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Other names: Wellbutrin, Bupropion
TOWARDS GOOD SLEEP: LEARNING TO RELAX
Although there are some excellent books on relaxation I feel that if you are under severe tension, there is nothing to beat personal tuition, in a group or class where you can get individual attention.
If you want to make a start on your own, choose a time and a place where you will be peaceful and undisturbed. Tell yourself that you are going to devote the next 20 minutes to completely letting go. (The aeroplane won’t fall down!) Sit comfortably with your back supported and your feet flat on the floor, your hands loose in your lap and your eyes closed. Or lie down, with your head and knees supported by cushions. There are several relaxation techniques favoured by experts. Here are two.
Progressive relaxation consists of alternately tensing and relaxing all the muscles in your body, from toe to head, or head to toe, in turn. Take it slowly. When you’ve been through all the muscles, notice if there are any tense spots left, and let them go. The jaw is often a tension-site; clench it and then let it drop. Make sure your tongue is relaxed too. Then enjoy the sense of relaxation until your 20 minutes are up. Come out of it slowly; if you jump up you may find yourself slightly giddy.
Another method is to start sitting or lying, stretch the whole body, and let it go, like a cat. Then simply sense that waves of relaxation are flowing through your body as you breathe in, while more and more tension is leaving you with every out-breath.
Relaxation can be aided by using mental imagery: as you let go physically, imagine that you are floating on a cloud or on a lilo on a sun-lit sea; or that you are a cat, totally relaxed and oblivious of your surroundings; or a heavy sackful of sand; or a balloon floating in a blue sky. (Images of both lightness and heaviness seem to aid relaxation equally well.)
Cassette tapes can also help you learn to relax on your own; there are a number of good ones on the market. Don’t, however, become dependent on one tape. What you are aiming for is the ability to relax whenever you want to ? not just at special relaxation times.
*56/169/2*

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TOWARDS GOOD SLEEP: FOOD AND OTHER HABITS
It’s impossible to get a really healthy balance in life without including nutrition. Food and drink have a direct chemical influence on our bodies, nervous system and moods. Overindulgence in junk food, coffee or alcohol ? all of which often accompany a stressed lifestyle ? affects your well-being, simultaneously over-stimulating the adrenal glands and nervous system and depleting the body of essential vitamins and minerals. In addition, some foods are more stimulating and some more sedative in their own right.
We get many contradictory messages these days about what’s good for us and what isn’t. And of course individual needs differ; while more and more people are becoming vegetarian, for instance, there are others whose systems really seem to need meat. If you’re in any doubt, consult a naturopath or nutritionist about your needs. Meanwhile, here are some general guidelines which hold good for everyone who wants to sleep better.
Foods and drinks to go for:
Plenty of fresh fruit and salads, dried fruits, green and root vegetables, live yoghurt (if it suits you), whole grains (brown rice, oats, wholemeal bread and flour), pulses (lentils and dried beans), fish and free-range chicken rather than red meats, and a moderate amount of fats, eggs, cheese and dairy products. Among these foods, the more stimulating are raw vegetables, salads and fruits; so naturopaths recommend fruit and/or dried fruit with breakfast and a large raw salad with lunch.
Root vegetables are believed to be more sedative than those growing above ground; also sedative are the unrefined carbohydrates ? potatoes, and wholegrain bread, pasta and rice, so these are best eaten with the evening meal.
Many foods, when combined with carbohydrates, lead to the production of an amino-acid called tryptophan, the main building block for serotonin, a neurochemical which is produced as a precursor to sleep. They include milk, eggs, meat, nuts, fish, hard cheeses, bananas and pulses.*
Drink herbal teas, spring water and pure fruit juices, or some of the non-caffeinated drinks you can buy in health food stores, such as dandelion coffee (made from the dried root rather than powder), or cereal drinks like Barley Cup and Pionier.
Food and drinks to avoid:
Sugar (including cakes, chocolate, biscuits etc.)
Refined carbohydrates (white flour and sugar), which fill you up and overwork the digestive system without giving your body any real fuel.
Processed foods. We have been made aware of the dangers of chemical additives, especially to the allergy-prone, but many processed foods still contain additives to which some people have an adverse reaction without always realizing it. In particular, tartrazine (E102) and monosodium glutamate can upset people’s sleeping patterns, especially if eaten in the evening.
High-fat foods also put a strain on the digestive system when eaten in the evening ? so there may be some truth in the suggestion that cheese can give you bad dreams!
Caffeine, found not just in coffee, but in tea, colas, and chocolate, doesn’t only affect you late at night. It can contribute to nervousness and depression at any time.
Excess salt raises the blood pressure and puts the body into overdrive.
*60/169/2*

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EFFECT OF STRESS BREAKDOWN ON THE SEXUAL RELATIONSHIP
One of the early symptoms of stage three breakdown is an inability to tolerate high levels of sensory stimulation. Previously enjoyable stimulation can become disagreeable and actually uncomfortable. Sexual stimulation, likewise, can become disagreeable.
In this stage of stress breakdown, men and women, particularly women, who previously enjoyed an active sex life, can be turned off sex for no reason apparent to either partner. The real reason is, of course, simply that the nervous system cannot tolerate high levels of stimulation. However, it is rare that couples have the insight to accept this as an explanation and leave it at that. If they did, there would be less unhappiness arising as a result of what these couples usually wrongly see as a failure of their sexual relationship.
Some women who are accustomed, at times, to having sexual intercourse with their husbands without orgasm, may be satisfied, when they are suffering from stress breakdown symptoms, with the warmth of close contact without orgasm. ‘I just don’t want to be bothered with feeling anything’, she says. Unfortunately, this turning off sex may be misinterpreted, usually by both of them.
There are always enough unresolved difficulties between husband and wife in any marriage which can be used to explain why one or both of them seem to have lost interest in each other sexually. Pressed for an explanation for the current lack of sexual interest, wife or husband might bring up one of their old, unresolved conflicts as a reason. The other partner might erroneously believe, then, that it is necessary to solve this particular problem in order to restore the former sexually-satisfying status quo. When this problem seems to be irresolvable, he or she may feel deceived or humiliated, hurt and rejected.
In our society, where it is culturally acceptable or normal for women to lose interest in sexual activity at times in their lives, a relatively young man who begins to lose interest in sexual relationships with his wife is usually suspected of having another woman, or of being mentally ill. It is often the wrong assumptions and misinterpretations in this situation which lead to trouble. Take, for example, the case where a couple was both experiencing stage three symptoms, behaving in unusual ways, responding strangely. He turns off sex, she thinks he has another woman (he hasn’t); she decides to behave in a way entirely inappropriate for her and goes out and picks up a casual lover. Such an out-of-character change in behaviour is not uncommon in third stage breakdown.
The marriage might then fail, not on the basis of the primary lack of sexual interest, but because of the unfortunate responses which might result.
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STRESS AND MARRIAGE BREAKDOWN: EXPECTATIONS OF MARRIAGE PARTNERS
Let us look at what each person takes into a marriage. A man takes into a marriage all his expectations about his wife, how she will behave towards him, the things that might disappoint her, the things he will have to do or not do, to express his love for her. He has derived this expectation of his wife’s behaviour and from the behaviour of his mother towards him. Likewise, a woman carries with her, expectations of how a man should act, what she might rightfully anticipate of how men behave in love relationships; she has derived most of these expectations from the experience of being loved by her father.
Both of them will have learned how to behave towards each other in a relationship by observing the way their respective parents related to each other.
We know that the unconscious mind does not differentiate between images of the father, the husband, and the eldest son. They all seem to be filed away in a big box, in the unconscious mind, labeled ’significant male’. Likewise the husband’s unconscious mind lumps together his mother, his wife, and perhaps his eldest daughter, in one box labeled ’significant female’.
For this reason, many couples find themselves accusing each other of things that each of them in fact doesn’t do. ‘You’re always complaining!’ accuses the husband (whose mother was always complaining). ‘When have I complained?’ answers his wife. ‘I can’t remember just now, but I know you’re always doing it!’ he answers. Really, it was his mother who was always complaining, and his unconscious mind has identified his wife with his mother.
Distortions such as these are commonplace, the cause of a great deal of mystifying confusion during discussions between spouses about their problems in relating to each other. Sometimes they become aware that they have been accusing each other of behaviour which is in reality the behaviour of a parent, and which this son or daughter didn’t like. Now the husband or wife behaves in a way that perhaps resembles slightly the unacceptable behaviour of that parent, and the result is that this person is accused of the behaviour which is in fact the behaviour of the parent, long ago.
*56/129/5*

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TOWARDS GOOD SLEEP: RELAXATION AND MEDITATION
The onset of normal sleep is a drowsy, relaxed state, a state of peaceful letting go. It should be a state that we drift into naturally, yet in this busy, stressed age, many people have simply lost the art of relaxation, and have to relearn it.
Watching television, going to the cinema, socializing and other off-duty activities all have their place, but they are not really relaxing.
True relaxation involves switching off the active right brain, and also the part of the nervous system that gears us up for action. It reverses the process of building up tension by bringing into play the parasympathetic nervous system, which counteracts the effects of stress, and helps to strengthen the immune system. Regular relaxation can actually alter body chemistry, and deep states can help the brain to produce endorphins, hormones that have been called ‘the body’s own morphine’, which have the effects of lifting the mood and relieving pain.
Meditation has many similar effects. Though relaxation is aimed chiefly at the body, and meditation at the mind and spirit, both slow down and rebalance the body-mind system. Many people who meditate regularly find they need less sleep than before, because during their meditation periods they are giving their systems deep rest. Both meditation and relaxation require us, and also enable us, to let go of worry and tension and focus on the present moment.
Some people are quite scared of letting go; they feel they must hang on and stay in control. This is partly because many of us have been brought up with the idea that ‘doing nothing’ is a waste of precious time, possibly even sinful; partly because of a not always conscious fear that something terrible will happen if we let go. The most vivid example of this I ever saw was on a plane journey with a friend who was scared of flying: she sat rigid in her seat clutching the armrests, and I suddenly realized that she was actually trying to hold the plane up.
Letting go is a normal part of life’s rhythm; hanging on to control builds up physical tensions which go to bed with you. A tense mind is less able to solve problems than a relaxed one: if you learn to relax you will find that it will not make you less efficient, but better able to cope, and with more control over your waking and sleeping patterns.
In 1985 a small study was carried out by the Sleep Laboratory at Leeds University, with a group of airline pilots. Pilots have such irregular hours and routines that they often have to take sleeping pills to get their rest, a far from ideal situation. Ten pilots were taught a mixture of muscle relaxation and mental meditational techniques, which enabled them to get to sleep whenever they needed to, in unusual environments, even on long taxi-rides. Eight months later, seven of them were still using these techniques; of the remaining three, one had been practising his own form of meditation before the study.
Most people in these tense days could benefit from regular relaxation or meditation. Build it into your day: give yourself a space to practise for 20 minutes at least once a day.
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STRESS AND MARRIAGE BREAKDOWN: SEXUAL RELATIONSHIP
The sexual relationship is the basis of married love. There can be no real marriage without sex. The mutual sharing of the exquisite pleasure of sexual love, in which we delight in the differences between each other, re-affirms the basis for marriage and at times helps with unresolved relationship difficulties.
The quality of love necessary to bind a lasting marriage is a love that accepts the other totally. Sexual love requires an openness towards each other’s bodily functions and needs, in which a true honesty and acceptance is an integral part. A good marriage needs the basic honesty and open sharing of a mutually satisfying sexual relationship. When stress breakdown in husband or wife, or both, makes sexual stimulation disagreeable, the marriage can be threatened.
However, when sexual love is interfered with by stress breakdown, it is usually not apparent that stress breakdown is the cause, and wrong assumptions may be made about infidelity or loss of love for the other person. Wrong assumptions about the reasons for the failure of the sexual relationship may indeed become more damaging to the relationship than the absence of sexual love itself.
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TOWARDS GOOD SLEEP: EXERCISE
If you’re out of training, don’t go in for a sudden enthusiastic burst and then give up on it; build up slowly and naturally. Try walking rather than driving or taking public transport to the station or to work; climb stairs rather than taking lifts. If you normally spend your lunch hour in a pub or canteen, try to take twenty to thirty minutes of that time walking (and I don’t mean shopping).
If you’ re not geared to exercising, it really is very helpful to join a class; having a regular commitment to a group helps to keep you motivated. It’s also a good way of making new friends. Have a look at what’s available at your local evening institute, adult education or health centre. Competitive sports like tennis, squash and golf can also be beneficial, but not if losing makes you upset or angry. Games are supposed to be enjoyable.
If you’re a rusher-round consider taking up a calming form of movement, like T’ai Chi or Yoga. Both will help to balance your energy system, as well as calming mind and body, and both can help you to face life with more tranquillity. Swimming is good, too, with its rhythmic movement and deep breathing; so is walking in the country.
If you are anxious or depressed pick a class with plenty of movement ? again, make sure it’s enjoyable, not a form of self-punishment. Aerobics, modern and jazz dance, and Medau movement are all cheering and energizing. Any kind of dance is good; some women who’ve taken up Spanish or Egyptian dancing have found a side benefit in the form of greater self-esteem. Even bopping to the radio or a tape at home can quickly lift your spirits; it’s really difficult to be depressed when you’re dancing.
For self-esteem, the increasingly popular martial arts are also good. Aikido or judo, for instance, will strengthen both your body and your sense of yourself.
If you are retired getting enough exercise will help to keep you healthy and youthful. If you’ve let yourself go, build up slowly, but add a bit more movement to your day, even if it’s just an extra walk round the block. Evening institutes often arrange movement and even yoga classes of the over 60s.
Whatever type you decide on, commit yourself to exercising regularly; build up slowly, and enjoy it.
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STRESS AND MARRIAGE BREAKDOWN: BLAMING MARRIAGE ITSELF FOR MARRIAGE BREAKDOWN
I think our society these days is inclined to see marriage itself as a cause of problems in marriage. For example, it is not uncommon to hear people blame their marriage for the deterioration in their sexual relationship: ‘I think I just got bored with the same old routine, Doctor!’ Likewise, people may blame their communication problems on ‘becoming bored with the same person’, or ‘We just grew apart.’
Therefore, people who blame the marriage for some of their relationship difficulties tend to see trial separation as an answer. Similarly, some people see divorce as an answer to problems of personal self-acceptance and personal worth. The tendency to think this way reflects primarily the philosophy of our post-war Western democracies, described ably by Paul Vitz as ’selfism’.
Vitz contends that what our culture has done in relation to its views on the rights and responsibilities of the individual self, is to take the Christian concept of the self – each person intimately loved by God, unique, with specific gifts and talents to be used for God’s service – and then take God out of the picture. Thus we are left with the concept of each individual as unique and important, each with a specific destiny to fulfill, but there is no God, and there is no evil. Therefore our society, once it did away with the concept of sin, was left without anything to explain why we, who begin life as beautiful, innocent children, can grow up to be selfish, greedy, power-hungry, dissatisfied adults.
The response of our society was predictable. We discovered new devils and new bad influences to explain why we human beings always seem to create problems in getting along with one another. I find that people now tend to blame marriage, commitment to love relationships in general, family influences and society, as prime causes of their own unhappiness.
I believe if I stood on the street, asking all the people who walked past, whether society has a good or a bad influence on the individual person, that a lot of the people answering would say it had a bad influence. Many of these people answering my question would be healthy and fit, protected by this same society against catching all sorts of diseases, fed, clothed and entertained by the very system which they think is the basis of a lot of our interpersonal difficulties.
Similarly, marriage as a concept has come in for a great deal of criticism in recent years, particularly from younger people, who tend to see the solution to their fears of rejection in not signing up for life in marriage, but instead negotiating limited contractual agreements, mainly for the sake of the orderly disposal of shared property once the relationship breaks down.
Therefore people experiencing stress breakdown symptoms and relationship problems, if they are to save their marriages, need to resist a general society tendency to drift into divorce. In this climate of peer-group pressure in favour of splitting up, it almost seems as if it takes more psychic energy to stay together and face problems than split up and start again.
However, the people who have opted for divorce often find that divorce hasn’t solved their problems, but in fact, magnified them. Ex-husbands don’t become ex-fathers, nor do ex-wives become ex-mothers of children whose big problems begin when parents become divorced. Often people, who find themselves divorced as the result of stress breakdown affecting the marriage, find that when they lose their ex-partner, they lose their best friend.
It might sound an unexpected thing to say, but I believe from my experience in psychiatry, that divorce solves the problems of very few people. Easy divorce is associated with an increasing number of people being raised in one-parent families, in real poverty. I believe that stress breakdown is a major reason for divorce in this country, and the majority of those divorces are unnecessary.
*55/129/5*

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TOWARDS GOOD SLEEP: A CHANGE OF PACE
Over the last few years the media have made it very clear that exercise is good for us. For the sake of your sleep you really do need to exercise regularly; the occasional burst won’t do much for you. One experiment showed that a single bout of strenuous daytime exercise increased the amount of slow-wave sleep that night in people who were already fit, but had no effect on the sleep of the unfit. On the other hand, research shows that athletes who exercise consistently seem to have more deep, delta sleep than non-exercisers, and when deprived of their exercise their delta sleep diminishes.
If you are physically unable to exercise, don’t despair. According to Dr James Home, there is no fall in slow-wave sleep in paraplegics or people obliged to take long periods of bed-rest.
It seems as if the body-mind system adjusts to such situations. But the potentially active body, under-used, will express its dissatisfaction by keeping you awake.
Regular exercise undoubtedly contributes to general health and well-being. For one thing, it tires the body in a healthy way ? which is quite different from the tiredness you feel when you’ve been rushing round getting mentally exhausted, or not rushing round, and getting bored and frustrated.
Exercise is also a wonderful way of clearing the body of the stress hormones that keep so many people awake, anxious or depressed. It can also help to clear your body if you are giving up smoking, alcohol or any other kind of drug. It’s also a wonderful way to get over depression or grief. Some people have lifted themselves right out of depression through regular
running or jogging. And a widowed friend of mine coped with the worst of her bereavement by joining a rambling club and walking for miles every weekend ? an excellent recipe for good sleep.
A word of caution; avoid taking exercise late at night, which actually over-stimulates the body. One man who sought help for insomnia was found to be running for several miles late every night. The simple answer was to schedule his exercise earlier in the day. For sleeping purposes, while a gentle walk round the block to unwind last thing is fine, the best times for strenuous exercise are the afternoon and early evening.
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STRESS AND MARRIAGE BREAKDOWN: THE LOVE RELATIONSHIP THAT FORMS THE BASIS OF MARRIAGE
One of the noticeable features of our society in recent years is the high divorce rate and the increasing number of one-parent families. I believe that stress breakdown is responsible for the failure of many of these marriages. In many cases, seemingly rock-solid marriages fail to withstand the effects of excessive stress, even where the stress was external to the relationship.
Of course, divorce and separation operate in our society as potent stressors, and are actually contributing towards causing stress breakdown.
The love relationship which forms the basis of marriage needs to be strong enough to withstand stresses and strains on the relationship in order for a marriage to last. Let us look first at some aspects of married love.
While we recognize that marriages between people who hold widely differing moral, cultural and political beliefs are not likely to last, nevertheless we are aware that love relationships are built partly on differences in personality. In stress breakdown these differences can become, instead of a basis for mutual attraction, the expressed reasons for seeking separation and divorce.
We tend to fall in love with people who have some of the qualities we lack, and the children that result from that union have the advantage of both sets of qualities. If this were not so, if instead we married people who were just like ourselves, we would soon lose that great variety of personalities and talents which are required to run a complex, co-operative society.
The tough, cruel people would beget tough, cruel kids, and the soft-hearted, weak people would beget soft-hearted weak kids. It would not be long before the cruel, tough ones would destroy the others, leaving us to try to run our country with a uniform batch of Nazi clones. Luckily we tend to be attracted not to opposites, but to people who have qualities we lack.
A moment’s reflection on the happily married couples we all know will reveal that this statement is generally true. Strong, mannish women seem to be happily married to round-shouldered ‘Walter Mitty’ types, who love their wives dearly. The tough, rugby second-row forward who seems to lack any trace of femininity in his make-up, usually seems to be, in my experience, married to a woman who seems to have very little in the way of masculinity in her make-up. I have been observing people for many years, and it always appeared to me that both husband and wife together seem to form a sort of basic unit. There seems to be in each person a kind of appetite, or longing, for some person who will provide in the relationship the qualities that each of them lack.
This isn’t to say that this mutual satisfaction is totally complete. The unit, the ‘one flesh’ (as described in the Bible) which results from that love relationship, may be only partly satisfying to both, but nevertheless, the concept of the two partners in a married relationship forming a basic unity is generally valid and real.
Therefore, in a situation where ‘both husband and wife are suffering from stress breakdown symptoms tending to interfere with their ability to accommodate the personality differences between them, the very basis of their love relationship can be threatened. Third stage stress breakdown produces an inability to tolerate previously tolerated differences.
*53/129/5*

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DRUGS SHOULD BE AVOIDED IN STRESS BREAKDOWN
I think that drugs should be avoided in stress breakdown. However, if drugs are used in third stage stress breakdown, theoretically the best drugs to use would be small doses of the anti-psychotic drugs used to treat schizophrenic patients, and then these drugs should only be given for a short period of time. The drugs which might be useful, would be small doses of chlorpromazine (Largactil), thioridazine (Melleril), trifluoperazine (Stelazine) and haloperidol (Serenace). These drugs have side effects, and when used in non-psychotic disorders such as stress breakdown, should be used sparingly and for a strictly limited time.
I think that a person with third stage stress breakdown needs to be physically removed from the stressful situation, if possible. A holiday, or a rest in hospital with visitors restricted, is useful.
Whatever stage off stress breakdown a patient is experiencing, recovery is rapid once stress is relieved, the patient is rested, and has caught upon some sleep. This rapid recovery serves to differentiate cases of stress breakdown from other disorders, such as endogenous depression, the symptoms of which can sometimes resemble those of stress breakdown. The symptoms of endogenous depression will not settle down rapidly with rest, and this condition requires specific treatment.
*52/129/5*

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TOWARDS GOOD SLEEP: LIVING IN THE PRESENT
Anxiety and sadness, anger and resentment, are always concerned with either past or future. If you are totally focused in the present moment you can’t be anxious. So try to take opportunities of living in the present as much as you can.
Put your full attention on whatever you are doing at the time when you’re doing it, whether it’s working, walking, or washing up. Let your thinking mind off the hook for a few minutes; pause and be aware of your physical body, of your feet on the ground, and your surroundings. If you are out walking, simply look at and experience the sights and sounds, without getting involved in a long train of thought. Gradually you will learn to switch off that over-busy mind and give it and you a rest.
Happiness, the opposite of anxiety and depression, is only ever found in the present moment. We look back with nostalgia, thinking ‘If only things had been different!’, or forward to achievements we believe will make us feel good; or we believe that someone else could make us happy, if only they would behave differently.
If you remember the real moments of happiness in your life you will know that they don’t really depend on other people or events, but on feeling good with yourself. Living in the present helps us to accept ourselves as we are, without judging ourselves by other people’s standards. It takes practice, and may not come easily at first, but it’s another habit that can be cultivated. And it’s a healing habit: one woman totally cured her depression by living in the present, giving up all regrets about the past and fears for the future.
It’s also a habit you can take to bed with you. Instead of worrying about whether or when you are going to get to sleep, simply be with yourself in the present moment, regretting nothing, expecting nothing, giving your body and mind permission to let go and rest.
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TOWARDS GOOD SLEEP: IT’S NEVER TOO LATE
Older people are often depressed simply because they feel lonely and useless. Family and friends move away or die, and it can feel as though nobody cares. But that may just be because nobody knows you’re there. You may have to make the first move, but do make it. Old age in itself doesn’t have to mean mental deterioration. Make sure that you have a regular routine, giving yourself proper meals and whatever exercise you can.
You may be entitled to rights that you don’t know about, like getting a telephone installed; contact your town hall and find out about your entitlements. Even if your body is slowing down, look for outside activities that can provide company and mental stimulation. Some local authorities operate ‘Adopt a Granny’ schemes, which have given a new lease of life to many elderly women who find themselves wanted members of a family again. Lots of families would appreciate baby-sitting services. Your local social services department or health visitor may be able to let you know of local groups that you can join.
It’s never too late for further education. Many older people get a great deal of stimulation ? and company ? from adult education classes. There is also The University of the Third Age, which has a number of branches countrywide.
*51/169/2*

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TOWARDS GOOD SLEEP: PLAYTIME
Most of our activities have a secondary purpose: to earn a living or keep the family and household going. One of the greatest pleasures of creative activities is doing them simply for their own sake, because you enjoy them.
An awful lot of our spare-time entertainment consists of watching other people do things, on television, at the cinema or sports matches. How much time do you spend actually doing something really enjoyable? Most people have a creative side which doesn’t always get a look in. Whether you’re over-stressed or not stressed enough, there’s probably a corner of your mind in which there’s an unfulfilled wish ? that you’d taken up music, or painting, or hang-gliding, or acquired a degree. But of course, now it’s too late, and you’re too busy, or too old . . . That unfulfilled part of you may be contributing towards keeping you awake.
You don’t have to be brilliantly talented to enjoy singing with a choir, or the pleasure of putting colours on canvas. You don’t have to be a genius to enjoy the stimulation and companionship of a creative writing class, or the fun of belonging to an amateur theatrical group. Maybe you feel you’ve never exercised your brain enough; don’t forget the Open University, or studying for A-levels at an evening class or by correspondence.
Even if you don’t think you’re particularly clever or creative, or your domestic set-up makes it difficult to get out to classes, skills like knitting or crochet, which engage your mind and hands gently, can be very satisfying. Some people find doing jigsaw puzzles immensely soothing. Growing plants, acquiring a pet, joining a cookery class ? there are all kinds of ways in which you can take your mind away from anxiety or loneliness or depression, and focus it on something that gives you pleasure.
This is something you can do all the time, incidentally. So often we move about the world abstractedly, ruminating about the past or the future and missing out on present pleasures. Make a point of noticing what gives you pleasure or lifts your spirits as you go through the day, however small: a child’s smile, the colours of nature, the sight of a brilliantly coloured flower-stall ? do you pass these things by, or do you take them in and allow them to nourish your spirit?
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STRESS BREAKDOWN: TREATMENT OF STAGE THREE SYMPTOMS
The treatment of stress breakdown is always rest, relief of stress, and sleep. In third stage breakdown the same rules apply.
However, third stage stress breakdown presents a major problem in that the changed behaviour of the person in stage three is almost inevitably going to be misinterpreted by someone as a problem which is not related to stress. The responses that other people make to the changed behaviour of the person with stage three stress breakdown may make the situation worse if the diagnosis is not made.
I would suggest the following golden rule: If a person’s unusual or abnormal behaviour has occurred in a time of high levels of stress or responsibility, the over-stressed person should not undergo psychotherapy, or counseling, or even have joint discussions until properly rested and relieved of stress.
All methods of psychotherapy impose a stress on the client or patient, even if it is just the requirement to be somewhere on time for an hour appointment. The requirement of just getting there and finding a parking place might be enough to further disable an over-stressed person. As well, most exploratory interviews, no matter how gentle, always include some personal stress, and the person experiencing stage three stress breakdown symptoms may be made worse if these exploratory interviews are carried out when the person is still over-stressed.
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TREATMENT OF STAGE TWO STRESS BREAKDOWN SYMPTOMS
The symptoms of stage two stress breakdown: loss of emotional control and failure of self-motivation indicate an urgent need for rest and sleep.
The cause of the symptoms of stage two is the run-down of the body’s inhibitory reserve, just like an automobile battery which has run flat. The body’s reserves will therefore need to be regenerated. The treatment for second stage stress breakdown symptoms will require emphasis on relief of stress, rest, extra sleep and adequate nutrition. Sleep is the most important factor in the speed of regeneration of the body’s inhibitory reserve.
The person suffering from stage two stress breakdown can be thought of as a person experiencing a functional health crisis. The proper course of action in treating someone with second stage stress breakdown, should be:
1. The person needs to be rescued from the stressful situation by someone who can step in and arrange for the over-stressed person to be relieved of responsibilities. In most cases, the rescuer role is performed by the family doctor, who has the authority to issue sickness certificates, as well as to influence his patient to rest.
2. The patient should go to bed, hopefully to sleep. Meals should be regular, and problems and relatives should be kept away from the over-stressed person.
3. Drugs should be avoided for two reasons. Firstly, the patient has already demonstrated loss 0f emotional control, hence the diagnosis of second stage, people suffering from stage two stress breakdown might be more likely to take impulsive mini-overdoses, and secondly, the over-stimulation of the cerebral cortex, which results from the body’s reaction to sedative drugs, would be theoretically likely to provoke stage three stress breakdown symptoms.
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TREATMENT OF STRESS BREAKDOWN: BRAIN RESPONSE TO SEDATION CAUSING WITHDRAWAL AGITATION
Sedative drugs include alcohol, chloral hydrate, barbiturates, and the benzodiazepine drugs such as diazepam (Valium), oxazepam (Serepax), nitrazepam (Mogadon), and the increasing number of drugs on the market whose generic names end in ‘azepam’. The effect of any of these drugs is mainly on the cerebral cortex, interfering with the inhibitory cell groups and the mechanisms which trigger the alarm or anxiety response. Some of us like to feel slightly sedated, relieved of our fears by the Dutch courage of alcohol and other sedative drugs.
However, while sedative drugs may make us momentarily feel good, the brain does not happily accept the sedative drug’s slowing-down effect on the brain cells in the cerebral cortex. In response, the reticular activating system reacts to the sedation by sending increased stimulatory impulses to the cerebral cortex.
As the sedation from the last dose of drug wears off, the person begins to experience a hangover, a feeling of touchy hypersensitive agitation, due to the over-stimulation by the reticular activating system. This vague over-stimulation of the brain, as a reaction to the last sedative dose, usually lasts four times as long as the sedation did. After that time, the brain is able to reduce the stimulation and the cells get back to normal function.
Thus, a person feels more anxious after a sedative drug wears off than he would have if he hadn’t taken the drug.
After the sedation wears off the mild agitation from the brain’s response to the drug feels very uncomfortable and the person seeks another dose to relieve the agitation resulting from the previous drug dose. The problem is that this agitation is additive; after taking multiple doses of the drug, the person will experience such a high degree of agitation on ceasing the drug, he or she may become fearful of not being able to relieve the agitation with another dose and drug dependence may result. The risk of sedative dependence is so high where a person is being treated for stress-breakdown symptoms that sedative drugs should only ever be given when the anxiety symptoms themselves have become the major cause for concern. For example, a person who reacted to stress-breakdown symptoms with a phobic avoidance reaction (such as agoraphobia) and became unable to leave the house for fear of experiencing anxiety, might be more disabled from being unable to leave the house from fear of anxiety than by drug dependence.
Sedative drugs, in order to bring the situation under control, might be justified in those circumstances. However, I believe that in the vast majority of cases of anxiety symptoms caused by stress overload, the use of sedative drugs cannot be justified.
*48/129/5*

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USE OF BETA-BLOCKING DRUGS IN TREATMENT OF STRESS BREAKDOWN
In recent years, drugs have been developed for the purpose of blocking the effects of adrenaline and noradrenalin on the body. These drugs are used by physicians to treat high blood pressure, rapid and irregular pulse, symptoms of over-activity of the thyroid gland and other conditions where too much adrenaline is circulating in the body.
These drugs have been found useful also for treating the body symptoms of anxiety.
If you refer back to the anxiety equation, you will note that these adrenaline blocking, or beta-blocking drugs (they block the beta-receptors which respond to adrenaline), do not prevent the warning feeling of unease of the anxiety response, while they do block some of the unpleasant body symptoms due to the body’s arousal for fight or flight.
The beta-blocking drugs may therefore be useful in treating anxiety symptoms from unavoidable stress because they do not prevent the warning function of the anxiety response. Theoretically these drugs should not make the person more likely to cross the thresholds to stage two or stage three breakdown because the warning function of the anxiety response is preserved. The most useful of the beta-blocking drugs for this purpose is propranolol (‘Inderal’). However, before we all run off to the doctor for prescriptions of propranolol for our stress-related headaches, muscle tension and tremor, we need to be reminded that all drugs have unwanted side effects, this drug included. The decision to use drugs at all for anxiety symptoms due to stress breakdown must be considered very carefully.
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STRESS BREAKDOWN TREATMENT: USING DRUGS FOR STRESS-CAUSED ANXIETY SYMPTOMS
In our society, the use of sedative drugs to reduce feelings of anxiety due to stress breakdown has become a major health problem. Sickness and death due to the use and abuse of alcohol, our first sedative drug, wastes huge amounts of the gross national product every year and has been recognized as one of our society’s major problems. The use and abuse of prescribed drugs is also giving us cause for great concern; it is becoming more obvious that many doctors prescribing sedative drugs for people under stress are doing so without a clear understanding of the nature of the condition they are attempting to treat.
The drugs known as sedative drugs prevent the anxiety response from occurring when the nervous system is overloaded. They also interfere with the processing ability of the brain; therefore, while people may be relieved of anxiety from first stage stress breakdown by taking a sedative drug they will also be functioning less efficiently.
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TOWARDS GOOD SLEEP: BALANCING YOUR LIFESTYLE
If you’ve read this far, you will probably have identified the causes of your insomnia, and some possible solutions. In this part of the book we’ 11 be looking at ways for making your daytime life more conducive to night-time sleep. It’s often said that it takes three weeks to change a habit. How long it will take you to break your habit of not sleeping I can’t say ? it may be sooner than you think. But three weeks is a good length of time to get yourself into a new rhythm of life and adopt habits which will help you towards acquiring a new, healthy sleep pattern. Firstly, here’s a check-list of some of the ground covered so far:
Get a physical check-up if it seems appropriate.
Stop thinking of yourself as insomniac, and start seeing
yourself as well on the way to good sleep.
Get up at the same time every day; don’t nap during the day,
or take lie-ins. Go to bed only when you feel sleepy.
Notice how you talk to yourself, and start rebuilding your
beliefs about both your sleep and yourself.
Practise letting go of feelings that keep you awake, like anger
and resentment, helping yourself with mental imagery.
If you have unresolved problems, make a commitment
during the next three weeks to finish unfinished business by taking action during the day, including getting help if you need it.
In this part we’ 11 be looking in more detail at further ways of helping yourself, including:
Creating more fulfilment in your life.
Getting regular non-competitive exercise appropriate to
your needs and age.
Learning to relax or meditate, and to include some relaxation ime in your daytime as well as night-time routine.
Making sure you have a healthy diet geared to sleeping well.
Winding down in the evenings and preparing yourself for
peaceful sleep.
Start by taking an objective look at your life now, in order to draw yourself up a new programme. Insomniacs, as we’ve seen, fall broadly into four categories, which often overlap: the anxious and stressed, the depressed, the dissatisfied, and the angry. In all these groups there is a lack of balance, in that parts of yourself are dissatisfied, rumbling away in the background, and keeping you awake.
Now’s the time to start filling in the gaps. If you never take time to relax, exercise, or play, now’s the time to incorporate these activities into your programme. Only you know what your needs are: if you are very depressed or lethargic, at this point exercise may be more indicated than relaxation. Conversely, if you’re a rusher-round, a regular daily period of relaxation or meditation may well be what you need. The idea is to balance up those parts of your life and of yourself that are currently being either overused, or neglected, and to be nice to yourself.
A word of caution: if you’re a perfectionist or over-stressed, don’t stress yourself further by setting yourself impossible targets. Decide on the most important changes to make, and make them. As your physical and mental energies begin to flow, further change will follow naturally.
You may need to change your eating and other habits; if beating insomnia is really important to you, regard making these changes as an adventure rather than an imposition. The important thing is to know that you are now tackling your problems, and doing what’s best for you.
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