The Stress Doc Letter
Cybernotes from the Online Psychohumorist ™

March 2000, No. 1, Sect. 1

Fight when you can 
Take flight when you must 
Flow like a dream 
In the Phoenix we trust!

Table of Contents

Heads Up: AOL and WebMD.com Chat Groups 
Q & A: The Biochemical-Psychosexual Revolution 
Shrink Rap: Learning to "Let Go" 
Readers' Submissions: Middle Age (siiigggghhhhh) 
Sect 2: Main Essay: Word to Word Combat at the Book Publishing Battlefront
Announcements: Q & A Links/Archives 

1. Change is in the air. All cyberites can now participate in my AOL/Digital City Chat Group. Stop by my online "Shrink Rap (TM) and Group Chat," Tuesdays, 9-10:45pm EDT.

Go to: http://home.digitalcity.com/washington/webchat, see DC Health Support Chat schedule. 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.

2. The Stress Doc Teams with WebMD.com

The Stress Doc leads his lively, twice/monthly mutually supportive one hour "Practice Safe Stress" Internet Support Group for WebMD.

Email me for April times.

Questions? Email Jon Roig at jroig@webmd.net or call 503.943.3279

For A QUICK GUIDE TO ENTERING WEBMD LIVE EVENTS: by Jon Roig, Producer for Healtheon-WebMD, jroig@webmd.net

(See end of Stress Doc Newsletter, MAR 2000, No. 1, Sect. 2 for Jon's Access Guide.) 

Ask the Stress Doc Love & Relationships

The Biochemical-Psychosexual Revolution: Getting Up and Close while Being Down and Out

A recent email plugged a hole in my curiosity zone. I believe the original series on my depression struggles and meds trials noted how reduced sex drive - whether capacity for erection or for orgasm - was a not too uncommon side effect of the new antidepressant SSRI medications. Around this time, another one word pharmaceutical product was stirring the next medical-psychosocial revolutional Prozac meet Viagra! And the inevitable question: which is greater, the immovable object or the irresistible force? Or is it the irresistible object and the immovable force? Careful, Doc, you're bordering on the psychosexually incorrect. More to the point, could Viagra counter the libido inhibiting tendencies of the new wave of antidepressants? And the first return is…Well, good news and bad news.

Prozac and its SSRI cousins often have a variety of side effects, for example, increasing general energy levels (though also inducing periods of drowsiness) and, for some, seemingly stimulating aggressive energy displays. These meds also help diminish levels of agitation and obsession. Yet, as noted, Prozac also dampens sex drive. (Of course, depression when serious enough can totally shut down interest in sex; mild-moderate depression, however, has been known to turn some folks loose sexually, albeit, dysfunctionally.)

As for Viagra, it has an arousing effect by directing blood flow to the male sexual organ. A guy gets pumped up, you might say. Some degree of sensitivity, along with erectile capacity, are enhanced. So...what's the resulting interaction -- is there any "chemistry" -- when Mr. P meets Ms. V? And the practical question: should a male consider using Viagra routinely when experiencing SSRI-induced sexual functioning side effects?

First Hand Account

Clearly, a male should consult his or her physician when pondering this issue. But for right now, here is a reader's online/frontline report (the first I've received) on the effects -- primary and side -- from mixing Prozac and Viagra:

"I don't even try to masturbate anymore, as it just doesn't work. (Our protagonist is on 20mg of Prozac. He's overseas, wife's in the states.) I was VERY glad though that when she visited me recently I had my first opportunity to test things out - taking Viagra during her time here. When I took the Viagra I was able to achieve good erection. However, I still couldn't climax - which was a real drag after enough time went by!! So this side effect is definitely one I don't care for! The only good aspect is I do maintain longer - just no pot of gold at the end of the rainbow. :( " (Of course, one suspects his wife is not complaining too vociferously. ;-)

Well Mr. Good News/Bad News some consoling words, if as the say, "Misery doesn't just like company but, actually, likes miserable company." More than one puzzled "e-male" correspondent has bemoaned the absolute or relative loss of a capacity to ejaculate on SSRIs. Other readers have also given up on masturbation.  Gee, talk about being disconnected from one's consoling inner adolescent; from being deprived of momentary stress relief in the palm of your hand, as it were.

Then again, sometimes there's an upside to being dammed (not damned) auto-erotically. When practiced compulsively, masturbation may also reflect a need to self-medicate (or to numb oneself) when feeling overwhelmed by depression, rage or panic. And when regularly combined with pornography, auto-eroticism may distort the ability to be emotionally intimate with a real partner. Also, I believe the latest statistics indicate that as many as 200,000 folks (mostly male, I suspect) are likely addicted to online pornography of some kind.

Of course, some men are hypercharged by agitation, an aggressive power status or drive and/or "The Big Dipper"-like testosterone levels. (For example, think of certain bipartisan residents of Washington, DC.) But for mere mortals, as a man ages and matures (or, at least, as some do) there often needs to be more than just a physical turn on for achieving satisfying sexual performance. And for genuine sexual and emotional intimacy...well, better living and relating takes more than just chemistry!

So today, let's grapple with how depression impacts the ability to healthfully and passionately unite sexuality and intimacy. (I'm as curious as you to discover what we uncover.)

1. Depression as a Biochemical Catalyst for Thrill-Seeking. If the depression state isn't completely overwhelming or paralyzing it can easily fuel risk-taking and addictive behavior. For example, one study found a relationship between mood disorder and compulsive gambling. The gambler needed to create excitement for temporarily escaping his moodiness. Of course, this usually produced a self-defeating and even more depressing outcome.

In addition to abusing substances like food and drugs, to compensate for diminished levels of mood regulating serotonin and dopamine, a person may self-medicate naturally through relentless aerobic-endorphin producing exercise or through sexual obsession and predatory activity. (Now some folks combine both, though it usually takes a very good male for sexual activity to rise to and to sustain aerobic levels. ;-)

So adrenaline and testosterone are often working overtime to fill the biochemical and hormonal gaps. And a variety of chronic stress conditions may result, including high blood pressure. Not just your hormones but your heart is at risk with unrecognized or untreated depression.

2. Depression as a Psychphysiological Catalyst for Diminished Energy. While depression often induces exhaustion, the prevalent image of a person cowering under covers or retreating to a bedroom for days and weeks doesn't do justice to the mind-body complexity. For example, let's look at agitated depression. A restless night, an inability to fall back to sleep, easily induces grogginess and fatigue. However, the same agitated component can have the depressed individual jumping out of bed at first morning light. For example, a hyper-depressed trait had me at a writer's desk two minutes after waking, without coffee. However, I could not sustain the intensity and concentration for long and would invariably crash. And it takes energy to preserve and recognize healthy boundaries

3. Depression as a Catalyst for Low Self-Esteem. Clearly, if you can't fully control and predict your own energy level, your ability to focus or to start and sustain tasks and achieve goals then seeds of self-doubt, unworthiness and inadequacy are being sowed. Dreams too are abandoned. Why is it that other's can be more disciplined, motivated and successful? And, of course, it's a short step from unfavorable social comparison to two distinct yet complementary "survival" patterns: a) avoiding others one finds ego deflating or intimidating or b) anxiously needing and soliciting the approval of others. Clearly, we are talking dysfunctional, often depression-inducing codependency.

4. Depression as a Catalyst for Psychosexual Fusion. A common experience for the clinically depressed individual is a profound sense of emptiness. A body aching yet, paradoxically, hollow inner feeling. One's inner foundation and scaffolding is fragile at best. For example, at nineteen, when my parents unexpectedly announced their separation, with my father moving out, I instantaneously burst into anguished crying. Not only was my family structure crumbling, but my personal facade was cracking: my inner hollowness was exposed. The game that a family and a child can cruise along blindly and self-deceivingly was being shattered. Yet, as the artistic giant, (though, perhaps, relationship pygmy) Pablo Picasso noted, "Every act of creation is first of all an act of destruction." Thankfully, the dissolution trauma was the beginning of a long and painful recovery process:

What made him break
our mistake 
Perhaps we'll never know.

But in the wake 
Of psychic quake 
The formula to grow.

The silence cracks 
Each spouse attacks 
The couple hardly known.

But on these tracks 
Of broken backs 
Emancipation sown.

However, at the time and for a seemingly interminable future, profound self-doubt lurked and stalked in the background and foreground.

And one way to shut down this chaotic Intimate FOE: Fear of Emptiness/Fear of Exposure become symbiotically attached to a partner. And the more intense the sexual relationship the more potent the anesthetic. There's the illusion of plugging the black hole of depression. With this desperate attachment, the depressed individual seemingly feeds intravenously off a partner, ravenously sucking away energy nutrients and ego needs. Or one can project feelings of inadequacy through hostile attack. And, surely, aggression and sex can also feed off, if not fuel, each other. And now those sexual hormones are percolating and pumping throughout the system. Alas, what goes up fast and over the intensity edge usually comes down fast and painful. Fuse hard - die hard!

5. Depression as a Barrier to Quietness and Separateness. The flip side of needing to numb and fuse is a profound difficulty living and relating in a state of quiet. We extol human doing not just being with another. First, with all the turbulence underneath the heavy depressive cover there's a fear, if not terror, of stillness and quiet. Stillness, for the depressive, borders on emptiness which can so easily morph into another "bottom of the dark and dank pit" free fall mood cycle.

Conversely, some of us use a manic-like, Type A achievement frenetic mode to defuse the depressive demons and impress a potential partner. Letting go of talking about work, especially of the high of one's most potent sources of identification and pride (for example, children, creative achievement, etc.) robs the emperor or princess of his or her clothes, that is, one's persona or psychic cover-up.

Now suddenly, one is vulnerable, shamefully flawed. Who would want to get close to this wounded, needy, spineless, bottom of the barrel creature. As Simon and Garfunkel observed decades ago, the "Sounds of Silence" can be fearfully deafening.

6. Depression as a Catalyst for the Separation-Attachment Catch-22. The eternal bind for the depressed individual is a need to numb the "chasmotic" inner dead and dread. (Chasmotic is my newly minted term uniting chasm (or disconnection and emptiness) and the chaotic. The depressive longs for and urgently seeks a sheltering partner from the storm. But as the storm is primarily inner, three possibilities likely unfold, especially as one gets increasingly intimate, physically and emotionally: a) a fear of psychological abandonment, that is, "something always goes wrong," "this good feeling can't last," "the person will eventually leave me" (or what's wrong with her for wanting me, anyway?"), b) a bailing out strategy – "I'll reject you before you reject me," and c) a tendency to find fault as the infatuation and hormone levels dim with an increasingly "obvious" imperfect mate. Yet, when the depressive isn't self-isolating he or she often will do almost anything not to be left alone or left out. The person too often lingers in a dysfunctional, ever critical and dissatisfied dance. Of course, if playing the role of the depressive's moody target, you are inviting your own "sympathetic," codependent mood disorder.

So the depressive wildly swings between what pioneering psychoanalyst Otto Rank called "The Life Fear and the Death Fear": The life fear occurs when the individual is afraid to separate from another for fear of isolation and emptiness. The death fear prevents closeness; it's the terror of being swallowed up, of losing one's sense of self in a too entangled, too smothering or, even, too intimate bond.

7. Depression as a Barrier to Trusting and Saying, "I Love You." If the depressive is forever caught in approach-avoidance mood shifts, chasing then running from commitment traps or clinging to codependent fusion one condition is obvious: there's no sense of a solid center, no clear sense of integrity. To be able to trust, openly not blindly, in a give and take adult relationship requires an ability to declare: "This is who I really am" (no matter what you may think or feel, or what I believe you think or feel). "This is what's happening to me in relation to you" (whether you think it's right or wrong, good or bad. And you are free to disagree.) "I have these thoughts and feelings I need to express constructively -- firmly, or tentatively, passionately or rationally" (whether you decide to stay or withdraw).

One must build trust, not simply declare it. Like commitment, trust evolves or erodes over time and space. And, of course, for the on the edge, untreated depressive frustration tolerance and patience, capacity for risk and for closeness are qualities often dangerously low in supply.

Clearly, there's a powerful interaction when mixing depression, sexuality and the quality of relating. As the German philosopher Friedrich Nietzshe observed in Beyond Good and Evil over a hundred years ago: "Sensuality often forces the growth of love too much; so that it's root remains weak, and is easily torn up." Nietzshe, a brooding genius, understood that a dark mood unchecked while seemingly cultivating the ambiance for romance, more likely yields a "romantasy" fungus. Craven sensuality and unchecked clinical depression erodes or suffocates the foundation of genuine friendship and the potential for a loving, sexually intimate partnership. This volatile mix makes an endangered species of "Four ‘C'-ing Love," a love based on: Chemistry, Caring, Cosciousness and Commitment. As that other, more contemporary yet no less soulful philosopher, Diana Ross, succinctly noted: "You can't hurry love."

For a future edition, thoughts on my ongoing learning curve about slow growth intimacy. For now, here's to a psychological and, if necessary, a biochemical process of doing and being that transforms depression and romantic addiction into patiently assertive and quietly playful exploration. It's a mutual sharing that also allows us to…Practice Safe Stress! --------------------------------------------------------------

Shrink Rapâ„¢:

The Stress Doc starts taking some of his advice about setting limits and "letting go." Not just mind-body exhaustion, but self-perception and creative expression are at stake.

Learning to "Let Go" Not Knowing Where You're Going...Yet Trusting You Will Get There

"Letting go." One of those pithy phrases that has multiple semantic shadings: a) letting it all hang out, b) letting it rip, going for it, come what may, or conversely, c) giving up the dream or illusion or, even, cherished belief, d) accepting the loss, especially the ability to control another, and e) no longer fighting or denying reality; going with the flow.

Letting go is on my mind these days. Two developments have insured this state of mental affairs: 1) the beginning battle and ongoing skirmishes with my book editor for the structure, style and soul of Practice Safe Stress with the Stress Doc (see today's "Main Article") and 2) the recent increase in conflict mediation, stress and team building workshops and speaking engagements. The speaking/consulting work is being generated by repeat business along with marketing team and new web site-bookings.

Also, I just discovered an old college and basic training bunkmate paved the way for me to speak at a legal conference in New Orleans. Neal and I had been out of touch for decades. Then, a couple of years ago, through the magic of the Internet, Neil finds me. I again let our connection slip away. Mr. G, now President of this legal association, insures the conference planner I will speak for less than my regular fee. That old wily fox! And the bond is as natural and close as ever. So maybe you can let go, even more than once, and come together again.

And, of course, there's a distinct connection between public speaking and letting go. I'm envisioning using my highly popular discussion and drawing workshop exercise with audiences as large as three hundred. We're attempting to generate a psychohumorist art happening, if you will. I've done it successfully with a hundred or so. Can it work with three times this number? So I'm trying to follow my opening process as outlined in, "Creative Risk-Taking: The Art of Designing Disorder": Aware-ily jump in and "let go" or "strive to survive the high dive." (Okay, as an honorary native of N'Awlins, check for alligators before taking the plunge. And email me for the risk-taking article.)

And today, there is another time and place for letting go; not as a stage performer but as a deadline writer. With the aforementioned engagements and the, prayerfully, final stages of manuscript editing generating a bimonthly "Notes from the Online Psychohumorist"â„¢ for the short-term future is beyond my grasp.

How hard it is at times to acknowledge the obvious, to reconsider an egoal standard, especially when one's goal and ego are both precariously intertwined and inflated. For my friend Hank (who has been one of the Stress Doc literary beta testers long before I even knew the term) it was a no-brainer. When I recently admitted "defeat," that is, acknowledging being able to just squeeze out one newsletter in March, his reply: "Good. I'm glad you're not being so compulsive."

It's true, too much of my own identity and self-esteem is tied to being productive as a writer. This may be due to late blooming. Also, for many years I had great doubts about my writing abilities. The lurking fear: "Use it or lose it!" If I don't write constantly or, at least, consistently, the magic may disappear. The red hot, glowing burning charcoal psyche will die down into a warmish wimpish ashen afterthought. Never enough heat to spark combustion, just a low grade fever. And, truth be told, having for years labored in relative obscurity both as a speaker and writer, there's the fear that if I don't keep performing, I'll again lose both the edge and my stage. (And I must say how reassuring it was getting several emails from readers wondering when the newsletter was coming out.)

The other vital problem: obsessively pondering, "Can there be life after deadlines?," is choking off the creative wellspring. Constantly trying to be original or imaginative on demand feels like the paradox engendered when someone suddenly barks at you, "Be spontaneous!" Your disoriented, paralyzed look comes closest to being the authoritative answer to the communication conundrum.

And it's also the way my brain feels trying to grind out uncommon work without enough down time. Living on the creative edge requires periodic retreats, taking an incubation vacation to hatch a new perspective. Hitting the wall stirs what psychiatrist Richard Rabkin called, "thrustration." I have defined this neologism thusly: when you're torn between thrusting ahead with direct action and frustration as you haven't quite put together the pieces of the creative puzzle. Thrustration which retreats into an incubation vacation is sowing the ground for...Aha! Creative retreating as "letting go."

It's suddenly obvious: life does not have to be all or none. I'm reminded of a classic New Yorker cartoon. A humble looking Charles Dickens is being dressed down by his self-righteous, power-suited, power-desked publisher: "Really Mr. Dickens, was it the best of times or was it the worst of times? It can scarcely have been both!"

So once I realize the issue isn't putting The Stress Doc Newsletter on the shelf but temporarily limiting publication to one newsletter per month, letting go feels affirming. (And it probably is a mutual relief, especially if feeling bad about being a two or three newsletters behind in your reading. Remember, you can always delete a newsletter guilt-free. Three deletions, then I might start inquiring, "What's your problem? Are you feeling overloaded? ;-) And now there's a solution: "letting go." Just keep in mind this newsletter's opening lyrical anthem:

Fight when you can
Take flight when you must
Flow like a dream
In the Phoenix we trust!

Letting go...It's a vital tool for keeping your cool and for helping us all... Practice Safe Stress!

Reader's "Higher Power of Humor" Section

MIDDLE AGE (siiigggghhhhh) From: MissPastel

Maybe it's true that life begins at fifty. But everything else starts to wear out, fall out, or spread out.

There are three signs of old age. The first is your loss of memory, the other two I forget.

You're getting old when you don't care where your spouse goes, just as long as you don't have to go along.

Middle age is when work is a lot less fun -- and fun a lot more work.

Statistics show that at the age of seventy, there are five women to every man. Isn't that the darndest time for a guy to get those odds?

You know you're getting on in years when the girls at the office start confiding in you.

Middle age is when it takes longer to rest than to get tired.

By the time a man is wise enough to watch his step, he's too old to go anywhere.

Middle age is when you have stopped growing at both ends, and have begun to grow in the middle.

Of course I'm against sin; I'm against anything that I'm too old to enjoy.

A man has reached middle age when he is cautioned to slow down by his doctor instead of by the police.

Middle age is having a choice of two temptations and choosing the one that will get you home earlier.

You know you're into middle age when you realize that caution is the only thing you care to exercise.

At my age, "getting a little action" means I don't need to take a laxative.

Don't worry about avoiding temptation. As you grow older, it will avoid you.

The aging process could be slowed down if it had to work its way through Congress.

You're getting old when getting lucky means you find your car in the parking lot.

You're getting old when you're sitting in a rocker and you can't get it started.

You're getting old when your wife gives up sex for Lent, and you don't know till the 4th of July.

You're getting old when you wake up with that morning-after feeling, and you didn't do anything the night before.

The cardiologist's diet: if it tastes good, spit it out.

Doctor to patient: I have good news and bad news: the good news is that you are not a hypochondriac.

It's hard to be nostalgic when you can't remember anything.

You know you're getting old when you stop buying green bananas.

Last Will and Testament: Being of sound mind, I spent all my money

Seek the Higher Power of Humor: May the Farce Be with You!

(c) Mark Gorkin 2000 Shrink Rapâ„¢ Productions