like tugging in your head, and not having anybody else in the world relate to you, or understand on the outside. i would call my best friend and say, "i feel like i'm on the elevator to hell." and i would just go down. narrator: one in four families have a loved one who suffers from some form of mental illness.

"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-- develops the sort of skill sets where they are always developing their ability to engage in the world. 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. they have schizophrenia. on the other hand, those aren't the only ways that we can experience mental trouble in our life. some of the things that give us trouble, is how we're constituted. not what we have, but who we are, will influence how we feel in certain situations, and sometimes how we feel in certain situations becomes so distressed, we need help with it. 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. a mood disorder is an emotional state, that to some degree, interferes with social, familial, occupational functioning. the most common mood disorder throughout the world is depression. andrew leuchter: depression can strike anybody at any time. the is no way of predicting who's going to get depressed. anybody from the highest functioning corporate executive, to somebody who is laboring day-toay, anybody can suffer from a depressive episode. i had a good life.

i had good parents, i had a good upbringing, i had a good education. it was all good, pretty much. andrew leuchter: one way of thinking of depression is that we all have a normal mood regulating mechanism and we all go up and down, but it's when you get stuck down, it's not just that you've gone down, but you go down and you stay down for weeks. i was an adolescent, somewhere around 11 or 12, and i can remember sitting in our living room in the dark, and just not really wanting to communicate with anybody, not wanting to say anything, just-- and i would have these thoughts that said, "they don't really love you. they don't like you. you're not worth anything," and they were just over and over. and i just began to retreat and thought, "well, i'll just be quiet." andrew leuchter: if somebody comes in a stressful life situation, they have a depression, they say, "doctor, this has never happened to me before."

we treat them, they get well and they stay well. unfortunately, many patients have had a previous episode and will go on to have huger episodes. once one has had a single episode of depression, the lifetime risk of recurrence, the chances of having a second episode are about 50%, about a coin toss. beverly: when i got to be early 20s, and i worked at big general hospital in the psych unit, no less, is when i began to really understand that there was something wrong, and that i needed some help. i ended up having a big episode of crying. i mean, i just cried. i cried for three days. i stayed home from work, and i-- you know, i had life problems but they weren't huge. i had a job.

it wasn't like i was going to be homeless or that kind of thing. i was just so down all the time. an obviously depressed mood is the most common manifestation of depression-- loss of energy, difficulty functioning on the job, feeling like you can't cope at home, feeling like you just want to withdraw and do nothing. i would go inside myself and feel inside myself, and not talk, not want to watch tv, not want to do anything, and then eventually, i'd go to a sleeping mode; i'd want to sleep a lot. you can't just say to yourself, "snap out of it and get back on your feet." some people with depression can force themselves to get out of bed, but they can't force themselves to enjoy life. they can't force themselves to concentrate. there are actual changes

in neurochemistry in the brain, there are changes in hormones in the body. there are actual physical, biological factors that prevent the depressed patient from being themselves. that can be hard to convince people of. there is a tremendous stigma against mental illness in general, and depression in partular, in this society. ...and i kind of go into a shell when i'm having an episode, because i don't want to hear that it's nothing, and that i can just, you know, pull up on my boot straps and move on, because sometimes you just can't. andrew leuchter: the key thing in terms of understanding depression is that this is an illness, not a weakness, and that we need to treat this illness in such a way that patients can get over it. beverly: i mean, if you're wheezing and you can't breathe,

then people understand that there's something seriously wrong with you. but if in your mind you're not having okay thoughts, they can't see that, and they don't understand. and they don't have the compassion. the major struggle that we face in psychiatry, is, i suppose, overcoming the stigma associated with mental illness. patients don't want to come in for treatment. they feel that they're being labeled. the ability to get somebody into treatment, to provide adequate psychotherapy, is greatly hampered by the fact that there is commonly very, very little coverage for anything more than an initial consultation or maybe a medication visit or two. i've had to look for clinics, free psych clinics, to get the support that i've needed. i've been fairly fortunate in finding them,

because i couldn't afford it. when i was going to virginia at the beginning of february to be with my daughter, it came up that i needed to get my medicine and it wasn't time yet with the insurance. so, i said, "well, but i'm going to be out of town when time comes, and i need my prozac, you know. gotta have it." and they said, "well, they won't authorize it, so you'll have to pay regular price," which was $400 for a one month supply. and at that point, i felt like, if i can't get my medicine, if i can't make enough money to buy it, i don't want to live. andrew leuchter: we have 20 different anti-depressants on the market that differ in their particular chemical profile, and we want to choose which medication

is most likely to help that individual as well. so, it's a matter of getting the patient to stick with the treatment, encouraging them to work through any side effects they might have from medication, getting them to stick with treatment long enough for the anti-depressant effects to kick in. now have you noticed your mood change in the last couple of weeks? yes. i tend to question my feelings, where as before, it was just how i felt. but now, is this me or is this the medication? you know, should i act on this, or should i ask somebody to look at me, or tell me if i'm okay? andrew leuchter: psychotherapy is vital in this. number one, we've got to give the patient support they need, help them get over their life problems, but also offer some encouragement to stick with the course of treatment. beverly: it gives me a place where i can come and say

anything about whatever's happening in my life, and not feel that i'm being judged for it... because i depend on the philosophy that therapists are there to help and not to judge, and all of that. and i use that as my place to vent and talk about anything. if somebody has had a particularly severe depression i might tell them, "i think you should stay on medication long-term, for many years, possibly for life." the medications we have now, the newer drugs, are pretty transparent to most patients. they can't tell they're taking them, there are minimal side effects and no long-term risks to taking the medication. so there really is very little downside to staying on the medications. 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. and that i do kind of stumble and fall,

but with the help of my medications, i don't fall so far and stay so long. mood disorders are just one category of mental illness. another is dementia-- when people experience impaired cognitive functioning, memory loss, delusions. dementia can be caused by brain injuries and tumors, or it can be part of the aging process, as in alzheimer's disease. one form of dementia is the thought disorder, schizophrenia. andrew leuchter: the most clear cut example of schizophrenia is where somebody has delusions or hallucinations. but the classic delusion would be... the belief that somebody is out to get you, that you're being followed, that you're being spied upon. it's frightening, at first. you can't distinguish reality from fantasy. there also are hallucinations, that one hears voices.

it used to be kind of scary. i'd just sit in my room and listen to the radio. i couldn't even watch tv for 4 or 5 years, because i just felt nervous. i don't know, the tv was sending out messages and stuff. in the last 30 years, as treatments for schizophrenia have become more sophisticated, victims have the hope of an most normal life. andrew leuchter: anti-psychotic medication can help to dissolve hallucinations and delusions, but also can help to order thoughts-- can help to restore thought patterns to normal, and bring the patient out of a negative symptom state. it's pretty miserable without medication. i recommend a lot of people to be on medication if they need it. some patients with schizophrenia will get back to normal function. commonly patients with schizophrenia

don't quite get back there, and we really need to work on rehabilitation and social skills training in addition to medication to maximize their function. since i've started taking the medicine, and staying on it, i can distinguish reality from fantasy, and i say, "hey, that's my illness," you know? there are patients who 20 years ago would have been locked up in an institution for life, who are now able to live in the community, commonly hold down some kind of job. the causes of schizophrenia are unknown, but the brains of people with this disorder tend to have biochemical or structural defects that may be inherited. andrew leuchter: when you look at the brain of a patient with schizophrenia what you commonly see is that first that there has been some shrinkage of the brain as compared with most adults of the same age group. the second difference that we can see

is in the function of the brain. so using something like a pet scan or an eeg brain map, we would see that there was diminished function in certain brain areas particularly in the prefrontal regions of the brain, the very far forward areas. it's sort of like a crucial connecting point-- which in many ways, makes us what we are. the way we synthesize information, the way we make decisions, the way we reason. in recent years, the use of scanning techniques has changed the way we look at mental disorders. now we're doing research that ties together the elements of molecular biology that forms the brain, the image that we can now take of the brain with all these wonderful cat scans and mris, and functional mris and various kinds of things, and tie that with the clinical behaviors that we see. many people, at some point in their lives,

experience what is referred to as a panic or anxiety attack. bulimia and anorexia nervosa are two such disorders that target teenage girls and young women. michael strober: in this case, the feared object, that which is phobically avoided is body shape, body fat. it's a morbid dread of body fat. ould i try it on? in anorexia nervosa, that's coupled with extreme weight loss, but in bulimia nervosa, one retains or maintains body weight within the normal range, and there is this pattern of overeating and vomiting. anything that i was feeling that i didn't want to feel or that i didn't know what it was, i could just shove back every time i threw up, because it numbs you. and it may be a half an hour numb or a five hour numb, but, for a little temporary bit, everything disappears, until after-- when it hits you. and then it just starts over. that's how the cycle begins.

adolescent girls who develop anorexia nervosa often share similar personality traits. michael strober: not that everyone with these traits will develop anorexia nervosa. in fact, it's probably a very, very, very small minority of people who do. but they are traits such as extreme compliance, perfectionism, regimentation, the need for order and sameness and regularity of routines, a tendency towards apprehensiveness, self doubting, insecurity. anorexics tend to be more introverted-- in the sense of more internally worried and also more stubborn in their thoughts about themselves and the world. whereas the bulimics tend to be more extroverted, more outgoing, more creatures of the moment and then regretting their behaviors. high school is one of my favorite times. i did-- i ran cross country. i ran track.

i did drama. i was always busy, no matter what. it was a great time. it was exciting, but it kind of-- lot of, i mean ups and downs in high school. so... that's kind of where everything started. in many instances, there is no obvious triggering event, other than, i suppose, this stress associated with puberty and all that that entails, social changes, changes in the body's shape and form, changes in family relationships which are just inherent to puberty. it's a time when you begin to seek out comforts outside the home. and for people with anorexia nervosa, and, to a certain extent, people with bulimia nervosa, that can be quite challenging. i was running and doing all that kind of stuff and really healthy and i had not eaten junk food for a year. and i had just said to myself, "i'm not going to do it." and then it was christmas and i did just because it had been over a year and i can be like everyone else. and then i panicked.

and i threw up for the first time that day and swore that would be the only time ever. that was four years ago. it's rare to develop anorexia nervosa after age 18 without having had a prior history of weight and shape preoccupation. i'm not saying it doesn't happen but it's uncommon. bulimia nervosa tends to develop between the ages of 15 and 25. erin chenoweth: in the beginning, i could care less what i looked like. 's all about what i thought of myself and i was never happy enough with myself. i don't think that physically i ever based this on, "oh, i have to weigh this much," or, "this size clothes has to fit." that wasn't important. it was just how i felt and i thought that the more i removed myself from my state of mind that the better i would feel and that along with that came everything else. eating disorders are complex illnesses. successful treatment programs blend a combination of therapies,

medical care and monitoring, psychotherapy, and nutritional counseling. erin chenoweth: my friends used to tell me, "well, why don't you just stop?" it's not how it works. you get out of control, and your brain spins, and your body spins, and you have no way of putting your foot down. 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. well, the first thing that we try to do, and it can be quite difficult, is to have the individual settle in, and feel as comfortable as possible with this environment. they're frightened. they're actually petrified. they feel they've entered a very dangerous place, not in terms of a threat to their physical safety but a threat to their psychological stability, their sense of integrity, because we are about to take something away that they hold very dear. they cherish,

or at least they need it for their own sense of equanimity, self control, feeling of wholeness or accomplishment, whatever they attribute psychologically to this disorder. erin chenoweth: the physical part of the refeeding process is a nightmare. i mean, you go from not digesting food for six months because everything you eat is thrown up, and then you're being forced to eat three, four, five times a day, and have all this food sit in your stomach-- your body doesn't know what to do. it was terrifying to sit down and have my first meal be-- it was like, chicken and a tortilla, but never, in the past four years, have i been able to keep down either, you know, so it was terrifying for me to look and see all this food. i'm, "okay, you have to eat all this and sit with it, and be okay." and then the next morning, and then the next lunch, and dinner. it was just, for the first about five days, it was just sheer just terror for me to sit and eat the food, because it would just hurt... and it was so uncomfortable to eat that. the first change point is over the first couple of days where people recognize that their thinking is restored,

their memory is improved, their concentration, and level of alertness is better. their sleep is better, their general activity level is enhanced because of feeding. the brain has energy and it begins to work. and people thus recognize just how disabled they were by their starvation. when your brain gets fed and you can finally think for yourself, and start to be rational, little things remind you of what it's like to be a normal human being. but then there's a second turning point that is much more-- is much less predictable as to when it occurs but very important, and that is the point at which people say, "i think i need another life than the one i've been living." and that's a profound psychological transformation. and when you see it, you know that the person is moving towards health. the next step, believe it or not, is not to put them into individual psychotherapy, but to begin them in group psychotherapy

with individuals who have suffered the condition or are further along in their recovery. because it's easy for a person with this way of life and these concerns to hold off an individual psychotherapist. but when they're surrounded by young women who have been where they are, and know the kinds of rationalizations they use, this helps them to find their way further along into the treatment. the group therapy actually helps a lot because you walk into this place thinking you're the only one that thinks this way and you're the only one that has to go through all these things, but the more you talk to people, the more everyone has the same stories, and it's kind of, "oh, my gosh, you've done that, too." it made me feel so much better to hear other girls talking to me about the same things i was feeling because it made me feel like i wasn't crazy. erin, you've been here two months now, and you have just resumed exercising, running, which i know, has been a passion of yours.

do you have faith in your ability to do it in moderation? i do. i mean, for two months here i didn't exercise, and i was okay with that. so'm trying to just remember that at home, when i feel like i should be doing more, just remember that for two months i didn't, and i was okay. and in bulimia nervosa where there's often a feeling of loneliness and lack of close intimate relationships, the psychotherapy permits somebody to feel understood and respected and regarded and cared about. that's very important to human beings. when you first came here, it was difficult, if not close to being impossible for you to have a sense of comfort with yourself, self acceptance. it was hard for you to be in your own skin. how do you feel about yourself now? i just try and look at everything that i've learned, and remember that in the back of my head, so that when i get discouraged, i can pull that back up. but it helps, i'm a lot more comfortable with myself. paul mchugh: finally, we look around with the patient to see

whether there are particular things about her and her life which have fundamentally been triggers to this behavior. i'm really trying to get away from the whole perfectionist-- and making everyone happy, because, it's so-- i mean it's difficult to try-- it's setting yourself up for failure. one of the key challenges that we face in psychiatric treatment today is less the development of effective treatments and more our ability to utilize the treatments in the most effective way we can. paul mchugh: we're going to understand how the brain and the body relate to the behaviors that ultimately are themselves 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, namely to free them from these particular burdens

that deprive them of their humanity, that deprive them ultimately of that great thing that human-- that the healthy human being mentally has, namely his freedom, his freedom to choose, his capacity to develop a sense of responsibility for himself 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.

"the human condition is a 26-part series about health and wellness. for more information on this program and accompanying materials, call 1-800-576-2988 or vit us online at www.intelecom.org. and then we have to come up with techniques to help individuals to learn to live with some of it

because we can't do without it. a certain amount of conflict, it's facilitating of growth, both on a personal as well as a social level. stress, to me, before october 6, would have been a very busy day with a lot of activity. all th changed dramatically after october the 6th.

narrator: we allnow about stress. we live with it every day-- the stress of driving crowded city streets, meeting deadlines, paying bills, ggling the many obligations and activities in our lives. you may be expected to work 60 or 70 hours a week, and you're trying to balance home life with work life and being a parent and all these different social and cultural roles. and those are stressors, i think, that throughout the centuries people have felt, relative to their own time frame. gail wyatt: we need to appreciate, it's not just adults who are stressed. kids have a lot of pressure on them, to do their homework, to have friends, to make friends, to-- you know, connect in so many different ways, to participate in extracurricular activities, to do well, to be what their parents want them to be, lots of stressors.

a certain amount of stress is necessary for life. deborah khoshaba: on a moment-to-moment basis, our body is always in the process of gauging how much arousal we need to function. okay? see, right now as i'm speaking, my sympathetic nervous system is on, and although i don't feel anxiety, i do feel a certain amount of arousal. you would say the organism's under stress. so stress is a very interesting term in that sense, that we're wired to respond to the environment. for many people, stress is so ingrained in their lives that it begins to feel natural. you'd be surprised how few people know what stress really is, because they're so accustomed to it. it becomes part of their everyday world,

and they can't appreciate it until they get away from it. chronic stress becomes a real problem if nothing is done about it, and there's an accumulative effect. the more chronic stress you have, the less acute stress it takes to push you over the edge and vice versa. when faced with a stressful situation, chronic or acute, the body gears up to respond. your mind gives your body a signal that there's danger, and your body mobilizes to meet the danger. it's all it knows how to do in a circumstance like that, and that's the so-called fight-or-flight reaction. the symptoms are recognizable. salvatore maddi: your nervous system gets very aroused, so you're going to be tense. you won't be able to sleep very well, you may not be able to concentrate very well, you may feel anxious, your digestive system will get suppressed, your body resources will get transformed into sugar

for the muscles and the brain so that they can do whatever they need to do quickly and strenuously. through the ages, this has been the body's normal reaction to stress, to surviving a difficult situation. but if you don't pay attention to it, and you do nothing to resolve the stressful problems that cause that... the time will come when your body will be depleted of resources. you know, the fight-or-flight reaction is a little bit like driving your sports car, you know, at engine revolutions beyond the red line. how long can you do that before there's a breakdown? and the breakdown, not unlike the overcharged sports car, may result in physical damage to the body. salvatore maddi: hans selye, the canadian physician, won a nobel prize for that. diseases of adaptation, he called them.

they're breakdowns. wear-and-tear diseases. heart disease, cancer, stroke, osteoporosis, alzheimer's disease, probably. there's a whole range of so-called wear-and-tear diseases that are the result of prolonged strain. prolonged stress can also lead to breakdowns in relationships. we call them behavioral breakdowns. let's say you're so preoccupied with your work and all of the stresses in it that you can't open up to your family and give them empathy and support in their problems. well, you're courting divorce. - come on in, joe. - i'm sorry i'm late. let's say you're so preoccupied with your stresses that you can't meet deadlines at work. well, you might lose your job. if it happens again, i'm afraid you can look for another job. the research shows that it's not stress that does you in per se, okay?

it's your ability to make use of the stressor in a way that adds to your life meaning. and what i mean by this is that we all have stress, but the organism that doesn't get undermined by stress looks at the changes in life, you know, like, "well i've been transitioned from a job," or this happened, or this happened, and they make meaning out of it that adds to their story line and moves them forward in life in a productive way. why is it that some people seem to deal with stress more effectively than others? of course, this can be complex, in the sense that the person who manages stress most effectively is also an organism that has a high capability for judgment, that, in other words, "okay, this happened to me, and this happened to me. what can i do,

given my current resources, my past history, and what i want which is realistic, what can i do to move me out of the stress and back into a lifestyle that feels fulfilling?" dr. maddi began studying this phenomenon, this positive response to stress, with workers whose jobs were threatened by the break up of at&t. salvatore maddi: we were doing a longitudinal research study at illinois bell telephone at the time, and, you know, we were confronted with some people who just fell apart completely in the upheavals that took place there when at&t was federally deregulated, and the companies were-- there was mandated divestiture of them. but there were some people who actually thrived on the upheavals, and we were confronted with those data, and we were trying to think of ways of referring to it easily,

and, you know, we started saying, well, these "hardy people," you know? and so that was kind of the beginning of the concept of "hardiness." deborah khoshaba: hardiness is a term of resiliency. it's about a set of attitudes that a person has that helps them to transform the problems that they encounter in life in a way that enhances their performance, their morale, their conduct, and their health. salvatore maddi: it's a pattern, a personality pattern where you have certain attitudes and certain skills, a sense of commitment, a sense of control, and a sense of challenge. if you have a strong sense of commitment... what's natural for you is to involve yourself with other people, involve yourself with whatever's going on, rather than hang back and feel isolated and alienated. if you have a strong sense of control, it's natural for you to struggle

and try to influence the outcomes that are going on around you rather than just sink into passivity and powerlessness. and if you have a strong sense of challenge... what feels natural to you is to continue to learn through your experience. but how do we know if we are effectively dealing with the everyday stress in our lives? salvatore maddi: one-- you've got to be able to recognize a stressful circumstance as stressful. two-- you've got to feel as if you can really do something effective about it. three-- you have to turn it into a problem to be solved, find a way to solve it, and carry that out. now, if you're able to do all of that regularly as stressful circumstances come up, you're hardy enough.

but not all people are equipped with the attitudes and skills to deal with stress-inducing events. deborah khoshaba: they may say intellectually, "oh, well, you know, i know life isn't fair." and intellectually, they will verbalize that we know this happens in life. emotionally, they don't really accept it. and the other part of self that's still like a child and, "this should not be happening to me," that ends up being-- ends up really... turning the stressor into something that becomes really unmanageable. the hardiness institute, founded in the early 1980s, is helping people develop qualities that will allow them to lk at stress in a whole new way. deborah khoshaba: basically, what we do is we help them to become very aware of the physiological signs that their body is starting to be too aroused,

and so if they can really cut that off at the pass, okay, their body never gets to a point where they're manifesting those symptoms. and then... once we help them manage their physiological stress, and they're more comfortable, we help them deal more with the cognitive and the emotional components of their stressors. salvatore maddi: you start with what we call situational reconstruction. this is a technique that asks you to become a kind of novelist about your own life. just let your imagination go and think of a way in which the stressful circumstance could be even much worse than it is. feeling as though i don't have any help... support from other people. salvatore maddi: the next step is to think of how the stressful circumstance could be better than it is, and the same thing there. you make up a story about it-- what would have to happen? having done that, you step back from your efforts

and ask yourself whether... you've been able to put the stressful circumstance in a broader perspective because of this kind of spading up the ground. see, what you're looking for is deeper understanding. that's all mental. and if the answer is yes to both of those, then you transcend the mental approach into action. you make a plan of action that can carry out what you now know, and you act on that plan. and then when you get feedback from that, you use the feedback to recognize the value of your efforts and to deepen those hardy attitudes of commitment, control, and challenge. in addition to such stress-reduction techniques, dr. wyatt believes it is important to learn to be quiet in a noisy world. gail wyatt: some people consider it meditation.

some people consider it prayer. i don't care what people call it. we all need to do it, and we need to do it at some point and time at the beginning of the day, and whenever we're aware that we're under too much stress. many people have other ways of dealing with stress that work for them. louis hernandez: i truly believe that some source of activity-- physical activity-- really helps to void your system of those stressors. and even those chemicals that your body produces when it realizes you're under stress, physical activity helps to void your system of that. and certainly, being careful about what you eat and being more careful about the life you lead is going to extend that, but it's work. it's something you have to do daily, you know, on a daily basis. salvatore maddi: the problem, for me, is that although that's fine as far as it goes, it's not enough. those bodily oriented lifestyle approaches

don't do very much to help you decrease the stressfulness of the circumstances that you're encountering. they only help-- once the stress has led to strain, they help by decreasing the strain. certain kinds of stress are easier to deal with than others. for the most part, we can predict what the daily problems in our lives are going to be. sometimes though, an unexpected stressful incident can change our lives forever. nancy bohl: when a critical incident happens, it's usually unpredictable, and it affects everything about the person and puts them in a... a physical reaction, and we say it's an abnormal event to people who are just-- aren't expecting it, something that you can't really say

is going to happen. it's really-- it's sudden, and it's usually a threat to life or a threat to safety or to loved ones that causes it to be a critical incident. for several riverside, california, city officials, october 6, 1998 is a date they will never forget. - good morning, ameal. - good morning. ameal moore: stress, to me, before october 6, would have been a hectic day or a busy day with a lot of activity. all that changed dramatically after october the 6th. there's no comparison to the kind of stress that one goes through on a regular basis as compared to the stress that i underwent following that october 6 incident. a distraught riverside resident, angry that his chess club meetings had been canceled, decided he would take his revenge.

ameal moore: and when we walked into the council chambers, the person that turned out to be the shooter was standing right just within the door at a table against the wall. he was a regular figure out in the audience. minutes later, the gunman entered the room next to the chambers, pulled out a gun, and began firing at the mayor and council members. ( gunshot ) laura pearson: i was turning very slowly and looking at him and thinking, "that's a nine millimeter. that should be a lot louder." you know, and then... watching him fire at-- he was a horrible shot-- but watching him and thinking, "this is real. this is not a toy gun. he's closing in on alex." you know, it was one of those where, you know, you can see the chips of the brick flying and realizing that, you know, "oh my, he's getting better."

we looked up and realized that we were under attack, and the mayor was standing right in front of me or sort of adjacent to me. he ducked under the table and i went under the table about the same time as he did, and the only thing that we could think to do at that point was just lay as still as we possibly could, hoping that the shooter would think that we were dead or seriously injured. that was the most terrifying moment that i have ever experienced. in the distance, the trapped city officials could hear the sound of sirens. laura pearson: and it was, oh god, it was wonderful. you know? but then it took forever, you know. and then i could hear somebody's voice outside saying, "are there friendlies in there?" and, you know, wanting to respond, but knowing that i shouldn't because last time i saw him, he still had the gun in his hand and not, you know, being able to remember

how many rounds, you know, did he have another clip, you know, what was going on-- so there was no way i was going to respond. gunfire was exchanged between the shooter and the police. and then all of a sudden the shot rang out. and then i felt the burning, the pain of the bullet or the lead that i got. and remembered-- i remember thinking, "hold still, hold still," you know, 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. the gunman was wounded, and the hostages were rescued just 18 minutes after the ordeal had begun. it was a great moment of relief to see them come into the chamber and rescue all of us, because as i lay under the table, to be honest with you, i thought that terri thompson really was dead,

but as it turned out, that was not t case. nancy bohl, a psychologist trained to deal with the aftermath of traumatic events, was called to the scene. nancy bohl: we get there, and it's chaos. people are upset. people don't know where anyone's going, who to go to, you know, and so we had debriefings and then individual one-on-ones. a debriefing is a group process with people that were involved, gave them an opportunity-- the support staff-- to talk, cry, you know, on how they felt. lots of emotions. and what she really did was prepare me, and, i'm sure, the rest of the council members that she talked to, for what we were going to experience following that incident. what's going to happen, she said, is you're going to relive this, time after time. but it's important, she said,

to remember it turned out okay. and don't think about what could have happened. you just remember that everything turned out okay. in addition to reliving the experience, the victim may go in and out of several emotional states in response to trauma. nancy bohl: there's a whole gamut of reactions that people go through, but one of the first things is denial. it's the denial that it's really happened. whether you've been shot or not, there's a moment of, "what just happened?" meaning, of denial. but also, if there's a loss of a loved one, people sometimes have longer denial. there's anger, anger towards perpetrator, anger towards self, anger towards the loss of your loved one. i mean, you can get angry with the loved one, angry at all kinds of external things, people, events that have happened. then there's usually anger as to, you know, "why?

why did it happen to me? why did that person decide to do that and put me in that situation?" what right did somebody have to come in and try to change people's lives like that, you know? i mean, that's not how you do things. nobody has that right, you know? my kids could've lost their mother. my mother could have lost her daughter, you know? and the multitude, you know, just through everybody, i mean, the same feeling, you know? how could anybody have done this to anybody? a couple of months later, laura's emotions had turned to what she can only describe as euphoric. laura pearson: i was euphoric i was alive. i was, you know, able to walk. i was fine. everybody else was pretty good, you know, considering how bad it could have been. it was pretty great. and i really, you know... went with that, and it kept me up, you know? i mean, instead of dwelling on how awful the experience had been,

it was, you know, the positive, that we were all fine. nancy bohl: there's depression. it's not always diagnosed depression, but it's just a really low-level feeling of sadness, and it can be diagnosed depression but very low affect, the person doesn't have a lot of high energy. i remember when i really noticed that i was depressed was that i'd wake up in the morning and i'd just pull the sheets over my head. i didn't want to go out. i didn't want to get cleaned up, dressed up, talk to anybody, listen to anybody, be confronted by anything. so that's when i really knew something was wrong, because normally i just, you know, bounce out. and then there's guilt and bargaining. you know, bargaining that you won't do what you've done before that you think might've not been the right thing to do. you know, you try to bargain a lot of that spiritually. the final stage, acceptance, means moving ahead with life. nancy bohl: acceptance happens at different stages

and different times for people. because we are resilient, most people will move into acceptance, and they waver a little bit in there, but they accept finally that this has happened and this is what they've been given and they need to try to get through it and to do it the best they can. often, survivors of a tum experience complain about the insensitivity of the news media in covering the crisis. nancy bohl: the media is probably the biggest offender to every person who's involved 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 lookinat 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 out my surroundings, ere i am, who's arou 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?

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