Antidepressants Blog

Man, I’m telling you, I think I almost threw my back out. We tried it on one of those water beds. We never got into the swing of the thing. The thing took control of us. It was like making love on a bucking bronco.

HUSBAND

In outfitting your clinic, pick a bed that is large, firm, and quiet while in motion. Test it out, at least a little, before you buy. Considering how much time you spend in bed, it is worth a major investment. If possible, dispense with a stand and place the mattress and springs directly on the floor. Doing so will add firmness and soundproofing. Forget water beds. Contrary to mythology, and except for variety, they are not the best environment for sex and certainly not for the posture of the future.

You will also need about ten large, firm pillows. Some wedge-shaped pillows will come in handy for the posture of the future. Bedding should be mutually appealing to both partners, but satin sheets, again contrary to popular myth, are not the best for sex. “I slip, he slips, the bed slips, the pillows disappear, and I almost get shot right out from underneath him. When I’m on top, I can’t get any traction,” reported one wife in the couples’ sample.

Make sure the colors in the room appeal to both of you. Both partners must be involved in the design and decorating of this clinic. It will take some time, but make this private place the best place for both of you to be free. Make sure the phone unplugs and anything distracting is removed. If you want mirrors, put them up. Nobody will see them if you keep this room locked.

If you have followed along to this point, stand back now and do an inspection of the construction. Any artwork should be mutually chosen, preferably enlarged pictures of both of you. No pictures of the kids, the dog, parents, or friends. This one private place should reflect a celebration of your marriage, your intimacy, and your sexuality. Add any last-minute details such as incense, candles, a new soft rug, space heater if it gets too cold, and air conditioner if it gets too hot. Make sure you have removed any and all excuses for why this room is not totally yours. Once you have done that, once you have prevented your bedroom from being a “bored” room, your clinic is ready for staffing.

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There is no research available documenting successful marital therapy. At best, researchers can identify “non-failures” in treatment programs. You will learn later how to treat your own sex and marital problems and how to select a professional helper if you need one. For now, do not go to a therapist who quotes “high success rates.” There is really no such thing. Therapists and therapy do not cure; people must heal their own relationships.

In spite of all marital advice available on television and from books, you are the only ones who know what you want and how to get it. There is probably too much communication in marriage, not too little, as therapists like to stress. We talk too much and sense too little. Therapists may tell you to talk more, listen more, use lotions, touch each other, or prescribe an array of supposedly “tested” techniques for improving sex in marriage. Unfortunately, these models are based on an incomplete perspective of the relationship between marriage and sex.

We are told that if we can find the right technique, if we can only “do something,” we can solve our problems. If I learned anything from observing these thousand “hardy” couples and the hundreds of others in my clinical experience, I have learned that marriage is first and foremost a system, the most complex of systems, and that it has been corrupted by the unquestioned acceptance of the “sex-perts” and their magic techniques for satisfaction.

The answer to any marital problem rests within, not without. It rests on understanding your unique system of interacting, independent of measures of vascular change, fluid discharge, orgasmic reflex, and communicational gimmicks. You will be learning a “super sex,” a way of interacting intimately that transcends the meeting of some historically imposed genital and orgasmic tradition.

Remember, if we chase a butterfly hard and fast, we will never eaten it. Perhaps if we learn to receive instead of achieve, we will be open to our own natural supersystem. The butterfly will light î our shoulder.

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One of the main, if not the main function of the doctor down through the ages, has been the relief of pain.

Perhaps, with the rapid increase in the means to actually treat the underlying cause, doctors have not recently concentrated enough on relieving chronic pain.

Certainly, the best pain-relieving drugs are those derived from opium and this hasn’t changed for centuries but doctors are again looking at the problem of pain and trying to do something about it.

Pain management clinics have sprung up in hospitals and as private clinics and usually consist of several different specialists working as a team.

The discovery of substances called endorphins occuring naturally in the body has prompted research to stimulate their production. These are pain-relieving chemicals believed to be stronger in action than morphine and heroin.

Acupuncture is believed to work in relieving chronic pain by stimulating the formation of endorphins and some forms of massage can do the same.

Chronic pain causes depression and, perhaps, depression itself is a cause of pain.

No longer is there any justification for the physician or surgeon to say to a patient with chronic pain that she will just have to learn to live with it. Referral to a pain clinic will bring the sufferer not only hope but, in many instances, considerable relief as well.

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Constipation leads to a bloated, uncomfortable feeling in the abdomen, to headaches and lethargy. These symptoms were once thought to be due to absorption of toxic products from the bowel. Experiments have shown that these symptoms are due only to distension of the bowel and not to any ‘poisoning’.

There are many causes of constipation. Some may be normal or physiological, such as from dehydration, from starvation or from a low or non-residue diet.

Local disease of the bowel, such as cancer or diverticulitis, may cause obstruction and so constipation.

General disease elsewhere may affect the bowel. When the thyroid gland is under-active (myxoede-ma) all the body functions slow down. Drugs may be a common cause of slowing down of the bowel activity. Opium and all its derivatives, including codeine, are constipating.

Prolonged immobility, from confinement to bed or a long car or plane trip, can be a cause. Constipation may also result from depression.

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The ideal parent should love, nurture and wisely discipline his children so they may develop as ideal children and into ideal adults. But the real world is rarely like that.

Even with the best will in the world and no matter how much we love our children, they sometimes do get us down. Perhaps we sometimes smack them as a result of our own anger or frustration rather than in a genuine desire to teach them not to do the wrong thing.

Recognise yourself in this description? Perhaps if you answer yes, you have some objection to seeing it included under a discusion on child abuse. It really is all a matter of degree.

Children of all ages are frequently abused in our community. This may be physical or mental abuse, they may be deprived of proper nutrition or they may be sexually abused. While we may rightly be offended by this behavior we will not solve the problem nor help the victims by seeking only to punish those parents who abuse their children.

There are many reasons why these parents may fall below what we regard as proper behavior to their children.

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Each organ consists of a number of different types of cells arranged in a characteristic pattern. For example, the stomach has an inner lining, a muscle layer and an outer protective coat. The lining contains acid-producing and mucus-producing cells. The middle layer contains muscle cells, blood vessels with the different types of blood cells within them, lymph vessels, lymph cells, and supporting cells which hold all the others together. The outer layer contains supporting cells and nerve cells.

Some cells, such as the acid-producing cells, occur only in the stomach. Some, such as the muscle cells, are also found in the intestines, bladder and other organs. Others, such as blood and lymph vessels, are found throughout the body. Each type of cell has a unique job and a unique appearance. A muscle cell cannot do the job of a nerve cell. An acid-producing cell cannot do the job of a blood cell, and so on.

The process of developing special functions is called differentiation or maturation. A cell with few or no special functions is called undifferentiated, immature or primitive. The only function of undifferentiated cells is to multiply when necessary to produce cells which are capable of developing into specialised cells. Once cells specialise they often lose the ability to multiply. For example, mature red blood cells are so specialised for carrying oxygen around the body that they cannot reproduce themselves. As old cells wear out or are lost by bleeding, new red blood cells come from undifferentiated cells in the bone marrow, not from the mature red cells in the blood.

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Once your body is no longer receiving the replacement oestrogen, the symptoms of oestrogen deficiency will start to return. For hot Rushes, unless you are several years past the menopause (or have been cutting down gradually), you will probably notice them appear within a few days; but you will continue to have the benefit of oestrogen on the condition of your skin, bones, vagina and bladder for a few months after you stop. Eventually, however, your skin will become thinner, your vagina drier, your bones less dense, and bladder problems may return.

Nature has pre-detennined for you how long your hot flushes and other short-term symptoms will last, and taking HRT will not affect this. So, for example, if you were genetically destined to have flushes for two years and you stop HRT after eighteen months, then the flushes will last for another six months; if you stop HRT after two and a half years, you will probably get some flushes as your body’s level of oestrogen falls, but once you have stopped taking it and oestrogen levels have stabilised again, the flushes should stop. What you can’t know, however, is what timespan. Nature has in mind for you, so it is impossible to predict exactly how you will be affected by the withdrawal of replacement oestrogen.

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Many women report a marked improvement in their symptoms after hysterectomy. Others experience a worsening of some symptoms, or the emergence of new symptoms that they attribute to the operation. The University of Newcastle/Macquarie University study mentioned earlier in this chapter found that while two-thirds of women considered that the symptoms they had before hysterectomy were improved by the operation, nearly as many women had symptoms which they thought were made worse or were caused by their hysterectomy. Participating women generally experienced less abdominal and back pain than before the operation, their incontinence improved, sex was less painful and they were less tired and tearful. However 29% were concerned about the development of hot flushes since their hysterectomy, 21% now had vaginal dryness and 17% had weight problems. Many also said they found the convalescence more difficult than they had expected, with pain a particular problem. Sizeable numbers would have liked more information about what was involved in recovering from hysterectomy before deciding on the operation, as well as more help in dealing with emotional problems associated with it and more information about alternative treatments. A small proportion thought they were worse off; 4% said the operation caused more problems than it solved and 7% that they would not have gone ahead had they fully understood what it entailed. Despite this, 96% of the women said they were satisfied that they had had the right treatment, and 95% said they would make the same decision again if the circumstances were the same.

The Maine study of hysterectomy also reported on the advantages and disadvantages of the operation. Many of the women who took part experienced relief from symptoms — especially pelvic pain, urinary symptoms, fatigue, psychological symptoms and sexual problems — although once again some women experienced new problems after hysterectomy including hot flushes (13%), weight gain (12%), depression (8%) and lack of interest in sex (7%). Many of the symptoms women experience after hysterectomy seem to relate to a downturn in the function of their ovaries. If women are aware of this they can give consideration before surgery to the possibility that hysterectomy and hormone therapy may turn out to be a ‘package’, both components of which are necessary to achieve an improved quality of life.

It is difficult to reconcile the prevalence of new or unresolved symptoms following hysterectomy and the generally high levels of satisfaction with it. Obviously there are many aspects that each woman needs to explore before embarking on a major medical treatment like hysterectomy. This may be more easily said than done; it amounts to putting a value on removal of our present problems while trying to estimate what value we place on a range of future possibilities that may or may not occur. In other words, the symptoms of pelvic pain, difficult bleeding and fatigue that encourage many women to have a hysterectomy are in the ‘here and now’. They make everyday living a chore, or worse, a nightmare. Furthermore many women who have hysterectomies have tried other treatments and found them wanting. In contrast, the outcome of hysterectomy is in the future. Every woman having the operation hopes it will relieve every symptom she has and create no new problems. Realistically, this may not occur. While one can comprehend in one’s mind the fact that up to half of the women who have a hysterectomy experience some adverse effects, and that these may resolve quickly or have a negative impact on quality of life long-term, there is always the possibility that a particular individual will be fortunate and experience no down side. Perhaps women with an optimistic frame of mind are more likely to ‘take the punt’ on hysterectomy than those with a pessimistic bent. Making a decision that takes account of all the possibilities is more difficult.

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The study of biological clocks and rhythms has now evolved into a special science called chronobiology. Chronobiologists are not only interested in the biological rhythm of sleep but also in other biological functions such as the rhythm of hormonal secretion, urinary excretion, gastric function, body temperature, and the periodical fluctuation of human performance during the 24 hour cycle. Some chronobiologists are even interested in the biological rhythms in animals and plants.

Franz Halberg, a US chronobiologist, divided biological rhythms into three types. In 1959 he described the familiar circadian rhythm— its period is about a day. Then, in 1967, he described ultradian rhythms, which are biological rhythms with periods of less than a day. These include the 90 minute sleep cycle, also known as the REM/NREM cycle or Kleitman’s basic rest activity cycle (BRAC). This has been described in chapter 5, Two kinds of Sleep. Rhythms of the third type are called infradian rhythms. These rhythms have periods in excess of a day; the most familiar is the monthly menstrual period. These biological rhythms can be summarised as follows:

(1) Ultradian rhythms: less than a day

(2) Circadian rhythms: about a day

(3) Infradian rhythms: more than a day

The ultradian rhythm with its periodicity of about 90 minutes determines human performance and arousal state both day and night throughout the 24 hour period. This 90 minute cycle has also been found to operate in other human biological activities; for example, urinary volume and concentration, gastric contraction activity, pupil size under constant illumination, respiratory rate, and even heart rate. This rhythm exerts its influence both in the awake and in the sleeping state.

The periodicity of the ultradian rhythm varies from species to species. In man, it is about 90 minutes; in cats, 20 minutes; in rhesus monkeys, 60 minutes. The significance of this ultradian rhythm and the reason for its existence is still a mystery.

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We have already discussed the mechanisms by which relaxation and regression of themselves work to reduce anxiety. Tension is eased, and so also are all the various symptoms which are the direct or indirect manifestations of anxiety. However, once we have mastered the relaxation of the body, the relaxation of the mind, and regression, we are in a position to use a more direct approach to the relief of symptoms and the promotion of better responses to life situations.

In its simplest form this consists of presenting to our mind very simple ideas for improvement while still in the relaxed and regressed state.

Regression and Sequences of Thought-We have discussed the idea of regression at some length as a process by which we drift back to a simple and more primitive way of mental functioning in which we cease to be alert and critical. In it we leave our mind to wander uncontrolled as in a state of reverie. Now that we have achieved this state of affairs we can go a step further. We can exert some control over our mind, but at the same time maintain our regression. This type of control must be very simple and primitive in itself, or it will bring us to be alert and critical, and our regression will immediately be lost.

The basis for the relief of our symptoms lies in the introduction of very simple trains of thought while we are still in our relaxed and regressed state of mind. It is emphasized that the trains of thought must be simple and direct or we will not be able to maintain our regression. The maintenance of the regression as we consider the train of thought is all-important. Without the regression the therapeutic train of thought has little or no effect at all.

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