Poetry, film give voice for OCD sufferers

(CNN) -- "I'm edging towards being a recluse, but choose daily to fight for release from this crippling prison."

This is how Gemma Boyd describes her life with obsessive compulsive disorder, a mental illness marked by unwanted thoughts and repeated behaviors or rituals intended to reduce anxiety. She wrote these words in a poem last November, the first time she tried to deal with her daily struggles through creative writing.

Boyd, a 35-year-old British musician and poet, shared her poem online with Machine Man, an online forum where anyone with something to say about OCD can submit art, creative writing and multimedia projects, in addition to joining conversations about the condition. The forum is the online counterpart to a movie project called "Machine Man," both of which aim to spread greater awareness of OCD.

The film will aim to "get it out there what OCD really is, and take away some of the shame and stigma," said Kellie Madison, writer and director of "Machine Man."

It will portray a young man's struggle with OCD, showing how intense anxiety and compulsions quickly take over his life and prevent him from pursuing a relationship with the woman he loves. The script is complete, and production is still in the fundraising stages.

In the online forum, Boyd and others with OCD have found a safe space to express a part of themselves previously shrouded in silence. And they're energized by the prospect of a movie that would both represent their struggles and educate a wide audience about the disorder.

"I'm hoping that I'll be able to have a platform with this movie, and to try to really change my life around, because I have no choice but to do that," said Stephanie, a poetry contributor to the "Machine Man" forum who suffers from OCD, who asked that her last name not be used.

About 2% of adults in the United States have OCD, according to the National Institutes of Health. Across the ocean, where Boyd lives, about 1% of the United Kingdom's population is thought to have it, although this estimate is probably low, says the organization OCD-UK.

The illness often has an element of predisposition, meaning some people are more likely to develop it than others, said John Tsilimparis, an OCD therapist in Los Angeles. In fact, there is some evidence that people with OCD have distinct brain activity patterns. Stressful situations and traumatic events can trigger symptoms.

"I'm the architect still, I forgot how to draw. My healthy balance and perspective is a bit flawed. I'm OCD, tried for perfection for too many reasons," writes Stephanie in a recent poem called "My Frame".

For Boyd, 35, it was a traumatic event (which she'd prefer to keep private) that got her obsessively worrying about contamination about five years ago. But prior that, she had a mountain of bad memories from being sexually abused as a child that she'd repressed, and which also fueled her anxiety.

The intrusive thoughts started with a fear of blood. Over time they expanded; she became afraid of being attacked by men, any men, and could vividly imagine assaults even from male friends. In some of the worst periods, she couldn't leave her house because she kept checking and checking appliances, fearing a fire or home invasion.

"Relentlessly checking and re-checking numbers, magazine pages, text messages, household appliances -- everything -- causes my nerves to jangle 24-7: a gradual wearing down of brain function and twisting and twirling children who repeat and repeat aggravate my stifled anger," Boyd wrote in her poem.

To this day, she avoids many situations she used to enjoy so that she can avoid social contact: swimming pools, movie theaters, and restaurants.

"It's a battle against things which lots of people take for granted. I don't let it completely ruin my life, but it has made my life an uphill struggle," she said.

Crowds are out of the question -- unless, curiously enough, the people are listening to her play music. A professional musician, Boyd has found that the anxiety that restricts her in daily life isn't as bad when she's behind the double bass (her website lists six gigs lined up in May already). Music has been a sort of medicine, she says.

"When I'm performing, because I've got an instrument in front of me, I feel I'm protected a bit," she said. "When I'm in a normal situation, I feel as if I haven't got a skin."

As freely as OCD may be mentioned these days in popular culture -- a recent episode of "Glee" focused on it, for example -- Boyd had a tough time getting help near her hometown of Brighton and Hove, England.

She underwent several psychological assessments before receiving the diagnoses of OCD and post-traumatic stress disorder. Then she waited. And waited. It took about three years before she got to see a therapist who was supposed to be the best person in the area for OCD relating to sexual abuse. As it turns out, the therapist admitted that she didn't know much about OCD at all. Boyd stuck with her anyway for two years, but it only partially helped.

"I'm scared of opening up and then being told that there's no help available," she said. "Instead of seeking that help, I'll read the literature (about OCD), which isn't ideal."

Boyd has gotten some of her most critical OCD education through watching television and reading. The A&E program "Obsessed" taught her the difference between "obsession" and "compulsion," as well as the biological underpinnings of the disorder and various kinds of therapies.

A behavioral treatment shown to help people with OCD is called exposure therapy. Basically, the patient is forced to confront her fears -- for example, going out in public if she wouldn't normally, or letting time pass without checking to see if appliances were left on. The therapist systematically helps the person desensitize herself, Tsilimparis said. Psychiatrists may also prescribe drugs called selective serotonin reuptake inhibitors, which help depression as well.

Since Boyd's struggle with OCD has become more difficult recently, she's eager to investigate more OCD-specific treatment options in her country.

She does not take medication, and has decided against it for the time being. She has tried exposure therapy techniques on her own, but it's exhausting without support.

"You do need somebody to physically be there while you're experiencing these feelings, which I think can be pretty terrifying," she said.

On the bright side, Boyd has received positive feedback on her poem in the "Machine Man" forum, and some people have asked her to write more about it. She says she probably will.

"It's kind of helped me feel not so alone with my OCD," she said. "Hopefully, I've helped other people see they're not alone."

Osama bin Laden's death: How should we feel?

(CNN) -- You may be relieved or even ecstatic about the end of a symbol of terror, or maybe it seems like the pain is just beginning all over again.

Both of these reactions to the death of Osama bin Laden, who was killed by U.S. troops in Pakistan, are natural, experts say.

From the celebrations in Washington and New York, it looks like lots of people are happy. Chants of "USA! USA!" reverberated outside the White House and at New York's ground zero as crowds celebrated the death of the terrorist leader, President Obama announced Sunday.

As far as the collective American psyche goes, it makes sense that this is a moment of celebration, says Columbia University psychiatrist Dr. Jeffery Lieberman. The country has been experiencing emotional malaise, with a slow-moving economy, a sense of America losing its No. 1 status in the world, and a decade of pent-up anguish about the threat of terrorism. Much like the World War II years, these have been uncertain times.

Then, rumors of bin Laden's death, confirmed by an announcement from the president, lifted that burden of pain and helplessness.

"In the blink of an eye, the gloom and doom and pessimism has dissipated," Lieberman said.

After bin Laden: What does it mean to you?

But wait a minute: Should we rejoice in the death of another human being?

But although bin Laden claimed responsibility for the destruction of the World Trade Center and the deaths of thousands of Americans, the outpouring of celebration doesn't feel right for everyone.

David Sirota, a newspaper columnist and a contributor to Salon felt uncomfortable with the jubilation because he said there is a "difference between relief and euphoria."

"A euphoric response instead of somber relief suggests that we are celebrating revenge. We are not celebrating an end to the war," he said, comparing it to the public's euphoria when World War II ended.

"What's a little scary about this: We were once a country that saw violence as regrettable, but sometimes necessary act. But we're not celebrating end of violence, but the exercise of it."

Josh Pesavento, 22, a journalism student in New York who photographed the cheering crowds in Times Square on Monday morning, also felt conflicted about the celebrations he witnessed.

"I don't believe that any person has the right to kill anyone, and I don't think that we should be cheering for yet more loss of life. However, I tell myself that in this situation, these people may be cheering for the end of an icon who led to the death of far, far too many," Pesavento said.

For some, bin Laden represents an idea more than a person who lived and died. More than the death of a human being, this ends the life of a powerful symbol of terrorism and destruction, said Nadine Kaslow, psychologist at Emory University. Bin Laden's death hits closer to home in the U.S. than the capture and execution of Saddam Hussein, for example, because the Iraqi dictator did not directly attack American soil, she said.

The celebratory mood reflects a sense that fairness and justice had been restored and that a terrorist got his comeuppance, said Kaslow.

"I think people feel like this guy got what he deserved. It was a sense that it was 'our family' that was killed," she said.

But there are likely others who aren't chanting on the streets for whom the death of bin Laden brings back painful memories of the September 11, 2001, terrorist attacks, she said.

People who lost loved ones on September 11, 2001, may have symptoms of post-traumatic stress disorder, and the killing of bin Laden may open old wounds, Lieberman said.

"It doesn't bring their loved ones back. It doesn't ease their pain. There was so much more to this than catching bin Laden. At best, they would be bittersweet: It feels good to have the relief of this guy being gone, but the pain of their loss is very strong and very real to them," said Dr. Susan Nolen-Hoeksema, a Yale University psychologist.

Diana Massaroli, who lost her husband, Michael Massaroli, in the World Trade Center on September 11, 2001, said the news of bin Laden's death made her feel an "overall calm that I haven't felt in 10 years."

"I feel better ... like I can start a new chapter in my life."

Sirota and Kaslow likened bin Laden's death to the execution of a convicted murderer of someone's family, which may bring a sense of closure for some. In the case of bin Laden, though, there is fear of retaliation from terrorist groups.

"Relief also comes with a kind of sadness that the victims can never be brought back and sadness at the world that creates such a perpetrator," Sirota said.

Even people who didn't feel the direct impact of the attacks on September 11, 2001, will feel relief, Kaslow said. After all, everyone gets reminded of the global insecurity that resulted whenever they go to the airport.

The terrorist leader's living situation also doesn't bring about any sympathy -- he wasn't starving and struggling in a cave, but rather lived in a mansion, which adds to his perceived arrogance, Kaslow said.

The news of bin Laden's death "allows us to put some sort of order" to the horror of 9-11 because otherwise, "it's upsetting, disconcerting when we're reminded how unpredictable life, death and the world around us could be," said Sam Sommer, associate professor of psychology at Tufts University.

People's reactions are likely tied to how emotionally and personally they felt to the events 10 years ago, Sommer said.

"It seems to me that the emotional reaction had a lot to do with the differences in how people view this -- whether it's the right triumphing over evil -- a lot of young people are viewing this in that way," Nolen-Hoeksema said.

She noted that her teenage son and his friends were enthusiastically tweeting about the news in a tone that "this is a bad guy, the good guys got him finally -- that's all they are seeing." After, all Jack Bauer of "24" was trending on Twitter.

But the one common factor was that everyone felt a need to share the news and their observations -- whether it was rallying in front of the White House, or tweeting or updating their Facebook page.

"These emotionally charged events send us back to our social roots and make us need to affiliate with other people," Sommer said.

CNN's Nicole Saidi contributed to this report.

Do women like adult media and content as much as men?

By, Ian Kerner, a sexuality counselor and New York Times best-selling author.

If you’d asked me this question a couple of years ago, I would have said “no.” But the times they are a-changing: just as female infidelity is on the rise, women are catching up to the guys in other ways, too - including a propensity for porn.

As a sex therapist and founder of the website Good in Bed, here’s what I’m observing:

– More couples are enjoying porn together, with women often taking the lead in choosing the material.

– More women are using porn to get themselves in the mood for sex or to enjoy their sexuality on their own.

– More women are using porn to learn new sexual techniques or to explore sexually adventurous situations.

– More women are using porn to satisfy a general curiosity about sex overall, and

– More women are comfortable and confident in asserting their opinions on the subject.

In short, women are increasingly using porn for pretty much the same reasons (and pleasures) as men. Meanwhile, guys are increasingly surprised to discover that their female partners are interested in porn - and tend to be even more surprised to discover what they’re watching (I’ll get to that in a moment).

So what’s going on? Why the apparent change? To be honest, I’d always been of the mind that men and women are somewhat different when it comes to porn, for both biological and sociological reasons:

On the biological side, I’ve often said female sexual desire is more complex than male desire, and that porn rather clearly illustrates that difference: In men, visual stimulation leads quickly to sexual arousal, and with that chain of arousal often comes a desire to be stimulated to orgasm. In that sense, arousal and desire are very closely related, and it’s one of the reasons that Viagra has been so successful with men: Give a guy an erection and he basically wants to use it. In men, porn initiates the “sexual-circuit” very quickly.

That’s not to say that women don’t respond to visual stimulation either, or that that stimulation doesn’t lead to genital arousal, but that arousal doesn’t always trigger desire in women the way that it does with men.

When I talk to guys about their porn use, many describe a lack of pre-meditation. For example, a guy could be hanging out on his computer, checking out his favorite sports site, when up pops an ad with a sexy woman in a bikini and, bang, next thing he knows he’s trawling porn sites in search of sexual release.

With women, however, the use of porn or the desire/decision to have an orgasm is often less opportunistic. A woman may see something super-sexy, and recognize it as sexy, and even arousing, but that doesn’t mean she’s necessarily going to stop what she’s doing to stimulate herself to orgasm. (By the way, if you don’t agree with any of this, please chime in below in the comments - sexual desire is by no means a one size fits all model: everyone is different and topic of women and porn is a highly debated one.)

On a more sociological level, generations of women have been told that porn is evil: that it exploits, objectifies, and degrades women, and that a woman who enjoys porn is a betrayer of Women. Some may still feel this is true, (and there are plenty of women who feel uncomfortable with porn), but there are also plenty of women who would beg to disagree and look at porn as a fairly innocuous form of erotic escapism that’s a personal choice and not a big deal.

Additionally, many women have contended that porn, until fairly recently, was never really created with female customers in mind; that porn was designed to appeal to men and lacked elements that were more organic to female sexuality, such as foreplay, intimacy and erotic storylines.

Well, today there are many porn sites geared toward women. In fact, there’s even a regular Feminist Porn Awards that recognizes erotic entertainment that is smart, sexy, and appreciates women as viewers.

Combine a recognition of a female audience with the rapid proliferation of easily accessible Internet porn, and it only makes sense that more women are enjoying porn. (By the way, if you’re a woman and you’re interested in dipping a toe - or perhaps nose-diving - into the world of porn, I suggest checking out the work of Violet Blue and her book, "The Smart Girl's Guide to Porn." Or if porn isn’t your thing, but you’re interested in some hot erotic literature, take a look at the anthologies that are edited by Rachel Kramer Bussell.)

As it turns our women may be able to enjoy porn with less guilt, or at least with less grief from their male partners. In my experience, women tend to worry a lot more about their man’s porn habits and what it means to their relationship, whereas many of the men I’ve spoken with tend to be intrigued by the idea of women and porn - especially since women are much more likely to enjoy porn that does not directly reflect their sexual orientation.

One study at Northwestern University, for example, examined the effects of porn on genital arousal and concluded that men responded more intensely to porn that correlated to their particular sexual orientation, whereas women tended to be genitally aroused by a much broader spectrum of erotic material. Who knows –- perhaps the enormous variety of material offered by the Internet will end up playing more to the spectrum of female desire than male desire in the long run?

For the moment, it would seem that women are not watching porn nearly as much as men. Recently, a researcher from the University of Montreal set out to study whether pornography had an impact on guys’ sex lives. He searched for men in their 20s who'd never consumed porn, and guess what? He couldn't find a single one. I can still show you plenty of women who have never looked at porn - but perhaps not for long.

So do women like porn as much as men? You tell me.

Understanding what bipolar disorder is and how to diagnose if you have it.

Bipolar disorder involves periods of elevated or irritable mood (mania), alternating with periods of depression. The "mood swings" between mania and depression can be very abrupt.
Causes, incidence, and risk factors

Bipolar disorder affects men and women equally. It usually appears between ages 15 - 25. The exact cause is unknown, but it occurs more often in relatives of people with bipolar disorder.

Types of bipolar disorder:

People with bipolar disorder type I have had at least one fully manic episode with periods of major depression. In the past, bipolar disorder type I was called manic depression.

People with bipolar disorder type II have never experienced full-fledged mania. Instead they experience periods of hypomania (elevated levels of energy and impulsiveness that are not as extreme as the symptoms of mania). These hypomanic periods alternate with episodes of depression.

A mild form of bipolar disorder called cyclothymia involves less severe mood swings with alternating periods of hypomania and mild depression. People with bipolar disorder type II or cyclothymia may be misdiagnosed as having depression alone.

In most people with bipolar disorder, there is no clear cause for the manic or depressive episodes. The following may trigger a manic episode in people who are vulnerable to the illness:

Life changes such as childbirth

Medications such as antidepressants or steroids

Periods of sleeplessness

Recreational drug use

Symptoms

The manic phase may last from days to months and can include the following symptoms:

Agitation or irritation

Inflated self-esteem (delusions of grandeur, false beliefs in special abilities)

Little need for sleep

Noticeably elevated mood

Hyperactivity

Increased energy

Lack of self-control

Racing thoughts

Over-involvement in activities

Poor temper control

Reckless behavior

Binge eating, drinking, and/or drug use

Impaired judgment

Sexual promiscuity

Spending sprees

Tendency to be easily distracted

These symptoms of mania are seen with bipolar disorder I. In people with bipolar disorder II, hypomanic episodes involve similar symptoms that are less intense.

The depressed phase of both types of bipolar disorder includes the following symptoms:

Daily low mood

Difficulty concentrating, remembering, or making decisions

Eating disturbances

Loss of appetite and weight loss

Overeating and weight gain

Fatigue or listlessness

Feelings of worthlessness, hopelessness and/or guilt

Loss of self-esteem

Persistent sadness

Persistent thoughts of death

Sleep disturbances

Excessive sleepiness

Inability to sleep

Suicidal thoughts

Withdrawal from activities that were once enjoyed

Withdrawal from friends

There is a high risk of suicide with bipolar disorder. While in either phase, patients may abuse alcohol or other substances, which can make the symptoms worse.

Sometimes there is an overlap between the two phases. Manic and depressive symptoms may occur together or quickly one after the other in what is called a mixed state.
Signs and tests

A diagnosis of bipolar disorder involves consideration of many factors. The health care provider may do some or all of the following:

Ask about your family medical history, particularly whether anyone has or had bipolar disorder

Ask about your recent mood swings and for how long you've experienced them

Observe your behavior and mood

Perform a thorough examination to identify or rule out physical causes for the symptoms

Request laboratory tests to check for thyroid problems or drug levels

Speak with your family members to discuss their observations about your behavior

Take a medical history, including any medical problems you have and any medications you take

Note: Use of recreational drugs may be responsible for some symptoms, though this does not rule out bipolar affective disorder. Drug abuse may itself be a symptom of bipolar disorder.
Treatment

Spells of depression or mania return in most patients, in spite of treatment. The major goals of treatment are to:

Avoid cycling from one phase to another

Avoid the need for a hospital stay

Help the patient function as best as possible between episodes

Prevent self-destructive behavior, including suicide

Reduce the severity and frequency of episodes

The doctor will first try to determine what may have triggered the mood episode, and identify any medical or emotional problems that might interfere with or complicate treatment.

Drugs called mood stabilizers are considered to be the first-line treatment. The following are commonly used mood stabilizers:

Carbamazepine

Lamotrigine

Lithium

Valproate (valproic acid)

Other antiseizure drugs may also be tried.

Other drugs used to treat bipolar disorder include:

Antipsychotic drugs and anti-anxiety drugs (benzodiazepines), which can be used to stabilize mood

Antidepressant medications can be added to mood-stabilizing drugs to treat depression. People with bipolar disorder are more likely to have manic or hypomanic episodes if they are put on antidepressants. Because of this, an antidepressant is only used in people who are also taking a mood stabilizer.

Electroconvulsive therapy (ECT) may be used to treat the manic or depressive phase of bipolar disorder that does not respond to medication.

ECT is a psychiatric treatment that uses an electrical current to cause a brief seizure of the central nervous system while the patient is under anesthesia.

ECT is the most effective treatment for depression that is not relieved with medications.

Transcranial magnetic stimulation (TMS) uses high frequency magnetic pulses that target affected areas of the brain. It is most often used as a second-line treatment after ECT.

Patients who are in the middle of manic or depressive episodes may need to stay in a hospital until their mood is stabilized and their behaviors are under control.

Doctors are still trying to decide the best way to treat bipolar disorder in children and adolescents. Parents should consider the potential risks and benefits of treatment for their children.

SUPPORT PROGRAMS AND THERAPIES

Family treatments that combine support and education about bipolar disorder (psychoeducation) appear to help families cope and reduce the odds of symptoms returning. Programs that emphasize outreach and community support services can help people who lack family and social support.

Important skills include:

Coping with symptoms that are present even while taking medications

Learning a healthy lifestyle, including getting enough sleep and staying away from recreational drugs

Learning to take medications correctly and how to manage side effects

Learning to watch for early signs of a relapse, and knowing how to react when they occur

Family members and caregivers are very important in the treatment of bipolar disorder. They can help patients seek out proper support services, and help make sure the patient follows medication therapy.

Getting enough sleep is extremely important in bipolar disorder, because a lack of sleep can trigger a manic episode. Psychotherapy may be a useful option during the depressive phase. Joining a support group may be particularly helpful for bipolar disorder patients and their loved ones.

A patient with bipolar disorder cannot always reliably tell the doctor about the state of the illness. Patients often have difficulty recognizing their own manic symptoms.

Mood variations in bipolar disorder are not predictable, so it is sometimes difficult to tell whether a patient is responding to treatment or naturally emerging from a bipolar phase.

Treatment strategies for children and the elderly have not been well-studied, and have not been clearly defined.

Expectations (prognosis)

Mood-stabilizing medication can help control the symptoms of bipolar disorder. However, patients often need help and support to take medicine properly and to ensure that any episodes of mania and depression are treated as early as possible.

Some people stop taking the medication as soon as they feel better or because they want to experience the productivity and creativity associated with mania. Although these early manic states may feel good, discontinuing medication may have very negative consequences.

Suicide is a very real risk during both mania and depression. Suicidal thoughts, ideas, and gestures in people with bipolar affective disorder require immediate emergency attention.
Complications

Stopping or improperly taking medication can cause your symptoms to come back, and lead to the following complications:

Alcohol and/or drug abuse as a strategy to "self-medicate"

Personal relationships, work, and finances suffer

Suicidal thoughts and behaviors

This illness is challenging to treat. Patients and their friends and family must be aware of the risks of neglecting to treat bipolar disorder.
Calling your health care provider

Call your health provider or an emergency number right way if:

You are having thoughts of death or suicide

You are experiencing severe symptoms of depression or mania

You have been diagnosed with bipolar disorder and your symptoms have returned or you are having any new symptoms

References

Moore DP, Jefferson JW. Bipolar disorder. In: Moore DP, Jefferson JW, eds. Handbook of Medical Psychiatry. 2nd ed. Philadelphia, Pa: Mosby Elsevier;2004:chap 80.
Schiffer RB. Psychiatric disorders in medical practice. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa:Saunders Elsevier;2007:chap 420.
Benazzi F. Bipolar disorder -- focus on bipolar II disorder and mixed depression. Lancet. 2007;369:935-945. [PubMed]
Morriss RK, Faizal MA, Jones AP, Williamson PR, Bolton C, McCarthy JP. Interventions for helping people recognise early signs of recurrence in bipolar disorder. Cochrane Database Syst Rev. 2007;24;(1):CD004854. [PubMed]
Sachs GS, Nierenberg AA, Calabrese JR, et al. Effectiveness of adjunctive antidepressant treatment for bipolar depression. N Engl J Med. 2007;356:1711-1722. [PubMed]

7 tips for moving past a rotten childhood

Author Tracy McMillan knows a thing or two about getting over a bad childhood. Her father was a drug-dealing pimp and convicted felon who spent most of his daughter's life behind bars. Her prostitute mother gave her away.

Here's what she wants you to know about getting over your past.

1. Get a new story

There are two ways for me to look at my childhood story. In one, I'm a person who is so unloved and unwanted, my own mother gave me away.

In the other, I was born, took a look around at my prostitute mother and criminal father, and said to myself, "I can totally do better than this. Get your stuff, we're leaving." In one I'm a victim, in the other, I'm in power.

2. Realize blame = same

Blame is awesome. It feels good, right? It feels righteous. It feels powerful. It feels like someone's going to pay for what they did to you.

The only problem is -- as long as you're blaming -- nothing can ever change. Why? Because in order for your life to change, you have to want things to be different.

And if it feels good to blame, you have to admit that you like it. And if you like it, you have to admit that you don't really want it to change. Which is why blame just gets you more of the same.

3. Pretend you work at a retail store

Sometimes, I look at my bad childhood like it's an unruly customer and I'm working customer service the day after Christmas. It'll be acting up, moaning and complaining about how hard everything is, and how unfair it all is.

I just have to say to it, "Yes, I see you, ma'am. I know you have a problem. But right now I'm busy, so please have a seat. I''ll be with you just as soon as I can."

Then I do something productive that will actually change my situation, like go to work.

4. Accept the fact that some don't really want you to succeed

This sounds harsh, and it is. But it's true.

Some of your family and friends "support" you by cosigning all your b.s. about how hard you have it, because if you succeed, two things will happen:
1) You will leave. And 2) They will be left behind.

This doesn't mean you have to get rid of your friends and family, you just have to remember that they love you so much, they're perfectly happy for you to stay exactly where you are right now.

5. Decide to KSA (Kick some ass)

When my 13-year-old said he hated science class, I told him that getting a 95 on the test was the equivalent of getting in the face of his least favorite teacher and saying, "Have some!"

In other words, kicking ass on the test is just like playing a video game. Needless to say, he's getting As now. Channeling your anger will get you a long, long way in life.

6. Hoard your money

The number one way to end your bad childhood is to save money. I have a very simple rule about money: If I never spend everything I make, I will always have money. And money is power.

All those commercials you see are a big, rich company's attempt to get you to give them your power. Don't do it! Think of every dollar you save as one step away from the people and places that have kept you down.

7. Get a paper route

In fifth grade, I wanted a 10-speed bike like all the other kids had. So I started delivering papers when I was 11. In Minnesota. In the winter.

Compared to that, every job I've had since has been easy. While there may not be papers to deliver in the snow, the point is to do the thing you don't want to do.

Get a hard/crappy job and do it until the voices in your head stop telling you that you can't take it another minute. Everything after that will be cake, and your bad childhood will be over. I promise.

Sexual side effects: A silent epidemic?

By, Ian Kerner

Are meds zapping your mojo? Is a prescription inhibiting your passion? If so, you’re far from alone. More than 27 million Americans take antidepressant drugs and research suggests that 37 percent of those people experience sexual side effects. And that’s just in the category of antidepressants! When you consider that millions of drugs are prescribed for common medical conditions, such as high blood pressure, and that many of those drugs can lead to sexual dysfunction of some sort, it’s no wonder that nearly 40 million Americans describe themselves as being stuck in sexless marriages. Many of us may be grappling with a sexual problem and not even realize that a drug or drug combination could be the underlying cause. In this sense, sexual side effects could be a silent epidemic.

But for many people going off their medications simply isn’t an option. In the case of antidepressants, most people who take them are actually happier than they were before they went on the drugs, and while they may be dealing with sexual side effects such as erectile disorder or loss of desire, they weren’t necessarily interested in sex before the medication either. “After addressing your depression, anxiety, or other mental health concern, you're interested in sex again—enough to worry about how the medication is affecting your sex life,” explains my Good in Bed colleague, psychiatrist Dr. Ed Ratush. “You may be bothered by what you think is a lower sex drive, but consider how you felt before. In a way, your libido has actually increased!”

Sexual side effects don’t have to destroy your sex life, but they may mean that you have to change your approach to sex. In the case of low desire (a very common sexual side effect), you may have to put your body through the motions in order to get your mind to follow. Or you may have to spend a lot more time on foreplay and getting yourself physiologically aroused. Ratush suggests trying a sexual warm-up, a technique that helps generate arousal but intentionally does not lead to climax or ejaculation. “The idea is that the process of getting aroused will increase the person's ability to generate more of the sex hormone testosterone later in the day or later in the week,” he says.

And remember that mental stimulation plays a big role in sexual arousal, so you may have to try some new things and develop some new routines.

What are some other things you can do?

• Talk to your doctor. Sounds simple enough, but many people are uncomfortable talking about sex with their doctors and, believe it or not, many doctors are uncomfortable as well. Not all doctors are adequately trained in human sexuality, and many don’t take the time to discuss all of a patient’s needs. It can be challenging to start a conversation about sex, but it’s worth it: Your doctor may be able to switch you to a similar medication with fewer side effects. Some people find that switching from Celexa to Lexapro, for example, helps treat their depression without affecting their sex life.
• Reduce your dose. It’s possible that you can still achieve benefits of medication, but at a lower dose that may not induce sexual side effects.
• Have sex at a different time. Sexual dysfunction may be significantly higher two hours after a dose of medication and may be less problematic two hours before the next scheduled dose, so time your rendezvous accordingly. Or have morning sex: Testosterone levels are generally highest in the morning and decline throughout the day.
• Add a sexual enhancer. Some medications can improve excitement by increasing either desire or blood flow. In the case of erectile disorder, for example, a physician may prescribe a medication such as Viagra, or in the case of low desire he or she may recommend a drug like Wellbutrin. It may sound a little strange to deal with the sexual side effects of one drug by adding another, but under the supervision of a physician who is familiar with your medical history, drugs can be combined in creative ways.
• Focus on diet and exercise. Your lifestyle and overall fitness plays a big role in your sexual health. For example, many people end up gaining weight once they go on an SSRI antidepressant, which also contributes to low libido and erectile disorder.

Dealing with sexual side effects can be tricky and frustrating, but the point is to not just give up. Go on the web and do some research. Be proactive in communicating with your doctor and your partner. Try new things in the bedroom. When you have to say “yes” to drugs, don’t say “no” to sex.

Too Old To Hold

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