shaped by life experience. once we understand them at that kind of vital level, then i think that we can do what people want us to do, like tugging in your head, namely to free them from these particular burdens and not having anybody else in the world relate to you, or understand on the outside. that deprive them of their humanity, i would call my best friend and say, that deprive them ultimately of that great thing that human-- "i feel like i'm on the elevator to hell." that the healthy human being mentally has, namely his freedom, his freedom to choose, and i would just go down. his capacity to develop a sense of responsibility for himself narrator: one in four families have a loved one who suffers from some form of mental illness. and his future, which are hindered with psychiatric disorders. i thought about a future and going to school again, and having a relationship with my parents and having my friends and having all these things that i want to in life, but having them completely, and being able to be a whole person as opposed to an eating disorder person, because it was so unpredictable and so up and down, and i know that's not who i am. i have learned that i need to cling to life. i want other people to know...

that it's worth trying. it's worth seeking help, that it can be better, that it really can be better. "how are you feeling today?" so often, the response to that question depends on a person's mood. people who have a positive mental attitude can deal with the challenges that come their way. they accept themselves, have an optimistic yet realistic outlook on life, and cope effectively with change. deborah khoshaba: a healthy person develops the kind of self care skills-- whether nutrition, exercise, self help and so forth-- "the human condition is a 26-part series develops the sort of skill sets about health and wellness. for more information on this program where they are always developing their ability and accompanying materials, call 1-800-576-2988 to engage in the world. or visit us online at www.intelecom.org. the person who's in good health... is able to do the things they want to do. there are not impediments to their being successful and productive at work,

being engaged in their family, having social activities. they also are able to enjoy life. yet, many people aren't able to enjoy life... their functioning impaired by some form of mental illness. james curran: well, one of the largest problems in the world is mental illness. it's poorly understood, it's stigmatized in virtually every society. the world health organization estimates that depression will be the most common cause of morbidity in the world, in the next several years. it's difficult to estimate problems such as anxiety, depression, other mood disorders affect our health. the causes of mental illnesses are often as varied as the people they affect. paul mchugh: some psychiatric disorders are due to a damage or an injury to the brain,

and thus can be construed as diseases, and the problem that the patient faces in life is what they have... they have alzheimer's disease, they have manic depressive disorder. and then we have to come up with techniques they have schizophrenia. on the other hand, those aren't the only ways to help individuals to learn to live with some of it that we can experience mental trouble in our life. because we can't do without it. a certain amount of conflict, it's facilitating of growth, some of the things that give us trouble, is how we're constituted. both on a personal as well as a social level. not what we have, but who we are, stress, to me, before october 6, will influence how we feel in certain situations, would have been a very busy day with a lot of activity. and sometimes how we feel in certain situations becomes so distressed, we need help with it. all that changed dramatically after october the 6th. and then finally, everyone knows and appreciates that you can have difficulty in life because of what's happened to you, what you've encountered. damage to the brain... the interplay of personality and environment... difficult life situations... all can contribute to mental distress.

so can family history. andrew leuchter: if an individual has a first-degree relative, that is a father, mother, brother, sister, who suffers from bipolar disorder, manic depressive illness, or from depression, they are at significantly increased risk for having a mood disorder themselves. narrator: we all know about stress. we live with it every day-- a mood disorder is an emotional state, the stress of driving crowded city streets, meeting deadlines, paying bills, that to some degree, interferes with social, ggling the manobligations and activities in our lives. familial, occupational functioning. you may be expected to work 60 or 70 hours a week, the most common mood disorder throughout the world and you're trying to balance home life is depression. with work life and being a parent andrew leuchter: depression can strike anybody at any time. and all these different social and cultural roles. and those are stressors, i think, there is no way of predicting who's going to get depressed. that throughout the centuries people have felt, relative to their own time frame. anybody from the highest functioning corporate executive, gail wyatt: we need to appreciate, it's not just adults to somebody who is laboring day-to-day, who are stressed. kids have a lot of pressure on them, to do their homework, to have friends,

anybody can suffer from a depressive episode. to make friends, to-- you know, connect in so many different ways, to participate in extracurricular activities, i had a good life. to do well, to be what their parents want them to be, i had good parents, i had a good upbringing, lots of stressors. i had a good education. a certain amount of stress is necessary for life. it was all good, pretty much. andrew leuchter: one way of thinking of depression is deborah khoshaba: on a moment-to-moment basis, that we all have a normal mood regulating mechanism our body is always and we all go up and down, in the process but it's when you get stuck down, of gauging how much arousal we need to function. it's not just that you've gone down, but you go down and you stay down for weeks. okay? i was an adolescent, somewhere around 11 or 12, see, right now as i'm speaking, my sympathetic nervous system is on, and i can remember sitting in our living room in the dark, and although i don't feel anxiety, i do feel a certain amount of arousal. and just not really wanting to communicate with anybody, you would say the organism's under stress. not wanting to say anything, so stress is a very interesting term just-- and i would have these thoughts that said, in that sense, "they don't really love you. they don't like you. that we're wired to respond to the environment. you're not worth anything," and they were just over and over. for many people, and i just began to retreat and thought, "well,

stress is so ingrained in their lives i'll just be quiet." that it begins to feel natural. andrew leuchter: if somebody comes in a stressful life situation, they have a depression, you'd be surprised how few people know they say, "doctor, this has never happened to me before." what stress really is, because they're so accustomed to it. we treat them, they get well and they stay well. it becomes part of their everyday world, and they can't appreciate it until they get away from it. unfortunately, many patients have had a previous episode chronic stress becomes a real problem and will go on to have huger episodes. if nothing is done about it, and there's an accumulative effect. once one has had a single episode of depression, the more chronic stress you have, the lifetime risk of recurrence, the less acute stress it takes the chances of having a second episode are about 50%, to push you over the edge and vice versa. about a coin toss. when faced with a stressful situation, beverly: when i got to be early 20s, chronic or acute, the body gears up to respond. and i worked at big general hospital your mind gives your body in the psych unit, no less, a signal that there's danger, is when i began to really understand and your body mobilizes to meet the danger. that there was something wrong, it's all it knows how to do in a circumstance like that, and that i needed some help. and that's the so-called fight-or-flight reaction. i ended up having a big episode of crying. the symptoms are recognizable. i mean, i just cried. i cried for three days. salvatore maddi: your nervous system gets very aroused,

i stayed home from work, so you're going to be tense. and i-- you know, i had life problems but they weren't huge. you won't be able to sleep very well, you may not be able to concentrate very well, i had a job. you may feel anxious, it wasn't like i was going to be homeless or that kind of thing. your digestive system will get suppressed, i was just so down all the time. your body resources will get transformed into sugar an obviously depressed mood is the most common manifestation of depression-- for the muscles and the brain so that they can do whatever they need to do loss of energy, quickly and strenuously. difficulty functioning on the job, feeling like you can't cope at home, through the ages, this has been the body's normal reaction to stress, feeling like you just want to withdraw and do nothing. to surviving a difficult situation. i would go inside myself and feel inside myself, but if you don't pay attention to it, and you do nothing to resolve and not talk, the stressful problems that cause that... not want to watch tv, the time will come not want to do anything, when your body will be depleted of resources. and then eventually, i'd go to a sleeping mode; you know, the fight-or-flight reaction i'd want to sleep a lot. is a little bit like you can't just say to yourself, driving your sports car, "snap out of it and get back on your feet." you know, at engine revolutions beyond the red line. some people with depression can force themselves to get out of bed, how long can you do that before there's a breakdown? but they can't force themselves to enjoy life.

they can't force themselves to concentrate. and the breakdown, not unlike the overcharged sports car, there are actual changes may result in physical damage to the body. in neurochemistry in the brain, salvatore maddi: hans selye, the canadian physician, won a nobel prize for that. there are changes in hormones in the body. diseases of adaptation, he called them. there are actual physical, they're breakdowns. wear-and-tear diseases. biological factors that prevent the depressed patient heart disease, cancer, stroke, osteoporosis, alzheimer's disease, probably. from being themselves. there's a whole range of so-called wear-and-tear diseases that can be hard to convince people of. that are the result of prolonged strain. there is a tremendous stigma against mental illness in general, and depression in partular, in this society. prolonged stress can also lead ...and i kind of go into a shell when i'm having an episode, to breakdowns in relationships. we call them behavioral breakdowns. because i don't want to hear that it's nothing, let's say you're so preoccupied with your work and that i can just, you know, and all of the stresses in it pull up on my boot straps and move on, that you can't open up to your family because sometimes you just can't. and give them empathy and support andrew leuchter: the key thing in terms of understanding depression in their problems. well, you're courting divorce. is that this is an illness, not a weakness, - come on in, joe. - i'm sorry i'm late. and that we need to treat this illness

let's say you're so preoccupied with your stresses in such a way that patients can get over it. that you can't meet deadlines at work. beverly: i mean, if you're wheezing and you can't breathe, well, you might lose your job. if it happens again, i'm afraid you can look for another job. then people understand the research shows that it's not stress that there's something seriously wrong with you. that does you in per se, okay? but if in your mind you're not having okay thoughts, it's your ability to make use of the stressor they can't see that, and they don't understand. in a way that adds to your life meaning. and they don't have the compassion. the major struggle that we face in psychiatry, and what i mean by this is that we all have stress, is, i suppose, overcoming the stigma but the organism that doesn't get undermined by stress associated with mental illness. patients don't want to come in for treatment. looks at the changes in life, you know, they feel that they're being labeled. like, "well i've been transitioned from a job," the ability to get somebody into treatment, or this happened, or this happened, and they make meaning out of it to provide adequate psychotherapy, that adds to their story line is greatly hampered by the fact and moves them forward in life in a productive way. that there is commonly very, very little coverage why is it that some people seem to deal with stress for anything more than an initial consultation more effectively than others? or maybe a medication visit or two. of course, this can be complex, in the sense that

i've had to look for clinics, the person who manages stress most effectively free psych clinics, to get the support that i've needed. is also an organism i've been fairly fortunate in finding them, that has a high capability for judgment, because i couldn't afford it. that, in other words, "okay, this happened to me, and this happened to me. when i was going to virginia at the beginning of february what can i do, given my current resources, to be with my daughter, my past history, it came up that i needed to get my medicine and what i want which is realistic, and it wasn't time yet with the insurance. what can i do to move me out of the stress so, i said, "well, but i'm going to be out of town and back into a lifestyle that feels fulfilling?" when time comes, and i need my prozac, you know. dr. maddi began studying this phenomenon, gotta have it." and they said, "well, they won't authorize it, this positive response to stress, so you'll have to pay regular price," which was $400 with workers whose jobs were threatened by the break up of at&t. for a one month supply. salvatore maddi: we were doing a longitudinal research study and at that point, i felt like, at illinois bell telephone at the time, and, you know, we were confronted if i can't get my medicine, if i can't make enough money to buy it, with some people who just fell apart completely i don't want to live. in the upheavals that took place there andrew leuchter: we have 20 different anti-depressants on the market when at&t was federally deregulated,

that differ in their particular chemical profile, and the companies were-- there was mandated divestiture of them. but there were some people and we want to choose which medication who actually thrived on the upheavals, is most likely to help that individual as well. and we were confronted with those data, so, it's a matter of getting the patient to stick with the treatment, and we were trying to think of ways of referring to it easily, and, you know, we started saying, well, encouraging them to work through any side effects these "hardy people," you know? and so that was kind of the beginning they might have from medication, of the concept of "hardiness." getting them to stick with treatment long enough deborah khoshaba: hardiness is a term of resiliency. for the anti-depressant effects to kick in. it's about a set of attitudes now have you noticed your mood change that a person has that helps them to transform the problems in the last couple of weeks? yes. that they encounter in life i tend to question my feelings, in a way that enhances their performance, where as before, it was just how i felt. their morale, their conduct, and their health. but now, is this me or is this the medication? salvatore maddi: it's a pattern, a personality pattern you know, should i act on this, where you have certain attitudes or should i ask somebody to look at me, and certain skills, or tell me if i'm okay? a sense of commitment, a sense of control, andrew leuchter: psychotherapy is vital in this. and a sense of challenge. if you have a strong sense of commitment... number one, we've got to give the patient support they need, help them get over their life problems, what's natural for you is to involve yourself but also offer some encouragement

with other people, involve yourself to stick with the course of treatment. with whatever's going on, rather than hang back beverly: it gives me a place where i can come and say and feel isolated and alienated. anything about whatever's happening in my life, if you have a strong sense of control, and not feel that i'm being judged for it... it's natural for you to struggle and try to influence the outcomes that are going on around you because i depend on the philosophy rather than just sink into passivity and powerlessness. that therapists are there to help and not to judge, and all of that. and if you have a strong sense of challenge... and i use that as my place to vent and talk about anything. what feels natural to you is to continue to learn if somebody has had a particularly severe depression through your experience. i might tell them, "i think you should stay on medication long-term, but how do we know if we are effectively dealing for many years, possibly for life." with the everyday stress in our lives? the medications we have now, the newer drugs, salvatore maddi: one-- you've got to be able to recognize are pretty transparent to most patients. a stressful circumstance as stressful. they can't tell they're taking them, two-- there are minimal side effects and no long-term risks you've got to feel as if you can really do something effective about it. three-- to taking the medication. you have to turn it into a problem to be solved, so there really is very little downside

to staying on the medications. find a way to solve it, and carry that out. i told my girlfriend, i said, "i feel like i'm on the edge of a cliff and i can fall off at any time," you know. now, if you're able to do all of that regularly and that i do kind of stumble and fall, as stressful circumstances come up, but with the help of my medications, you're hardy enough. i don't fall so far and stay so long. but not all people are equipped with the attitudes and skills to deal with stress-inducing events. mood disorders are just one category of mental illness. deborah khoshaba: they may say intellectually, another is dementia-- "oh, well, you know, i know life isn't fair." when people experience impaired cognitive functioning, and intellectually, they will verbalize that we know this happens in life. memory loss, delusions. dementia can be caused by brain injuries and tumors, emotionally, they don't really accept it. or it can be part of the aging process, and the other part of self that's still like a child as in alzheimer's disease. and, "this should not be happening to me," one form of dementia is the thought disorder, schizophrenia. that ends up being-- ends up really... andrew leuchter: the most clear cut example of schizophrenia turning the stressor is where somebody has delusions or hallucinations. into something that becomes really unmanageable. but the classic delusion would be... the belief that somebody is out to get you, the hardiness institute, founded in the early 1980s, that you're being followed, that you're being spied upon. is helping people develop qualities it's frightening, at first. that will allow them to look at stress

you can't distinguish reality from fantasy. in a whole new way. deborah khoshaba: basically, what we do is there also are hallucinations, we help them to become very aware that one hears voices. of the physiological signs it used to be kind of scary. that their body is starting to be too aroused, i'd just sit in my room and so if they can really cut that off at the pass, and listen to the radio. i couldn't even watch tv for 4 or 5 years, okay, their body never gets to a point because i just felt nervous. where they're manifesting those symptoms. i don't know, the tv was sending out messages and stuff. and then... once we help them manage their physiological stress, in the last 30 years, and they're more comfortable, we help them deal more as treatments for schizophrenia have become more sophisticated, with the cognitive and the emotional components of their stressors. victims have the hope of an most normal life. salvatore maddi: you start with what we call andrew leuchter: anti-psychotic medication situational reconstruction. can help to dissolve hallucinations and delusions, this is a technique but also can help to order thoughts-- that asks you to become a kind of novelist can help to restore thought patterns to normal, about your own life. just let your imagination go and think of a way and bring the patient out of a negative symptom state. in which the stressful circumstance could be even much worse than it is. it's pretty miserable without medication. i recommend a lot of people to be on medication if they need it. feeling as though i don't have any help...

support from other people. some patients with schizophrenia will get back to normal function. salvatore maddi: the next step is to think of how commonly patients with schizophrenia the stressful circumstance could be better than it is, don't quite get back there, and the same thing there. you make up a story about it-- and we really need to work on rehabilitation what would have to happen? having done that, you step back from your efforts and social skills training in addition to medication to maximize their function. and ask yourself whether... since i've started taking the medicine, you've been able to put the stressful circumstance and staying on it, in a broader perspective i can distinguish reality from fantasy, because of this kind of spading up the ground. and i say, "hey, that's my illness," you know? there are patients who 20 years ago see, what you're looking for is deeper understanding. would have been locked up in an institution for life, that's all mental. who are now able to live in the community, and if the answer is yes to both of those, commonly hold down some kind of job. then you transcend the mental approach the causes of schizophrenia are unknown, into action. you make a plan of action but the brains of people with this disorder that can carry out what you now know, tend to have biochemical or structural defects and you act on that plan. that may be inherited. andrew leuchter: when you look at the brain of a patient with schizophrenia and then when you get feedback from that, you use the feedback what you commonly see is that first to recognize the value of your efforts that there has been some shrinkage of the brain and to deepen those hardy attitudes

of commitment, control, and challenge. as compared with most adults of the same age group. in addition to such stress-reduction techniques, the second difference that we can see dr. wyatt believes it is important is in the function of the brain. to learn to be quiet in a noisy world. so using something like a pet scan or an eeg brain map, gail wyatt: some people consider it meditation. we would see that there was diminished function some people consider it prayer. in certain brain areas particularly in the prefrontal regions of the brain, i don't care what people call it. we all need to do it, the very far forward areas. and we need to do it at some point and time it's sort of like a crucial connecting point-- at the beginning of the day, and whenever we're aware which in many ways, makes us what we are. that we're under too much stress. the way we synthesize information, many people have other ways of dealing with stress the way we make decisions, the way we reason. that work for them. louis hernandez: i truly believe that some source of activity-- in recent years, the use of scanning techniques physical activity-- has changed the way we look at mental disorders. really helps to void your system of those stressors. now we're doing research and even those chemicals that ties together the elements that your body produces of molecular biology that forms the brain, when it realizes you're under stress, physical activity helps to void your system of that. the image that we can now take of the brain and certainly, being careful about what you eat with all these wonderful cat scans and mris, and being more careful about the life you lead and functional mris and various kinds of things, is going to extend that, but it's work.

and tie that with the clinical behaviors that we see. it's something you have to do daily, you know, on a daily basis. many people, at some point in their lives, salvatore maddi: the problem, for me, experience what is referred to as a panic or anxiety attack. is that although that's fine as far as it goes, it's not enough. bulimia and anorexia nervosa are two such disorders those bodily oriented lifestyle approaches that target teenage girls and young women. don't do very much michael strober: in this case, the feared object, to help you decrease the stressfulness that which is phobically avoided is body shape, body fat. of the circumstances that you're encountering. it's a morbid dread of body fat. they only help-- should i try it on? once the stress has led to strain, in anorexia nervosa, that's coupled with extreme weight loss, they help by decreasing the strain. certain kinds of stress are easier to deal with than others. but in bulimia nervosa, one retains or maintains for the most part, we can predict body weight within the normal range, what the daily problems in our lives are going to be. and there is this pattern of overeating and vomiting. sometimes though, an unexpected stressful incident anything that i was feeling that i didn't want to feel can change our lives forever. or that i didn't know what it was, i could just shove back every time i threw up, nancy bohl: when a critical incident happens, it's usually unpredictable, because it numbs you. and it may be a half an hour numb or a five hour numb, and it affects but, for a little temporary bit, everything disappears, everything about the person

and puts them in a... until after-- when it hits you. a physical reaction, and then it just starts over. that's how the cycle begins. and we say it's an abnormal event to people who are just-- aren't expecting it, adolescent girls who develop anorexia nervosa often share similar personality traits. something that you can't really say is going to happen. it's really-- it's sudden, michael strober: not that everyone with these traits will develop anorexia nervosa. and it's usually a threat to life in fact, it's probably a very, very, very small minority of people who do. or a threat to safety or to loved ones but they are traits such as extreme compliance, that causes it to be a critical incident. perfectionism, regimentation, for several riverside, california, city officials, the need for order and sameness and regularity of routines, october 6, 1998 is a date they will never forget. a tendency towards apprehensiveness, - good morning, ameal. - good morning. self doubting, insecurity. ameal moore: stress, to me, before october 6, anorexics tend to be more introverted-- would have been a hectic day or a busy day with a lot of activity. in the sense of more internally worried and also more stubborn in their thoughts about themselves all that changed dramatically after october the 6th. and the world. there's no comparison to the kind of stress whereas the bulimics tend to be more extroverted, that one goes through on a regular basis

more outgoing, more creatures of the moment as compared to the stress that i underwent and then regretting their behaviors. following that october 6 incident. high school is one of my favorite times. i did-- i ran cross country. i ran track. a distraught riverside resident, i did drama. i was always busy, no matter what. angry that his chess club meetings had been canceled, it was a great time. it was exciting, decided he would take his revenge. but it kind of-- lot of, i mean ups and downs in high school. ameal moore: and when we walked into the council chambers, so... that's kind of where everything started. the person that turned out to be the shooter in many instances, there is no obvious triggering event, was standing right just within the door other than, i suppose, this stress at a table against the wall. associated with puberty and all that that entails, he was a regular figure out in the audience. minutes later, social changes, changes in the body's shape and form, the gunman entered the room next to the chambers, pulled out a gun, changes in family relationships and began firing at the mayor and council members. ( gunshot ) which are just inherent to puberty. laura pearson: i was turning very slowly it's a time when you begin to seek out comforts outside the home. and looking at him and thinking, "that's a nine millimeter. that should be a lot louder." and for people with anorexia nervosa, you know, and then... and, to a certain extent, people with bulimia nervosa, watching him fire at-- he was a horrible shot-- that can be quite challenging. i was running and doing all that kind of stuff but watching him and thinking, and really healthy and i had not eaten junk food for a year. "this is real. this is not a toy gun.

and i had just said to myself, "i'm not going to do it." he's closing in on alex." and then it was christmas and i did you know, it was one of those where, just because it had been over a year you know, you can see the chips of the brick flying and i can be like everyone else. and then i panicked. and realizing that, and i threw up for the first time that day you know, "oh my, he's getting better." and swore that would be the only time ever. we looked up and realized that we were under attack, that was four years ago. it's rare to develop anorexia nervosa after age 18 and the mayor was standing right in front of me without having had a prior history of weight and shape preoccupation. or sort of adjacent to me. he ducked under the table i'm not saying it doesn't happen but it's uncommon. and i went under the table about the same time as he did, bulimia nervosa tends to develop between the ages of 15 and 25. and the only thing that we could think to do at that point erin chenoweth: in the beginning, i cod care less what i looked like. was just lay as still as we possibly could, 's all about what i thought of myself hoping that the shooter would think that we were dead and i was never happy enough with myself. or seriously injured. i don't think that physically i ever based this on, that was the most terrifying moment "oh, i have to weigh this much," or, "this size clothes has to fit." that i have ever experienced. that wasn't important. it was just how i felt and i thought that in the distance, the trapped city officials the more i removed myself from my state of mind could hear the sound of sirens. laura pearson: and it was, oh god, it was wonderful. that the better i would feel and that along with that you know? but then it took forever, you know.

came everything else. and then i could hear somebody's voice outside eating disorders are complex illnesses. saying, "are there friendlies in there?" successful treatment programs and, you know, wanting to respond, blend a combination of therapies, but knowing that i shouldn't medical care and monitoring, because last time i saw him, he still had the gun in his hand psychotherapy, and nutritional counseling. and not, you know, being able to remember erin chenoweth: my friends used to tell me, "well, why don't you just stop?" how many rounds, you know, did he have another clip, it's not how it works. you get out of control, you know, what was going on-- and your brain spins, and your body spins, so there was no way i was going to respond. and you have no way of putting your foot down. gunfire was exchanged between the shooter and the police. and the only way i would've been able to break the cycle is-- that's why i came here, because there's no way i could've done it on my own. and then all of a sudden the shot rang out. well, the first thing that we try to do, and then i felt and it can be quite difficult, is to have the individual settle in, the burning, the pain of the bullet or the lead that i got. and feel as comfortable as possible with this environment. and remembered-- i remember thinking, "hold still, hold still," you know, they're frightened. they're actually petrified. i don't know if he's up, i don't know if he's down, i don't know if he has a gun, but, you know, hold still. they feel they've entered a very dangerous place, the gunman was wounded, not in terms of a threat to their physical safety and the hostages were rescued but a threat to their psychological stability, just 18 minutes after the ordeal had begun.

their sense of integrity, because we are about to take something away it was a great moment of relief to see them come into the chamber that they hold very dear. they cherish, and rescue all of us, or at least they need it because as i lay under the table, for their own sense of equanimity, to be honest with you, i thought that terri thompson really was dead, self control, feeling of wholeness or accomplishment, whatever they attribute psychologically to this disorder. but it turned out, that was not t case. erin chenoweth: the physical part of the refeeding process is a nightmare. nancy bohl, a psychologist trained to deal i mean, you go from not digesting food for six months with the aftermath of traumatic events, because everything you eat is thrown up, was called to the scene. and then you're being forced to eat three, four, five times a day, nancy bohl: we get there, and it's chaos. and have all this food sit in your stomach-- people are upset. your body doesn't know what to do. people don't know where anyone's going, who to go to, you know, it was terrifying to sit down and have my first meal be-- and so we had debriefings it was like, chicken and a tortilla, and then individual one-on-ones. but never, in the past four years, a debriefing is a group process have i been able to keep down either, you know, with people that were involved, so it was terrifying for me to look and see all this food. gave them an opportunity-- the support staff-- i'm, "okay, you have to eat all this to talk, cry, you know, and sit with it, and be okay." on how they felt. lots of emotions. and then the next morning, and then the next lunch, and dinner. and what she really did was prepare me, it was just, for the first about five days, it was just sheer just terror for me to sit and eat the food, and, i'm sure, the rest of the council members

because it would just hurt... that she talked to, and it was so uncomfortable to eat that. for what we were going to experience following that incident. the first change point is over the first couple of days what's gointo happen, she said, where people recognize that their thinking is restored, is you're going to relive this, their memory is improved, their concentration, time after time. but it's important, she said, and level of alertness is better. their sleep is better, their general activity level to remember it turned out okay. is enhanced because of feeding. the brain has energy and it begins to work. and don't think about what could have happened. and people thus recognize just how disabled they were you just remember that everything turned out okay. by their starvation. when your brain gets fed and you can finally think for yourself, in addition to reliving the experience, and start to be rational, the victim may go in and out of several emotional states little things remind you of what it's like to be a normal human being. in response to trauma. but then there's a second turning point nancy bohl: there's a whole gamut of reactions that is much more-- that people go through, but one of the first things is denial. is much less predictable as to when it occurs it's the denial that it's really happened. but very important, and that is whether you've been shot or not, the point at which people say, "i think i need another life than the one i've been living." there's a moment of, "what just happened?" meaning, of denial. but also, if there's a loss of a loved one, and that's a profound psychological transformation. people sometimes have longer denial. and when you see it, there's anger, you know that the person is moving towards health. anger towards perpetrator, anger towards self,

the next step, believe it or not, anger towards the loss of your loved one. is not to put them into individual psychotherapy, i mean, you can get angry with the loved one, but to begin them in group psychotherapy angry at all kinds of external things, with individuals who have suffered the condition people, events that have happened. or are further along in their recovery. then there's usually anger as to, you know, "why? because it's easy for a person with this way of life why did it happen to me? why did that person decide to do that and put me in that situation?" and these concerns to hold off an individual psychotherapist. what right did somebody have to come in and try to change people's lives like that, but when they're surrounded by young women you know? who have been where they are, i mean, that's not how you do things. and know the kinds of rationalizations they use, nobody has that right, you know? this helps them to find their way my kids could've lost their mother. further along into the treatment. my mother could have lost her daughter, you know? the group therapy actually helps a lot because and the multitude, you know, just through everybody, you walk into this place thinking you're the only one that thinks this way i mean, the same feeling, you know? how could anybody have done this to anybody? and you're the only one that has to go through all these things, a couple of months later, but the more you talk to people, the more everyone has the same stories, laura's emotions had turned to what she can only describe and it's kind of, "oh, my gosh, you've done that, too." as euphoric. it made me feel so much better to hear other girls talking laura pearson: i was euphoric i was alive. i was, you know, able to walk. to me about the same things i was feeling because it made me feel like i wasn't crazy. i was fine. everybody else was pretty good, erin, you've been here two months now, you know, considering how bad it could have been.

and you have just resumed exercising, it was pretty great. and i really, you know... running, which i know, has been a passion of yours. went with that, do you have faith in your ability to do it in moderation? and it kept me up, you know? i mean, instead of dwelling on how awful the experience had been, i do. i mean, for two months here i didn't exercise, it was, you know, the positive, and i was okay with that. that we were all fine. so i'm trying to just remember that at home, nancy bohl: there's depression. when i feel like i should be doing more, it's not always diagnosed depression, just remember that for two months i didn't, and i was okay. but it's just a really low-level feeling of sadness, and in bulimia nervosa where there's often and it can be diagnosed depression a feeling of loneliness and lack of close intimate relationships, but very low affect, the psychotherapy permits somebody to feel understood the person doesn't have a lot of high energy. i remember when i really noticed that i was depressed and respected and regarded and cared about. was that i'd wake up in the morning and i'd just pull the sheets over my head. that's very important to human beings. i didn't want to go out. when you first came here, it was difficult, i didn't want to get cleaned up, dressed up, if not close to being impossible talk to anybody, listen to anybody, for you to have a sense of comfort with yourself, be confronted by anything. self acceptance. so that's when i really knew something was wrong, it was hard for you to be in your own skin. because normally i just, you know, bounce out. how do you feel about yourself now? and then there's guilt and bargaining. i just try and look at everything that i've learned, you know, bargaining and remember that in the back of my head,

that you won't do what you've done before so that when i get discouraged, i can pull that back up. that you think might've not been the right thing to do. t it helps, i'm a lot more comfortable with myself. you know, you try to bargain a lot of that spiritually. paul mchugh: finally, we look around with the patient to see the final stage, acceptance, whether there are particular things about her and her life means moving ahead with life. nancy bohl: acceptance happens at different stages which have fundamentally been triggers to this behavior. and different times for people. because we are resilient, i'm really trying to get away from the whole perfectionist-- most people will move into acceptance, and making everyone happy, because, and they waver a little bit in there, it's so-- i mean it's difficult to try-- but they accept finally that this has happened and this is what they've been given it's setting yourself up for failure. and they need to try to get through it one of the key challenges and to do it the best they can. that we face in psychiatric treatment today often, survivors of a traumatic experience is less the development of effective treatments complain about the insensitivity of the news media in covering the crisis. and more our ability to utilize the treatments in the most effective way we can. nancy bohl: the media is probably paul mchugh: we're going to understand how the brain and the body the biggest offender to every person who's involved relate to the behaviors that ultimately are themselves in a disaster or a critical incident. they don't realize that just keep going over it and hammering it

and bringing it up again causes a person never to be able to put it in any compartment because it's in their face constantly. i can remember seeing the press photographer with this lens from hell and knowing, you know, i could see him screwing it on, i thought, "oh no!" you know? "this guy, he's in like a vulture, in for the kill." and they put me on the stretcher, and i remember specifically not looking at him and trying to be-- you know, keep my legs together because i had nothing on, and, you know. sometimes, survivors of trauma may seek some sort of closure to the incident in order to be able to move on in their lives. you know, i don't think that there's ever closure. people will say, "so, maybe when he goes to trial, i'll have closure," and i always say, "how do you put closure on such a significant event in your life?" they have anniversary dates.

usually, it's like clockwork. if it's a true traumatic incident they've been involved in, they have recollection of that almost a year to the date later. physical responses are there. emotional responses can sometimes be there. and if you just make them aware of that, then they're prepared for it, they're prepared to handle it. you can put it where it belongs, in a compartment inside, and you can retrieve it when you want to, but the emotional reactions, the surge of emotions won't be as intense through time. the passage of time will lessen it, but it doesn't mean that you forget it. it's something that makes the person up as the years go on. there's no doubt that such an event changes your life in a number of ways. ameal moore: you feel that you are vulnerable. and not only in a situation where we found ourselves, but you know that if someone

really wanted to do you harm, they could. laura pearson: i'm real hypersensitive about my surroundings, ere i am, who's around me, where i park my car, you know, sit with your back to a wall always. look and notice where all the openings are. and that's the first blush when i walk into a room, every time i go somewhere. which is kind of... you know, my life has just changed. so you guys got a break from school, huh? some changes that result from trauma can be surprisingly positive. ameal moore: i feel very grateful for life, even, now, for that experience. and that may sound foolish, but i think i'm a better individual today for having gone through that experience. i believe i'm stronger. i believe i appreciate people more.

i understand the importance of relationships, the importance of expressing to people your feeling that you care about them, that you're concerned about them. laura pearson: now i don't take anything for granted. not friendships. not family. you know, not every day. and that probably is the biggest change. you know, before, you're coasting along, and life gives what it gives to you, and now i seek things out. you know, i pull my family together, try to, every week, have dinner at my house. you know, that kind of thing. i make more of an effort with my friends and with my family than i had because my life was busy, you know? and i liked it that way. that was fine.

and i like it this way. it's better. what do you think? okay, let's do that. where do you want to go? "the human condition" is a 26-part series about health and wellness. for more information on this program, and accompanying materials, call: or, visit us online at: [♪...]

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annenberg media ♪ by: era la agente de bienes raíces. un empresario de los estados unidos está interesado en comprar la gavia. pero... todavía no está en venta, ¿verdad? narrador: bienvenidos a destinos: an introduction to spanish.

primero vamos a ver algunas escenas de este episodio.