October 13th, 2002



I've been tossing and turning in bed, and my jaw has been hurting. I took some Excedrin, wanting to limit my use of Vicodan (save it for when I feel I can really use it!) and here I am up again, and reading more of "Hormone Heresy". Although I do not think this is a great book, I do think the subject matter is important and the general direction of the book is important. I am disturbed by the author's tendency to rely entirely on the opinions of others, making this book more like an extended book report than a book in itself. She repeats whole paragraphs from the books of others, then throws in conclusions that are sprinkled with unnecessary modifiers ("extremely important", "very minor side effects"), and does not provide, in my opinion, adequate backing for some of her generalizations.

Even so, the book offers food for thought. It also provides some limited information on the female reproductive system and the function of hormones in the human body, which helps me see where HRT has gone wrong.

For it does appear to have gone wrong. What strikes me is that the story of hormone replacement therapy is similar to that of drugs used for depression. It appears that, rather than an estrogen deficiency, women at the time of menopause actually have more of an "estrogen dominance" situation, because of a lack of sufficient progesterone. That lack can come from many factors, but primarily appears to arise from nutritional deficiencies and environmental pollution. This much makes sense to me. What women need, then, is supplementation of natural progesterone rather than estrogen, especially rather than synthetic estrogen.

Here's one question I want an answer to: why do so many women believe that estrogen therapy has helped them? How are their symptoms responding? If they do not need estrogen, and in fact have too much, I'd expect to see an increase in symptoms, not a decrease. I have read no explanation for this.

However, I have read that there appear to be withdrawal symptoms that mirror those of many antidepressants: the withdrawal symptoms mimic the original symptoms of complaint - hot flashes, weight gain, and so forth. So a woman wanting to get off HRT will experience withdrawal that makes it appear that her original symptoms have returned, when in fact they have not; she is simply going through withdrawal. This much is very like antidepressants.

Although I do not feel this book is sufficiently supported by direct evidence - in the form of scientific double-blind studies, for example, by disinterested researchers - I feel the information in it is worth consideration. I intend to seek out other, more authoritative sources on the subject.

What I wonder, though, is why some of us are willing to question our long-held beliefs when presented with alternative possibilities, and some will instead resist any opinion change.

When I was young, I initially supported the war in Vietnam, because - I remember this feeling - I felt that the people in our government knew more than I did, were in a position to make better decisions than I was, and were fundamentally doing the best they could. It was hard for me to imagine that people really do make decisions based on greed, face-saving, and other self-protective reasons. It took some time before I became convinced that our government was in over its head - and even then I did not entirely blame the then-president, Johnson, feeling instead that he got caught in a net of someone else's making. Yes, of course he did, but he was in a position to do something about it sooner than he did.

I still don't believe anyone is purely evil. I don't believe that everyone who works for Lilley is laughing at Lilley's deceit of the public all the way to the bank. I don't believe that most doctors are insensitive and only out for the buck. I do believe that most doctors are too busy to question the information given to them about various medications. Where are they going to get alternative information when the FDC does not monitor long-term drug use or order long-term studies? It's only natural that most doctors will tend to believe articles in their medical journals and will not dig into the credentials of the writers, will not find out that they are being paid by drug companies. It can't be easy to find these things out.

So here we are, doctors and patients alike swallowing whole theories that happen to be completely wrong. They make sense on paper but don't prove out in people. Why, then, do some of us choose to question and others not?

Also, why, when I state my beliefs here, either after extensive reading or just because something doesn't feel right to me, why am I attacked for those beliefs? They are different from "common knowledge" but that doesn't make them wrong. But even if I am wrong, which is unlikely, why attack me? Am I speaking at a medical forum, pretending to be a doctor and to have done the research myself?

What disturbs me personally is that I am so devastated by these attacks. I'd like to develop thicker skin, be able to let it all bounce off. Instead, I become angry, defensive, unable to control the quickening of my heartbeat. I suspect that this anger and anxiety is misplaced. I am feeling attacked for something else perhaps.

When I was a child, my sister Mary always had to have the last word. No matter what the argument, she always came back with one more retort. I got so that I stopped arguing with her because it frustrated and upset me so much. Could this be a part of it? If so, my reaction to her seems to stem from something else further back.

In my personal life I hate to be hated. When someone who has been my friend or close relative believes I have somehow wronged that person, I somehow feel guilty, like I really have. These days, when this happens, it is more a problem of how I have responded, my reaction, than the original "transgression", whatever it was. I want to be able to have my opinion, let others' opinions enter but not bother me, and to be able to control my reactions. I can do this at work. I can even be, in a way, proud to have upset someone because I have held my ground. But usually holding my ground in these cases is easy and does not involve my losing control.

It's all control. I mean, control is what I want, all the time. Control, mostly, of my own reactions. I have it most of the time but not always. I want it always - except when I want to let go, as in intimate situations. But why? Why must I have it?

Late night is often a good time to write out these musings. It has been a while since I have even felt like writing my thoughts, although I have continued to have them. I hope this signals a return to my former self, in some form.

My jaw is feeling quite a bit better now. I'd like some ice cream, though.
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overcoming phobias

In the terrific book, "Prozac Backlash" (which, unlike "Hormone Heresy" is well-documented and written by a doctor who practices what he preaches) Dr. Glenmuller tells of "exposure therapy" for persons with phobias. He tells how the patient is gradually exposed to the object of fear, learns at each step that it will not harm him, and, ideally, also undergoes psychotherapy intended to root out the original cause of the phobia. I suspect that this digging into the past helps the patient realize that the fear is irrational.

I did none of this in conquering my own fear of height. My approach was simpler and every bit as effective, and I never found out the actual cause of the fear. I suspect I gained it by suggestion from my mother, who also had this phobia (along with many others that I did not gain). But I don't know. It's as good an explanation as any, yet I did not even look into that part of it. I just set out to attack the fear from a rational point of view and succeeded.

I grew up believing that deep psychotherapy was the only way to get to the root of my problems, that I would never solve any of them without that. I do believe that therapy has helped me tremendously over the years. However, I also believe that I am fully capable of doing the work myself, at least at this stage of my life. I go to my therapist once a month these days, and mostly spill what I have worked out about myself. She does not direct, although sometimes she asks questions that get me thinking. I would get nowhere if I were not intensely committed to working out what about me gets in my own way.

As long as I was convinced that there was no way I could help myself on my own, there simply was no way. As long as alcoholics are convinced that they cannot make it on their own they won't. As long as depressed patients are convinced that they cannot make it without drugs they won't. It's necessary at times to look at these beliefs. They have us tied up, trussed, unable to move on our own. This is a form of "learned helplessness". I apologize to those I may have offended here but I don't take it back. I have come full circle from believing that we are victims of our own histories, unable to break out, to believing we have far more power than we let ourselves use. Incidentally, this is not a sermon to "snap out of it," to those who are in pain. I know pain, mental, emotional pain, as well as anyone else, and I know that the last thing we seem capable of doing when we feel badly are those things that will help us. It is perverse and I understand it. We can forgive ourselves for not acting. We can forgive ourselves for relying on drugs long enough to get back on some sort of track. I don't advocate the "buck up!" school. I don't suggest that this pain is not real and is not debilitating. I do suggest that we can take one tiny step at a time, even if that step is to lie down and accept being a rug for a day or a week or whatever, and know that we have it in us to get past it.

Speaking of suggestibility! My mother mentioned, when I was in seventh grade, that she had had laryngitis when she was my age and it kept her out of school for six weeks. I developed laryngitis and I malingered for eight weeks! I do not think I was conscious of what I was doing but I was certainly highly suggestible to have done this. Funny thing about that period is that it took me about two days to get back on track at school when I returned. I felt disappointed by this, that the rest of the class had not really been learning anything anyway.

(no subject)

Things have a way of going haywire when Mary shows up. She brought her new heavy comforter to wash, and it was too heavy for my washer, caused it to blow the circuit. So I dragged it out of the washer and into the tub, leaving a trail of water and breaking apart the weak plastic clothes sorter that is next to the washer.

Now she's at the laundromat with the comforter, which we stuffed into a large plastic bag and then into her hamper and into her car. I'm feeling hungry and a little tired.