An update from an impatient

Dear Friends, Family and Caring People,

To ease the pressure on poor G [my partner], I felt I must offer an update so you can all stop asking him how I am for a bit. He has been, and is being, the most extraordinary support system for me, for which I am deeply grateful, but he deserves a break now. He’s truly special, that man. For those who know some of this, please forgive the repetition.

I am doing really well. The op was a great success (3 hours instead of the expected 3,5) and both surgeons were delighted with themselves. The reconstructive surgeon had a look at my now-deformed bits immediately post-op and exclaimed that they were ‘very beautiful’. I’m glad he thinks so.

I came home on Tuesday and it was so fabulous to be able to sit in my garden and not have someone poking or prodding or fiddling with me every five minutes. No offense to the terrific nursing staff at [the hospital], but hospitals are exhausting. Plus, I was constantly in trouble for opening the window instead of using the aircon, and received little sympathy when I was savaged by mozzies on Sunday night. I think one arrived, had a sip, and called all its mates to come share the delicious drug-pub on offer. I’ve also now had two good nights of sleep, the first in quite a while.

My drains came out today, which is such a liberation. Carrying around little plastic containers of your own body fluid is neither dignified nor fun and rather limits your mobility. The physio is hard because I’m still very sore, particularly on the right side where a nerve is being pinched, but if I don’t do it I will battle later. The arm movement takes a beating because they cut through so many nerves. I managed to blow dry my hair yesterday, an awkward and long process with a far from perfect result. G was elated. He gets very worried about me when bad hair is not an issue .

Emotionally I’m also feeling strong. I have not had any of the drastic downers I was told to expect. The odd bit of weepiness does hit me every now and then but it doesn’t last for long. I’m hoping that this bodes well for future coping with the chemo. I know it’s early days, so let’s see

My pathology results came back yesterday and there was more cancer in the right breast, but removed with ‘large margins’ {of healthy tissue around it} as the surgeon puts it, which is excellent news. It also validates my decision to have the mastectomy completely. I feel almost hysterically grateful that I’ve got rid of this creeping threat early, and blessed to be given the chance to beat it.

So, all in all, it gets better every hour of every day.

The next step is getting used to my rather massacred chest until after chemo when they can finish the reconstruction. Going from a D cup to an odd-shaped A (that A is courtesy of my ‘chest expanders’ which will slowly stretch the skin to allow for implants later) is a weird feeling, and it looks pretty hideous right now. But it’s temporary, and I will be finding a way to look normal when I am out and about.

Thank you to those who were ‘allowed’ to visit me in hospital for doing so and cheering me up enormously, to those who had the EQ to leave me alone (that much-needed space was appreciated), and to every single one of you for the extraordinary outpouring of caring, concern, offers of help, and incredible help already given. I’m feeling quite overwhelmed.

I’m still not really up for many visitors right now, but will let you know when I am. Soon, I’m sure. G says I’m being an ‘impatient’ as per the header of this mail. Not surprising to any of you, I know.

I’ve been receiving daily ‘notes from the universe’  <http://www.tut.com> which are incredibly inspiring and great fun. Here’s today’s, auspicious for me right now I think:

“Sadness, illness, and despair, are less conditions than they are decisions – to see yourself as less than you really are. Good thing that’s all, huh, ‘Chantal’?
Yours, The Universe”

Thank you again, all you very wonderful people.

Love, C

*******

09 March 2011

Impatient update #2

Dear All,

So many people have been asking how I’m doing – thank you for caring – that I think it’s time for another update.

It’s now close to five weeks since my op and I’m feeling so much better. The body is pretty amazing, the way it heals. The next part of this journey is one I’m not looking forward to, but more about that later.

My biggest issue when I decided it was time to lose the PJs was what to wear. My dear friends all either shopped or raided their wardrobes on my behalf, and G scampered through Cavendishm for me, fingering lingerie and urging every female shop assistant to book a mammogram immediately! Thank you, special people.

This cancer thing seems to be an epidemic, with both a close colleague of ours and an associate of G’s having been diagnosed with one sort or another in the past few weeks. If I could ask all of you for only one more thing, it would be to please be sure to have checkups and screenings regularly. If I hadn’t had mine in December it would have been much harder for me. It’s so important to catch stuff in time and age increases the chances of something cropping up. Please take care.

As G drily remarked last week as we successfully negotiated our way through the maze of corridors at Vincent Pallotti from a different direction than usual: “We once knew Long Street, now we know Pallotti and Constantiaberg Hospitals”.

After my last mail I developed a bacterial skin infection that I ignored for too long and which needed vicious doses of penicillin to clear. Since I was out in [the small town of] Riebeekkasteel at the time, when I finally decided it wasn’t going away, my surgeon had to diagnose the problem via a cell phone pic which I mailed. iPhones have their uses!

The consequence was that I couldn’t have my first ‘expansion’ as planned a few days later. For those who are confused about this process, here’s how it works. I have ‘expanders’ under the skin which are basically plastic bags (very hi-tec ones, mind) that are filled with saline via syringe over an extended period. This stretches the skin slowly until, as the delightful ‘Dr Smiley’ puts it, “You say, OK Shane, that’s big enough”. Then it’s surgery again to remove the expanders and insert proper implants. The expanders sit against my chest muscles and are most uncomfortable (they make for some very bizarre sensations while driving) but are necessary means to an end. G says if he puts his head on my chest he can hear me creaking like an old gomma-gomma chair.

I did have that first expansion a week later, a whole two tablespoons on each side. It doesn’t sound like much, but that tiny bit of saline made all the difference to me. I could actually see it filling out my concave bits ever so slightly, a totally marvellous indication of a more normal shape to come.

Sadly, this will be a slow process since I cannot have the final surgery until two months after my next step is over, which brings me to the chemo.

My oncologist laid out some facts and figures, using a remarkable professional online resource which produces graphs and percentages according to the specific age, cancer stage and type, and general health of the patient. If I go for both recommended treatments, hormone therapy and chemotherapy, my chances of being alive in ten years increase from 84% to 91%. And my chances of not having cancer pop up somewhere else in my body in ten years time increase from 66% to 84%.

Those figures did it for me. Chemo is a dreadful and very damaging procedure but I cannot turn down this opportunity to give myself the best chance of zapping any cancer cells that may be lurking. In addition, the hormone therapy (generally a five-year course prescribed for oestrogen-receptive cancers) is apparently ghastly as it strips all oestrogen out of the body, putting one straight into full-blown menopause. Some women decide they cannot handle the side-effects and stop taking it. Should I be one of them, I will still have improved my chances through chemo, keeping the positive percentages higher than they would have been with no treatment at all.

Of course, everyone is different, and statistics cannot allow for that but I have to base a decision on something tangible.

I’ve also been looking at ways to boost my immunity in preparation for this, and have had a few brushes with some rather strange natural recommendations. I’m all for homeopathic, but not when those touting a product as a definite cancer cure urge me to reject chemo in favour of their elixir and cannot give me facts, figures and testimonials. “A certain plant from somewhere in Africa that’s dried in a special way but we can’t mention the name because it’s so successful that the pharmaceutical companies are trying to shut us down” doesn’t do it for me. Call me a cynic. If anyone has any recommendations that have been tried and tested, I’d appreciate input.

The chemo is an 18 week course split into two parts. The first, which is the brutal one, is three treatments, every three weeks. The second is a nine-week course of treatments every week.

There goes the hair. My first infusion of the Red Devil, as it’s referred to, is next week on Thursday the 17th. They tell me the hair starts coming out in clumps about ten days after the first treatment. It’s recommended that you shave it off immediately to minimise the trauma. I went to buy a wig on Monday which is a lot shorter and quite a bit darker than my own hair. The style is called ‘Posh’ as in Spice and is quite a nice cut. It’s not as easy as one would think to just pick the perfect one off the shelf. I’m not sure I’ll be wearing it much but I want to be prepared. It’s difficult for me to put on with all my hair at the moment so G modelled it for me when I brought it home. That was quite a sight. I haven’t laughed that much since December.

The hair thing, I have to say, is probably the worst of this. I think I can handle the other side effects, knowing they’re very temporary, but the hair takes six months to grow back enough to lose the head coverings. And apparently it usually grows out darker and very curly at first, so I’m girding my loins for a new afro. Like my wig on G, I don’t think that look will be a good one for me.

Every step on this journey is another one towards it being over, but I do feel like getting past the hair loss will be the bumpiest bit still ahead. Once that’s happened, it surely cannot get rougher on this road.

Apart from that, I’m in good spirits and am eating a far healthier diet. My brain, however, is still AWOL but it’s been phoning home recently so hopefully will be back soon. I’m battling terribly to concentrate when I work, but the missed deadlines are now a top priority so it cannot be soon enough.

G continues to be a very precious support system. He’s my trellis and I’m clinging on at the moment, but he’s helping me grow stronger every day.

And yes, I’m still being an ‘im’patient but given how quickly the last five weeks have passed, I know it won’t be long before this is over. I asked my oncolgist how I refer to myself post-op, and she said to say “I HAD breast cancer”. So there you go. Better and better.

Thank you for the calls, the sms’s and the mails. I remain overwhelmed by how many people care. I will keep you posted as to progress.

Love, C

           C & G after Shavathon

*******

03 April 2011

Impatient update #3

Dear All,

It’s funny the way the ‘how are you doing?’ messages flood in as I’m about to do my next update. I must have the timing right. I’d hate to be boring anyone with excessive frequency. So much has happened in the past few weeks.

I’m through the first dose of the Red Devil, and as of Tuesday, am a skinhead. Not quite so much of an ‘impatient’ any more though, now that those two steps are over.

G has shaved his head as a sign of solidarity, and says he’ll keep shaving it till mine grows back. I love that. I attach a pic of the two baldies on G’s patio. I’m not quite brave enough to share a front view yet, but I will soon.

I continue to receive fabulous support and help. Except from my neighbour who rather thoughtlessly invited me to join the National Cleavage Day (wear your Wonderbra) event on Facebook. Go figure.

The first chemo two weeks ago did not knock me in any serious way. I’m a little suspicious about that. I believe, however, that the effects are cumulative. But I’m still holding out hope that it really won’t be so bad after all. Yes, I can do this!

The nurses at the Vincent Palotti chemo section are lovely. Professional and practical, but very kind and caring. The room is set up with three groupings of four la-z-boys (I can’t look at them without remembering my dad), each with its drip stand, a side table and a visitor’s chair. There’s an in-house pharmacist to give you your suitcase of anti-nausea drugs when you leave, a few TVs, and tea and coffee on tap. You’re allowed to move around with your stand, but have to keep the drip arm down and remember to unplug it from its power source first. I kept forgetting that bit and got jerked back to reality a lot. The cell phone reception is poor, which is good. Perhaps it’s a conspiracy.

The actual process took over three hours and involved ten different drips, so a lot of swopping of little bags of stuff. The first drip was an anti-nausea (which definitely worked for me), followed by steroids (those had me bouncing off the walls and eating like a horse for two days – more please) and then three different types of chemo drips including the dreaded Red Devil, the one that makes the hair fall out. After each, they use a saline drip to flush the veins before the next one. Thank heavens for the loo right there.

Soon after I got plugged in, a youngish woman wearing a snazzy leopard-print headscarf and huge hoop earrings sashayed in and did a little tango across the room yelling “Today’s my last one!”. That was so inspiring. I can’t wait to get there. Her mom arrived a bit later bearing chocolate cake for all. Bugger the cake. On my last day I’m taking champagne.

I’m always fascinated by synchronicity, so here’s some that I loved. When I saw my oncologist before the chemo, she told me that the woman outside in the waiting room was my ‘twin’ since it was her first chemo day too. I approached her in the chemo section later. It turns out that her name is H-, which floored me just as a start. It’s not a common name, but I have so many H-‘s in my life, each of whom has played a really special role (including my friend of 38 years and more recently, my oncologist’s lovely nursing sister). She had exactly the same op, done right after me on the same day, by the same surgeons, went to the same wig man, and chose the same wig in the same colour. We spent half an hour going: “Really? Me too!”. Amazing.

G took me straight out to Riebeek afterwards, expecting me to spend the next few days hanging over the loo, too ill and weak to eat. He was delighted that his preparations for chicken soup and smoothies came to nought. My appetite was terrific, I had barely any nausea – and when I did, a tablet dealt with that immediately – and I carried on working. The worst is probably the headaches and a bit of fatigue that hits very suddenly, but that is sorted with a lie-down for an hour or two. All totally do-able.

Then came the hair. My Cancer-Twin H- e-mailed to ask if I wanted to join her for a shavathon on Tuesday the 29th. I said yes, then got very icy feet, feeling I couldn’t do it without knowing I really had no choice. Well, the timing was impeccable. I got up on Tuesday morning, ran my hands through my hair, and great clumps came away from my head. Just like that, with a tiny popping sound. I decided that shedding for days was not something I could deal with so kept the appointment.

My friend H- (she of the 38 years) came with me to do the deed. Walking into [the] home salon was like entering the house of doom. We were a little late and C-Twin was already done and having her wig trimmed. That gave me great courage and it really wasn’t so awful. H- took photos and I heard this plaintive “I think I’m going to cry” from behind the camera. That nearly set me off. Anyhow, I was pleased to find out that my head is not a bad shape at all, and discovered a long-forgotten dead-centre scar. I’ll have to tell people it’s from my frontal lobotomy.

Post-shave, I dropped H- at home and stayed for tea, taking my wig off because it’s very hot and quite itchy. My 16 year-old Godson A arrived home from school, and without blinking an eye gave me a hug and said: “You’ve done something to your hair.” I love you too, A.

I saw my reconstruction surgeon two days later for my last expansion before the end of chemo. As he puts it, just enough so you feel happy to be seen, not enough to make you terribly uncomfortable for too long before final surgery. I was wearing a little soft hat loaned by my friend D, and took it off in his office. He looked at me for a long time and said: “That look really brings out your eyes.” I love you too, Sh-.

It’s a very odd look for me, but I feel quite exotic in a way. G keeps kissing the back of my head and telling me he thinks I look beautiful. Obviously he prefers me with hair, but that validation of me being me with or without means such an enormous amount. I love you too, G. So very much.

I went hat/scarf/beanie shopping with my friend S, and think I scared the wits out of some poor woman looking at scarves by exposing myself to try stuff on in front of the mirror. I’ll try not to do that too often. I’ve now been out in Riebeek since Thursday, having had a house-guest from America (M, an old friend of G’s), and am very proud of the fact that I really don’t mind being seen kaalkop [lit. “naked head”]. It’s far more comfortable when I’m not in public. G’s family arrives today for a bit and I hope they don’t mind that I don’t mind.

I test-drove the wig at a local eatery on Friday night, and the proprietor kissed me on the cheek and asked how I was. Not a mention of my new ‘do’. I guess that means it works for me and is not too drastic a change. I couldn’t wait to take it off though, and stripped down in the car. I think I’ll be doing far more hats and scarves than false hair.

However, this is all so temporary. With any luck the hair will start growing again in about eight weeks during the second round of not-so-vicious chemo.

So, things are good. In fact, far better than expected. I’ll keep you posted.

As always, I remain overwhelmed by the caring, the help, the messages and the thoughts. Thank you all.

Love, C

*******

10 May 2011

Impatient Update #4

Dear All,

Getting down to this episode has taken some time due to my being temporarily down and out. I’m sorry to say that Joan of Arc here dropped her pennant and sat down snivelling at the side of the road for a bit. Since my last mail I’ve had two chemo sessions, the last of which knocked me sideways.

They really should warn you that session 3 is a near-killer. But I’m fast discovering that doctors cover their rears by being very selective with information. If it works out well they can congratulate you and themselves. If it works out badly, they’re not to blame for telling you it wouldn’t. As the pharmacist in Malmesbury put it to G when he embarked on the second mercy mission in two days: “In my experience, the third one is when they bring you as close to death as possible”. I have no idea if that’s true, but I believe it.

The details of that fall down are too gross to go into, but I will say this: Appreciate your immune systems people! Thank them every day for behaving well and nurture those good flora.

Thankfully, session 3 was the last of the brutal stuff so with any luck it’s onwards and upwards. The next round, which starts in just over a week, involves nine weeks of weekly chemo, but sans the nasty Red Devil. Apparently this treatment (called Anzatax) is much less damaging, though the brochure they gave me has a long list of side-effects that pretty much tally with those of the first lot of treatment. I can but hope.

So I’m now half way through the chemo and back to being more of an Impatient than ever. My oncologist says to blame my impatience (and my occasional rattiness) on the steroids they’re giving me. I blame it on having my hormones taken away. The girls will understand.

In general though, I’m doing really well. I function more-or-less normally and am not lying around in my jammies. The fatigue is still a constant companion, my entire drip arm is incredibly painful where the veins have taken a hit, and much of the hair has finally said ‘cheers’. I still have to shave my head frequently as some bits insist on growing while others are totally bald. If I let it get out of hand, it makes for some interesting velcro moments when I put on and take off headgear. Try pulling a beanie onto a bottlebrush.

I’ve worn the wig very seldom, but had some great compliments when I have so I hope it forgives me for speaking ill of it to others. My vet said: “Great new haircut” so I told him it was done in China. I wore it to Woolies recently and was crouching down to rifle through the camembert when a staff member stepped backwards into me. She put her hand on my head and ruffled my ‘hair’ with a “Sorry dear.” Aarggh! Don’t touch me on my wig! It could come off.

But it’s not just the hair on the head. It falls out everywhere … sorry, I’ll give you a moment to cope with that rather bizarre mental picture.

We spend so much of our lives shaving and waxing and plucking and depilating and lasering unwanted hair but we seldom appreciate that some of it still has the practical function that it did in prehistoric times. Nose hairs are an essential filter and not having any makes for a constant and most annoying sniffle. Eyebrows are perspiration barriers so thank heavens I’m not lumbering around the desert because I have barely any of those left either. The lashes are thinning too, which makes putting on mascara a challenge as I sweep around with the brush hoping to hit one every few yards or so. I was totally determined that I wouldn’t lose the lashes and brows, but alas. I guess you can’t fight medical science.

Apparently (I’m getting to loathe that word) if I’m lucky, the hair will start growing back during the next batch of chemo. Whether that means more will fall out before it does begin to sprout, I have no idea. Apparently, everyone’s response is different, so apparently no-one’s saying. Seems to me (as with the reaction to the third chemo) one could do a gallup poll and at least come up with some statistics to guide patients. As in ‘you have a 30% chance of not going totally bald’. But what do I know. I’m not a doctor, just a communicator.

Possibly the worst of the side-effects though is the lack of cognitive functioning. G’s been teasing me about the really stupid things I’ve been doing lately, jokingly calling me ‘chemo-brain’. I mentioned my mental dysfunction to my oncologist and she said: “Yes, it’s called {wait for it …} chemo-brain. Perfectly normal. It comes back … eventually”. So I googled it and there it was. 694 000 matches. It’s real. God help those around me. I hope people still love me after who knows how long of behaving like a vegetable. There is an upside. I’ve noted an excessive use of ‘so’, ‘very’ and a few other words in my updates. I print them out for my mom after sending as she’s not on e-mail and find myself having to edit before I do. It’s not me. It’s my chemo-brain.

On a different topic, I had some very sad news right after my last mail. Dr John Marr, the specialist surgeon who removed my lump in December, had to tell me I had cancer, and did the mastectomy in February, has untreatable pancreatic cancer himself and not much time left. He’s in his mid forties, a gorgeous-looking, tee-totalling fitness junkie, and the most caring healer. He twice called me after nine at night to give me pathology results because he knew I’d want to know as soon as he’d seen them. It was he who first spoke to me about mastectomy and somehow removed the horror of that necessity because of his manner. I recall sitting in his office after my first op, looking at the pics of his wife and children playing on the beach, and wondering what it was like to be so blessed while having to tell patients about their possible termination. There’s no point wondering why, but it puts my very manageable situation into crisp perspective. I feel blessed to have had him as my doctor when I did.

Another thing that makes me grateful every day is watching what my C-Twin H- is having to deal with. She had ongoing infection that required her one expander to be removed until after chemo, delaying the entire reconstruction process for quite a while. On top of that, she also has to cope with five weeks of daily radiation after chemo since her cancer had spread to the lymph nodes. Through all this she remains totally upbeat and incredibly cheerful. Our frequent mails help to keep me going and she’s always chirpy and funny in response to any whines I have.

I am constantly reminded how lucky I am, and how much better off than so many people battling this terrible disease, in small ways and huge ones.

Speaking of lucky, almost every day someone does me some extraordinary kindness, usually unbidden and unsolicited. Far too many to mention here, but there have been some special efforts that I want to acknowledge. So, at the risk of this sounding like an Oscar acceptance speech, I’d like (in no particular order) to thank:

• My mom: For her love, incredible support, and cooking an entire dinner (from snacks to desert) which she delivered to my home (all the way from Somerset West) for my hosting of book club when I was feeling too tired to cook. I love you so much mom.

• Illa, my Sanlam colleague of many years: For loaning me two cute blonde wigs she wore when battling allergy and moving half the contents of her kitchen and bathroom cupboards to her office so she could type up a list of natural, non-carcinogenic products for me.

• Paul and Catrien: For their beautifully-wrapped box of ‘support’ personally delivered to my door. It was full of carefully labelled goodies, from dried fruit (fibre and energy support) to Goji berries (anti-oxidant support),  ginger (support for possible nausea), chocolate (serotonin support), and my personal favourite, an airline-sized bottle of Famous Grouse (relaxation support). Laughter is the best medicine.

• My sister Carol: For plumbing the depths of her and her friends’ knowledge to provide homeopathic and spiritual support.

• Maria: For a special care package, cupcakes, another wig (sassy red bob!) and lots of other stuff.

• Jackie: For scouring London for nice easy-to-wear scarves and then ordering some off a website to bring back when she couldn’t find any.

• Kay, G’s sister M’s mom-in-law: For buying me a ready-tie headscarf (you cannot get them here) and giving it to M who posted it all the way from Australia. I’ve never met Kay. The incredible kindness of almost-strangers.

• Sara: For the amazing massage. So needed, and so appreciated.

• Ingrid: For the incredibly generous spoil-yourself-at-a-spa voucher which I still have to take up. Soon, I promise. And for inspiring me via http://www.alieofthemind.com/ (read it, it’s special) to risk introducing some heartfelt profanity into my updates. Shock warning! I may soon.

• Shirley: For always popping in to see me at chemo and cheering me up enormously.

• Heather and Deb: For more than I can list, but also for sitting with me at chemo 3 and suffering the Royal Wedding on a tiny screen in a room full of patients and drips!

• Aletta: For the boerekos, the caring and a lot to do with work and patience that shall go unspecified.

• Pieter K: For my financial assistance. You’re the menschest mensch I know.

• Minna: For taking, and sharing, that pic of G and I on his patio attached to last mail that so many people loved.

• Anneliese: For the book posted down, the hand-knitted beanie, and the caring.

• Murray: For the book. It’s a bible to me.

• Annie: For the book (a great laugh) and the suitcase of DVDs to see me through down-time.

• Mara: For posting me a very special book from Joburg that meant a lot to her.

• R: For offering a free self-hypnosis session to help me through the chemo, which I’ve never taken up. It’s far from over, and I will.

• C-Twin H-: For going through this with me in the closest way possible and offering to make me some funky head coverings.

• Michelle, Eric and Gary: For shaving their heads in my honour! You all made me weep.

I KNOW I’ve left someone out.  Chemo-brain. Everyone’s been amazing in one way or another. Of course, it almost goes without saying that the person I have to thank the most is G. He’s being beloved, best friend, shopper, cook, bottle-washer, nanny, nurse and rock, all rolled into one. He’s borne the brunt of my neediness since December. I will find a way to give that back, but heaven knows how.

I’ve decided to be very brave and take pics of the baldie from the front. Actually, it’s the bravery of others that motivates me. M- (my surrogate daughter), her brother E, and my bud Ga- all wielded the razor on my behalf.

Love, C

*******

21 June 2011

Impatient Update #5

Dear All,

I’ve been tardy in getting out this update because I felt there wasn’t much to say. With the weekly chemo, life at the moment seems to be just treatment, after blood test, after treatment, after blood test, after treatment …

But now there is. Please excuse me while I break all my netiquette rules by shouting and using excessive punctuation: THE HAIR HAS STARTED GROWING AGAIN!!!

Not much, but enough to show me that I am getting around that final corner of my chemo, albeit on two wheels and listing quite dangerously at times. That slightly out-of-control feeling reminds me of being little, and in a go-kart hurtling down some slope with only the vaguest idea of how to steer. I generally ended up with seriously skinned and bloodied bits, but I’ve obviously learned something in the past 40-something years. I’m leaning into the curve and managing to stay vertical. As of last Friday, only one month left to go. The end is in sight.

That lack of control has a lot to do with the chemo itself, and a little to do with getting to a point in the process where I’m battling to find the reserves for that last push. Despite the fact that it’s eased up the toxic grip on my follicles, this round of treatment is not great. It’s undoubtedly less damaging in general, but with only a week between each of the nine treatments it tends to knock me again when I’ve barely recovered from the previous one. I definitely feel that it’s accumulated in my system over the past three months and is making me feel quite out of my skin and disconnected.

So my tank is rather empty at the moment, despite being indulged by everyone. The upside is being allowed to get away with all sorts of stuff, like scarfing the last piece of chocolate at book club. Thanks Girls!

What also flattened me a bit recently was the death of my surgeon Dr John Marr. I mentioned his sudden and virulent pancreatic cancer in a previous update. He died on the morning of 28 May, just nine weeks after diagnosis. I was kept informed and knew his time was short, but it seemed so appallingly quick. As I said last time, it puts my very do-able situation into such clear perspective.

But back to the hair. My lashes and eyebrows are coming back, and the hair on my head is sprouting. Unfortunately, the head hair is only making its very valiant attempts in patches. I’ve stopped shaving it and will see what happens. What is there is such different lengths that I can see myself having to go to G’s little Muslim barbershop at some point and asking for a Number 2 to even it all out. That will be a first for them, I’m sure. You’ll have to wait to hear about the new colour and texture. So far, quite dark and very fine. The first hairs that appeared were quite pale, which made me think I might end up with a silvery crop. Once I got over the fear of looking gran instead of glam, I quite liked that idea as a temporary experience, but it looks like it’s not to be.

Oddly, I seem to also be growing fine baby down all over. I’m noticing it on my face in particular. The battered follicles overcompensating perhaps? I’m a bigfoot already with my size eights, but maybe I can still become a yeti.

One of the chemo nurses told me not to get too excited since it’s very weak hair that will probably still keep falling out until after treatment. I will get excited though, and I am. She’s the same nurse who asked me how I felt about the hair loss, and I replied that it had been no problem. When I told G that he did his raised-eyebrow thing. He’s right.

I’ve hated losing the hair. It’s made me far less sociable and painfully aware of looking like a cancer victim in public. Those sympathetic smiles from strangers are sometimes harder to bear than the blatant stares. Even worse are the occasional sniggers from (mostly younger) people who obviously think the headgear is an inappropriate attempt at ‘cool’. But as the very German Norbert from my Toastmasters club said in an e-mail: “Rather bald and alive than full of hair and under ground (sic).” So right.

But here’s something interesting that it has done for me. My hair has, for as long as I can remember, been my security blanket. My old varsity friends have never let up over the years on teasing me about the fact that I often missed breakfast or first lectures because I was blow-drying. A bad hair day for me was a literal thing that influenced my mood enormously. Pathetic really. Now, I’ve literally and metaphorically been stripped bare of my protection. For the first time in my life, I’ve grown accustomed to my face, as it is, with no adornment. It’s been a lesson in self-acceptance that nothing else could have triggered, and I’m grateful for that.

Strangely, I remain the only woman at chemo who takes off her covering and sits there, queen of the shiny orb, every week. The others wear wigs and scarves and hats. I can’t quite figure that one out. If you can’t be comfortably bald in that environment, where can you?

Speaking of the chemo room, I’ve made some interesting acquaintances. A senior buyer from Woolies (a hat lady) and a physiotherapist (a wig lady) have become my little coffee-klatsch on Friday mornings. Both have largely stopped working for now, courtesy of company HR policy and PPS cover respectively. Last week’s conversation turned to the benefits of being able to spend more time with their respective husbands and children and because of the circumstances. One actually said: “I’m quite enjoying this,” and the other chimed in with: “Me too”. Jeez. What does that say about the way we devote our too-short lives to work? Makes you think.

Another chemo-buddy (who’s now finished and undergoing radiation) was the recipient of a pair of ‘boobs’ I bought in February, expensive silicone prostheses that I ordered when desperate about my flat chest, forgetting how temporary that was to be. I can be a creature of impulse and instant gratification. I wore them once before my gradual expansions made them turn me into Pamela Andersen. I thought I’d give them to the Breast Clinic at Groote Schuur. Then at chemo I met a woman who said she’d never been offered the possibility of reconstruction, but I got the strong impression that she simply can’t afford it. Medical aid pays very little of the actual cost, as they see reconstruction as ‘cosmetic’. The week after I gave them to her she came into chemo beaming about how much better she now felt about being at work and in public. As thanks, she gave me a massive bottle of perfume. It was nice to be able to do something for someone else.

When this is over, I will be doing something practical for cancer patients. I’m not sure what just yet, but there is a huge need, particularly when it comes to those who don’t have medical aid and the benefit of the best treatment and doctors.

In other news, the chemo-brain persists but work continues. G had to face my ire recently when he commented on my lack of usual creativity (actually it was one of those Girl things that I started: “Does my brain look stupid in this?”) but he remains my staunchest support. I know he’s also battling during this almost-there phase, but we’ll make it.

As always, thank you for the mails, the thoughts, the prayers and the ongoing support. Hopefully, my next update will be to say that chemo is done, after which I can turn some stomachs with a graphic descriptions of my reconstruction surgery and recovery .

I’ll leave you with a bit of appropriate profanity. A T-shit ["F- Cancer!"] will soon be winging its way to me from the US, courtesy of a friend of my C-Twin H-. My mom doubts I’ll wear it. Watch me!

Love, C

*******

5 September 2011

Impatient Update #6

Dear All,

In the more than two months since my last update, a great deal has happened. I finished chemo, got annoyingly ill, grew some hair and managed a short holiday. Oh yes … and G had a heart attack and landed up in ICU.

I know this year has all been about me, me, me, but he really didn’t have to go to such extremes to get a break from his nurse’s uniform. It was horrible to watch him hooked up to drips and machines and feel that terrible fear and anxiety. He’s fine, although has to take it easy, and is enormously lucky, the doctors say. His standard response to concerns afterwards was a Monty Pythonesque: “It was just a flesh wound”. That Scottish forbearance, which is so typical of his character.

He glanced at my first draft of this update and was horrified that I devoted seven paragraphs to his ‘little incident’, but hey, this is my mail G!

By the time they booked him into ICU at Vincent Pallotti, it seems he had already had one heart attack and probably ongoing smaller ones for another day and a half. He was alone in Riebeek when the first one happened in the wee hours, and drove himself to Malmesbury Hospital with terrible chest pains. Once an ECG had identified that he wasn’t dying at that precise moment, he checked himself out, drove back to Riebeek to deal with a new alarm installation later that morning, waited to catch the-cat-that-prefers-the-country, and then drove himself back to Cape Town in the late afternoon.

After another night of awful pains, he finally saw our GP early on the Friday morning, and a blood test confirmed a heart attack. The cardiologist he was sent to told him to get to intensive care post-haste, preferably in an ambulance. Not G. He insisted on coming back to the office to leave our production in good order for me to deal with in his absence. That Scottish thing again.

When we got to the hospital and sought directions to the ICU ward, a delightful male nurse called Craig took us up in the lift and asked who the patient was. When I pointed to G, his eyes nearly popped out of his head. “WHY are you WALKING?”

In my defense, I did offer/nag/plead/try to insist on all kinds of assistance, but he kept saying: “I’m fine, feeling much better.” Lesson learnt. Heaven forbid there would ever be a next time, but I think I would stun him with the frying pan and call 107.

His angiogram showed two obstructed arteries, too small for stents, so they kept him in ICU for the next two days to flush them out with the equivalent of Rattex. The drug apparently gives you a headache the size of Alaska, and he looked and felt terrible. He was home on Sunday, a little frail but decidedly alive. Apparently his heart is in good shape considering, and it could have been so much worse. He now faces daily meds for life. A small price to pay.

His weight, blood pressure and cholesterol are fine, so the big culprit has to be smoking, combined with stress. Let’s not go there. Suffice to say he’s cut down drastically in the fight to give up, and is rolling his own (no chemicals, hard work to make and keep alight) that look suspiciously like spliffs. And yes, he knows. We know. No nagging please. We tried a hypnotherapist who fired us before the second session. I’m not going there either, right now.

What a bloody year. Matching Zimmer frames next?

OK, that’s enough about G, so on to me.

I finished chemo on the 15th of July and I was dismayed to find it was the most depressing anticlimax. I said in an early update that I would be taking champagne, but felt nothing like celebrating. I’m certainly not alone in that. I watched a chemo buddy who finished two weeks ahead of me weeping in her chair on her last day, for no apparent reason. I fully understood when my turn came.

My amateur psychology skills tell me it may have to do with a feeling of helplessness. What follows cancer diagnosis is pure adrenaline for a bit, then coping with treatment. You’re taking action, and your entire being is absorbed in getting through it all. Post-treatment is inaction. It’s: “What now?” There’s nothing more you can really do, apart from trying to live healthily, and praying that you’ve zapped all the bad cells and that it never comes back. It’s a whole new prognosis of now being a ‘survivor’ with all that implies, and it’s pretty daunting.

I did expect some kind of frequent testing in the future, but apparently, in my situation, there’s nothing left to test for. There’s no catch-all test for cancer cells of every type, so I have to see the oncologist every six months and she’ll keep an eye on my general health. We’ll test if something specific sounds a warning.

One of the things that frustrated me most after chemo was very well-meaning people assuming that the last session marked instant wellness. Not so. As C-Twin Heather put it in an e-mail: “Do you find that everybody seems to think – ‘Wow, you are all better now!’? Noooooo … hell no … after 12 sessions of chemo I am depleted!” I got that entirely.

I think that depletion is what resulted in the worst flu I’ve had in a decade flooring me for weeks, right after chemo ended. I started feeling ill before my last session but managed to fend it off since nothing on earth was going to stop me finishing treatment as planned. Maybe the bed time was needed.

Now though, six weeks down the line, I can feel my energy levels rising, but I’m decidedly not back to my old self yet. I am, however, recovering better than others I talk to, most of whom are now dealing with six weeks of radiotherapy as well. I am so grateful I don’t have to go through that.

My next step will be final reconstruction surgery in early October when they take my creaky ‘expanders’ out and give me proper prostheses. I never thought I’d look forward to surgery. Miss Gomma-Gomma can finally, as as G put it, swop her airbags for something better. It’s been a dreadfully uncomfortable past seven months. That said though, I still do not regret my decision to go the whole hog with mastectomy for one second.

I have also just started medication called Tamoxifen, which I am supposed to be on for five years. It strips all the oestrogen out of the system and apparently reduces the possibility of any hormone-receptive cancer coming back quite substantially. I’ve been dreading this since it will essentially fling me into full-blown menopause almost overnight. I have visions of being a snarly fat woman from hell, having hot flashes and wild rages and throwing plates around the kitchen. Like PMT on steroids. Poor G. Hopefully not, but I have to give it a try.

And then there’s the hair, which is growing really well, but is baby soft. G thought that my last update was a bit too hair-focused, but it’s such a huge thing. If Andre Agassi could be so neurotic about being bald that he played Wimbledon in a bushy frosted wig, then my vanity pales by comparison. That’s true by the way – I highly recommend his fascinating (ghost-written) autobiography ‘Open’, even if you’re a tennis ignoramus like me.

My hair has gone from “something out of Blade Runner” (G) to “Très élégant” (my beloved friend Deb) to “Boksburg ‘sidies’” (G again) to “Cheeky” (my friend Shirley). Right now it’s creeping over my ears and curling uncontrollably, which is not a brilliant look. Something like the baby from Hi and Lois, except she’s 1 and I’m 51. I’m torn between neatening it up and leaving it alone so I can get through the inevitable mullet that comes with growing short hair out as soon as possible. I’m totally grey, which I never was before – darker at the back and sides and paler on top. I am now going public bare-headed and I know I scare the Constantia Village shoppers, but I don’t care. It’s such a liberation. The wig is dead, long live the wig!

While the head hair is behaving like a weed, the lashes have been troublesome. Half of them (bizarrely, only the top ones) have fallen out all over again. I googled it and it’s not uncommon. One woman wailed on a message board: “Why can’t it be the hair on my legs?” I’m with her.

G and I managed our first little holiday in over a year a few weeks back. I almost cancelled when he was admitted to hospital, but his doctor said a rest would be a good thing. We spent five days in a gorgeous cottage on a working farm in the Cederberg, and it was sublime, though of course too short. We did very little, venturing out only to trek up the hillside through the blossoming peach orchards (that flattened G a bit) and wallow in the hot springs at Citrusdal. Mostly we read, lounged around like lizards and worked on turning the farm Labrador into a blimp by feeding her all our leftovers. I also made my first ever ciabatta from scratch (it takes two days), and I’m hooked. The lab liked that too. Baking bread is such a satisfying thing to do when you have the time. If you want to know about a fantastic getaway spot close to Cape Town, mail me for details of Pomegranate Cottage.

I’m still astonished that I managed the bread so well because my chemo brain remains firmly attached to me. I found my portable office phone in the car and my toothpaste in my handbag recently. I hope early dementia has not set in.

To end off on a high note (excuse the boast please) on Friday we won the biggie at the annual SA Publication Forum awards for Contact, the staff newspaper we do for the City of Cape Town – Best Corporate Publication of 2011! G flew to Joburg with our client A-, but I was not feeling up to going this year, so I had to bask in long-distance glory. I am, though delighted, rather surprised. We’ve won it twice in the past but I didn’t expect much this year given our annus horribilis. We haven’t been (as my friend and a Contact contributor P so diplomatically put it) exactly firing on all cylinders.

As always, thank you all for the messages, the concern, and the caring. I’ll write again post-surgery.

Love, C

Learn to be able to speak for hours without hosting frogs in the throat or getting physically or vocally tired!- After all, a Wagner opera may go on for over four hours with the soloists belting away for most of it, night after night, without any sign of vocal or physical collapse.Or you can use Plan B:continue speaking with casual disdain for your speaking instrument, and pay an understudy to stand by to deliver your next speech!

Stance [or Seat – for disabled speakers and workshop facilitators!]:

Balance implies equi-librium, or “equal freedom” to move effortlessly and with control in any direction.Always speak and move in balance.

When standing, put one foot slightly ahead of the other at comfortable width –usually at ½ o 2/3 of shoulder width.Balance so that body’s centre of gravity is in the lower torso, equal distant from both feet, i.e. “centre” yourself in the lowest part of belly, groin and buttocks.Lean in onto front leg for connection or emphasis when suitable.

Stand in a “pelvic tilt” position – singing and speech teachers often use the metaphor “push the pelvis up as if you’re on the toilet”.This ensures free breath energy and strong, enduring posture.

When sitting, sit up straight, with both feet on the floor;do not cross your legs.Do not lean back into the seat [If you’ve ever been in a wheelchair you’d know the exquisite surprise of landing on your neck and head if you became too “laid-back”!].If necessary, balance on the front half of the chair to ensure good mobility, sustain energy, and free the lungs for proper breathing.Always use lower back and belly muscles to create a groin centre of gravity and free arms and legs for non-verbal communication.

Posture:

While it is not essential to hold arms up and carry a huge white handkerchief throughout your speech, your posture should be balanced enough so that such an operatic moment – or any other weird and wonderful pose you might wish to strike – is effortlessly achievable.The Recipe:chest out, chin strong, jaw relaxed!, belly and buttocks held in but not too tightly [unless your speech is about the army, or on how to look thinner], head up, eyes wide open and pupils moving with energy, shoulders comfortably back, and hands relaxed at sides when not intentionally conveying meaning.

Breathing:

Lungs are pear-shaped, and proper and healthy breathing, for speech and health, is to draw air into to bottom half of the lungs, so that the lower belly and back can fill out like an inflatable tube, allowing you to speak from the abdomen, rather than the danger zones of chest [good for night club crooners and drunken rock stars only] or throat [only good for when you catch your spouse in bed with a lover].

Speak on the breath:use all the air from the lungs in a controlled way, without letting air escape from nose or sides of mouth, which may sound breathy or soft or lacking in confidence.Make sure you save enough breath – or breathe again – for endings of phrases…If using Power Point, tele-prompters or notes, don’t look down at end of phrases!Look at your crib aid in the course of the phrase, or during a meaningful pause after its completion, to avoid losing vocal control and audience contact.

In the Mask:

Voice should resonate in sinuses and other spaces in head in order to be audible, full-bodied and clear.If you focus your voice in the “mask” [front of face], you will get a resonant sound that can be heard far and clearly even when speaking softly.A good way to practise this is by doing vocal exercises using nasal sounds or “ree” combinations:
- ng… nnn…mmm… ngah… ngoo…ngay… mmmmmee… [etc]
- bring me spring ringing in freely…. [make all the “i’s”a long “ee” sound and tie the together:“breengmeespreeng-reengeengeenfreelee”]

Paint the Walls…:

When speaking softly, you must still be heard clearly and effortlessly by everyone in the audience.A great technique is to imagine you are painting the back wall of the venue with your voice.[This is how opera singers can be heard above an 80 piece orchestra even when they whisper an evil plot, loving words, a prayer, or a 50 minute death scene!]

Respect:Prepare Well!

If opera singers can learn many hours of singing off by heart in many foreign languages, in addition to their own music lines, movements, responses, orchestra cues, and other singers’ entrances, there is simply no excuse for speakers to be PPt or note bound, to have meaningless gestures or comfort-movements, or to speak in boring or irritating voices.Avoid mannerisms like repeating phrases or stock words [“obviously”, “naturally”, ”of course”, etc] or crutch gestures [like smacking lips, flapping hands like dying fish, etc].Always bring the finished product, the complete opera [which means “work”] to your audience, who pay you, whether with money or their time and attention.There is no such thing as an unworthy audience – only an unworthy speaker.

Final words:Remember “You are just as good as your last performance.”If you can’t bring performance-level preparation, enthusiasm and passion even to a small audience or your colleagues or mentees, rather insult them unashamedly on a social media site than to waste their time with a show that doesn’t live up to your or the speaking community’s reputations!

“Break a leg!”

Regards, Reinette

savannahs-story-prog-and-his-beauty

A phobia is the sensation of extreme fear which is greater than fear which would be reasonable in a particular situation, or which is completely unrelated to any real threat. The phobic person, when confronted with even the idea of whatever s/he fears, feels extreme anxiety which is emotionally manifested as extreme terror and physically manifested in symptoms typical of anxiety or panic attacks. [See “Panic Attacks” article at www.selfgrow.co.za.]

Phobic people will go to extreme lengths to avoid the phobic object/event/experience, often endangering their own well-being, or impairing their happiness and success in life: People have, for instance, jumped out of moving vehicles or from high buildings to avoid such things as cockroaches or grasshoppers. Many people turn down promotions at work because they are afraid of flying or using a lift [elevator]; others live a life of seclusion because they are afraid of leaving their homes; some walk long distances to avoid passing near a home with barking dogs or a black door. Even commercially phobias are catered for, in that, for instance, buildings are numbered without a 13^th floor, or offices and hotels without a room #13, or airplanes without seat #13: money was being lost because so many people fear the number thirteen.

Some phobias lead to Obsessive-Compulsive behaviours. In order to “neutralise” the felt threat which they obsess or think constantly about, sufferers will engage in an action, such as washing hands, or counting, or touching something a set number of times compulsively, until such actions take over their lives and significantly impair their ability to live, work or socialise.

The main difference between a Phobia and a Fear is that a phobia is deemed irrational, often even by the person who is phobic: “I know a cockroach can’t hurt me but I just panic when I see even just a picture of one” is a typical comment. Phobic people often become immobilised and panicky in the face of the threat and will go to great lengths to avoid it, whereas people who have a rational fear of a threat will often face their fears in order to be safe or successful or happy. People will often overcome real terror of something they have true cause to fear, in order to save themselves or others from further negative consequences: A mother may rush into a burning home to try to save her children; people in the armed forces or rescue units [like fire fighters] regularly overcome their rational fears of a situation for the sake of others’ safety. People can use reason to overcome their rational fears, but by its very definition, the irrational fear in a phobia can usually not be addressed by reason. Some phobic people overcome their avoidance, for instance of flying or snakes, but will still experience the bodily arousal [panic state], racing thoughts, helplessness, powerlessness and terrible foreboding that the experience arouses, often needing medication to get through the phobic experience.

Unlike fears of actual danger, phobias are irrational and result in panic symptoms and extreme avoidance. If you live in a rural area and are scared of snakes and very vigilant when you walk in scrub areas, this would be a rational fear. If you live in a city and are so afraid of snakes that you can’t look at a toy snake in a shop window without feeling faint, you probably have a phobia.

Some people have a specific phobia, such as a fear of feathers, whereas other have combinations of many phobias, such as fear of confined spaces, and thus also of lifts and of flying. Sometimes people also have more than one mental disorder in addition to phobias, such as Obsessive-Compulsive Disorder and some form of Personality Disorder, as is seen in the movie As good as it gets.

The most common phobias are the fear of having to speak in public, which is often related to performance anxiety, and social phobia [or social anxiety].

Phobias vary from the rare [such as the fear of peanut butter sticking to the roof of your mouth] to the very common, such as the fear of public speaking, meeting strangers or being in social situations, dogs, small spaces, lifts, flying, spiders, snakes, heights, failure, driving, water [to swim in], the number 13, or open spaces.

Here are names given to some common phobias: #13 = trikadekaphobia; animals = zoophobia; clowns = coulrophobia; confined spaces = claustrophobia; open or crowded spaces = agoraphobia [common with Panic Disorder]; crawling insects & snakes = herpetophobia; doctors/medical treatment = iatrophobia; foreigners – xenophobia; loud noises = ligvrophobia; needles = aichmophobia; night/dark = nyctopohobia; marriage = gamophobia; speaking/public speaking = glossophobia; spiders = arachnophobia; stage fright = topophobia. For a very long list of many different kinds of phobias, see http://phobialist.com .

Phobias are categorised as Anxiety Disorders. They affect more than ten million adults in North America alone, and are twice as common in women as in men. Some phobias are related to specific cultures or religions, some are common to families or small communities, others to events or eras, whereas many are specific to an individual. Examples of group phobias are the fear of witches or witchcraft at various times in various countries, the Tokoloshe in some South African cultures [a small man who will steal children or eat your feet or rape women, etc, if you do not put your bedposts on piles of bricks so that he can’t reach you], demons, black or the dark, water, the numbers thirteen or four or “666”, and now also “9/11”, solar or lunar eclipses, owls/crows, etc.

Causes of Phobias

Have you ever experienced that terrible feeling when you are so afraid of something that is not dangerous enough to warrant extreme panic, that you’ll do anything to avoid it? Afraid you would faint if someone just mentioned or showed you a picture of that feared object or event? So scared you would grab hold of a stranger, or lose bladder control, or vomit if you encountered it, that you start staying away from any place or situation you may think of it, to your own detriment? So embarrassed at what you knew was an irrational fear but beyond your control, that you withdraw from social situations and even from close friends?

Phobias can start at any time in someone’s life, and also occur in group settings. Sometimes the phobia is caused by a scary experience, such as being bitten by a dog, but often the phobia occurs because of indirect influences: A child may learn phobic behaviours or beliefs from adults or older children. Adults may similarly learn phobic responses from others. Phobias may be due to associated learning, such as hearing a scary or loud noise while encountering, for instance, an insect, or being on a high place. Sometimes it’s symbolic. Sometimes it’s the result of unpleasant emotions aroused by a story in a book, or told by someone else, or a movie, or actual historical events.

Most phobias are thus related to actual or imagined traumatic events, which is why De-briefing [or Desensitization] is an essential element in effective modern treatment protocols. As in PTSD [Posttraumatic Stress Disorder] or Acute Stress Disorder, symptoms include avoidance, sensory flashbacks, hyperreactivity [i.e. the reaction is extreme for a relatively non-dangerous trigger], hypersensitivity [jumping and screaming when a leaf falls on you under a tree because you fear it’s a snake, etc], hypervigilance [constantly being on the look-out for the possible stimulus object or event], anticipatory anxiety [of encountering the stimulus], and severe, undue emotional distress.

Phobias and the Brain

As indicated before, phobias constitute an irrational and strong fear/terror response to a relatively safe trigger. It is considered rational to be afraid when encountering a dangerous snake in the wild, but not to faint or panic when you see a plastic one in a shop, a picture of a snake, or a real snake in a sealed container.

Our four basic emotions [from which other emotions are derived] are formed in a primitive part of the brain, common to reptiles and even lower forms of life on the evolutionary development scale, like molluscs. These emotions help to keep us safe, through flight, fight or freeze responses, from real physical threat, to find food in order to live, and to procreate in order for the species to survive. 50% of these basic emotions create fear-based responses: the Panic system and the Fear system. [The other two are the Aggression-Rage and Seeking-Lust systems.]

Panic and phobic reactions are caused by responses from the Reptilian Brain just above the brain stem [involved in survival reflexes]. The Reptilian Brain is in charge of our physical survival and thus dominates any responses or response patterns required for what it perceives to be a dangerous threat. Just like it’s useless to try to reason with a crocodile that’s got hold of your foot, the Reptilian Brain does not respond to reason/rational thinking or speech. So it does not help to tell ourselves we should not be afraid of e.g. a lift [elevator] or cockroach or flying: the Reptilian Brain does not compute this.

The word “perceives” in the above paragraph is important. Reptiles react to the belief that they are in danger when they try to destroy, for instance, a person who is trying to rescue them from a danger like flood, fire or injury. When we see a scary movie or hear bad news about a scary event in another country, our brain causes our body chemicals to create a state of physical arousal of anxiety, fear, terror or panic – which is why many people cover their eyes during a scary part of a movie, or some dogs panic during thunder storms or even when they smell a benign smoke like from a barbecue fire: the primitive brain responds to the images of doom created by sensory or imagined or remembered stimuli, and creates a flight/fight physiological response. [Some people have spontaneously overcome this by Flooding or other techniques, for instance by watching numerous horror movies, and thus no longer interpret the stimuli as dangerous – see Treatment below.]

So when we see a plastic pink-spotted toy snake, our brain may create an image of how it becomes a real snake, sinks its now enormous fangs into our flesh and kills us in some agonising manner. [People who suffer from a phobia off snakes would probably have had a severe physiological fear reaction just reading that sentence!]

Deep within the Reptilian Brain is a tiny almond-shaped brain structure called the Amygdala [Greek word for almond]. The amygdala remembers actual or imagined experiences that trigger a strong emotional response like fear. This is important for survival for actual danger experiences like falling off a cliff or eating poisonous berries. The amygdala’s function is to prevent us having a repetition of such a dangerous and potentially fatal event at any cost, and thus creates a preventative or preparatory flight/fight/freeze response every time we encounter the potential or actual event, or even imagine it. That is why it is necessary to treat phobias through a combination of desensitization/debriefing, exposure [actual or imagined] and relaxation/self-soothing techniques.

Treatment

Many people handle phobias by simply avoiding the stimulus object or event altogether but for some people the phobia/s begin to control their lives and significantly impair their personal, work and social life – as seen in the examples above. This is so sad when most phobias can be cured relatively easily.

A further problem – as with any behavioural habit – is that the longer we reinforce a brain or neuronal pathway, the more fixed it becomes. Such pathways can allow the easy development of more and more phobias or other anxiety disorders.

I urge you to seek effective professional help as soon as possible if you suffer from any phobia.

Effective [modern] treatments for phobias usually include an examination of the stimulus characteristics, its possible origins in traumatic experiences or imaginings, various levels of symptoms, a change in ways of thinking and behaviour around the idea of the stimulus [CBT, or Cognitive-Behavioral Therapy], some form of de-briefing and/or de-sensitization with Exposure to the stimulus, relaxation responses, ego-strengthening hypnosis, and the practice of alternative [healthy] response patterns. Some people also use prescription anxiolytic [calming] medication or beta-blockers in order to begin the process.

The oldest form of exposure treatment was called Flooding: The phobic person had to be very brave and agree to be exposed to the stimulus in large quantities or over a long period of time, “flooding” the brain with distressing chemicals over time, while the expected disaster did not happen so that the amygdale “cancelled” its survival response programming. You can imagine one has to be very motivated and brave for this sort of treatment. Imagine sitting in a room full of creepy-crawlies until you’re no longer afraid of them! Flooding was later paired with Modeling, where the patient watches another non-phobic person encounter the stimulus in a calm manner.

A South African, Wolpe, devised a protocol of Systematic Desensitization which was more gradual and thus could be used by anyone, although it could take a long time, especially when multiple phobias had to be treated consequentially. It is still a common treatment for phobias today. First a list would be drawn up representing on a scale [e.g. of 0 to 100] the strength of the fear elicited by the phobia in various guises, for instance from encountering a venomous, hissing snake up close while alone [at 100 Units of Distress] to perhaps flowers arranged in a snake shape [at 10 or 5]. The patient would then be taught relaxation techniques [e.g. self-hypnosis]. The lowest level distress stimulus would be presented and the patient would be helped to relax until there was little or no distress. Then the next level would be presented, with relaxation, continuing until the patient could experience or imagine the highest level of fear stimulus with tolerable or no distress. The final step for most phobias would usually be in vivo desensitization: The therapist may, for instance, repeatedly go up and down in a lift with the client until the distress was manageable, and then let the client ride alone until s/he was confident of being able to manage in future. Sometimes a single level of desensitization took one or many weeks, so the treatment could take long and be expensive, especially if in vivo treatment required travel time for the therapist or renting a plane, a snake handler, or scuba equipment, etc. was required.

These days we can use computer technology to create Simulated Phobic Stimuli [similar to those used in, or instance flight simulator games] in place of real life [in vivo] situations, which makes the process more cost effective. We can also use calming computer imagery, with music or brainwave altering sounds to help patients relax effectively and quickly. Even so, the use of rhythmical and deep breathing techniques is still one of the most useful adjuncts to any protocol, as this form of breathing can stop even severe panic symptoms in a few minutes. [See the article on “Panic Attacks” on this web site.]

I find that a protocol consisting of panic or anxiety management [through information about the brain and its responses, plus calming breathing techniques], plus EMDR [Eye Movement Desensitization & Reprocessing – see the article on this web site] with relaxation/hypnosis, CBT [Cognitive-Behavioral Therapy] and Systematic plus in vivo or simulation desensitization, is the most effective and most cost-effective for treatment of any form of anxiety, and especially for phobias.

Some specific common phobias:

These were issues raised at a South African television show “Keeping it Real” on SABC 2, broadcast on 4 January 2011 [on which I acted as consultant]:

One of the most common phobias is that of speaking/presenting in public. Laura has suffered badly from this fear all her life, but was able to give an excellent account of her journey overcoming her fear, with the help of a Toastmasters Club. Although she showed us how her hands were shaking, there were no other noticeable signs of nervousness or anxiety and she spoke excellently, appearing very confident. It is interesting that the Toastmasters program incorporates support, modelling, gradual exposure, systematic desensitization of a kind, and plenty of practical information to help create competency feelings.

Another common phobia is social phobia, on a continuum with social anxiety. Tygerberg Hospital in Cape Town is conducting a research program in this disorder in 2011. People who believe they suffer from this disorder can apply to them to be part of the treatment program.

I have had cooperation from private individuals who are prepared to work in alliance with the therapeutic process for various phobias, for instance [in Cape Town] a driving instructor called Elda has helped some of my patients who were terrified of driving, to get their licences or regain confidence after accidents, for the in vivo part of the treatment [feel free to contact me for her details]. Places like the Sports Science Institute can help with in vivo part of treatment for fear of water. Some dentists have allowed me go with phobic clients so that I could induce a relaxed state through hypnosis anchors, allowing the patients to begin repair to badly damaged teeth and gums after several decades of avoidance due to severe phobias of dentists or of needles.

People in South Africa can contact the Depression and Anxiety Support Group for information, support and therapists, or find a suitably qualified therapist on the Psychology Society web site www.psyssa.com.

The following very useful and informative article is published by kind permission of the author, Gerrie Dresser – Enjoy!

NEW PARADIGMS IN LEADERSHIP

“What’s the Link between Walt Disney
and Transcendent Leadership?”

Article by Gerrie Dresser of Success Associates

When I first heard the term, ‘transcendent leadership’, it piqued my curiosity. I’ve heard about transformational leadership, and wondered how it differed from transcendent leadership.

According to one expert, transcendent leaders connect today with tomorrow. They set a vision and focus on how an organization can move beyond ‘just meeting its goals’. Just as Caroline described about the value of visioning, to ‘transcend’ your goals, you need to connect with a bigger vision. It’s actually your mindset and aligns with Andrea’s explanation about how to retrain your ‘executive’ brain for peak performance.

Transcendent leadership is emerging as a new framework for leadership in our global economy with communication happening at lightening speed. When asked to identify a transcendent leader, one who I highly respected, someone who was well regarded and trusted by others at all levels, and had many ‘fans’, one immediately came to mind. Let’s call him John.

John was known for his bold vision, collaborative style, authenticity, strong and active network that reached through all levels in the organization. His ideas were always about how to improve the organization, create more challenging opportunities, and advance changes that would benefit others.

Since people had an emotional connection with him, they were compelled to go the extra mile, consistently, and delivered on his vision.

According to Lee Meadows, Ph.D, Management Professor and Consultant, Walt Disney was a transcendent leader who was ahead of his time!

His vision of the Magic Kingdom reflected the mindset of a transcendent leader. He was able to formulate a vision that clearly aligned with his mission, “to make people happy”, and think way beyond the bottom line.

He had competing factors in advancing his vision of the company because many people thought he was foolish and ‘unrealistic’. However, he had a circle of trusted advisors and advocates that believed in his vision.

Again, he had a “passion around a vision that created a compelling reason to follow.” (Pam Boney, founder of Tilt360, a parallel solution model based on transcendent leadership.)

Before I began my research about transcendent leadership, I played with the question about character traits and behaviors that I attributed to people who stood out IN a crowd with an authentic brand … people who lived their Unique Genius.

Just for fun, I decided to capture my brainstorming exercise on a chart and recently compared these results with my research about the character traits and behaviors of transcendent leaders. The similarities are amazing!

A few of the personal attributes and character traits that the two have in common include:

• Uses intelligence for the better good.
• Is well respected and liked.
• Extends self to a widely diverse group.
• Generous in sharing wisdom.

Let’s take a look at your leadership style …

Your Coaching Challenge this month . . . How does your style align with transcendent leadership?

How would you rate yourself on the characteristics below?
1 = Rarely            2 = Sometimes            3 = Frequently

1. If there is a change in my company / organization, I am prepared for the impacts and am well connected both internally and externally.  Opportunities typically find me.

Your Personal Rating:

2. I mapped out a professional development plan that plays to my strengths and provides some ‘stretch’ so that I am continually becoming more ‘expert’ in my chosen career path.

Your Personal Rating:

3. I’ve identified what’s most important to me, and am already noticing internal shifts that need to occur to continually align my career with what’s most important to me.

Your Personal Rating:

Tune into future editions ofSuccess Matters and identify what you can do to discover more secrets to sustainable success!

copyright 2005 – 2010. All Rights Reserved.
Unique Genius, a division of Success Associates

INSOMNIA comes in many forms and has many causes – from side effects of prescription medication, alcohol, coffee, vanilla [yes, it’s a stimulant], physical illness, depression or anxiety, negative emotions like guilt or anger, to excitement, diet, disturbance of usual sleep patterns, physical discomfort, allergies [e.g. to invisible pollens], or concrete disturbances like noise.  Add a long et cetera to the list!

Forms of Insomnia:  Difficulty falling asleep, Disturbed sleep, Nightmares or night terrors, Inability to access Deep Sleep, Too deep and too long sleep periods, Interruption of [+- 90 minutes] sleep cycles, Medical problems like Sleep Apnea;  Early Waking.

The pattern of someone’s particular sleep disturbance can often suggest the cause/s and thus the best solutions.  Unfortunately too many people become dependant on drugs [prescription, alcohol, other drugs or even starchy foods] in order to get enough rest while sleeping.  Except during times of trauma [physical, emotional, societal] it should not be necessary to use chemicals in order to get a great night’s sleep. 

Ironically, the same “rules” for having good sleep experiences generally have applied over many centuries and in different cultures, despite great changes in environmental or social circumstances or demands.  For instance, if you wouldn’t have felt restful if a troupe of actors came to perform Macbeth in your bedroom in 1620, you also will be unlikely to sleep well if you watch television in the bedroom in the 21^st century! 

Most cases of insomnia can be easily cured by simple changes in our lifestyle or thinking habits!

That would of course imply that we have to give up the immediate gratification type of comfort or stimulation for the longer-term benefits of great sleep.

If you believe you have sleeping problems or a sleeping disorder, it is a useful first step to note patterns of disturbance and possible correlation to patterns of behaviour or state of mental or physical well-being or discomfort.  Many times you will then be able to correct the problem appropriately [and without drugs!] but sometimes it may be necessary to consult a health professional like a Clinical Psychologist or a Doctor, or even to be assessed at a Sleep Laboratory, to find the best solution for the problem. 

Specialised techniques like Hypnosis or relaxation exercises are very useful adjuncts to any other methods to alleviate or manage sleep disturbance. 

More about types/forms of sleep disturbance and their causes:

First, unless you are quite sure that the cause is purely psychological or in your life style, it is always wise to rule out possible medical causes, then rule out possible substance causes [including prescribed medication], as sleep disturbances could be an early warning system that there is a physical problem that needs attention.

We can test for lifestyle causes by changing the things we are doing according to the list later in this article for at least 10 days, consistently:  If our sleep improves significantly, then we no longer have a problem!  If not, consult a physician who may also require some blood tests, if medical conditions [like thyroid malfunction or hormonal problems] are suspected.  Please note that while conditions like Sleep Apnea may have lifestyle causes [like being overweight and/or using too much alcohol] they can be life threatening conditions that need medical intervention until the lifestyle changes have positive results over time;  some conditions require medical management for life.

Medical conditions that may be misdiagnosed on initial inspection as Psychological, include Thyroid malfunction, Hormonal imbalance [in men also, not just the stereotyped women’s states of PMS, pregnancy or menopause! – for instance, low testosterone could contribute to high anxiety and sleeplessness in men].  It is important to treat the medical condition rather than its “psychological” symptoms only.

Conditions like diabetes, high or low blood pressure, kidney malfunction, sinusitis, digestive system problems, etc, etc, may also cause or contribute significantly to sleep disturbances.  The medication used to treat these and other disorders [like cancer, or allergies] can frequently be a cause of sleep disturbance, for instance, many medications used for high blood pressure can cause “restless legs” [also found in diabetes] that interferes with sleep.  Spinal injuries, especially if high in the spine, can cause interference with sleep due to conditions like spasticity of the limbs or “high tonus” [tension state] of skeletal muscles generally.  Acute and chronic pain can interfere with sleep.

Patterns of Sleep Disturbance and emotional arousal:  Generally difficulty falling asleep, or frequent waking [once medical causes are ruled out] appear to be related to stimulant/excitement chemical states of the brain [like anxiety or excitement], and early waking with inability to resume sleep appears to be associated with depressed chemical states of the brain [like depression or grief].

Lifestyle causes of sleep disturbances:

Diet:  Eating a heavy meal  or meat late at night;  eating too much meat at supper, eating dairy products at/after supper if you are sensitive to them;  garlic, onions, vanilla, alcohol, caffeine [including in chocolate, tea, soft drinks, some food energy supplements], acidic fruits, MSGs [Monosodium Glutamate found as taste enhancer in many “fast” foods like potato crisps, pizza, sauces, Chinese food and most soya sauces, fish or chicken batter at fast food vendors, gravy or basting at many steak houses, some commercial salad dressings];  too low or too high blood sugar, etc.

Distraction/Stimulation: 
1] Every authority on sleep disturbances states that “The bedroom should be used for sleep, rest and sex only”.  Add to that meditative exercises or spiritual rituals like praying.
2] Do not read in bed.  Read on a chair, seated [not slumped/lying down], under good light somewhere else in or out of the bedroom.
3] Except if you are bed-ridden no one should have a TV or PC in the bedroom;  if you are renting a single room, then do not watch or work from your bed.  Lying down should be associated with rest, sleep, and sex/comfortable togetherness only.  We form “habit” brain pathways with repeated action and the brain gets confused when it has opposing pathways associated with the same situation [e.g. being in bed] – it does not know whether to sleep or not, which leads to sleep disturbance.
4] Some forms of meditation can actually stimulate the brain:  we need alpha states to rest:  do not play eg Beta state generator CDs/MP3s etc late at night.  Do not play arousing music or engage in arousing reading/Tv etc [eg thrillers] before going to bed/sleep.
5] As far as possible, keep regular times to fall asleep or wake up.  The Reptilian centre of our brain becomes anxious when patterns are interrupted frequently, and will assume a watchful-wakeful state.
6] Do not over-sleep or sleep late to “make up” for sleep lost through late night activities.  This affects your sleep-waking cycle.  Rather “catch up” with shorter rest or sleep sessions [“siesta” or “forty winks” are sufficient to replenish energy till the next “normal” sleep time.]
6] Do not exercise vigorously within 2-3 hours before bed time [certain yoga or gentle stretching exercises may be acceptable – always test to see if it makes a difference].
7] Create a “settling down” period of at least 30 minutes before attempting sleep.  This can include calm music, rubbing on body lotion, prayer/visualisation, affirmations of peaceful, positive thoughts, etc.
8] Use self-hypnosis/relaxation/autogenic training exercises if you feel alert/ anxious/ depressed/ irritable/ aroused at bed time, or if you are in physical discomfort like pain.

Hypnosis recordings can be extremely helpful in combating both sleep disorders and their causes, whether physical like pain or illness, or psychological like anxiety or depression.  A properly qualified Clinical Hypnotherapist [i.e. someone like a psychologist/psychiatrist who is qualified not only in hypnosis but also in the neurology and physiology affecting sleep] is recommended although there are also very good commercial sleep-hypnosis products available on the internet. PLEASE READ THE ARTICLES ON HYPNOSIS ON THIS SITE before you buy a product or see a hypnotist as here could be dangers if the hypnotist is not adequately trained or experienced.  Always ask for credentials before submitting to any form of treatment!

Disruptive Emotions or Thinking:

There is by now overwhelming evidence, especially since research by Cogitive-Behavioral and Brain scientists in the last half of the 20^th century and later, that any form of mental or physical distress can be exacerbated and often even caused by incorrect/dysfunctional habits of thinking or behaving.

Many people frequently sleep very little when they’re involved with something fun or stimulating, and feel fine [though I would recommend that this practice is limited to “occasional” sleep deprivation!].  Suddenly if we can’t sleep due to physical or mental discomfort, we tend to “catastrophise” [i.e. give it more power to disrupt us than necessary or real]…  People say “I had ONLY 5 hours’ sleep last night;  I MUST be tired and today therefore WILL be terrible!”  [So many thinking errors in one statement!] Rather say “I’m so happy and excited that I had a FULL five hours’ sleep and am looking forward to a wonderful day, full of positive energy, and a great night’s sleep thereafter!”

Use phrases like “I’m looking forward to a wonderful night’s rest, and a positive, glorious day tomorrow!” or “I’m welcoming this being awake and am grateful for the wonderful, restorative sleep I will soon enter…” etc, to plant seeds for good outcome in your mind.

Dr Wayne Dyer recommends that we use two verbal techniques to help us be at peace:
- Repeat words like Serenity, Calm, Peace, Joy, Tranquillity, Abundance [etc] until you feel good
- Say “I want to feel good!”, followed by “I intend to feel good!”

Remember, your words [and thoughts] create your reality!

To learn more about this, read books on positive thinking, or watch the commercially available DVD of The Secret.

There are also many “releasing” techniques:  Find a therapist or life coach who is trained and experienced to help you to release whatever habits or experiences are interfering with good sleep.  Most of us really do not need medication in order to have fantastic sleep!  If insomnia is interfering with your ability to be happy and successful, it’s certainly worth the investment to see someone competent who can help you professionally.  When people prioritise health, all other aspects of their lives tend to improve dramatically also, at little or no further cost.

Please read the article “Difficult People” on the web site first!  It is important to understand that we all have functional and even dysfunctional personality traits, and at various levels of toxicity:  You cannot diagnose yourself or someone else as having a Personality Disorder unless you are a properly trained, licensed and experienced clinician [like a psychiatrist or clinical psychologist].

In Part I we looked at Antisocial and Narcissistic Personalities:  the causes of their defense mechanisms, the nature of the defenses and the effects on other people.  In Part II we will briefly highlight Borderline and Histrionic Personality Disorders.

Borderline Personality Disorder [BPD]

One of the best books about BPD that I’ve come across is titled Stop Walking ON Eggshells!  This really encapsulates the effects of the Borderline personality on others – in that you have to be extremely careful as anything you say or do may be construed as a rejection of them or an attack on them.  By the way, I recommend this book to people who suffer from borderline Traits, and to their partners.  It’s written in comfortable lay language and incorporates also such useful insights as revealed by transcripts of internet information groups’ communications, in which Borderline personalities and their partners freely participate.

An insightful description of the Borderline state [by one of my lecturers long ago] is that the person takes in the Good, but then feels that it has become Poisonous, and has to Get Rid of it.  [And there is a degree of correlation between Borderline functioning and Bulimic functioning.]  BP’s are thus in constant need for reassurance that the relationship or situation is still Good, that they are not being rejected or attacked or betrayed or lied to, or about to be rejected, etc etc…

They also watch critically or any signs of such rejection or abandonment and tend to project the fears of what may happen as actual occurrences, on significant others.  If I dream my friend has gossiped about me, I may investigate the possibility, or wonder what in me made me dream such content, but the BP tends to immediately act out on the dream as if it’s reality, and will, or instance, strangle the partner while s/he is still asleep, for “having done” the betrayal. 

For the BP there are no grey areas:  you are either completely For them or you have Betrayed them and are an Enemy.  You cannot risk having a different point of view about anything, admiring any one else even briefly [e.g. saying you like a recording by a singer – any singer of the same gender, or any singer at all, if the BP either sings or wishes s/he could], suggest that someone else’s actions may not be as evilly motivated as the BP has stated they were…   They split the world into two groups: Those who are Against Me, and those who – at the moment – are On My Side and who have to keep proving it every second, but especially during one of my frequent Tests of their Unconditional Loyalty.  And the BP can be so charming, loving and engaging while desperately trying to create and maintain the Those On My Side group that just about any kind of person can become ensnarled in the Borderline net.

Hence the “Walking on Eggshells” analogy:  this fascinating and engaging person chooses to be with me and to be protected by me, and since s/he trusts so few, it means I’m special, so now I become extraordinarily careful not to lose him/her or cause the inevitable rejection/s [the forgive and reject cycle can repeat endlessly].

BPs tend to quickly put people who have attractive and desirable qualities [in their eyes or according to their needs] on a pedestal – which is part of their attractiveness, because the recipient of their favour is treated with adoration and attention, and we all respond favourably to that.  But when s/he inevitably fails at some stage to meet increasingly higher demands for devotion and for tolerance of invasive and disruptive Borderline traits, not only is s/he cast off the pedestal but also re-defined of being cruel, selfish, nasty, untruthful, not committed enough, etc.

Typical of Borderline traits are:

-          Continual instability of emotions [frequent and unpredictable mood swings];

-          Continual instability of relationships, with extreme idealization and then devaluation of the same person;

-          Continual instability of self-image; lack or repeated loss of sense of self;

-          Continual impulsivity – generally, or associated with acts that actually or potentially harm the self, such as spending, sec, driving recklessly, using banned substances or drinking too much, binge eating;

-          Self-mutilating [e.g. cutting self on thighs or arms, etc] and frequent suicidal behaviours, attempts, threats or gestures;

-          Frantic attempts to prevent abandonment and rejection [real or imagined];

-          Chronic feelings of emptiness;

-          Irritability and constant or frequent displays of rage;

-          “Micro-psychotic Episodes” like sudden and brief periods or paranoid thinking;

-          Dissociative episodes [feeling uninvolved or that ”This is not really happening”], especially with heightened stress;

-          Projecting previous traumatic intention and behaviours of people in previous relationships onto the present one/s.

Remember that anyone can have some of these traits in mild, moderate or severe concentration, without being fully Borderline Personality Disorder, and that the Disorder cannot be diagnosed before early adulthood.  Specifically keep in mind that many of the traits also occur as a cluster in, for instance, Posttraumatic or Acute Traumatic Stress Disorder, without the person having the spectrum of Borderline traits.  Also not that – as with Antisocial and Narcissistic Personality Disorder formation, the likelihood of underlying trauma in the form of physical, emotional or [frequent in BPD] sexual abuse is high.

I do not have enough years to describe the effect of these traits, especially when frequent and florid, on close relationships – with colleagues, friends or romantic partners.  The terror of abandonment by anyone but especially by people who are special enough to be selected as “close” is experienced as suggestive that the BP is “bad”, and that can’t be tolerated:  For the infant abandonment means death, so BPs may try to restore previously discontinued relationships for even many decades after the “loss”, while re-playing the script that makes it possible to blame the one who “left” them for the problems, never the self.  What starts as surprise or confusion for the partner or friend, ends in torture of recriminations and approach-reproach cycles that can repeat endlessly even when there are new objects of affection available.

Relationally [and therapeutically] what is necessary for the BP to begin to heal is consistency, very strong boundaries, and repeated proof that the partner cannot be destroyed by the “poison inside” of the “bad” BP.  And probably the resilience and skin of a rhino – for the attacks are chronic, unpredictable, irrational, and the demands for rescue are heart-rending.

While therapists have immense empathy for people with such strong and disruptive defensive structures as they understand the massive injuries to the early formation of he Self that cause them, and can set boundaries and stay consistent, therapists do not have to live 24-7 with the symptoms.  People who do, are almost always overwhelmed by the exhausting and disrupting nature of the interactions over time.  People with strong Borderline traits or BPD should be helped to engage in appropriate therapy so that they can be free, over time, from the hurts and the damaging defenses against the pain.  This is not a disorder that can be managed by self-help techniques and there is also a significant danger that in group types of therapy that are not very carefully managed by clinical experts, the sufferer of such traits may collapse psychically, or succeed [sometimes accidentally] in destroying the self.

______________________

Histrionic Personality Disorder [HPD]

Defining metaphors: “Over The Top!”, “Drama Queen”, “Melodramatic”.

If one were to write text for a Histrionic Personality [HP] in a play, one would run out of exclamation points, and probably out of highly emotive and excessively passionate adjectives and adverbs.  No, even nouns and verbs would be carefully selected to make much ado about very little, everything aimed at focussing the attention of anyone, everyone and everything [pets and cameras definitely count] solely on the HP.  And should the attention be called away for a moment or even lapse [as when the baby actually falls asleep while the caregiver needs it to stare adoringly], the attention-demanding behaviours, attitudes or emotional expressions escalate, to greater flamboyance, loudness or unexpectedness. 

There is usually little fact or reason that underlies strong and dramatic expressions of opinion of the HP, and hyperbolic speech is the norm.  Negative events are catastrophised [“It was horrific to sit in that awful traffic for so many hours; it ruined my whole day!” = 10 minutes in mild traffic]; others’ striking qualities are minimised, and own achievements greatly enhanced or embellished.

While such persons can be amusing or even attractive to bystanders for short periods of time, they tend to wear out the capacity for giving constant attention and adoration of people in closer relationships very quickly.  They also tend to be insensitive to snubs or ignoring, and have no respect for others’ needs for personal space, quiet, or consideration.  People who are legally caught up in necessary continued close contact [in business, for instance, or in marriage] usually have one of two options of response, neither of which seems to have any effect on the pervasive pattern of histrionic behaviours:  either flattery and fake, public adoration [as the Director supplied to the movie star] or avoidance, with clever snide remarks that can be misconstrued as compliment [as seen in several of Jane Austin’s characters].

Typical traits are:

-          Excessive emotional expression and constant need to be the centre of everyone’s attention;

-          Inappropriate sexual or provocative behaviour in social contact;

-          Superficial but dramatic emotionality, with rapid shifts in expression and kind;

-          Use of physical appearance to draw attention to the self;

-          Elaborate and embellished style of speech, with little underlying substance;

-          Over-dramatic, theatrical and exaggerated expression of emotion and description;

-          External-directed: Easily influenced by others or by circumstances;

-          Interprets relationships as closer or more intimate than they are in reality.

HPs typically lack the introspective ability, insight and motivation for change required in therapeutic journeys.  It seems they either find a niche where they can be accepted or tolerated, or move in circles where superficial expression is the norm.

Persons with sufficient intellect and hurt of failed relationships may be willing to modify over-dramatic and attention-seeking behaviours while also understanding that it is a disturbance and not a talent to act in such self-absorbed ways.

______________________

Toxic implies poisonous, dangerous, distressing to the equilibrium of Self and Others, damaging, infectious, debilitating, sapping strength, interfering with healthy [“normal”] functioning…

Now be careful:  Don’t judge!  The most dangerous thing about toxic people is their frequent lack of insight into their own toxicity and their judgment of Others as Toxic or bad!  A recent episode of the sitcom Two and a Half Men demonstrated the total denial a toxic person can have of his/her own toxicity, beautifully:  The dysfunctional mother of the two anti-heroes reports that she went to a funeral of a woman who was so critical, judgmental, pedantic, self-centred and un-empathic [read “Narcissistic Personality Disorder!] that nobody else went to her funeral.  Her sons finally revealed that her fate was likely to be similar since her personality was identical!

Personality Disorders

Personality Disorders are sets of dysfunctional patterns of behaviour that are usually caused by repeated failures of Significant Others to meet childhood needs appropriately, and these symptoms cause significant distress in relationships with Self or Others at personal, social, work, intimate and family level.  Such Disorders [or PDs] may only be diagnosed in adulthood [i.e. usually after 20 years of age] and the diagnosis may be made only by a clinician, like a Psychiatrist or Clinical Psychologist.  No, your conviction that your mother-in-law is the world’s most toxic Narcissist, is not legal or valid, and may have you sued for character defamation!

There is a list of the diagnosable PD’s on the web site, but do remember

[a] all people have some measure of defensive dysfunctional traits, and most of them are not PD’s;

[b] unless you have said clinical qualification and the person is not in close relationship to you, you are not qualified – or objective enough – to make the diagnosis;

[c] and also not objective or qualified to diagnose yourself.

That being said, since the symptoms are generally caused by very early and chronic interpersonal failures, the chief defense mechanisms are Denial [I’m not like that, thank Goodness!] and Projection [But she/he/all others are!] and Splitting [If you’re not 100% validating everything I say and do, you’re obviously betraying me and must be shunned/won back/punished…!]  So perhaps if we get some inkling that we just may have some of the dysfunctional traits ourselves, there is already potential for growth in that we could come out of Denial.

1:  Fatal Poisoning: Antisocial Personalities

It’s not usually appropriate to talk about degrees of dysfunctionality among the PD’s as all of them cause severe distress at personal, social or work level.  But from a therapeutic perspective the Antisocial Personality Disorder can be the most damaging as it is highly resistant to any intervention:  People can have decades of different kinds of therapy and yet remain as toxic as at the start.  And while other poisons usually cause from moderate to severe illness in relationships, Antisocial PD frequently causes complete destruction of the Other’s sense of self, or even their life.  Previously this category was termed Psychopath [as in the famous movie Psycho], later Sociopath and since 1994, Antisocial PD.  Typical are career criminals, from those who create child pornography to drug pedlars and mass murderers.

The most common Antisocial traits are a complete absence of Empathy for others [people and animals], coupled with compelling deceit and manipulation, and frequently a sadistic enjoyment of others’ pain [as seen in the movie The Silence of the Lambs].  In childhood, symptoms of an inability to feel empathy for others, plus sadism towards animals may predict that a person would have strong Antisocial traits in adulthood, or even the Disorder, if effective and long-term therapeutic intervention is not given early enough.

Criteria for diagnosis include any 3 or more recurrent traits of the following [traits from age 15, but PD is never diagnosed before age 18]:

-          Repeated criminal / illegal acts

-          Deceitfulness / lying / conning others for personal gain

-          Impulsivity & Immediate gratification no matter what

-          Repeated physical violence [breaking things, hurting animals or people]

-          Reckless, disregarding own or others’ safety

-          Consistent irresponsibility [e.g. in relationships, with others’ money or possessions, or at work]

-          Complete lack of empathy or remorse [often, lack of any “real” emotions except pleasure]

Plus history of Repeated acts of Conduct Disorder with onset before age 15.

2:   Violent bouts of illness, sometimes causing death: Narcissistic Personalities

I’ll give more information on the other PD’s at later occasions – probably by adding more articles on the web site – but now also want to talk a little bit about the Narcissistic Personality Disorder [NPD].  Please again remember that everyone of us has Narcissistic traits, and that there are Functional ones, like healthy ambition, good interpersonal judgment, self-respect and self-confidence, as well as the Dysfunctional ones, which I’ll discuss in brief [in no particular order].

Grandiosity:  No matter what you’ve achieved, experienced, or where you’ve holidayed, the Narcissist has done better!  They have a grandiose sense of self-importance and feel superior to everyone else, from Nobel Prize winners to mere Therapists, and are thus highly resistant to therapy:  they’ll go to sessions but keep “proving” how wrong you are and how much they know better!  This is also reflected in other relationships and the critical, judgmental, arrogant and perfectionist attitude is a major stressor in, for instance spouse abuse or emotional abuse in general – whether derogating your child, or being obnoxious to a waiter in a restaurant.  Their “victims” report that it feels like the Narcissist is always on the look-out to catch them doing something wrong, or being slightly imperfect in some way, and this “fault” is then catastrophied and focussed on and punished in humiliating and extreme ways.

Entitlement:  Why should the Narcissist have to wait in a queue like mere other human beings?  Why should the doctor, teller, therapist, spouse, or nurse in a hospital not be instantly available at the moment their need is felt, the bell is rung for attention, or the person is called.  Talk about Immediate Gratification!  While this immediate gratification need is normally in the form of service or attention from others [including pets], Narcissists also frequently have substance addiction disorders, which tends to further impair their insight and judgment, and to escalate their pathology to dangerous levels.

Lack of Empathy:  Or sometimes Fake empathy:  if they believed they lacked empathy, they would have to admit to a flaw, so they deny that possibility to themselves, and research “how to be empathic” [as they research and challenge anything else in order never to be caught of guard], and act as empathic people are supposed to act – sometimes.  Their words may sound empathic but their body language may at the same time be threatening, rejecting or denigrating. Basically their chief defense [against chronic early failures of empathy or positive attention from Significant Others] mechanism is total self-absorption and they are unwilling or unable to recognise and deal with needs or feelings of Others.

According to the DSM [Diagnostic and Statistical Manual of Mental Disorders, internationally used for clinical diagnosis], people with any five of the following [chronic or daily] personality traits, either have “Narcissistic Personality traits” [shown as +, ++, or +++ depending on severity and impact on others] or a full-blown Narcissistic Personality Disorder…  Now, remember that we ALL display many of these traits some of the time or in specific situations, without them being our main, only, or chronic defenses!

-          Grandiose sense of self-importance

-           Preoccupied with fantasies of unlimited power, success, beauty, brilliance or ideal love

-          Believes s/he is special/unique and can only be understood by or be associated with others who are “the best” in any field

-          Demands or invites excessive admiration

-          Sense of entitlement

-          Exploits others to achieve his/her own goals

-          Lacks empathy

-          Believes others are envious of him/her, yet also envies [and often denigrates] success of others

-          Arrogant, haughty behaviours and attitudes

Impact on Relationships:

Borderline Personality Disorder [BPD] can be as destructive to Self and Others in relationships [in fact, commonly more directedly self-destructive than NPD or Antisocial PD] and its defensive causes are usually as early as in the previously discussed PD’s, resulting in equally primitive defensive mechanisms [e.g. Splitting, Projection, Denial].  And people with strong BPD traits cause massive havoc in relationships too, but I will discuss that Disorder on its own elsewhere [BPD sufferers are often overwhelming, so it’s not just a matter of physical space here!]

For now, let’s just consider the common effects of Antisocial PD and Narcissistic PD on relationships. 

Very often we find some sort of abuse of Others with both, and it’s difficult for the lay person to differentiate causal factors:  Is the person abusive because of anti-social tendencies, or because of a deeply repressed terror of being abandoned, or losing control? [Or are they on a continuum of similar dysfunction?]

It’s important to understand that when there is abuse in a relationship – financial, power, social, emotional, sexual, verbal, and especially if its already escalated to physical violence [breaking objects, smashing doors or walls, or physically attacking or threatening to injure others or animals] – it is highly unlikely that a few weeks or even months of couples’ counselling/therapy will create lasting levels of greater harmony.

Unfortunately, the converse is true.  Even when there is some behaviour change on the part of the abusive partner, it may be manipulative [conscious or unconscious] or a False Self formation* underneath which parts of the personality build up resentment and rebellion against the therapist as authority figure, often resulting in higher levels of control and abuse if the person feels that the partner is gaining self-esteem and confidence.

It is never safe to be in any form of relationship with the Antisocial Personality:  even if you’re part of their “gang” and have similar behaviours, you are never safe [“blood in, blood out”]. And there really is no safe way to remain in an intimate relationship with a Narcissistic Personality, not while they’re either not yet in therapy, or even for many years while they are in therapies of various kinds.  While the traits remain, the danger is high, and the behaviours are likely to escalate or at least recur, despite remorseful promises and apparent acts of contrition, that may last for months. Only when a mental health professional can assure you that it’s safe, should you consider being in a close relationship with formerly abusive people.

If you suspect that your romantic or business partner/s may be Narcissists, the only way you can be relatively safe from some form of abuse in the relationship, is to insist on regular [i.e. at least once a week, and probably in terms of years rather than months] couples therapy as well as individual therapy for the abuser.  And maybe the therapist is a religious counsellor or social worker or guru, but, because of the power dynamic and primitive defenses, without some authority figure to whom there is accountability, most clinicians appear to hold little hope for good prognosis.

In other words, if there is ever any form of abuse [psychological or physical, or at any other level, especially if recurrent], get professional help, and urgently!  Do not delay until the co-dependency and the behaviours are so fixed that it’s extremely difficult to find an antidote for the “poison”.

Conversely, if you recognise the traits at toxic level in yourself, it is very important to commit to the right kind of psychotherapy as soon as possible, understanding that the long-term investment of time and money is worth it, as the gains are safer and happier relationships with yourself and Others at all levels of your life, which in turn promotes financial and physical well-being.

*See C20 psychoanalyst Donald W Winnicott’s essays on the formation of the defensive False Self structures

Unfortunately it is true that every one of us – even the most saintly – has some character traits that irritate some other people!  The good news is that it’s not always the fault of the person who is perceived to be irritating:  for instance, a “Type A Personality” may benefit from having some traits of more peaceful and joyful people that s/he finds highly annoying because they may not behave rashly enough to suit his/her needs for immediate gratification.  So, the person described as “difficult” may not be as problematic interpersonally as the one who describes him/her in such terms.Traits are considered to be dysfunctional if they interfere significantly with our optimal functioning in our personal life [e.g. causing depression, anxiety, addictions], our social life [e.g. our ability to function effectively socially or in intimate or family relationships], or our work life [e.g. in concentration, or in relationships at work].

Character or personality traits are qualities we all have, in various combinations.  They can be adaptive or functional, like certain life skills:  An accountant needs to be precise in her work, but hopefully not in exact in the way she arranges her flowers every day.  That would be bordering on maladaptive or dysfunctional behaviour, and may be traits or indicative of a fixed and invasive Personality Disorder which generally can affect people around her negatively or lead to arguments or rejection.

Traits are called ego-syntonic if we are proud of them and wish to keep them, despite others not believing we should indulge in them, or despite their interference with our optimal functioning as described above [e.g. "I like being aggressive: it gets me what I want"].  Traits that we ourselves recognise as dysfunctional or negative are termed ego-dystonic [e.g. "I would like to stop being addicted to cocaine because I realise it's harming me and my family"].

Certain clusters of traits appear to occur in set patterns and are always dysfunctional. These clusters are diagnosed only in adults [i.e. people over 20] and are well researched so that reasonably accurate conclusions can be drawn as to their causes and how they affect an individual and his/her life.  We can even predict with reasonable validity when a teenager who displays these clusters is likely to develop them into the fixed patterns of behaviour called Personality Disorders, by the time s/he reaches adulthood.

Although a person must fulfil all the criteria to be diagnosed with a Personality Disorder [and only a professional with clinical certification, like a psychiatrist or a clinical psychologist, may make such diagnoses!], some adults have enough of the traits to make their or others’ lives a misery – hence “difficult people”.

The following PDs [Personality Disorders] are stipulated in the current Diagnostic and Statistical Manual of the Psychiatric Disorders [DSM].  There are also other proposed categories [e.g. Depressive PD] that are being researched and may be added later.

CLUSTER A                                     CLUSTER B                         CLUSTER C

PARANOID PD                                ANTISOCIAL PD                 AVOIDANT PD

SCHIZOID PD                                  BORDERLINE PD                DEPENDENT PD

SCHIZOTYPAL PD                          HISTRIONIC PD                  OBSESSIVE-COMPULSIVE PD

                                                       NARCISSISTIC PD              PD NOS [Not Otherwise Specified]

Personality traits are not chosen as an act of will, and they are not signs of “madness”, though they may make people feel “mad, bad, or sad” if the traits are strong! [with prevalence of the traits notated as ++ or +++].  “Madness” [or psychosis] implies that an individual is frequently and grossly out of touch with reality, and no longer generally able to function effectively in his/her life – personally, socially or occupationally.  Even persons with “text book” PDs, tend to function quite well in some of these areas most of the time, and – except for Antisocial PDs – are usually not hospitalised or institutionalised [eg in forensic settings] – unless there is a specific symptom or threat such as attempted suicide.

Even for certifiable “madness” [psychosis – see below], there is always a Cause or Etiology.  The old psychotherapy cliché “It’s all my mother’s fault” is not as inappropriate as most of us would prefer it to be, especially if we are a parent or a caregiver! But the failure to make an individual feel safe and wanted in the world is often caused by peers, or by other authority figures or caregivers than the mother.  

Defense / Coping mechanisms are the infant’s and the young child’s attempt to ward off perceived terror / anxiety in repeated early situations that suggest to the person that s/he is in danger of abandonment / rejection / annihilation that would end in the destruction of the integrity of the Self.  Such defense mechanisms are not “genetic”, although symptoms could be similar: Being born with brain damage, for instance, may predispose a person to act out violently, similar to someone with Antisocial PD, or to have severe mood swings like someone with Borderline PD;  however, the cluster of symptoms and etiology is what allows us to differentiate between various mental disorders, according to a Differential Diagnosis.

Other disorders now clearly associated with brain damage [eg low brain matter density and resultant enlarged ventricles] include psychotic disorders, like the schizophrenias [typically demonstrating symptoms like auditory hallucinations or various delusions], and these may be aggravated by inadequate parenting. 

“Psychotic / psychosis” implies an inability to stay primarily in objective reality.  We might all like to call our mother-in-law or boss a “Devil”, but when we actually believe her/him to be Beelzebub, horns and tail and pit of sulphur and all, we are diagnosed as “psychotic”.  Psychosis may usually be indicated in any of three categories: 

[1] Not being orientated to Person [who I am], Place [where I am], Time [when is this] or Situation [what is happening]. 

[2] Hallucinations [seeing or hearing or smelling or tasting or feeling things that are not there as if they are, or vice versa, not experiencing them when they are present], or Illusions [experiencing distortions in sensory perceptions, such as “walls bending in on me”]. 

[3] Delusions [fixed beliefs that are not real to objective others, eg "I can fly off the roof", or "There is a snake in my belly and it's eating me up inside"].  Note that such psychotic symptoms are commonly associated with people who do not have a general psychotic illness but who are intoxicated by drugs, and they can also occur in certain cultural milieu such as “mass hysteria” and a “calling to be a spiritual healer”, without indicating a fixed psychotic disorder.

NB: Note that psychiatric disorders are diagnosed according to an Exclusion principle, i.e. first eliminate possible medical causes of symptoms, then possible substance causes, then genetic, etc…   And diagnoses are based on patterns or clusters of symptoms, not on a single symptom.  [This means, Gents, that a woman who is pregnant and has mood swings because her hormones are not balanced, may NOT primarily be diagnosed as "Borderline" because of the one symptom;  it is however possible to be both Borderline PD and pregnant.]

While people with PDs may have certain symptoms that appear delusional [such as the belief "I am the greatest person on earth and therefore deserve special treatment" in Narcissism, or "I am helpless and can't do anything for myself" in Dependent PD] or hallucinatory [such as the body dysmorphia associated with some eating disorders], the person with a PD moves generally in the world of objective reality, with short lapses into unreality [often described as micropsychotic episodes] from which s/he can usually emerge without medication or any overt intervention.

PDs are resistant to therapy:  How can one be expected easily to give up the very habit/s one unconsciously believes are the only defense that wards off one’s annihilation?  For the first part of the 20^th century Freud and his followers generally de-selected people for analysis if they suffered serious deficits such as found in the PDs.  Even in face-to-face psychoanalytic therapy it could take many years of thrice or twice a week therapy for the PD to abate sufficiently for people to live more peacefully with others and themselves.  Speedier results have been reported with modern integrated therapies that include techniques like Hypnosis or EMDR, but the danger of causing collapse if the defenses are too quickly overwhelmed, is significant, and such work should only be attempted by licensed and experienced or supervised clinical psychotherapists.

Remember that PDs are formed after repeated and continuous failures of caregivers to provide a safe, accepting, welcoming, non-intrusive yet stimulating, caring environment, with appropriate freedom and boundaries, over time.  And none of us are taught this art in schools!  We learn our parenting skills from the often inadequate role-modelling by our own parents, early teachers and other caregivers.  And if there is a severe enough failure to provide such a safe and nurturing environment by even one “big person” [such as being emotionally abused by a teacher or sexually molested by a family member], not even the best efforts of relatively good parents may be sufficient to ward off severe defensive traits or even disorders of the personality.

Half a century ago British psychoanalyst Donald W Winnicott coined the phrase “good-enough mother”, which can be extrapolated to good-enough parents, father, nanny, teacher, etc.  Different behaviours are required of good-enough parents in the child’s different developmental stages [for instance, not still breastfeeding the seventeen year old may be a good idea].  An infant psychologically needs a great deal more eye contact and physical holding than a teenager, as another instance.  Modern psychotherapists generally believe that optimal provision of a child’s emotional needs should include unconditional love / positive regard, freedom from intrusion and neglect, and appropriate boundary setting for his/her behaviour, and some add optimal frustration, which stretches his/her resourcefulness without being overwhelming.

When parents / significant others repeatedly fail in one or more of these areas, the child is likely to develop such strong defenses against unconscious fears of being hurt / annihilated / abandoned / rejected, that the formation of a PD defensive structure is likely.

So, generally “difficult” people can become “nicer” people if they get a chance to have these basic developmental needs consistently met at some stage in their life, for instance in therapy.  In interaction it nay be useful to remember that the “difficult” behaviour in any specific moment points to a fear of a perceived threat:  If Alex suddenly becomes bombastic / grandiose/ arrogant, it’s likely that someone has done something [or Alex believes in fantasy  that this has been done!] to make her/him feel small, powerless, disrespected, ignored, diminished, worthless, unheard… [for instance, in ignoring his/her contribution to a discussion].

The answer to the question of how to change his/her defensive behaviour seems obvious:  to acknowledge that s/he is worth some positive regard.  Similarly, if Ashley is acting in an over-controlling manner, it is likely that more structure or safeguards are necessary in the situation/s that evoke the behaviour.  But such “therapeutic” responses are hard to sustain in practice with a “difficult” person, who may often have the effect on others to suggest or make them feel “mad, bad, or sad”!

Some specific examples of various PD’s are discussed in the 2009 monthly Selfgrow newsletter, to which you can subscribe on this web site.  There are also various internet News groups that focus on specific Personality Disorders.

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Whether big or small, Trauma has always implied disruption of our sense of being “OK”.

The German word Traum means Dream, suggesting an experience in Dream State, or Nightmare, if you will.  Traumatic experiences generally have dream state power: symbolism, irrationality, unpredictability, polarised effects, and 2-dimensional characters – good or bad, victim or perpetrator.

Psychoanalyst Melanie Klein held that the Imagoes or mental representations we create of people who have in some way damaged us, are far fiercer and more relentless than the real life people on whom they are based; they are indifferent to all others’ pain or even delight in it.

I believe the same holds true for damaging or threatening events or experiences in general. 

They seem one-sided and overpower us with their unmittigating attack – Nightmare stuff.

The counter-balance for a nightmare, with all its vivid imagery, movement, unpredictability, and frenetic action, can’t be just a calm dream.  We need a similar strong arousal level as that of the trauma or nightmare experience, one that would stimulate the release of large quantities of positive neurochemicals to neutralise or displace the negative ones.

We need colour, movement, rush of action, stimulation of all senses, and exuberant energy in our healing imagery.  Let’s call it a Brightmare!  A wonderful, bright, positive dream state experience, with imagoes as impossibly real and incongruous to everyday experience, as those of negative trauma states.

The changing of the brain state to a positive but aroused state is an important intervention since we know that our brain functioning is so-called “State-Dependent”:  It is very difficult for us to access positive memories or habits if we’re feeling depressed, or calm memories or experiences if we’re feeling anxious, or powerful feelings when we’re in a trauma-induced powerless state.  And since the brain appears to prioritise highly aroused states as mode of ensuring survival, we need to create a similar level of arousal priority for the brain to change to a more positive and powerful state of functioning.

Different de-briefing therapies appear to have 3 common elements in their various protocols:
1]  Re-visit the traumatic experience in minute details, accessing all 7 senses, and replay with different perspective and speeds.
2]  Re-frame aspects of the experience so that they are more empowering & validating.
3]  Generate a containment / safe space experience.

In EMDR the protocol typically ends with 3 containment steps:
a]  De-potentiate the threatening negative imagoes, for instance by putting them into a Perspex bubble, or a composting tank, or shark cage.
b]  Anchor a feeling of being protected through a suitable image – blue light, angels, huge dog, etc.
c]  Help client to create or access a Conflict-Free Image [CFI].  Examples from patients include floating in a dam, playing with their dog as a child, flying overseas on holiday, throwing clay at opponents across a stream, giving birth, a secret place in a garden, etc.

Making light of actual traumatic events [big or small] is likely to be harmful, invalidating the painful experience, causing repression of the negative impact, and hugely annoying the defensive or protective ego-states, which may have disruptive and damaging consequences…

But we can speed up the process of re-empowerment and stabilisation of the self by enlivening the safe space imagery to create an effective counter-balancing “Brightmare” to the trauma-bad dream experience.  We do this through adding incongruous, laughter-evoking imagery to the client’s CFT or safe space.

Example:  To a young rape victim’s Safe image of eating ice-cream on the beach, one ciould suggest that the “ice-cream baby” had a big protector ice-goose that would nozzle her neck with its flat orange beak, and tuck her under its belly to keep her safe, till she sneezed so hard that it somersaulted backwards and looked very funny trying to regain composure.  Experience shows that clients, old or young, keep remembering the incongruous image and e laughter thus evoked seems to speed up the creation of efficacy and normalcy neuronal pathways.

We can thus play the role of movie or dream state director, generating strong and vivid positive states, to create an exciting Brightmare through suggesting additions to patient imagery, using the following tools:

- Add colour, brightness, temperature, physical comfort – or even slight discomfort such a tickling, texture, smell, taste, sounds.
- Enlarge the protagonist/s [including the Self] to absurdly huge size in relation to other elements or characters.
- Add incongruous characters, actions, occurrences, and situations.  It should end up being “silly” and laughter-provoking, while remaining reassuring and protective.
- Add fast movement, unexpected behaviours or events, dramatic, positive action, and make sure the client is part of the action in a powerful way.

Benefits are numerous, for instance:

- Neuro-chemicals evoked by laughter and energetic imagery create a brain state in which it is easier to recall victory and positive experiences, in contrast to the disempowering state created by traumatic experiences;
- Re-association to three-dimensionality of one’s life and reintegration of positive life experiences into the life narrative can occur readily;
- Through the balancing of Nightmare Dream States with Brightmare Dream States, normalcy is validated and permission is given to the self to laugh and experience happy feelings “in spite of” negative experience, etc.

The possibility for selection of possible characters and events is endless:  Why can’t the Elvis impersonator surfing on a Harley Davidson bike near the person’s safe place not have a mouse with long green eye-lashes playing ego-strengthening songs on the red lacquered guitar across his back, while the foam that shoots up from the Hog comfortingly tickles the client’s cheecks?

As long as the characters and events maintain the client’s sense of safety and security, and integrity of self, and add humour and some form of reconnection to happier or more ppowrful experiences, anything is possible.