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One of the commonest causes of insomnia is stress.

The Oxford Dictionary defines ’stress’ as a force, an effort, a demand upon physical or mental energy. We use the word ’stress’ very often, but what is stress, what is it doing to us, and how do we react to stress and cope with it? Stress can be compared to a mechanical force or pressure exerted on an object To understand the relationship between stress and the object under stress, let us look at a simple example, such as what happens when pressure is exerted on a piece of fruit.

If you put a lot of apples in a bag, the apples exert pressure on each other, and each apple is subject to pressure from surrounding apples. This is a normal level of pressure and stress. However, if you take an apple out of the bag and drop it to the floor, the apple is bruised. If you accidentally step on this apple, you leave a big scar on it Dropping the apple and stepping on it are both extraordinary stresses not normally exerted on apples.

Hence, to put it in plain language, there are two kinds of stresses in our lives: ordinary stress, which most of us experience every day, as in the example of the apples in the bag, and extraordinary stress, comparable to dropping the apple or stepping on it, which we only experience once or twice in our lives, and which some of us may never have to face at all.

However, we are not all apples. Some of us may be stronger, like a coconut, which when dropped on the floor will not be harmed as it takes a few strokes of a hammer to crack it. Or some of us may be weak, like a ripe tomato, that even ordinary pressure can bruise. People come in all shapes and sizes and possess different inner strengths and energies. Some of us may be like coconuts, some like apples, and some like ripe tomatoes. We have no choice as to what we are, as part of this is our inheritance from our parents and part is based on our life experience, just as an apple cannot change into a coconut, and a tomato cannot change into an apple. However, with some help we can strengthen ourselves a lot more and can deal with stress a lot better. Einstein reminded us that we use only 10 per cent of our potential, and there is a lot of strength inside us that we have not recognized.

Hence there are two factors in stress. The first factor is the kind of stress, whether it is ordinary stress or extraordinary stress. The other factor is how tough the person is. Some of us may not be able to face up to ordinary stress, just as the ripe tomato. But some of us may be extremely tough and need a hammer to crack us, like the coconut.

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A man of twenty-two came to see me in great distress. He quite openly said that he was a homosexual. He had been caught by the police picking up another homosexual in a public bar. The police had been very considerate and had made no charge against him, but had advised him to seek the help of a psychiatrist, and to report back to them in a month.

In spite of his distress he kept saying that he was glad he had been, caught. He described his furtive sexual life with casual men. He said he had been actively homosexual since aged twelve or thirteen. On one occasion four years ago, by great act of will he had had no homosexual experience for a month. On further questioning it became clear that he did not really enjoy these experiences. In a way he hated them. But he was so lonely, and so timid toward girls that this type of human contact was preferable to utter loneliness and isolation.

I explained to him that he had been driven to this form of sexual experience by his own introvert nature and not by true homosexuality. He learned to do the relaxing mental exercises. As his anxiety abated, he gradually became friendly with various girls. He found that he could like them and enjoy their company. It soon came about that he was talking of love, and he told me he was having normal sexual intercourse with the girl of his choice. With this there was a remarkable change in his personality.

This man had believed that he was destined to live a life in the shadows as a homosexual. Something happened to him beyond his wildest dreams. It is well to remember that there are many like him.

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The fear of insanity is the second most common fear. We all try to get control over what is happening to us and the harder we fight, the worse we get.

Trying to understand what is happening to us continually pushes us to the limits of our knowledge. We cannot find anything in our past experience that even comes close to what we are experiencing now, so many of us feel we are going insane.

We’re not, although it often feels like it. Some of the other symptoms we experience don’t help to break this fear; they usually add to it.

Dissociation

The role dissociation plays in anxiety disorders is now being examined. From what I have found over the years, the ability to dissociate is found in a large subgroup of people who experience spontaneous panic attacks. Dissociation can also be described as altered or discrete states of consciousness or trance states. Altered or trance states are found in many cultures. They can be an ‘accepted expression of cultural or religious experience in many societies’ (APA 1994). A leading expert in altered or discrete states, Dr Charles Tart (1972) comments that many other cultures, ‘believe that almost every normal adult has the ability to go into a trance state’.

Individuals in other societies induce trance states not only by meditation, but by fasting, sleep deprivation and other forms of physiological stress. For those of us who have the ability to dissociate, major stress can make us more vulnerable to dissociation, or the stress can be a cause of our not eating properly or of losing sleep, which in turn increases our vulnerability to dissociate.

The ability to dissociate is not harmful in itself, but our lack of understanding* of the phenomena can lead to acute anxiety and panic. Although some people with panic disorder report they are not frightened of these sensations, others are, and the fear contributes to the feeling of going insane or loss of control.

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The anger many of us feel can be used in a positive and constructive way. When we direct our anger towards the disorder instead of ourselves, it can be the ‘rocketship’ towards recovery. I will discuss this further in chapter five.

We can also use our anger to help bring about changes to the health care system. If we are being completely open with our doctor or therapist, and they don’t know or want to understand, then we need to find someone who does. In the past this was not easy, but the situation is changing and will continue to change if we break our silence.

While we may still not wish to tell employers and friends, there are still other things we can do. We can write letters to the governing bodies of the various health professions and to the local state and federal members of parliament. We can keep writing until we receive a satisfactory response. Local self-help groups or the Consumer Health Advocacy agencies in each state are also available for advice and support. Individually we live in silence. Together we can break it.

Most importantly, our anger must not prevent us from seeking help. Understanding why various therapies haven’t worked will help us understand what will.

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Paul

Paul sat on the side of the hospital bed. He was being discharged after a night in hospital for observation because he felt as if he were having a heart attack. The specialist had told him he had not had a heart attack, but a panic attack. Paul had tried to tell the specialist that of course he had panicked. He had felt terrible and thought he was going to die. Surely, he thought, it was normal to panic under those circumstances.

Julie

The end of Julie’s shift was in sight. Another hour and she could go home, but first she had to hand over to the nurses on afternoon shift. She felt her stomach tighten and her anxiety increase. Julie had never had problems talking in front of other people before but the thought of hand-over today terrified her. She remembered the last few weeks and how it had become increasingly difficult for her to appear ‘normal’. Julie had had her first panic attack at work. Although she knew what was wrong with her, she was having enormous difficulty trying to ‘pull herself together’. She couldn’t control what was happening to her. She knew the other nurses wouldn’t understand if they found out. Julie felt she couldn’t go to any of the doctors at the hospital where she worked, as she was frightened they would make her resign.

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Carolyn

It had been a long and difficult week. Carolyn was glad she now had some time to herself. She curled up on the lounge with a book she had been wanting to read. As she relaxed she felt the tension ease from her body and she felt herself drifting into sleep. Without warning, she felt a wave of incredible energy surge through her body. As it moved through her, her heart rate doubled, she had difficulty breathing, she felt lightheaded and dizzy, a wave of nausea swept over her and she began to perspire. She jumped up and ran outside to her husband. ‘Help me, something is happening to me, I don’t know what but something is very wrong.’

Alex

Alex disliked staff meetings and social get togethers and did what he could to avoid them. He felt more comfortable just doing his job and avoiding any personal interaction with other staff. Now the new owners of the business had arranged a dinner for all staff and their partners and, like it or not, Alex had to go. He had been feeling uncomfortable all day and he knew his anxiety levels were very high. As he and his wife sat down at their table the people next to them began to make conversation. His heart began to race, his breathing became short and shallow, he began to perspire heavily and his hands trembled violently. As he tried to control it, he thought to himself, I shouldn’t have come. This always happens every time I am in this situation.

Jessica

Jessica turned on the ignition of her car. She was feeling very anxious. Is it going to happen today? As she pulled out of her driveway she tried to rationalise with herself for the hundredth time. She wasn’t frightened of driving, in fact she used to enjoy driving before she began to have spontaneous panic attacks. But there was one set of traffic lights where she would sometimes have an attack. There was no pattern to it. Sometimes it happened, sometimes it didn’t. Sometimes she would have an attack after she had driven through the traffic lights; on other days there were no attacks at all. Someone had told her she was frightened of that particular intersection, but she thought that was ridiculous. She was frightened of the attacks and their unpredictable nature, it had nothing to do with the intersection.

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