Health related information and news from around the world.

The use of barbiturates for sleep has all but disappeared in recent years. In 1971 these drugs accounted for 47 percent of the prescriptions for hypnotic medications; six years later the figure had dropped to 17 percent, and by 1982 it was 9 percent. That the figure is even this high has more to do with entrenched prescribing habits among some physicians than with appropriate choice of therapy. One reason for the decline is the high risk of tolerance, dependence, and addiction involved with the use of barbiturates. Besides, such drugs as Seconal and Nembutal lose their effectiveness quickly, compelling users to step up the dosage.
Barbiturates can be deadly drugs; a dosage only fifteen times higher than that needed for sleep can be fatal. In the past barbiturates were the drugs most frequently used in suicide attempts. The presence of alcohol greatly increases the danger; even relatively small doses of barbiturates and alcohol can be fatal. Furthermore, the liver deterioration that accompanies alcoholism means that heavy drinkers are at special risk if they also use barbiturates because these toxic drugs must be broken down in the liver. These drugs may actually worsen sleep by suppressing the deep NREM and REM stages. And during withdrawal from medication, sleep can be even worse than before use of the drug and is marked by REM rebound, hallucinations, anxiety, or, in severe cases, seizures.
*279\226\8*

Unresolved grief reaction. Is there anything we can do to ease the grief reaction? Not really. In fact grieving is to be encouraged, so that the locked up energy generated from the stress reaction can be expressed and shared. A person can be affected in the future if this locked up energy is allowed to remain inside. This is called unresolved grief reaction and can be damaging. One patient who was referred to me, a young lady, had agoraphobia after the death of her father. She was using up all her time to help her grieving mother and did not grieve for herself. Her mother was depressed and suicidal. The patient was young and just married, she moved in with her mother to comfort her, and was afraid to show her own emotion, as she was afraid this could harm her mother. Her mother got better, but the daughter fell ill and this lasted for many years afterwards.

Acceptance. The next phase of healing is acceptance of what has happened. A homeostatic peaceful rearrangement or a new balance of the psyche is reached. The person may be badly scarred, but may find life has a different meaning or that his feelings and experiences may now be in a different level of existence. Extraordinary stress sometimes changes a person for the better. Things that he used to take for granted are now treasured. Happiness is now more like a spice in life, a gift rather than a necessity.

Insomnia. Sleep may be a problem in the initial phase. But most patients do not want any sleeping medication. They want to feel the pain and want the wound to heal in its natural way. There will always be a scar. But they treasure the experience and look back on it occasionally. Once an equilibrium state is reached, most people are able to continue their normal life. They will never forget this kind of extraordinary stress and the loss they can never replace. Somehow life goes on and the sun is always up the next day.

We normally cope adequately with most stresses, but there are occasions when the coping mechanisms fail. We call this a nervous breakdown, and in such cases professional help is called for, as medications and other forms of treatment are sometimes indicated.

*80\174\4*

We generally think of the sensation of pain as something we could well do without. When we are more thoughtful we can see the need for pain, but it still seems that pain as a warning sensation is much too severe and too prolonged. However, when we come to examine the situation more closely, we see that there is a reason for this. For instance, let us suppose that we burn our hand. The pain from the burn is sudden, intense, and severe. It overwhelms us and we immediately withdraw our hand. The pain is so intense that this reaction occurs automatically, quite beyond our control, and in the time of a split second. In this way the intensity of the pain causes the immediate withdrawal of our hand and so preserves it from further injury. We are not even given the chance to think about it. Thus, the severity of the pain is essential for its protective purpose. But the pain persists after we have withdrawn it from the flame, and is still so intense that we cannot even bear to touch the burnt area. This is again protective. By not touching it, we avoid bringing infection to the raw burn.

We sprain our ankle. The initial pain is so intense that we involuntarily fall to the ground, and our ankle is thus saved from further injury by immediately putting a stop to the stress which was tearing the ligaments. If we turn our foot in the direction of the twist there is an immediate recurrence of pain. So this movement is avoided and there is no further injury. This state of affairs persists for some days. The painful movement is avoided, and the torn ligaments are left undisturbed so that the process of repair can proceed in a way that would not be possible if the injured ankle was allowed pain-free movement.

*102\57\2*

Why meditation?

As I have been discussing throughout the book, our recovery depends upon learning to manage our anxiety and attacks ourselves. Understanding and accepting our disorder are the first two steps to taking the power back. Learning to manage the attacks and anxiety are the third and fourth step.

This chapter will look at meditation; what it is and why it works. In the next chapter two different meditation techniques will be described.

Managing them means we need to follow a disciplined approach to a formal relaxation program. At first glance some people hesitate. Although they want to recover they don’t like the idea of having to become disciplined in their approach to relaxation.

Meditation can become a superior relaxation technique if it is practised daily. In one way, ‘having to relax’ is a contradiction to the practice itself, but many of us find we reach the stage where we do it because we want to, not because we have to.

*62\94\8*

Cynthia

Cynthia had panic disorder but didn’t avoid anything. She went to work and did everything she had to do, but it was very difficult. She went to see a specialist, although she had to wait five months for an appointment. When she got there he was three hours late. He finally arrived, but didn’t apologise for keeping her waiting. Although Cynthia had an hour appointment, it only lasted for twenty minutes. She told the specialist about the panic attacks and he kept asking her what she was scared of. Cynthia kept telling him she was always scared and anxious that she might die from the attacks. The specialist kept saying she had to be scared of something and Cynthia wasn’t sure what he was getting at. In the end she said she had always been scared of elevators, but that was long before the panic attacks started. The specialist told her to go into the foyer and get into an elevator and go up and down in it until her anxiety disappeared. With that he finished the appointment and told her to book another with his secretary. She was so confused and angry she never went back.

Alice, Toni, Carlie

Alice asked the local discussion group what she should do about her therapist, who always went to sleep during her appointments. Toni and Carlie looked at her and told her their therapists always went to sleep too. It didn’t take long for them to realise they were talking about the same therapist. When the group asked them why they didn’t speak to him about it or try and find another therapist, the three of them said he was obviously very tired and they didn’t want to hurt his feelings.

*44\94\8*

Medication

Drugs are another control people use. The risk of dependence on drugs is well researched. Medication is one of the main treatments for the disorder, yet the anxiety and panic attacks can blast through our ‘chemical calm’. In many cases the dosage is increased, either by ourselves or by our doctor. When attempts are made to withdraw from the medication, anxiety and panic attacks can return in full force, along with withdrawal symptoms. In an effort to stop the increased anxiety, panic attacks and symptoms of withdrawal, some people will continue with the medication and become trapped in the cycle of dependence.

Depression

With little or no effective treatment many people may develop a major depression in reaction to their disorder. Until recently this depression was also seen as a primary condition. Although steps were taken to treat the depression, the primary cause—the anxiety disorder—was rarely considered, let alone treated.

*25\94\8*

It is the lack of diagnosis and the lack of adequate treatment services which is the driving force behind the development of the secondary conditions of these disorders. Although the symptoms of panic disorder were first noted in the 1800s (Boyd et al. 1991), panic disorder was only classified as a separate anxiety disorder by the American Psychiatric Association in February 1980 (APA 1980). As a consequence there was little understanding of it, not only by the people who suffer from it, but by the health professions generally. Many people have developed secondary conditions such as agoraphobia, major reactive depression, and drug and/or alcohol abuse.

The development of major depression can lead to suicide. According to one American study, 26.5 per cent of people who experience panic disorder will attempt suicide. People who have not been diagnosed as suffering from panic disorder, but who nevertheless experience panic attacks, are seven times more likely than the general population to attempt suicide (Malison et al. 1990). Other studies confirm that 10-40 per cent of people with an alcohol dependence had an anxiety-related disorder before their dependence developed (Cox et al. 1990).

The recognition of the sometimes severe disabilities associated with anxiety disorders has seen the inclusion of the more severe forms of panic disorder, obsessive compulsive disorder and social phobia into the category of serious mental disorder

(Andrews 1994). This is not to say people with severe disorders have a serious mental illness. Rather it is the recognition of the extreme disablement caused through the disorders.

*9\94\8*