Max Fink, the grandfather of American ECT

Grandpa Max used to claim that ECT worked by causing brain damage. He argued for years that the therapeutic effect from ECT is produced by brain dysfunction and damage. He pointed out in his 1979 textbook that "patients become more compliant and acquiescent with treatment," and he connected the improvement with "denial, disorientation," and other signs of traumatic brain injury and an organic brain syndrome.

Fink was even more explicit in earlier studies. In 1956, he stated that the basis for improvement from ECT is "cranio-cerebral trauma." In 1966, Fink cited his own research indicating that "there is a relation between clinical improvement and the production of brain damage or an altered state of brain function." He does not, however, make such statements in public, in court, or in the 1990 APA Task Force Report.

Max has also been busy with other ventures. Born in 1923, he is currently professor (emeritus) of psychiatry at SUNY at Stony Brook. His CV is too long to list here, but here are a few interesting appointments:

• Founding Editor, Convulsive Therapy
  Consultant to the FDA
  U.S. Army on the Feasibility of Using Incapacitating Agents Against Terrorists.
  Captain, U.S. Army.

• The Finkeroo owns a company called SciData, based in Atlanta, Georgia. Organized in 1967, the last year's sales were listed at $170,000.

• Fink helps out his buddy, Richard Abrams, with Somatics, Inc. He narrates Abrams' videotapes for Somatics, Inc., which sell for $350 to health professionals, or $360 for patients and families. Or you can buy a "preview version" for $25.

Max has a habit of being a little less than honest at times. For example, he is responsible for the famed 1 in 200 statistic, which the APA uses in its literature. This statistic, long criticized by ECT advocates and survivors, supposedly reflects the number of patients who suffer memory loss. Recently, Max admitted the number was *not* based on any scientific studies, as had been widely claimed, but rather, was an "impressionistic" number - meaning he made it up.

Here's another example, in a post of his from the shock doc mailing list:

"2. The second question is how to achieve an effective treatment in the face of the limited output of brief-pulse devices.

The usual approaches are to use bilateral placement; change anesthetic from methohexital to etomidate; determine the dosing of benzodiazepines and if these were used, block with the antagonist flumazenil; enhance seizure duration by either caffeine or theophylline; and when these fail, double stimulation. If the lack of adequate energy is a frequent issue in practice, the THYMATRON can be modified to the British version, or the MECTA can have the Sackeim modification added -- for research purposes."

For research purposes, Max??? That's his way of covering his butt. He's telling other shock docs how to boost the juice way past the machinery's capabilities....for "research" purposes. This post was in response to a query from another doctor with legitimate patient concerns.

Max also doesn't take confidentiality very seriously. He's often harassed a certain ECT survivor, shutting down question and answer periods when she arrived. But he's gone beyond that by shouting at her and telling the entire workshop medical information from her confidential medical records.

All in the name of science for Max Fink.

Here is an example of his condescension towards mental patients: during a session on ECT for doctors, a doctor is explaining a patient he has who is afraid she'll die if the machine shuts down, and the need for backup batteries. Max finds this to be a chuckle. He also sees himself as a celeb of sorts, illustrating how "fans" approach him after seeing his old video.

Reporters are frequently invited by Max Fink to witness patients being given the treatment. Psychiatrist Peter Breggin has urged him to allow them to see his patients *after* they have received a full course of shocks. Under pressure, Fink agreed, but with a catch. While he charges nothing for the media to watch a patient undergo the procedure, he decided to charge $25,000 for himself and $15,000 for the patient for a single interview with the patient awake after a course of ECT.

This old goat needs to be put out to pasture....

next: My Turn: ECT Editorial Casts Shadow on Author and JAMA's Credibility
~ all Shocked! ECT articles
~ depression library articles
~ all articles on depression

Scenario 1

Let's set the scene: You're in the grocery store squeezing melons and all of a sudden you feel a wave of dizziness wash over you. Your palms begin to sweat, your heart races, and you become short of breath. You don't know what's causing this, but one thing is crystal clear: You have to get out of there!

You leave your shopping cart, your coupons, your grocery list (and maybe even the kid you have sitting in the cart!--just kidding!) in the middle of the aisle and race out of the store. And it's not until you're on your way home that these symptoms begin to subside. Sometimes you'll feel brave enough to go back to the store, but as you approach those melons again the memory of what happened the last time invades your brain and the symptoms reoccur. So it's exit, stage right once more. The next time you need to go to the store, the memory of that horrible feeling becomes overwhelming, so you get your spouse/neighbor/relative to do the shopping for you. Thus begins the chain of avoidance.

Scenario 2

Next scenario: You're standing in line at the bank, tapping your foot impatiently at the little old lady in front of you counting out 86 years worth of pennies. You look around, check out the bank manager's new suit, stock up on deposit slips (and any other freebies sitting on the counter), look out the window. All of a sudden, the thought occurs to you that this little old lady could take a very long time to make her transactions and you could be trapped in that line forever!!!

Instead of brushing the thought away with a "Nah never happen," you begin to obsess on the idea of being trapped. The dizziness, palpitations, sweating and shortness of breath begin again and the next thing you know, you're halfway home, driving 90 miles per hour, deposit slips fluttering in the breeze. You think, "I sure don't want that to happen again!" and the chain of avoidance continues.

So now there are two places you won't go...

Once this chain of avoidance begins, it snowballs until you find there's very little you're comfortable doing. Your "safety zone," or territory, continues to shrink until even the thought of going too far from home can bring on the symptoms. And before you know it, you're reduced to the perimeters of your home.

It's not uncommon for phobics to shrink their territory to the point of becoming uncomfortable by simply looking out a window. Suddenly, all those tasks we took for granted: bringing in the mail, taking out the garbage, grabbing the Sunday paper off the front step, become Herculean in nature. And we simply can't.

Actually, it's not all that sudden. It takes a long time, even years, to become sensitized. But once that chain of avoidance begins though, it's very difficult to stop it. Sometimes it's so subtle, we don't even realize it is happening until it has.

Anticipating Anxiety

Another of the extra-added attractions of agoraphobia is one of my personal favs, anticipatory anxiety. This involves not only becoming anxious or panic-stricken in the actual event, but anticipating how you're going to feel, react, etc. This can bring on the same or higher levels of anxiety than the actual situation itself.

For example: If you're socially phobic in conjunction with being agoraphobic, the thought of someone being in your home is particularly uncomfortable for you. And one stormy winter day your heater cuts out. Now, you have to call a repairman to come and fix it. The thought fills you will terror. Your mind begins to race: "What if there's something horribly wrong with the heater and I have to get it replaced, and he'll be here for days, and I'll have to hand him tools, and feed him dinner, and put him up in my guest room, and he'll like it here so much he'll never leave?"

So now, before you even make the phone call, you're running around with your hair on fire, and have yourself so juiced, you'd rather freeze to death than have that repairman in your house. You finally work up the courage to make the call, the repairman gets there only to find it's simply the pilot light that has gone out and it's a 3-minute fix. So, you've spent an entire day panicked to the eyeballs, when in fact, the reality wasn't all that bad. You coped, got your pilot light lit and he left. End of story. But the anticipatory anxiety really had you going and made you miserable for the better part of that day.

Just My Imagination

Another classic symptom of agoraphobia is "what if" thinking (which ties in very nicely with anticipatory anxiety). Phobics are extremely intelligent, creative and imaginative people, but we allow those wonderful qualities to work against us. It's because we have that incredible imagination that we can see every conceivable side to any given situation (I used to tell myself that if I ever recovered to the point where I could travel, I was heading for Sweden to have my imagination surgically removed!). Let's set another scene:

You're stopped at a traffic light, one car ahead of you, and a few behind you. You drum your fingers against the steering wheel, impatiently waiting for the light to turn green. Suddenly, the thought floats through your mind: "What if this light is broken and I am stuck here forever??? (Phobics are also absolute thinkers: We don't have many gray areas, just black and white. And everything is extreme, like "never", "forever", "always.") What if I have a heart attack and the ambulance can't reach me because of all these cars around me? What if the car in front of me breaks down and I can't get around him?" (You get my drift here.) Now, the three other non-phobic drivers stuck in that line of traffic are calmly distracting themselves by filing their nails, reading the paper, cleaning out the glove box and digging out the spare change from between the seats, while YOU are having a grand old time making yourself nuts by coming up with scenario-after- scenario, each one worse than the last. So you're off to the races again, adrenaline pumping merrily away.

Okay, now that I've scared the beejeebers out of you, let me give you the good news...

YOU ARE NOT CRAZY!

That bears repeating:

YOU ARE NOT CRAZY!

Say that to yourself 50 times a day until you start believing it. Paste it on your bathroom mirror and read it while you're brushing your teeth. Hire a sky-writer to fly over your house and put it up there in 50-foot tall letters if you have to. But believe it. It's the truth.

Wait a sec... I feel another truth coming on...

YOU ARE NOT GOING TO GO CRAZY EITHER!

Repeat the same procedure, as above, for this one, too.

Agoraphobia is caused by a combination of heredity and environment. It's a behavioral disorder, not a mental illness. There are those of us with personalities pre-disposed to being phobic. We're highly intelligent, creative, imaginative and sensitive (and no, "sensitive" is NOT a bad word!). We have many, many sterling qualities and are viable, productive and useful members of society. We are very loving, kind, compassionate and caring. We are "people" persons, always willing to give and give of ourselves. And these are NOT bad things!

The other good news is that this is a very treatable condition. You do NOT have to relegate yourself to the attic and become crazy Aunt Hattie who no one ever sees. The process is a slow one, but look how long it took you to get to this point! And once the recovery process begins, it too snowballs until your world begins expanding once again.

Good luck and Godspeed!

next: Panic/Anxiety Triggers
~ all articles on living with agoraphobia
~ anxiety-panic library articles
~ all anxiety disorders articles

Living with Agoraphobia.. and other anxiety related challenges

Well, now that you've made your way to Living with Agoraphobia, I suppose you just might like to know what that funny-sounding name means.

There are many technical definitions with all kinds of slants. For practical purposes, I'll just give you a brief definition given to me by a counselor I once worked with. According to her, agoraphobia is an anxiety condition wherein the one challenged with it suffers extreme anxiety, or even terror, when subjected to any situation which is outside of his or her "safety zone."

The focus of this site is a practical one, one which explains in everyday terms what it's like to be phobic (shortened word for agoraphobic), written by a person who's been phobic for about 37 years now.

To be sure, like most life situations, being phobic has its upsides and its downsides. I hope to give you a smattering of it all, as told by those of us who know the challenge first-hand.

Luci, a good friend of mine and sister phobic, will also be contributing her input throughout this site. I hope you find it interesting, as well as informative.

Cruise around and enjoy your "surf"!

Contents:

• Agoraphobia and I
• All About Luci...
• Agoraphobia: What the Heck Is It???
• Phobics: Masters at Avoidance!
• Panic/Anxiety Triggers
• Anxiety - Panic Attack Coping Tips
• Systematic Desensitization for Treatment of Agoraphobia
• The Snake and the 'Snake'
• Anxiety on the GO - Travel Anxiety Breakthrough
• I Picked Up a Few Groceries Today...
• Poetry
• Bill of Rights
• A Bill of Assertive Rights
• Resources for Help and Change
• A Little Humor to Bring a Smile to Your Face
• Are ya smilin' yet?
• Anxiety on the GO - Anxiety Hurts

next: Agoraphobia and I
~ anxiety-panic library articles
~ all anxiety disorders articles

Business Week
BY SUSAN GARLAND
10-16-2000

Wednesday, October 21, 1998
(This is an unedited, uncorrected transcript.)
From ABC's 20/20

SAM DONALDSON: Tonight, we bring you word of an amazing medical discovery. It's not a bio-engineered drug or a dazzling piece of high-tech equipment. This is a breakthrough treatment for depression and anxiety that is so simple, even the Harvard doctor who came up with the idea couldn't believe it would work. Our own DR TIMOTHY JOHNSON: turns the spotlight on this cutting-edge therapy -a pair of goggles and some tape, giving some patients a dramatically different view of the world.

DR TIMOTHY JOHNSON, ABCNEWS MEDICAL EDITOR (VO)
Depression and anxiety - what is the key to unlocking the troubled mind? Psychologists believe in the healing power of talk therapy. Neuroscience, on the other hand, tells us that emotions are generated by brain chemistry and that drugs like Prozac are, therefore, crucial. But now, Dr Fredric Schiffer, a Harvard psychiatrist, has come up with a startling new concept to explain some common emotional disorders. And he says he's found a safe, cheap and surprising way to help treat them-a simple pair of goggles, seen here in a college class demonstration. These ordinary goggles are taped so that a person can see only out of the extreme left side, and these goggles allow the person to see only to the extreme right. Dr Schiffer says that the light from looking out just one side activates the opposite side of the brain, and, therefore, triggers thoughts and emotions specific to that side.

DR FREDRIC SCHIFFER, PSYCHIATRIST: I'm so amazed at this.

DR TIMOTHY JOHNSON: (VO): So are his patients. This patient agreed to talk to 20/20 if we did not identify him. We'll call him "Joe." Three years ago, JOE: felt himself slipping dangerously into depression. The pressures of a new job had quickly overwhelmed him. The anxiety he felt was intense and painful. He tried one medication after another, but nothing worked.

JOE, GOGGLE THERAPY PATIENT: When you're depressed and you're severely depressed, one of the things that seems to disappear is hope.

DR TIMOTHY JOHNSON: (VO): He says the first time he tried on the goggles in therapy, they dramatically lifted his dark and pessimistic mood.

JOE: It was such an immediate difference. It was startling. And this was the very first time.

DR TIMOTHY JOHNSON: (VO): Dr Schiffer, who is on the staff at the world-famous McLean Hospital in Boston, believes, like many people do, that we often have two sides to our personalities-one that's more calm and accepting, another that's more emotional and impulsive.

ANGRY MAN: It's insane.

DR TIMOTHY JOHNSON: (VO): But he takes it one giant step further. In his book, "Of Two Minds: The Revolutionary Science of Dual-Brain Psychology," he argues that sometimes we literally have two different minds in our brain-a calm, optimistic mind on one side, and an anxious, pessimistic mind on the other. Dr Schiffer says visual stimulation with the special goggles he uses in therapy can activate one or the other side of the brain and therefore trigger either the calm and optimistic mind or the anxious and pessimistic mind. Dr Schiffer says the glasses help his patients get better by calling on their calm mind to help teach their anxious mind. (on camera) So the glasses, really, through the eyes, help to isolate one part versus the other part.

DR FREDRIC SCHIFFER: It's to get the healthy part to help the troubled part.

DR TIMOTHY JOHNSON: Looking left or right in order to change our feelings or emotions is controversial. Some neuroscientists are skeptical. But many other experts believe that Dr Schiffer's theory is a logical extension of past studies showing that the two halves of our brain function quite differently. In other words, if our two halves can function differently, maybe they can feel differently. In 1995, Dr Schiffer decided to test that theory with an admittedly very low-tech experiment.

DR FREDRIC SCHIFFER: I decided to put my hands over my eyes like this to see if I felt a little different that way versus that way.

DR TIMOTHY JOHNSON: (on camera) Yeah?

DR FREDRIC SCHIFFER: And I didn't feel any different. But I went to the office that afternoon and, not expecting anything, I asked a patient to do it.

DR TIMOTHY JOHNSON: Figured it wouldn't hurt. Might be worth trying.

DR FREDRIC SCHIFFER: Yeah, it wouldn't hurt. And the patient says, "Oh, my God." I said, "What's the matter?" He says, "I got all my anxiety back." And he was a guy who had come in six months earlier for anxiety, and he was doing much better. And so, I quickly said, "Well, try the other side." And he said, "Oh, that feels good." So I was amazed. I was absolutely amazed.

DR TIMOTHY JOHNSON: (VO): All five of Dr Schiffer's patients that day had similar dramatic responses. So just two days after the first attempts with patients using hands in his office, Dr Schiffer tried using taped goggles instead.

DR FREDRIC SCHIFFER: The patients would tell me how far to put the tape over, and they'd say, "No, that's not as strong." And I'd move it over a little more. "Yeah, that's better," and ...

DR TIMOTHY JOHNSON: (on camera) So you'd experiment with them?

DR FREDRIC SCHIFFER: Yeah. They would literally give me feedback, and it was very accurate and consistent.

DR TIMOTHY JOHNSON: (VO): The next step was to test the goggles more scientifically. Dr Schiffer tested emotional responses in 70 patients while provoking different feelings with the right or left-sided goggles. He noticed that some had the anxious and pessimistic feelings in their left brain, others in their right brain. It would vary from one individual to another, and it was difficult to predict which side had which feelings until he tested them with the goggles. He also used brain wave studies in 15 test subjects to demonstrate that left-looking goggles, indeed, aroused the right brain and vice versa. I observed a volunteer test subject, a college student named Chris. It was his first time trying the special goggles. Neuroscientist Carl Anderson (ph) asked CHRIS: to rate how anxious he felt while looking out goggles that were taped to allow him to see only out of the extreme right side.

CARL ANDERSON, NEUROSCIENTIST: How much anxiety do you feel now? None at all, mild amount, moderate amount, quite a bit or an extreme amount?

CHRIS: I want to say an extreme amount.

DR TIMOTHY JOHNSON: (VO): CHRIS: also reported that he felt extreme tension and anger while looking to the right. But when he put on goggles that let him look out the left, his reactions were quite different. When asked to rate his anxiety level ...

CHRIS: I don't want to say I feel like none, but I don't feel like really anxious.

DR TIMOTHY JOHNSON: (VO): Dr Schiffer asked CHRIS: to retry the right-looking glasses that seemed to provoke him.

DR FREDRIC SCHIFFER: Tell me what you're feeling.

CHRIS: I'm feeling like I want to take these glasses off.

DR TIMOTHY JOHNSON: (on camera) Because?

CHRIS: They're making me angry.

DR FREDRIC SCHIFFER: Now I want you to try this other pair again.

CHRIS: OK.

DR TIMOTHY JOHNSON: (VO): These glasses allow CHRIS: to again see out the left side, and they seem to comfort him.

CHRIS: This side feels more easy-going, more happy-go-lucky kind of personality. The other side, I kind of feel like I want to go to war or something.

DR FREDRIC SCHIFFER: Go to war?

CHRIS: Yeah.

DR TIMOTHY JOHNSON: (VO): What CHRIS: has just demonstrated in the lab is what Dr Schiffer says he's observed in his patients. Their psychological suffering seems to be located more profoundly in one side of the brain than the other. I had the opportunity to sit in on a therapy session with Joe, the patient we met earlier. In previous sessions, he had learned how his two brain sides differ.

DR FREDRIC SCHIFFER: Why don't you pick a pair?

JOE: These? Well, the negative side first?

DR TIMOTHY JOHNSON: (VO): For Joe, the negative side is in the left brain. I observe how quickly Joe's distress sets in.

JOE: It immediately puts you in an uncomfortable situation.

DR FREDRIC SCHIFFER: What are you feeling?

JOE: Anxious. I'm a walking advertisement for, you know, just insecurity and ultimately failure at what I'm setting out to accomplish. And it manifests itself in anxiety because I don't want to feel that way.

DR FREDRIC SCHIFFER: It sounds very painful.

JOE: Yes, it is. Life would be intolerable if you had to live it constantly out of this one side.

DR TIMOTHY JOHNSON: (VO): Dr Schiffer now asks JOE: to switch to the positive goggles. I can see the anxious expression on Joe's face change immediately.

JOE: See, it never ceases to amaze me. Right now-and I always chuckle with you when this happens. I mean, despite that we've been together for a while. I mean, I still get a kick out of it.

DR TIMOTHY JOHNSON: (VO): The difference in JOE: is startling.

JOE: The perspective from this side is just so much different than the other side. I mean, it's incredible. Right now, I'm looking at, you know, just going forward instead of swimming against the tide. It's a wonderful feeling.

DR TIMOTHY JOHNSON: (VO): Dr Schiffer reports that 40 percent of his patients had no response to the goggles, and 30 percent had a mild to moderate response. However, another 30 percent of his patients report an intense response, overall about the same response reported with Prozac. But even for the positive responders, the glasses are still just a tool.

DR FREDRIC SCHIFFER: No one is going to be helped by just putting on a pair of glasses. They're an adjunct for teaching the person how to communicate with themselves.

DR TIMOTHY JOHNSON: (VO): But many of his patients say the glasses are the medicine they need to keep their mature mind in focus.

JOE: has had special sunglasses made that are tinted so he can see clearly to his left, but not to his right. They look like regular sunglasses, except that by forcing him to activate his optimistic mind, they provide a very practical boost to his mental health.

JOE: It gives you hope. And you know, hope is, you know, obviously a very important thing. Because with hope, anything can happen, and it's worked for me.

SAM DONALDSON If this therapy looks easy enough to try at home, Dr Schiffer says it is. And you don't even need goggles to do it. Simply hold your hands in front of your eyes, as you saw in our story, covering one eye completely, the other halfway-so you're looking out from the extreme left or the extreme right. If you feel more relaxed seeing from one side than from the other, then goggle therapy might be able to put you in touch with the bright side of your brain. We'll be right back.

next: CHAPTER 13: Management of Patient's Post-ECT Course
~ all Shocked! ECT articles
~ depression library articles
~ all articles on depression

next: Anxiety on the GO - Anxiety Hurts
~ all articles on living with agoraphobia
~ anxiety-panic library articles
~ all anxiety disorders articles

Techniques to help reduce the effects of trauma, make lifestyle changes to positively affect emotional well-being, and build strong relationships are a few of the issues addressed in a series of new self-help guides developed to help people with psychiatric disabilities. The booklets were released today by the Substance Abuse and Mental Health Services Administration (SAMHSA).

"The self-care skills and strategies outlined in the guides can be used to complement other mental health care treatment," said SAMHSA Administrator Charles G. Curie. The guides offers practical steps that people need to keep in mind as they work on their own recovery.

The booklets, produced by SAMHSA's Center for Mental Health Services, cover the following topics: Building Self-esteem, Making and Keeping Friends, Dealing with the Effects of Trauma, Developing A Recovery and Wellness Lifestyle, Speaking Out for Yourself, Action Planning for Prevention and Recovery.

The Recovering Your Mental Health series offers specific information guided by an understanding of consumer self-help issues, to enhance quality of life for people from a variety of backgrounds. There are six booklets in the comprehensive, yet brief series. Each booklet contains ideas and strategies that people from all over the country have found to be helpful in managing their own illnesses and services. A section on additional resources is located at the end of each guide.

"These user-friendly guides will help persons living with mental illness to achieve higher levels of wellness, stability and recovery," says Bernard S. Arons, M.D., Director of the Center for Mental Health Services.

Copies of these six new self-help guides are available free of charge by calling SAMHSA's Clearinghouse at 1-800-789-2647; TTY 301-443-9006 or logging on to http://www.samhsa.gov.

CMHS is a component of the Substance Abuse and Mental Health Services Administration (SAMHSA). SAMHSA, a public health agency within the U.S. Department of Health and Human Services, is the lead federal agency for improving the quality and availability of substance abuse prevention, addiction treatment and mental health services in the United States. Information on SAMHSA's programs is available on the Internet at www.samhsa.gov.

next: Pathway to Health
~ all Shocked! ECT articles
~ depression library articles
~ all articles on depression

As I have said before, all things, agoraphobia included, have their lighter side. When I think back, I can recall several times when my "condition" gave me (or others) a good chuckle.

Here, Crackers

Usually, when I'm very anxious I "zone out" and have trouble paying attention to anything "in the moment". This was exemplified a few times with my poor parrot, "Crackers."

One time, while I was going to put him back in his cage from his perch, I opened the microwave door and tried to stuff him in there! Thank goodness I caught myself before I pushed the "start" button!! LOL.

I had one other similar occasion with Crackers, but this time instead of trying to stuff him in the microwave, I tried to stuff him in the garbage can! He had a 55 word vocabulary and yelled at me clearly before I could put the lid down on him!

Sometimes practice doesn't make perfect

Another funny incident happened when I was practicing going to the mall, a real biggie for me. I was with my friend, "J".

"J" knew me pretty well. As we approached the middle of the mall and I began to feel more-and-more trapped, she picked up on my anxiety. I think my face looked something like a scarlet blowfish!

Anyway, she was very good at trying to distract me in such situations and on this particular occasion she grabbed me by the scruff of the neck and started heading my disoriented self toward the door. BUT along the way, she paused briefly at every other store, still holding me by the collar, and made me look into the window. She declared that if I didn't knock it off she was gonna drag me into the store and make me fill out a job application! LOL. Well, by the fourth or fifth store I was laughing so hard I could barely remember that I was anxious.

It was a memory that has stayed with me (and probably everyone else in the mall) for many, many years!!

Where's the health inspector?

Here's a pretty funny story from one of my friends in the Agoraphobia Discussion Group:

"When I first started having panic attacks, and before I knew what was happening to me, we would visit restaurants quite often and I would get confused trying to exit the ladies' room and constantly end up in the kitchen. I saw many kitchens until my husband started escorting me to the powder room and back. I can still see the cooks' startled faces when I wandered in and I don't think they ever believed my mumbled story about looking for the health inspector, but it worried them enough to shift focus from me and start looking for the health inspector too. I can laugh about it now!"

next: Are ya smilin' yet?
~ all articles on living with agoraphobia
~ anxiety-panic library articles
~ all anxiety disorders articles

Sometime around 1984, I discovered what I "had" by means of a talk show here in sunny Florida. Up until that time, from the age of 13 to my mid 30's, I just thought I had some form of mental illness. After all, being afraid of going to my mailbox was a pretty strange thing to have happen to me!

Anyway, I saw a local talk show featuring a woman who was talking about a "challenge," just like the one I had. Immediately, I knew she was talking about me! She was offering a self-help group about 15 miles from my house that dealt with something called "Agoraphobia". At long last, I had a name for my "challenge" and I soon learned that I certainly was NOT crazy, that I wasn't alone in my challenge, and that there was help.

The program I attended taught the concept of systematic desensitization to deal with agoraphobia.

Systematic desensitization involves reducing your sensitivity to certain stimuli in a given anxiety-producing situation in very small, controlled steps. This is done by exposing yourself to the situation a little bit at a time, and never letting yourself get beyond a level of #3 on the anxiety scale (scale goes from 1-10). By doing this, your mind can never remember having a "bad" experience in any given place, and therefore you're more likely to return.

Listen to a relaxation tape or use another method of relaxing before going out and trying this method. Doing a trial-run in your mind can also be useful, so that when you actually face the situation, you'll feel that it's a familiar scene that you've already been through successfully.

Always keep the "5 R's" in mind. They are:

1. React
2. Retreat
3. Relax
4. Recover
5. Repeat

Here's a sample summary of a practice situation:

I walked into the supermarket and experienced a #2 anxiety level. I stood and used my tools (talk to self or to partner, count labels, look out the door. Anything to keep anxiety levels down).

I proceeded to the middle of the supermarket and checked my symptoms and decided I felt okay and was under a #3. I decided to walk to the back of the store and suddenly my anxiety rose to a #4.

Slowly I turned around, verbalized what I was feeling to my support person and walked outside. I went to a "safe place" in my imagination (imagined a quiet, relaxing scene) recovered and relaxed fully. I then decided to try again.

I walked back into the supermarket, felt comfortable. Walked to the back of the store and decided to buy ONE item. I got to the checkout line and only felt a #2 anxiety level. I paid for my purchase and left.

By going to the supermarket with a short list of have to's, it's easier to relax and do the practice in small steps. You can't do a practice when you have to do your weekly shopping.

If you never let yourself get above a #3 anxiety level while practicing, you'll eventually desensitize to the situation! This method can be applied to most life situations, driving, doctor's visits, having company in your home, social situations, etc.

If you're willing to go out the next day and practice again in the same situation, you know you've done your practicing correctly! :)

Click here for Barb's suggestions for desensitizing, using shopping as an example.

Psst..... If you're practicing desensitization and would like a little help explaining your challenge to a doctor, dentist, etc., the form letter here might be of help to you!

next: The Snake and the 'Snake'
~ all articles on living with agoraphobia
~ anxiety-panic library articles
~ all anxiety disorders articles

It's taken me many years to learn that at the core of my anxiety are the feelings that I have stuffed for many years, and that when I'm able to express my feelings appropriately and in a timely fashion, my anxiety is oftentimes kept to a minimum. It's almost like magic.

I, like so many others, came from a relatively dysfunctional family (thank goodness there has been a lot of improvement in later years) and I was literally not allowed to "feel" when I was younger.

It seemed the only feeling I did develop was the feeling of anxiety. Some 30+ years later, I'm finally learning what real feeling is and how to express it as it comes up. It's been the greatest gift my "recovery" process has given me in recent years. It doesn't always "feel" good, but it's much better than always being anxious.

I've stumbled across many versions of a personal "Bills of Rights" in the past few years and I will list some of the major points stated within them (not in any order). They essentially are guidelines for giving ourselves permission to think, feel and express, and value who we are. Some of the most significant points are:

• I have numerous choices in my life beyond mere survival.
• I have a right to discover and know my Child within.
• I have a right to grieve over what I didn't get, that I needed or wanted.
• I have a right to follow my own standards and values.
• I have a right to dignity and respect.
• I have a right to make my own decisions.
• I have a right to determine and honor my own priorities.
• I have the right to terminate conversations with people who make me feel put down and humiliated.
• I have the right to have my needs met at least half of the time (especially in a relationship).
• I have a right to make mistakes and not have to be perfect.
• I have a right to expect honesty from others.
• I have a right to be angry at someone I love.
• I have a right to all of my feelings.
• I have the right not to be OK all the time.
• I have the right not to settle for crumbs.
• I have a right to feel scared and to say, "I am afraid."
• I have a right to change my mind at any time.
• I have the right to be happy.
• I have a right to stability and security.
• I have the right to my own personal space.
• There is no need to smile when I cry.
• I have the right to change and grow.
• I have the right to have friends and to openly share with them.
• I have a right to a non-abusive environment.
• I have a right to grieve over actual or threatened losses.
• I have a right to give and receive unconditional love.

next: A Bill of Assertive Rights
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• You have the right to judge your own behavior, thoughts, and emotions, and to take the responsibility for their initiation and consequences upon yourself.
• You have the right to offer no reasons or excuses for justifying your behavior.
• You have the right to judge if you are responsible for finding solutions to other people's problems.
• You have the right to make mistakes--and be responsible for them.
• You have the right to say, "I don't know."
• You have the right to be illogical in making decisions.
• You have the right to say, "I don't understand."
• You have the right to say, "That is unacceptable to me."
• You have the right to say, "I don't care."
• We have the right to have needs and to have those needs be as important as other people's needs.
• We have the right to ask other people to respond to our needs.
• We have the right to have feelings--and to express these feelings in ways which do not violate the dignity of other people.
• We have the right to decide whether we'ill meet other people's expectations or whether we'ill act in ways which fit us, as long as we act in ways which don't violate other people's rights.
• YOU HAVE THE RIGHT TO SAY NO, WTHOUT FEELING GUILTY!

next: Resources for Help and Change
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~ anxiety-panic library articles
~ all anxiety disorders articles