PSYCHOLOGICAL CAUSES OF INSOMNIA

By far the most frequent source of insomnia is some form of mental or emotional disquiet. Since one primary biological reason for sleep is to provide the brain with a chance to rest, it is perhaps not surprising that one consequence of a troubled mind should be troubled sleep.

I must hasten to point out that in using such terms as "mental disquiet" or "psychological disturbance" I am not suggesting, by any stretch of the imagination, that people with insomnia are thereby crazy, or that their sleep troubles are "all in their minds." Quite the contrary. Insomnia is a very real, and very widely experienced, phenomenon. Insomniacs really do sleep less than other people, as measured not just by their own perceptions but clinically and scientifically in sleep laboratories. Nor do victims of insomnia have unrealistic expectations or beliefs about what constitutes a good night's sleep; studies have shown that insomniacs desire only the same amount of sleep as other people.

While it is true that insomnia is a feature of a number of severe mental disorders, including clinical depression, it may also appear when a psychologically healthy person's life is unusually stressful or tension-filled. Often people with sleep disorders have endured troubling situations over which they had no control—an unhappy home life during childhood, for example/ And the increasing pressure and pace of today's society adds to everyone's mental load. The primary purpose of labeling insomnia as largely psychiatric in origin is not to suggest that the disorder is illusory or that its victims are mentally disturbed but to call attention to the types of therapy that have the greatest chance of succeeding.

With that in mind, then, let me proceed to describe some of the behavioral patterns and mental attitudes that are frequently associated with insomnia. Perhaps you will recognize one or more of these traits in yourself or in a loved one who suffers from sleepless nights. If so, you will be better able to focus on the cause of the problem—the first step toward resolving it.

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FEMALE STRESS SYMPTOMS: ORGASM PROBLEMS

Perhaps the most common sexual stress symptom among women is orgasmic dysfunction. The statistics vary, but here are some approximations that give the general picture.

Five to 15 percent of the female population surveyed reports never having achieved an orgasm. This is called primary orgasmic dysfunction. Most researchers, including William Masters and Virginia Johnson in Human Sexual Inadequacy, associate this condition with the stress created by guilt. Sexually repressive backgrounds seem common among those who suffer from it.

Forty-five to 60 percent of the female population surveyed reports having difficulty achieving orgasm at certain times or with certain partners. This is called situational or secondary orgasmic dysfunction, and is usually related to lack of sexual arousal due to the stress of fights or fears. An orgasm requires an autonomic "letting go" and giving up of control; fights and fears, on the other hand, require "holding on" and a struggle for control.

There are many other stresses that can inhibit orgasm. Listen to the women in a Westchester, New York, sex therapy group as they discuss this problem.

"I realized, finally, that I was afraid of looking silly if I had an orgasm with my boyfriend. I didn't know if I would make noise or curl my toes the way I do when I come by masturbating. Then I took a good look at him while he was coming. He became spastic and noisy and I loved it. It made me feel great to be part of that; so I let myself go also—and bingo!"

"You know, I never really wanted to let Eric give me an orgasm. I didn't want him to have that kind of power over me—pleasure power."

"Fred criticizes me about everything else, so I expected criticism in bed too. Now it doesn't matter to me any more, because I am not criticizing myself. Now I look at him as if he's crazy when he starts in on me—and he stops! Since I began to feel that I'm supposed to enjoy sex, he has picked up on that idea."

"Believe it or not, I was thirty years old before I tried to masturbate, and I was thirty-three before I had an orgasm. My secret fear was that it would feel so good that I'd never want to do anything else! Like women who can't stop eating or drinking, I was afraid I'd have no control over this. The funny thing is that now I feel the opposite way—since I can give myself an orgasm, I am more relaxed about the whole thing."

Fear of punishment, fear of criticism, fear of abandonment, concern with appearing aggressive or selfish, reluctance to give a partner the power of pleasure, anxiety about religious taboos, misinformation, guilt, anger, and control issues can all raise female stress levels and inhibit the orgasmic response. After all, the center for both stress and sexual stimulation is the mind.

Success rates for the treatment of both primary and secondary orgasmic dysfunctions are usually reported to be as high as 80 percent. However, J. LoPiccolo, a well-known researcher in human sexuality, reminded sex therapists at Mount Sinai Hospital in New York City that these success rates reflect the achievement of an orgasm through any means: genital stimulation, clitoral stimulation, masturbation, and vibration—usually not through intercourse alone. For many women, orgasm through intercourse alone, without direct clitoral stimulation, is improbable. So why fight Mother Nature?

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