most important, your childhood training influences which categories you mark as "important" and "unimportant." For example, one person may consider relationship with one's family or work success as very important, whereas another person may consider neither important because of (or in reaction to) childhood experience.

Those are some of the ways in which a depressive may differ from a normal person, differences that may cause the depressive to suffer prolonged sadness in the face of a set of external conditions whereas they cause only fleeting sadness to the normal person.

Many of the above tendencies can be summarized as a propensity for seeing a half-empty glass instead of a half-full glass. This propensity is neatly demonstrated by an experiment that showed people two images at the same time -- a positive and a negative, one in each eye--with a special viewing device. Depressed persons "saw" the unhappy image and did not "see" the happy image more frequently than persons who were not depressed (6). And other research shows that even after a siege of depression is over, the former sufferers have more negative thoughts and biases than do normal persons.

There are many possible reasons why depressives differ from other persons. For example, depressives may have experienced especially strong pressure from parents to set and achieve high goals, and in response have come to rigidly believe that those goals must be sought . They may have suffered traumatic loss of parents or others as children. They may have genetically-caused biological makeup's, such as a low energy level, that may easily make them feel helpless. And there are many other possible causes. But we need not further consider the matter because it is the current thinking and behavior patterns that must be changed.

Biology and Depression

Earlier, it was mentioned that biological factors--genetic origins, physical constitution, state of your health --may influence your propensity for depression. A word about them seems appropriate here.

Biological factors can apparently operate directly upon the emotions of sadness-happiness, and/or upon the comparison mechanism to make a comparison seem more negative or positive than it otherwise would be perceived. This is consistent with such observed facts as that:

1) Being sad often comes with being tired. Being tired also makes depressives judge that endeavors will fail, that they are helpless as well as worthless, and so on. This makes sense because when one is tired it is objectively true that one is less competent to control the circumstances of one's life than when one is fresh. And the tiredness also typically makes depressives project into the future that they will not be successful. Hence the bodily state of being tired affects the person's self- comparisons and hence her sadness-happiness state.

2) Postpartum depression follows a whole series of biological changes, and seems to have no psychological explanation.

3) Mononucleosis and infectious hepatitis tend to cause depression. (7)

4) Some geneticists have concluded that there is "strong evidence in favor of considering manic-depressive psychosis to be genetically influenced in good part, [but] we are unable to come to any conclusions regarding its mode of inheritance."(8) And for a while it was believed that the causal gene had been identified, but later reports have cast doubt on this conclusion (Washington Post, November 28, 1989, p. Health 7). And some researchers believe that there is evidence for a "biochemical scar" which remains from past depression and which continues to influence feelings in the present; a deficiency of the chemical norepinephrine is commonly implicated by the biochemists. (This need not contradict the observation mentioned earlier that survivors of catastrophes such as concentration-camp experience do not suffer unusual amounts of depression.

There is clear biological evidence that depressed people have differences in body chemistry from non-depressed people.10 There also is a direct biological connection between negative self-comparisons and physically-induced pain. Psychological trauma such as a loss of a loved one induces some of the same bodily changes as does the pain from a migraine headache, say. When people refer to the death of a loved one as "painful", they are speaking about a biological reality and not just a metaphor. And it is reasonable that more ordinary "losses" -- of status, income, career, and of a mother's attention or smile in the case of a child -- have the same sorts of effects even if milder.

The Appendix to this chapter discusses the role of drugs in treating depression.

From Understanding To Cure

Ultimately we are interested in the mechanism of depression so that we can manipulate it to treat depression. Let's say that you have a Life Report which is predominantly negative, and it causes you to be sad and depressed. As noted in many places in this book, there are several ways to get rid of your sadness at any given moment. These include putting the Life Report out of your mind by pushing it out; changing some of the negative categories from important to unimportant; changing the standards by which you grade yourself on particularly important negative matters; learning how to interpret the external evidence more accurately, if you now do not interpret the evidence well; and involving yourself in work or creative activity that pulls your mind away from the Life Report.

The advantages and disadvantages of these and other methods of preventing depression depend upon your own psychology and your life situation. The pros and cons of each are discussed later in this book.

Summary

This chapter discusses why a particular person is more predisposed to depression than are other people who are closer to "normal".

The main elements that influence whether a person is sad or happy at a given moment, and whether one does or does not descend into the prolonged gloom of depression are as follows: 1) Experiences in childhood, both the general pattern of childhood as well as traumatic experiences, if any. 2) The person's adult history: the recent experiences have the greatest weight. 3) The actual conditions of the individual's present life-- relationships with people as well as such objective factors as health, job, finances, and so on. 4) The person's habitual mental states, plus her view of the world and herself. This includes her goals, hopes, values, demands upon herself, and ideas about herself, including whether she is effective or ineffective and important or unimportant. 5) Physical influences such as whether she is tired or rested, and anti- depression drugs she is taking, if any. 6) The machinery of thought which processes the material coming in from the other elements and produces an evaluation of how the person stands with respect to the hypothetical situation taken for comparison. (7) A sense of helplessness.

The depressive differs from the normal person in having a propensity for prolonged sadness; this is the stripped-down minimum definition of a depressive.

There are many possible reasons why depressives differ from other persons. For example, depressives may have experienced especially strong pressure from parents to set and achieve high goals, and in response have come to rigidly believe that those goals must be sought . They may have suffered traumatic loss of parents or others as children. They may have genetically-caused biological makeup's, such as a low energy level, that may easily make them feel helpless. And there are many other possible causes. But we need not further consider the matter because it is the current thinking and behavior patterns that must be changed.

Appendix: On Drug Therapy For Depression

Why not simply prescribe anti-depression drugs--several of which are in the armamentarium of physicians--for all cases of depression? The fact that bodily states may be related to depression suggests the use of drugs to artificially remove neurochemical imbalances, that is, to alter bodily states in such manner as to relieve depression. Indeed, Kline suggested that "physical repair through drug therapy is probably useful even in cases in which the original problem was primarily psychological." (9)

The word "repair" seems overly strong. The most important reason not to rely on drug therapy is that, in the words of one psychiatrist, "The drugs do not cure the illnesses; they control them."(11) As noted earlier, one long-term follow-up study shows that patients treated with cognitive-behavioral therapy in addition to drugs have few recurrences than do patients treated with drugs alone. (11.1 Miller, Norman, and Keitner, 1989)

There are also several other persuasive reasons why one should continue to seek psychological understanding of depression, and psychological methods for its treatment:

1. It is not clear in most cases whether depressed thinking caused the chemical imbalances, or the chemistry caused the depression. If the former is true, though drugs may help temporarily, is reasonable to expect a recurrence of the depression when drugs are stopped. If so, it seems more reasonable to attack the depression by working on the bad thinking as the first method, rather than by starting with drugs.
2. Physical treatment can have side-effects years after their use, as too many tragic examples such as improperly- prescribed birth-control pills and x-ray radiation have shown too well. Since there is an inherent unknown danger in the use of drugs, non-drug treatment that promises equal success must be preferable.
3. There are some immediate physically dangerous side- effects from the common anti-depressant drugs.(12)
4. There may be immediate mental side-effects destructive to creativeness and other thinking faculties, though there is little discussion of such side effects by such psychiatric drug enthusiasts. A reasonable conclusion drawn from the studies that have been made on this issue suggest that anti-depressant drugs reduce the creativity of some writers (and presumably, other artists) while increasing the creativity of others by enabling them to work. The crucial dosage is "delicate" and "complex", according to physicians who have studied the matter.(13)
5. Drugs do not work in some cases.
6. For at least some people the process of conquering depression without drugs can lead to valued states of ecstasy, self-knowledge, religious experience, and so on: Bertrand Russell is one such example:
   
   The greatest happiness comes with the most complete possession of one's faculties. It is in the moments when the mind is most active and the fewest things are forgotten that the most intense joys are experienced. This indeed is one of the best touchstones of happiness. The happiness that requires intoxication of no matter what sort is a spurious and unsatisfying kind. The happiness that is genuinely satisfying is accompanied by the fullest exercise of our faculties, and the fullest realization of the world in which we live.(14)
7. There can be damaging psychological side-effects of drug treatment. According to a physician, the anti-depressant drug may become "a nagging reminder that something within is not working as it should...[and] has the potential for decreasing one's sense of self-worth"(15)...."It is not uncommon for patients to go off the medications a number of times, testing their limitations. This often (but not always) results in further episodes....This returns the patient to square one and further disturbs his sense of self-worth".(16)
   
   "Some patients are very upset by the idea that it is not their own will but a medication that is responsible for preserving control over their behavior, mood, or judgment...as a weakness. These feelings can lead to a rather negative attitude...."15

8. Understanding depression as part of human psychology is of interest for its own sake. Hence the existence of effective anti-depression drugs is not a good reason to cease searching for psychological understanding of depression.

   There are a variety of anti-depressant drugs and a variety of side-effects. A convenient up-to-date summary of them is in Chapter 5 of the book by Papalos and Papalos referred to in the bibliography..

   Present Conditions (Conditions (Interpretation of these) Childhood Recent history (General or (History weighted Traumatic) by recency) Anti-Depression Drugs or (Comparison) - Habitual States Goals Self demands hopes FIGURE 4-1 3 Low self-esteem Negative self-comparisons Sadness Sense of helplessness Figure - 5

next: Good Mood: The New Psychology of Overcoming Depression Chapter 5
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I have just gone through an adventure in Love.   A expedition into the realm of Romantic Relationship.   It turned into an experience of Love and Joy so exquisite and sublime that my life has been changed forever.   I have Loved and been Loved - and on the wings of that Love have soared to elevations of vibrational consciousness that approached (as near as I have ever been) the level of the kingdom of Heaven within - and I have (seemingly) lost the person that I Love without losing access to those heights of consciousness.   A "Miracle" is far too small a word for what I have experienced.   "Grateful" is but a drop of water in an ocean of what I feel for the incredible, amazing gift which I have been given - and have, I am extremely thankful, been courageously working on my healing long enough to be open to receive.

There are a multitude of levels to this tale of Romantic Love - some involving lifetimes tens of thousands of years apart, some containing lifetimes of experience in only a few hours of two souls excruciatingly touching with Love.   The version shared here is but a limited, linear perspective of an outline of the events as they unfolded.

It is a tale of how my greatest fear came true but my response to it took me to a place of Joy and Love that is sublimely, exquisitely, magical and mystical - and Amazingly miraculous.

Prologue

Last summer (98), three slight but ultimately - in hindsight - very significant insights were reveled which led to shifts in my relationship with my self that manifested recently.

1. I got in touch (in a CoDA meeting I think) with the fact that I was totally shut down to the romantic in me.   Like all of the inner child places and archetypes within me - I had spent most of my life reacting to the romantic within me by swinging to extremes.   I would let my endless, aching need to find her lead me to casting the wrong person in the part of the princess in my romantic fairy tale - and then when I got really hurt by allowing the romantic to be in control - I would shut down to it completely.   I would throw the romantic me into an inner dungeon and throw away the key - until some time years later when I would repeat the pattern by letting the romantic take over again.

It made me sad to realize that I had left the romantic locked away for quite awhile again.   The romantic within me is one of my favorite parts of me.   The idealist and dreamer - creative and spontaneous and very Loving.   I decided that I would start opening up to letting the romantic out on parole to see if it was possible to be open to doing a relationship in balance.   I heard myself saying to people:   that hurt was inevitable and should be accepted as part of the path;   that it was better to Love and lose then to never to take the risk of Loving;   that the only way to really learn how to do a relationship was in one;   that relationships that didn't work out were lessons - not mistakes, not a wrong choice;   and other such Truths - and realized that once more I was teaching what I needed most to learn.   Theoretically I knew these things to be True - but on an emotional level I was absolutely terrified of intimacy because I didn't trust myself to make good choices.

I could see clearly that though I said I was trying to heal my relationship phobia - I had been basically unavailable for relationship for over 5 years since a 2 year living together relationship ended.   About 4 years ago I had a short fling with a really good woman who I wasn't emotionally mature enough to appreciate (it is of course possible to be very wise, competent, and mature in many areas and completely immature in others - intimate relationships being the foremost area of immaturity for many of us).   And then had two dating relationships with women who weren't even a remote possibility to be her.   The last dating situation was like a manifestation of my disease - with me attempting to rescue the most wounded, negative part of me as manifested in a very wounded woman.   That one scared me so much that I shut down to any possibility of a relationship and put up my force shield that gives off those "stay away vibes" - for almost 2 years by last summer.

So, when I had the insight about the romantic within me, I started considering the possibility that maybe I might do a relationship again one of these days - possibly.   (Change starts with surrendering to being open to considering the possibility.)

2. In doing my daily prayers and affirmations (which I don't always do daily by the way) I was led to add a phrase to one of my affirmations.   It changed from "I am a magnificent Spiritual Being full of Light and Love.   I am radiantly beautiful and vibrantly healthy" to "radiantly beautiful, vibrantly healthy, and Joyously Alive."   Six months later, I am more Joyously Alive than I had ever imagined possible - affirmations work folks.

3. In another part of my affirmations, a slip of my tongue (I always pay attention to those Freudian slips) caused me to mention my twin soul in an affirmation about how emotional support, friendship, and Love are manifesting in my life easily and effortlessly, freely and abundantly.   I thought, oh that is interesting, and then let it go because I had completely let go of the possibility that I would be united with my twin soul in this lifetime.   Then the next week the same slip occurred again.   So I added it to my affirmation and started making room in my consciousness for the possibility.

The next part of the process was that the Universe, through the late summer and fall put me in numerous situations where I got to see how good I had gotten at setting boundaries, speaking my Truth, and just generally taking care of myself.   Since I know that my Spiritual growth process is why I am here and the absolute number 1 priority in my life, I pay attention to all of the accidents and coincidences   Everything that happens in my life is part of my growth process.   I take note of it and then file it away to be recalled when the next little bit of the puzzle is revealed.   I was aware that I was gaining more confidence and trust in myself - and that there was a reason that this was happening.   I wasn't particularly thinking of the relationship thing - I knew it was a possibility, but I have learned to head in the direction that the Universe points me while also letting go of trying to figure out where I am going to end up. The outcome is what I am powerless over - I have the power to take action in a direction / to plant some seeds but then I need to surrender to the Universe being in charge.   Oh, I will water and weed and tend to the seeds every once in a while but it is important that I not get too focused on any future stuff because then I will miss some of today.

So, I was focusing on being present today and taking note of the accidents and coincidences that were unfolding without having a clue about the Amazing, Magnificent, Miraculous, Magical, Fiery Eruption of Joy & Love & Dazzling Light that was about to change my life forever.

next: Union Within

What are the signs that your child is being bullied? Plus learn how bullies abuse their victims and how to protect your child from bullies.

by Kathy Noll- author of the book: "Taking The Bully By The Horns"

Did you know that over 6 million boys and 4 million girls are involved in fights every year on school grounds? Many are physically threatened while a large number of students are also robbed.

Bullying has become a very serious "Hot" topic today. It's been in the news, and the theme of several talk shows in the past year. The problem has been around for as long as people have been around, but it's only been recently that we've become aware enough to do something about it.

Signs Your Child is Being Bullied

Mental and physical signs for parents to look for to find out if their child is being bullied include: Cuts, bruises, torn clothing, headaches and/or stomach pains before it's time to go to school, or a reluctance to go to school, poor appetites, poor grades, decline or withdrawal from usual activities, anxiety, not many friends, always loses money, depression, fear, anger, nervousness, and relates better to adults and teachers than children.

How Bullies Abuse Their Victims

It also helps to understand the different types of abuse the bully can inflict. This can vary from physical (juvenile violence) to verbal, and include mental control tactics. (Crushing your self-esteem).

The bully's pattern of physical abuse might include: pushing, tripping, slapping, hitting, wrestling, choking, kicking, biting, stealing, and breaking things. (80% of the time bullying becomes physical).

The bully's pattern of verbal abuse might include: twisting your words around, judging you unfairly, missing the point, passing blame, bossing, making you self-conscious, embarrassing you, making you cry, confusing you, and making you feel small so he/she can feel big.

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Children between the ages of 5-11 begin using verbal abuse, and are capable of some physical abuse such as fist fighting, kicking, and choking. However, once a child reaches the age of 12, psychological changes take place and the bullying becomes more violent. This might include the use of weapons and sexual abuse.

Murder between children was up 35% in 1997. Today's 3, 4, and 5 year-olds could grow up to be a generation of serial killers. Some signs to watch for in younger children include setting fires, and torturing animals.

How A Child Becomes A Bully

Usually bullies come from middle-income families that do not monitor their activities. The parents of bullies are either extremely tolerant and permissive, and allow them to get away with everything, or physically aggressive and abusive.

However, the parents are not always the cause. There are many very loving and caring parents who do not understand what went wrong.

Other reasons why kids slip into their "bully suits" might include violence on tv/movies, and the influence of "bully" friends.

You can't watch your child while he/she is at school, so there is the possibility of him/her hanging out with a child (or children) of negative influence. Sometimes kids admire bullies for their strength, or befriend them so as to stay on their good side!

So if you're a wonderful parent knocking yourself for what you did wrong, understand what a strong influence other peers can have on your child.

Bullies need to be in control of situations, and enjoy (gain power from) inflicting injury on others. They are not committed to their school work or teachers and may also show a lack of respect towards their families. Usually bigger and stronger than other children their own age, bullies believe that their anger and violent behavior is justified. They see threats where none exist out of paranoia, or fear of facing reality.

The bully might lash out at people because he's (or she's) angry about something. Maybe someone in his life is bullying him. He could be hurting from abuse he received in the past, or maybe he grew up observing those around him using violence as a means of settling differences.

Sometimes jealousy is the culprit. He needs to feel better about himself in order to change, and to stop bullying.

Or, in a worse case scenario, he might actually be a sociopath, in which case he/she would need to get professional help.

Protecting Your Child From Bullies

What can parents do to prevent their children from getting bullied? Tell your children to walk or play with friends, not alone, and to avoid alleys and empty buildings, especially after dark. Make a list with the child as to where they are allowed to go, and places/phone numbers where they can get help.

Know your child's friends and make sure that everyone understands your view of teasing and violence. Maintain a trusting, open communication with your child while teaching him/her to be both strong and kind.

If your child is a victim, he needs to know that he's ok, and not the one with the problem. Have him tell his school guidance counselor the name of the bully who is victimizing him. Or you might try talking to the principal or his teachers directly. And if you know the parents of the bully, you might try confronting them as well. However, there's a good chance they'll either be in denial, or be as unconcerned as their child.

If physical abuse is the problem, and you're afraid of angering the bully (revenge), tell the teacher, or whomever, not to pass on your or your child's name while settling the situation unless it's absolutely necessary. There's a good chance he's victimizing other children as well, and won't need to know exactly who busted him.

Children who use violence to resolve conflicts, grow up to be adults who use violence to resolve conflicts. However, if a child is backed up against a wall, or into a corner, then he obviously needs to defend himself and should not stand there while getting pounded. He could walk (or run) away. But in order to escape conflict in the first place, the child should ignore, or avoid the bully. Don't play with (or for older kids "hang out" with) the bullies, and don't play or hang out "near" them. Teach your child to only fight back if he/she *needs* to defend himself - - as a last resort.

Young people need to believe in themselves in order to feel better. (self-esteem) Not by winning a fight, or even being part of a fight that he/she didn't initiate. In order to be a strong person, you have to learn what to say at the right time, and believe in what you are saying. ("I won't fight you because it is wrong" or "This isn't what friendship is about") Walking away from the fight, knowing you are the *better* person, is a lot healthier for the body and mind.

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If verbal abuse is the problem, your child could try confronting the bully himself. Get him alone. Bullies like to show off by embarrassing you in front of a group of people. They might not be so tough without a crowd. Tell your child to be firm, stick up for himself, and tell the bully, "I don't like what you're doing to me, and I want you to stop."

If the child is old enough to reason, have him tell the bully how it feels to be bullied. Don't stress what the bully did, or the accusations might make him defensive. Then he'd be less likely to listen. If he's willing to listen at all, he might be willing to change. However, if he's unwilling to listen and starts getting nasty, your child is better off staying away from him, or ignoring him. But if his verbal abuse turns into threats, notify someone in authority.

Sometimes having things/property stolen victimizes a child. Putting your child's name on everything is an important thing to do. This means each and every crayon! It also helps to not allow him/her to take things of any major importance or value to school. Again, if nothing else works, have the bully reported.

For the past 10 years child on child violence has been increasing. Physical abuse, sexual harassment and robbery have driven many victims to substance abuse or suicide.

Kathy Noll has written a series of articles on bullies and how to deal with bullies.

• Help For Parents and Teachers On Dealing With Bullies and School Violence
• Bully Advice For Kids
• Empowering Kids to Deal with Bullies and Low Self-esteem
• Child on Child Violence

If you'd like to learn more about bully and self-esteem issues, purchase Kathy Knoll's book: Taking The Bully By The Horns.

next: Help For Parents and Teachers On Dealing With Bullies and School Violence

Several studies suggest that yoga is beneficial for anxiety disorders, stress and depression. Read more.

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

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

Background

Yoga is an ancient system of relaxation, exercise and healing with origins in Indian philosophy. Yoga has been described as "the union of mind, body, and spirit," which addresses physical, mental, intellectual, emotional and spiritual dimensions toward an overall harmonious state of being. The philosophy of yoga is sometimes pictured as a tree with eight branches:

• Pranayama (breathing exercises)
• Asana (physical postures)
• Yama (moral behavior)
• Niyama (healthy habit)
• Dharana (concentration)
• Pratyahara (sense withdrawal)
• Dhyana (contemplation)
• Samadhi (higher consciousness)

There are several types of yoga, including hatha yoga, karma yoga, bhakti yoga and raja yoga. These types vary in the proportions of the eight branches. In the United States and Europe, hatha yoga is commonly practiced, including pranayama and asana.

Yoga is often practiced by healthy individuals with the aim to achieve relaxation, fitness and a healthy lifestyle. Yoga may be practiced alone, or with a group. Yoga classes and video tapes are available. There are no official or well-accepted licensing requirements for yoga practitioners.

Theory

It has been hypothesized that yoga may benefit health through mind-body interactions. In yoga, poses are held for varying lengths of time using gravity, leverage and tension. Breathing techniques are also used. Rapid breathing (kapalabhati) and slow breathing (nadi suddhi) may be practiced along with stretching exercises.

Yoga has been shown to reduce heart rate and blood pressure, increase lung capacity, increase the amount of time you can hold your breath, improve muscle relaxation and body composition, cause weight loss and increase overall physical endurance. Yoga may affect levels of brain or blood chemicals, including monoamines, melatonin, dopamine, stress hormones (cortisol) and GABA (gamma-aminobutyric acid). Changes in mental functions such as attention, cognition, processing of sensory information and visual perception have been described in some research studies in humans. Suggested mechanisms of action include increased parasympathetic drive, calming of stress responses, release of hormones, and brain (thalamic) activity.

Evidence

Scientists have studied yoga for the following health problems:

Anxiety and stress (in healthy individuals): Several studies report that yoga may reduce anxiety and stress and improve mood in healthy people who practice yoga several times per week for 30 to 60 minutes. However, most studies have not been well designed, and different yoga techniques have been used.

Anxiety disorders, obsessive-compulsive disorder, schizophrenia : Several studies in humans report benefits of yoga in the treatment of anxiety disorders, obsessive-compulsive disorder, and schizophrenia. Kundalini meditation and relaxation have been used for anxiety disorders and obsessive-compulsive disorder. Further well-designed studies are needed before a firm conclusion can be drawn.

Asthma: Multiple studies in humans suggest benefits of yoga (such as breathing exercises) when used in addition to other therapies for mild-to-moderate asthma (such as prescription drugs, diet or massage). Some research demonstrates improved lung function, overall fitness and airway sensitivity and reduced need for asthma drugs, but there is also research showing no significant changes. Many of these studies are poorly designed, and because of conflicting evidence, better research is needed before a strong recommendation can be made.

High blood pressure (hypertension): Several studies in humans report benefits of yoga in the treatment of high blood pressure. However, many of these studies are not well designed. It is not clear if yoga is better than other forms of exercise for blood pressure control. Additional research is needed. Yoga practitioners sometimes recommend that patients with high blood pressure avoid certain positions, such as headstands or shoulder stands (inverted asanas), which may temporarily increase blood pressure.

Heart disease: Several studies in humans suggest that yoga may benefit people with heart disease. Along with positive lifestyle changes, yoga may help decrease angina (chest pain) and improve the ability to exercise and perform household physical activities. Yoga may also improve balance, coordination, and flexibility. Yoga may improve cardiovascular function and decrease risk factors for heart disease, including high blood pressure, cholesterol and blood sugar levels. It is unclear if yoga reduces the risk of heart attack or death or if yoga is better than any other form of exercise therapy or lifestyle or dietary change. Yoga may be a useful addition to standard therapies (such as prescription blood pressure or cholesterol-lowering drugs) in people at risk of heart attack. Further research is necessary before a strong recommendation can be made.
People with heart disease should consult their health care provider before starting any new exercise program.

Depression: Several studies in humans support the use of yoga for depression in both children and adults. Studies have compared yoga with low-dose antidepressants, electric shock therapy or no treatment. Although this preliminary research is promising, better studies are needed that examine people with clearly defined clinical depression.

Seizure disorder (epilepsy): Several studies in humans report a reduction in the number of monthly seizures with the use of sahaja yoga, when it is used with standard antiseizure drugs. This research is preliminary, and better studies are necessary before a firm conclusion can be drawn.

Carpal tunnel syndrome: Yoga therapy has been studied for carpal tunnel syndrome, but it is not clear if there are beneficial effects. Further research is needed before a recommendation can be made.

Diabetes: Several studies in humans report that daily yoga may improve control of blood sugar levels in people with type 2 diabetes. It is not clear if yoga is better than any other forms of exercise therapy for this purpose. More research is necessary before a recommendation can be made. People with heart disease should consult their health care provider before starting any new exercise program.

Diabetes: Several studies in humans report that daily yoga may improve control of blood sugar levels in people with type 2 diabetes. It is not clear if yoga is better than any other forms of exercise therapy for this purpose. More research is necessary before a recommendation can be made. People with heart disease should consult their health care provider before starting any new exercise program.

Attention-deficit hyperactivity disorder (ADHD): There is limited study in humans of yoga in the treatment of ADHD. Further research is needed before a recommendation can be made.

Low back pain: Preliminary research in humans reports that yoga may improve chronic low back pain. However, larger, better designed studies are needed before a firm conclusion can be drawn.

Fatigue: Preliminary studies in humans report that yoga may improve fatigue in adults. However, better designed studies are needed before any conclusion can be made.

Headache: Preliminary research reports that yoga may reduce the intensity and frequency of tension or migraine headaches, decreasing the need for pain-relieving drugs. However, better studies are needed before any recommendation can be made.

Insomnia: Preliminary research reports that yoga may benefit sleep efficiency, total sleep time, number of awakenings, and quality of sleep. Well-designed research is necessary before a firm recommendation can be made.

Irritable bowel syndrome (IBS): Early evidence suggests that yoga may be beneficial in the management of IBS. Further research is needed to make a recommendation.

Memory: There is limited study in humans of yoga for improving memory. Most research focuses on memory in children. Better studies are needed before a recommendation can be made.

Posture: Preliminary studies in humans report that yoga may improve posture in children. However, better-designed studies are needed before any conclusion can be drawn.

Performance enhancement: Preliminary studies in humans report that yoga (mukh bhastrika) may improve human reaction time, arousal, information processing, and concentration. Further research is needed before a clear recommendation can be made.

Lung disease and function: Limited study in adults has evaluated yoga as a treatment for lung conditions such as bronchitis, fluid around the lungs (pleural effusion) or airway obstruction. Limited study in children suggests potential improvements in pulmonary function. Better designed research is necessary before any firm recommendations can be made.

Mental retardation: There is limited study of yoga therapy in children with mental retardation. Preliminary research reports improvements in IQ and social behavior. Better studies are needed to confirm these results and to evaluate the effects of yoga in mentally retarded adults.

Muscle soreness: There is limited study in humans of yoga for improving muscle soreness. Preliminary research suggests possible benefits of implementing yoga training as a preseason regimen or supplemental activity to lessen symptoms associated with muscle soreness. Further research is needed before a recommendation can be made.

Muscle soreness: There is limited study in humans of yoga for improving muscle soreness. Preliminary research suggests possible benefits of implementing yoga training as a preseason regimen or supplemental activity to lessen symptoms associated with muscle soreness. Further research is needed before a recommendation can be made.

Multiple sclerosis (fatigue, cognitive function): There is limited study of yoga therapy in patients with multiple sclerosis. Preliminary research suggests possible improvement in measures of fatigue, but no improvement of cognitive function. Further research is needed before a recommendation can be made.

Pregnancy: Early research suggests yoga during pregnancy is safe and may improve outcomes. Additional research is needed before a clear recommendation can be made. Pregnant women who wish to practice yoga should discuss this with their obstetrician or nurse-midwife.

Weight loss, obesity: Preliminary research does not provide clear answers. Yoga in addition to healthy eating habits may reduce weight. Better studies are necessary to form conclusions about the potential benefits of yoga alone.

Substance abuse: Preliminary research reports that yoga may be beneficial when added to standard therapies for the treatment of heroin or alcohol abuse. However, better studies are needed before any recommendation can be made.

Stroke: Preliminary study suggests possible benefits of a yoga-based exercise program on people who have had a stroke and have impaired health status and reduced level of activity. Although results seem promising, further well-designed research is needed to confirm these findings.

Ringing in the ears (tinnitus): One study reports that yoga therapy does not improve tinnitus. Although relaxation may theoretically benefit this condition, additional research is needed before a recommendation can be made.

Antioxidant: A small study in men showed that yogic breathing may have an antioxidant effect. Larger well-designed studies are needed before conclusions can be drawn.

Cancer: Several studies in cancer patients report enhanced quality of life, lower sleep disturbance, decreased stress symptoms and changes in cancer-related immune cells after relaxation, meditation and gentle yoga therapy. Yoga is not recommended as a sole treatment for cancer but may be helpful as an adjunct therapy.

Unproven Uses

Yoga 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 yoga for any use.

Potential Dangers

Yoga has been well tolerated in studies, with few side effects reported in healthy people. Yoga is believed to be safe during pregnancy and breast-feeding when practiced under the guidance of expert instruction (the popular Lamaze techniques are based on yogic breathing). However, yoga poses that put pressure on the uterus, such as abdominal twists, should be avoided during pregnancy.

The following have been rarely reported:

• Nerve or vertebral disc damage — Caused by prolonged postures, sometimes involving the legs
• Eye damage and blurred vision, including worsening of glaucoma — Caused by increased eye pressure with headstands
• Stroke or blood vessel blockage — Caused by decreased blood flow to the brain or other body parts from postures

There is a case report of a woman who presented with pneumothorax (potentially dangerous air around the lung) caused by a yoga-breathing technique called Kapalabhati pranayama. There is another report of a teen-age girl who died of obstructed breathing associated with mouth-to-mouth yoga (in which one person breathes into another person's mouth using yoga breathing techniques). However, a long-acting barbiturate (which can cause decreased breathing) may have been partially at fault. Chronic cheilitis (inflammation of the lips) and persistent reflux have been reported in yoga instructors with unclear relationship to this modality.

People with disc disease, fragile or atherosclerotic neck arteries, a risk of blood clots, extremely high or low blood pressure, glaucoma, retinal detachment, ear problems, severe osteoporosis or cervical spondylitis should avoid some yoga poses. Certain yoga breathing techniques should be avoided in people with heart or lung disease.

Some experts advise caution in people with a history of psychotic disorders (such as schizophrenia), because there is a risk of worsening symptoms, although this has not been clearly shown in studies.

You should speak with your health care provider before starting yoga or any new exercise regimen.

Summary

Yoga has been suggested for many conditions. There is preliminary evidence that yoga may be beneficial when it is added to standard treatments for several conditions, including anxiety disorders or stress, asthma, high blood pressure, heart disease and depression. It is not clear if yoga is any more or less effective than other forms of exercise. Damage to nerves or discs in the back have been reported, and caution is warranted in some individuals. Speak with your health care provider if you are considering starting yoga, or any new exercise program.

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: Yoga

Natural Standard reviewed more than 480 articles to prepare the professional monograph from which this version was created.

Some of the more recent studies are listed below:

1. Ades PA, Savage PD, Cress ME, et al. Resistance training on physical performance in disabled older female cardiac patients. Med Sci Sports Exerc 2003;Aug, 35(8):1265-1270.
2. Ades PA, Savage PD, Brochu M, et al. Resistance training increases total daily energy expenditure in disabled older women with coronary heart disease. J Appl Physiol 2005;Apr, 98(4):1280-1285.
3. Bharshankar JR, Bharshankar RN, Deshpande VN, et al. Effect of yoga on cardiovascular system in subjects about 40 years. Indian J Physiol Pharmacol 2003;Apr, 47(2):202-206.
4. Bastille JV, Gill-Body KM. A yoga-based exercise program for people with chronic poststroke hemiparesis. Phys Ther 2004;Jan, 84(1):33-48.
5. Behera D. Yoga therapy in chronic bronchitis. J Assoc Physicians India 1998;46(2):207-208.
6. Bentler SE, Hartz AJ, Kuhn EM. Prospective observational study of treatments for unexplained chronic fatigue. J Clin Psychiatry 2005;May, 66(5):625-632.
7. Bhattacharya S, Pandey US, Verma NS. Improvement in oxidative status with yogic breathing in young healthy males. Indian J Physiol Pharmacol 2002;Jul, 46(3):349-354.
8. Bhavanani AB, Madanmohan, Udupa K. Acute effect of Mukh bhastrika (a yogic bellows type breathing) on reaction time. Indian J Physiol Pharmacol 2003;Jul, 47(3):297-300.
9. Bijlani RL, Vempati RP, Yadav RK, et al. A brief but comprehensive lifestyle education program based on yoga reduces risk factors for cardiovascular disease and diabetes mellitus. J Altern Complement Med 2005;Apr, 11(2): 267-274.
10. Biswas R, Dalal M. A yoga teacher with persistent cheilitis. Int J Clin Pract 2003;May, 57(4):340-342.
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12. Boyle CA, Sayers SP, Jensen BE, et al. The effects of yoga training and a single bout of yoga on delayed onset muscle soreness in the lower extremity. J Strength Cond Res 2004;Nov, 18(4):723-729.
13. Brown RP, Gerbarg PL. Sudarshan Kriya yogic breathing in the treatment of stress, anxiety, and depression: part I-neurophysiologic model. J Altern Complement Med 2005;Feb, 11(1):189-201.
14. Carlson LE, Speca M, Patel KD, Goodey E. Mindfulness-based stress reduction in relation to quality of life, mood, symptoms of stress, and immune parameters in breast and prostate cancer outpatients. Psychosom Med 2003;Jul-Aug, 65(4):571-581.
15. Chusid J. Yoga foot drop. JAMA 1971;217(6):827-828.
16. Cohen L, Warneke C, Fouladi RT, et al. Psychological adjustment and sleep quality in a randomized trial of the effects of a Tibetan yoga intervention in patients with lymphoma. Cancer 2004;May, 15(10):2253-2260.
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19. Dahiya S, Arora C. Impact of exercise on nutritional status and health profile of urban obese women in Hisar City. Asia Pac J Clin Nutr 2004;13(Suppl):S138.
20. Delmonte MM. Case reports on the use of meditative relaxation as an intervention strategy with retarded ejaculation. Biofeedback Self Regul 1984;9(2):209-214.
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22. Galantino ML, Bzdewka TM, Eissler-Russo JL, et al. The impact of modified Hatha yoga on chronic low back pain: a pilot study. Altern Ther Health Med 2004;Mar-Apr, 10(2):56-59.
23. Garfinkel MS, Schumacher HR, Husain A, et al. Evaluation of a yoga based regimen for treatment of osteoarthritis of the hands. J Rheumatol 1994;21(12):2341-2343.
24. Garfinkel MS, Singhal A, Katz WA, et al. Yoga-based intervention for carpal tunnel syndrome: a randomized trial. JAMA 1998;280(18):1601-1603.
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27. Janakiramaiah N, Gangadhar BN, Murthy PJ, et al. Antidepressant efficacy of sudarshan kriya yoga (SKY) in melancholia: a randomized comparison with electroconvulsive therapy (ECT) and imipramine. J Affect Disorders 2000;57:255-259.
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29. Jensen PS, Kenny DT. The effects of yoga on the attention and behavior of boys with attention-deficit/hyperactivity disorder (ADHD). J Atten Disord 2004;May, 7(4):205-216.
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Prior to recovery, my life was one of extremes. Particularly in regards to my feelings.

Three primary feelings drove my thoughts, actions, and relationships: sad, mad, and glad. These three feelings controlled my life. They ruled me. I had no idea I could control my response to these feelings. I constantly fluctuated between them, often cycling through one to the other or all three in a few minutes. At one point, my therapist diagnosed me as bipolar.

However, as my recovery progressed, and I grew emotionally, I discovered I had a choice regarding my response to my basic, primal feelings. I learned my responsibility in controlling how I handled these feelings. Believe it or not, in 33 years I had never learned that I am not my feelings!

Now, my feelings no longer control me. I also learned how to feel the broad spectrum of feelings between sad/mad and glad. There are many subtle variations and layers of feelings between these extremes, of which I was completely unaware.

Most importantly, between these extreme feelings, or perhaps, apart from them, I discovered a perfect center point of absolute stillness. Serenity is at the calm center of the storm. Serenity is the choice I make about how I choose to respond (not react) to my feelings.

Serenity is feeling all my feelings with the full awareness and realization I don't have to act upon them; I don't have to act them out; I don't have to judge them. I merely acknowledge my feelings, identify them, calmly accept them, observe the situation that is producing them, and then decide, consciously, whether a response is warranted.

When my feelings ruled me, my life was miserable. Once I began the practice of responding to my feelings, my life filled with serenity. The good stuff started happening.

The key to the balance of power between my head and my heart was in my possession all along, but I didn't know it. Emotional maturity was not in my educational curriculum. By giving away this power, by being unaware of it, I created untold misery in my life and in the lives of others.

Am I always living from the calm center? No. Sometimes my feelings still take over. (In fact, I am learning there are times when it is OK for my feelings to be in control.) Sometimes I still over-react. Sometimes I am still paralyzed by fear (a variation of mad). Sometimes I allow people to push my buttons and I react too quickly. But at least now I recognize the process, whether I always use it or not. I am learning how to use this process—I haven't perfected it yet.

Every day is a new lesson. Every situation adds to my repertoire of healthy recovery behaviors. Awareness of the process is a goal of recovery, and now I am gratefully aware of how to live cooperatively with my feelings and consciously maintain the balance of peace and serenity my life deserves.

next: What is Co-Dependence?

What role do pleasant activities play in the recovery from depression? Learn more.

What are Pleasant Activities?

A person who is depressed identifies activities that give them pleasure. They then try to do more of these activities.

How does Pleasant Activities for Depression work?

There is a theory that a lack of pleasant activities might be one cause of depression. In addition, a reduction in engaging in pleasant activities is a symptom of depression. It is thought that if depressed people do pleasant activities more often, it will help their depression.

Is Pleasant Activities Therapy effective?

Engaging in pleasant activities is an important component of cognitive behavior therapy for depression. This type of therapy is known to be effective. However, there is not much research on whether pleasant activities, on their own, are helpful for depression. One study found that pleasant activities produced as much improvement as some other psychological therapies. However, this study did not assess whether pleasant activities produced more improvement than no treatment at all. Another study found that when depressed people engaged in pleasant activities, their mood did not improve.

Are there any disadvantages?

No major ones known.

Where do you get it?

This is a simple treatment that anyone could do on their own.

Recommendation

There is not much evidence that pleasant activities are helpful on their own for depression.

Key references

Biglan A, Craker D. Effects of pleasant-activities manipulation on depression. Journal of Consulting and Clinical Psychology 1982; 50: 436-438.

Zeiss AM, Lewinsohn PM, Munoz RF. Nonspecific improvement effects in depression using interpersonal skills training, pleasant activity schedules, or cognitive training. Journal of Consulting and Clinical Psychology 1979; 47: 427-439.

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Overview of pet therapy as an alternative treatment for depression and whether pet therapy really works in treating depression.

What is Pet Therapy for Depression?

Owning a pet is promoted in the media as being good for health. Pet therapy is also used to help people living in nursing homes and other long-term care.

How does Pet Therapy work?

Having a close relationship with another person is thought to help depression. A relationship with a pet may have a similar effect.

Is it Pet Therapy for Depression effective?

Very few studies have been carried out on the effects of pet therapy on depression. Typically, these studies compare pet therapy with some other treatment or with no treatment. Most of them find no improvement in depression.

Are there any disadvantages to Pet Therapy?

Owning a pet is a long-term commitment. While pets can give affection and companionship, they require the same level of care in return.

Where do you get Pet Therapy?

Pet breeders, pet shops or the RSPCA.

Recommendation

There is no good evidence at present that contact with pets helps depression.

Key references Barker SB, Dawson KS. The effects of animal-assisted therapy on anxiety ratings of hospitalized psychiatric patients. Psychiatric Services 1998; 49: 797-801.

Zisselman MH, Rovner BW, Shmuely Y, Ferrie P. A pet therapy intervention with geriatric psychiatry inpatients. American Journal of Occupational Therapy 1996; 50: 47-51.

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Overview of light therapy for seasonal affective disorder (SAD) and whether light therapy works in treating winter depression.

What is Light Therapy?

Light therapy involves exposure to bright light for around 2 hours each day, usually in the morning.

How does Light Therapy work?

Light therapy is mainly used for people who tend to become depressed in autumn and winter, when the daylight is shorter. These people then get better in spring and summer. The lack of light in winter is thought to affect their natural body rhythms.

Is Light Therapy effective for depression?

There is good evidence that light therapy helps people with winter depression. It works better than placebos (treatments with no known effect) and as well as antidepressant drugs. The therapy works best if given early in the morning rather than later in the day. Also, the brighter the light, the greater the benefit. There is less evidence on whether light therapy helps people whose depression is not seasonal. However, the small number of studies show that it could be beneficial.

Are there any disadvantages to Light Therapy?

Light therapy can produce mild mania (over-excitement) in some people. Problems in getting to sleep at night have also been sometimes found.

Where do you get Light Therapy?

Light therapy usually involves sitting in front of a bank of bright fluorescent lights. Equipment such as light boxes and dawn simulators are available to buy over the Internet. However, except in countries that have very short winter days, you can get the necessary light exposure by a 1 or 2 hour walk outside in the morning, even on overcast winter days.

Recommendation

Light therapy is one of the best treatments for winter depression and may also be helpful for other types of depression.

Key references

Tuunainen A, Kripke DF, Endo T. Light therapy for non-seasonal depression (Cochrane Review). In: The Cochrane Library, Issue 3, 2004. Chichester, UK: John Wiley & Sons, Ltd.

Wirz-Justice A. Beginning to see the light. Archives of General Psychiatry 1998; 55: 861-862.

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