In our culture, single adulthood is a time when people are particularly vulnerable to anxiety because it is a time of strong expectations for creating a foundation for "when you really grow up." Messages about career, marriage, and children begin to dominate many people's lives that previously had been occupied with creativity and exploration. Single adults often show up in therapy with anxiety associated with one of three kinds of experience: Physical sensations such as shortness of breath, racing heart, and shakiness, for which no physical cause can be found.

• A tremendous sense of pressure and fears about not being able to live up to expectations or a sense of being a failure.
• Worry and a sense of panic that get in the way of moving toward goals.

For all of these experiences, young adults have found it helpful to identify the expectations placed on them and evaluate whether those are fitting for them. Often these expectations come directly from their families, but are really nested within larger cultural ideals.

• Elizabeth couldn't stop focusing on her inability to catch her breath and her pounding heart. When she realized she had used family connections to gain a job that wasn't satisfying and acknowledged to herself that she really wanted to be an artist, these feelings stopped.
• In his first business job, Tom was preoccupied with thoughts of failure and compared his progress against other people's promotions. Looking at the bigger picture and at what was most important to him helped him appreciate both his job and other aspects of his life.
• Lynn always expected that, in her twenties, she would marry and have kids. As she approached her thirtieth birthday still single, she felt a sense of growing panic and despair. Once she recognized how the panic was keeping her from enjoying anything, she realized there could be other ways to live a productive and enjoyable life.

Questions for Single Adults

• What do you think are the cultural messages, in terms of expectations, for you at this time of your life?
• What do you find most fulfilling in your life?
• If you were to be guided by fulfillment instead of the pressure of expectations, what would that be like? Would that be a good thing or bad thing? Is there a middle ground that would be more fitting for you?
• Who would support this kind of direction for your life? Why?

next: What Are Night Terrors
~ anxiety-panic library articles
~ all anxiety disorders articles

Why do women in their 20's face so much anxiety? These women are supposed to have a career, find a partner, make money, have a life. Do it all. Do it now.

In an Ally McBeal episode from late 1997: Ally: "Why do you think that women feel the need to be married anyway?"

Renee: "Society drills it into us that women should be married. Society drills it into us that smart people should have careers. Society drills it into us that women should have children and mothers should stay at home. And society condemns the working mother who doesn't stay at home. So what chance do we really have when society keeps on drilling us?

Ally:"We can change it, Renee. . . . I plan to change it! I just want to get married first." A young woman recently told a therapist she was having problems with "anxiety." In the conversation, the therapist mentioned that in her generation women went to college to get their "Mrs." The young woman looked at her blankly, having no idea what she was talking about, not getting the reference. The therapist said, "You know, to find a husband, to get married." The idea was so foreign to the young woman, she had trouble comprehending. "That's not what's happening now," she said. "I have to go to college, get a degree, and be good at what I choose to do. Otherwise I won't make it." The therapist asked, "What do you mean-- 'make it'?""Well, you know, have a career, make lots of money." And what else?" Get married and have children, of course." They then entered into a discussion about the kinds of pressures young women in their 20's experience.

• They (we) live in a time of increased production and consumption
  --faster, better, smarter, more power.
• They have increased access to information
  --information the media moguls decide to produce.
• They are bombarded by how they are supposed to look, what they are supposed to eat, what to wear, how to keep fit, where to be seen
  --the computer-generated "perfect" female image.

Then the young woman said that many of her friends, ranging in age from 21-29, were also experiencing different versions of what they call "anxiety." Why were she and her friends having this particular experience? The woman and the therapist thought that perhaps these young women, who go to college to get degrees in biology, psychology, film, communications, anthropology (not to get their Mrs.), are horribly affected by the pressures enumerated. These women are supposed to have a career, find a partner, make money, have a life. Do it all. Do it now. Responding to all of these expectations is, of course, impossible. And what happens when women see how impossible it is?

They experience anxiety. Although single men may not experience the degree of pressure to get married and have children that women do, expectation is something they have to deal with as well. They are also subjected to the expectation to do it all and do it now. For both men and women who stay single, unless they have entered an alternative life in which marriage is not the expectation, the pressure can continue throughout life. James, a 48-year-old architect, reports that 80% of the clients he works with ask about his marital status and wonder what the problem is that keeps him unmarried!

next: Anxiety Overlooked, Under Recognized Component of Mood Disorders in Women
~ anxiety-panic library articles
~ all anxiety disorders articles

Thanks for the memories, Fox TV

BY LIZ SPIKOL
lspikol@philadelphiaweekly.com

It is not my habit to sit at home on Saturday night and watch the Fox 10 O'clock News. It is my habit to sit at home on Saturday night, but watching Fox doesn't generally enter into it. One night, though, my tendency toward the raw side of the TV dial got the better of me.

It was a strange twist of fate, I guess--one of those moments some would say was guided by a Higher Power but that I say was simply guided by desperation in the newsroom. The dirty, hidden secret Fox unscraped from beneath the news desk was this: Shock treatments are still performed in the United States and a new study says their benefit is even shorter-term than previously believed.

The coincidence was that I had spent much of the day before reading that study, talking to people about it and even being interviewed for an AP wire report about it. Even at home on a Saturday night, I couldn't escape that study. And I was reminded of it again this week, when 60 Minutes II did a similar story documenting the shock experience.

I had shock treatments for depression in 1996, which I suppose seems like a long time ago. One negative side effect has been that the passage of time does not compute for me the way it does for others. I couldn't tell you a thing about what I did two weeks ago, so it's as if two weeks ago never happened. If you go through years like that, the years easily disappear.

The benefits were short-term--about three months. Exactly one year later, I was back in the psych ward once again. If it surprises you that I had shock treatments, it shouldn't--between 100,000 and 200,000 people will have them this year, and that's just an estimate.

Unfortunately, there are no reliable statistics on the administration of shock treatments because, unlike most medical practices, reporting is not federally required. Just this year, Vermont became the first state to mandate record-keeping about shock therapy. And the machines used to perform shock treatments have been grandfathered out of regulation, so they can be as old as a Chevy in Cuba.

Fox News didn't say much about regulation, but they did something few media outlets had done before this week: They showed someone receiving shock treatments.

In most people's minds, the image of shock is of Jack Nicholson in One Flew Over the Cuckoo's Nest . That's no longer accurate. As the doctors will tell you, with the IV muscle relaxant, the most that happens to the body when the electric shock induces a grand mal epileptic seizure is a slight curl of the toes.

The woman on Fox, who was a patient of Dr. Harold Sackheim, the author of the new study everyone's in a lather about, was pretty, with dark brown hair, and looked to be in her 40s. As Sackheim is a great proponent of shock therapy, and a financial beneficiary (hence the controversy surrounding his research), he was likely more than happy to provide Fox with an exemplar of how well the therapy can work.

But if you're at the point in your mental illness where you need shock treatments, you are truly in extremis. Is this an appropriate time for a doctor to ask his patient to appear on television?

I'm not surprised by Sackheim because, as I'll relate later, I think he lacks integrity. Nor do I blame Fox, because I imagine Sackheim (the supposed expert) told them she was fit as a fiddle for an interview.

But she wasn't, really. One friend who saw the broadcast said, "She looks like she's on Pluto."

There she sat, her hair still wet from the gel they use for the electrodes. She had a strange half smile on her face and her eyes were looking beyond the camera. She spoke of feeling like this might actually be the answer for her. But her voice was light and airy and she gave the impression of being less than her physical being would imply. I felt sorry for her.

When I had shock treatments, I was just as hopeful. I wonder if she will be as crushingly disappointed when she discovers how short-term her relief will be. Will she, like me, think it darkly comic that though shock treatments are most often given to people who are suicidal, the majority of those who end up killing themselves have already had shock treatments?

I did all the right things the following Monday--called the bioethicist, talked to the activists, did the research on the newest research. I don't think the information on this study is being disseminated properly, and I'll do my best to remedy that. But for now, I can't help thinking of that woman and the newscast of her shock treatments.

I was expecting the curl of her toes. But I had no idea the face contorts like that.

I understand now why I had a huge mouthpiece between my teeth. They told me it was just a precaution in case something went wrong. But the muscles in the face tense pretty violently.

So now I have another memory I didn't have, courtesy of Fox News on a Saturday night. Who says it's a bore to stay home? PW

---

The Shocking Truth, Part II

Why the sudden media blitz? And why is it all so lacking?

BY LIZ SPIKOL
lspikol@philadelphiaweekly.com

The Pelican Brief is bad, stupid filmmaking. But Sunday night, I sat in my bedroom, transfixed by Julia Roberts as a young law student pursuing The Truth despite the fact that it puts her life in danger and kills her older/drunk/ depressive lover. Denzel Washington plays Woodward and Bernstein all by himself -- taking deep-throated tips on the phone, calling his editor from pastoral scenes that actually bristle with malice. With all that expressionless tenacity and sleeping upright with scribbled notes in lap, the only cliche Washington isn't shoved into is an affair with Roberts, which I assume is because he's black and she's white.

Thing is, the movie does get you all runny about being a journalist. It makes you ask yourself, again, why you do what you do. And when I get really, really mad at another media outlet, I try to think of a producer from, say, 60 Minutes II, watching The Pelican Brief in his pajamas on a Sunday night getting all runny inside, too. Maybe it's at a moment like this that he thinks, "Gee, I really screwed that story up ..."

I'll own up to mistakes myself. In my last column, I said Vermont was the first state to require record-keeping in relation to shock treatments. That's not true. Normally, the column would have been fact-checked, but I told our copy editor, "I fact-checked it myself." (If that isn't a cry for help, I don't know what is.) The other states that require record-keeping are California, Colorado, Texas, Illinois and Massachusetts.

I know 60 Minutes II has to give Charles Grodin his 30 seconds or so to be droll and effete, so I thought I'd issue a clarification on its behalf--when I got a call from Joel Bernstein, the producer of the segment on shock treatments who I'd just, one night before, been envisioning in footies.

Turns out, of course, that Bernstein and I were talking about radically different shows. While I heard him call Dr. Harold Sackheim a "physician," he told me that right before the show he changed that to "doctor," after he was informed that Sackheim was not, in fact, an M.D. We had other disagreements about Sackheim: I think the show made an error in judgement by giving Sackheim a disproportionate amount of air time, making it seem as though he were the primary expert in the field.

Bernstein told me, "The hospital where he works does a lot of it [ECT]. They have a strong research program there." Well, I do a lot of playing with my dog, but that doesn't make me an animal behaviorist. And Sackheim doesn't actually "do" any ECT--because he's not a psychiatrist. Bernstein told me, "I'm sure Sackheim makes a nice salary, but he doesn't make any money from doing the treatments himself." Because he can't--but those research grant applications have been rolling in under his name since 1981, garnering roughly $5 million dollars from the National Institute of Mental Health.

Sackheim has also acted as a (paid and unpaid) consultant to a company that makes ECT machines, MECTA. The show did not disclose Sackheim's ties to MECTA, including the fact that he testified on their behalf in a product liability suit against a shock machine manufacturer in 1989.

"I knew about his ex-ties with MECTA," Bernstein said, but he also said Sackheim denied any current financial connection, which would--he's right--negate conflict of interest. Should the past linkages bother me? They don't bother Bernstein, and he's been doing this a lot longer.

Bernstein and I quibbled on other details, but he believes he presented a balanced view. "We pointed out what everybody ought to know by now--that there is no cure for depression. I never implied that this was a magic bullet." That's true, but Sackheim was allowed to say on-camera, with no opposition, that, "The medical community recognizes universally that ECT is the most effective antidepressant we have."

The "medical community" does no such thing--and who is Sackheim to speak for it?

ECT can be effective for roughly 80 percent of those who undergo it. But as with any medication, if you stop taking it, you stop receiving the benefits. Interestingly, the most recent study on the devastatingly high relapse rate was done by Sackheim himself. The study showed that more than half of those who undergo ECT will relapse in 6-12 months. One wonders if Sackheim's increased media presence isn't the industry's way of putting a spin on those very depressing results.

Sometimes journalists rely on others to tell them who to interview. "Who's the best person to talk to in this field?" I might reasonably ask someone who specializes in hot-metal biomechanics.

In this case, 60 Minutes II didn't do enough backgrounding. I find it discouraging that with so many qualified, uncompromised, knowledgeable and honest psychiatrists who practice ECT, 60 Minutes II chose to highlight Harold Sackheim. Nothing could be worse for the show's credibility.

Producer Joel Bernstein told me at the end of our call, "We did this whole thing in 10 days--it was very fast. In retrospect, I wish I could have taken more time with it." I have a feeling he wouldn't have relied on Harold Sackheim if he did.

I asked Bernstein where he got the idea for the story. "A psych friend told me that shock therapy was making a comeback and then The Atlantic magazine story came out, and that was the shove I needed."

Perhaps that's the real story here. Is all this damage control, orchestrated by Sackheim and friends? Who called The Atlantic Monthly --or Associated Press or Reuters or Fox News--and pitched the story? That, I'm sure as I am a journalist, is the bigger tale to tell. PW

---

The Shocking Truth, Part III

As the battle over "informed consent" rages on, when does "yes" mean "yes"?

BY LIZ SPIKOL
lspikol@philadelphiaweekly.com

I have a vague memory of it, sitting across from my mother in a booth at PhilaDeli on Fourth and South, begging for shock treatments. I'm not sure what I had heard and where, but on that day, I would not be deterred: Give me ECT or give me death.

From research, I had come to believe that electroconvulsive therapy was not only my last hope, but also my best hope. And though I was not well enough to work or to live alone or to even get through the day without my mother's care, I could still, through it all, be as persuasive as the captain of a winning debate team.

It wasn't so much the logic of what I said that convinced her, but more how I said it--tacking on a guarantee (and she knew it was no bluff) that I would kill myself if we didn't try it. My life was ruined, over, everything had been lost. I had failed to respond to every medication combination, and lived in constant pain. What did I have to lose?

Of course, my mother didn't leave that conversation and immediately sign me up. She did her own extensive research and she and my father spent long hours talking about whether they could subject their child to such seeming barbarism. She spoke to various experts on the subject who told her the pros and cons.

At the time, we were all desperate, and wanted badly to hear the pros outweigh the cons. And luckily, they did.

The experts talked only of immediate after-effects: headache, nausea, muscle aches. They also talked about memory loss, but said it was transient.

There would be short-term amnesia--a post-ECT "Where am I?" kind of thing--and some memory loss of the events surrounding the treatments themselves. Worst-case scenario: permanent memory loss for the couple months preceding the treatments and maybe a month after.

A missed movie, perhaps. Or a forgotten conversation. All of which sounded like small-time worries compared to suicide.

This was presented as the treatment of last resort--as the one thing that might save me. So I consented. I signed the forms myself because, though I was in terrible shape, I was able to do so.

It amazes me now that a doctor considered me competent enough to sign a consent form at the time. But I'm sure it helped having my parents standing right there with me.

Knowing what I do now, I'm not sure I (or my parents) would make the same decision again. What the doctors don't tell you is that the memory loss is much more devastating--and the ECT industry continues to deny this, to cover it up. Of the 240 online responses to last week's 60 Minutes II broadcast on shock treatments, most were from people saying they'd had ECT.

What, in particular, compelled them to write?

The issue of memory loss.

I started to count, but I'm horrible with numbers. One after another, the posts are a sad catalog of anger and despair. The majority spoke of losing more memory than the doctors said they would. "I don't remember my children being born," says one.

The loss these ECT patients suffer goes far beyond the commonly cited "1 in 200" figure that shows up on the model consent form drafted by the American Psychiatric Association (APA). It is this consent form that most hospitals in America still use before giving ECT. It is the consent form I signed.

In a 1996 article from the Washington Post, Dr. Harold Sackheim, whom I wrote about last week, admitted the 1-in-200 number was a fabrication, "an impressionistic number" that would "most likely be omitted from APA reports in the future." That was five years ago, and it has yet to happen.

The real number, of course, is much higher. The fact of the matter is that despite numerous journal articles and testimony from many respected neurologists and psychiatrists, the psychiatric establishment continues to ignore the problem of memory loss. Since research dollars are monopolized by those with an interest in sustaining the industry, no reliable post-ECT studies are being conducted.

When I said "yes" to ECT, I did not truly know what I was saying "yes" to. I was not accurately presented with the risks, benefits and outcomes.

Did I know it was possible I would lose years of memory? Did I know I would forget how to spell certain words, that it would take me years to be able to read a book again? Did I know it was possible the benefits would last only a few months?

No one told me these things. If they had, would I still have done it? I highly doubt it.

I gave consent to the procedure, but it wasn't truly informed--something the supervising doctor on my case admitted to me years later. Unfortunately, the alternate consent forms I've seen proposed are so extreme as to serve only as a deterrent. What is needed is a form that fesses up to the very real probabilities--both good and bad.

But if you think it's a violation of human rights to get a treatment that destroys your brain in ways doctors didn't warn you about, think about the injustice of receiving that treatment against your will. Paul Henri Thomas has already received 40 forced electroshocks at Pilgrim State Psychiatric Center in New York. Another patient there, Adam Szyszko, has gone to court to stop the same hospital from forcing him to receive ECT.

I'll write about both their cases next week. Stay tuned. PW

---

The Shocking Truth, Part IV

Forced electroshock isn't just the stuff of movies.

BY LIZ SPIKOL
lspikol@philadelphiaweekly.com

I've always been somewhat awed by the Hippocratic Oath. Unlike the presidential Oath of Office, forever tarnished by Bill's perjury, the Hippocratic Oath is still imbued with dignity. I saw this at work on 60 Minutes Sunday, in a story about a mentally ill man who had been moved from death row to a psychiatric facility once it was discovered he was incompetent to stand trial.

His doctor had the ability to make him well enough to stand trial, but told Leslie Stahl that making a man well in order to have him killed violated his notion of the Hippocratic Oath's primary dictum: Do no harm. Why don't doctors who perform electroshock therapy feel the same way?

New York State Supreme Court Justice W. Bromley Hall decided April 16 that Pilgrim Psychiatric Center on Long Island can resume its shock treatments of Paul Henri Thomas, despite Thomas' opposition. Thomas is a 49-year-old inpatient at Pilgrim, which is under the jurisdiction of New York State Office of Mental Health (OMH). He emigrated to the U.S. from Haiti in 1982. Though he has been diagnosed with schizoaffective disorder and bipolar mania (among other diagnoses), he does not believe he is mentally ill. This, according to doctors at Pilgrim, is part of his illness.

Thomas did initially consent to ECT in June 1999. At that time, he was considered competent to consent. But after three treatments he decided he'd had enough--at which point the Pilgrim doctors decided Thomas was incompetent.

Newsday staff writer Zachary R. Dowdy characterized the situation as "a kind of Catch-22--the strange circumstance that Thomas was fine when he consented to the procedure but mentally incompetent when he refused it." Since 1, Thomas has received nearly 60 forced electroshocks.

Part of the doctor's defense of Thomas' forced ECT was the patient's erratic behavior. Justice Hall agreed, writing in his decision, "He was wearing three pairs of pants which he believed provided therapy for him. At the same time he was found, in the ward, wearing layers of shirts which were inside-out, together with jackets, gloves and sunglasses."

Oh my God! Someone stop this man before his commits another fashion faux pas! Strap him down, put him in a diaper, shove a mouthguard between his teeth, administer sedatives and then induce a grand mal seizure in him against his will. Surely after that he'll be calm enough to reconsider his wardrobe.

As his case heated up, Thomas issued a public statement in which he said, "I am currently undergoing forced electroshock treatment. ... It is horrible. ... I am strong. But no human being is invincible. ... I ask God to bless you in anticipation of your helping me in my torture and traumatization. ...Do whatever is possible!"

Anne Krauss worked as a peer advocate in the New York OMH and was assigned to Thomas' case. Krauss supported Thomas' fight against forced ECT but was ordered by her superiors to cease action on his behalf.

On March 21, Krauss resigned. In her letter of resignation, she wrote, "The New York State OMH is taking the position that for me to actively advocate (on my own time and at my own expense) on behalf of Paul Thomas creates a conflict of interest for me in my job .... Given the choice between continuing to work for an agency which so discounts recipients' voices that it will repeatedly force electroshock on someone who has clearly said that he experiences it as torture, or advocating for this person's right to make his own decision about whether electricity should be run through his brain, I am choosing to advocate."

Referring to Thomas' history as a human rights activist, Krauss said, "I am following Mr. Thomas' own example in putting ideals of human rights and liberty before my desire for personal comfort or job security."

Doctors say Thomas' liver would be "further damaged" by giving him antipsychotics. ECT is approved, recommended and effective primarily for depression. It has never been definitively proved, in any clinical study, to be effective for psychosis. Did someone fail to tell the judge that ECT does not equal treatment with antipsychotics?

They also say one of the reasons Thomas denies his illness is because in Haiti, cultural perceptions of mental illness are different. Additionally, doctors admitted that if Thomas were at a private facility, he'd be unlikely to receive ECT.

Is it fair to discriminate against someone simply because he doesn't have money for private care? Or because he comes from a different culture?

If this seems like an isolated case, one need look no farther than down the proverbial hall--where 25-year-old Adam Szyszko also fights forced electroshock at Pilgrim. Szyszko was granted a temporary restraining order. His mother told the Associated Press, "I think it's horrible they are holding my son prisoner. I want the treatments stopped." Her son, a diagnosed schizophrenic, is allergic to the medications Pilgrim would prescribe. Forget the fact that Szyszko and family prefer he try psychotherapy instead of drugs.

Why is Paul Henri Thomas being forcibly shocked while Adam Szyszko--while admittedly in a horrible situation--is not? I wonder if it's because Thomas is black and Szyszko is young and white. Isn't it more wrenching to read about a young man who played classical piano and won awards in grade school? The New York Post sees fit to blare, "MOM'S IN TEARS AS DOCS 'TREAT' HER CAPTIVE SON" about Szyszko, but says nothing about Thomas.

"do no harm." Can anyone at Pilgrim be said, like the doctor on 60 Minutes, to be guarding the integrity of the Hippocratic Oath? It would seem that in New York, the oath has long been forgotten. PW

next: Shock Therapy...IT'S BACK
~ all Shocked! ECT articles
~ depression library articles
~ all articles on depression

Thursday, March 29 the Appellate Division will hear oral argument in Matter of Adam S. The case is scheduled for approximately 10 AM at the 45 Monroe Place courthouse in Brooklyn. Twenty-five year old Adam Szyszko is appealing an order authorizing Pilgrim State Psychiatric Center to involuntarily administer up to twenty electroconvulsive shock treatments. Pilgrim psychiatrists shocked Adam twice before a stay was obtained by his attorney Kim Darrow of Mental Hygiene Legal Services Second Department. Adam's sister, Anna Szyszko, will be available to speak with the media following the hearing. At 11:30 she will hold a press conference outside the courthouse, together with representatives of Disabled In Action, Network Against Forced Electroshock, Brooklyn Mental Hygiene Court Monitors Project and other disability and human rights activists.

"This whole thing is not about Adam but about power for Pilgrim State Hospital," said Anna Szyszko. "How dare they prevent us from trying treatments that have helped so many people just because they don't offer them in their facility and insist on forcing Adam to undergo a procedure that does more harm than good -against his and his family's wishes?" When asked for comment, Bill Brooks, Supervising Attorney of the Mental Disability Law Clinic at Touro Law Center said: "When psychiatrists want to treat, they will frequently take steps to do so regardless of whether the treatment conforms with the legal rights of patients."

"This is not just one case," remarked Connie Lesold of the Brooklyn Mental Hygiene Court Monitors Project, who has been following Matter of Paul Henry Thomas. "Pilgrim is openly using electroshock to stun disabled people into submission." Nadina LaSpina of Disabled In Action added: "Running 150 volts of electricity through someone's brain against his will is a crime against humanity."

next: Terrible Legacy of Lake Alice Psychiatric Hospital
~ all Shocked! ECT articles
~ depression library articles
~ all articles on depression

Women and Anxiety: Twice as vulnerable as men. Why?

If the thought of delivering a speech makes your heart race, your palms sweat, and your stomach turn, you are not alone. Fear of public speaking ranks ahead of illness and dying. Why? Many women dread the public embarrassment and humiliation that might come from making a mistake, being perceived as incompetent, or being judged.

For some women, however, this fear becomes overwhelming to the point that it interferes with their daily lives. They might retreat into a "safe" job with little public contact or turn down a job that requires making presentations. When that happens, the fear has escalated into a more intense state - anxiety. From a biological standpoint, anxiety is grounded in the "fight or flight" response that protects human beings from real physical threats.

Anxiety isn't bad. It motivates us to get out of harm's way and is an important part of living," according to Jerilyn Ross, M.A., L.I.S.W., and author of Triumph Over Fear: A Book of Help and Hope for People with Anxiety, Panic Attacks and Phobia. "But when anxiety becomes disproportionate to the situation and leads to avoidance of the fear-inducing situation and other undesirable consequences, it should be assessed", says Ross.

The Female Factor

Women are more prone to anxiety due to a variety of biological, psychological and cultural factors. Although the exact cause is unknown, recent research suggests that fluctuations in the levels of female reproductive hormones and cycles play an important role in women's enhanced vulnerability to anxiety. There is also some evidence that women become more anxious when their levels of estrogen and progesterone are low, such as in premenstrual syndrome (PMS), premenstrual dysphoric disorder (PMDD), post-partum depression, and menopause.

Some research points to psychological and cultural factors playing a role in a woman's propensity towards anxiety. These theories propose that women are less assertive and thus more vulnerable to stress, or that it is more acceptable for women to express fear. Ross doesn't buy this theory, which she believes furthers a stereotypical view of females.

Finally, genetics plays a role in susceptibility to anxiety.

next: Postpartum Anxiety Disorders
~ anxiety-panic library articles
~ all anxiety disorders articles

Suggestions for parents on how to explain war and terrorism to your children.

20 Tips for Parents

Once again, parents and teachers are faced with the challenge of explaining war and terrorism to their children. Although these are understandably difficult conversations, they are also extremely important. While there's no "right" or "wrong" way to have such discussions, there are some general concepts and suggestions that may be helpful. These include:

1. Create an open and supportive environment where children know they can ask questions. At the same time, it's best not to force children to talk about things until they're ready.
2. Give children honest answers and information. Children will usually know, or eventually find out, if you're "making things up". It may affect their ability to trust you or your reassurances in the future.
3. Use words and concepts children can understand. Gear your explanations to the child's age, language and developmental level.
4. Be prepared to repeat information and explanations several times. Some information may be hard to accept or understand. Asking the same question over and over may also be a way for a child to ask for reassurance.
5. Acknowledge and validate the child's thoughts, feelings and reactions. Let them know that you think their questions and concerns are important and appropriate.
6. Be reassuring, but don't make unrealistic promises. It's fine to let children know that they are safe in their house or in their school. But you can't promise children that no more planes will crash or that no one else will get hurt.
7. Remember that children tend to personalize situations. For example, they may worry about friends or relatives who live in a city or state directly or indirectly associated with any of the recent terrorist incidents.
8. Help children find ways to express themselves. Some children may not want to talk about their thoughts, feelings or fears. They may be more conformable drawing pictures, playing with toys, or writing stories or poems.
9. Avoid stereotyping groups of people by country or religion. Use the opportunity to explain prejudice and discrimination and to teach tolerance.
10. Children learn from watching their parents and teachers. Children will be very interested in how you respond to events in the world. They will also notice changes in your routines such as reducing business travel or modifying vacation plans, and they will learn from listening to your conversations with other adults.
11. Let children know how you're feeling. It's OK for children to know if you are anxious, confused, upset or preoccupied by local or international events. Children will usually pick it up anyway, and if they don't know the cause, they may think it's their fault. They may worry that they've done something wrong.
12. Don't let children watch lots of TV with violent or upsetting images. The repetition of frightening scenes of planes crashing or buildings falling down can be very disturbing to young children. Ask local TV stations and newspapers to limit the repetition of particularly frightening or traumatic scenes. Many media outlets have been receptive to such overtures.
13. Help children establish a predictable routine and schedule. Children are reassured by structure and familiarity. School, sports, birthdays, holidays and group activities all take on added importance.
14. Don't confront your child's defenses. If a child is reassured that things are happening "very far away" it's probably best not to argue or disagree. The child may be telling you that this is how they need to think about things right now in order to feel safe.
15. Coordinate information between home and school. Parents should know about activities their child's school has planned. Teachers should know about discussions which take place at home, and about any particular fears, concerns or questions a child may have mentioned.
16. Children who have experienced trauma or losses in the past are particularly vulnerable to prolonged or intense reactions to the recent tragedies. These children may need extra support and attention.
17. Monitor for physical symptoms including headaches and stomachaches. Many children express anxiety through physical aches and pains. An increase in such symptoms without apparent medical cause may be a sign that a child is feeling anxious or overwhelmed.
18. Children who are preoccupied with questions about war, fighting or terrorism should be evaluated by a trained and qualified mental health professional. Other signs that a child may need additional help include ongoing trouble sleeping, intrusive thoughts, images, or worries, or recurring fears about death, leaving their parents or going to school. Ask your child's pediatrician, family practitioner or school counselor to help arrange an appropriate referral.
19. Help children reach out and communicate with others. Some children may want to write to the President or to a State or local official. Other children may want to write a letter to the local newspaper. Still others may want to send thoughts to soldiers or to families who lost relatives in the recent tragedies.
20. Let children be children. Although many parents and teachers follow the news and the daily events with close scrutiny, many children just want to be children. They may not want to think about what's happening halfway around the world. They'd rather play ball, climb trees or go sledding.

Recent events are not easy for anyone to comprehend or accept. Understandably, many young children feel confused, upset and anxious. As parents, teachers and caring adults, we can best help by listening and responding in an honest, consistent and supportive manner.

Fortunately, most children, even those exposed to trauma, are quite resilient. Like most adults, they will get through this difficult time and go on with their lives. However, by creating an open environment where they feel free to ask questions, we can help them cope and reduce the risk of lasting emotional difficulties.

David Fassler, M.D. is a child and adolescent psychiatrist practicing in Burlington, Vermont. He is also a Clinical Associate Professor in the Department of Psychiatry at the University of Vermont. Dr. Fassler chairs the Council on Children, Adolescents and their Families of the American Psychiatric Association. He is also a member of the Work Group on Consumer Issues of the American Academy of Child and Adolescent Psychiatry.

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Learn about what you can do to help a loved one with anxiety.

People who have generalized anxiety disorder worry excessively and uncontrollably about things that can range from global issues to everyday occurrences. If you have a loved one who suffers, it's important to know that family support helps recovery. Some things family members can do to help a loved one diagnosed with an anxiety disorder are:

• Learn about the disorder.
• Recognize and praise small accomplishments.
• Modify expectations during stressful periods.
• Measure progress on the basis of individual improvement, not against some absolute standard.
• Be flexible and try to maintain a normal routine.

Source: Anxiety Disorders Association of America

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Learn about the different types of stress that can affect us.

Stress management can be complicated and confusing because there are different types of stress--acute stress, episodic acute stress, and chronic stress -- each with its own characteristics, symptoms, duration, and treatment approaches. Let's look at each one.

Acute Stress

Acute stress is the most common form of stress. It comes from demands and pressures of the recent past and anticipated demands and pressures of the near future. Acute stress is thrilling and exciting in small doses, but too much is exhausting. A fast run down a challenging ski slope, for example, is exhilarating early in the day. That same ski run late in the day is taxing and wearing. Skiing beyond your limits can lead to falls and broken bones. By the same token, overdoing on short-term stress can lead to psychological distress, tension headaches, upset stomach, and other symptoms.

Fortunately, acute stress symptoms are recognized by most people. It's a laundry list of what has gone awry in their lives: the auto accident that crumpled the car fender, the loss of an important contract, a deadline they're rushing to meet, their child's occasional problems at school, and so on.

Because it is short term, acute stress doesn't have enough time to do the extensive damage associated with long-term stress. The most common symptoms are:

• emotional distress--some combination of anger or irritability, anxiety, and depression, the three stress emotions;
• muscular problems including tension headache, back pain, jaw pain, and the muscular tensions that lead to pulled muscles and tendon and ligament problems;
• stomach, gut and bowel problems such as heartburn, acid stomach, flatulence, diarrhea, constipation, and irritable bowel syndrome;
• transient over arousal leads to elevation in blood pressure, rapid heartbeat, sweaty palms, heart palpitations, dizziness, migraine headaches, cold hands or feet, shortness of breath, and chest pain.

Acute stress can crop up in anyone's life, and it is highly treatable and manageable.

Episodic Acute Stress

There are those, however, who suffer acute stress frequently, whose lives are so disordered that they are studies in chaos and crisis. They're always in a rush, but always late. If something can go wrong, it does. They take on too much, have too many irons in the fire, and can't organize the slew of self-inflicted demands and pressures clamoring for their attention. They seem perpetually in the clutches of acute stress.

It is common for people with acute stress reactions to be over aroused, short-tempered, irritable, anxious, and tense. Often, they describe themselves as having "a lot of nervous energy." Always in a hurry, they tend to be abrupt, and sometimes their irritability comes across as hostility. Interpersonal relationships deteriorate rapidly when others respond with real hostility. The work becomes a very stressful place for them.

The cardiac prone, "Type A" personality described by cardiologists, Meter Friedman and Ray Rosenman, is similar to an extreme case of episodic acute stress. Type A's have an "excessive competitive drive, aggressiveness, impatience, and a harrying sense of time urgency." In addition there is a "free-floating, but well-rationalized form of hostility, and almost always a deep-seated insecurity." Such personality characteristics would seem to create frequent episodes of acute stress for the Type A individual. Friedman and Rosenman found Type A's to be much more likely to develop coronary heat disease than Type B's, who show an opposite pattern of behavior.

Another form of episodic acute stress comes from ceaseless worry. "Worry warts" see disaster around every corner and pessimistically forecast catastrophe in every situation. The world is a dangerous, unrewarding, punitive place where something awful is always about to happen. These "awfulizers" also tend to be over aroused and tense, but are more anxious and depressed than angry and hostile.

The symptoms of episodic acute stress are the symptoms of extended over arousal: persistent tension headaches, migraines, hypertension, chest pain, and heart disease. Treating episodic acute stress requires intervention on a number of levels, generally requiring professional help, which may take many months.

Often, lifestyle and personality issues are so ingrained and habitual with these individuals that they see nothing wrong with the way they conduct their lives. They blame their woes on other people and external events. Frequently, they see their lifestyle, their patterns of interacting with others, and their ways of perceiving the world as part and parcel of who and what they are.

Sufferers can be fiercely resistant to change. Only the promise of relief from pain and discomfort of their symptoms can keep them in treatment and on track in their recovery program.

Chronic Stress

While acute stress can be thrilling and exciting, chronic stress is not. This is the grinding stress that wears people away day after day, year after year. Chronic stress destroys bodies, minds and lives. It wreaks havoc through long-term attrition. It's the stress of poverty, of dysfunctional families, of being trapped in an unhappy marriage or in a despised job or career. It's the stress that the never-ending "troubles" have brought to the people of Northern Ireland, the tensions of the Middle East have brought to the Arab and Jew, and the endless ethnic rivalries that have been brought to the people of Eastern Europe and the former Soviet Union.

Chronic stress comes when a person never sees a way out of a miserable situation. It's the stress of unrelenting demands and pressures for seemingly interminable periods of time. With no hope, the individual gives up searching for solutions.

Some chronic stresses stem from traumatic, early childhood experiences that become internalized and remain forever painful and present. Some experiences profoundly affect personality. A view of the world, or a belief system, is created that causes unending stress for the individual (e.g., the world is a threatening place, people will find out you are a pretender, you must be perfect at all times). When personality or deep-seated convictions and beliefs must be reformulated, recovery requires active self-examination, often with professional help.

The worst aspect of chronic stress is that people get used to it. They forget it's there. People are immediately aware of acute stress because it is new; they ignore chronic stress because it is old, familiar, and sometimes, almost comfortable.

Chronic stress kills through suicide, violence, heart attack, stroke, and, perhaps, even cancer. People wear down to a final, fatal breakdown. Because physical and mental resources are depleted through long-term attrition, the symptoms of chronic stress are difficult to treat and may require extended medical as well as behavioral treatment and stress management.

Adapted from The Stress Solution by Lyle H. Miller, Ph.D., and Alma Dell Smith, Ph.D.

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Six myths surround stress. Dispelling them enables us to understand our problems and then take action against them. Let's look at these myths.

Myth 1: Stress is the same for everybody.

Completely wrong. Stress is different for each of us. What is stressful for one person may or may not be stressful for another; each of us responds to stress in an entirely different way.

Myth 2: Stress is always bad for you.

According to this view, zero stress makes us happy and health. Wrong. Stress is to the human condition what tension is to the violin string: too little and the music is dull and raspy; too much and the music is shrill or the string snaps. Stress can be the kiss of death or the spice of life. The issue, really, is how to manage it. Managed stress makes us productive and happy; mismanaged stress hurts and even kills us.

Myth 3: Stress is everywhere, so you can't do anything about it.

Not so. You can plan your life so that stress does not overwhelm you. Effective planning involves setting priorities and working on simple problems first, solving them, and then going on to more complex difficulties. When stress is mismanaged, it's difficult to prioritize. All your problems seem to be equal and stress seems to be everywhere.

Myth 4: The most popular techniques for reducing stress are the best ones.

Again, not so. No universally effective stress reduction techniques exist. We are all different, our lives are different, our situations are different, and our reactions are different. Only a comprehensive program tailored to the individual works.

Myth 5: No symptoms, no stress.

Absence of symptoms does not mean the absence of stress. In fact, camouflaging symptoms with medication may deprive you of the signals you need for reducing the strain on your physiological and psychological systems.

Myth 6: Only major symptoms of stress require attention.

This myth assumes that the "minor" symptoms, such as headaches or stomach acid, may be safely ignored. Minor symptoms of stress are the early warnings that your life is getting out of hand and that you need to do a better job of managing stress.

Adapted from The Stress Solution by Lyle H. Miller, Ph.D., and Alma Dell Smith, Ph.D.

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Discover the many different ways stress affects us.

The subject of stress has become a favorite subject of everyday conversation. It is not unusual to hear friends, coworkers, family members, and ourselves, talk about the difficulty we have with managing the stress of everyday living. We talk about being burned out, overwhelmed and "losing it." We also hear and talk about our efforts to control the events that cause stress, and most of us understand the results of not controlling our reactions to stress. Yes, we know that stress may cause heart disease. But most of us are unaware of the many other emotional, cognitive and physical consequences of unmanaged stress.

• Forty-three percent of all adults suffer adverse health effects from stress.
• 75 to 90 percent of all physician office visits are for stress-related ailments and complaints.
• stress is linked to the six leading causes of death--heart disease, cancer, lung ailments, accidents, cirrhosis of the liver, and suicide.
• The Occupational Safety and Health Administration has declared stress a hazard of the workplace.

Stress is expensive. We all pay a stress tax whether we know it or not. Currently, health care costs account for approximately 12 percent of the gross domestic product, escalating yearly. In terms of lost hours due to absenteeism, reduced productivity, and workers' compensation benefits, stress costs American industry more than $300 billion annually, or $7,500 per worker per year.

While stress plays havoc with our health, productivity, pocketbooks, and lives, stress is necessary, even desirable. Exciting or challenging events such as the birth of a child, completion of a major project at work, or moving to a new city generate as much stress as does tragedy or disaster. And without it, life would be dull.

Adapted from The Stress Solution by Lyle H. Miller, Ph.D., and Alma Dell Smith, Ph.D.

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