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The Stress Doc Letter
Cybernotes from the Online Psychohumorist ™

January 2000, No. 2, Sect. 1

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

Table of Contents

News Flash: WebMD.com and iSyndicate.com Announcements: AOL Chat Group and Q & A Links/Archives Q & A: Online Acting Out or New Husband Ambivalence? and When the Night Shift Is a Pain in the Back Shrink Rap: Listening to Readers on Prozac, Depression & the Medical System Readers' Submissions: New Age Humor and Merger Mania Main Essay: Readers' Take (on) Prozac -- Part I Sect 2: Main Essay: Readers' Take (on) Prozac -- Part II

Heads Up: Alas, only for AOL members, stop by my online "Shrink Rap (TM) and Group Chat," Tuesdays, 9-10:45pm EST <A HREF="aol://4344:363.gorkin.5732839.568857121"> Chat with the Stress Doc</A>: It's a dynamic, lively, at times witty and always warm, thoughtful and supportive problem-solving group. We raise questions and share our ideas, hopes and experiences with each other. ----------------------------------------------------------

News Flash:

1. The Stress Doc Teams with WebMD.com On January 19th the Stress Doc launched his one hour "Practice Safe Stress" Internet Support Group for WebMD. Opening topic was "The Four Stages of Burnout." Participants were very enthusistic about the information and and the lively mutual sharing.

Up Next: February 17, 10pm EST/7pm PST. Brief Opening: "Getting Ahead without Losing Your Heart: Managing Anger and Self-Defeating Type A Traits."

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

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

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

2. Stress Doc Teams with iSyndicate.com.

Publishers, editors can obtain Stress Doc writings for their e-zines, online newsletters or other web publications. Go to www.isyndicate.com or click on iSyndicate link on the stressdoc home page -- www.stressdoc.com . -------------------------------------------------------------

And finally, check out my monthly column appearing in worldwidesingles.com -- http://worldwidesingles.relianthosting.com/WWS/mag/jan/articles2.htm

A lot of good stuff for singles.

Announcements: 1) For all cyberspace travelers, there's the new Ask the Stress Doc Q & A -- Work Stress Digital City - Washington, DC - Ask the Stres... and Love and Relationships Digital City - Washington, DC - Relations . Also, check the Doc's Q & A Archives: Stress Doc's Q&A and Q&A: Love and Relationships .

Ask the Stress Doc: AOL/Digital City--Washington, DC Love & Relationships Work Stress

1) Online Acting Out or New Husband Ambivalence? 2) When the Night Shift Is a Pain in the Back

Q. I am stressed out. I have been single 23 years and just got remarried. I found out that my husband placed a romance ad when we were seriously involved but not yet married. He first said he didn't remember it, now the story changes daily. He said he was awareI would have broken up with him had I found out. I don't trust him now at all. I am not sure how I feel about him anymore. Help

A. I can imagine discovering that your husband had placed a romance ad shortly before your marriage was distressing. Also, having been single 23 years, you were not just tying the knot impulsively or casually. I'm sure warning bells were pealing. And his daily changing storyline does nothing god for the trust level. Nonetheless, don't give up the ship -- the relationship -- just yet. What you may be seeing is a not uncommon symptom of ambivalence about marital commitment, especially among the male species. (Hey, I've been accused of being a commitment-phobe, myself. Of course, I defended my honor by writing some lyrics called "Singular Man." Does the Doc doth protest too much? Anyway, email for the lyrics.) The reality of marriage can evoke latent fears. I recall counseling a client who had a fling with an old flame shortly before his wedding date. But we were able to work through his "loss of control" issues in therapy. He had no doubt about loving his wife to be. So the key is whether hubby will get some counseling, stop feeling so ashamed at being caught, acknowledge his fears so he can stop with the story-game playing. If he won't consider counseling...you go. Cause you will now have some tough soul searching. A Marriage or any intimate relationship based on mistrust has a shaky foundation. Without outside support, this house often cannot stand.

Q. What can u do with lower back pain? I do not get sleep in the day (no more than 4 hrs) work at night.

A. While my experience with the night shift is limited to a year as a US Postal Service consultant for a 24-hour processing and distribution plant, for me it was always troublesome. I never adjusted to once/week 9pm-5am rotation. So if you are sleep deprived then you are also vulnerable to all kinds of stress-related ailments. What to do? For the back pain there's physical therapy or a chiropractor. For a repetitive motion disc in jury (exacerbated by an ergonomically incorrect computer chair and desk) I found a mix of physical therapy, advil, swimming and light stretching to be the answer. Certainly, consult with a physician before undertaking any rehab.

As for the sleep deprivation, if you truly can't change your work shift, I'd consider a consult with a physician about getting some sleep medication. And, if there are other stress issues in your life besides night work, lack of sleep and back pain, I'd seek an evaluation from a psychiatrist to rule out any underlying anxiety or chronic depression issues. Also, consider a chronic pain support group, online or offline. Offline, a good local hospital should have a group or can make a referral. Just remember...Practice Safe Stress!

Shrink Rap™: Listening to Readers on Prozac, Depression & the Medical System

This is why I love the Internet: the insightful, heartfelt and genuinely vulnerable outpouring elicited by the two essays on the dangers and opportunities with the new generation of antidepressant medications. (Email s tressdoc@aol.com if you missed the JAN 2000, No. 1, Stress Doc Newsletter essays, "The Liberating and Entangling Webs of Technology, Depression and Prozac" and "Twelve Steps for Beating (Mostly) Chronic Clinical Depression.") Before posting about a dozen reader responses, some reflections on the nature of this cyber exchange, including key issues identified. There truly is an engaging connection between writer and reader and reader as writer.

Grappling with Prozac

First, and foremost, readers have reaffirmed a profound truth: for many folks, the decision to take antidepressant medication is as much a sign of courage and commitment as of necessity or practicality. For a sizeable number, even with the cleaner Selective Serotonion Reuptake Inhibitors – like Prozac, Zoloft et al. – there are noticeable if not disorienting side effects in the early stages of the trial or until the drug with the best fit is discovered. (Alas, some will never find a good fit; others may need to supplement an SSRI with Lithium, for example.) Patients need sound information and reassurance that with proper medication and drug supervision, along with psychotherapeutic support, taking SSRIs for depression will not necessarily produce a cure worse than the disease. Actually, with the proper biochemical and psychotherapeutic trial, effects can be distinctly positive, if not a revelation.

Let me illustrate with a very gratifying email, like this one from Carrie: "…I owe a deep debt to your writings on depression. It finally enabled me to take my Doctor’s advice and go back on medication. Prozac had posed real problems for me – the AM haze was just too hard for me to fight through. I found Zoloft to be the perfect solution for me, and I could afford it now, being self-employed. I’ve known for a long time, being a Winter SAD [Seasonal Affective Disorder] that the lights weren’t doing everything I needed. Zoloft is the solution that I didn’t know existed. After an unsuccessful trial of Serazone, my Doc thought that Zoloft might be the answer. It sure has been. And thanks to your writings, I’m no longer defensive about taking it. I’ve finally come to believe that there is just something missing in the chemical soup in my brain, and this drug supplies it. Bravo, mark and thank you."

Prozac Provocateurs

Next let me share the words of another reader understandably troubled by very early meds trial side effects. This individual attempted to do some rational research on Prozac to make sense of her mind-body confusion. She was suddenly confronted, if not assaulted, by one-sided anti-drug writings and ranting on the "Prozac Survivors" site. (See URL in email below.) Even though labeled a "killer" for writing positively about Prozac, I had not quite realized the wide schism between the various Prozac antagonists nor of the extent of the Molotov Cocktail-like rhetoric being lobbed about in cyberspace. (Though I should not have been that surprised. Living three blocks from a Church of Scientology, I’m accosted periodically with virulent anti-psychiatry propaganda literature and protests.) Holly’s note reflects a mature startup perspective; a voice of thoughtful exploration and calculated risk-taking:

"I discovered your site while reading other sites regarding Prozac. I just started taking it and had an odd feeling the first day. Kind of like my head was not connected to my body. I was concerned and looked online. Finding the 'Prozac Survivors' site (http://www2.netdoor.com/~bill/prosurv/prosurv.html) I freaked out reading the information. At the bottom it had a link to your site saying, "Some people don't mind it," so I thought I'd read the ones where people didn't think it had detroyed their lives. (I just started taking the medicine... The other site scared me to death!) Anyway, I read through your Prozac 'journal' and loved it. I felt the same way about so many things so I thought I would join the newsletter mailing.

Thanks for helping me see that Prozac hasn't destroyed everyone's life! It has such a stigma I didn't want to take it... When I checked into it online I REALLY didn't want to take it. After reading through your site I'm willing to give it a chance. Thanks for the wonderful info!!

Still, there’s room for rational controversy, as an email from halfway around the world attests: "Hi there Mark, the Sydney Morning Herald (Australia) recently ran a lead article in its 'good weekend' section about 'murderous' Prozac. And after reading it and then reading your things I did wonder if you were going to talk about this other side to Prozac. At one point I (cynically, momentarily) thought you were an employee or shareholder for Prozac. But from your style, your stuff, I think not." (Ed. note: I told her I was too poor to be connected to pharmaceuticals!)

A Potent Side Effect

Another emailer, who’s been on Prozac for a good while, is experiencing a most troubling side effect. Certainly, it’s one that vividly illustrates the mind-body-biochemistry-self-esteem connection. And like the double-edged Chinese symbol for crisis, there is both danger and opportunity: the side effects can either spread the dis-ease or, if properly engaged, can increase the understanding and support:

"Hi Mark, I have been being treated with Prozac now for almost 2 years. I have recently (about 6 months) been with a wonderful woman. On New Year's Eve we went out and afterwards got a motel room for the night. No, I did not drink any alcohol and found that I was unable to be aroused by her. She is a beautiful woman and fulfills all the qualifications to become my second wife. I spoke to the Doc who is treating me for depression and he feel as though Prozac is the problem with what is going on. I don't know if any other readers of your mail have had the same experience but it sure can be a great let down. This woman feel as though she can't turn me on. I have told her that she does, and I didn't understand what was going on. So that is why I contacted the Doc who is treating me. I have to see him in the morning. I will let you know what all he has to say to me. This can be a very troubling thing for someone who is finally getting over PTSD. I thank you for your mail and will continue to read it faithfully. I hope to see you on line this up and coming Tuesday evening. Respectfully, Buddy."

My response: Reduced libido, difficulty being erect or having an orgasm is a somewhat common side effect of using SSRI medication. Sometimes it’s a sign that the dosage is too high. Also, consider scheduling a consult with your doctor for you and your woman friend. Hopefully, the more she understands the nature of antidepressant medication, the more she can be an understanding partner.

And, hopefully, this introduction has whetted your appetite to read through the topically wide ranging reader responses. Other issues or questions include: a) start up and stopping meds effects as well as long term impact on gut functioning and low blood sugar, b) does Eli Lilly (the producer/distributor of Prozac) recommend a specific duration for usage?, c) how the past newsletter essays affirmed readers’ decisions about medication usage, interacting with doctors, etc., d) do you have to combine psychotherapy with biochemistry?; a loner wants to know if you can "get back" without human intervention, e) a cautionary note on the potential for employers to engage in online invasion of privacy, including checking insurance company medical records, f) the realities of antidote or prevention potential of antidepressants regarding alcoholism, along with some 13th-step wisdom for drunks and addicts and for their therapists and doctors, g) an insider perspective on the medical and Managed Scare system from a former medical group business manager, including the tension between "shrinks and docs" and bias against employees with psychiatric conditions and, finally, h) closing comments from a feisty and youthful 79 year old to put it all in perspective and to help us…Practice Safe Stress!

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Reader's "Higher Power of Humor" Section

New Age Humor From: DARLENE IL

I was having an out of body experience one day so I grounded myself and got centered with the help of my spirit guides and almost astral traveled anyway, but the phone rang. I sensed the negative vibrations so threw the I-Ching and checked my numerology chart and nearly had a primal scream, but my energy was too blocked, so I did some bioenergetics and self parenting, took some flower essence and ate an organic oat bran ginseng muffin, but my inner child wasn't feeling nurtured yet so I had a Rice Dream Frozen Pie too, but that made me hyper so I did the relaxation response while listening to my subliminal tapes, but I was feeling depersonalized so I did some polarity work, foot reflexology and past life regression, then rebirthed myself and called Moon Beam, the bodyworker, to make an appointment for a Shiatsu, Reiki, Rolfing, Feldenkreis, Swedish, Japanese deep tissue massage, but she flaked out and never returned my call, so I decided to energize myself and do some positive imagery because all my visualization techniques and affirmations made my space feel invaded, so to get empowered, I got a psychic reading from Mother Heart Love around the issue of my assertiveness so I could feel my radiance and have some energy for my psycho-calisthenics and inversion swing before my harmonic brain-wave synergy session, which made me more focused for my actualization seminar, holistic healing class and dream workshop, so I'd be more clear for my Gestalt behavioral cognitive transpersonal Reikian Jungian Freudian Ericksonian session at the hot springs but my aura was weak for my trance-channeling group so I fasted until noon to recharge my chakras and sensed my intuition was high and my cycle was focused, so I turned on my ion generator to open up for my neuralinguistic programming session, but I needed to have my pyramid recharged before my guided synchronicity meditation, so I got some cranio-sacral therapy, which aligned me for the fire walk, which was between my tarot card reading and my sensory deprivation tank appointment, but after all that I felt what I truly needed was a meaningful relationship to mirror myself so I went to my personal shaman, and then to my guru, but they were no help, so instead I went to the Intensive Whole Life Earth Rebirth Cosmic Expo Symposium Workshop to find someone who really knew what was going on, but that didn't work either, so I locked myself in a calcium coated Orgone Box and went to sleep so I could "get it" in the dream state.....

(Ever have one of these days...? ) ------------------------------------------------------------------

Merger Mania From: garysos@earthlink.net

In the wake of the AOL mega-merger, here are the latest mergers we can expect to see:

** Hale Business Systems, Mary Kay Cosmetics, Fuller Brush, and W.R.Grace Company merge to become Hale Mary Fuller Grace.

** Polygram Records, Warner Brothers, and Keebler Crackers merge to become Polly-Warner-Cracker.

** 3M and Goodyear merge to become MMMGood.

** John Deere and Abitibi-Price merge to become Deere Abi.

** Zippo Manufacturing, Audi Motors, Dofasco, and Dakota Mining merge to become Zip Audi Do Da.

** Honeywell, Imasco, and Home Oil merge to become Honey I'm Home.

** Denison Mines, and Alliance and Metal Mining merge to become Mine All Mine.

** Federal Express and UPS merge to become FED UP.

** Xerox and Wurlitzer will merge and begin manufacturing reproductive organs.

** Fairchild Electronics and Honeywell Computers will merge and become Fairwell Honeychild.

** 3M, J.C. Penney and the Canadian Opera Company will merge and become 3M Penney Opera.

** Grey Poupon & Dockers Pants will merge and become Poupon Pants

** Knott's Berry Farm & National Organization of Women will merge and become Knott NOW!

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

``````````````````````````````````````````````````````````````````` Main Article

Readers' Take (on) Prozac: Part I

Hi Mark, I just wanted to let you know I have been depressed and taking 40mg of Prozac for three years (along with therapy weekly). The only side effects I had were appetite loss and vivid dreams. I am very fortunate to have found a medication that helps me. My depression has greatly decreased and I'm able to carry out a "normal" life.

There is a great book called Talking Back To Prozac (what doctor's aren't telling you). It is by Dr. Peter R. Breggin. You might find it interesting. I purchased it through Amazon.com books, it was only $5.00. Thanks for your interesting newsletters and stay well. Sincereally, (Debbie) [Ed Note: Will now also consider this salutation, "Surreally yours"] ~~~~~~~~~~~~~~~~~~~~~~~~~~~

Good newsletter Mark. Do you think that those who have "low blood sugar," generally speaking, are basically depressed? That is, does depression CAUSE low blood sugar? I have heard that it is vice-a-versa, but am wondering if depression itself can cause it? I have seen so many people with lots of problems and feeling over-whelmed by life, that then get hypoglycemia. I have had the problem myself, and have found that diet has helped, but am still anxious and have occsassional depression. Thanks, and Happy New Year!! Marilyn ------------------------------

Hi Marilyn,

Thanks for the thoughtful note. My sense is that prolonged, if not chronic, stress lies behind both, in addition to any genetic predisposition. Clearly low blood sugar can create mind-body effects that seem like depressive symptoms and people may mistakenly think and label signs of depression as simply low blood sugar. Anyway, that's my take.

To an energetic New Year. ~~~~~~~~~~~~~~~~~~~~~~~~~~~

From Lilly http://www.prozac.com/general.htm

Let me know if you get through to this link?

I just read the site again Lilly, says 6mos is recomended time for AD-s [antidepressants].

What do I know? If the stuff wasn"t so expensive I would give it to my dog first to see results but I can get info on the web sooner and less chance of getting bit. (forgive pun)

Anyway you seem to have a handle on it, I am the one mixed up about the whole deal. Sorry to trouble you. Am lookin foward to AOL chats if I can find them. Many thanks

AL S ----------------------------

Thanks for the link. Yes, I read where the recommended time for Prozac is 6-12 months. What I didn't read is that there's a contraindication for longer usage. I suspect they are including the 6-12 month range to educate people who think depression is quickly fixed with Prozac. And, I suspect (hope) that if there was research stating damaging side effects of long term use then that would be reported by the FDA (if not by Lilly). But as always, consumer beware!! ~~~~~~~~~~~~~~~~~~~~~~~~~~~

Noting with interest your information on use of Prozac, I thought I would let you know about a new book called The Second Brain, by Michael D. Gershon (Harper Collins, l998). The impact of seratonin on the guts is profound because, as a separate nervous system parallel to the brain and activated by exactly the same neurotransmitters at differing sites, it seems to be related to an increasing epidemic of bowel disorders. First it stimulates gut motility, then depending on does and length of use, burnout, leads to dismotility. The problem is that gut function is the last connection that doctors or patients make concerning psychotropic drugs.

The book is within a determined layman's grasp. It is, however, without an index or footnotes, with suggests to me some degree of haste. As confirmation of its thesis, the new drugs for Irritable Bowel Disorder, are anti-seratonins. I can't help wondering what it must feel like to make yourself have less seratonin. [Ed. Note: Living a life of high anxiety and panic, helplessness and depression should do it.]

Best Regards, Kirsten ~~~~~~~~~~~~~~~~~~~~~~~~~~~

hi stressdoc, happy new year and all that happy bloody stuff. thanks for all the efforts you put in for us mentally disfunctioning dudes and dudettes out here in cyberspace reading your work. i have dropped the the prozac meds trial after 6 weeks and have switched to remeron. i felt all that prozac was doing for me was making me less nervous about feeling so apathetic, although as you noted this was probably more impatience toward not reaching some sort of functional state quick enough. needless to say the remeron does not feel much better but i am going to stick with it and give it a chance. the last time you wrote to me personally you asked whether i was including group or interpersonal therapy and whether i had a support group or family to lean on with my meds trial, well i was going to write back but got into and have been in one of my lowest and most disinterested moods that i have been in for a very long time. i hear what you say about the human interaction and therapy but the problem for me is that i have been a loner for most of my cognitive life and generally do not get along with and dislike most humans, disowned my own family a long time ago and could probably say i have only had one relationship in my lifetime that did not end disastrously.

why am i telling you this when i know you've probably heard every depressive story there is to hear in this world? i suppose i just want you to tell me that it is possible to get back without human intervention and the meds will eventually make it all right again, okay, i know you are going to say "wrong," like most people do who are trying to help me but as we know we are creatures of habit and i have spent a lifetime building a wall around myself trying to isolate myself from society and as i sit writing to you trying to think of something to say that could spark the magic words from your great wisdom and insight that would change me back to having some zest for life, i have to wonder whether i would listen because it seems deep within myself through the trials and tribulations of life which to me for myself seem to have been unnecessarily hard and unhappy like a nail that has slowly been hammered into wood there's not much left sticking out to hit. my spirit feels very tired and mangled and i just want to give up, i do not feel suicidal but everyday i really just wished that i could go to sleep and not wake up. nothing interests me and even getting this far with this letter has surprised me, not to mention thoughts in my head of just how rude it is downloading this crap on you anyway, (sorry) anyway i'm going continue on the meds track and hope that one morning i'm going to awake a happy smiling person all interested in life. thanks for your ear if you got this far without hitting the trash button.

mark, congratulations on your site award, in my humble opinion you really deserve it. keep up the fantastic work and all the best. sean ---------------------------

Sean, First of all, thanks for the very poignant and well-written email/essay. You should be doing more writing if you aren't. Second, I'd like to reprint it anonymously in my next newsletter. How about taking a creative writing course at some point? But I get ahead of myself. I'll make a bargain with you: I won't suggest human interaction (for now) if you'll start a physical exercise program, even if it's just brisk walking, gradually building up to 30-45 minutes a day.

To hard work, some inner peace and some support. Mark ------------------------------

mark, thank you, your mail really made me feel good and you are welcome to use what i wrote, i take heed of your words and am trying to crank that old handle to get back up to speed. have a lovely weekend sean ~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Hm-m-m...interesting article on the "murderous" side effects of taking Prozac. I took Effexor for a good part of last year because of a diagnosis of Post Traumatic Stress . Went through the whole schtick...talked to my doctor about feeling depressed, and after a rather lengthy evaluation by my Psychiatrist I was told I was not clinically depressed, but PTS-ed. I tried Prozac and another med, but got rashy...hence the Effexor. BUT, in the process of reading everything I could get my hands on concerning the meds, a kind of universal aspect of these meds is that they take a while to "kick in", on the average, around three weeks minimum. How long were the people with criminal actions on the meds before they became violent? And I certainly was told of all the drug interactions possible between all my meds prior to initiating treatment...including the interactions with alcohol, etc. Guess my VA hospital is pretty on the ball here in Colorado. And hey, Mark...best to ya in 2000 and thanks once more for all your good work. By the way, I'm doing a really important paper...could you give me statistics on....ahahahahahahhahaha! (Ed note. For those who recall the last Q & A, you'll know this emailer is a real wise guy ;-) ----------------------------

REALLY good article! It clearly explains the myriad of feelings possible when depressed, and the accompanying throughts regarding initiation of a meds trial. Its satisfying to reconfirm that I made the correct decision for me to bring my feelings up to my doctor. I knew something wasn't right, and I also knew that even though I could intellectualize what was happening, I COULDN'T CONTROL IT TO ANY DEGREE WITHOUT SUFFERING EVEN MORE. I'm off the med now, because of reactions to the med I was using, but I wouldn't hesitate to begin a new trial if my therapist recommended that it was needed. How marvelous to look forward to 2000 as the year of joy. God bless you for the wonderful work you're doing. Syl ~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Mark, Thank you!! You so eloquently explain the unexplainable. I'm forwarding this newsletter to (my husband), my in laws and my parents. This contains the answers to questions I didn't even know to ask. I'm so thankful to have your help on this journey.

Be well, Nance --------------------------

Thanks Nance,

Your heartfelt words also touch me and help validate my struggle to make sense of a once very confusing, at times overwhelming, extended period in my life. And also help reaffirm my identity as a writer with a message. We all need that occasional reaffirmation. To the good fight.

[More thought-provoking letters in Part II] ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

(c) Mark Gorkin 2000 Shrink Rap™ Productions