Weathering the Extremes of Bipolar Disorder

Medically Reviewed On: Thursday, May 05, 2005

Many people feel sluggish and down during the gray, cold months of winter but when spring begins, the whole world seems to burst with energy and life and moods seem to magically improve. However, for the 2 million American adults living with bipolar disorder, the change of seasons can mean a change in behavior; the highs are much higher and the lows, much lower. New evidence has shown that the changing of the seasons may drive some of these extremes.
In a study published in April 2004 in the Journal of Affective Disorders, a team of scientists surveyed patients with various mood disorders, including depression and bipolar disorder. At the end of the year-long survey, it was found that individuals with bipolar disorder were much more likely to have mood fluctuations with the seasons than those from the depressed or normal populations.
While the true impact of this study is yet to be seen, it may change our understanding of bipolar disorder, and ultimately the way it is treated. Karen Shin, MD, the head researcher of the study and resident in psychiatry at the Sunnybrook and Women's College Health Sciences Centre, University of Toronto, tells us about these new findings.
What is bipolar disorder?
Bipolar disorder is a type of mental illness. It's in the category of mood disorders. Patients with bipolar disorder suffer from both highs and lows in their mood. When you're high it's called a manic episode; people can feel euphoric and elated. It can lead to impairment in judgment and disruption in sleep and eating. Similarly, when people are depressed their mood drops. They feel quite down and sleeping, eating, social activities can also be disrupted.
What causes bipolar disorder?
We don't know any specific causes. We know there is a genetic component; there is an element of heredity and we believe that neurotransmitters in the brain are contributory, but we don't know the fine details of what causes it.
What are the types of bipolar disorder?
There is bipolar disorder type 1 and bipolar disorder type 2. For bipolar disorder type 1, patients suffer from a cluster of symptoms that together would be called a manic episode. That includes severe euphoria and elation and a severe impairment in functioning. People might become psychotic, become very grandiose and have hallucinations. They may or may not have a depressive episode.
For bipolar disorder type 2, patients have what's called a hypomanic episode; it's an elevated mood, but not to the same severity of a bipolar disorder type 1 manic episode. Also, they will have had a depressive episode sometime in their life as well.
What are the first signs of bipolar disorder?
It's generally an early onset illness that usually appears in one's 20's. But it can happen across the lifespan. Someone who notices that they don't need to sleep at night, but they're still energized during the day [may have bipolar disorder.] They're not hungry. They're not bothering to eat. Family members or other people might notice that they're talking very quickly. Their thoughts might be racing and they become very distractible, these are things that you yourself might notice, but also people who know you well. People with bipolar disorder might start to feel overconfident and this is when it can lead to problems. This elation is related to the mania, like you're on top of the world and you can accomplish anything. This overconfidence can lead people to make poor decisions; start up their own business, clear out their bank account, go on shopping sprees or start gambling.
Someone with bipolar disorder might first have an episode of depression and they might be labeled as someone with a major depressive disorder. Then, say, ten years into it, they get a manic episode and then you look back and say, "Oh, actually this person is bipolar and not just depressed." Then, treatment would have to be tailored because treatment for depression is obviously different. The problem is that patients with bipolar disorder, run into manic times and depressive times, and antidepressants, which are used to treat depression, can sometimes trigger a manic episode. So it's a very careful balance in deciding what treatment is required.
What can trigger episodes?
Life stresses can trigger an episode. And not taking medications will trigger an episode. Compliance can become an issue because it is a chronic illness. To prevent episodes, you need to be vigilant in taking your medications every day. It's hard for patients to continue that over decades, especially when they're feeling better. That's when you can run into some problems with people that stop medications on their own.
But also disruptions in sleep, related to things such as seasonal changes, can perhaps trigger episodes.
How does seasonality affect bipolar disorder?
If you look across the general population, people might complain of differences in their mood and behaviors across the different seasons. Our study looked bipolar disorder patients and how they feel their moods and behaviors fluctuate across the changing seasons. And we found that they do experience significant difficulty. We measured their mood, sleep, social activity, weight, appetite and energy [over one year]. In our survey, bipolar disorder patients reported that these items would fluctuate according to the changing seasons. The spring and summer would be times when you're more likely to see patients with a manic episode whereas the depressive episodes are less likely during this time.
Medically Reviewed On: Thursday, May 05, 2005
Is this at all related to seasonal affective disorder?
There is one line of thinking that it is related to seasonal affective disorder (SAD), [a condition in which people experience depression during the winter months which subsides in spring and summer] It's not known in either case what triggers the mood changes; its never been clearly described.
What treatments are available to people with bipolar disorder?
Mood stabilizers are the mainstay of treatment. With a mood stabilizer you want to prevent manic episodes and depressive episodes. There are several different mood stabilizers and they all have different side effects.
Lithium, valproic acid and carbamazepine are common mood stabilizers. They require that your doctor constantly check to make sure that blood levels are proper. Lithium can cause some sedation and weight gain. It can cause dizziness and upset stomach. People might develop tremors. Valproic acid can also cause some sedation, some upset stomach.
And then a class of antipsychotic medications is also available as mood stabilizers. Often people do complain that they cause some tiredness. Sometimes people get some muscle stiffness as well.
All of these side effects would be monitored by a physician and medication adjustments made to minimize the side effects and maximize the treating potential.
Do you think the new information about seasonal affects on bipolar disorder might effect treatment?
Bipolar disorder is a chronic illness with a high mortality rate; between 10 and 15 percent of patients commit suicide. This stresses the need for appropriate illness detection, care and treatment. Finding out that bipolar patients have more difficulty in certain times of the year, shows that it would be important to monitor their symptoms, sleep and activity levels [during the different seasons]. They might need a little bit more medication to stabilize them over certain period of time where things are a bit more tenuous. You might have to add medications to help them sleep a little bit more. But these are projected ideas, there is no standard method to deal with seasonal changes and bipolar disorder.

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Men and Depression--It Takes Courage to Ask For Help

source: http://www.4therapy.com/consumer/life_topics/article/7143/110/Men+and+Depression--It+Takes+Courage+to+Ask+For+Help

Frequently, male depression first shows up in physical symptoms, such as headaches, gastrointestinal distress, and sexual dysfunction. When you're suffering from depression, you and others close to you may notice some of the following changes in your overall affect:

You're performing less well at work;

You're unusually quiet and seem unable to share what's bothering you;

You’re worrying--even obsessing--about things more than usual;

You’re more irritable than usual and may lash out at those who try to offer help.

Researchers estimate that more than six million men in the United States have a depressive disorder--about one-third of all adults living with depression in any given year. However, men are typically less likely than women to recognize, acknowledge, and seek treatment for their depression. In addition, their loved ones and even their physicians may not always detect depressive symptoms in men.

Depression is a serious medical condition that can affect both men and women. A depressive disorder is not the same as a passing blue mood. It is not a sign of personal weakness or a condition that can be willed or wished away. People with a depressive illness cannot merely "pull themselves together" and get better. Without treatment, symptoms can last for weeks, months, or years. Appropriate treatment, however, can help most people who suffer from depression.

Research and clinical findings reveal that while both men and women can develop the standard symptoms of depression, they often experience depression differently and may have different ways of coping with the symptoms. Men may be more willing to acknowledge fatigue, irritability, loss of interest in work or hobbies, and sleep disturbances rather than feelings of sadness, worthlessness, and excessive guilt, which are commonly associated with depression in women. Men may turn to alcohol or street drugs when they are depressed instead of seeking appropriate medical treatment.

Men with depression may become frustrated, discouraged, angry, irritable and, sometimes, violently abusive. Some men may deal with depression by throwing themselves compulsively into their work; others may respond to depression by engaging in reckless behavior, taking risks, and putting themselves in harm's way. Depression is a risk factor for suicide, and there is an alarming rate of completed suicide among men in the U.S. - particularly older white men and younger black men.

Symptoms of Depression may include:

• Persistent sad, anxious, pessimistic or "empty" mood

• Diminished sex drive

• Feelings of guilt, worthlessness, helplessness

• Loss of interest or pleasure in hobbies and activities that were once enjoyed

• Decreased energy, feeling "slowed down," fatigued, or "heaviness"

• Lapses in usual hygiene and fitness routines

• Trouble sleeping, early-morning awakening, or oversleeping

• Appetite and/or weight changes

• Thoughts of death or suicide, or suicide attempts**

• Restlessness, irritability

• Persistent physical symptoms, such as headaches, digestive disorders, and chronic pain, which do not respond to routine treatment

Four Steps to First Understand and Then Get Help For Depression:

1. Look for signs of depression

2. Understand that depression is a real illness

3. See your doctor--get a check-up and talk about how you’re feeling

4. Get treatment for your depression—you can feel better

Step One: Look For Signs of Depression

If any of the following symptoms apply to you, please seek professional advice from your doctor. You could be suffering from depression. Take this list to your doctor and discuss the symptoms you identified with.

1. I am really sad most of the time.

2. I don’t enjoy doing the things I’ve always enjoyed doing.

3. I don’t sleep well at night and am always restless.

4. I am always tired. I find it hard to get out of bed.

5. I don’t feel like eating much.

6. I feel like eating all the time.

7. I have lots of aches and pains that don’t go away and have no real medical cause.

8. I have little to no sexual energy.

9. I find it hard to focus and am very forgetful.

10. I am mad at everybody and everything.

11. I feel upset and fearful--but don’t know why.

12. I don’t feel like talking to people.

13. I feel like there isn’t much point to living—nothing good is going to happen for me.

14. I don’t like myself very much. I feel bad most of the time.

15. I think about death a lot. I even think about killing myself.**

Step Two: Understand that Depression is a Real Illness

Depression is a serious medical illness that involves the brain. But, there is hope. Depression can be treated and you can feel better. Depression is not something that you have "made up in your head." It’s more than just feeling "down in the dumps" or "blue" for a few days. It’s feeling "down" and "low" and "hopeless" for weeks at a time. About 19 million Americans have depression. It can happen to anyone, no matter what age you are or where you come from.

Depression can make it very hard for you to care for yourself, your family, or even hold down a job. But, there is hope. Depression can be treated and you can feel better.

Step Three: See Your Doctor

Don’t wait. Talk to your doctor about how you are feeling. Get a medical checkup to rule out any other illnesses that might be causing signs of depression. Ask if you need to see someone who can evaluate and treat depression.

If you don’t have a doctor, check your local phone book. Go to the government services pages (they may be blue in color) and look for "health clinics" or "community health centers." Call one near you and ask for help.

Step Four: Get Treatment For Your Depression. You Can Feel Better

There are two common types of treatment for depression: (1) medication and (2) "talk" therapy. Ask your doctor which type is best for you. Some people need both treatments to feel better.

Medications for depression are called "antidepressants." Your regular doctor or a psychiatrist (a medical doctor trained in helping people with depression) can prescribe them for you.

Antidepressants may take a few weeks to work. Be sure to tell the doctor how you are feeling. If you are not feeling better, you may need to try different medicines to find out what works best for you.
Medicines sometimes cause unwanted "side effects." You may feel tired, have blurred vision, or feel sick to your stomach. Tell the doctor if you have these or any other side effects.

"Talk" therapy involves talking to someone such as a psychologist, psychotherapist or counselor. It helps you learn to change how depression makes you think, feel, and act. Look to 4therapy.com’s Therapist Locator for someof the nation’s finest therapists near you. You can feel better.

How to Help Someone You Care About Who May Have Depression:

If you have a friend or loved one who seems depressed and may need help, here are some things you can do:

• Tell your friend or loved one that you are concerned about him.

• Talk to him about seeing a doctor or therapist.

• Offer to call a doctor or a therapist and help your friend or loved one make an appointment.

• Take him to the appointment.

• "Be there" for him after he starts treatment.

**Sometimes depression can cause people to feel like killing themselves. If you are thinking about killing yourself or know someone who is talking about it, get help:

Call 911.

Go to the emergency room of the nearest hospital.
Call and talk to your doctor or therapist now.

Ask a friend or family member to take you to the hospital or call your doctor ASAP.

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Important New Insight Into How Antidepressants Work

By: James L. Helmuth, Ph.D.

"Coming out," as in "coming out of the closet," represents the personal and public acknowledgement of being romantically attracted to individuals of the same sex. It is a process of choosing to integrate this knowledge into one’s personal, social and vocational life.

Coming out is not just a single event of disclosing that one is gay to someone. It is a long and often difficult process of coming to terms with one’s gay, bisexual or lesbian identity. While not necessarily experienced in the following order, six common stages or steps can be identified:

1. Pre-Coming Out Stage:

This stage is the awareness that I am different from friends in some basic way regarding romantic attraction and that I am attracted to the same sex. This may take from weeks to years to understand the meaning and implications of this basic difference.

The challenge in this stage is to overcome the fear, sense of isolation, and self-alienation that is often present with this awareness. The defenses of denial, repression or projection are often used to delay this self-understanding. Exploratory sexual experiences with others of the same sex does not in itself indicate one’s orientation. Ongoing thoughts, feelings and experiences will often confirm and reinforce that this romantic attraction is very basic and very strong. It is not just a phase and cannot be fundamentally changed for most if not all individuals, even with "reparative therapies or aversive conditioning.

2. Coming Out To Self:

This involves some initial acknowledgement to myself that "gay, lesbian or bisexual" does describe what I feel and want. Acknowledgement does not mean acceptance that I am gay. There often is a long inner struggle between the internalized homophobic parts of us and the desire to be real, honest and who I am. Efforts to relate sexually to the opposite sex or change orientation are usually met with frustration and failure.

Strong feelings of guilt, shame and fear of rejection keep this new self -knowledge hidden. There are usually more frequent same sex sexual experiences at this time and the beginnings of romantic attraction as in "having a crush on someone" or just feeling magnetically drawn to someone is experienced more fully. The wonderful joy of being deeply in love cements the awareness of being gay as a fundamental part of one’s being.

3. Coming Out To Others:

Once there is some initial acceptance of a new identity as being gay, bisexual or lesbian, there is usually disclosure to some significant other. Most likely it starts with a trusted friend but it can be anyone. The response one gets to early coming out disclosures has much influence on how this process continues. Sometimes we do not get to tell our own story and we are "outed" by someone else, which violates our privacy boundary and is experienced as emotional rape. The process of coming out to others can take from a day to a lifetime depending on many factors. It is like being pregnant with a frightening secret and it must come to full birth and be born in due time or the person dies inside or physically.

4. Exploration:

This stage is often one of awkwardness, intensity and confusion. It is a time of seeing what is out there in this new world and how I fit into it, if at all. This can be scary!!! Because of long repressed and disowned feelings of attraction to the same sex, this time is often highly sexual and may be mistaken for promiscuity.

If this exploration stage happens as an adult, it can be understood as a late adolescence, a retracing of a stage that was skipped or inhibited during teen years. Depending on the social and sexual experience in finding sexual partners, this stage can enhance self esteem and gay identity. But it can also become compulsive and possibly addictive.

5. Relationships:

Coming out alone is different than coming out with someone else in a relationship. Here the challenge is to negotiate and establish some ongoing agreement with one person that meets most of the sexual and emotional needs of both. First relationships may be forever. Often they are not and are transitional. This is not necessarily bad. We can learn something from each relationship as to what works for us and what does not work for us.

Often unresolved "coming out" issues complicate the formation of secure, mutually respectful agreements. E.g. not feeling deserving of love; fear of emotional and/or sexual intimacy; having guilt/shame/blame issues. All of us need to practice relationships until we get it right-- that is becoming comfortable and adept at taking care of ourselves while at the same time living intimately with another in an often hostile society!!!!

6. Integration:

This last stage lasts forever. In this stage the individual is more or less comfortable with being who he or she is and is able to talk about this at times. Here most of the initial panic, fear, self-hatred, grief and anger is resolved and replaced by a more secure sense of being at peace with who I am as a gay, lesbian or bisexual person. One is not trying to use the gay partner to help avoid facing some personal life problem (e.g. like with rejecting parents, past abuse, or fear of responsibility.

With integration, there is no compulsive need either to hide or to broadcast the awareness of being gay. It truly does not matter so much who knows or what those who do know think or feel about my being gay. This is very different from the defensive/angry statement, "I don’t give a s_ _ _ what anyone thinks of me!" Anyone of us may go back to earlier steps of non-acceptance, anger and fear in certain situations even after feeling secure and good for years. And the energy of anger may be helpful in bringing justice and fairness in our society.

About James L. Helmuth

source: http://www.4therapy.com/consumer/life_topics/article/5532/441/Coming+Out+to+Your+Parents

Once you’ve decided to tell your parents you’re gay, it’s natural to worry about just how you’re going to tell them and how they’ll then react. Becoming informed about the process other individuals and their families have gone through can help you feel better prepared to take the big step of coming out to your parents.

Questions to Confront Before Coming Out To Your Parents:

Before you take the big step of coming out to your parents, there are some key questions you can ask yourself that can help you become clear in your own mind that you’re coming from a position of relative clarity:

Are you sure about your sexual orientation?

Uncertainty on your part may only increase your parents’ confusion and could affect their confidence in your judgment. Before you raise the issue, it’s important that you be able to respond with confidence to the question “Are you sure?”

Are you comfortable with your gay sexuality?

Before you come out to your parents, you need to be at a stage beyond just knowing that you’re gay. Since coming out to your parents may require a tremendous amount of emotional energy on your part, you might consider waiting until you feel you have a relatively positive comfort level with your sexual orientation before you tell them.

Do you have support?

In the event your parents’ reaction is difficult or traumatic for you, it’s critical to have someone—a close friend and/or a therapist--you can turn to for emotional strength, solace and support.

What’s the emotional climate at home?

Timing can be everything! If you have the choice of when to tell, choose a time when your parents are as un-stressed as possible. It’s also very important that you choose a time when you’re feeling good about yourself, not when you’re in a crisis.

What’s your motive for coming out to your parents now?

An example of a preferable motive would be that you love your parents and are uncomfortable with the distance you’re feeling because they’re unaware of this important aspect of you. Coming out in anger or during an argument is never a good idea and can only result in hurtful repercussions for you and for your family.

Are you financially dependent on your parents?

If you think your parents might reject your homosexuality and retaliate by withdrawing your college finances or forcing you to leave the house, you might consider waiting until they no longer have this kind of leverage.

Can you be patient?

If they haven’t already considered it prior to your disclosure, your parents may need time to deal with the news about your homosexuality and, as hard as it may be for you, you need to be prepared to be patient rather than force a quick resolution.

Is this your decision?

Don’t be pressured into telling your parents until the time feels right for you.

How to Present the News

Your particular style of communicating and your unique relationship with your parents will certainly shape the way you present the news, but basically, you can begin by saying something like: “There’s something about me that I want to share with you because I love you very much and I want you to know me fully. I’ve been questioning my sexuality for a long time now and I’ve come to the conclusion I’m gay.”

Many have found that it helps to have gathered together facts and statistics to share in an effort to help dispel any negative preconceptions their parents may have. A local mental health professional who’s experienced in gay and lesbian issues can provide you useful and current reading material that will give your parents good information and support.

Stages of Understanding

Each family is uniquely different and every parent reacts in their own way when first learning that their child is gay. There are, however, general “stages of understanding” that describe the overall process many families have experienced, beginning from the child’s initial disclosure and proceeding through to their parents’ final resolution. Some parents take as few as several months to move through these stages, while others can take years.

The stages of understanding are:

o Shock
o Denial
o Guilt
o Expressing feelings
o Making decisions
o True acceptance

It’s important to note that these stages aren’t necessarily experienced as an absolute, linear progression for everyone. For instance, it’s not uncommon for a stage to occur out of order, to re-occur (sometimes repeatedly), or to be skipped altogether.

Stage 1: Shock

If the Information is Brand New to Them…

Shock is a natural reaction to new and unexpected information. If you suspect that your parents have no idea about what you’re about to share, you can anticipate an initial state of shock that may last anywhere from a few days to a week.

Occasionally, a parent will experience no shock at all, either because they’ve already considered the possibility that you are gay or perhaps because they inadvertently learned about it and have been waiting for you to tell them. In these instances, your experience of sharing your information will be easier for you since your parents have already had a chance to work through some of the stages of understanding on their own.

Stage 2: Denial

They Attempt to Protect Themselves From the Information

Denial is an attempt to protect oneself from what feels like a painful or threatening situation. Denial is different from shock because it indicates the person has heard the message and that they are now responding by attempting to build a defense mechanism to keep it at bay. Parents’ denial responses can take many forms, some examples include:

o Hostility: “No son/daughter of mine is going to be gay.”
o Non-Registering: “Oh really. Now what would you like for dinner?”
o Non-Supportive: “If that’s the lifestyle you choose, fine, just don’t tell me about it.”
o Rejection: “It’s just a phase you’re going through; you’ll get over it.”

You should be prepared to deal with your parents individually, if necessary. It is not uncommon for one parent to take the lead and move towards resolution ahead of the other. Don’t be upset with the “slower” of the two.

Stage 3: Guilt

They Feel They’re to Blame For Your Homosexuality

When first learning of their son or daughter’s homosexuality, some parents initially perceive of it as a problem for which there must be a cause. It’s not uncommon for parents to think that they are to blame, that something they did or didn’t do is responsible for you being “different” (even though you and they know there is absolutely nothing wrong with you). If you find that your parents take this self-incriminating approach, you can help by telling them something like, “You didn’t do anything wrong; just the fact that I feel good enough about myself to come out and to share it with you says you did something very right.”

Stage 4: Expressing Feelings

They Acknowledge a Range of Emotions

This can be the point at which some of the most productive dialogue between you and your parents takes place. As the feelings of guilt and self-incrimination that many parents initially experience subside, they become ready to acknowledge some of what they’re feeling, to ask questions and to be receptive to your answers. Even though anger and hurt may be amongst the feelings expressed, it’s much better for you and for your parents to share the full range of what you’re feeling rather than attempting to deny the existence of some of your more distressing emotions.

Stage 5: Making Decisions

They Consider the Options That Lie Ahead

When the initial emotional trauma quiets down, your parents will be increasingly able to deal more rationally with the issue. At this time, it’s common for them to retreat for a while and consider the options that lie ahead. The eventual stance each parent makes is a reflection of the attitudes he or she is ready to adopt in dealing with your sexual orientation. Three typical stances include:

o Supportive — accepting the reality of their child’s homosexuality and becoming aware of and supportive of your needs.
o “This Far and No Further” - making it clear that their son or daughter’s sexual orientation is an issue that they no longer want to discuss. This does not necessarily reflect a negative attitude toward you, rather they know their limits and don’t want to be pushed beyond them.
o Adversarial — taking the negative position that their son or daughter’s homosexuality is a “problem” which then becomes a constant source of disagreements and criticism.

Relapses (They Revisit Previous Stages)

At this point, it’s important to address the real and present possibility of recurrent relapses to previous stages. Accepting new information and changing personal attitudes can often be thought of as taking two steps forward and one backward. When parents are dealing with understanding their child’s homosexuality it is not at all uncommon for them to feel the need to revisit previous stages of understanding that were seemingly already resolved. While it can be disappointing and/or frustrating for you when and if this happens, it’s the course of events that is often required for change and resolution to eventually come about.

Stage 6: True Acceptance

They View Your Homosexuality As a Legitimate Expression of Your Sexuality

Many, though not all, parents reach this stage. While a great number of parents may certainly love their son or daughter, there are some that cannot reach the point of accepting their child’s sexual orientation. However, others are able to express true acceptance and view their son or daughter’s homosexuality as a legitimate expression of their sexuality. Some parents even become ardent advocates on behalf of raising community awareness about gay issues and speak out against societal oppression. When these parents are asked if they wish their child was not homosexual, they may say something like: “If I could change anything, I’d prefer to change our homophobic society so that my child could live a happy and fulfilling life without having to deal with the threat of rejection or fear.”

Getting Help

Coming out--whether it’s to your parents, friends or to the outside world--can be an extremely complex emotional process. Going through it alone can be very, very hard. It can make all the difference in the world to your position of clarity and self-confidence to have the support of someone who has a good understanding of the many emotional aspects of coming out and can offer useful insight into your particular situation. Many have found that the support of a mental-health professional was extremely instrumental in helping them cope with outside obstacles and work through personal uncertainties and apprehensions.

There are therapists who are especially experienced in gay and lesbian issues. You might consider contacting a therapist in your area who can help you with your particular issues so that you are able to effectively integrate your sexual orientation into a strong and confident self-image.

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Homophobia

By: Jim Weinstein, M.F.T.
http://www.4therapy.com/locator/viewtherapist.php?noemail=1&uniqueid=29

Homophobia: Irrational fear of, aversion to, or discrimination against homosexuality or homosexuals (Merriam-Webster’s Collegiate Dictionary, 10th Edition, 1993).

As is the case with racism, numerous and complex societal factors contribute to homophobia. And, as with racism, homophobia is based on prejudice towards those who are different. The primary source of homophobia in most Western nations seems to be the Judaeo-Christian religious tradition of opposition to homosexuality, justified by certain passages in Scripture (although in recent years certain “progressive” branches of Protestantism and Judaism are increasingly accepting of homosexuality). From its roots in religion, homophobia has institutionalized itself in the law (in many states one can be legally fired for being homosexual), psychology (until 1980, homosexuality was deemed a mental disorder by the official diagnostic manual of psychology, the Diagnostic and Statistical Manual of Mental Disorders), the military (unlike any other minority, avowed homosexuals may not enlist or serve in the armed forces) and popular culture (homosexuals until very recently were usually depicted in movies and on television as either depressed, diseased, deranged, or preying on children).

The evidence that homophobia is a culturally based aversion, rather than a "natural" one, is extensive. Merely contrast the tolerance for gays and lesbians evidenced in Manhattan, Hawaii, or Amsterdam with the intolerance from much of rural America. This is not to say that aversion among many heterosexuals to same-sex sexual relations is in any way unnatural. However, because certain behaviors may be personally distasteful does not mean that they should be universally banned or even condemned (e.g. eating snails!).

Internalized Homophobia: the hatred of one’s own homosexuality

Because of the pervasiveness of homophobia in our culture, we are exposed from a very early age to a constant stream of messages that denigrate homosexuality and homosexuals. For example, “faggot” is one of the most common names used by boys in elementary school to denigrate a classmate. For most people these negative messages become internalized as truths about “the way things really are.” The fact that the messages are culturally constructed becomes invisible (this phenomenon is perhaps most apparent with gender stereotypes--girls “are supposed to be” be sweet and demure, boys aggressive and competitive--but is equally operative vis-à-vis homosexuality).

For someone coming to terms with a homosexual orientation, internalized homophobia can be a devastating, ego-undermining psychological phenomenon. Many believe that the higher rates of substance abuse and suicidality in the gay community are directly related to this internalized homophobia--each offering a means of escape from the pain of feeling that one is fundamentally not O.K., that one is somehow "less than."

Dealing with Internalized Homophobia

The single most important step in liberating oneself from internalized homophobia is recognizing that the source of the bad feelings is external--“programming” written by a society which in general is very negatively disposed towards homosexuality. Homosexuality is generally felt to have a strong genetic component, and is not a deviance or an illness, any more than being left-handed or blue-eyed are.

Another vital step in escaping the grip of internalized homophobia is to “come out” (i.e. reveal one’s sexual orientation) to a trusted friend or relative. Unfortunately, the same forces that create such a stigma around homosexuality can also conspire to prevent people from taking this step.

Some people are so distressed by their homosexual orientation that they seek therapy to alter it. The American Psychological Association has taken the position that there are NO therapies that have demonstrated success in altering sexual orientation, although some have claimed such a focus and ability.

The Value of Professional Counseling

Coming out--whether it’s to your parents, friends, the outside world, even to yourself--can be an extremely complex emotional process. Going through it alone can be very, very hard. It can make all the difference in the world to your position of clarity and self-confidence to have the support of someone who has a good understanding of the many emotional aspects of coming out and can offer useful insight into your particular situation. Many have found that the support of a mental-health professional was extremely instrumental in helping them cope with outside obstacles and work through personal uncertainties and apprehensions.

There are therapists who are especially experienced in gay and lesbian issues. You might consider contacting a therapist in your area who can help you with your particular issues so that you are able to effectively integrate your sexual orientation into a strong and confident self-image.

Eating Disorders:What you Need to Know

By Amy Paturel

About 10 million women and one million men in this country starve themselves or engage in dangerous binge/purge cycles to control their weight, and another 25 million are struggling with binge eating disorder, according to the National Eating Disorders Association. But scores more suffer from sub-clinical forms of the diseases, that is, their eating and weight-control behaviors are not normal, but they do not meet the definition of an eating disorder -- and the problem is growing.

For people with eating disorders, dieting, binging and purging may begin as a way to cope with and mask painful emotions and to gain a sense of control over them and their lives. Here is some crucial information about how these disorders manifest themselves a list of resources for help.

Anorexia

Signs and Symptoms: Anorexics tend to consume very few calories, exercise incessantly or use laxatives to keep their weight at often, dangerously low levels. Relying on the number of the scale to determine their self worth, anorexics often find themselves locked in a pattern where they find fleeting relief as their weight drops. "People with anorexia also frequently suffer from high anxiety, obsessive-compulsive tendencies and are perfectionists," says Lynn Grefe, chief executive officer of the National Eating Disorders Association.

Health Consequences: Anorexia can have a devastating effect on the mind and body. In fact, it has the highest mortality rate of any psychiatric illness. Starvation robs the body of the essential nutrients required for normal functioning. The body slows down all its processes to conserve energy, resulting in a slower heart rate, reduction in bone density, muscle loss and weakness, dehydration and hair loss. Often, anorexics grow a thin layer of hair all over the body called lanugo (developed to keep the body warm).

Bulimia

Signs and Symptoms: Unlike anorexia, people with bulimia often have a normal body weight, which allows them to better keep their illness a secret. Extremely concerned with body image and weight, bulimics regularly engage in binge-eating episodes, consuming large amounts of food in a short time period followed by vomiting or fasting. Use of laxatives, over-exercising and other strategies to quickly lose weight compensate for the calories eaten. People with bulimia also tend to suffer from depression.

Health Consequences: "There's a misconception that bulimia doesn't kill," says Grefe. "That's absolutely not true." The recurrent binge-and-purge cycles can impact the entire digestive system and purging can lead to potentially fatal electrolyte and chemical imbalances in the body that affect the heart and other major organ functions. Other medical complications can include tooth decay, gastric rupture and inflammation or rupture of the esophagus.

Amy Paturel is a freelance writer for several publications, including Cooking Light and Health, and holds a Master of Science in Nutrition and a Master of Public Health.

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