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By L. Sugut. University of Hawai`i, Hilo. 2019.

David: I know that this is sort of controversial purchase extra super cialis 100mg with visa impotence propecia, but just so we know and understand where you are coming from Dr purchase 100 mg extra super cialis with visa erectile dysfunction medication new zealand. Pratt buy discount extra super cialis 100 mg on line erectile dysfunction injections treatment, is "healing" to you the same as "integration" of the personalities purchase extra super cialis 100 mg overnight delivery erectile dysfunction juice recipe, or is it getting the alters to work and exist together? Pratt: I think that everyone needs to define healing for themselves. I cannot dictate my idea of what healing is to another person. I personally believe that doctors have made too much of the idea of integration. Many multiples, if they are able to cooperate internally and are not losing time or missing what is going on when others are out, can live completely satisfactory lives without trying to integrate. If someone chooses to work toward integration, that is certainly their option. If they choose not to, I would support that decision too. I have been trying to contract with her, or reach her in some way, but have been unable to. Do you have any suggestions in obtaining a contract or communication with her? Pratt: Asilencedangel, you are describing one of the most difficult problems to address. I would make the same suggestion, though, with perhaps the added encouragement to persist, and keep on persisting. However, the key is definitely, "I disagree with your method, but I think we may have something we do agree about. Pratt: This is where the help of a therapist sure comes in handy. As that happens in the very beginning, sometimes the therapist is the conduit for communication between alters. Falcon2: How do you teach alters to do specific things when you are not co-conscious? Pratt: Falcon2, I guess the answer is, you try to communicate and really try to listen. But you might be able to ask them to do "x" for you if you can do "y" for them. For example, they will refrain from drinking, if you can give them some time for recreation for themselves. David: Besides the journaling, what other ways are there to establish a workable system of existence with your alters? Pratt: I think that the help of a therapist is really useful in helping people develop internal communication and cooperation. Sometimes the therapist is the one who can most easily recognize the common goals, from alters who seem to have very different goals indeed. These comments illustrate how much good information multiples can get from each other. Pratt: I would have to underscore what We B 100 said, that giving alters their own time to do their own thing is a very positive step. Everyone, multiple or not, has different needs, and in a multiple, meeting the needs of alters is one way to keep everyone settled down and willing to work together. David: One of the common questions we are getting, Dr. Pratt, is how long should it take to obtain a peaceful coexistence with your alters? I think, if the person has alters who are doing highly destructive, scary things (like intensely suicidal or self-injurious behavior, severe addictions or eating disorders, to name a few, it may take a few years to get it all settled down. Not everyone with multiplicity experiences these very difficult adaptations. The goal of internal communication and cooperation might be accomplished with almost NO rehashing of the past. But the reasons why alters do various things, and the reasons why one has alters to begin with, will probably mean some thinking about and talking about the past. We are at a loss as to what to do to try get her back. Our job, up until now, has been to teach her how to live, and we feel very alone. Pratt: Jewlsplus38, I think you are most likely doing a great job. I would guess that, if all her life she has dissociated strong feelings, the process of learning to feel them for the first time is going to be on-again/ off-again. Offer support when she reappears, and keep her life in order while she is away. It reminds me of my first question tonight and the answer is very similar: Make sure that there is safety for those alters. If you (or anyone inside) has an idea about what those alters might need in order to feel safe, then I would try to create that safety. And make sure that it is communicated to them that it is up to them. JoMarie_etal: Prior to about six years ago, we were at least communicating and cooperating to some extent. Then something terrible happened to us and it totally destroyed all trust inside and out. I have been trying to reestablish some communication and cooperation, but everybody went into their own protective shells and there is extreme resistance to any kind of cooperation. In fact, there is a lot of energy going into disrupting day-to-day living. Is there any way of reestablishing the communication and getting everyone to work together again? Pratt: JoMarie_etal, you are also describing one of the hardest situations to deal with. A new trauma on top of all the old has to be one of the hardest things for all of your alters to cope with. They were partially convinced that cooperating and communicating (breaking down the barriers among them) was a good idea, and then something awful happened and they went back to what they know best. It comes back to safety again, and perhaps, a strong dose of not blaming. Try to make it safe to be out again, safe to be talking together again, and stress that everyone has the same goal: keeping safe and not letting bad stuff happen. Then try to focus on ways that everyone can agree to accomplish that goal. Wind: How do you feel about locking away a destructive alter for a period of time in order to gain co-consciousness? I do know someone who has had some success with locking away destructive alters, but I have never suggested it, or witnessed it myself. Talk with someone you have confidence in and who knows your situation well. David: An audience member says she talks with a DID friend by phone almost nightly. Her friend switches a lot and she wants to know how she can contact the core/main person to continue the conversation? Pratt: If possible, that is something she should talk over with her friend.

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Many patients suffer a generalized form of social phobia order 100mg extra super cialis overnight delivery vodka causes erectile dysfunction, in which they fear and avoid most interactions with other people buy extra super cialis 100 mg free shipping erectile dysfunction doctors in maine. This makes it difficult for them to go to work or school order extra super cialis 100 mg doctor for erectile dysfunction in chennai, or to socialize at all purchase extra super cialis 100mg erectile dysfunction after 60. Social phobias occur equally among men and women, generally developing after puberty and peaking after age 30. A person can suffer from one or a cluster of social phobias. Derived from the Greek, agoraphobia literally means "fear of the marketplace. It causes its victims to fear being alone in any place or situation from which he or she thinks escape would be difficult or help unavailable if he or she were incapacitated. People with agoraphobia avoid streets, crowded stores, churches, theaters and other crowded places. Normal activities are restricted by this avoidance, and people with the disorder often become so disabled they literally will not leave their homes. If people with agoraphobia do venture into phobic situations, they do so only with great distress or when accompanied by a friend or family member. Most people with agoraphobia develop the disorder after first suffering a series of one or more spontaneous panic attacks. The attacks seem to occur randomly and without warning, making it impossible for a person to predict what situations will trigger the reaction. The unpredictability of the panic attacks "trains' the victims to anticipate future panic attacks and, therefore, to fear any situation in which an attack may occur. As a result, they avoid going into any place or situation where previous panic attacks have occurred. Agoraphobia victims also may develop depression, fatigue, tension, alcohol or drug abuse problems and obsessive disorders. These conditions are treatable with psychotherapy and with medication. Psychiatrists and other mental health professionals use desensitization techniques to help people with phobic disorders. They teach patients deep muscle relaxation techniques, and work to understand what provoked the anxiety. As the sessions progress, the object or situation that provokes the fear no longer has its hold on the person. Panic disorder, while it often accompanies phobias such as agoraphobia, can occur alone. People with panic disorder feel sudden, intense apprehension, fear or terror, that can be accompanied by heart palpitations, chest pain, choking or smothering sensations, dizziness, hot and cold flashes, trembling and faintness. But psychiatrists diagnose panic disorder when the condition has become chronic. People with generalized anxiety disorder suffer with unrealistic or excessive anxiety and worry about life circumstances. Patients with this disorder often feel "shaky," reporting that they feel "keyed up" or "on edge" and that they sometimes "go blank" because of the tension they feel. The behaviors that are a part of obsessive-compulsive disorder include obsessions (which are recurring, persistent and involuntary thoughts or images) which often occur with compulsions (repetitive, ritualistic behaviors -- such as hand washing or lock checking -- which a person performs according to certain "rules"). Often beginning in adolescence or early adulthood, obsessive and compulsive behaviors frequently become chronic. Some investigators believe these disorders result from a traumatic experience in childhood that has been consciously forgotten, but surfaces as a reaction to a feared object or stressful life situation, while others believe they arise from imbalances in brain chemistry. Several forms of medication and psychotherapy are highly effective in treating anxiety disorders, and research continues into their causes. Like depression, schizophrenia afflicts persons of all ages, races and economic levels. It effects up to two million Americans during any given year. Its symptoms frighten patients and their loved ones, and those with the disorder may begin to feel isolated as they cope with it. The term schizophrenia refers to a group of disorders that have common characteristics, though their causes may differ. The hallmark of schizophrenia is a distorted thought pattern. The thoughts of people with Schizophrenia often seem to dart from subject to subject, often in an illogical way. Patients may think others are watching or plotting against them. Often, they lose their self-esteem or withdraw from those close to them. Persons suffering schizophrenia sometimes hear nonexistent sounds, voices or music or see nonexistent images. Because their perceptions do not fit reality, they react inappropriately to the world. Patients react in an inappropriate manner or without any visible emotion at all. Though the symptoms of schizophrenia can appear suddenly during times of great stress, schizophrenia most often develops gradually, and close friends or family might not notice the change in personality as the illness takes initial hold. Theories about the causes of schizophrenia abound, but research has not yet pinpointed what causes the disease. In recent years, laboratory findings have suggested strongly that schizophrenia is passed on genetically from generation to generation. Some studies have found abnormal levels of some chemicals in the blood and urine of people with schizophrenia. One study has suggested that the alignment of cells in a particular area of the brain goes awry before birth. Schizophrenia cannot be cured, but it can be controlled. Thanks to new treatments, most persons with schizophrenia are able to work, live with their families, and enjoy friends. Very few are ever violent or behave in unacceptable ways. But, like a person with diabetes, the person with schizophrenia probably will have to be under medical care for the rest of his or her life. Researchers have found a number of antipsychotic medications that aid in the treatment of schizophrenia. Of course, these drugs should be used only under the close supervision of a psychiatrist. Additionally, psychotherapy can offer understanding, reassurance, and careful insights and suggestions for handling the emotional aspects of the disorder. Substance abuse should be a part of any discussion about mental illnesses. Substance abuse -- the misuse of alcohol, cigarettes and both illegal and legal drugs -- is by far the predominant cause of premature and preventable illness, disability and death in our society. According to the National Institute of Mental Health, nearly 17 percent of the U. When the effects on the families of abusers and people close to those injured or killed by intoxicated drivers are considered, such abuse affects untold millions more. While abuse of and/or dependence on substances may in their own right bring suffering and physical sickness that require psychiatric medical treatment, they often accompany other seemingly unrelated mental illnesses as well. Many people who struggle with mental illnesses also struggle with alcohol or drug habits that may have begun in their mistaken belief that they can use the substance to "medicate" the painful feelings that accompany their mental illness.

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