This rare cause of hypersomnia usually affects males, most often between the ages of ten and twenty-one. Victims experience bouts of extreme daytime sleepiness coupled with unusual eating patterns. The fact that victims alternate between periods of enormous appetite and near starvation leads some authorities to suspect that the cause of the syndrome lies in a malfunctioning appetite control center in the brain. Other behavior helps differentiate this syndrome: irritability, confusion, incoherent speech, delusions, social isolation, shyness, and apathy. Victims may demonstrate exceptionally aggressive or inappropriate sexual activity, such as exhibitionism. Metabolic disturbances can be detected through urinalysis. Victims experience earlier and shorter REM periods and less deep NREM sleep. After a period of time the condition enters a stage of remission that can last months or even years. Sleep during this time is normal. Diagnosis of this unusual condition is tricky, since some of these symptoms may appear to be just part of the transition from prepubes-cence to young adulthood. Indeed, there may be some connection to the rampaging hormonal activity of this stage of life. Treatment with lithium carbonate may prevent (but not eliminate) attacks; the condition usually resolves itself spontaneously before the age of forty.*161\226\8*
Aggression and violence in stage two breakdownIt is readily obvious that where people lose emotional control in a situation of high anxiety, violence may result. This is particularly so if the person is experiencing significant threat to the integrity of his or her territory, that aspect of a person which is held inviolable by others. One’s territory might be actually one’s own backyard, and someone is intruding uninvited. Or one’s territory might be a role, or a job, or a specific responsibility. People react fairly quickly in response to others trying to take over their jobs. Territorial threat will, in ordinary circumstances, provoke defensive aggression.In stress breakdown, that defensive aggression is apt to be sudden, unpredictable, and violent, because of the loss of emotional control. Violence is even more likely if the person under stress has been using sedative drugs.
The use of sedative drugs in stress breakdownSedative drugs such as alcohol, barbiturates, chloral hydrate and the benzodiazepine drugs such as oxazepam (Serepax), diazepam (Valium) and nitrazepam (Mogadon) are able to switch off the anxiety response to nervous system overload. The person under stress, who is uncomfortable from anxiety symptoms, can temporarily feel a lot better on taking a sedative drug. The temptation is therefore to stay in the stressful situation and suppress the anxiety symptoms with drugs or alcohol. This situation is something like a motorist blocking out the oil-pressure warning light because the light is interfering with his driving, instead of stopping the car and investigating why the oil pressure has dropped. Ignoring warning signals leads to trouble.When the sedative effect of these drugs wears off, the person is left with a low-grade agitation which makes the person feel worse than he did before taking the drug. This heightened feeling of anxiety may lead to a desire for further doses of the drug to suppress the agitation; the stage is then set for continued use of the drug and the beginnings of a drug dependency problem.In my experience, the use of sedative drugs to suppress anxiety symptoms in stress breakdown lowers the inhibitory reserve and makes the stressed person more prone to aggressive outbursts and actual violence. At this point, the problems of the person with stress breakdown, complicated by continued use of drugs, begin to merge with the problems of alcoholism and sedative abuse. Sorting out the problems of a person with stress breakdown when that person has been using sedative drugs regularly, presents a complex situation requiring expert skills.
Depression can certainly be an extremely serious and, in some cases, even a fatal condition. But the symptoms of depression range in severity from severe cases to milder instances of feeling stressed and overwhelmed or lacking in energy and enthusiasm. In this regard, depression is like many medical problems, for example headaches, which can range from tension headaches to the intense throbbing pain of migraine or the pressure headaches that may signal the presence of a brain tumour. While tension headaches can be treated simply with painkillers, the more severe headaches need the help of a neurologist. Just as you might not consider going to a doctor if you suffered from mild tension headaches, so you might not feel the need to get medical help for mild symptoms of depression or stress.
Regardless of what one believes the ideal course of action in dealing with depression to be, a simple inspection of the numbers will indicate that it is impossible for all people with depressive symptoms to be taken care of by doctors. According to one estimate, 17.6 million people in the US alone suffer from major depression. There are approximately 38,000 psychiatrists and 17,000 GPs in the US. If all the depressed people were evenly divided among these providers, that would mean approximately 320 depressed patients for each doctor. Such numbers would pose an overwhelming case load for a practitioner, who would also be expected to care for patients with other types of disorders as well. In addition, patients with major depression constitute only a fraction of individuals with depressive symptoms. According to one widely respected population study, more than one in five adults complained of depressive symptoms in the month before they were surveyed. Many of these were regarded as suffering from what is known as subsyndromal depression, a less marked form of the condition but one that is nevertheless responsible for considerable misery and suffering. Clearly it is unrealistic to imagine that all of these people could be properly taken care of by the mainstream medical establishment and the evidence bears this out.
In a recent consensus statement in the authoritative Journal of the American Medical Association, a group of leading researchers pointedly observed:
In the Epidemiological Catchment Area study, a nationwide community survey of psychiatric illness that was conducted around 1980, approximately one third of people suffering from a major depressive disorder sought no treatment for it. Of those who sought treatment, few received adequate treatment. In fact, only about one in 10 of those suffering from depression received adequate treatment.
R Hirschfeld and colleagues,
These same authors reviewed the psychiatric histories of people who entered various depression research studies even more recently than the 1980 study mentioned above, during the years when the SSRIs became very popular. Even so, the researchers concluded:
The lack of any prior anti-depressant treatment of patients is striking, ranging from 67 per cent to 48 per cent, who despite being ill for a median of … 20 years never received any anti-depressant medication. The range of patients who received adequate treatment is also sobering: from a low of 5 per cent to a high of 27 per cent.
Experts in public health have pondered the reasons why people have not received treatment for their depressive symptoms. In some cases, medical personnel may fail to make the correct diagnosis or to treat the problem adequately. In other instances, the depressed person may not recognize the problem, may be embarrassed to seek help for it, may feel afraid of going to a psychiatrist or deterred by the stigma associated with the diagnosis.
Whatever the reasons for the failure of mainstream medicine to take adequate care of depression in a large proportion of affected individuals, there is general agreement that depression is common, exacts a serious toll on the lives of those who suffer from it, is underdiagnosed and undertreated, and that there is a great deal of room for improvement in the situation.
Robin, aged twenty-three, was given Valium as a muscle relaxant when he injured his knee playing rugby. After four months he was walking normally and decided to stop taking the Valium. He became anxious and depressed and could not sleep. This was very unusual for him. He thought the injury must have upset him more than he realized. The same thing happened again when he stopped the Valium three weeks later.
His doctor said he had become physically dependent, and apologized for not watching him more closely. With regular support from his doctor, and a slow withdrawal programme, Robin did very well. He learnt to meditate and felt that this helped him to accept the insomnia and physical discomfort.
Laura’s story illustrates how a combination of a psychiatrist who only knows half the story, plus repeated dosing with tranquillizers and anti-depressants can result in what appears to be a serious psychiatric problem.
Start by asking the members of the group who only want to chatter to leave the room.
Sit in a circle on stools or hard chairs. Notice how many members are pulling one or both shoulders up to their ears, and how many heads are pulled to one side or pulled down and back with chins poking forward. The reason for this is that in withdrawal, muscles on the side of the neck shorten. This unbalances the head, and because it is so heavy (about one and a half stones), it puts a strain on the neck and shoulders that goes right down the spine through the pelvis to the knees. That is why so many people complain of weak aching knees. Notice how many people are pulling their feet back under the chair, or have their legs crossed.
Retraining muscles involves learning where tensions are and, without causing more tension by trying too hard, letting them go. The blur of aches and pains all over that people endure are often nothing more than tension. The pain-relieving chemicals produced by the brain are disturbed during withdrawal and that is why pain from old injuries or scars often reappears for a time.
If there is a teacher of the Alexander technique in your area you would not regret money spent on some lessons. The principle of the teaching is to show you how to live in the world without your body reacting to stress.
In withdrawal, suicidal feelings can come out of the blue’. Some people don’t get them at all, others have vague feelings, some feel as if they are at risk. If you are worried, see your doctor as soon as possible. He may want you to take an anti-depressant for a while.
Many callers say, ‘I have a wonderful family, why do I get overwhelming suicidal feelings?’ Over-strained nerves often provoke suicidal thoughts, but in withdrawal, it may be an indication that you are cutting down too quickly.
The Samaritans are always there ready to listen. Many people say ‘I had awful suicidal feelings, but felt I could not ring the Samaritans because I knew they were just feelings and that I would not do anything.’ The Samaritans give up their time to comfort and support people. Use the service if you need it.
Creative visualization is helpful in agoraphobia too. Several times a day take a moment to relax, close your eyes, and see a television screen and make a picture of yourself looking happy and relaxed. Do it again and again until it B easy to imagine yourself with a smile on your face taking a short walk in the street. Keep at this until you extend your imaginary trips to crowded shops, or whatever you are most afraid of.
If any anxiety symptoms appear, practice abdominal breathing and put cold wet cloths on your face to control them. You will be surprised by what can happen when you give your brain the right messages.
In most people, the symptoms disappear when the physical symptoms improve, particularly if there was not a problem before taking tranquillizers.
Dr Claire Weekes’s book on agoraphobia is very helpful.
Loss of Memory
When users become aware again after years of emotional hibernation, they realize that they have no recollection, or only vague impressions of significant events in their lives. One woman said ‘My grandson is now eleven, he has always lived in my house, and since I have come off pills, my thinking is clearer, but I cannot remember his birth or his growing up’. This experience is typical.
Some people have said that they have gone back to the emotional state they were in when they first took drugs. One man in his thirties who was first prescribed tranquillizers when he was seventeen said he felt adolescent again when he was drug-free.
These can cause a great deal of distress during withdrawal. The sufferer is suddenly overwhelmed by fear for no apparent reason, and often feels that death is not far away. Some feel unable to move or speak, others shout out for help. Although the attacks usually last only a few minutes it can seem much longer to the sufferer.
In a person who is not nervously ill, an exam, or even an exciting social event may produce ‘butterflies in the stomach’; sweating hands; constriction of the chest; a rise the heart rate, etc. This is a normal response. A panics attack is an exaggeration of this, due to an exhausted nervous system. If you are over-enthusiastic the ^first time you go out jogging, your muscles will complain the next day, by being stiff and sore. Panic attacks, agoraphobia, irritability, and many other symptoms are a similar cry for help from your nervous system. It is raying ‘Do not abuse me, I have had enough’.
It is often hard to convince someone who is having pani^ attacks that it is not the onset of some terrible disease. Every symptom—wildly beating heart; rapid breathing; sweating; shaking—is part of the ‘fright and flight’ response. We would be lost without it. We do not want to stop it, but to get it back to normal.
Primitive man needed to be able to react like this to escape from dangerous animals. We may need it now to get out of the path of the number 33 bus, or a youth on a skateboard! Fear stimulates the chemicals that make us respond quickly. That unpleasant sinking feeling in the abdomen is only a sudden diversion of blood away from internal organs to the legs to make them move faster.