TESTIMONY OF JOHN M. FRIEDBERG, M.D., NEUROLOGIST, BEFORE THE MENTAL HEALTH COMMITTEE OF THE NEW YORK STATE ASSEMBLY

MARTIN LUSTER PRESIDING

NYC, May 18, 2001

"In view of the primitive simplicity of their minds, they (the masses) more easily fall victim to a big lie than to a little one, since they themselves lie in little things, but would be ashamed of lies that were too big." Adolph Hitler. Mein Kampf, Vol.1, Ch. 10, 1924 tr. Ralph Manheim, 1943

INTRODUCTION

My name is John Friedberg. I am a board certified neurologist practicing in Berkeley, California.

I was born in Far Rockaway (NYC) in 1942, graduated Lawrence High School, Yale University and the University of Rochester School of Medicine and for the past twenty years I've been seeing patients with every conceivable neurologic problem, from headaches to Huntington's, in my office and in hospitals.

I am in good standing with my hospitals, professional societies and licensing boards and I'm proud to say I've never been successfully sued.

In 1975 I published my book "Shock Treatment Is Not Good For Your Brain" and in 1979 "Shock Treatment, Brain Damage and Memory Loss," a peer reviewed article in the American Journal of Psychiatry.

I do not believe in mental illness. Depression is no more "the same as diabetes" than heartbreak is the same as a heart attack.

I do not believe in hypothetical diseases of the mind but there is no mistaking damage to the brain. Psychiatric drugs and electroshock inflict real injury in the name of treating fictive maladies. Paul Henri Thomas has Tardive Dyskinesia and heptatitis from psychiatric drugs and amnesia from the ECT.

BASIS FOR OPINIONS

My opinions are based on my years of experience with patients and review of records from all over the country as an expert witness in electroshock malpractice cases. They are based on ECT statistics from the six states which mandate reporting; and of necessity, my opinions are based on a lifetime following publications and statements issuing from the small but vocal minority of psychiatrists who believe in ECT and usually nothing but.

Fortunately for me, the believers don't always believe each other; their data frequently belie their conclusions; and what they actually do contradicts what they say they do. The truth slips out.

As one example: we have known since the 1950's that confining electroshock to the non-verbal hemisphere (usually the right as in "unilateral non-dominant ECT") causes less verbal impairment and memory loss than bilateral ECT but the recommendation to begin with non-dominant ECT is honored mostly in the breech.

Another example: the "grandfather" of ECT, Dr. Max Fink claims the rate of memory loss is 1 in 200. He has repeated this so often it sounds like a fact. But Harold Sackeim, Ph.D., just as much an enthusiast and just as aggressive, says Fink's figure has "no scientific basis."

Who to believe? My view is that memory loss from ECT is no "side effect;" it's the main effect and the best studies find it in 100% of subjects.

Incidentally, Dr. Fink didn't pick the number 1/200 out of thin air. 1/200 has consistently been the death rate from ECT administration - as far back as 1958 and as recently as Texas and Illinois in the 1990's.

FIVE BIG LIES

Big Lie 1: Dr. Fink tells people that ECT is safer than childbirth. If one out of every 200 women were dying in delivery it would be front page news.

Big Lie 2: ECT doesn't cause brain damage. One picture will refute that. The illustration below (MRI on the right, CT left, same patient) depicts a large hemorrhage from ECT. Hemorrhages, large and small, cause permanent seizure disorders in some patients.

Another MRI study documented a breakdown of the blood brain barrier and cerebral edema - brain swelling - after each and every shock. (Mander et al: British Journal of Psychiatry, 1987: V 151, p 69-71)

Big lie 3: ECT is new and improved. The whole point of ECT is to trigger a convulsion and there is simply no way around the brain's threshold: 100 joules of energy, a typical "dose," whether brief pulse, square wave, sine wave, AC or DC, unilateral or bilateral, with or without oxygen equals the energy it takes to light up a 100 watt bulb for one second or drop a 73 pound weight one foot. And it's the energy that does the damage.

Big lie 4: ECT is a "Godsend" (Fink again). In March of this year, Dr. Sackeim published a study in JAMA showing a "relapse rate" of 84% within six months of stopping ECT. It is no coincidence that improvement ceases just as the concussive effects are finally waning. Sackeim's solution?: more ECT. Call it "maintenance" or call it "continuation," just don't stop. (JAMA. 2001;285:1299-1307).

Big lie 5: No one knows how ECT works. On the contrary, everyone knows how ECT works. It works by erasing memory and terrifying people.

CONCLUSION

ECT isn't back - it never went away. It's more common than appendectomy.

What has happened is that it's advocates have grown more arrogant and the number of patients forced to undergo ECT against their will is increasing.

This was brought to public attention by Paul Henri Thomas fighting for his life and his mind at Pilgrim State Hospital on Long Island. Over the past two years he has been subjected to 60 shocks and a judge just ordered up 40 more. The newspapers state the Mr. Thomas was born in Haiti, emigrated from oppression and was granted American citizenship.

To be held down, drugged and forcibly administered convulsive dose after convulsive dose of electroshock to the head: can anyone think of a greater assault on a human being's rights - short of death - in the whole world? And it's happening here in the land of the free. That's not acceptable.

We have had 60 years of poignant testimony from eloquent victims of electroshock. Ernest Hemingway complained it ruined his memory and put him out of business. He killed himself within weeks of concluding a second course of ECT. George Orwell ends 1984 with his protagonist being forced to love Big Brother on an electroshock table.

I urge you to declare a moratorium on electroconvulsive therapy until it can be proven safe by evidence, not proclamation.

I urge you to declare a moratorium on electroconvulsive therapy until patients can be guaranteed free and informed choice.

Thank you.

next: Testimony of Linda Andre, Director of Committee for Truth in Psychiatry
~ all Shocked! ECT articles
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TESTIMONY OF LEONARD ROY FRANK AT A PUBLIC HEARING ON ELECTROCONVULSIVE "TREATMENT" BEFORE THE MENTAL HEALTH COMMITTEE OF THE NEW YORK STATE ASSEMBLY, MARTIN A. LUSTER (CHAIRMAN), MANHATTAN, 18 MAY 2001

My name is Leonard Roy Frank, from San Francisco, and I'm here representing the Support Coalition International based in Eugene, Oregon. SCI unites 100 sponsoring groups who oppose all forms of psychiatric oppression and support humane approaches for assisting people said to be "mentally ill." This year the United Nations recognized Support Coalition International as "a Non-Governmental Organization with Consultative Roster Status."

I've taken the epigraph for my presentation from a talk on the Holocaust by Hadassah Lieberman, the wife of Sen. Joseph Lieberman, which was rebroadcast on C-SPAN last month. She quoted the Bal Shem Tov, founder of Hasidism: "In remembrance lies the secret of redemption."

Introduction

Some personal background is relevant to the substance of my testimony: I was born in 1932 in Brooklyn and was raised there. After graduating from the Wharton School at the University of Pennsylvania, I served in the U.S. Army and then worked as a real estate salesman for several years. In 1962, three years after moving to San Francisco, I was diagnosed as a "paranoid schizophrenic" and committed to a psychiatric institution where I was forcibly subjected to 50 insulin-coma and 35 electroconvulsive procedures.

This was the most painful and humiliating experience of my life. My memory for the three preceding years was gone. The wipe-out in my mind was like a path cut across a heavily chalked blackboard with a wet eraser. Afterwards, I didn't know that John F. Kennedy was president although he had been elected three years earlier. There were also big chunks of memory loss for events and periods spanning my entire life; my high school and college education was effectively destroyed. I felt that every part of me was less than what it had been.

Following years of study reeducating myself, I became active in the psychiatric survivors movement, becoming a staff member of Madness Network News (1972) and co-founding the Network Against Psychiatric Assault (1974) -- both based in San Francisco and dedicated to ending abuses in the psychiatric system. In 1978 I edited and published The History of Shock Treatment. Since 1995, three books of quotations I edited have been published: Influencing Minds, Random House Webster's Quotationary, and Random House Webster's Wit & Humor Quotationary.

Over the last thirty-five years I have researched the various shock procedures, particularly electroshock or ECT, have spoken with hundreds of ECT survivors, and have corresponded with many others. From all these sources and my own experience, I have concluded that ECT is a brutal, dehumanizing, memory-destroying, intelligence-lowering, brain-damaging, brainwashing, life-threatening technique. ECT robs people of their memories, their personality and their humanity. It reduces their capacity to lead full, meaningful lives; it crushes their spirits. Put simply, electroshock is a method for gutting the brain in order to control and punish people who fall or step out of line, and intimidate others who are on the verge of doing so.

Brain Damage

Brain damage is the most important effect of ECT. Brain damage is, in fact, the 800-pound gorilla in the living room whose existence psychiatrists refuse to acknowledge, at least publicly. Nowhere is this more clearly illustrated than in the American Psychiatric Association's 2001 Task Force Report on The Practice of Electroconvulsive Therapy: Recommendations for Treatment, Training, and Privileging, 2nd ed. (p. 102), which states that "in light of the accumulated body of data dealing with structural effects of ECT, 'brain damage' should not be included [in the ECT consent form] as a potential risk of treatment."

But 50 years ago, when some proponents were careless with the truth about ECT, Paul H. Hoch, co-author of a major psychiatric textbook and New York State's Commissioner of Mental Hygiene, commented, "This brings us for a moment to a discussion of the brain damage produced by electroshock.... Is a certain amount of brain damage not necessary in this type of treatment? Frontal lobotomy indicates that improvement takes place by a definite damage of certain parts of the brain." ("Discussion and Concluding Remarks," Journal of Personality, 1948, vol. 17, pp. 48-51)

More recently, neurologist Sidney Sament backed the brain-damage charge in a letter to Clinical Psychiatry News (March 1983, p. 11):

"After a few sessions of ECT the symptoms are those of moderate cerebral contusion, and further enthusiastic use of ECT may result in the patient functioning at a subhuman level.

Electroconvulsive therapy in effect may be defined as a controlled type of brain damage produced by electrical means....

In all cases the ECT 'response' is due to the concussion-type, or more serious, effect of ECT. The patient 'forgets' his symptoms because the brain damage destroys memory traces in the brain, and the patient has to pay for this by a reduction in mental capacity of varying degree."

Additional evidence of ECT-caused brain damage was published in an earlier APA Task Force Report on Electroconvulsive Therapy (1978). Forty-one percent of a large group of psychiatrists responding to a questionnaire agreed with the statement that ECT produces "slight or subtle brain damage." Only 28 percent disagreed (p. 4).

And finally there is the evidence from the largest published survey of ECT-related deaths. In his Diseases of the Nervous System article titled "Prevention of Fatalities in Electroshock Therapy" (July 1957), psychiatrist David J. Impastato, a leading ECT proponent, reported 66 "cerebral" deaths among the 235 cases in which he was able to determine the likely cause of death following ECT (p. 34).

Memory Loss

If brain damage is electroshock's most important effect, memory loss is its most obvious one. Such loss can be, and often is, devastating as these statements from electroshock survivors indicate:

"My memory is terrible, absolutely terrible. I can't even remember Sarah's first steps, and that's really hurtful... losing the memory of the kids growing up was awful."

"I can be reading a magazine and I get halfway through or nearly to the end and I can't remember what it's about, so I've got to read it all over again."

"People would come up to me in the street that knew me and would tell me how they knew me and I had no recollection of them at all... very frightening." (Lucy Johnstone, "Adverse Psychological Effects of ECT," Journal of Mental Health, 1, vol. 8, p. 78)

Electroshock proponents are dismissive of the memory problems associated with use of their procedure. The following is from the sample ECT consent form in the APA's 2001 Task Force Report (pp. 321-322): "The majority of patients state that the benefits of ECT outweigh the problems with memory. Furthermore, most patients report that their memory is actually improved after ECT.  Nonetheless, a minority of patients report problems in memory that remain for months or even years." The text of the Report supplies flimsy documentation for the claims in the first two sentences, but the third sentence, at least, is closer to the truth than coverage of the same point in the sample consent form of the first edition of the APA's Task Force Report (1990, p. 158) which reads, "A small minority of patients, perhaps 1 in 200, report severe problems in memory that remain for months or even years." And even the more recent Report underestimates the prevalence of memory loss among ECT survivors.

The vast majority of the hundreds of survivors I've communicated with over the last three decades experience moderate-to-severe amnesia going back two years and more from the time they underwent ECT. That these findings do not appear in published ECT studies may be accounted for by the bias of electroshock investigators, virtually all of whom are ECT proponents, by denial (from ECT-induced brain damage) on the part of participants and their fear of punitive sanctions if they were to report the extent and persistence of their memory loss, and finally by the difficulty in having anything published in a mainstream professional journal that seriously threatens the vested interests of an important segment of the psychiatric community.

Death

The 2001 Task Force Report on ECT states, "a reasonable current estimate is that the rate of ECT-related mortality is 1 per 10,000 patients" (p. 59). But some studies suggest that the ECT death rate is about one in 200. This rate, however, may not reflect the true situation because now elderly persons are being electroshocked in growing numbers: statistics based on California's mandated ECT reporting system indicate that upwards of 50 percent of all ECT patients are 60 years of age and older.

Because of infirmity and disease, the elderly are more vulnerable to ECT's harmful, and sometimes lethal, effects than younger people. A 1993 study involved 65 patients, 80 and older, who were hospitalized for major depression. Here are the facts drawn from this study: The patients were divided into 2 groups. One group of 37 patients was treated with ECT; the other group, of 28 patients, with antidepressants. After 1 year, 1 patient among the 28, or 4 percent, in the antidepressant group was dead; while in the ECT group 10 patients among the 37, or 27 percent, were dead. (David Kroessler and Barry Fogel, "Electroconvulsive Therapy for Major Depression in the Oldest Old," American Journal of Geriatric Psychiatry, Winter 1993, p. 30)

Brainwashing

The term "brainwashing" came into the language during the early 1950s. It originally identified the technique of intensive indoctrination, combining psychological and physical pressure, developed by the Chinese for use on political dissidents following the Communist takeover on the mainland and on American prisoners of war during the Korean War. While electroshock is not used overtly against political dissidents, it is used throughout most of the world against cultural dissidents, nonconformists, social misfits and the unhappy (the troubling and the troubled), whom psychiatrists diagnose as "mentally ill" in order to justify ECT as a medical intervention.

Indeed, electroshock is a classic example of brainwashing in the most meaningful sense of the term. Brainwashing means washing the brain of its contents. Electroshock destroys memories and ideas by destroying the brain cells which store them. As psychiatrists J. C. Kennedy and David Anchel, both ECT proponents, described the effects of this tabula rasa "treatment" in 1948, "Their minds seem like clean slates upon which we can write" ("Regressive Electric-shock in Schizophrenics Refractory to Other Shock Therapies," Psychiatric Quarterly, vol. 22, pp. 317-320). Soon after published accounts of the erasure of 18 minutes from secret White House audiotapes during the Watergate investigation, another electroshock psychiatrist reported, "Recent memory loss [from ECT] could be compared to erasing a tape recording." (Robert E. Arnot, "Observations on the Effects of Electric Convulsive Treatment in Man--Psychological," Diseases of the Nervous System-, September 1975, pp. 449-502)

For these reasons, I have proposed that the procedure now called electroconvulsive treatment (ECT) be renamed electroconvulsive brainwashing (ECB). And ECB may be putting it too mildly. We might ask ourselves, Why is it that 10 volts of electricity applied to a political prisoner's private parts is seen as torture while 10 or 15 times that amount applied to the brain is called "treatment"? Perhaps the acronym "ECT" should be retained and have the "T" stand for torture - electroconvulsive torture.

Seven Reasons

If electroshock is an atrocity, as I maintain, how can its use on more than 10 million Americans since being introduced more than 60 years ago be explained? Here are seven reasons:

1. ECT is a money-maker. Psychiatrists specializing in ECT earn $300,000-500,000 a year compared with other psychiatrists whose mean annual income is $150,000. An in-hospital ECT series costs anywhere from $50,000-75,000. One-hundred thousand Americans are believed to undergo ECT annually. Based on this figure, I estimate that electroshock is a $5 billion-a-year industry.

2. Biological model. ECT reinforces the psychiatric belief system, the linchpin of which is the biological model of mental illness. This model centers on the brain and reduces most serious personal problems down to genetic, physical, hormonal, and/or biochemical defects which call for biological treatment of one kind or another. The biological approach covers a spectrum of physical treatments, at one end of which are psychiatric drugs, at the other end is psychosurgery (which is still being used, although infrequently), with electroshock falling somewhere between the two. The brain as psychiatry's focus of attention and treatment is not a new idea. What psychiatrist Carl G. Jung wrote in 1916 applies today: "The dogma that 'mental diseases are diseases of the brain' is a hangover from the materialism of the 1870s. It has become a prejudice which hinders all progress, with nothing to justify it." ("General Aspects of Dream Psychology," The Structure and Dynamics of the Psyche, 1960) Eighty-five years later, there's still nothing in the way of scientific evidence to support the brain-disease notion. The tragic irony is that the psychiatric profession makes unsubstantiated claims that mental illness is caused by a brain disease while hotly denying that electroshock causes brain damage, the evidence for which is overwhelming.

3. The myth of informed consent. While outright force is seldom used, genuine informed consent is never obtained because ECT candidates can be coerced and because electroshock specialists refuse to accurately inform ECT candidates and their families of the procedure's nature and effects. ECT specialists lie not only to the parties vitally concerned, they lie to themselves and to each other. Eventually they come to believe their own lies, and when they do, they become even more persuasive to the naïve and uninformed. As Ralph Waldo Emerson wrote in 1852, "A man cannot dupe others long who has not duped himself first." Here is an instance of evil so deeply ingrained that it's no longer recognized as such. Instead we see such outrages as ECT specialist Robert E. Peck titling his 1974 book, The Miracle of Shock Treatment and Max Fink, who for many years edited the leading professional journal in the field, now called The Journal of ECT, telling a Washington Post reporter in 1996, "ECT is one of God's gifts to mankind." (Sandra G. Boodman, "Shock Therapy: It's Back," 24 September, Health [section], p.16)

4. Backup for treatment-resistant psychiatric-drug users. Many, if not most, of those being electroshocked today are suffering from the ill effects of a trial run or long-term use of antidepressant, anti-anxiety, neuroleptic, and/or stimulant drugs, or combinations thereof. When such effects become obvious, the patient, the patient's family, or the treating psychiatrist may refuse to continue the drug-treatment program. This helps explain why ECT is so necessary in modern psychiatric practice: it is the treatment of next resort. It is psychiatry's way of burying their mistakes without, except rarely, killing the patient. Growing use and failure of psychiatric-drug treatment has forced psychiatry to rely more and more on ECT as a way of dealing with difficult, complaining patients, who often are hurting more from the drugs than from their original problems. And when the ECT fails to "work," there's always -- following an initial series -- more ECT (prophylactic ECT administered periodically to outpatients), or more drug treatment, or a combination of the two. That drugs and ECT are for practical purposes the only methods psychiatry offers to, or imposes on, those who seek treatment or for whom treatment is sought is further evidence of the profession's clinical and moral bankruptcy.

5. Lack of accountability. Psychiatry has become a Teflon profession: criticism, what little there is of it, doesn't stick. Psychiatrists routinely carry out brutal acts of inhumanity and no one calls them on it -- not the courts, not the government, not the people. Psychiatry has become an out-of-control profession, a rogue profession, a paradigm of authority without responsibility, which is a good working definition of tyranny.

6. Government support. Not only does the federal government stand by passively as psychiatrists continue to electroshock American citizens in direct violation of some of their most fundamental freedoms, including freedom of conscience, freedom of thought, freedom of religion, freedom of speech, freedom from assault, and freedom from "cruel and unusual punishment," the government also actively supports electroshock through the licensing and funding of hospitals where the procedure is used, by covering ECT costs in its insurance programs (including Medicare), and by financing ECT research (including some of the most damaging ECT techniques ever devised). A recently published study provides an example of such research. The ECT experiment, which was conducted at Wake Forest University School of Medicine/North Carolina Baptist Hospital, Winston-Salem, between 1995 and 1998, reports the use of electric current at up to 12 times the individual's convulsive threshold on as many as 36 depressed patients. The destructive element in ECT is the current that causes the convulsion: the more electrical energy, the greater the brain damage. This reckless disregard for the safety of ECT subjects was supported by grants from the National Institute of Mental Health. (W. Vaughn McCall, David M. Begoussin, Richard D. Weiner, and Harold A. Sackeim, "Titrated Moderately Suprathreshold vs. Fixed High-Dose Right Unilateral Electroconvulsive Therapy: Acute Antidepressant and Cognitive Effects," Archives of General Psychiatry, May 2000, pp. 438-444)

7. Electroshock could never have become a major psychiatric procedure without the active collusion and silent acquiescence of tens of thousands of psychiatrists. Many of them know better; all of them should know better. The active and passive cooperation of the media has also played an essential role in expanding the use of electroshock. Amidst a barrage of propaganda from the psychiatric profession, the media passes on the claims of ECT proponents almost without challenge. The occasional critical articles are one-shot affairs, with no follow-up, which the public quickly forgets. With so much controversy surrounding this procedure, one would think that some investigative reporters would key on to the story. But it's happened only rarely up to now. And the silence continues to drown out the voices of those who need to be heard. I'm reminded of Martin Luther King's 1963 "Letter from Birmingham City Jail," in which he wrote "We shall have to repent in this generation not merely for the vitriolic words and actions of the bad people, but for the appalling tilence of the good people."

Conclusion

As noted earlier, I'm here representing the Support Coalition International. But more significantly, I'm also here representing the true victims of electroshock: those who have been silenced, those whose lives have been ruined, and those who have been killed. All of them bear witness through the words I have spoken here today.

I'll close with a short paragraph, in way of summary, and a poem I wrote in 1989.

If the body is the temple of the spirit, the brain may be seen as the inner sanctum of the body, the holiest of holy places. To invade, violate, and injure the brain, as electroshock unfailingly does, is a crime against the spirit and a desecration of the soul.

Aftermath

With "therapeutic" fury
search-and-destroy doctors
using instruments of infamy
conduct electrical lobotomies
in little Auschwitzes called mental hospitals

Electroshock specialists brainwash
their apologists whitewash
as silenced screams echo
from pain-treatment rooms
down corridors of shame.

Selves diminished
we return
to a world of narrowed dreams
piecing together memory fragments
for the long journey ahead.

From the roadside
dead-faced onlookers
awash in deliberate ignorance
sanction the unspeakable --
Silence is complicity is betrayal.

next: Compilation of EMDR Studies
~ depression library articles
~ all articles on depression

Panic attacks in men often go undiagnosed because the symptoms mimic a heart attack. Men also resort to self-treatment of the problem with alcohol.

They're hard to treat

Because the symptoms of panic disorder include chest pain, pounding heart and shortness of breath and because men are traditionally considered to be more prone to heart attack than women, panic attacks in men often go undiagnosed because the symptoms mimic a heart attack.

This is possibly the most prevalent of the many reasons for the apparent inequality in diagnosis of a panic attack in men compared to women. There are other reasons, however to the extent that there appears to be almost a sex bias. On the surface women suffer from panic disorder and other anxiety disorders in significantly higher numbers than men, but this may be because they seek help more readily. Whatever the reason, such disorders are, consequently, more often associated with women. Female behavior in recognizing fear and asking for help has always been characterized as weakness while traditional male behavior in hiding or dealing with emotional problems alone is perceived to be strong and manly. Somehow even the heart attack scenario may be seen as more manly than admitting to a panic attack something traditionally associated with women and nerves...

It's not only the victims of panic attack themselves, however, whose perceptions are ruled by such fallacy. Diagnoses in men are highly influenced by the more usual male illnesses and, while doctors may recognize psychological disorders in women, preliminary diagnoses of the identical symptoms in men usually point to physical ailments..., the most obvious being the suspected heart attack. Other conditions - of which symptoms of panic attacks are commonly suspected of being are mitral valve collapse, excessive production of thyroid hormone, cardiac arrhythmias and epilepsy.

The result of a man's first panic attack, then, is likely to be painful tests in the hospital, the medical possibilities being ruled out and subsequent panic attacks which may or may not eventually be diagnosed as panic disorder.

Another common reason for men with anxiety disorders whether panic disorder, generalized anxiety disorder, social phobia or agoraphobia not being diagnosed and treated is due to the likelihood of self-treatment of the problem with alcohol. Clinical studies of both alcoholic and non-alcoholic male and female agoraphobics show that twice as many of the men as the women are alcoholics.

The American Journal of Psychiatry recently reported a five-year comparison study of the differences in the course of panic disorder in men and women. All selected patients had panic symptoms of comparable levels of severity. Women proved to be somewhat more likely to have panic disorder with agoraphobia, while men showed about the same degree of likelihood to have panic disorder without agoraphobia. Rates of remission and recurrences were analysed and compared in the male and female patients over the five year period. Both sexes achieved the same rates of remission for both panic disorder and panic disorder with agoraphobia. Recurring symptoms were ten per cent higher in women than in men. In summary, men with panic disorder were found to be less likely than women to have agoraphobia and less likely to have a recurrence of symptoms after remission.

Men often resist recognizing the fact that they are experiencing an anxiety disorder simply because they are conditioned to associating emotional illness with women. Many refuse to come to terms with it and stumble on to lives controlled by agoraphobia and further complicated by alcohol and drug abuse. It is not until the patient accepts that yes, he does have an anxiety disorder and understands that it is treatable, that he can discuss the treatment options with his doctor and make decisions on how to get on with his life. Learning about anxiety disorders and accepting that they can happen to anybody is preferable to attempting to hide or to ignore the problem and allow it to jeopardize and eventually to ruin career, marriage and relationships with children, parents and friends.

Source: Lifeline Anxiety Disorder Newsletter

next: How to Help Your Child Overcome Shyness and Social Anxiety
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~ all anxiety disorders articles

Though people experiencing anxiety sometimes prefer to attribute their symptoms to physical conditions, there are real medical conditions that may cause what looks like anxiety. These must always be ruled out. Drugs like amphetamines and cocaine, caffeine and alcohol may all precipitate anxiety attacks. Numerous medical conditions mimic many of the symptoms of anxiety, and some disorders in particular must be ruled out:

• coronary conditions are frequently accompanied by dread and apprehension
• hyperthyroidism
• systemic lupus
• erythematosus
• anemia
• as well as respiratory conditions, such as asthma, chronic obstructive pulmonary disease and pneumonia

can all result in symptoms that can be confused with anxiety.

There are also many medications, both prescription and over-the counter, that can precipitate anxiety. Your nutrition should also be considered. Look carefully at the amount of caffeine in coffee, soda, diet soda, chocolate and some aspirin preparations (e.g., Excedrin ®) likely to be circulating in your system. precipitate or exaggerate anxiety. Even small amounts of caffeine in some at-risk individuals can precipitate or exaggerate anxiety.

Source:

• Kathryn J. Zerbe, M.D., Psychiatric Education and Women's Mental Health, The Menninger Clinic

For more information on anxiety disorders, as well as other psychiatric disorders, Dr. Zerbe has written Women's Mental Health in Primary Care, which is available at bookstores and on the Web. The book contains guidelines to help you overcome anxiety and depression and refers you to other sources of information that can help.

next: Mass Psychogenic Illness
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8-steps to help you live a happier life.

1. Remember that work is not the only facet to your life. In these demanding times, it's easy to focus more on the workplace, but finding a time to "play" is just as important. Making special time to enjoy interests, hobbies, and family, not only makes life happier, but helps us be more productive on the job.

2. Realize that you are just as important as other people -- and say "no" when your obligations and responsibilities are too much. You can only spread yourself so thin before you're no good for yourself or anyone else.

3. Don't compare yourself to other people - at work or in your personal life. In the first place, no one knows what other people are going through. More importantly, when you compare yourself to other people, you always tend to see yourself on the "short end". So this is never a good or helpful thing for you to do.

4. Make a scheduled time every day for relaxation.

   This is not a "lazy" relaxation, but a time when you regroup, let go of your stresses, and read something that is positive and uplifting. This is a good time to go over any therapy that you're working on. Having a "relaxation" time or a "quiet time" every day strengthens you, allows the stress and tension in your life to evaporate, and keeps you more on a positive, even keel.

5. Take time to laugh at yourself and the situations you find yourself in. Laughter is a powerful, positive medicine and the calmer and more peaceful you can take things, the happier your life will be.

6. Surround yourself with friends who are positive, encouraging, and helpful. This has a nice reciprocal benefit: As you are positive and encouraging to others, your friends become positive and encouraging to you. We all need this continuing, positive encouragement to make solid positive progress in life.

7. If you have problems getting your feelings and opinions out, learn the techniques of self-assertion, rather than using anger or avoidance by bottling them all up inside. Burying your feelings and pushing them deep down into yourself only creates blockages in your growth and progress as a human being.

8. Relax, calm down, take things slower. The cliché is passé, but there's a big element of truth to it: When you stop to smell the roses, the world is just a brighter, happier, and more beautiful place to live.

Source: Thomas A. Richards, Ph.D., Psychologist

next: Social Phobia, Social Anxiety
~ anxiety-panic library articles
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Read about the family dysfunction caused by anxiety disorders.

Regardless of who actually has the anxiety disorder, it is a condition that affects the lifestyle of everybody in the family - whether husband, wife, mother, father, sister, brother...

While anxiety disorders, by their very nature, isolate those who suffer from them, they are also isolating for members of the victim's family. It is almost impossible to effectively explain the last minute cancellations of attendance at social events, meetings and other pre-arranged appointments. It is hard to find the right words to excuse what appears to be lack of interest or plain bad manners. And how can you expect people to understand why your brother, wife, mother or son is never seen outside the house - does he/she really exist? - to your neighbors who think you are such a strange family? You cannot. And the misinterpretations and false perceptions of you and your family continually compound the problem.

The resulting family dysfunction caused by anxiety disorders often results in the problem becoming further complicated by the psychological and physical reactions of other family members - the husband who drifts in and out of affairs because his social phobic wife is unable to participate in the social areas of his business life, the teenager who rebels against the restrictive family life imposed by his father's fear of having a panic attack, and ends up involved in drugs and petty crime, the mother who finally suffers a mental breakdown, after years of coping with the manipulations of her anxiety-disordered child...

This is why it is so important for the media to feature programs and articles which communicate the symptoms, effects and treatment of anxiety disorders. At a lesser level, however, it is equally important for the people who are directly affected - whether as sufferers of anxiety disorders or as family members - to attempt to communicate the facts within their individual circles of friends and acquaintances. Even seemingly insignificant things, such as getting a copies of this - or a similar - newsletter to the people who are important in your life or drawing their attention to television programs on the subject, can become important factors in raising awareness and creating understanding.

We are a lot more fortunate than we were ten - even five - years ago. Anxiety disorders are recognized by the health profession today. We no longer have to try to explain about something that is not officially an illness. The challenge now is to communicate the problem to the many people who are not, themselves, directly affected but who do directly or indirectly affect the lives of the people upon whom anxiety disorders impact every day.

Source: Lifeline Anxiety Disorder Newsletter

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Ten steps to help a family member with an anxiety disorder.

1. Be predictable, don't surprise them. If you say you are going to meet them somewhere at a certain time, be there. If you agree to respond to a certain anxious habit in a certain way, stick to the plan.

2. Don't assume that you know what the affected person needs, ask them. Make a mutual plan about how to fight the anxiety problem.

3. Let the person with the disorder set the pace for recovery. Its going to take months to change avoidance patterns, expect slow but increasingly difficult goals to be attempted.

4. Find something positive in every attempt at progress. If the affected person is only able to go part way to a particular goal, consider that an achievement rather than a failure. Celebrate new achievements, even small ones.

5. Don't enable. That means don't let them too easily avoid facing their fears, yet DO NOT FORCE them. Negotiate with the person to take one more step when he or she wants to avoid something. Gradually stop cooperating with compulsive or avoidant habits that the person may be asking you to perform. Try to come to an agreement about which anxiety habit you're going to stop cooperating with. Take this gradually, it's an important but difficult strategy.

6. Don't sacrifice your own life activities too often and then build resentments. If something is extremely important to you, learn to say so, and if it's not, drop it. Give each other permission to do things independently and to also plan pleasurable time together.

7. Don't get emotional when the person with the disorder panics. Remember that panic feels truly horrible in spite of the fact that it is not dangerous in any way. Balance your responses somewhere between empathizing with the real fear a person is experiencing and not overly focusing on this fear.

8. Do say: 'I am proud of you for trying. Tell me what you need now. Breath slow and low. Stay in the present. It's not the place that's bothering you, it's the thought. I know that what you are feeling is painful, but it is not dangerous.' Don't say: ' Don't be anxious. Let's set up a test to see if you can do this. Don't be ridiculous. You have to stay, you have to do this. Don't be a coward.'

9. Never ridicule or criticize a person for becoming anxious or panicky. Be patient and empathetic, but don't settle for the affected person being permanently stagnant and disabled.

10. Encourage them to seek out therapy with a therapist who has experience treating their specific type of problem. Encourage sticking with therapy for as long as steady attempts at progress are being made. If visible progress comes to a stop for too long, help them to re-evaluate how much progress they did make, and to renew their initial efforts at getting better.

Source:

• Freedom From Fear, a national non-profit mental illness advocacy organization

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Things family members can do to help a loved one diagnosed with an anxiety disorder.

Sufferers of anxiety disorders and their families may spend months, even years, without knowing what is wrong. It can be frustrating and can put a strain on relationships; this strain is not necessarily alleviated once there is a diagnosis. Recovery can be a long process.

Family members often want to help the anxiety sufferer, but do not know how. An important fact to keep in mind is that anxiety disorders are real, serious, but treatable medical conditions. Having one is not a sign of weakness or lack of moral fiber. There is reliable evidence linking Panic Disorder, Obsessive Compulsive Disorder, and other anxiety disorders to brain chemistry, and even life events can trigger the onset of an anxiety disorder in a person who is genetically predisposed.

Like any other illness, anxiety disorders can take a toll on the family and friends of the sufferer. Household routines are disrupted, sometimes special plans or allowances need to be made, and the person with the disorder may be reluctant to participate in typical social activities. These factors can have a negative impact on family dynamics. Family members should learn as much as they can about the disorder, which will help them know what to expect from the illness and from the recovery process. Family member should also learn also when to be patient with the sufferer and when to push.

Family support is important to the recovery process, but there is no magic cure. Getting better takes hard work, mostly on the part of the sufferer, and patience, mostly on the part of the family. Some things family members can do to help a loved one diagnosed with an anxiety disorder are:

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

It is also important for family members to keep in mind that the recovery process is stressful for them too. They should build a support network of relatives and friends for themselves. Remember that with proper treatment by a mental health professional anxiety disorders can be overcome.

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Evidence is growing that epilepsy drugs are useful in treating seemingly unrelated conditions, including anxiety.

Pfizer Inc. just unveiled data showing that its experimental epilepsy medicine, pregabalin, appears to be as effective at treating severe anxiety as several established medicines used for the illness, but doesn't have two of those drugs' biggest drawbacks, addiction and sexual dysfunction.

If that proves to be true after further testing, pregabalin could join a number of drugs that were first developed to control epileptic seizures and are more frequently prescribed to treat a host of seemingly unrelated conditions ranging from bipolar disorder to migraines.

Researchers believe that pregabalin, and perhaps other related drugs, could someday supplant the current medicines used to combat severe anxiety.

"We hope that a drug like pregabalin can replace benzodiazepines," says Karl Rickels, a professor of psychiatry at the University of Pennsylvania, Philadelphia, who led the study. The benzodiazepine class includes well-known tranquilizing drugs such as Xanax. Last year, 30 million prescriptions were filled at retail pharmacies for alprazolam, the generic name for Xanax, making it one of the most prescribed drugs in the country, according to NDCHealth, Atlanta.

Pfizer, which funded the new studies, expects to file for Food and Drug Administration approval of pregabalin as a treatment for epilepsy, generalized anxiety disorder and persistent nerve pain later this year.

Though most unconventional uses of epilepsy drugs haven't yet been approved by regulators, doctors now commonly prescribe anticonvulsant medicines for many other illnesses. For instance, the drugs are used to reduce persistent pain caused by nerve damage. Lately, these drugs have also been used to treat conditions that are even further afield, including obesity and bulimia.

Indeed, when physicians mention the epilepsy drugs as options for patients, about a third of the time it is in relation to epilepsy and a third of the time for bipolar illness, which previously was called manic depression. Migraine prevention and a host of other uses account for roughly another third.

How can a drug for controlling epileptic seizures be useful for bipolar illness, migraines and persistent pain? In general, these other neurological and psychiatric conditions stem at least in part from overstimulated nerve cells, called neurons.

In many of these illnesses, the "neurons need to slow down and take a break," says Stephen Silberstein, a professor of neurology at Thomas Jefferson University in Philadelphia. The antiepileptic drugs are designed to tame the most violent neuronal excess, an epileptic seizure. But they also appear to be able to calm related but less extreme conditions. Dr. Silberstein has performed tests of Johnson & Johnson's epilepsy drug Topamax in the prevention of migraines and regularly prescribes the drug for that use.

In the case of pregabalin, the drug targets a switch on nerve cells that controls the flow of electrically charged calcium in and out of the cells. The drug's principal effect is to calm neurons down when they become overloaded, which happens in epilepsy -- and in anxiety.

The two head-to-head studies being presented by doctors Tuesday show that pregabalin appeared to be more effective than alprazolam, a cousin of now available in generic form, and Effexor, an antidepressant made by Wyeth, in quickly taming generalized anxiety disorder, which affects an estimated 5% of people at some point in their lives.

More than 450 patients with the disorder, which is marked by persistent uncontrollable worry or anxiety for at least six months, randomly received four weeks of treatment with one of three different doses of pregabalin, a placebo or alprazolam. A second study in Europe compared various doses of pregabalin, Effexor and a placebo in 426 patients.

The tests indicate pregabalin works more quickly than the antidepressants, like Effexor, and even the anti-anxiety drug Xanax. Acute side effects with pregabalin, such as nausea and headaches, were similar to the acute side effects with the traditional medicines, except for dizziness, which was the problem most frequently reported by pregabalin patients. About a quarter of pregabalin patients in the comparison with Effexor reported dizziness, while a third of the pregabalin patients were dizzy in the comparison with alprazolam. That was twice the rate of dizziness reported by patients taking either of the other medicines.

Severe dizziness was rare with all the drugs, however, including pregabalin. While some antidepressants, including Effexor and Paxil, are approved to treat anxiety, these medicines take a month or more to provide relief and frequently cause sexual side effects. Alprazolam and other similar tranquilizers can be addictive.

If the results seen so far on pregabalin hold up, Dr. Rickels says, the study leader, the drug would have "a big advantage over benzodiazepines," the established standard for treating severe anxiety. Dr. Rickels, a pioneer in the development of benzodiazepine drugs, cautions that the four-week study needs to be confirmed with longer-term results.

Besides Pfizer, Johnson & Johnson and GlaxoSmithKline PLC are actively testing their epilepsy medicines in large clinical tests to support expanded claims for the medicines.

Scientists have yet to determine precisely how epileptic drugs work on so many different conditions. "The mechanism is still catching up with the observation of clinical application," says Mark Pollack, a psychiatrist at Massachusetts General Hospital who was an investigator on one of the pregabalin anxiety studies.

One puzzle is that the epilepsy drugs don't all act on the same chemical pathways. Some mimic a natural substance called GABA, short for gamma-aminobutyric acid, that inhibits neuron activity. Others may block the effects of a neurotransmitter called glutamate that excites neurons. Pregabalin is thought to constrict pores on the surface of neurons that allow electrically charged atoms to pass in and out of the cells.

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Read about diagnosis and treatment of anxiety in older adults and how adult children can recognize if their aging parent has an anxiety problem.

Research, on both the course and treatment of anxiety in older adults, lags behind that of other mental conditions, such as depression and Alzheimer's. Until recently, anxiety disorders were believed to decline with age. But now experts are beginning to recognize that aging and anxiety are not mutually exclusive: anxiety is as common in the old as in the young, although how and when it appears is distinctly different in older adults.

Anxiety disorders in the elderly population are real and treatable, just as they are in younger people. Another commonality between old and young is the high incidence of depression with anxiety. Depression and anxiety go together in the elderly, as they do in the young, with almost half of those with major depression also meeting the criteria for anxiety and about one-quarter of those with anxiety meeting criteria for major depression. As with younger persons, being a woman and having less formal education are risk factors for anxiety in older adults.

Most older adults with an anxiety disorder had one when they were younger. What "brings out" the anxiety are the stresses and vulnerabilities unique to the aging process: chronic physical problems, cognitive impairment, and significant emotional losses.

Late-life anxiety disorders have been underestimated for several reasons, according to experts. For example, older patients are less likely to report psychiatric symptoms and more likely to emphasize their physical complaints, and some major epidemiological studies have excluded Generalized Anxiety Disorder, one of the most prevalent anxiety disorders in older adults.

Recognizing Anxiety in the Aging

Recognizing an anxiety disorder in an older person poses several challenges. Aging brings with it a higher prevalence of certain medical conditions, realistic concern about physical problems, and a higher use of prescription medications. As a result, separating a medical condition from physical symptoms of an anxiety disorder is more complicated in the older adult. Diagnosing anxiety in individuals with dementia can be difficult, too: agitation typical of dementia may be difficult to separate from anxiety; impaired memory may be interpreted as a sign of anxiety or dementia, and fears may be excessive or realistic depending on the person's situation.

Treatment of Anxiety in Seniors

Diagnosis and treatment in most cases should start with the primary care physician. Many older people feel more comfortable opening up to a doctor with whom they already have a relationship. Also, if they already trust their primary care physician, the chances are increased that they will go along with treatment or a referral to a mental health professional."

Both medication and psychosocial therapies are used to treat anxiety in older persons, although clinical research on their effectiveness is still limited. Anti-depressants (specifically the selective serotonin reuptake inhibitors or SSRIs), rather than anti-anxiety medication (such as the benzodiazepines), are the preferred medication for most anxiety disorders. Cognitive Behavioral Therapy (CBT) is being used increasingly to reduce anxiety in older adults. CBT may involve relaxation training, cognitive restructuring (replacing anxiety-producing thoughts with more realistic, less catastrophic ones) and exposure (systematic encounters with feared objects or situations). CBT can take up to several months and has no side effects.

Success in treating anxiety in the older patient depends, in part, on a partnership between the patient, the family, and the doctor. Everyone needs to agree on what the problem is and make a commitment to stick with treatment until the patient can return to normal functioning. Family members may need to advocate for the older person, ensuring that issues encountered during treatment--such as drug side effects--are dealt with promptly.

Diagnosing Anxiety in the Aging

Often the elderly are reluctant to report psychiatric problems. To help identify anxiety it may be useful to phrase questions in the following way:

To identify anxiety:

To identify how and when physical symptoms began:

Adapted from Ariel J. Lang, Ph.D., and Murray B. Stein, M.D., "Anxiety Disorders: How to Recognize and Treat the Medical Symptoms of Emotional Illness," Geriatrics. 2001 May; 56 (5): 24-27, 31-34.

Worried about an Anxiety in Your Aging Parent?

Talking to your elderly parent or loved one about any changes in their lives is one of the best ways to find out if there is a problem. Ask about any changes you notice in the following:

Source:

• Anxiety Disorders Association of America Newsletter, New Thinking on Anxiety and Aging: Anxiety Disorders Common in the Elderly.

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