The Stress Doc Letter
Cybernotes from the Online Psychohumorist
March 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: AOL and WebMD.com Chat Groups
Q & A: The Biochemical-Psychosexual Revolution
Shrink Rap: Learning to "Let
Readers' Submissions: Middle Age (siiigggghhhhh)
Sect 2: Main Essay: Word to Word Combat at the Book Publishing Battlefront
Announcements: Q & A Links/Archives
1. Change is in the air. All cyberites can now participate in my AOL/Digital
City Chat Group. Stop by my online "Shrink Rap (TM) and Group Chat,"
Tuesdays, 9-10:45pm EDT.
Go to: http://home.digitalcity.com/washington/webchat,
see DC Health Support Chat schedule. 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.
2. 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 firstname.lastname@example.org
or call 503.943.3279
For A QUICK GUIDE TO ENTERING WEBMD LIVE EVENTS: by Jon Roig, Producer for
(See end of Stress Doc Newsletter, MAR 2000, No. 1, Sect. 2 for Jon's Access
Ask the Stress Doc Love & Relationships
The Biochemical-Psychosexual Revolution: Getting Up and Close while Being
Down and Out
A recent email plugged a hole in my curiosity zone. I believe the original
series on my depression struggles and meds trials noted how reduced sex drive -
whether capacity for erection or for orgasm - was a not too uncommon side effect
of the new antidepressant SSRI medications. Around this time, another one word
pharmaceutical product was stirring the next medical-psychosocial revolutional
Prozac meet Viagra! And the inevitable question: which is greater, the immovable
object or the irresistible force? Or is it the irresistible object and the
immovable force? Careful, Doc, you're bordering on the psychosexually incorrect.
More to the point, could Viagra counter the libido inhibiting tendencies of the
new wave of antidepressants? And the first return is‚¶Well, good news and
Prozac and its SSRI cousins often have a variety of side effects, for
example, increasing general energy levels (though also inducing periods of
drowsiness) and, for some, seemingly stimulating aggressive energy displays.
These meds also help diminish levels of agitation and obsession. Yet, as noted,
Prozac also dampens sex drive. (Of course, depression when serious enough can
totally shut down interest in sex; mild-moderate depression, however, has been
known to turn some folks loose sexually, albeit, dysfunctionally.)
As for Viagra, it has an arousing effect by directing blood flow to the male
sexual organ. A guy gets pumped up, you might say. Some degree of sensitivity,
along with erectile capacity, are enhanced. So...what's the resulting
interaction -- is there any "chemistry" -- when Mr. P meets Ms. V? And
the practical question: should a male consider using Viagra routinely when
experiencing SSRI-induced sexual functioning side effects?
First Hand Account
Clearly, a male should consult his or her physician when pondering this
issue. But for right now, here is a reader's online/frontline report (the first
I've received) on the effects -- primary and side -- from mixing Prozac and
"I don't even try to masturbate anymore, as it just doesn't work. (Our
protagonist is on 20mg of Prozac. He's overseas, wife's in the states.) I was
VERY glad though that when she visited me recently I had my first opportunity to
test things out - taking Viagra during her time here. When I took the Viagra I
was able to achieve good erection. However, I still couldn't climax - which was
a real drag after enough time went by!! So this side effect is definitely one I
don't care for! The only good aspect is I do maintain longer - just no pot of
gold at the end of the rainbow. :( " (Of course, one suspects his wife is
not complaining too vociferously. ;-)
Well Mr. Good News/Bad News some consoling words, if as the say, "Misery
doesn't just like company but, actually, likes miserable company." More
than one puzzled "e-male" correspondent has bemoaned the absolute or
relative loss of a capacity to ejaculate on SSRIs. Other readers have also given
up on masturbation. Gee, talk about being disconnected from one's
consoling inner adolescent; from being deprived of momentary stress relief in
the palm of your hand, as it were.
Then again, sometimes there's an upside to being dammed (not damned)
auto-erotically. When practiced compulsively, masturbation may also reflect a
need to self-medicate (or to numb oneself) when feeling overwhelmed by
depression, rage or panic. And when regularly combined with pornography,
auto-eroticism may distort the ability to be emotionally intimate with a real
partner. Also, I believe the latest statistics indicate that as many as 200,000
folks (mostly male, I suspect) are likely addicted to online pornography of some
Of course, some men are hypercharged by agitation, an aggressive power status
or drive and/or "The Big Dipper"-like testosterone levels. (For
example, think of certain bipartisan residents of Washington, DC.) But for mere
mortals, as a man ages and matures (or, at least, as some do) there often needs
to be more than just a physical turn on for achieving satisfying sexual
performance. And for genuine sexual and emotional intimacy...well, better living
and relating takes more than just chemistry!
So today, let's grapple with how depression impacts the ability to
healthfully and passionately unite sexuality and intimacy. (I'm as curious as
you to discover what we uncover.)
1. Depression as a Biochemical Catalyst for Thrill-Seeking. If the depression
state isn't completely overwhelming or paralyzing it can easily fuel risk-taking
and addictive behavior. For example, one study found a relationship between mood
disorder and compulsive gambling. The gambler needed to create excitement for
temporarily escaping his moodiness. Of course, this usually produced a
self-defeating and even more depressing outcome.
In addition to abusing substances like food and drugs, to compensate for
diminished levels of mood regulating serotonin and dopamine, a person may
self-medicate naturally through relentless aerobic-endorphin producing exercise
or through sexual obsession and predatory activity. (Now some folks combine
both, though it usually takes a very good male for sexual activity to rise to
and to sustain aerobic levels. ;-)
So adrenaline and testosterone are often working overtime to fill the
biochemical and hormonal gaps. And a variety of chronic stress conditions may
result, including high blood pressure. Not just your hormones but your heart is
at risk with unrecognized or untreated depression.
2. Depression as a Psychphysiological Catalyst for Diminished Energy. While
depression often induces exhaustion, the prevalent image of a person cowering
under covers or retreating to a bedroom for days and weeks doesn't do justice to
the mind-body complexity. For example, let's look at agitated depression. A
restless night, an inability to fall back to sleep, easily induces grogginess
and fatigue. However, the same agitated component can have the depressed
individual jumping out of bed at first morning light. For example, a
hyper-depressed trait had me at a writer's desk two minutes after waking,
without coffee. However, I could not sustain the intensity and concentration for
long and would invariably crash. And it takes energy to preserve and recognize
3. Depression as a Catalyst for Low Self-Esteem. Clearly, if you can't fully
control and predict your own energy level, your ability to focus or to start and
sustain tasks and achieve goals then seeds of self-doubt, unworthiness and
inadequacy are being sowed. Dreams too are abandoned. Why is it that other's can
be more disciplined, motivated and successful? And, of course, it's a short step
from unfavorable social comparison to two distinct yet complementary
"survival" patterns: a) avoiding others one finds ego deflating or
intimidating or b) anxiously needing and soliciting the approval of others.
Clearly, we are talking dysfunctional, often depression-inducing codependency.
4. Depression as a Catalyst for Psychosexual Fusion. A common experience for
the clinically depressed individual is a profound sense of emptiness. A body
aching yet, paradoxically, hollow inner feeling. One's inner foundation and
scaffolding is fragile at best. For example, at nineteen, when my parents
unexpectedly announced their separation, with my father moving out, I
instantaneously burst into anguished crying. Not only was my family structure
crumbling, but my personal facade was cracking: my inner hollowness was exposed.
The game that a family and a child can cruise along blindly and self-deceivingly
was being shattered. Yet, as the artistic giant, (though, perhaps, relationship
pygmy) Pablo Picasso noted, "Every act of creation is first of all an act
of destruction." Thankfully, the dissolution trauma was the beginning of a
long and painful recovery process:
What made him break
Perhaps we'll never know.
But in the wake
Of psychic quake
The formula to grow.
The silence cracks
Each spouse attacks
The couple hardly known.
But on these tracks
Of broken backs
However, at the time and for a seemingly interminable future, profound
self-doubt lurked and stalked in the background and foreground.
And one way to shut down this chaotic Intimate FOE: Fear of Emptiness/Fear of
Exposure become symbiotically attached to a partner. And the more intense the
sexual relationship the more potent the anesthetic. There's the illusion of
plugging the black hole of depression. With this desperate attachment, the
depressed individual seemingly feeds intravenously off a partner, ravenously
sucking away energy nutrients and ego needs. Or one can project feelings of
inadequacy through hostile attack. And, surely, aggression and sex can also feed
off, if not fuel, each other. And now those sexual hormones are percolating and
pumping throughout the system. Alas, what goes up fast and over the intensity
edge usually comes down fast and painful. Fuse hard - die hard!
5. Depression as a Barrier to Quietness and Separateness. The flip side of
needing to numb and fuse is a profound difficulty living and relating in a state
of quiet. We extol human doing not just being with another. First, with all the
turbulence underneath the heavy depressive cover there's a fear, if not terror,
of stillness and quiet. Stillness, for the depressive, borders on emptiness
which can so easily morph into another "bottom of the dark and dank
pit" free fall mood cycle.
Conversely, some of us use a manic-like, Type A achievement frenetic mode to
defuse the depressive demons and impress a potential partner. Letting go of
talking about work, especially of the high of one's most potent sources of
identification and pride (for example, children, creative achievement, etc.)
robs the emperor or princess of his or her clothes, that is, one's persona or
Now suddenly, one is vulnerable, shamefully flawed. Who would want to get
close to this wounded, needy, spineless, bottom of the barrel creature. As Simon
and Garfunkel observed decades ago, the "Sounds of Silence" can be
6. Depression as a Catalyst for the Separation-Attachment Catch-22. The
eternal bind for the depressed individual is a need to numb the "chasmotic"
inner dead and dread. (Chasmotic is my newly minted term uniting chasm (or
disconnection and emptiness) and the chaotic. The depressive longs for and
urgently seeks a sheltering partner from the storm. But as the storm is
primarily inner, three possibilities likely unfold, especially as one gets
increasingly intimate, physically and emotionally: a) a fear of psychological
abandonment, that is, "something always goes wrong," "this good
feeling can't last," "the person will eventually leave me" (or
what's wrong with her for wanting me, anyway?"), b) a bailing out strategy
‚ "I'll reject you before you reject me," and c) a tendency to
find fault as the infatuation and hormone levels dim with an increasingly
"obvious" imperfect mate. Yet, when the depressive isn't
self-isolating he or she often will do almost anything not to be left alone or
left out. The person too often lingers in a dysfunctional, ever critical and
dissatisfied dance. Of course, if playing the role of the depressive's moody
target, you are inviting your own "sympathetic," codependent mood
So the depressive wildly swings between what pioneering psychoanalyst Otto
Rank called "The Life Fear and the Death Fear": The life fear occurs
when the individual is afraid to separate from another for fear of isolation and
emptiness. The death fear prevents closeness; it's the terror of being swallowed
up, of losing one's sense of self in a too entangled, too smothering or, even,
too intimate bond.
7. Depression as a Barrier to Trusting and Saying, "I Love You." If
the depressive is forever caught in approach-avoidance mood shifts, chasing then
running from commitment traps or clinging to codependent fusion one condition is
obvious: there's no sense of a solid center, no clear sense of integrity. To be
able to trust, openly not blindly, in a give and take adult relationship
requires an ability to declare: "This is who I really am" (no matter
what you may think or feel, or what I believe you think or feel). "This is
what's happening to me in relation to you" (whether you think it's right or
wrong, good or bad. And you are free to disagree.) "I have these thoughts
and feelings I need to express constructively -- firmly, or tentatively,
passionately or rationally" (whether you decide to stay or withdraw).
One must build trust, not simply declare it. Like commitment, trust evolves
or erodes over time and space. And, of course, for the on the edge, untreated
depressive frustration tolerance and patience, capacity for risk and for
closeness are qualities often dangerously low in supply.
Clearly, there's a powerful interaction when mixing depression, sexuality and
the quality of relating. As the German philosopher Friedrich Nietzshe observed
in Beyond Good and Evil over a hundred years ago: "Sensuality often forces
the growth of love too much; so that it's root remains weak, and is easily torn
up." Nietzshe, a brooding genius, understood that a dark mood unchecked
while seemingly cultivating the ambiance for romance, more likely yields a
"romantasy" fungus. Craven sensuality and unchecked clinical
depression erodes or suffocates the foundation of genuine friendship and the
potential for a loving, sexually intimate partnership. This volatile mix makes
an endangered species of "Four ‚C'-ing Love," a love based on:
Chemistry, Caring, Cosciousness and Commitment. As that other, more contemporary
yet no less soulful philosopher, Diana Ross, succinctly noted: "You can't
For a future edition, thoughts on my ongoing learning curve about slow growth
intimacy. For now, here's to a psychological and, if necessary, a biochemical
process of doing and being that transforms depression and romantic addiction
into patiently assertive and quietly playful exploration. It's a mutual sharing
that also allows us to‚¶Practice Safe Stress!
The Stress Doc starts taking some of his advice about setting limits and
"letting go." Not just mind-body exhaustion, but self-perception and
creative expression are at stake.
Learning to "Let Go" Not Knowing Where You're Going...Yet Trusting
You Will Get There
"Letting go." One of those pithy phrases that has multiple semantic
shadings: a) letting it all hang out, b) letting it rip, going for it, come what
may, or conversely, c) giving up the dream or illusion or, even, cherished
belief, d) accepting the loss, especially the ability to control another, and e)
no longer fighting or denying reality; going with the flow.
Letting go is on my mind these days. Two developments have insured this state
of mental affairs: 1) the beginning battle and ongoing skirmishes with my book
editor for the structure, style and soul of Practice Safe Stress with the Stress
Doc (see today's "Main Article") and 2) the recent increase in
conflict mediation, stress and team building workshops and speaking engagements.
The speaking/consulting work is being generated by repeat business along with
marketing team and new web site-bookings.
Also, I just discovered an old college and basic training bunkmate paved the
way for me to speak at a legal conference in New Orleans. Neal and I had been
out of touch for decades. Then, a couple of years ago, through the magic of the
Internet, Neil finds me. I again let our connection slip away. Mr. G, now
President of this legal association, insures the conference planner I will speak
for less than my regular fee. That old wily fox! And the bond is as natural and
close as ever. So maybe you can let go, even more than once, and come together
And, of course, there's a distinct connection between public speaking and
letting go. I'm envisioning using my highly popular discussion and drawing
workshop exercise with audiences as large as three hundred. We're attempting to
generate a psychohumorist art happening, if you will. I've done it successfully
with a hundred or so. Can it work with three times this number? So I'm trying to
follow my opening process as outlined in, "Creative Risk-Taking: The Art of
Designing Disorder": Aware-ily jump in and "let go" or
"strive to survive the high dive." (Okay, as an honorary native of N'Awlins,
check for alligators before taking the plunge. And email me for the risk-taking
And today, there is another time and place for letting go; not as a stage
performer but as a deadline writer. With the aforementioned engagements and the,
prayerfully, final stages of manuscript editing generating a bimonthly
"Notes from the Online Psychohumorist"‚Ę for the short-term
future is beyond my grasp.
How hard it is at times to acknowledge the obvious, to reconsider an egoal
standard, especially when one's goal and ego are both precariously intertwined
and inflated. For my friend Hank (who has been one of the Stress Doc literary
beta testers long before I even knew the term) it was a no-brainer. When I
recently admitted "defeat," that is, acknowledging being able to just
squeeze out one newsletter in March, his reply: "Good. I'm glad you're not
being so compulsive."
It's true, too much of my own identity and self-esteem is tied to being
productive as a writer. This may be due to late blooming. Also, for many years I
had great doubts about my writing abilities. The lurking fear: "Use it or
lose it!" If I don't write constantly or, at least, consistently, the magic
may disappear. The red hot, glowing burning charcoal psyche will die down into a
warmish wimpish ashen afterthought. Never enough heat to spark combustion, just
a low grade fever. And, truth be told, having for years labored in relative
obscurity both as a speaker and writer, there's the fear that if I don't keep
performing, I'll again lose both the edge and my stage. (And I must say how
reassuring it was getting several emails from readers wondering when the
newsletter was coming out.)
The other vital problem: obsessively pondering, "Can there be life after
deadlines?," is choking off the creative wellspring. Constantly trying to
be original or imaginative on demand feels like the paradox engendered when
someone suddenly barks at you, "Be spontaneous!" Your disoriented,
paralyzed look comes closest to being the authoritative answer to the
And it's also the way my brain feels trying to grind out uncommon work
without enough down time. Living on the creative edge requires periodic
retreats, taking an incubation vacation to hatch a new perspective. Hitting the
wall stirs what psychiatrist Richard Rabkin called, "thrustration." I
have defined this neologism thusly: when you're torn between thrusting ahead
with direct action and frustration as you haven't quite put together the pieces
of the creative puzzle. Thrustration which retreats into an incubation vacation
is sowing the ground for...Aha! Creative retreating as "letting go."
It's suddenly obvious: life does not have to be all or none. I'm reminded of
a classic New Yorker cartoon. A humble looking Charles Dickens is being dressed
down by his self-righteous, power-suited, power-desked publisher: "Really
Mr. Dickens, was it the best of times or was it the worst of times? It can
scarcely have been both!"
So once I realize the issue isn't putting The Stress Doc Newsletter on the
shelf but temporarily limiting publication to one newsletter per month, letting
go feels affirming. (And it probably is a mutual relief, especially if feeling
bad about being a two or three newsletters behind in your reading. Remember, you
can always delete a newsletter guilt-free. Three deletions, then I might start
inquiring, "What's your problem? Are you feeling overloaded? ;-) And now
there's a solution: "letting go." Just keep in mind this newsletter's
opening lyrical anthem:
Fight when you can
Take flight when you must
Flow like a dream
In the Phoenix we trust!
Letting go...It's a vital tool for keeping your cool and for helping us
all... Practice Safe Stress!
Reader's "Higher Power of Humor" Section
MIDDLE AGE (siiigggghhhhh) From: MissPastel
Maybe it's true that life begins at fifty. But everything else starts to wear
out, fall out, or spread out.
There are three signs of old age. The first is your loss of memory, the other
two I forget.
You're getting old when you don't care where your spouse goes, just as long
as you don't have to go along.
Middle age is when work is a lot less fun -- and fun a lot more work.
Statistics show that at the age of seventy, there are five women to every
man. Isn't that the darndest time for a guy to get those odds?
You know you're getting on in years when the girls at the office start
confiding in you.
Middle age is when it takes longer to rest than to get tired.
By the time a man is wise enough to watch his step, he's too old to go
Middle age is when you have stopped growing at both ends, and have begun to
grow in the middle.
Of course I'm against sin; I'm against anything that I'm too old to enjoy.
A man has reached middle age when he is cautioned to slow down by his doctor
instead of by the police.
Middle age is having a choice of two temptations and choosing the one that
will get you home earlier.
You know you're into middle age when you realize that caution is the only
thing you care to exercise.
At my age, "getting a little action" means I don't need to take a
Don't worry about avoiding temptation. As you grow older, it will avoid you.
The aging process could be slowed down if it had to work its way through
You're getting old when getting lucky means you find your car in the parking
You're getting old when you're sitting in a rocker and you can't get it
You're getting old when your wife gives up sex for Lent, and you don't know
till the 4th of July.
You're getting old when you wake up with that morning-after feeling, and you
didn't do anything the night before.
The cardiologist's diet: if it tastes good, spit it out.
Doctor to patient: I have good news and bad news: the good news is that you
are not a hypochondriac.
It's hard to be nostalgic when you can't remember anything.
You know you're getting old when you stop buying green bananas.
Last Will and Testament: Being of sound mind, I spent all my money
Seek the Higher Power of Humor: May the Farce Be with You!
(c) Mark Gorkin 2000 Shrink Rap‚Ę Productions