The Stress Doc Letter
Cybernotes from the Online Psychohumorist ™

Heads Up: Media Exposure, AOL/Digital City and Online Psych Chats

Q & A: N/A

Shrink Rap: The Illusion of Intimacy: Identity, Continuity and Change (with uncommon lyric -- "The Alchemy of Miss P"

Main Essay: Designing a Receptive and Reflective Incubation Vacation: The Stress Doc’s Five Prescriptive Interventions

Sect 2:

Main Essay: Designing a Receptive and Reflective Incubation Vacation (cond.)

Readers' Submissions: Kids and Marriage and Jack and Jill

1. Media Exposure:

a) Some European exposure this month; quoted in a thoughtful and comprehensive essay by David Gahagan on, "Surviving Stress," European Cleaning Journal, SEP 2000 and

b) A first... Two of my articles appeared in Opportunity World: The Ultimate Survival Magazine for Start-Up Entrepreneurs, SEP 2000 -- "Declaring Your Emancipation Procrastination" and in the Stress Bustes Forum: "Building Natural SPEED: Part II. For info about the magazine, call 212-785-9080 or email OppWorld@aol.com .

2. Chat Groups:

a) Stop by my AOL/Digital City "Shrink Rap (TM) and Group Chat," Tuesdays, 9:30-11pm EDT DC Support Chat . It's a dynamic, lively, at times witty and always warm, thoughtful and supportive problem-solving group. We raise questions and share our ideas, hopes and experiences with each other.

b) The Stress Doc Teams with AOL/Online Psych. The Stress Doc leads his lively, monthly mutually supportive one hour "Practice Safe Stress" chat the first and third Thursdays of the month, 10-11pm EDT: OLP Chat

Lately, I've been contemplating intimate relationships, especially the transition that occurs over time, whether by volition and/or attrition. And invariably questions arise concerning autonomy and dependency, reality or illusion along with the security of constancy and the risk of change. Hmm, or is it the risk of constancy and the security of change? Then add the gnawing generated by a self-imposed, potentially creative quandary and a challenging Muse. Well I finally ventured forth, not without trepidation, into the lyrical lion's den. (Where’s Russel Crowe when you need him?)

So here’s an overdue tribute to a longtime partner that also grapples with complementary personal conflicts at the commitment crossroads:

a) the fear of entropy or "death fear" – pioneering Psychoanalyst, Otto Rank’s fear of being consumed, controlled or overtaken by another and

b) the fear of exploration or "life fear" – the fear of being overwhelmed or disoriented by emptiness, isolation and alienation.

Consider the uncertain dangers and transformational opportunities in…

It was chemistry at first sight
More precisely, first bite
Between you and me.

How you muted the pain
Redesigning my brain
It's a mystery.

Such a shape sleek and slender
Can one befriend her
Without surrender
Emotionally?

If I trust you my Muse
To seduce those old blues
Will I still refuse
The valley and shadows of intimacy?

My eyes close and we're close
But where is your heart pulse?
Poof...Are you that real ghost
Of dependency?

Yet, dearest Miss P
When tears couldn't stop
With fear over the top
When I felt like a flop
About ready to drop...

You then rescued me
From that lonely black hole
You unearthed my true soul
Now is there self-control
Or more fantasy?

No, you mirror my eye
Look, sweet tears when I do cry
As you ground my sky high
At least let us fly high
Through poetry.

When rage couldn't stop
With fear over the top
When I felt like a flop
About ready to drop.

Oh my dearest Miss P
Despite all of the flack
From my manic attack
On your white or black track...Still

If I should wander
Angst-ridden and ponder
Just don't let us crack...up
Oh please take me back...up.

With your magical sauce
Is it you and me, boss?
My crown and my cross
Is there no going back?

Once making a pact
With that alchemical genie
A lily so dreamy
Will you ever wean me
Miss Lady Prozac?

(c) Mark Gorkin 2000

Shrink Rap Productions (TM)

Okay, now let me come clean. On Prozac for six years, I’ve periodically raised and lowered the dosage as needed, to a current level of 10mgs once/day. 20mgs, my highest dosage, is considered the clinical baseline. Prozac increases the effectiveness of the neurotransmitter Serotonin, a vital agent for mood stability. And while the benefits have far outweighed the side effects, gradually, dissatisfaction increased with the prolonged spacey state upon waking and with periodic daytime drowsiness. And, sometimes there's just a time-limited effectiveness or habituation point for folks and their meds.

Amidst this low level background static, reading a fairly recent article on the use of antidepressant medication in the "Health" section of The Washington Post disturbed my consciousness and complacency: For a number of patients with depression, the most effective intervention (in addition to psychotherapy) involves a medication regimen that targets some combination of the three main neurotransmitters affecting the clinical mood state. The article likened the optimal functioning of Serotonin, Dopamine and Norepinephrine as creating biopsychic synergy and harmony among "The Three Tenors" – Lucianno Pavarotti, Placido Domingo and José Carreras. (I recall a friend, years back, insisting that my "Shrink Rap" singing – talk about an oxymoron – had dramatically improved on Prozac. Hmm, could I add a duet to my workshop repertoire, allowing my bipolar personality to reach it's full musical potential? ;-)

The functions of these psychopharmacological tenors: 1) Serotonin targets anger and worry, 2) Dopamine stimulates initiative and pleasure and 3) Norepinephrine primes energy and alertness.

As I mentioned, Prozac has been my Serotonin supplement for years. So I definitely had some anxiety about rocking the biochemical boat. Still I began wondering about a medication that could both: a) sustain the psychic calming and massaging Serotonin presence and b) stimulate the neurotransmitter Norepinephrine’s brain wiring and alertness enhancing functions. As a booster of integrating hi-tech and hi-touch (I especially like the massaging part), as well as a cautious ally of the upgrade philosophy, I was tilting toward change yet ambivalent. And then a client of mine, in consultation with a psychiatrist, started a trial with an antidepressant med that targets both of the above neurotransmitters. The new post-Prozac generation drug is Effexor. And his response seemed positive.

After conferring with my doctor, we set up a trial – stopping the Prozac and starting the Effexor combo. A month later, I’ve had no Prozac withdrawal effects and the drowsy drugged state appears to be gradually receding in intensity and duration.

So this is some of the context for "The Alchemy of Miss P." And, of course, I’ll keep you posted on subsequent trials, tribulations and triumphs. For now, a final moral: Sometimes it’s important to change "it --" if not "fix it" -- even "if it ain’t broke." This approach is a modus operandi for experimentation and psychological growth, not simply biochemical survival. And surely, it’s also a strategy for helping us…Practice Safe Stress!

When heading for an east of the Mississippi River mountain vacation, hiking in lushly forested, stream-lined trails is a high priority. Such a setting always provides a mental massage for my periodic case of the "brain strain." However, on a recent escapade, the early eruption of fairly serious lower back strain compelled a rethinking of vacation strategy and itinerary. For the record, the body was an accident waiting to happen. So hiking on a rocky trail was simply the proverbial straw for the Stress Doc’s back. With hindsight, clearly I’ve been both ergonomically and kinesthetically incorrect – working too many intense and uninterrupted hours with the computer, insufficient lower back support when sitting, too few breaks and not doing regular preventive stretching and muscle building exercises.

But in life’s paradoxical way, the vacation glass wasn’t truly broken or, even, just half empty. Being physically restricted, along with having to let go of original plans, unexpectedly revealed unforeseen vistas and pathways. To quote French philosopher and Nobel Prize-winning novelist, Albert Camus: "Once we have accepted the fact of loss we understand that the loved one (or, in this instance, the vacation ideal, the perceived healthy body) obstructed a whole corner of the possible pure now as a sky washed by rain."

And just what was this dark cloud clearing epiphany? Simply this: that "R & R" can go beyond "Rest and Recreation." When open to a slower, gentler and quieter pace, whether chosen or mandated, time off and away can evolve into an "incubation vacation." R & R goes beyond diversion and begins to morph into a process for contemplation. Think of it as transitional space for discovering a magic lantern which when rubbed unconsciously and tenderly, passionately and purposefully releases your rejuvenative and meditative muse. Now R & R – a "Receptive" and "Reflective" mode – combining relaxation and psychological incubation yields the potential for sowing and cultivating unexpected mind-body insights and problem-solving perspectives along with barrier transcending bridges and new self-environmental action plans. (For those affiliated with East and West Coast holistic institutes or Washington, DC "think tanks," novel paradigmatic possibilities abound.)

So turn on your meditative mode and muse. Here are "The Stress Doc’s Five Commandments for a Receptive and Reflective Incubation Vacation for Healing and Rejuvenating Body and Brain Strain":

1. Listen to Your Body. Why is it so difficult for so many of us to connect with our bodies in a knowing and healthy way? For many men there’s a tendency to deny or tune out physical conditions and conditioning. For women, I suspect, there’s an inverse problem. Pushed by the media and other sociocultural forces the female mind-body is often pressured to inhibit or mask the aging process. Obsession with the external surface reduces exploration of the subterranean beauty. The woman’s body becomes the symbol, perhaps the worshipped idol, of youth and of sensuous, if not carnal, desire.

Let me return to gender behavior with which I am more knowledgeable, that is, the male tendency to ignore signs of medical complication or physical stress. Some contributing factors:

a) Real Men Slogans. A favorite brainwashing one-liner from mom was, "God helps those who help themselves" (with it’s subtle injunction to suffer in silence or to ask for celestial rather than familial help.) This aphorism was only topped by slogans modeled, if not verbalized, by my idealized athletic uncle: "Play through the pain" or "No pain, no gain." Black and blue marks from crashing on asphalt playing football or basketball were proudly worn as urban purple hearts, further encouragement to "suck it up" and quietly bear your burden. Today, of course, as a back-strained baby boomer I’m ready to edit "No pain, no gain" to "No brain, no gain."

b) Beware Tuning Out Pain. In the mind-body system, for the pain-gain connection pain must be seen as both a signal from the brain and a signal to the brain. In hindsight, I’ve been blocking out strained and tightened back muscle feedback for months, more likely years. Periodically, muscle strain would flare on a tennis court and the rationalization was, "I just overdid it." This seemed plausible not playing tennis on a regular basis.

One belatedly grasps that aging means eventually having to be "sorry" while elastic youth scoffs at the word. Yet, the acknowledgment of physiological downgrading becomes a catalyst for mind-body upgrading.

c) Nurturing Reality. A slowed down vacation, taxing neither psyche nor corpus (other than adopting to a non-Type A, absence of adrenaline rush pace) allows for reconnecting to the needs of the body. A consult with a chiropractor yielded both helpful back and neck adjustments and, more important, a series of exercises for strengthening lower back muscles and flexibility. Placing a rolled towel between my lower back and the back of an already ergonomically primed computer chair (a client calls it my "Star Trek" chair) is, surprisingly, providing added support. Long live the pain-brain-gain connection!

2. Quiet the Mind. If your brain could be hooked up to a psychic radar screen, conscious and unconscious data patterns would likely be whizzing helter-skelter across the monitor, whether awake or in a REM/dream state. Sitting or lying quietly, practicing being a silent observer, allows us to tune in to these overt and covert mental meandering and memory minefields. There are past emotional depth charges - joyful and painful - attached to these cognitions. Especially regarding past trauma, we often keep busy, distracted or addicted as a way of numbing or sealing off this potential emotional feedback.)

Not allowing these cognitive-affective percepts to see the conscious light of day or have a voice keeps them in a feverish state. Sometimes they briefly escape into awareness through nightmares or dreams. During waking hours much energy is often expended restricting mental and behavioral exploration and decision-making for fear of being overwhelmed or consumed by this psychological angst.

Of course, someone struggling with unresolved trauma – abuse or abandonment pain, with associated rage, panic and/or shame states, underlying clinical depression or morbid, "black hole" grief – may find the quiet opening of the psychic Pandora’s Box particularly frightening or disorienting. Still, even for folks not profoundly abused, existential angst is actually quite "normal," when in a truly self-reflective and receptive state: a sense of loneliness or emptiness, lost dreams, a disparity between an ideal and real self, the balance in your life between security and vitality, passivity and passion, etc.

So attempting to calm the mind by observing and gently uncovering its overt and covert manifestations with relaxed attention isn’t just an awkward meditation learning curve. This process for many individuals is an act of courage.

3. Being with Nature. Getting out of the city scene and into natural surroundings – especially the height, breadth, expanse and contrasting perspectives found among mountain peaks, ridges and valleys, meadows and forests, rushing streams and dreamy clouds – for me evokes a sense of the spiritual and a sense of cosmic consciousness. One fleetingly grasps "the big picture"…the mother (nature) of all creations. Finally, there’s something more compelling than whatever trials and triumphs (real or imagined) are swirling about me. A holistic, intuitive floodlight perspective is reflexively triggered by this majestic panorama that inundates my categorizing, analytical, logical left hemisphere.

Simultaneously, my senses are attuned and transfixed in a way not possible in my obsessive workaday or static generating urban mindscape and landscape. I revel in the nuance of the various birdcalls, the healing sounds of a gurgling stream. This forest symphony has its woodwind section as the air whips through a lush arboreal canopy accompanied by a percussion-like crunch of pine needles or leaves under foot. One recalls the primal "tree top" lullaby as well as a mysterious, ever lurking ebb and flow of stillness and sound. And when the holistic, soft perspective mixes and marinates with an acute focus a synergistic, poetic mindscape-landscape is born. Consider these lines from "Mountain Vision."

(Email stressdoc@aol.com for the complete lyric.)

Engaging peacefully with nature fosters the temporary suspension of my Type A – ambition and achievement – orientation. Human doing goes into hibernation; my receptive and reflective human being nature comes to the fore. In the survival of the fittest, Richard Hatch to the contrary, perhaps there is room for the person capable of being quietly humbled. If not likely to win a million dollars, this individual may inherit some priceless earthly and cosmic wisdom.

4. Seek Solitude in a Wired World. Today’s passwords and mantras are "24/7," "do more with less," "anytime, anywhere." Email, FAX, laptops and palmtops continue to blur, if not obliterate, the division between work life and home life. Everyone seemingly has access to everyone else. And I’m getting tired of being trapped in other’s wired nets. Cell phones now routinely invade Teaism, my artistic hangout and safe haven. Self-absorbed individuals throwing privacy and protected space to the ether, covering their rudeness or justifying their loudness with cell phone "urgent" (or, more likely, self-important) speech. Or maybe these folks are simply oblivious. This Practice Safe Stress slogan may have potential for reinforcing civility and social boundaries: "Idiocy or Cell-ibacy…It’s Your Call!" (I like the policy in one playhouse. If an audience member needs to be available for an urgent call, the theater manager will baby-sit the individual’s cell phone and, when necessary, retrieve the patron.) Laptops, cell phones and the like have become such everyday mind-body extensions that when we are disconnected for even a relatively limited period separation anxiety increasingly erupts.

With data, if not meaningful information, continuously flooding our conscious and unconscious, with constant demand for our attention time and space for percolating and playing with subterranean ideas and salient information is becoming endangered. In a waking state, one hardly ever has to be truly alone with oneself. The evolution of dysfunctional techno-dependency along with an undeveloped capacity for self-awareness and psychological integrity seem inevitable.

So in my proposed "R & R" schema, a key component of taking an incubation vacation involves unplugging electronically and tuning in organically to the ultimate hi-tech and hi-touch computer – your own mind-body system.

(Ed note: The fifth and final commandment continues in Sect. 2.)

Shrink Rap™ Productions