At this point of acknowledgment, seeing alcohol as the culprit, and with a desire to change, the alcoholic by himself is at a dead end. If he knew what to do, he would have done it. Thus he, in essence, turns the steering of his life over to the counselor or therapist. The counselor, in turn, must respond by providing clear, concrete, simple stage directions. The alcoholic needs to have a rehabilitative regimen set forth for him. He needs his environment simplified. The number of decisions he is confronted with must be pared down. He is able to deal with little more than “How am I going to get through this day (or hour) without a drink? ” Effort needs to be centered on doing whatever is necessary to buy sober time. To quote the old maxim: “Nothing succeeds like success.” A day sober turns on the light a little. It has become something that is possible. For the alcoholic, this is an achievement. It does not guarantee continued sobriety, but it demonstrates the possibility. In the sober time, the alcoholic is gaining skills. He discovers behavior that can be of assistance in handling those events that previously would have prompted drinking.
Although we are not attempting to discuss specific techniques of treatment here, a mention of AA is nonetheless in order. Anyone in the alcoholism treatment field will acknowledge that clients who take up AA have a much better chance of recovery. This is not accidental. AA has combined the key ingredients essential for recovery. It provides support; it embodies hope. It provides concrete suggestions without cajoling. Its slogans are the simple guideposts needed to reorder a life. And its purpose is never lost.
The necessity for a direct and uncluttered approach to the alcoholic cannot be overstressed. He is not capable of handling anything else. This is one of several reasons for the belief that alcoholism has to be the priority item on any treatment agenda. The only exceptions are life-threatening or serious medical problems. For the alcoholic to work actively and successfully on a list of difficulties is overwhelming. Interestingly enough, when alcoholism treatment is undertaken, the other problems often fade. Furthermore, waiting to treat the alcoholism until some other matter is settled invites the alcoholic’s ambivalence to surface. This waiting feeds the part of him that says, “Well, maybe it isn’t so bad after all,” or “I’ll wait and see how it goes.” Generally the matters are unsolvable because an actively drinking alcoholic has no inner resources to tackle anything. He is drugged.
Focusing on alcoholism as a priority, the alcoholic’s acceptance of this, and providing room and skills to experience sobriety make up the meat of therapy. As this takes place, the alcoholic is able to assume responsibility for managing his life, using the tools he has acquired. With this, the working relationship between counselor and client shifts. They collaborate in a different way. The counselor may be alert to potential problematic situations, but the client increasingly takes responsibility for identifying them and selecting ways to deal with them. Rather than being a guide, the counselor is a resource, someone with whom the client can check things out. At this point, the alcoholic’s continuing treatment has begun.
*100\331\2*

In children the list of allergic symptoms is even longer than it is in adults, who got in while the going was safer. Dr William Crook, a paediatric allergist famous for his work with Candida and author of many reports on the subject, notes that, with children, people fall into the ‘it’s-all-psychological’ trap. Very often the child’s symptoms are seen as an indication that the parents are at fault (the chief offender is usually the mother) because they have not loved the child enough, not responded enough, or responded too much, at the wrong time or in the wrong way.
The idea that autism was caused by unloving, emotionally inept parents has faded, but in its place have come similar concepts about other ailments from asthma to hyperactivity, from learning difficulties and short attention span to bed-wetting, nose-picking and thumb-sucking.
Invariably, psychological factors do influence disease processes, but there’s growing evidence that their influence is greatly aggravated by other factors. In some cases, the illness may be the result of faulty biochemistry, which plays a part in allergic reaction. From schizophrenia to migraine, from menstrual difficulties to alcoholism, the search for a biochemical cause can be found in all major scientific research. It makes sense to tackle things that can be fixed simply before trying to fix the more difficult and intangible factors that may be contributory causes.
Tracing an allergenic substance, whether it is food or something in the environment, isn’t simple, but it’s still far easier, cheaper and quicker than putting the sufferer in hospital for long periods. If you’re cynical, you may think it’s too simple a solution in a complicated society like our own; and allergy testing isn’t the only solution to a health problem that has been given this backhanded compliment.
According to Dr Crook, most childhood allergies are caused by sensitivity to something the child eats, breathes or touches. As well, infections, emotional stress and weather change can trigger or aggravate allergic symptoms, because all these things make demands on a comparatively sensitive body. But whether these external factors cause a child to develop allergies depends on many complex internal factors such as heredity, the state of the immune system, general health, emotional status and age.
For example, hypoglycaemia (low blood sugar) was once thought to be a disease. Now we know it is often one of the symptoms of an allergy. It can cause many disturbances in children, such as tiredness and slowness to learn, and especially in the sort of child who skips breakfast or who snacks on sugary carbohydrates. Paradoxically, children who are forbidden to eat anything at all between meals may also be in danger if there is a likelihood of their having an unusual glucose metabolism; if, for instance, there is a history of diabetes in the parents or grandparents.
Low blood sugar can be caused by a high consumption of sugary and starchy foods. The trusty pancreas, called into action time and time again to deal with an onslaught of sugar, eventually becomes trigger-happy in producing insulin to ‘zap’ down blood sugar levels not wisely but too well. The resultant condition, hypoglycaemia, is now known to be the forerunner of diabetes or high blood sugar, which is what happens when the pancreas, after years of churning out insulin at the first sign of a blood sugar rise, slumps back exhausted and refuses to function.
There is a strong suspicion at the moment that cow’s milk may be one of the allergic triggers that alters our immunity and leads to diabetes. Allergists have found that blood sugar levels are intimately bound up with allergic symptoms. In some cases sensitivity to a specific substance can cause a child’s blood sugar level to fall. Even more interestingly, low blood sugar can cause stress, which makes a child more likely to develop allergies. In other cases low blood sugar is due to some substance other than sugar; but sugar is still the trigger. The body may be just managing to cope with the allergy when it gets a deluge of sugar and the whole delicate balance between blood sugar and insulin goes haywire.
The things parents need to watch for are anything the child eats, breathes or touches: things that cause chilling, overheating or changes in atmospheric pressure (going to the mountains, plane travel, air-conditioned rooms); things that encourage emotional upsets and inner worries (hard to recognise if you’re a tyro parent, because children don’t react like adults); and finally, viruses and bacteria, the ‘bug’ that is forever going around schools and kindergartens and which young children seem to attract by magic. Any of these things can trigger or aggravate a reaction in a child who is intrinsically allergic.
The trouble is that the symptoms may be the last thing a parent or doctor would attribute to allergy — hence the title of this chapter.
If a child has circles under the eyes, for instance, we usually think of lack of sleep. Today, perhaps, we’d suspect it was too much television; for the last few centuries it was considered a sure sign of masturbation; and for a long time one naturopath insisted that it was a sign of poor kidney function. Now they are called ‘allergic shiners’ because they are often a sure sign that the child is allergic.
Excessive sweating at night doesn’t immediately make you think of allergy either. Fever, yes; perhaps menopause. But something you’ve eaten, breathed or touched? No, it’s not crazy Allergy is like an iceberg, inasmuch as asthma, hay fever and rashes are only the visible one-eighth, the easy-torecognise part. It’s the submerged symptoms, the invisible seven-eighths of the allergy iceberg, that often escape detection.
Let’s look at what happens when a child develops an allergy. Firstly, the child’s body produces antibodies to combat the offending substance, even though other people’s immune systems simply don’t consider whatever-it-is worth worrying about. Some people, after all, can cuddle cats, stroke horses, smell privet, eat eggs and drink litres of milk without coming to the slightest harm.
Once the antibodies are there, for ever afterwards there will be trouble when antibody and allergen meet. Literally, a small explosion occurs in the child’s body as various sorts of chemical substances are released by the vigilant immune system. The body ‘means well’, of course — its aim is to fight what the immune system sees as the enemy — but in the process different body tissues get caught up in the drama as innocent bystanders and are irritated and injured.
Allergies are tricky because there’s no knowing which disguise they’ll take. That is, which part of the body, which process, is going to get knocked down in the scuffle between antigen and allergen. It may, for instance, be the mucus membranes of the nose, causing what is medically known as allergic rhinitis.
When faced with such symptoms in a child, nine parents out of ten will say, ‘You’ve got a cold’ (or are about to get whichever type of flu is fashionable that year), and are seen as normal, decent, aware and concerned for the child’s safety. The tenth parent who says, ‘It’s all those chocolate biscuits you ate yesterday at Grandma’s', is often considered eccentric. How can chocolate biscuits cause a cold when everyone knows you catch colds from other people?
What may be happening, especially these days, is that the child is allergic to chocolate. Or if not to chocolate itself then to the honeycomb or the colouring or the flavouring or the emulsifiers or sixteen other things. So out come the antibodies from their foxholes, blazing away, so that the body is under further stress, and in moves a virus looking for a cosy environment in which to settle.
Of course, it might not be chocolate. It might be Grandma’s cat, the budgerigar next door or the painting going on at school. A parent really needs to be a detective to track down the cause.
Although a runny nose can be caused by a virus or germ (and there’s no doubt that both these things love to snuggle down in little children who are below par), it’s just as often caused by allergy. But because it has taken a long time for us to understand the working of allergy, and because allergenic substances multiply every year in our increasingly chemical-ised environment, most parents still plump for the idea that the child has caught a cold or is ‘getting something’.
This seems a logical conclusion if the allergy has caused a nasal discharge, but in some children the discharge goes by the back route and becomes post-nasal drip or phlegm. So some kids simply develop a blocked, snuffy nose which they’re perpetually picking at, or a tendency to snort in an attempt to clear it. Others push and rub their noses so constantly that in time a fine horizontal crease can develop across the fleshy lower end. The chronic snorters get nagged for not learning how to blow their noses properly or, worse, the snorting may be seen as a nervous habit and an indication that the child requires psychological counselling.
Obviously the best treatment for a child with a suspected allergy is to find the culprit and eliminate it. Once you’re out in the wide world there’s a whole new ball-game of potentially allergenic substances waiting to strike, as well as the good old familiar ones you come home to every night.
*20\145\2*

A good way to begin would be to explore your public versus private eating. I can’t tell you the number of individuals, predominantly women both overweight and at an appropriate weight, who eat little if anything in public. I have been seated at charity benefits and dinner parties next to overweight women who play with their food. They barely take a bite. It’s 8:00 at night. These parties may not be over for hours, but that doesn’t matter. They are in public. They feel they will be judged for what they eat; therefore, they elect to not eat. You and I both know that either on the way home or the moment they step inside they will binge. How could they not? They’re starving!
I worked for a period of time with a young, attractive woman with a serious eating disorder. She simply could not eat in public. She would starve herself all day, eat nothing, drink only Diet Coke or coffee, and then go home late at night (as she has a very demanding job) and eat everything, I mean everything, in sight. Most of it was salt and fat – chips, popcorn, crackers -and then she would shift to sugar and fat- cake, cookies, pie, and ice cream. The reason for this behavior? It turns out that her mother used to scrutinize every bite she put into her mouth. This caused such a fear of eating in public that this otherwise intelligent woman just could not do it. She could not attend a business meal or holiday function. She always had to arrive after the meal was served. Granted, this is an extreme case, but I have had numerous clients express to me a similar fear of eating in public or a fear of having their eating “discovered.”
So what do people who don’t eat in public do? Generally, they will hide food. I see it all the time. While I don’t want to give away my trade secrets, I frequently check out clients’ kitchen garbage cans so that I can see what is inside. The garbage tells a story and often gives me clues. Right there, after asking clients what they ate the previous day, I see what they really ate. I get the data that tells me I am dealing with someone who has strong emotional issues surrounding eating. When I feel the time is right, I will attempt to get to the core of the problem.
*52/280/5*

Migraine is far from being a trivial disorder, not least because the problems posed by migraine in the community and in the family can be enormous.
Migraine cost the National Health Service 2.8 million pounds in 1970, consisting of pharmaceutical costs of 1.6 million pounds, general practice expenses of 0.7 million pounds, and hospital investigations of 0.5 million pounds. Private treatments, and remedies bought privately, add further to this. In 1968-9, 295 000 man-days and 167 000 woman-days were lost from work on account of migraine. This, too, is an under-estimate since the calculation is based on health certificates which are issued only after three days off work, and most sufferers from migraine are often away for less than this at any one time. A recent survey showed that 21 per cent of Members of Parliament have migraine and that each one lost an average four man-days a year. Those who persist in working during an attack are likely to be less efficient, which also contributes to the problems caused by migraine.
Nearly everyone has a headache at some time in their lives but migraine with its special features affects only a minority. Estimates vary, depending on how migraine is defined, but it probably affects over 10 per cent of men and over 20 per cent of women. The reason as to why it should be commoner in women is not precisely known but this sex difference could be one more clue as to the cause.
The age at which migraine begins is also variable. It usually starts in adolescents and young adults but many of these have warnings as children of its likely development.

*12/152/5*

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There is no effective treatment for tics. Sometimes relaxation techniques are recommended, and occasionally therapy or counselling for the child, but there is little evidence of their efficacy. It is worthwhile for parents to search for any ongoing stresses for the child in the family, but this must be done with subtlety and discretion, or else it may make matters worse. In most cases it is not immediately possible to locate any particular factors causing stress.

The best advice is to pay absolutely no attention to the tics — to ignore them completely. Some parents believe that if they bring the tic to the attention of the child each time it happens, they will help make the child more aware of his behaviour. They feel that this will be the first step in helping him control the tic. It must be emphasised, however, that the tics are not under any voluntary control that is, the child is unable to control them. Drawing the child’s attention to them is likely to make matters worse by increasing his anxiety and making him even more self-conscious.

When to see your doctor

Many parents will take their child to the doctor when the tics first appear, to make sure that there is no underlying medical cause that can be treated. The doctor will undertake a careful history and perform a physical and neurological examination, and perhaps test the child’s vision, but it is rare to find any medical problem. It is almost never necessary to order any special tests.

*198\90\8*

MAGNETIC RESONANCE IMAGING (MRI)

This is a specialised radiological technique which uses radio waves to produce an image of highly detailed anatomy of the brain and spinal cord on a screen. No discomfort or pain is experienced, and there is no exposure to radiation. Smaller children may require sedation in order to keep them perfectly still during the procedure.

SKIN TESTS FOR ALLERGY (SENSITIVITY TESTS)

These tests may be recommended by your doctor if your child suffers from allergic conditions such as hayfever. Tiny amounts of various substances which are known to cause allergic reactions (allergens) are placed on the skin. A tiny needle is then used to prick the skin very lightly through the drop of allergen. After 15 minutes the skin is ‘read’ for allergic reactions. If a child is allergic to a certain substance an itchy, red lump will have formed in reaction to it over the area where it was originally placed. Because the solutions used are so diluted, a full-blown allergic reaction will not occur. Sometimes patch tests are used where a particular substance is placed on a small patch on the surface of the skin.

*31\90\8*