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The Stress Doc Letter
Cybernotes from the Online Psychohumorist ™

April 2000, No. 1, Sect. 1

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

Table of Contents

Heads Up:  Media Exposure, AOL/Digital City Chat and WebMD
Q & A:  Multimedia Training Livens the Health & Safety Message
Shrink Rap:  Cosmo Magic to Cyclothymic:  Highs, Lows & States of Flow
Readers' Submissions:  Hmmmm and Dear Reflection
Sect 2: Main Essay:  Good Grief:  Is It Mourning or Is It Depression? -- Part I

Heads Up:

1.  Media Exposure: 
a) recent interview with BloombergNews.com.  The issue:  Is the "24/7"
Informational Technology world actually creating more burnout for employees? 
Duh???; if anyone sees the interview, please let me know
b) look for the Stress Doc's sidebar tips for managing high anxiety and panic
in the July issue of Cosmopolitan Magazine; Cosmo may even use a "Shrink Rap"
(see Q & A lyrics below)
c) feature on the Stress Doc and his uncommon entrepreneurial --
online/offline -- mix in the airport publication, Washington Flyer, July 2000

2.  Chat Groups:
a)Once again, until the webchat bugs are worked out, AOL/Digital City Chat
Group  has to be limited  to AOlers.  Stop by my online "Shrink Rap (TM) and
Group Chat," Tuesdays, 9-10:45pm EDT.  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.

b)  The Stress Doc Teams with WebMD.com

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

Email me for April times.

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

by Jon Roig, Producer for Healtheon-WebMD, jroig@webmd.net...

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

Ask the Stress Doc
Work Stress Q & A

1)  Multimedia Training Livens the Health & Safety Message

(Ed. Note:  This question was first answered for workforceonline.com .)

Q.  My question is in regards to Occ. Health + Safety.  As a member of such a
workplace committee I am always on the lookout for new ways to present ideas
or tips on health and safety without them being boring or repetitive.  As
with most workplaces, the employees know the do's and dont's, but we forget
or take short cuts. I feel that "team" competitions could lead to
nonreporting of accidents. Apart from hypnosis, I have very few Ideas that
keep the employee aware of the issue at all times. Has Workforce Online
strategies in this field, or could they suggest where to look? Thanking You,

A.  Hi Mike, Todd passed along your request for new and fresh ways to present
ideas or tips on "Occupational Health and Safety."  Here are three
"multimedia" activities and workshop productions I use in my "Practicing Safe
Stress Programs:  Managing Stress and Building Team Morale through Humor." 
Clearly, these presentations can be part of a workshop; but they also can be
employed during brown bag lunches, at "all hands" or department meetings. 
And you may even create some lasting works of art…but I get ahead of myself. 
So, on with the show:

1.  Slam or Rap Session.   One of the most dramatic, amusing and memorable
moments in the workshop occurs after presenting some hard-hitting info on the
erosive spiral (and four stages) of burnout.  With a somewhat heavy tension
in the room, I suddenly announce having a secret identity.  I proceed to don
a blues brothers hat, black sunglasses and a tambourine with a sea of
incredulous eyes upon me.  And then the predictable groans when I a declare
that as a psychotherapist I’m pioneering the field of psychologically
humorous rap music, calling it, of course – "Shrink Rap" (TM) Productions! 
Here is, "The Stress Doc’s Stress Rap":

When it comes to feelings do you stuff them inside?
Is tough John Wayne your emotional guide?
And it's not just men so proud and tight-lipped.
For every Rambo there seems to be a Rambette.

So you give up sleep, become wired and spent
Escape lonely frustration as a mall-content.
It's time to look at your style of stress.
You can't just dress or undress for success.

Are you grouchy with colleagues or quietly mean?
Hell, you'd rather talk to your computer machine.
When the telephone rings, you're under the gun
Now you could reach out and really crush someone.

The boss makes demands yet gives little control
So you prey on chocolate and wish life were dull, but
Office desk's a mess, often skipping meals
Inside your car looks like a pocketbook on wheels.

Those deadlines, deadlines...all that aggravation
Whew, you only have time for procrastination.
Now I made you feel guilty, you want to confess
Better you should practice "The Art of Safe Stress."

(c)  Mark Gorkin   1992
"Shrink Rap" Productions

By the end the participants are cheering heartily.  Of course, I let them
know, "I can tell when an audience is applauding out of relief." ;-)  My
"fast food for thought" hits home.  And, of course, folks are more open to
serious content when the message is gift-rapped with humor.

So why not a team poetry slam or rap session with the focus being
occupational health and safety issues.  Perhaps you can record (or even
video) the best efforts and then strategically place the tape around the
workspace.  Hey, if Superbowl bound football teams can make their own videos,
why not your super employees!

2.  Discussion and Drawing Exercise.  In a two-fold exercise, audience
members are divided into groups of four and are asked to grapple with the
following:  "What are the sources of stress and conflict in your everyday
work operations?"  Why not ask folks to dialogue around the "barriers and
bridges" to occupational health and safety.  (I usually give the groups ten
minutes or so for discussion.)  Then the teams are challenged to design a
group picture (also in a 10-15 minute period) that pulls together their
individual ideas during the collective brainstorm.  The picture should be
some kind of symbol or tell a story.  I discourage team members from just
doing their own thing in a corner of the paper.  The goal is "a whole greater
than the sum of its parts."  (Large flip chart paper and boxes of magic
markers are provided each team.  I also let folks know that I’m a graduate
from the Institute for the Graphically-Impaired…Stick figures are fine.)

Being a bit outrageous is also encouraged.  Believe me, when doing these
programs, for example, with US Navy personnel I see sinking ships, folks
stranded on downsizing rafts, sharks circling the water, etc.   As the
drawings evolve the laughter in the room builds and builds.  The groups love
showing and telling their creative designs.  Again, why couldn’t some of the
better creations be hung up in work or break areas.  I think your employees
will respond to these homemade posters more than to the standard "rah-rah"
teamwork poster pattern.  (How often do your employees skull together down a
river with a deep orange sun setting in the background:?  Let’s get real!)

3.  Role Play.  Finally, having groups enact skits depicting workplace
safety/stress issues can generate a wonderful learning and sharing forum. 
(And we know accidents increase when people are overstressed or exhausted for
prolonged periods.)  These role plays are especially instructive and
effective when the safety concerns involve interpersonal conflict.  Role
plays are great mediums for acting out frustration and anger (passive or
explosive) and generating group problem-solving while modeling good
communication and conflict resolution skills.  The role plays are most
valuable when all levels of the organization – managers, supervisors, types
of employees – workfloor vs. office staff –  even, customers are
represented.  Again, the listening and learning is only outdone by the
audience laughter.  This exercise also lends itself to videotaping and
workplace distribution.  (Though if a particular stress carrier is singled
out in the skit, it probably shouldn’t leave the editing room.)

Experimenting with these three media approaches will help folks be more
conscious of key health and safety issues.  And the group participation,
design and play will both build department and company morale and insure that
the men and women in your shop…Practice Safe Stress!

Feel free to email stressdoc@aol.com if you have more questions or desire
more information and ideas regarding the above.  To good adventures.

Shrink Rap™: 

Initial musings on anxiety and physiological arousal and an unexpected
interview with Cosmopolitan Magazine stimulate personal examination of the
Stress Doc's own intense and fluctuating mood states.  One mood cycle and an
"aha!" yields a compact model for envisioning levels of arousal-activation.

Cosmo Magic to Cyclothymic:  Highs, Lows and States of Flow

What makes us anxious?  This question has been meandering in my mind. 
Recently, through both professional and personal roles, I’ve been directly or
indirectly involved in a variety of tension-generating scenarios:
-- government employees and contractors anxious about or intimidated by a
volatile, periodically verbally explosive and potentially violent office mate
-- a self-employed, highly technical employee concerned about a new client
drought and having to more aggressively network and market; he’ll be pushing
outside his comfort zone
-- a 30-something woman dissatisfied with her stint in therapy, wants to
change counselors and to bypass a closing session with her therapist
anticipating an angry, hurtful and guilt-producing exchange
-- a shy computer specialist asks for help in breaking the ice with a new
acting Division Head whom he perceives as "brusque"
-- a high strung woman who acknowledges feeling anxious during the break in a
workshop; she must keep busy, the word "relax" isn’t in her vocabulary
-- and my own pit in the stomach when presenting a fee to a
workshop/consulting client and there’s a pregnant pause on the line…Am I
being selfish or greedy?  Perhaps they’ll take their business elsewhere...

But anxiety or, more broadly, physiological arousal doesn’t just get jump
started by aversive stimuli or a problematic situation.  According to Elaine
Aron in, The Highly Sensitive Person, "Stimulation is anything that wakes up
the nervous system, gets its attention, makes the nerves fire off the
electrical charges that they carry.  Stimulation doesn't just come outside
but also from our body -- such as pain, hunger, thirst or sexual feelings or
as memories, fantasies, thoughts or plans...Arousal may appear as blushing,
heart pounding, hands shaking, foggy thinking, stomach churning, muscles
tensing and body parts perspiring."  Stimulation can vary in intensity (like
loudness or lustful excitement) or duration (usually short if real intense
lustful excitement ;-).  Arousal levels are also affected by stimulus novelty
(joyful surprise to shock) and complexity (from optimally challenged to
overwhelmed or bored).

Intense and exciting possibilities don't just turn on my motor; actually,
they often quickly have my engine racing.  In fact, one of those catalytic
cyber moments just occurred.  A writer for Cosmopolitan Magazine called
waking me from a post-lunch nap.  She wants some hands-on stress tips for
managing an anxiety or panic attack.  We conclude the phone interview with my
singing her lines from a "Shrink Rap."  She then wonders who wrote the
lyrics.  Hello…Can you imagine.  I told her, "Just wait.  Some day I may no
longer be just a legend in my own mind!"  She agrees to my sending her the
lyrics as a possible sidebar inclusion in the July issue.  (She also asks if
I have a book.  Do I have a book?  Hey gang.  Let’s not blow this deadline!)

Cosmo and Cosmic Cravings

And as soon as we hang up, the mind-body is juiced with adrenaline; the
electricity is running through me.  Wired is wonderful!  The feeling is
similar to when meeting a woman who turns me on, especially on multiple
levels – mind-body-spirit.  The state of "romantasy" quickly kicks in:  Is
she the one?  And if we go out and seem to have a real good time…How come she
doesn’t return my call?  Is she involved with someone else?  Has she sensed
my intensity?  Have I pushed her away already?  And if we've previously added
sex to this combustible mix, now why am I feeling so dependent so quickly? 
My agitation seems bordering on mania:  "an excessive, persistent enthusiasm
or craving; or obsession or craze for," as defined in Websters New Universal
Unabridged Dictionary.

When it comes to a woman that "turns me on," I seem to go from 0 to 100 in a
few barely perceptible ticks of the testosterone; from fantasy to romantasy
in a heartbeat.  Maybe it's being a Type A New Yorker.  Despite sixteen years
in New Orleans, I never did pick up a Southern accent.  Perhaps its pursuing
(and forever generating anew) artistic goals and elusive dreams or madly
circling around a fog covered and fame shrouded mountain career path that
keeps performance anxieties revved up.  My standing arousal level often
hovers between 30-50 on the emotion-motion meter.  Is this why I like hiking
in mountains...To get off the fast lane path and to help slow down my motor?)

Suddenly, an "Aha!".  It’s not just the excitement of the Cosmo pub or the
fantasy ideal woman…I crave, perhaps I’m habituated to, this physiological
juice, these mind-body chemicals coursing through me.  Could I be an
adrenaline and testosterone addict?

For years, make that decades, very challenging work and periodically pursuing
magical (and, obvious in hindsight, elusive) women have been standard
operating -- psychological and biochemical -- procedures for pulling me out
of my depressive base.  Of course, pursuing an unconventional path while
often struggling to hurdle that creative status and financial success bar
reinforced the feelings of despair, self-doubt and moodiness.  Frequently, a
self-induced electric current provided a jump start after my battery was run

Another "Aha!"  For many years my father received shock therapy for his mood
disorder, which was originally diagnosed as manic depression.  To escape the
biopsychological emptiness and ennui, have I become reflexively habituated to
my own self-medicating jolt?  And while not a direct issue, problems with
alcohol run on both sides of he family tree.  A propensity for addictive
behavior one might say.  And certainly for some denial.

It was only five years ago that I finally accepted that psychotherapy and
jogging alone could not touch the biochemical piece of my long-standing
clinical depression.  Still, much like Pavlov’s dog, a Cosmo interview or a
Cosmo girl almost immediately triggers flying and fantasizing.  These
provocative stimuli, like that Pavlovian bell, still can elicit remnants of a
deep hunger and present day salivation.  Formerly, when my clinical
depression was untreated, my biochemical gauge often hovered near empty.  So
despite my long-term trial with Prozac, perhaps this emptiness-excitability
pattern is a leftover habit if not a trait of habituation.

Predisposed and/or Addicted to Mood Swinging

Or maybe underlying all the various personality disorders and dependencies is
301.13, the DSM’s "Cyclothymic Disorder":  "the presence of hypomanic
symptoms and numerous periods of depressive symptoms that do not meet
criteria for a Major Depressive Episode."  (Some feel Cyclothymia is a milder
form of Bipolar Disorder.)  There’s a too close for comfort psychic fit
beyond my father’s original diagnosis; a number of the symptoms ring true,
especially when I’m "on":
1. grandiosity (fueled by resentment or rage and a cover for humiliation and
2. decreased need for sleep during the manic episodes
3. more talkative than usual
4. flight of ideas and racing thoughts
5. distractibility (especially by my own obsessions and free associations)
6. increase in goal-directed activity or psychomotor agitation
7. excessive involvement in pleasurable activities that have a high potential
for painful consequences (like impulsive romantasy pursuits).

And now it finally hits me diagnostically.  Okay, sure there’s been a
narcissistic sense of self-importance or occasional grandiosity.  And yes a
need for admiration, perhaps some whiny feelings of entitlement because of my
creative quest and struggles.  (Also some entitlement of favorable or special
treatment for past and more recent trauma endured.)  And yes, I have been
envious of others’ achievements while I labored in a darkly labyrinthine, "Am
I going anywhere?," career/artistic path. 

But, there’s not a diminished capacity for empathy.  I certainly have become
less and less exploitative of others as my depressive moods diminish and my
integrity and self-worth have increased; and for the most part, I’ve become
more humble than haughty.  Maybe what I thought was a
self-absorbed/self-centered personality dimension was at least influenced by
some biochemical or bipolar dynamic.

This differential diagnostic thinking presents another possibility.  Not just
narcissistic nourishment but some interactive mix of mind-body-chemistry,
complexity and creativity compels the public performer and writer roles:  the
stage (or computer screen) enables me to both act out and integrate drives
and needs to be both dynamic and dy-manic.  (And if you keep pushing the
psychic envelope, what’s next…demonic?)  Talk about being on the aggressive
and performance edge.  And after an intense program, if I’m not totally wiped
out, (people frequently comment on my energy and intensity as a workshop
leader and speaker) it can take hours for the churning chemistry and racing
thoughts to return to normally obsessive-introspective baseline levels.

Tea and Sympathy

Yes, with senses and mind focused the cyclothymia seems fairly palpable. Why
do these epiphanies take so long; all those decades before fully
acknowledging my chronic depression?  Today’s realization yields a psychic
clearing, not unlike when a morning sunshine burns off a heavy mountain mist.
  Horizons and landscapes loom large and seem newly framed and focused;
unforeseen connections and possibilities are beckoning.

But yesterday, the mist was thick at the tea house, it’s soft background jazz
and muted ambiance the right fit for my ennui.  Feeling vaguely inert. 
Nothing was cooking, inside or out.  Waiting for the editor to send the next
to last installment of the book manuscript for my review.  (After a final
explosion, we seem to have achieved a détente.  My concession:  she and the
house set the parameters of the forest and I try to plant as many trees as
possible while editing out wordy weeds and uninspiring shrubs.)  There was no
lingering self-righteous rage to get me pumped up.  Makes me wonder how often
we latch onto relatively trivial irritations or exaggerate an insult so that
mostly self-induced anger at others becomes a way to escape a low energy,
running on empty if not depressed state.  Aggression as self-medication.  My
father was an expert at that one, even without the alcohol.

Soon I’m getting antsy with my boring state.  What do I work on next?  Yet,
at the same time, not having a big workshop looming or a major writing
deadline lurking, pretty mellow is an apt description...if I can allow it. 
Maybe the Jasmine Pearl and simple sugared ginger scones are doing their
thing.  Suddenly, the double-edged nature of physiological arousal jumps at
me:  too little and I’m sliding into a depressed funk, too much and I’m
surging into mania.  And then there’s the search for that optimal level of
physiological arousal with it’s chemical and creative edge -- making work and
love productively exciting as opposed to destructively crazed.  It's an
exciting edge that, for the moment, I seem to have stumbled upon.

>From Mood to Model

And in this agitatedly mellow mood, trying to make sense of this edgy yet
fluid, if not somewhat volatile mind-body state, I visualize my "Four Faces
of Anger" matrix.  Can this be a template for representing states of
physiological arousal-activation?  But this schema will need two extra boxes:

1) levels of physiological arousal-activation:
    a) insufficient level
    b) excessive level
    c) optimal level.

2) source of physiological arousal-activation:
    a) internal – biochemical-psychological stimuli source (or the deficiency
    b) external – environmental-psychological stimuli source (or the
deprivation thereof)

Interrelating these two dimensions yields Six States of Physiological Arousal
- Activation:

A.  Internal Source of Arousal-Activation

1.  Emptiness-Exhaustion (Insufficient Levels of PA-A)
2.  Agitation-Manic           (Excessive Levels of PA-A)
3.  Relaxation-Meditation  (Optimal Levels of PA-A)

B.  External Source of Arousal-Activation

1.  Boredom-Inertia           (Insufficient Levels of PA-A)
2.  Phobia-Panic               (Excessive Levels of PA-A)
3.  Alertness-Animation    (Optimal Levels of PA-A)

Here's a sketch of a homemade matrix.  (Let me know if the matrix doesn't
travel well and I'll send it as an attachment.)

                                    Six States of Physiological Arousal -

                                                 Levels of Arousal -

                                         Insufficent           Excessive     
Arousal Source               
     Internal                         Emptiness-           Agitation-        
                                         Exhaustion           Manic          


                                          Boredom-             Phobia-       
     External                          Inertia                  Panic        

The above matrix clarifies somewhat a thorny dimension.  The Source of
Physiological Arousal - Activation Categories are not absolutely discrete,
that is, Internal or External.  One can envision a gradation or continuum (as
seen above) from Biochemical (Internal) to Environmental (External) Sources
with Cognitive-Affective (or Thinking-Feeling) moving fluidly along the
spectrum.  Sometimes Cognitive-Affective is more representative of internal
stimulation, other times it is primarily of the external variety.

Or, one might speculate that the interaction of inner sources of
arousal-activation (biochemical) and outer sources of arousal-activation
(environmental) is what yields or significantly shapes the
cognitive-affective dimension.  And cognitive-affective processing in turn
surely influences how biochemical and environmental arousal-stimuli are
perceived and experienced and reacted or responded to. 

Actually, it is the rich historical and ongoing mix of the biochemical
(including genetic predisposition), cognitive-affective (conscious and
unconscious) and environmental (interpersonal roles and communicational
relations) comprising a specific individual within a specific family, work
organization and/or socio-cultural system that determines aptitude and
motivational strengths and vulnerabilities, the limitations and opportunities
as well as the processes and products of a person's life journey.  And for us
humans there is much individual variation.  For example, skydiving or public
speaking may evoke arousal states of agitation or panic for one person and an
optimal level of animation, if not relaxation, for another.

Clearly, all the dimensions of the matrix excite or inhibit each other in an
ongoing feedback loop, affecting the functionality and vitality of our lives.
 The dimensional interplay influences the ability to:  a) manage one's
psychophysiological arousal and the resulting emotions, b) process and make
sense of past, present and future self-world information, including memories
and dreams, goals and visions and c) respond to everyday problems and

A Closing Example

By way of illustration, let's go back to that unrequited phone call.  If I
leave a voice mail message with a woman to whom I'm very attracted (someone
who is a trigger -- which I pull -- for my hypomanic response) and she
doesn't return the call that day (stress by omission) I'm a bit perturbed,
starting to get agitated.  As 24 hours move to 48, my rising agitation may
now be accompanied by feelings of rejection, some abandonment feelings and
memories fueling further resentment.  Stress levels can be further
exacerbated with such defeating self-talk:  "I need her so badly.  I'm tired
of being so lonely." Or, "What did I do wrong?"  From internal irritation and
rumblings to external "provocation," a minor panic state is setting in.  Why
is it so hard to rationalize the fact that the timing or chemistry or
compatibility just may not be the right?

Clearly, it's my interpretations of the silent void and the concomitant
feelings of loss and longing that shape the nature and intensity of the
stress gestalt.  The interpretations jump start the hypomanic rollercoaster
-- with the initial infatuated highs. Then, with the first signs of delay or
disappointment -- it's feeling deflated if not crashing down.  Clearly,
taking Prozac has smoothed out the mood disorder ride some which, for me,
reinforces how much the biochemical dimension is involved in this stress-mood
gestalt.  So, will I finally screw up my courage and call, prepared to accept
any and all possibilities?  Will being quietly centered and optimally present
help overcome my habituated, narcissistic and mood disordered ways?

Well, dear reader, I have to sign off for now.  Perhaps, the sketching of
this model is beginning to whet your appetite.  Next newsletter will begin to
define and explain the various states.  I will also expand the two optimal
states of arousal-activation into four "powerful" modes of being/responding. 
It's "food for thought" hopefully worth waiting for and it's a model to help
us...Practice Safe Stress!

Reader's "Higher Power of Humor" Section

Subj:    Hmmmmmmmmm
From:   garysos@earthlink.net

All those who believe in telekinesis, raise my hand.

I almost had a psychic girlfriend but she left me before we met.

Depression is merely anger without enthusiasm.

When everything is coming your way, you're in the wrong lane.

Hard work pays off in the future.  Laziness pays off now.

Everyone has a photographic memory.  Some just don't have film.

Shin: a device for finding furniture in the dark.

Eagles may soar, but weasels don't get sucked into jet engines.

24 hours in a day ... 24 beers in a case.....coincidence?

When I'm not in my right mind, my left mind gets pretty crowded.

What happens if you get scared half to death twice?

I used to have an open mind but my brains kept falling out.

If at first you don't succeed, destroy all  evidence that you tried.

Experience is something you don't get until just after you need it.

For every action, there is an equal and opposite criticism.

No one is listening until you make a mistake.

Success always occurs in private and failure in full view.

The colder the X-ray table, the more of your body is required to be on it.

The hardness of the butter is proportional to the softness of the bread.

The severity of the itch is proportional to the reach.

To steal ideas from one person is plagiarism, to steal from many is research.

The problem with the gene pool is that there is no lifeguard.

Monday is an awful way to spend 1/7th of your life.

The sooner you fall behind, the more time you'll have to catch up.

A clear conscience is usually the sign of a bad memory.

If you must choose between two evils, pick the one you've never tried before.

A fool and his money are soon partying.

Plan to be spontaneous tomorrow.

If you think nobody cares about you, try missing a couple of payments.

I'd kill for a Nobel Peace Prize.

Bills travel through the mail at twice the speed of checks.

Borrow money from pessimists-they don't expect it back.

Half the people you know are below average.

99 percent of lawyers give the rest a bad name.

42.7 percent of all statistics are made up on the spot.

Dear Reflection
From:  jokeserver@joke-mail.net

After being away on business, Tim thought it would be nice to bring his wife
a little gift.  "How about some perfume?" he asked the cosmetics clerk.  She
showed him a bottle costing $50.00.  "That's a bit much," said Tim, so she
returned with a smaller bottle for $30.00.  "That's still quite a bit," Tim
complained.  Growing annoyed, the clerk brought out a tiny $15.00 bottle. 
"What I mean," said Tim, "is I'd like to see something really cheap."

So the clerk handed him a mirror.

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

(c)  Mark Gorkin 2000
Shrink Rap™ Productions