OPTIMISM INCLUDES the assumption I can do something to change this situation for the better. Defeatism or pessimism includes the assumption probably nothing I do will make any difference.

So when you're optimistic, you are more willing to take action to change things for the better, which increases the likelihood that things will change for the better.

To learn more about how optimism works and how to become more optimistic, check this out:
Optimism Why not order Self-Help Stuff That Works now from any of twelve online bookstores? These are the most popular:

Here's a conversational chapter on optimism from a future book:
Conversation on Optimism

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

Learn how to prevent yourself from falling.into the common traps we are all prone to.because of the structure of the human brain:
Thoughtical Illusions

next: Why Pessimism Shuts Down Our Immune System

Getting a clinical history is an important part of the bipolar diagnosis in children and adolescents.

No laboratory study can be used to confirm the diagnosis of bipolar disorder. Therefore, gathering the history of present and past disturbances of mood, behavior, and thought is critical to properly diagnose a psychiatric condition such as bipolar disorder. Unlike other areas of medicine, in which the clinician often relies on laboratory or imaging studies to identify or characterize a disorder, mental health professionals rely almost exclusively on descriptive symptom clusters to diagnose mental disorders. As a consequence, the history is an essential part of the patient examination.

• The appropriate first step in evaluating a person for a psychiatric disorder is to ensure that no other medical condition is causing the mood or thought disturbance. Thus, the evaluation of the patient is best started by obtaining their oral history of current and past medical and behavioral symptoms and treatments. To further clarify the problem, gathering additional information from family and friends always is urged for a person experiencing an altered mood or behavioral state.
• After interviewing the patient, performing a physical examination, and gathering more information from family, friends, and perhaps other physicians to whom the patient is known, the problem may be classified as being primarily caused by a physical health problem or by a mental health problem.
  • While obtaining the history, the physician must explore the possibilities that substance abuse or dependence, trauma to the brain in the present or past, and/or seizure disorders may be contributing to or causing the current symptoms of illness.
  • Similarly, central nervous system (CNS) insults, such as encephalopathy or medication-induced mood changes (ie, steroid-induced mania), must be considered. Delirium is one of the most important medical conditions to exclude early in persons presenting with altered mental states or acute disturbances of mood and conduct.
  • Perhaps more relevant to youth is the evaluation of substance abuse patterns because acute drug intoxication states may mimic bipolar disorder.
• If the physical examination does not reveal a medical condition contributing to the patient's mental state, a thorough mental health evaluation is appropriate. Through observation and interviewing, mental health professionals may learn of mood, behavioral, cognitive, or judgment and reasoning abnormalities.
• The mental status examination (MSE) is the essential component of a mental health evaluation. This examination goes beyond the mini-mental status examination (eg, Folstein Mini-Mental State Examination to screen for dementia) often used in emergency departments. Rather, the MSE assesses general appearance and demeanor, speech, movement, and interpersonal relatedness of the patient with the examiner and others.
  • Mood and cognitive abilities (eg, orientation to circumstance; attentiveness; immediate-, short-, and long-term modes of memory) are assessed in the MSE.
  • Some of the most important components of the MSE are those addressing issues of safety of individuals and members of a community. Thus, suicidal and homicidal issues are explored.
  • Similarly, screens for the more subtle forms of psychosis, such as paranoid or delusional states, in addition to screens for overt psychosis, such as observing the patient responding to unseen others or other non-reality-based internal stimuli, are explored.
  • Lastly, insight into the patient's mental and physical states, the current circumstances of medical or mental health care, and the patient's ability to use age-appropriate judgments are assessed and integrated into the evaluation of the global mental state of the patient at that moment.
• Because bipolar disorder may cause a transient but marked impairment of judgment, insight, and recall, multiple sources of information are crucial to understand a particular patient. Thus, other family members, friends, teachers, caregivers, or other physicians or mental health care workers may be interviewed to clarify the full clinical picture.
• Nonetheless, the patient's subjective experience is essential in the evaluation and treatment processes, and the establishment of a therapeutic alliance and trust early in the assessment is vital to obtaining an accurate and useful history from the patient.
• Knowledge of the family's psychiatric history is another essential part of the patient's history because bipolar disorder has genetic transmission and familial patterns. A genogram may be developed to further describe a particular patient's risk of bipolar disorder based on familial and genetic attributes within the family system.

Physical:

• The physical examination must include a general neurologic examination, including examination of cranial nerves, muscular bulk, and tone and deep tendon reflexes.
• Cardiovascular, pulmonary, and abdominal examinations are also essential because abnormal pulmonary functioning or poor vascular perfusion of the brain may cause abnormal mood, behavior, or cognition.
• If these examinations do not reveal a medical condition contributory to the current mental state, a mental health evaluation should be sought

Causes:

• Genetic and familial factors have profound influence in the propagation of bipolar disorder.
  • Chang and colleagues (2000) report that children who have at least one biological parent with bipolar I or bipolar II disorder have increased psychopathology. Specifically, 28% of the children studied had attention deficit/hyperactivity disorder (ADHD); this figure is far above the general population prevalence of 3-5% in school-aged children. Also, 15% of the children had a bipolar disorder or cyclothymia. Approximately 90% of children who have bipolar disorders had comorbid ADHD. Moreover, in this study, both bipolar disorder and ADHD are more likely to be diagnosed in males than in females.
  • Early age of onset of bipolar disorder is predictive of a higher rate of mood disorder among first-degree relatives of the proband (Faraone, 1997). Also, adolescents who have onset of true mania with childhood-associated psychotic symptoms, such as aggression, mood shifts, or attention difficulties, have a greater genetic risk (family loading) for bipolar I disorder than adolescents with more adult-related psychotic symptoms, such as grandiosity. Other unique features of youths with early-onset bipolar disorder include (1) poor or ineffective response to lithium therapy (administered as Eskalith) and (2) an associated increased risk of alcohol-related disorders in the family members of the probands.
  • Twin studies of bipolar disorder show a 14% concordance rate in dizygotic twins and a 65% concordance rate (ranging from 33-90%) in monozygotic twins. The risk for the offspring of a couple in which one parent has bipolar disorder is estimated to be approximately 30-35%; for an offspring of a couple in which both parents have bipolar disorder, the risk is approximately 70-75%.
  • Faraone further delineated the differences among children with mania, adolescents with childhood-onset mania, and adolescents with adolescence-onset mania. Important findings in this work include the following:
    • Socioeconomic status (SES) was statistically lower in families of children with mania and adolescents with childhood-onset mania.
    • Increased energy was twice as common in childhood mania, euphoria was most common in adolescents with childhood-onset mania, and irritability was least common in adolescents with adolescent-onset mania.
    • Adolescents with adolescent-onset mania statistically had more abuse of psychoactive drugs and exhibited more impaired parent-child relationships than individuals in the other 2 groups with mania.
    • ADHD was more common in children and adolescents with childhood-onset mania than in patients with adolescent-onset mania, leading the authors to theorize that ADHD may be a marker for juvenile-onset mania.
  • This and other studies (Strober, 1998) suggest that a subtype of bipolar disorder may exist that has a high familial transmission rate and presents with childhood-onset of mania symptoms suggestive of ADHD.
  • Faraone proposes that early-onset mania may be the same as the comorbid state of ADHD and bipolar disorder, which has a very high rate of familial transmission. The question exists regarding whether youths who later are given the diagnosis of bipolar disorder may have a prodromal phase in early life that appears to be ADHD or another behavioral disturbance or whether many simply have bipolar disorder and comorbid ADHD.
• Cognitive and neurodevelopmental factors also seem to be involved in the development of bipolar disorder.
  • A case-cohort study of adolescents with affective disorders reveals that neurodevelopmental delays are overrepresented in early-onset bipolar disorders (Sigurdsson, 1999). These delays occur in language, social, and motor development approximately 10-18 years before affective symptoms appear.
  • Adolescents who had early developmental antecedents were noted to be at high risk of developing psychotic symptoms. In addition, intelligence quotient (IQ) scores were significantly lower in patients with early-onset bipolar disorder (mean full scale IQ 88.8) than in patients with unipolar depression (mean full scale IQ 105.8).
  • Lastly, a statistically significant difference in the mean verbal IQ and mean performance IQ was found only in patients with bipolar disorder.
  • Overall, patients with more severe bipolar disorder had an average lower IQ than those with mild-to-moderate forms of the disorder.
• Finally, environmental factors also contribute to the development of bipolar disorder. These may be behavioral, educational, family-related, toxic, or substance abuse-induced.
• Diagnoses of mental health problems increase the risk of suicide in adolescents compared to their healthy peers.
  • Adolescent patients in whom bipolar disorder is diagnosed are at higher risk of suicide than adolescents with other behavioral illnesses. Family conflict and substance abuse exponentially increase this risk.
  • Another risk factor for suicide in youths is legal problems. One study found 24% of adolescents who attempted suicide had faced legal charges or consequences within the past 12 months.
• Incarcerated youths also have an inordinately high number of mental illnesses; some are facing legal consequences as a direct result of behaviors that arise from uncontrolled or untreated mental disorders. The manic state of bipolar disorder can be particularly problematic for adolescents because the disinhibited risk-taking behaviors driven by the disorder can easily lead to legal problems, such as public disorderly conduct, theft, drug seeking or use, and agitated and irritable mood that results in verbal and physical altercations.

Biological and biochemical factors

• Sleep disturbances often aid in defining abnormal mood states of bipolar disorder in either the manic or depressed state.
  • A profoundly decreased need for sleep in the absence of a sense of fatigue is a strong indicator of a manic state.
  • An uncomfortable reduction of sleep is a pattern of an atypical depression episode in which more sleep is wanted but cannot be achieved. Conversely, a typical depression episode may be indicated by hypersomnolence, an excessive but irresistible need for sleep.
  • The biology that drives these anomalies of sleep in mood disturbances is not fully appreciated. Some suggest that neurochemical and neurobiological shifts cause these episodic sleep disturbances in conjunction with other shifts that occur in the evolution of manic or depressed states.
• Bipolar disorder and other mood disorders are increasingly better understood in the context of neurochemical imbalances within the brain.
  • Although the circuits of the brain that modulate mood, cognition, and behavior are not well defined, the database of neuroimaging studies that facilitate increased appreciation of possible modulating pathways that connect several brain regions to work in unison to regulate thoughts, feelings, and behaviors is constantly growing.
  • An association of neurotransmitters acts upon various brain regions and circuits to modify and regulate brain activity. Table 1 reflects the putative roles of some CNS neurotransmitters within brain circuits.

  Table 1. Neurotransmitters of the CNS

  Neurotransmitter	Activity Modified
  Serotonin	Mood (happy, sad, euthymic)
  Dopamine	Pleasure (hedonia, anhedonia)
  Norepinephrine	Alertness, energy level (lethargy, frenzy, vigilance)
  Acetylcholine	Memory and cognition
  GABA	Inhibition of CNS neurons
  Glutamate	Excitation of CNS neurons

   

  • One proposal suggests that several neurotransmitters acting in unison but with dynamic balance act as modulators of mood states. In particular, serotonin, dopamine, and norepinephrine appear to modify mood, cognition, and sense of pleasure or displeasure.
  • Pharmacotherapy for the regulation of bipolar mood swings is thought to be based on the use of medications that facilitate the regulation of these and perhaps other neurochemicals to restore a normal mood and cognition state.

Sources:

• AACAP Official Action. Practice parameters for the assessment and treatment of children and adolescents with bipolar disorder. J Am Acad Child Adolesc Psychiatry. Jan 1997;36(1):138-57.
• Biederman J, Faraone S, Milberger S, et al. A prospective 4-year follow-up study of attention-deficit hyperactivity and related disorders. Arch Gen Psychiatry. May 1996;53(5):437-46.
• Chang KD, Steiner H, Ketter TA. Psychiatric phenomenology of child and adolescent bipolar offspring. J Am Acad Child Adolesc Psychiatry. Apr 2000;39(4):453-60.
• Faraone SV, Biederman J, Wozniak J, et al. Is comorbidity with ADHD a marker for juvenile-onset mania?. J Am Acad Child Adolesc Psychiatry. Aug 1997;36(8):1046-55.
• Sigurdsson E, Fombonne E, Sayal K, Checkley S. Neurodevelopmental antecedents of early-onset bipolar affective disorder. Br J Psychiatry. Feb 1999;174:121-7.

next: Bipolar Symptoms in Children Mimic Other Psychiatric Disorders
~ bipolar disorder library
~ all bipolar disorder articles

Self-Therapy For People Who ENJOY Learning About Themselves

Natural scare only occurs when we are face to face with a real threat to our existence (a high speed auto coming toward us, threats with a weapon, etc.).

Almost No Problems At All: Natural fear causes almost no psychological problems at all at the moment of the threat. And it disappears almost immediately after the threat.

Almost everyone automatically does what is in their own best interest at such times. Our innate sense of survival serves us very well. Once the frightening event is over, however, there may be "flashbacks."

Flashbacks: When a fearful situation is so horrible that we think we will not survive the pain, we may "split" or temporarily "leave our bodies" mentally. We do this as a natural, automatic attempt to survive.

If the situation was so awful that we had to split, we may experience "flashbacks" of the event later. It's as if our psyche gives us a chance to reprocess the event later, when we are stronger.

[Flashbacks are discussed in some detail in the Childhood Sexual Abuse topics.]

PROBLEMS WITH UNNATURAL SCARE

The distinction between natural and unnatural scare relates to: Whether the threat is real or imagined, whether the event is current or future.

Even though natural scare is seldom a problem, everyone has problems with unnatural scare.

SOME IMAGINED FEARS

Each of these common fears is imagined:

• Fear of public speaking.
• Fear of "crime" (in general).
• Fear of intimacy.
• Fear of commitment.
• Fear of our own inadequacies.
• Fear of failure.
• Fear of disappointing someone.
• Fear of our own future actions.
• Fear of flying.
• Fear of strangers.
• Fear of embarrassment.
• Fear of illness.

(A complete list could fill a telephone book.)

ALL IN YOUR HEAD?

The pain of unnatural fear is in your body. The solution must come from your mind.

Certain kinds of thinking can help but the overall solution comes from believing you are smart now,
and trusting that you will still be smart in the future!

WHAT'S THE WORST POSSIBLE?

When you are afraid, ask yourself: "What is the worst possible thing that could happen in this situation?"

Then decide what you would actually DO if the worst possible happened.

Example #1:
Someone who is afraid of public speaking may believe they could "die from embarrassment."

They may feel better when they realize that nobody ever does and they will definitely live even if they are embarrassed.

Example #2:
Someone who is afraid to hear the results of an upcoming medical exam may be afraid they'll hear that they will die soon.

Since this is possible (although unlikely), the person would need to make clear decisions about what they would actually do if that happened. (Where they'd get support, what they'd do with the time remaining in their lives, etc.)

WHAT ARE THE ODDS?

It can be extremely helpful to put a real number to the odds of something fearful happening.

For instance: The odds of dying in a plane crash are millions to one.

We owe it to ourselves to base our decisions on the real odds, good or bad.

YOUR BEST THINKING MATTERS!

If this kind of healthy thinking about scare doesn't help, you probably doubt your own ability to think clearly.

Your task then is to learn to trust your own best thinking.

(Since you are reading and understanding these topics, you are smart! Period!)

"What if I'm not thinking so clearly later?"

If you can think clearly now you will be able to think clearly in the future! (Same you. Same brain.)

A REMINDER

We all confuse our feelings sometimes. If you thought you had a problem with scare
but these words don't fit, your problem may be related to one of the other feelings.

Enjoy Your Changes!

Everything here is designed to help you do just that!

next: Quitting Addictions

Short essay addressing the American people's preoccupation with money, power, and heroes and our own potential for transformation.

Life Letters

"If the world is to be healed through human efforts, I am convinced it will be by ordinary people, people whose love for this life is even greater than their fear. People who can open to the web of life that is called us into being, and who can rest in the vitality of that larger body." Joanna Macy

In a paper delivered to the Harvard Seminar on Environmental Values in 1996, Catholic environmentalist, Thomas Berry, wrote about the mighty Titanic. The Titanic, a technological wonder and triumph, was thought to be unsinkable. What happened to this magnificent ship according to Berry serves as a Parable for our time.

While there were several warnings issued regarding the potential danger of icebergs, the Titanic continued speeding along in the frigid waters. The captain trusted his "invincible" ship, and the passengers surrendered responsibility for their lives to the captain. When the ship sunk, it was the poor who suffered the greatest fatalities, although a great number of the wealthy perished along with the "underclass."

Today we sail along on our giant spaceship earth. It too has been thought to be (metaphorically speaking), "unsinkable." And while we've received countless warnings regarding the perils she confronts, we continue to entrust our governments with the authority and responsibility to successfully navigate around them. The technology that made the Titanic possible and yet could not prevent her destruction, is the very same that we collectively count on to save us now. And like the poor who were confined within the bottom decks of the Titanic, our own poor receive the least of our ship's bounty, and suffer the greatest discomfort. And yet in the end, no degree of wealth or status guaranteed salvation for the passengers of the Titanic, nor will it ultimately prevail on our own magnificent and yet vulnerable vessel.

Just as the passengers of the Titanic remained for the most part oblivious to the dangers confronting their ship, our own civilization fails for the most part to fully recognize that the destruction we wreak upon "spaceship earth," not only places our outer world in peril, but ravages our inner lives as well.

The Titanic broke records in design and engineering, and in an attempt to break yet another record, she perished. Collectively, we've repeatedly broken records, many of which foster significant pride. We've demonstrated the brilliance of humankind in countless ways, and with the best of intentions - to improve the quality of our lives. And yet what of the ominous record broken in less than one hundred years? A single generation has managed to destroy more species and ecosystems than all previous generations before us.

Speaking of records, Mark McGwire, first baseman for the Cardinals, recently beat the world record for the most home runs in the history of baseball. Rick Stengel, Senior Editor at Time Magazine, examines in an article for MSNBC why McGwire's "getting more press coverage than the fall of the Berlin Wall."

Stengel points out that McGwire represents the archetypal hero that exists within our collective unconscious, following Joseph Campbell's pattern of departure, initiation, and return. First, McGwire suffers through a devastating divorce and confronts a batting slump that threatens to ruin his career. Next, McGwire enters psychotherapy to face his inner demons. Finally, McGwire works through the pain of his divorce, establishes an even greater level of intimacy with his son, and becomes the greatest single season home-run hitter in history. His story of loss and redemption resonates within the wounded soul of an America whose national leader bears a public shame. We who have always loved tales of the fantastic have unconsciously longed for a new hero.

There's a saying that I have come to value tremendously, "If the people will lead, the leaders will follow." It wasn't the force of the United States government that essentially abolished slavery, established civil rights, or won the right to vote for women, it was the power of the American people. It wasn't the auto industry that initiated the manufacturing of smaller and more gas efficient cars, it was only responding to our demands for them. Many Americans became concerned about global warming and energy conservation long before the government and industry began to act. It was average citizens who defeated the nuclear power industry. An enormous amount has changed throughout the world in just a few short years, and many of the transformations we've witnessed were not led by world leaders, charismatic heroes, or great super powers -- they were propelled forward by everyday people not so unlike you and I.

We too embark on our own hero's journey. We struggle to resolve the woundings of our yesterdays, and to reconcile ourselves to what we've left behind. We each have experienced our own unique and individual initiations, and encounter our own quest as we move towards are personal destinies. And so while we relish the fantastic stories of the Titanic and Mark McGwire, let us not forget the enormous potential for triumph and transformation that flows through each of us.

John Gardener wrote that, "a civilization rises to greatness when something happens in human minds." Just as history doesn't stand still but continually moves onward, we too continue to evolve into increasingly more powerful co-creators. And yet even as we actively create, we also remain in the process of becoming. Goethe observed that, "we are shaped and fashioned by what we love." Americans have been accused of being like materialistic sheep obsessed with consumption and status. While it has been our behavior that has so often defined us, and the outward trappings to which so many of us have become preoccupied, it's time I believe that we each looked inward, and ask ourselves what it is that we truly love. Once we have the answer to that question, then perhaps what occurs in the hearts, and minds, and souls of Americans will indeed lead our civilization to greatness, and our lives will collectively tell a story far more significant than the grandest epic.

next:A Conversation with Michael Lindfield

Detailed information about Zinc, signs and causes of zinc deficiency and who may need extra zinc and zinc supplements.

• Zinc: What is it?
• What foods provide zinc?
• What is the Recommended Dietary Allowance for zinc for infants, children, and adults?
• Table 1: Recommended Dietary Allowance for zinc for infants over 7 months, children and adults
• When can zinc deficiency occur?
• Signs of zinc deficiency
• Who may need extra zinc?
• What are some current issues and controversies about zinc?
  • Zinc, infections, and wound healing
  • Zinc and the common cold
  • Zinc and iron absorption
• What is the health risk of too much zinc?
• Table 2: Upper Levels for Zinc for Infants, Children, and Adults
• Table 3: Selected Food Sources of Zinc
• References

Zinc: What is it?

Zinc is an essential mineral that is found in almost every cell. It stimulates the activity of approximately 100 enzymes, which are substances that promote biochemical reactions in your body (1,2). Zinc supports a healthy immune system (3,4), is needed for wound healing (5), helps maintain your sense of taste and smell (6), and is needed for DNA synthesis (2). Zinc also supports normal growth and development during pregnancy, childhood, and adolescence (7, 8).

What foods provide zinc?

Zinc is found in a wide variety of foods (2). Oysters contain more zinc per serving than any other food, but red meat and poultry provide the majority of zinc in the American diet. Other good food sources include beans, nuts, certain seafood, whole grains, fortified breakfast cereals, and dairy products (2,9). Zinc absorption is greater from a diet high in animal protein than a diet rich in plant proteins (2). Phytates, which are found in whole grain breads, cereals, legumes and other products, can decrease zinc absorption (2, 10, 11).(Refer to Table 1: Selected Food Sources of Zinc lists a variety of dietary sources of zinc.)

What is the Recommended Dietary Allowance for zinc?

The latest recommendations for zinc intake are given in the new Dietary Reference Intakes developed by the Institute of Medicine. Dietary Reference Intakes (DRIs) is the umbrella term for a group of reference values used for planning and assessing nutrient intake for healthy people. The Recommended Dietary Allowance (RDA), one of the DRIs, is the average daily dietary intake level that is sufficient to meet the nutrient requirements of nearly all (97-98%) healthy individuals (2). For infants 0 to 6 months, the DRI is in the form of an Adequate Intake (AI), which is the mean intake of zinc in healthy, breastfed infants. The AI for zinc for infants from 0 through 6 months is 2.0 milligrams (mg) per day. The 2001 RDAs for zinc (2) for infants 7 through 12 months, children and adults in mg per day are:

Table 1: Recommended Dietary Allowances for Zinc for Infants over 7 months, Children, and Adults

References

When can zinc deficiency occur?

Zinc deficiency most often occurs when zinc intake is inadequate or poorly absorbed, when there are increased losses of zinc from the body, or when the body's requirement for zinc increases (14-16).

Signs of zinc deficiency include growth retardation, hair loss, diarrhea, delayed sexual maturation and impotence, eye and skin lesions, and loss of appetite (2). There is also evidence that weight loss, delayed healing of wounds, taste abnormalities, and mental lethargy can occur (5, 15-19). Since many of these symptoms are general and are associated with other medical conditions, do not assume they are due to a zinc deficiency. It is important to consult with a medical doctor about medical symptoms so that appropriate care can be given.

Who may need extra zinc?

There is no single laboratory test that adequately measures zinc nutritional status (2,20). Medical doctors who suspect a zinc deficiency will consider risk factors such as inadequate caloric intake, alcoholism, digestive diseases, and symptoms such as impaired growth in infants and children when determining a need for zinc supplementation (2). Vegetarians may need as much as 50% more zinc than non-vegetarians because of the lower absorption of zinc from plant foods, so it is very important for vegetarians to include good sources of zinc in their diet (2, 21).

Maternal zinc deficiency can slow fetal growth (7). Zinc supplementation has improved growth rate in some children who demonstrate mild to moderate growth failure and who also have a zinc deficiency (22). Human milk does not provide recommended amounts of zinc for older infants between the ages of 7 months and 12 months, so breast-fed infants of this age should also consume age-appropriate foods containing zinc or be given formula containing zinc (2). Alternately, pediatricians may recommend supplemental zinc in this situation. Breastfeeding also may deplete maternal zinc stores because of the greater need for zinc during lactation (23). It is important for mothers who breast-feed to include good sources of zinc in their daily diet and for pregnant women to follow their doctor's advice about taking vitamin and mineral supplements.

Low zinc status has been observed in 30% to 50% of alcoholics. Alcohol decreases the absorption of zinc and increases loss of zinc in urine. In addition, many alcoholics do not eat an acceptable variety or amount of food, so their dietary intake of zinc may be inadequate (22, 24, 25).

Diarrhea results in a loss of zinc. Individuals who have had gastrointestinal surgery or who have digestive disorders that result in malabsorption, including sprue, Crohn's disease and short bowel syndrome, are at greater risk of a zinc deficiency (2, 15, 26). Individuals who experience chronic diarrhea should make sure they include sources of zinc in their daily diet (see selected table of food sources of zinc) and may benefit from zinc supplementation. A medical doctor can evaluate the need for a zinc supplement if diet alone fails to maintain normal zinc levels in these circumstances.

What are some current issues and controversies about zinc?

Zinc, infections, and wound healing
The immune system is adversely affected by even moderate degrees of zinc deficiency. Severe zinc deficiency depresses immune function (27). Zinc is required for the development and activation of T-lymphocytes, a kind of white blood cell that helps fight infection (2, 28). When zinc supplements are given to individuals with low zinc levels, the numbers of T-cell lymphocytes circulating in the blood increase and the ability of lymphocytes to fight infection improves. Studies show that poor, malnourished children in India, Africa, South America, and Southeast Asia experience shorter courses of infectious diarrhea after taking zinc supplements (29). Amounts of zinc provided in these studies ranged from 4 mg a day up to 40 mg per day and were provided in a variety of forms (zinc acetate, zinc gluconate, or zinc sulfate) (29). Zinc supplements are often given to help heal skin ulcers or bed sores (30), but they do not increase rates of wound healing when zinc levels are normal.

Zinc and the common cold
The effect of zinc treatments on the severity or duration of cold symptoms is controversial. A study of over 100 employees of the Cleveland Clinic indicated that zinc lozenges decreased the duration of colds by one-half, although no differences were seen in how long fevers lasted or the level of muscle aches (31). Other researchers examined the effect of zinc supplements on cold duration and severity in over 400 randomized subjects. In their first study, a virus was used to induce cold symptoms. The duration of illness was significantly lower in the group receiving zinc gluconate lozenges (providing 13.3 mg zinc) but not in the group receiving zinc acetate lozenges (providing 5 or 11.5 mg zinc). None of the zinc preparations affected the severity of cold symptoms in the first 3 days of treatment. In the second study, which examined the effects of zinc supplements on duration and severity of natural colds, no differences were seen between individuals receiving zinc and those receiving a placebo (sugar pill) (32). Recent research suggests that the effect of zinc may be influenced by the ability of the specific supplement formula to deliver zinc ions to the oral mucosa (32). Additional research is needed to determine whether zinc compounds have any effect on the common cold.

References

Zinc and iron absorption
Iron deficiency anemia is considered a serious public health problem in the world today. Iron fortification programs were developed to prevent this deficiency, and they have been credited with improving the iron status of millions of women, infants, and children. Some researchers have questioned the effect of iron fortification on absorption of other nutrients, including zinc. Fortification of foods with iron does not significantly affect zinc absorption. However, large amounts of iron in supplements (greater than 25 mg) may decrease zinc absorption, as can iron in solutions (2, 33). Taking iron supplements between meals will help decrease its effect on zinc absorption (33).

What is the health risk of too much zinc?

Zinc toxicity has been seen in both acute and chronic forms. Intakes of 150 to 450 mg of zinc per day have been associated with low copper status, altered iron function, reduced immune function, and reduced levels of high-density lipoproteins (the good cholesterol) (34). One case report cited severe nausea and vomiting within 30 minutes after the person ingested four grams of zinc gluconate (570 mg elemental zinc) (35). In 2001 the National Academy of Sciences established tolerable upper levels (UL), the highest intake associated with no adverse health effects, for zinc for infants, children, and adults (2). The ULs do not apply to individuals who are receiving zinc for medical treatment, but it is important for such individuals to be under the care of a medical doctor who will monitor for adverse health effects. The 2001 Upper Levels for infants, children and adults are (2):

Table 2: Upper Levels for Zinc for Infants, Children, and Adults

Selected Food Sources of Zinc
The 2000 Dietary Guidelines for Americans state, "Different foods contain different nutrients and other healthful substances. No single food can supply all the nutrients in the amounts you need" (36). The following table suggests a variety of dietary sources of zinc and lists the milligrams (mg) and percent Daily Value (%DV*) per portion. As the table indicates, red meat, poultry, fortified breakfast cereal, some seafood, whole grains, dry beans, and nuts provide zinc. Fortified foods including breakfast cereals make it easier to consume the RDA for zinc, however they also make it easier to consume too much zinc, especially if supplemental zinc is being taken. Anyone considering taking a zinc supplement should first consider whether their needs could be met by dietary zinc sources and from fortified foods.

References

Table 3: Selected Food Sources of Zinc (9)

Source: Office of Dietary Supplements,National Institutes of Health

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References

• 1. Sandstead HH. Understanding zinc: Recent observations and interpretations. J Lab Clin Med 1994;124:322-327.

• 2. Institute of Medicine. Food and Nutrition Board. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. National Academy Press. Washington, DC, 2001.

• 3. Solomons NW. Mild human zinc deficiency produces an imbalance between cell-mediated and humoral immunity. Nutr Rev 1998;56:27-28.

• 4. Prasad AS. Zinc: An overview. Nutrition 1995;11:93-99.

• 5. Heyneman CA. Zinc deficiency and taste disorders. Ann Pharmacother 1996;30:186-187.

• 6. Prasad AS, Beck FW, Grabowski SM, Kaplan J, Mathog RH. Zinc deficiency: Changes in cytokine production and T-cell subpopulations in patients with head and neck cancer and in noncancer subjects. Proc Assoc Am Physicians 1997;109:68-77.

• 7. Simmer K and Thompson RP. Zinc in the fetus and newborn. Acta Paediatr Scand Suppl 1985;319:158-163.

• 8. Fabris N and Mocchegiani E. Zinc, human diseases and aging. Aging (Milano) 1995;7:77-93.

• 9. U.S. Department of Agriculture, Agricultural Research Service. 2001. USDA Nutrient Database for Standard Reference, Release 14. Nutrient Data Laboratory Home Page, http://www.nal.usda.gov/fnic/foodcomp Search the database online.

• 10. Sandstrom B. Bioavailability of zinc. Eur J Clin Nutr 1997;51 Suppl 1:S17-S19.

• 11. Wise A. Phytate and zinc bioavailability. Int J Food Sci Nutr 1995;46:53-63.

• 12. Alaimo K, McDowell MA, Briefel RR, Bischlf AM, Caughman CR, Loria CM, Johnson CL. Dietary Intake of Vitamins, Minerals, and Fiber of Persons Ages 2 Months and Over in the United States: Third National Health and Nutrition Examination Survey, Phase 1, 1988-91. In: Johnson GV, ed. Hyattsville, MD: Vital and Health Statistics of the Center for Disease Control and Prevention/National Center for Health Statistics, 1994:1-28.

• 13. Interagency Board for Nutrition Monitoring and Related Research. Third Report on Nutrition Monitoring in the United States. Washington, DC: U.S. Government Printing Office, 1995.

• 14. Prasad AS. Zinc deficiency in women, infants and children. J Am Coll Nutr 1996;15:113-120.

• 15. Hambidge KM, Mild zinc deficiency in human subjects. In: Mills CF, ed. Zinc in Human Biology, New York: Springer-Verlag 1989 Pp 281-296.

• 16. King JC and Keen CL. Zinc. In: Modern Nutrition in Health and Disease, 9th ed. Shils ME, Olson JA, Shike M, Ross AC, eds. Baltimore: Williams & Wilkins, 1999, Pp223-239.

• 17. Krasovec M and Frenk E. Acrodermatitis enteropathica secondary to Crohn's disease. Dermatology 1996;193:361-363.

• 18. Ploysangam A, Falciglia GA, Brehm BJ. Effect of marginal zinc deficiency on human growth and development. J Trop Pediatr 1997;43:192-198.

• 19. Nishi Y. Zinc and growth. J Am Coll Nutr 1996;15:340-344.

• 20. Van Wouwe JP. Clinical and laboratory assessment of zinc deficiency in Dutch children. A review. Biol Trace Elem Res 1995;49:211-225.

• 21. Gibson RS. Content and bioavailability of trace elements in vegetarian diets. Am J Clin Nutr 1994;59:1223S-1232S.

• 22. Brown KH, Allen LH, Peerson J. Zinc supplementation and children's growth: A meta-analysis of intervention trials. Bibl Nutr Dieta 1998;54:73-76.

• 23. Krebs NF. Zinc supplementation during lactation. Am J Clin Nutr 1998;68 (2 Suppl):509S - 512S.

• 24. Menzano E and Carlen PL. Zinc deficiency and corticosteroids in the pathogenesis of alcoholic brain dysfunction--a review. Alcohol Clin Exp Res 1994;18:895-901.

• 25. Navarro S, Valderrama R, To-Figueras J, Gimenez A, Lopez JM, Campo E, Fernandez-Cruz L, Rose E, Caballeria J, Pares A. Role of zinc in the process of pancreatic fibrosis in chronic alcoholic pancreatitis. Pancreas 1994;9:270-274.

• 26. Naber TH, van den Hamer CJ, Baadenhuysen H, Jansen JB. The value of methods to determine zinc deficiency in patients with Crohn's disease. Scand J Gastroenterol 1998;33:514-523.

• 27. Shankar AH and Prasad AS. Zinc and immune function: The biological basis of altered resistance to infection. Am J Clin Nutr. 1998;68:447S-463S.

• 28. Beck FW, Prasad AS, Kaplan J, Fitzgerald JT, Brewer GJ. Changes in cytokine production and T cell subpopulations in experimentally induced zinc-deficient humans. Am J Physiol 1997;272:E1002-1007.

• 29. Black RE. Therapeutic and preventive effects of zinc on serious childhood infectious diseases in developing countries. Am J Clin Nutr 1998;68:476S-479S.

• 30. Anderson I. Zinc as an aid to healing. Nurs Times 1995;91:68, 70.

• 31. Garland ML, Hagmeyer KO. The role of zinc lozenges in treatment of the common cold. Ann Pharmacother 1998;32:63-69.

• 32. Turner RB and Cetnarowski WE. Effect of treatment with zinc gluconate or zinc acetate on experimental and natural colds. Clin Infect Dis 2000;31:1202-1208.

• 33. Whittaker P. Iron and zinc interactions in humans. Am J Clin Nutr 1998;68:442S-446S.

• 34. Hooper PL, Visconti L, Garry PJ, Johnson GE. Zinc lowers high-density lipoprotein-cholesterol levels. J Am Med Assoc 1980;244:1960-1961.

• 35. Lewis MR and Kokan L. Zinc gluconate: Acute ingestion. J Toxicol Clin Toxicol 1998;36:99-101. 3

• 36. Dietary Guidelines Advisory Committee, Agricultural Research Service, United States Department of Agriculture (USDA). HG Bulletin No. 232, 2000. http://www.ars.usda.gov/dgac

• 37. Center for Nutrition Policy and Promotion, United Stated Department of Agriculture. Food Guide Pyramid, 1992 (slightly revised 1996). http://www.usda.gov/cnpp/pyramid2.htm

back to: Alternative Medicine Home ~ Alternative Medicine Treatments

(banned by the FDA, but may be found in some products manufactured outside the U.S. and imported illegally or purchased while traveling abroad)

Ma huang uses include the treatment of upper respiratory diseases, fever, headache, edema and arthritis. Ma huang has been used in the West as a stimulant and an appetite suppressant ("herbal fen-phen"). Ma huang contains ephedrine, pseudoephedrine, norephedrine and several other central nervous system stimulants. These alkaloids stimulate receptors and cause the release of epinephrine. In the past, ephedrine was used in conventional Western medicine for the treatment of asthma and as a topical nasal decongestant, but has generally been replaced by safer drugs.

Quality & Labeling

There is marked variability between labeled ephedra alkaloid/ephedrine content and actual content, and is one of the many concerns with the use of this herb. A study of twenty products found discrepancies between labeled and actual content for 10 products and significant lot to lot variations for four of the products.

Adverse Effects

The adverse effects of Ma huang include anxiety, insomnia, headache, increased heart rate, increased blood pressure, urinary retention, increased blood glucose and a "flushing" sensation. The FDA has received hundreds of adverse effect reports, including deaths in previously healthy, young adults taking the manufacturer's recommended dose of ma huang supplements. Acute hepatitis, kidney stones, myocarditis, stroke and psychosis have been reported. Excessive doses have resulted in heart failure, hypertensive crisis, and death. The FDA recently withdrew recommendations for a daily intake of no more than 24 mg ephedrine, used for no more than 7 consecutive days. More information on the FDA and Ma huang/ephedrine is available on the FDA website.

As might be expected, other CNS stimulants such as decongestants and caffeine should be avoided or used with caution by individuals taking Ma huang. Alarmingly, supplements often contain MH in combination with other stimulants, including botanical sources of caffeine such as guarana and kola nut. Ma huang has the potential to interact with a plethora of conventional drugs, including theophylline, MAO inhibitors, hypoglycemic drugs, antihypertensives and digoxin.

Patients should be counseled to avoid products that contain Ma huang. Individuals with hypertension, angina, heart failure, diabetes, a psychiatric condition, or a previous heart attack or stroke should be especially advised to avoid this herb.

Source: Rx Consultant newsletter article: Traditional Chinese Medicine The Western Use of Chinese Herbs by Paul C. Wong, PharmD, CGP and Ron Finley, RPh

next: Preventing the Devleopment of Alzheimer's

Some people unwittingly choose destructive relationships over and over again. The consequences of their choices are painful and emotionally damaging, yet those that engage in this repetitive behavior never seem to learn from their experience. Instead they go from one bad partner to the next, much to the chagrin of those closest to them (including therapists) who pull their hair out trying to stop them. Why does this happen?

Traditional psychoanalytic theory offered an intriguing, yet seemingly unlikely explanation for such self-destructive relationship choices. People who choose such partners must derive pleasure from being mistreated. Simply stated, the choosers are masochistic. If the "pleasure principle" drives people, as analysts argued, certainly this behavior follows the same rules. The therapist's task was to make the unconscious pleasure known to the patient--and then they would be free to choose a more appropriate partner.

Yet, in my years of doing therapy, I never found any client who received any pleasure at all, conscious or unconscious, from the abuse and neglect heaped on them by narcissistic or otherwise destructive partners. Rather, my clients were simply hurt over and over again. Still, the "repetition compulsion" was true enough: no sooner had a client ended with one particularly hurtful person then they found another wolf in sheep's clothing. There had to be a good reason. Here's what my clients have taught me over the years.

People who have not been given "voice" in childhood have the lifelong task of repairing the "self." This is an endless construction project with major cost overruns (much like the "Big Dig" in Boston). Much of this repair work involves getting people to "hear" and experience them, for only then do they have value, "place," and a sense of importance. However, not just any audience will do. The observer and critic must be important and powerful, or else they will hold no sway in the world. Who are the most important and powerful people to a child? Parents. Who must a person pick as audience to help rebuild the self? People as powerful as parents. Who, typically, is more than willing to play the role of power broker in a relationship, doling out "voice" only insofar as it suits him/her? A narcissist, "voice hog," or otherwise oblivious and neglectful person.

And so it goes. The person goes in the relationship with the hope or dream of establishing their place with a narcissistic partner, only to find themselves emotionally battered once again. These are not "oedipal" choices--people are not choosing their father or mother. They are picking people they perceive powerful enough to validate their existence.

But why doesn't a person leave when they realize they are in yet another self-destructive relationship? Unfortunately, on occasion things go well with a narcissistic partner--particularly after a blowout fight. A narcissist is often expert in yielding just enough "voice" to keep his or her victim from leaving. They grant a place in their world, if only for a day or two. The wish that this change is permanent sustains the voiceless person until the relationship regresses back to its usual pattern.

Giving up a destructive relationship is difficult. The brief moments of validation are cherished, and the person who finally leaves must relinquish the hope of "earning" more. When the person finally breaks free they are faced with an immediate and lasting feeling of emptiness and self-blame that makes them question their decision. "If only I had been different or better--then I would have been valued," is the usual refrain. Once the old relationship is sufficiently grieved, the person immediately resumes their search for another partner/lover with the qualifications and authority to again secure him or her a "place" in the world.

Ironically, this "repetition compulsion" is hardly masochistic. Instead, it represents an ongoing attempt to heal the self, albeit one with disastrous results. The cycle repeats itself because the person knows no other way of preventing themselves from feeling tiny or immaterial.

This is exactly where therapy comes into play. The analysts were correct in at least one important matter. This repetitive behavior has its roots in childhood, the time in which "voice" and self are established. People are often aware that they are struggling to be heard, to have a sense of agency, and to be valued in a relationship, but they are unaware that this is usually the very same struggle they had with one or both parents. A good therapist reveals this by closely examining their personal history.

And so the presenting problem is redefined and broadened to a life issue--and the work begins. A therapist bears down with all the resources available to him or her. Insight is certainly one--for, as suggested above, there is much the client does not know about the depth and breadth of the problem. Just as important is the relationship between therapist and client. Simply put, the relationship must be real, meaningful, and deep. The client must learn to establish voice, and it must be appreciated by the therapist in a genuine way. For the therapy to be effective, the relationship will likely be different from every other one the client has had. Advice and encouragement, often seen as hallmarks of good therapy, are by themselves insufficient. To make headway, the therapist must partially fill the same void that the client was unconsciously hoping their lover would. The client must feel: "My therapist is someone who hears me, values me, gives me a 'place' where I feel real and significant."

Once the client feels certain of this, they can begin looking for partners using more realistic, adult criteria. And they can finally free themselves from people who chronically hurt them. In this way, the self-destructive, repetitive cycle is broken.

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

next: Relationships: The Role of the Hidden Message

Self-Therapy For People Who ENJOY Learning About Themselves

We are all lonely sometimes. One of the best things we can do for ourselves is to arrange our lives to be sure it doesn't happen regularly.

Everyone needs regular doses of attention every day.

DAILY LONELINESS

Daily loneliness comes from ignoring our natural impulses to make contact with other human beings. When we ignore these impulses we say something like this to ourselves:
"She'd probably be too busy."
"He might be in a bad mood."
"I'd better not go out. I don't look my best today."

Whenever you catch yourself saying such things you need to know that your impulse to talk to someone is far more trustable than this self-talk inside your head. Even if you decide not to talk to a certain person for some reason, remember that your impulse to make contact is still there.
So talk to someone else, spend time with your kids, or take a deeper interest in someone you've known casually... but do something with somebody. Or be lonely.

WEEKLY LONELINESS

Weekly loneliness refers to all the temporary, short term ways we create loneliness in our lives.
These usually have to do with screwed up priorities.
We say:
"I'd like to go to see him BUT..."
"... I need to clean out that closet"
"... this project at work is all I can think about now"
or "... It's too early (or too late, or too sunny or too cold, or.........)."

Weekly loneliness is about screwed up priorities. We think something is more important than the human contact we crave, and we are almost always wrong.

LONELINESS AS A LIFE PATTERN

Some people have always been lonely and expect that they always will be. They think "that's just the way I am" and that they can't change.

When Weeks Turn Into Years: Many people make loneliness into a way of life by continually thinking the way the "weekly" people do. They say, and somehow keep believing, that "the rush will soon be over." They are always shocked to look back a few years and find that they've been thinking this way regularly, habitually, continually.

I'm Just Not Good Enough: People who were neglected and demeaned in childhood believe they were destined to be alone. Some were so neglected by the adults in their house that they believe they aren't worth our time. Others were shamed and ridiculed so much that they assume we will look down on them. From their point of view, they are doing us a favor
by not making us "bother" with them. From our point of view, they are robbing us
of their presence in our lives.

People Are Just Too Scary: People who were abused in childhood believe they were destined to be hurt by everyone they meet. From their point of view, they are just protecting themselves
by staying away from us. From our point of view, they are grossly insulting us
by thinking we are so cruel.

Everyone who has a lonely life pattern thinks that something is more important than their need for human contact. And they are wrong 99.9% of the time! (Only our physical needs - like food, air, and water - are more important.)

REGULATING THE RISK

When you examine all of the reasons we have for avoiding each other they all come down to what therapists call "fear of intimacy." Some day I'll write about this fear more directly, but for now here's what we can do when we feel this fear.

We can regulate the degree of contact we allow. When we are lonely, we don't need intense human contact. We just need some human contact. Period.

We can decide whether to look people in the eye, and how long to keep the eye contact. We can decide whether to talk to the mailman and the sales clerk, and how much to say. We can decide how big of a psychological risk we are willing to take with each person we meet today.

Once we know we can regulate the amount of contact we have, we can go get what we want and need: CONTACT with the rest of the human race.

[Read "How Are You Spending Your Time?" for more information about regulating this risk.]

Enjoy Your Changes!

Everything here is designed to help you do just that!

next: Love Relationships

Chapter 76 of the book Self-Help Stuff That Works

by Adam Khan:

HERE'S AN ODD SUGGESTION: When you're working, try to burn calories. Be useful, helpful, and as productive as you can. Even if your job is sitting at a keyboard all day, try to do it energetically and with enthusiasm. It may seem stupid, but give it a try before you decide. Blast out your effort like a thousand-watt bulb and here's what you'll get in return:

1. You'll be more energetic, not less. You'd think it would wear you out, but that's not the case, as you can find out for yourself by trying it. You may have a pleasant sense of relaxation at the end of the day, as you would from some good exercise, but it won't make you tired. Holding back makes you tired. Going through the motions makes you tired. Just trying to get through the day makes you tired.
2. You'll advance faster. Of course, when opportunities come around, the person putting their all into the work (you, for instance) is going to be chosen over the people who are getting by doing as little as possible. Obviously.
3. Your job will be more secure. Giving your all will make you feel more secure in a sometimes insecure world. And you'll not only feel more secure, your feeling will be an accurate perception of the reality.
4. You'll feel better about yourself. It feels good to do well. And you can look your boss in the eye and know s/he's getting a good deal. You can see that there are very few people you work with (or none at all) who give their all. The comparison between you and the rest of the pack will make it very clear in your mind you can stand tall and proud when your supervisor is around.
5. You'll improve your abilities faster. Whatever skills your job requires will be honed more quickly when you're giving it your all.

THE HUMAN BRAIN and body has a default setting: Conserve energy. You know this from personal experience. It's probably hardwired genetically and kicks in with the onset of adulthood. You and I have a natural tendency to try to be conservative with our energy output. That's there naturally, but you're not stuck with it. You can override that default setting with a simple decision: Put out as much effort as you can.

Put the decision into action and before long, you'll forget. You'll be back to your default setting. When you notice you've gone back to the conserve energy mode, decide again to try to burn calories. Remake your decision again and again. Blasting out the energy won't wear you out or make you tired. But it will make you feel proud, secure, and confident.

When you're working, try to burn calories.

Here's a way to make your work more enjoyable.
Play the Game

One way to be promoted at work and succeed on the job may seem entirely unrelated to your actual tasks or purpose at work.
Vocabulary Raises

This is a simple technique to allow you to get more done
without relying on time-management or willpower.
Forbidden Fruits

Here is a way to turn your daily life into a fulfilling, peace-inducing meditation.
Life is a Meditation

A good principle of human relations is don't brag,
but if you internalize this too thoroughly, it can make
you feel that your efforts are futile.
Taking Credit

next: An Island of Order in a Sea of Chaos

Patti's Panic Place

I always remember being anxious. Growing up, everyone would simply say, "you are just a nervous child." So life went on.

I was raised, as many, in a "dysfunctional" family. I had scary thoughts and bad dreams. My father's alcoholism created chaos and additional feelings of insecurities. As a teenager, I suffered from eating disorders, bleeding stomach ulcer, irritable bowel problems. I began avoiding situations where I could not come and go as I pleased; situations where I couldn't be in control. High school was extremely hard. I was absent a lot and I became very good at making excuses.

By age nineteen, I was out on my own, controlling my anxious feelings with alcohol. I learned to cope with everyday situations, working and socializing, by drinking.

I was working in a disco, when I was 21 and met my first husband, David. I got married, had my first daughter, Lindsey, and moved into my home.

The marriage was not a good one. My husband was very irresponsible and didn't like the "tied down" feelings of being married and being a father. I was very insecure. David lost it one night and punched me once and I ended up in the hospital with a fractured nose. I had to have plastic surgery to replace the bones in my nose. We divorced when I was 26.

As a single mother I felt more insecure than ever before. Not only did I have myself to deal with, but I had a child. I was scared and lost.

My World Becomes Smaller:

By this time in my life, I started to avoid more-and-more places. I would wake up in the morning and get Lindsey up and go to my parents. I only went places with my mom. I'd go to the store and begin to feel dizzy and would leave and go sit in the car. I stayed at my parent's house all day and, reluctantly, would come home at night.

I increasingly started feeling more out of control. I had my first full-blown panic attack while shopping for asparagus with my parents and my daughter. I was in the car and all of a sudden I felt this overwhelming urge to find my parents and leave. When I got home, I felt better.

At this point, I stopped going to my parent's house. I stayed home and for a period of time. I didn't even leave my bedroom. My mom would come to my house and pick-up Lindsey and take her to her house. I was so alone and frightened.

I saw programs about panic disorder. I listened intently. They were describing what happened to me. There was a name for what I had: "Agoraphobia".

However, I soon discovered that knowing about the disorder didn't make it go away. And since I didn't know where to turn for help, things didn't get any better. I found doctors that prescribed a variety of tranquilizers, but they made things worse. As a result, I decided to live with the anxiety rather than the zombie fog of the tranquilizers.

Then I met my second husband, Clay. He was a very needy person. Since I couldn't help myself, helping him was my new project. It kept my mind off my problem.

I got pregnant with my second child. Now being completely housebound, I searched for a way to have my baby without leaving the house. I found a midwife and she came to the house for pre-natal visits.

We planned for a home birth. It didn't happen that way. Problems arose with the pregnancy. I had to go the hospital to try and have the baby turned. It didn't work. On the way home, I went into labor and my water broke. The ambulance was called, the babies heart wasn't beating, I had a prolapsed cord. At the hospital, they did a emergency C-section and my daughter, Kaydee, was born. It was a miracle, she was in the intensive care unit for sometime. She was premature, but healthy. Thank-GOD. I wasn't in very good shape, physically or mentally. I wanted out of the hospital, NOW!.

I came home with my new baby. Clay was sinking into drugs and alcohol. He was a very controlling, physically abusive man. He actually found pleasure in the fact that I was agoraphobic. The situation worsened, the arguments, constant upheaval, beatings-- my life was at the lowest point.

My daughters were suffering. Lindsey was a teenager and resented Clay and his sickness. I was losing her. Kaydee was scared and didn't understand what was going on. Things had to change. But how?

I got a computer for Lindsey, and soon found a library at my fingertips. I read everything I could find on panic disorders. I found support groups, other people to talk to. I wasn't alone anymore.

A New Beginning

At this point I had been on-line and reading everything I could get my hands on, finding out new information about PAD (panic anxiety disorder) with agoraphobia. I felt there was help out there for me, I just had to find it.

I sat down with the phone book and started getting phone numbers to therapists that specialized in PAD. I was really anxious and afraid to make the phone calls. What would I say? Would they think I was totally crazy? All these thoughts kept running through my head. I had to do this. I wanted out of this self-made prison I had built for myself.

I made the first phone call. I left messages and some returned my calls. I would explain how I was housebound and really needed someone to come to my house for the first visit. This is the point in the conversation where the therapist would usually say something to the effect of: "I don't make house calls." I felt so stupid and started slipping back into my old thoughts, that there was no help for me and I was being absurd for asking for a therapist to come to my house.

I was getting worse-and-worse. I couldn't sleep. I was waking in the middle of the night in a full-blown panic attack. I started making phone calls again. I had one therapist call me back and after explaining my situation to him, he said, "In the first place, I don't make house calls and I have a waiting list of people who want to come to my office to see me. How could I possibly come to your house!" "OH MY GOD," I thought, how awful for a therapist to say this. I thought "good thing I wasn't suicidal". At first, I felt like crawling in a hole, but then I thought, NO-WAY! I was actually moredetermined to find someone who understood.

The very next day, I got a phone call from another therapist. Once again, I explained. He started asking me questions. This was different. My heart started racing. He stopped and told me that he would think about it and call me back. I waited anxiously for his call. The phone rang, it was him, Dr. Cohn. He told me he had never come to anyone's house before (my heart sunk). I could hear his next words in my head, but then, to my surprise he said he was willing to come to my house!! I couldn't believe what he said. He said he would come. He set up a day and time for the appointment.

When the big day arrived, I was nervous and excited. I saw his car pull up. He was a tall, gray-haired man. He came in and smiled at me and introduced himself. I liked him already. He asked me a lot of questions, writing as we talked. He diagnosed me with extreme panic disorder plus agoraphobia.

He also asked about my family background, any other family members who suffered with any forms of PAD. I told him about my grandmother, who had committed suicide because of her problems with PAD and of my other family members with alcohol problems. He explained about the hereditary aspects of this disorder and chemical imbalances.

He wanted to start me on some medications. He told me to please take the medications as he prescribed and then explained how his patients were afraid of taking any medications. "He must be reading my mind," I thought. He talked about how the fear of taking medications is actually a symptom of PAD, how someone like me, is so in-tune with every little change in our body's reactions to anything that we won't take medications.

I felt reassured about the medication. I promised I would take them. He set up another appointment, in his office. He told me if I didn't feel like I could come, he would make one more visit to my house.

I started taking the medications. It wasn't easy. I was so afraid of putting anything inside my body, fearful of how it would make me feel. He started me out very slowly on low doses, increasing the dose in 5 days. I was on my way. I felt few side-effects from the medications.

The day came for my appointment. My daughter drove me to his office and there I was. Dr. Cohn gave me a big hug and we started talking. I had made it to his office. I felt like I had just ran a marathon and won. This was my first step back into my life.

My Angel

I met Sue, on a day that was like every other day, filled with loneliness and despair. She's the mother of Kaydee's (my daughter) friend, Whitney. Whitney came over to our house to play with my daughter. Sue came to pick her up. We started talking and Sue started to share with me her experiences with panic disorder. As I listened, I couldn't believe I was hearing that she too had suffered with this disorder. I was, to say the least, shocked to actually be hearing someone else had these symptoms I was having. I couldn't get enough. I was like a sponge, soaking up everything that came out of her mouth. I wasn't alone anymore. She knew. She understood. She wanted to help.

Sue started doing "Behavioral Therapy" with me. She would come over to my house and we started out with very small steps. First, she walked down to the corner of my street with me and then back. My legs shook, but I made it. I felt a great sense of confidence that night, something so small, but yet so important. The next time we walked to a park by my house. Sue held my arm and kept reassuring me I was okay, then she let go of my arm and walked ahead of me and then said, walk up to me. I remember telling her I couldn't. She said "Sure you can." I did and we walked further. Then we came home.

These were the first small steps, and how wonderful I felt, and how safe I felt with Sue. I practiced on my own and I noticed the panic feelings weren't there. I was totally amazed. It was working!!

Sue had everything planned out. I wouldn't know where or what we were doing next. The next things we did involved taking rides in Sue's van. She took me for a short drive the first time and it was so strange, like I had been in a coma for a very long time. How things had changed, streets, stores. With each new journey, I conquered another fear and built confidence.

I remember the first day Sue took me to Kaydee's (my daughter) school. It made me so happy to see where Kaydee was going to school. The first time in the grocery store, Sue came in with me. The next time we went, she parked and gave me a list and sent me in by myself. GEESH, was I nervous. I did it, I did it... YEAH

At this point, Sue decided it was time for me to go out on my own. This was really hard. She was my support and I didn't know if I could do it without her. Little-by-little I did, but I still missed her a lot.

Sue's family and I met for dinner a few times. It was really nice to go and do things like that. At this point, my husband was drinking and doing a lot of drugs. Finally one night, Clay went into a rage. He found out that I was going to my therapist without him. He thought I had been telling my therapist things about him and he got really mad. I told him that we needed to go for a ride because I wanted to get him away from the kids.

He lost it, Totally, and beat my head against the dashboard until I was unconscious and then threw me out of his truck, in front of my house. He called from his cell phone and told me he would be back with a big gun. Well, I called the police and they issued a warrant for his arrest. I was taken to the hospital, had a broken jaw and fractured arm. He did show up in the middle of the night, with a rifle and the police arrested him and he spent one night in jail. This was the beginning of more tests of my strength, I believe. I had to have many surgeries on my jaw, braces and pins, lots of physical therapy. After about a year of court dates, he spent 3 months in jail and is now on 5 years ISP probation. Our divorce was final in April of 98.

Sue and I still talk and visit, she will always be my Angel. I will be eternally grateful for her support, guidance and friendship.

My Life Now

It has been almost 3 years now since I started therapy. Many things have changed. I continue to see my therapist, but now our visits consist of different discussions. After one of my sessions, Dr. Cohn asked me if I would be willing to talk to a few of his patients. I did and little did I know this would be yet another journey. Now I do Cognitive Behavioral Therapy with patients of Dr. Cohn's. This has been such a rewarding experience for me. Being a part of their recovery inspires me so much. To see their strength and determination to fight this battle makes everything I went through totally worth it. Dr. Cohn told me that since agreeing to a house call for me, that he now will continue to do so if anyone asks.

I am now remarried to a unbelievable man, who has shown me what love, security and trust are really all about. He supports me in everything I do. I have truly been blessed.

My road to recovery was long, but not nearly as long as the years I did nothing and lived in fear. I challenged my fears. I had weekly appointments with my therapist. I did Cognitive Behavioral Therapy, relaxation exercises, breathing exercises, meditation and kept a journal of all of it. Recovery is a re-learning and re-training process. We need to learn coping techniques so that we can handle stressful situations in a different way than we did. So, I am going to explain the methods I used and continue to use. I hope they will help you too

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