If bringing up the drinking practices and potential problems of a family member or close friend makes someone squirm with discomfort, the idea of saying something to a coworker is virtually unthinkable. Almost everyone accepts a separation between work and home or professional and private life. So until the alcohol problem flows into the work world, the worker’s use of alcohol is considered no one else’s business. That does not mean that no one sees a problem developing. Our suspicion is that someone with even a little savvy can often spot potentially dangerous drinking practices. The office scuttlebutt or work crew’s bull sessions plus simple observation make it common knowledge who “really put it away this weekend,” or the “poor devil who just got picked up DWI,” or “you can always count on Sue to join in whenever anyone wants to stop for a drink after work.”
Even if an employee does show some problems on the job, whether directly or indirectly related to alcohol use, coworkers may try to “help out”—by doing extra work, or not blowing the whistle. Because employee assistance programs, if they are present, are based on identifying work deterioration, any attempt by coworkers to help cover up job problems makes spotting the alcohol problem all the more difficult. If a company does not have a program to help alcoholics, odds for a cover-up by coworkers are even greater. Another important party in this concealment strategy is predictably the spouse, who usually doesn’t want to do anything to threaten the paycheck.
In the past when the cover-ups no longer could hide a problem, the alcoholic usually got fired; this may still happen in many companies. In such instances, the company loses a formerly valuable and well-trained worker, statistically a costly “solution.” The current thinking is that it is cheaper for a company to identify problems earlier and to use the job as leverage to get the employee into treatment and back to work.
*112\331\2*

If people with BDD see someone who looks as bad as they do, they still don’t feel much better about themselves. Somehow they interpret the situation negatively, thinking such things as “He doesn’t have much hair, but he’s laughing and seems to be enjoying himself. Why can’t I?” Or “She looks as bad as I do, but she has a boyfriend. What’s wrong with me?” A 40-year-old man said, “I stare at peoples’ faces thinking ‘He has freckles and he’s talking to people. Why can’t I do that?’” The situation is interpreted in terms of—and usually ends up reinforcing—the BDD sufferer’s own perceived shortcomings.
“When I’m standing in line at the drug store or the grocery store, I talk to myself, trying to reassure myself that I don’t look so bad and that I should stay in line instead of leaving,” Jason said. “I look at other people and think they’re uglier and worse off than me. But then my thinking takes a negative turn: I think things like ‘It’s true, he’s really ugly, but he doesn’t seem to care. He seems to be doing fine! What’s wrong with me?’ Or I check out all the successful people on TV—a lot of them aren’t attractive, but they’re smiling and seem happy, so I think maybe I can be happy too. But then I get down on myself because I’m not.”
*106\204\8*

The design and operation of the human body and the way in which it operates on an automatic level never ceases to astound me. Among the things I find really fascinating is the way the human body knows how to hold to life, to protect its existence. As part of its innate knowledge about how to protect itself, the body tends to prepare itself in ways that I call the as if syndromes. The body changes of these ‘as if patterns of preparedness can cause physical symptoms in stage one stress breakdown. For example:

‘As If I’m fighting for my life
There was an interesting article in one of the medical journals a few years ago about the use of onions and garlic to reduce the risk of thrombosis, that is, the clotting of blood within veins and arteries. It was based on an old French veterinary remedy for thrombosis in horses, and it sparked off some witty letters to the editor about this proposed method of preventing heart attacks. An experiment was described where medical students going into examinations had their blood tested for its clotting ability, some of them having had a meal with onions and some having had a meal without them. The researchers purported to show that the students who had not eaten onions prior to the examination showed an increased tendency for the blood to clot as a result of the stress of the examinations.
What interested me more than the onions or their effects on interpersonal relationships was that the blood of healthy young people should be more ready to clot when they go ‘to do battle’ with the examiners. I have heard that people in hiring and firing jobs have a higher risk of heart attack. (Heart attacks are usually caused by a clot of blood blocking up the coronary artery to the heart – coronary thrombosis.)
It is as if the person going out to face some conflict has his body made ready to respond to a possible loss of blood. It is said that soldiers sustaining severe wounds in battle often don’t bleed much at all, whereas if a person sustains a severe, unexpected wound, as in the case of a butcher severing a femoral artery while boning the ribs of a carcass, there is a real risk of dying immediately from loss of blood. Clearly, readiness for conflict can minimize blood loss.
It is as if the body tones up the blood vessels so they are all ready to shut down the moment they are severed and the blood made ready to clot at a moment’s notice. Unfortunately, if the battle involves a politician under attack from his opposition having to defend himself against a barrage of criticism at question time in the parliament, the toned up blood vessels and quick-clotting blood would be of no good use to him at all. Instead, the increased tone of the blood vessels and the extra clotting ability might cause a clot to form in a vein or artery. I remember how President Nixon suffered from thrombosis of his leg veins when he was in a beleaguered state prior to his resignation.

‘As If I’m hanging on by the skin of my teeth
There are many patterns of preparedness characterized by chronic contraction of specific muscle groups. A common pattern is seen in the person who is expecting the worst and has the teeth clenched and the head held rigidly in anticipation. This may cause severe pain in the temporo-mandibular joint in front of the ear, as well as headaches and neck pain. In general, I find that people who are always psychologically bracing themselves for disaster tend to suffer with stiffness and pain of the extensor muscles of the body. These include not only the muscles at the back of the neck, but those of the shoulders and the lower back.

‘As If I’m starving to death
Diabetes mellitus, or sugar diabetes, used to be considered a psychosomatic disorder, particularly when it was discovered that the extra Cortisol released by the adrenal cortex under conditions of stress tends to increase the body’s blood glucose level and produce symptoms similar to diabetes.
However, there is now no real need to think of diabetes mellitus as a psychosomatic disorder (it doesn’t avail us much), because the treatment for diabetes is by insulin injections and diet, or diet and pills, or diet alone. However, I have been impressed with the number of diabetic patients who have in (their history a significant cause of deep insecurity, an insecurity so profound that they may have feared, at least unconsciously, starving to death.
In diabetes mellitus, the body behaves as if it only has fat from the body stores to live on, as if it is starving to death. The body seems to ignore food coming in to the stomach – with regard to secreting suitable quantities of insulin at least – and occupies itself with breaking down stores of body fat. The result is a combination of excess acid in the blood from breaking down fat, plus an inability to metabolize carbohydrates, with excess glucose flowing out in the urine.
Let me say, however, that while this theory is an interesting one and attention should be paid to deeply-held fears of being abandoned and starving, the correct treatment of diabetes mellitus is by the medically proven methods of diet, hypoglycemic drugs and insulin.

*66/129/5*

There are two kinds of sleep which alternate four to five times each night:

* Non-REM sleep: brain is relaxed, but body is active

* REM sleep: brain is actively dreaming, but body is relaxed

During REM sleep, a lot is going on besides dreaming, and rapid eye movement is only the tip of the iceberg. In a man, although he is completely relaxed and unable to move even one muscle, one part of his body, the penis, is moving, becoming hard and erect. This is one of the most important discoveries made in the sleep laboratory, and has led to a very rapidly progressing field in the treatment of impotence.

It has been confirmed again and again in sleep laboratories that men have erections in the dream state during REM sleep. Hence they have several erections a night, corresponding with the several episodes of REM sleep. This is called dream erection and is completely automatic, furthermore, most of the time the dreamer is not aware of the erection. Most men will tell you that they experience a morning erection when they are just waking up from a dream.

Why do men have these dream erections? Do they serve any purpose? No one has so far been able to give a good reason;

*31\174\4*

The graph of improvement from nervous illness is not a straight line. It is a graph that leads steadily upward, but at the same time has many minor ups and downs. This is inevitable until the initial improvement becomes consolidated. A very common pattern is one of improvement for a week or so, and then a down—a minor relapse. When this happens it is very easy to think you are right back where you were. But of course you are not. These minor reverses are simply things that we must learn to take in our stride as best we can. We can reassure ourselves in the knowledge that they will become less severe and less frequent until they cease altogether. Of course, I can help patients whom I see personally through these bad patches. In your case, just remember that they are part of the general pattern of getting well, and you will be all right.

Bring Yourself to Like Doing It-The attitude of mind in which you approach your relaxing mental exercises is quite important. It is not a chore that you have to do when you would really prefer to be doing something else. There is no strain about it. Instead there is a feeling of ease. It is something that you like doing. It is something natural, something refreshing, something good; and you look forward to doing it, just in the same way as you look forward to any other pleasant experience.

*56\57\2*