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STRESS AND MARRIAGE BREAKDOWN: HOW HUSBANDS AND WIVES VIEW EACH OTHER’S FAULTS
I have observed differences in the way men and women react to discovering faults in each other. Perhaps I may be just expressing a view based on experience in Australian society; perhaps I may even be wrong. Perhaps there are men who hold what I would see as a female view, and women who hold what I would term a male view.
It seems to me that men don’t like to think of their girlfriends and wives as having any faults. It is as though they prefer to see them through the soft-focus lens of rose-coloured glasses, because if they had in mind their wives’ faults, their wives might be less desirable in their eyes. A man may not be able to say what colour his wife’s eyes are, or what dress she was wearing when he last saw her, but this failure to perceive basic facts about his wife’s external appearance is not due to lack of interest or ‘taking his wife for granted’. Far from taking their wives for granted, as some women wrongly suspect, men tend to see their wives in a sort of dream image of beauty. If they are pressed to acknowledge some unpleasant fact about their wives, they will resist accepting it as long as possible.
Women, on the other hand, tend to be well aware of the failings of the men they love. It is as though they have a list of the faults and weaknesses of their boyfriends and husbands which they are willing to overlook. ‘He may not be all I ever wanted in a man,’ she says, ‘but he’s still my Jack!’ She sees his faults, she accepts them, perhaps secretly intends to work on them after they’re married, and loves him in spite of them. She needs, therefore, to be able to ignore significant things about his behaviour, things that would otherwise bother or irritate her.
From what the reader has already learned about the symptoms of severe stress breakdown in the third stage, it will be apparent that an over-stressed wife may not be able to overlook, or forgive, or not respond to, the little faults and failings of dear Jack, and she may begin responding angrily to them.
‘Jack,’ she says, ‘I have put up with your mess in the bathroom without saying anything for the last fifteen years. The very next time I have to go into that bathroom after you and wipe up the water from where you left the shower curtain open, so help me mate, you’ll die!’
Jack’s response, of course, is utter bewilderment. Thinking like a male who never sees his wife’s bad points if he can get out of it, he has assumed all these years that the water just evaporated very quickly, and that nobody seemed to care if there was a bit of water lying around the floor. He feels guilty, and a little betrayed, because Beryl had never told him how this made her angry.
A male response to being unable to tolerate things previously tolerated might be exemplified by the following situation. Jack has met up with an old friend who used to take his wife Beryl out before they were married. Perhaps the relationship between the wife and her previous beau became too intimate, and she had confessed this to her present husband before they were married. Now, after ten years, they all meet up again. This time, it happens that Jack, the husband, is suffering from stage three stress breakdown symptoms.
A few days after their group outing, Jack finds he is unable to block out the thought of his wife and the previous boyfriend becoming intimate. He refuses to sleep with his wife – ‘I can’t get the picture out of my mind of you and that creep being together!’ he says. She is hurt and humiliated at the thought that her husband could be such a hypocrite. She told him about the previous boyfriend in good faith. He has now revealed himself as a person who is unforgiving and unreliable!
*58/129/5*

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STAGE THREE OF STRESS BREAKDOWN: DIFFICULTIES IN FINDINGS AND STUDIES
It is very difficult to find out what happens exactly in the brain at the cellular level
While scientists now understand a great deal about the brain, and while our knowledge of brain structure and function is expanding at an increasingly rapid rate, there are major problems in trying to work out how the individual cells and cell groups are affected by excessive stress.
The brain is a complex, living organ, encased in a thick bony box, the skull; there is almost no way we can examine it closely without interfering with its function. Therefore, although we know a great deal about the structure of the brain, which we’ve learned from cutting it up and examining it under microscopes, we don’t know as much about the behaviour of cells in the normal functioning brain.
The difficulty of studying chemical changes in the normal functioning brain
If we wanted to study how certain types of brain stimulation might change the levels of neuro-transmitter chemicals in the brain, we are immediately hampered by the fact that the brain is full of enzymes, whose job it is to destroy the neurotransmitter chemicals as soon as they are produced and have done their job of firing off the next neuron.
Therefore, in order to study changes in these neuro-transmitter chemicals occurring under conditions of high stress when the brain’s cells are over-stimulated, we would need to stop enzyme activity the moment that the over-stimulation occurred. In the laboratory, this would probably mean we would have to stimulate the brain, then immediately plunge it into liquid nitrogen to freeze it instantly, before cutting the brain into pieces and examining it.
Of course, doing something like this is totally out of the question when we are trying to learn something about the way human brain cells respond to over-stimulation; therefore much of what we believe about brain function is often in the form of workable theories, which persist until a better theory comes along.
*26/129/5*

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Other names: Wellbutrin, Bupropion
HOW IS BDD DEFINED: PREOCCUPATION – THE DEFECT IS REALLY ONLY SLIGHT
Occasional BDD sufferers themselves agree that the defect is really only slight and that they have a distorted view of how bad it is. They’re more likely to recognize this after they’ve had psychiatric treatment. As one young man told me, “My view of my appearance is illogical—I know I really look okay. I’m making a mountain out of a molehill.”
If the defect is slight, then BDD’s definition requires that the person’s concern is “markedly excessive”—that is, they must be preoccupied. In addition, they overreact to the minor defect in terms of how it affects their life. Charles, a college student, left his dorm room only once during a two-week period when his mild acne worsened. He missed his classes and avoided all social activities. He even didn’t visit a close friend who just learned he had cancer. True, Charles had some pimples, but hardly enough to warrant such extreme avoidance. Charles qualified for BDD because his defect, while present, wasn’t particularly noticeable, and his reaction was excessive.
What if I can’t assess the severity of the defect because of its location? This is another challenge in diagnosing BDD. Many people with an “unassessable” defect have another supposed defect that’s visible and can be assessed, which allows the diagnosis to be given. For example, although I didn’t evaluate one patient’s buttocks, I could see that his concern with his “crooked” eyes was unfounded. In other cases, an “unassessable” defect has been assessed by someone else who thinks it’s fine; men with penis concerns often say that spouses and doctors alike have told them the size is normal. This information also allows a presumptive diagnosis of BDD to be made. Making the diagnosis can also be complicated if skin picking (a common symptom of BDD) has caused noticeable scarring. If it can be ascertained that the acne or scarring was fairly mild before the picking began, the person is a candidate for the BDD diagnosis.
*25/204/8*

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DEALING WITH THE CAUSE OF INSOMNIA: THOUGHT AND ENERGY
Balancing the two hemispheres of the brain can also help to balance the energies of your body. Alternative practitioners and healers in particular, together with a few doctors, are increasingly recognizing that human beings are more than their physical bodies. We also consist of a complete energy system: the energy-field surrounding the body (often referred to as the aura), together with channels of energy flowing through the body and a number of major energy centres (also called chakras) which relate to the endocrine glands.
To feel balanced, harmonious and healthy, the energies within the body need to be flowing harmoniously, without resistance, and the energy field needs to be clear. Negative thoughts, traumas, griefs, stress, can clutter the energy field and clog the channels. In insomnia it seems as if the energies are somehow stuck; changing your thoughts and taking physical action can help to restore the normal, healthy flow.
Although invisible to most people, the energy system can be seen by some psychics and healers, and physically sensed by many healers and natural therapists. Many of those who work directly on the body, like manipulative therapists, massage practitioners and healers, can help to rebalance your energies, and will encourage you to maintain that balance.
The healer Betty Shine stresses the importance of the energy of the mind, which she sees as separate from that around the body. In her book Mind to Mind (Corgi, 1989) she describes how, when someone is depressed, the mind energy funnels down like a black cloud, compressing the physical organs and eventually impeding their healthy functioning; conversely, when someone thinks happy, positive thoughts, she can see the mind energy radiating outwards like a halo, lifting depression from the physical system. As you become more self-aware it’s possible to sense this for yourself; negative thoughts and unhappiness create a feeling of contraction and constriction, while happiness and optimism make your head and body feel lighter and clearer.
Most healers and health practitioners agree that your thoughts have a direct effect on your body and energy system, which is worth bearing in mind next time you start brooding about something unpleasant. In fact, many go further: thoughts, they say, are forms of energy which, if focused on often enough, will take material form. This helps to explain why people who expect disasters very often get them, and why it’s important to exchange negative views of life for positive ones.
*25/169/2*

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THE THIRD STAGE OF STRESS BREAKDOWN
Stage three sees marked changes in behaviour and attitudes quite out of character for the over-stressed person.
A person experiencing stage one and stage two symptoms of stress breakdown will, if the stress is not relieved, develop symptoms of stage three stress breakdown. These symptoms are observed primarily in changed behaviour towards others and are not easily recognized as stress-related. In contrast, the symptoms of stages one and two are usually easily identified as being stress-related.
A most important point about third stage symptoms is that they are often wrongly seen as variants of normal behaviour and may therefore be described variously as problems with communication, change in priorities, marriage problems, or life crises. It is essential that we understand the symptoms of stage three, so that we don’t respond inappropriately to them and make the stress situation even worse.
There are three extra symptoms in stage three
1. A relative intolerance of sensory stimulation.
2. A loss of the ability to ignore things which were previously tolerated.
3. Changed response patterns which superficially resemble a change of personality.
*25/129/5*

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HOW IS BDD DEFINED: PREOCCUPATION
The Criterion describes the preoccupation that occurs in BDD. People with BDD worry that some aspect of their appearance looks defective in some way. They may describe the body area or areas as ugly, unattractive, flawed, “not right,” deformed, disfigured, or even as grotesque, hideous, repulsive, or monstrous. People with BDD have more than an occasional thought that they don’t look right—they’re preoccupied. They think excessively about their supposed appearance problem; some people in fact find it hard not to think about it. They say such things as “I think about it a lot,” “It’s always on my mind,” “It’s like a second reel that’s always going,” or “I’m obsessed.” People with BDD generally spend at least an hour a day thinking about the supposed defect. On average, they spend somewhere between 3 and 8 hours a day.
The definition then states that the defect is imagined or slight. Some people with BDD “imagine” their defects, in the sense that they’re preoccupied with something that others don’t perceive at all. Other people with BDD actually have a physical defect, such as mild acne, a small scar, or slightly thinning hair, but by definition the flaw is slight. Nonetheless, they’re preoccupied with it and consider it ugly and clearly visible to others. A study from England, which used an objective measure of facial appearance known as morphoanalysis, found that in BDD the disliked body area usually looks normal. I’ve found that about a third of people with BDD have a defect that’s slight, whereas in about two thirds the body part of concern looks completely normal. Considering their overall appearance, in my experience, nearly everyone with BDD is of average or above average attractiveness.
But the word “imagined” is complicated and can be problematic. While some people with BDD realize that they imagine their defect—that it really looks okay and they’re blowing it out of proportion—many are certain—or nearly certain—their view is correct. They think they really do look terrible, and they balk at the word “imagined.” They worry that if they’re imagining their defect, they may be labeled as “crazy.” Some insist that because they’re not imagining the defect, they must not have BDD, even though they really do. One person asked me, “My problem is really there; it’s true. Do you deal with true things or only imaginary things?” He thought that if I dealt only with “imaginary things,” then I wasn’t the doctor he should be seeing.
*23/204/8*

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STRESS BREAKDOWN AND VIOLENCE
There is no doubt that breakdown due to excessive environmental stress is associated with physical violence. Studies have demonstrated a relationship between poverty, environmental stress, and violence. Gil (1969, 1970) found that family violence in poor families with high levels of stress from socio-economic deprivation was more frequent, less restrained and more lethal than family violence occurring in middle-class families under less stress.
It might be argued that poor people are more violent because of some factor other than that of increased stress, but other research supports the relationship between the stress level itself, as measured objectively, and the tendency to violence.
A lot of the violence associated with stress occurs in the second stage of stress breakdown, which can be easily identified and prevented. When drugs have been used as a means of staying in the stressful situation without feeling the discomfort of anxiety symptoms, violence is even more likely. I think it is quite probable that simple education on stress breakdown might help to prevent some of the violence in our too-busy society.
I would hope that the reader has understood the following points:
• Anxiety is an alarm reaction triggered when the nervous system is failing to process incoming information adequately.
When a person experiences anxiety, there are five questions to answer. These may point to the cause of the anxiety.
• Anxiety can be caused by excessive stress – an overload of the nervous system. Anxiety is thus the first sign of overload, that is, stage one of stress breakdown.
• By ignoring the warning of anxiety symptoms, people experiencing anxiety under stress may use up their inhibitory and will-power reserves, and develop the symptoms of stage two -loss of emotional control and inability to motivate the self.
*24/129/5*

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DEALING WITH THE CAUSE OF INSOMNIA: SELF-HYPNOSIS AND VISUALIZATION
Once their clients are familiar with the experience of reaching a state of hypnosis, most hypnotherapists encourage them to practise self-hypnosis at home; some make tapes for their clients. Many other alternative practitioners also encourage people to use visualization, which is really identical with self-hypnosis, to help their own healing process.
The imagination can have a direct effect on the body, for good or ill. When you imagine or remember a disaster, your pulse can start racing and your breathing can become more shallow, as the body’s stress system starts revving up. It doesn’t matter that the disaster isn’t real: your body and nervous system react as though it is. Similarly, when you imagine yourself healthy and happy, your body starts to feel healthier and stronger.
In a relaxed, day-dreaming state, you can mentally picture the outcome that you want, whether it’s better sleep, or confidently taking and passing your driving test. It’s important to believe and expect that what you visualize will come about. In so doing, you are using an in-depth way of reprogramming your computer.
Visualization techniques may not be right for everyone: if you are an anxious striver, you may put too much effort into what should be effortless, or make yourself worse by focusing on symptoms rather than health. But even if you don’t use specific techniques, you are using the power of thought and imagination throughout the day, both mentally and verbally. All the more reason to exchange depressing thoughts about your life and your sleep for positive ideas about what you really want.
For successful self-hypnosis, the first, essential step is to be able to relax deeply. If you are normally tense, you may need some help in learning to relax sufficiently. Some people have successfully taught themselves to visualize from books; there are also some good tapes on the market which can start you off, though it’s not a good idea to rely on them for the rest of your life. For most people it’s easier initially to be taught by someone else.
A good training course in visualization techniques is the Silva Method, named after its Mexican founder Jose Silva. The Silva Method is taught over two weekends; starting with learning to relax and enter the alpha-state, it includes techniques for using the whole of your mind, from problem solving, getting to sleep and programming helpful dreams, to healing and the development of ESP. It has helped numbers of people to sleep better, and to give up addictions including alcohol, smoking and tranquillizers.
*24/169/2*

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HOW IS BDD DEFINED: PREOCCUPATION – ‘REAL’ AND ‘IMAGINED’
It isn’t known why people with BDD see themselves differently than other people do. Do they see what other people see but interpret it differently, considering the body part unattractive when others don’t? Or do they actually see the body part differently? The question isn’t so much whether the defect is “real” versus “imagined,” but rather why it is that people with BDD perceive their appearance differently than other people do.
Yet another knotty issue is how to determine whether a defect, if present, is “slight,” which the definition requires. If the defect is very obvious to others—if it’s immediately noticeable—then by definition the person doesn’t have BDD. But what if the defect is more subtle? Who’s to judge whether it’s slight or not? These questions take us into a subjective realm where reality and distortion can’t always be clearly differentiated. To some extent, just as beauty is in the eye of the beholder, so is ugliness. If someone with BDD thinks her legs are huge, but I think they’re only “slightly” big, who is right? Should a woman who’s 5′ 11″ and preoccupied with her height be considered “slightly” or obviously tall? In some cases, I don’t notice the defect when I meet someone, but when it’s pointed out I can see that it’s actually there. Is such a defect “slight” or “nonslight”?
It’s helpful to consider what most people observe. I often have corroboration from others—clinicians, family members, or friends—who agree that the defect is nonexistent or slight. The most common reason people with BDD are turned down for surgery or other medical treatment is that the physician can’t perceive the defect or considers it too minimal to treat. One patient was referred to me by a dermatologist who described her as “a woman with beautiful skin.” Many patients have been brought to me by family members who recognize that their loved one has an inaccurate view of how bad the defect is. I and several dermatologists did a study in which we independendy rated the severity of skin defects and found that in general we closely agreed about which defects were slight and which were clearly noticeable. This suggests that such judgments can be made with reasonably good agreement and objectivity.
*24/204/8*

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TOWARDS GOOD SLEEP: BREATHING
Correct breathing is important in both relaxation and meditation. As body and mind slow down, so does the breath; conversely, slowing and deepening your breathing automatically makes you calmer. However, when we are tense we tend to breathe fast and shallowly, high up in the chest, which makes it very hard to relax. Some chronically tense people hyperventilate; that is, they over-breathe all the time, which keeps them in a permanent state of anxiety. Hyperventilation also prevents sufficient oxygen reaching the brain and can have other
unpleasant side effects like migraines, dizziness, nausea and palpitations.
Learning to breathe naturally helps you to keep calm. Try this: lie on the floor with a cushion or book under your head. Put a heavy-ish object (a large book or a beanbag) on your midriff, between your abdomen and lower ribs. As you breathe in and out, the object should rise and fall; if it doesn’t, you are breathing too high up in the chest.
Using the weight as a guide, you can retrain yourself to breathe diaphragmatically: full breathing should expand your diaphragm, lower ribs, and abdomen. Don’t force yourself to breathe deeply; simply be aware of how you are breathing now. Then think of your ribs and lungs expanding and contracting, and allow your breath to become deeper, slower and calmer. Think of your ribs expanding sideways as well as up and down. If you practise this for a few minutes every day, you will acquire the habit of calmer, relaxing breathing when you get to bed at night.
Another sign of anxiety is holding your breath. A good exercise when you feel yourself tensing up during the day is to consciously breathe out, at the same time letting the tension flow away from your neck, shoulders and arms. Practise this in situations which would normally make you uptight: in traffic jams and queues, or waiting to be put through on the telephone. As it starts to become a habitual response, you can use these occasions as opportunities for relaxation instead of anxiety, irritation or anger.
A good method of getting back in touch with your body and breathing pattern is the Alexander Technique, which (among its other benefits) helps to free tensions locked into the back and rib-cage. Osteopathy and chiropractic can also help to free tight chest muscles, enabling you to breathe more fully. Yoga, too, lays much stress on breathing; one very simple exercise is to breathe in to the count of six, hold your breath to the count of six, breathe out to the count of six, and then either breathe in again or hold the outbreath for six, before resuming the cycle. It is very calming.
*58/169/2*

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STRESS BREAKDOWN: AGGRESSION AND VIOLENCE, USE OF SEDATIVE DRUGS
Aggression and violence in stage two breakdown
It is readily obvious that where people lose emotional control in a situation of high anxiety, violence may result. This is particularly so if the person is experiencing significant threat to the integrity of his or her territory, that aspect of a person which is held inviolable by others. One’s territory might be actually one’s own backyard, and someone is intruding uninvited. Or one’s territory might be a role, or a job, or a specific responsibility. People react fairly quickly in response to others trying to take over their jobs. Territorial threat will, in ordinary circumstances, provoke defensive aggression.
In stress breakdown, that defensive aggression is apt to be sudden, unpredictable, and violent, because of the loss of emotional control. Violence is even more likely if the person under stress has been using sedative drugs.
The use of sedative drugs in stress breakdown
Sedative drugs such as alcohol, barbiturates, chloral hydrate and the benzodiazepine drugs such as oxazepam (Serepax), diazepam (Valium) and nitrazepam (Mogadon) are able to switch off the anxiety response to nervous system overload. The person under stress, who is uncomfortable from anxiety symptoms, can temporarily feel a lot better on taking a sedative drug. The temptation is therefore to stay in the stressful situation and suppress the anxiety symptoms with drugs or alcohol. This situation is something like a motorist blocking out the oil-pressure warning light because the light is interfering with his driving, instead of stopping the car and investigating why the oil pressure has dropped. Ignoring warning signals leads to trouble.
When the sedative effect of these drugs wears off, the person is left with a low-grade agitation which makes the person feel worse than he did before taking the drug. This heightened feeling of anxiety may lead to a desire for further doses of the drug to suppress the agitation; the stage is then set for continued use of the drug and the beginnings of a drug dependency problem.
In my experience, the use of sedative drugs to suppress anxiety symptoms in stress breakdown lowers the inhibitory reserve and makes the stressed person more prone to aggressive outbursts and actual violence. At this point, the problems of the person with stress breakdown, complicated by continued use of drugs, begin to merge with the problems of alcoholism and sedative abuse. Sorting out the problems of a person with stress breakdown when that person has been using sedative drugs regularly, presents a complex situation requiring expert skills.
*23/129/5*

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DEALING WITH THE CAUSE OF INSOMNIA: HYPNOTHERAPY
Some people still have a cartoon-type image of the hypnotist as a Svengali-like figure with dotted lines coming out of his eyes, intoning: ‘You will sleep, you will sleep!’ and rendering you unconscious while you obey his will. In fact, a psychologist practising hypnotherapy says, ‘There is only one kind of hypnosis — self-hypnosis.’
Under hypnosis you reach that relaxed, dreamy (but not usually unconscious) state in which suggestions can be more readily received by your right brain, bypassing the disbelieving left brain. It has sometimes had remarkable results in healing the physical body, and can be very helpful in the relief of pain. But your mind will only receive those suggestions it is willing to receive.
Hypnotherapy is not a simple process of telling you that you will sleep well, or stop smoking, or eat less. A good hypnotherapist will need to know why you are not sleeping, and will help you to tackle the problems underlying your insomnia, before going on to help you make inner changes to achieve more control over your own behaviour.
Hypnotherapists work in a variety of ways, but will normally start by taking your case history and discussing your current problems. They have their own favourite methods of helping you to relax, perhaps by counting down slowly from ten to one, or by asking you to take yourself in imagination to a peaceful, pleasant place — perhaps a country scene, or the seaside, imagining the sights, colours, scents and sounds.
In this relaxed state, with the logical brain on hold, the therapist can help you review your anxieties and fears in a safe atmosphere. He or she may help you to discover those other, more helpful parts of yourself that have been repressed, and explore ways of making changes in your life. This can be quite an enjoyable game, in which you imagine new scenarios with yourself as both actor and director.
‘Hypnotherapy can give you a kind of breathing space,’ says hypnotherapist Gloria May, ’so you can stand back from what’s going on and view it a bit more objectively. When you go into the alpha state you are more creative and you can often get a handle on things, which is impossible when you’re in an overstressed, anxious state.
‘Plugging into your unconscious heals the rift between consciousness and unconsciousness, and the more conscious you are the better position you are in to handle more and more. It’s not really the stress that makes people insecure, it’s the way they see it. Hypnotherapy can be a tremendous help in increasing the level of stress people can handle. It gives you a chance to look at problems in a less emotional way’
It can be very useful if you suffer from recurrent bad dreams or nightmares. A hypnotherapist can help you to discover what those dreams are trying to tell you, and resolve the tension that keeps them recurring. It is also possible to learn to take an active part in one’s dreams and so gain some control over them. Challenging and overcoming a fearful figure or event in a dream can have a big spin-off effect on your self-esteem and ability to control your own destiny.
Hypnotherapy is not an instant answer (there are not too many instant answers, unfortunately) and a number of sessions are usually needed to bring about change. But it can be extremely helpful for insomnia, particularly if the insomniac co-operates by making any other necessary changes to his or her lifestyle and daily habits.
It is important to go to someone who is also an experienced psychotherapist. Hypnotherapy is a wide-open field with more than 80 training courses, some of them excellent, some of them superficial. Medical hypnotherapists express concern about those without medical training; if someone goes to them for help with headaches or indigestion, believing the symptoms to be stress-induced, it is feared that a serious physical problem may be overlooked. However, a responsible hypnotherapist, medically qualified or not, should ensure that you have had a medical diagnosis before treating you.
*23/169/2*

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Other names: Fludac, Rapiflux, Sarafem

HOW IS BDD DEFINED?
The basic features of BDD—what everyone with the disorder experiences—are from DSM-IV (the Diagnostic and Statistical Manual, Fourth Edition). DSM-IV is the manual used in the United States and many countries around the world by health professionals to make psychiatric diagnoses. Although the criteria may seem skeletal, they are useful because they provide guidelines for identifying who does and does not have BDD. What these diagnostic criteria indicate, in a nutshell, is that people with BDD look normal, but they’re preoccupied with the idea that their appearance is defective in some way. This preoccupation causes them significant distress or interferes with their functioning.
I’ll now go through BDD’s diagnostic criteria, shown in Table 1, one by one. This may help you figure out if you or someone you know has BDD.
*22/204/8*

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STRESS BREAKDOWN: MISTAKING STAGE TWO FOR ENDOGENOUS DEPRESSION
It is very important, therefore, that we discern stage two symptoms for what they are, so that stress breakdown can be prevented from getting worse. The most common misdiagnosis in stage two stress breakdown would be to mistake the symptoms for those of endogenous depression.
Endogenous depression is primarily a mood disorder in which the person feels weak and tired, experiences broken sleep or early-morning waking, feels worse at a particular time of day, especially in the mornings, and feels generally sad, sometimes enough to suicide. Stage two symptoms can resemble depression, but there are differences:
1. The sleep disorder in stage two stress breakdown tends to be one of difficulty in getting off to sleep, while in endogenous depression, the patient has difficulty in staying asleep.
2. The person with stress breakdown often feels better after a night’s sleep, while the person with endogenous depression may feel worse.
3. There may be a tendency to burst into tears in depression, but the emotional lability of stress breakdown is one of inability to control both high and low swings in mood, momentarily.
4. In endogenous depression, the atmosphere portrayed by the patient is one of loss – loss of energy, loss of enjoyment of life, loss of the will to live. In stress breakdown, the atmosphere is one of load. Suicide threats expressed in stress breakdown are impulsive gestures of despair and not based on the quiet, sad conviction of the patient with endogenous depression that the world would be better off without him.
*22/129/5*

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DEALING WITH THE CAUSE OF INSOMNIA: RESTORING THE BALANCE
Our brains aren’t purely computers. The human brain is divided in two, like a walnut, and each half has specific functions. As a rule the left hemisphere controls the right side of the body, and deals with functions like speech and logical thinking. The right hemisphere, controlling the left side of the body, is responsible for abstract thought, dreaming, intuition, and visual imagery. In a few people, the sides are reversed.
To be in harmony with ourselves, both sides of the brain need to be equally active, and to work in co-operation with each other. In this hectic world most people use the logical side most of the time, at the expense of the intuitive, imaginative side. To restore the balance, the day-dreaming part of our minds needs to be exercised as much as the logical part.
A left-right imbalance is often reflected in the physical body; people can be quite lop-sided without realizing it, because they are putting all their energies into one aspect of themselves. Alternative therapies like osteopathy, kinesiology and the Alexander Technique can help to correct this.
The intuitive hemisphere has been called the gateway to the unconscious; through it we can get in touch with our creativity and inspiration, our hidden desires, needs, memories, and inner wisdom. It is this side of the brain that comes up with brilliant flashes of intuition, or solutions to problems that logic has been unable to solve. Have you ever found that when you stop worrying about a problem and let it go, the answer just pops in — sometimes during a dream, sometimes when you wake up in the morning? Quietening the chatter of the logical brain gives the creative side a chance to help us.
Yet we have been taught to neglect it. You could compare the two hemispheres to a hard-working, serious-minded parent, and a creative child who wants to play. The parent concentrates on telling the child how to behave, and doesn’t listen to what it has to say. Yet given a chance, the creative child can come up with original ideas and solutions that the conformist parent hasn’t considered.
When mind and body are allowed to relax, the activity of the two hemispheres starts to equalize. At the same time, the brainwaves slow down from the active, busy beta rate, producing the alpha-rhythm that normally precedes sleep. We become both more peaceful and more creative.
This state of mind can be achieved in a number of ways, for instance through relaxation and meditation, and through the use of mental imagery, including hypnotherapy, self-hypnosis and visualization.
*22/169/2*

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BDD – A SPECTRUM OF SEVERITY: DEPRESSION CAN BE SEVERE AND LIFE-THREATENING
So BDD’s severity spans a spectrum, ranging from relatively mild to life-threatening. In this way, BDD is like other medical problems. Severe diabetes can lead to hospitalization and serious medical complications, such as blindness, whereas people with a milder form can remain active and productive. Heart disease, too, spans a spectrum from severe to mild; it can seriously limit one person’s ability to work and engage in leisure activities but impose few limitations on another person’s activities and enjoyment of life.
Psychiatric problems are no different. Depression can be severe and life-threatening: a severely depressed person may be unable to eat, sleep, or get out of bed, and may even commit suicide. But depression can be milder: many depressed people, despite their suffering, manage, with effort, to function adequately. No one would ever know they were depressed. One person with a severe phobia may not be able to leave her house, whereas someone with a milder case may go out despite her fear. BDD is similar. When it’s severe, it’s as crippling as any serious psychiatric or medical illness. At the milder end of the spectrum, it’s more manageable and even shades into normality.
Some people I’ve seen, who had heard or read about a particularly severe case of BDD, told me they thought they didn’t have the disorder because their symptoms “weren’t that bad.” Others, with severe BDD, thought they might not have the disorder because their symptoms were so severe there couldn’t possibly be other people who had the same problem, who suffered as much as they had. But they all had BDD.
BDD varies from person to person in other ways. Some people are preoccupied with their hair, others with their buttocks, others with their legs, testicles, or eyebrows. Any body part can be the focus of concern. Even among people concerned with the same body part, exactly what they dislike can differ. One person might think her hair is too flat, whereas another believes his sticks out too much. One person may think his skin is too red, whereas another feels hers is too white.
Although no one with BDD has exactly the same experience as anyone else with BDD, all people with BDD have important things in common. The severity may differ, the body areas may differ, the behaviors may differ somewhat from person to person, but there are many things they share. Everyone with BDD is concerned with some aspect of their appearance that they consider ugly, unattractive, or “not right” in some way. Everyone is distressed or doesn’t function as well as they might because of their preoccupation. The details differ from person to person, but these basic themes are shared by all.
*21/204/8*

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DEALING WITH THE CAUSE OF INSOMNIA: CONDITIONED INSOMNIA
A very few cases of insomnia are purely habitual, but they are interesting, because they show how strong conditioning can be. Insomnia often starts with a short-term crisis or emotional upset; for most people, normal sleep returns once the crisis is over. But for others, not sleeping becomes a habit which can last a very long time.
One woman suffered from insomnia for 20 years, which began when she had a nervous breakdown. She had long since recovered from the breakdown and the reasons for it; she had simply developed, at a time when she was vulnerable, the habit of not sleeping. She visited a hypnotherapist for a totally unrelated problem; on her third session she fell spontaneously into a very deep sleep. The therapist wrapped her in a rug and left her for an hour before waking her. When she got home she slept for the rest of the day and through the night. The pattern was broken, and she returned to normal sleep.
Insomnia quite often starts during an emotional crisis, when the sufferer’s pre-bed routine, the bedroom and even the bed, become associated with unhappiness and sleeplessness. People whose insomnia is conditioned in this way often sleep very well in strange beds when they go away — or in even odder circumstances.
A 19-year-old American student usually took two to three hours to fall asleep. As a child he had lain awake, anxious and unhappy, listening to his parents’ violent quarrels. They were divorced when he was 13, but his insomnia continued. He had two years of psychotherapy, but although his therapist found him remarkably healthy in view of his family difficulties, his sleep didn’t improve. Asked to describe his best night’s sleep during the past year, he said that it had been during a mountain-climbing expedition; forced by circumstances to spend the night on a cold, narrow ledge, tied to the rocks, he fell asleep almost immediately and had a very good night! In those desperately uncomfortable surroundings there were no associations with his childhood anxiety*
Much conditioned insomnia starts in childhood. People who were sent to bed when they were small for being naughty may subconsciously associate bed and bedtime with anger and punishment. Some children are sent to bed for adult convenience long before they are really sleepy; they lie awake Reeling bored and frustrated, developing a habit of wakefulness which continues into adulthood.
These negative feelings are enhanced if the child overhears family rows, or even their parents entertaining friends and having a good time. The children of single parents can feel particularly excluded if they are suddenly packed off to bed when a friend or lover arrives. Lying in bed becomes associated with anxiety, or a feeling of being unwanted, feelings which can also spill over into everyday life. You can begin to make changes to ensure that bedtime and your bedroom become associated with sleep, not sorrow.
*20/169/2*

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IMPORTANCE OF SECOND STAGE OF STRESS BREAKDOWN:
It is very important that people in stressful situations recognize the symptoms of stage two stress breakdown as serious enough to force a change in lifestyle, or relief of the stress. Thankfully, many stress breakdowns do not progress past stage two. This is probably because, as I indicated before, most people recognize the symptoms of stage two as serious and will be moved to try to ‘rescue’ the person displaying these symptoms. In the majority of cases this rescue operation succeeds in removing the person from the stress, or the stress from the person, sufficient to prevent a further progression of stress breakdown.
As we will see a little later, the threshold between stage two and stage three is very important, because while people generally can identify the symptoms of stage one and stage two as associated with stress, the symptoms of stage three are not easily recognized as stress related. Therefore, people tend to make wrong assumptions about the causes of the unusual behaviour observed in stage three stress breakdown, and sometimes the treatment based on these wrong assumptions can make the situation worse.
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BDD – A SPECTRUM OF SEVERITY: FROM MILD TO LIFE-THREATENING
Milder BDD, like Sarah’s, can be distressing and can interfere to some extent with living. But it isn’t devastating. However, when BDD is very severe, it can destroy virtually every aspect of one’s life. Some people, like Jennifer, stop working and stay in their homes, sometimes for years. Some adolescents drop out of high school or college. Parents may stop caring for their children because they’re so preoccupied with their appearance that they can’t focus on their children’s needs. Some people with BDD think they look so ugly that they never date or marry. Some don’t even buy food because they can’t leave their home. Others, in an attempt to look better, lose dangerous amounts of weight.
Some even get into life-threatening accidents. Jennifer ran through red lights because she was convinced people were laughing at her while she was waiting for the light to change. One man stared so intently at his reflection while washing windows that he fell off a three-story ladder. Others are so intent on examining their face in the rearview mirror while driving that they get into car accidents. One man, who thought he looked like an “alien,” planned to get into a car accident. He felt so hopeless over his facial “defects” that he planned to crash his car so he could destroy his face and have it completely surgically reconstructed. He explained that the car accident was necessary because 15 surgeons had refused to do the procedures he requested; even if he could find a surgeon willing to operate, his insurance company wouldn’t pay for it, so the accident was necessary. That way the surgery would be paid for—and it would have to be done. Another woman was equally desperate; she was so distressed by the shape of her breasts that she repeatedly slashed them with a knife. Some suffer so intolerably that they attempt suicide. Some people kill themselves.
*19/204/8*

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STRESS BREAKDOWN: THE SYMPTOMS OF STAGE TWO
It is important to realize that the symptoms of stage two are the symptoms of stage one plus the symptoms of emotional lability and inability to motivate the self. The person suffering from stage two stress breakdown will therefore experience the jumpiness, muscle tension, sleeplessness and churned-up feelings in the stomach of stage one, plus the tendency to lose control of the emotions and an inability to motivate oneself.
An important aspect of the loss of emotional control in stage two is that it is not just the tendency to break into tears easily. This symptom can occur with depression. The emotional lability of stage two is an inability to control displays of any emotion. Thus the person may burst into tears and a moment later be laughing. We tend to recognize the symptom of suddenly bursting into tears very easily as stress-related, but the symptom of laughing too loudly, too readily, is also a symptom. Sometimes the first sign of stage two breakdown in a person under stress is that he or she might laugh a little too loudly at someone’s corny, usually unfunny, jokes.
I wonder if the reader can identify with the woman in stage two stress breakdown who accidentally dropped a jar of honey on the kitchen floor, and then just sat there for half an hour looking at the broken glass and the sticky mess? This loss of the ability to motivate oneself feels to the person at the time as if there is no energy left to force the self to do anything.
*20/129/5*