4 Energy Metabolic Deficiency: the Focus of NAD Therapy

Research indicates that 10% of the world's population is suffering from EMD, mostly manifesting as chronic fatigue syndrome (CFS), substance abuse, depression, stress, anxiety and various other chronic illnesses. EMD is a spectrum disorder, which is initially difficult to understand. Grandmother might, for example, be suffering from EMD masked as obesity, her son's workaholism masked his EMD and her granddaughter might be a drug addict. The daughter-in-law is a religious addict, who never misses any prayer meeting. All of them wonder where the granddaughter could pick up this dirty and sinful habit. All four of these seemingly unrelated conditions are masks of EMD, which are only revealed on different levels and in different ways. This ebook will clearly demonstrate the golden thread of EMD that exists amongst these various "unrelated disorders" and the effective role of NAD Therapy in the treatment thereof.

4 Energy Metabolic Deficiency: the Focus of NAD Therapy

Research indicates that 10% of the world's population is suffering from EMD, mostly manifesting as chronic fatigue syndrome (CFS), substance abuse, depression, stress, anxiety and various other chronic illnesses. EMD is a spectrum disorder, which is initially difficult to understand. Grandmother might, for example, be suffering from EMD masked as obesity, her son's workaholism masked his EMD and her granddaughter might be a drug addict. The daughter-in-law is a religious addict, who never misses any prayer meeting. All of them wonder where the granddaughter could pick up this dirty and sinful habit. All four of these seemingly unrelated conditions are masks of EMD, which are only revealed on different levels and in different ways. This ebook will clearly demonstrate the golden thread of EMD that exists amongst these various "unrelated disorders" and the effective role of NAD Therapy in the treatment thereof.

Energy metabolic deficiency (EMD) differs from energy deficiency that is defined as the lack of food and in its worst state is called famine. EMD is the cellular energy metabolic state, irrespective of the amount of food available or consumed, that develops and persists when there is not enough molecules of NAD and the other energy metabolic cofactors or energy factories (mitochondria) to convert the organic energy in food to chemical energy for use in the cells, tissues and organs. EMD is insufficient chemical energy for life and must not be confused with the spiritual or psychological exhaustion, which often accompanies it or is confused with it. There are several definitions and descriptions of physical energy and they lead to confusion on the part of most people. Parents, for example, incorrectly think that a hyperactive child (kinetic energy) possesses too much physical energy, when he merely has to little energy (chemical) to lead a controlled life. Before the organic energy in food can be carried into the body's cells it must first be converted by means of several steps, like digestion and metabolic processes, so that it can then be released as chemical energy in the cells. Such released energy in cells only then becomes available, so that conscious and subconscious activities (kinetic energy) can take place on the physical, psychological and spiritual level. Research indicated, that 90% of our physical energy must be made available from the biochemical processes in the cells. Some people experience problems with the metabolic processes, even though enough nutritional particles are available due to a lack of sufficient mitochondria for the final conversion of nutritional particles to an adequate amount of chemical energy cannot be made available. Such conditions are referred to as EMD, in order to distinguish them from chronic fatigue, which is merely one form of EMD.

4.1 THE COURSE OF EMD

Genetic EMD is already present at birth in some babies and symptoms vary greatly. The symptoms and signs depend on where and which organs are affected by EMD, and vary from person to person. In most cases of EMD, it manifests itself in children in the form of changes in sleeping patterns, academic stress, problems with concentration, hyperactivity, behavioural problems and academical underachievement. After puberty sexual problems might arise and problems start developing with regard to relationships. In another group of persons with EMD, it can only be highlighted after a job has been accepted in low productivity, workaholism and high degree of absence are displayed. In elder persons and the aged EMD can hide behind masks like Alzheimer or Parkinson's disease. The EMD masks of the youth years such as enuresis and academic stress can be exchanged in later years for masks of alcoholism or toxic relationships. In brief, it means that EMD can become visible as a result of non-execution or over-execution of any activity, which requires energy for the execution thereof.

4.2 EMD IS A SPECTRUM DISORDER

Fatigue is a prominent disabling symptom in a variety of medical and neurologic disorders268. The familiar example of how white light viewed through a prism, splits into the colours of a rainbow is a good analogy of what is meant. EMD can be viewed as a form of a spectrum disorder. In other words, one common cause (EMD) can cause, maintain or contribute to a variety of disorders. All cells, tissues, organs and systems in our bodies need energy to function optimally. An EMD can cause, depending on the cell location, various symptoms and disorders ranging from cell death to death itself.

4.3 THE MOST COMMON CONDITION IN THE 21st CENTURY

Dr Ali predicts in a group discussion of professionals, that chronic fatigue (which can be viewed as a form of EMD) will probably be the most common condition in the 21st century, for which treatment will be sought3. Dr Gentile provided the following criteria during the same discussion, as an indication of chronic fatigue88:

∙ Exhaustion, which lasts for more than six months, without any diagnosed cause.
∙ No diagnosed physical cause of illness, that would provide an explanation.
∙ Sleeping disorders and no revitalisation on waking.
∙ Low tolerance of stress that is often associated with exhaustion and a vague sense of discomfort a few days after having participated in sport or strenuous physical activity.

Another well-known example that can also serve as an example of what is meant by EMD, is the blocking of the recycling of nicotinamide adenine dinucleotide (NAD) by acetaldehyde. Restricting NAD recycling can lead to symptoms like problems with memory, irritability, problems with concentration, depression, apathy, low intellectual energy, increased anxiety and panic, increased craving for alcohol, sugar and nicotine, decreased sex drive and increased premenstrual tension214.

4.4 METABOLIC INDICATORS OF EMD

"The researcher must account for and reflect on innumerable variables. The clinician must choose key variables and act"455. Treatment differs from research in so much that it must be based on sound research findings and that it must be feasible and affordable. There are various methods to measure energy metabolic deficiencies in research, but only a few are affordable and feasible to be used in daily practice. Treatment is also based on the most cost effective methods to obtain results in the alleviation of patients' suffering. The metabolic indicators of EMD (lactate and pyruvate blood tests) that are reviewed in this publication meet the requirements of affordability, feasibility and general accessibility for most practitioners.

4.5 EMD INHERITED, ACQUIRED AND INDUCED

"Recent advances in our understanding of the structure and function of the mitochondria have led to the recognition that inherited and acquired mitochondrial dysfunction may be responsible for diseases affecting the liver and other organ systems. Secondary mitochondrial hepatopathies are conditions in which the mitochondria are major targets during liver injury from another cause, such as metal overload, certain drugs and toxins, alcoholic liver injury, and conditions of oxidant stress. Treatment of these disorders is currently empirical, involving agents that may improve the redox status of mitochondria, promote electron flow, or act as mitochondrial antioxidants"535.

Many acquired conditions including infections, severe catabolic states, tissue anoxia, severe dehydration and poisoning can lead to hyperlactacidaemia. All these causes should be ruled out before considering inborn errors of metabolism436. "Lactic acidosis is associated with both inherited and acquired metabolic diseases. Lactic acid metabolism in the presence of altered gluconeogenesis, anaerobic glycolysis, and acid-base balance is a major factor in many disorders. Inborn metabolic errors accompanied by derangement of metabolic pathways of glucose, pyruvate, amino acids, and organic acids and toxic and systemic conditions that promote tissue hypoxia or mitochondrial injury result in lactic acidosis. In the presence of acquired disorders, treatment is directed initially toward modification or cure of the primary condition and then toward eliminating acidosis and other metabolic complications. Specific therapy is available for some inborn errors of metabolism"536. The rare congenital lactic acidosis is a consequence of enzyme defects. The acquired form is relatively common in critically ill patients537.

4.5.1 Genetic EMD (Irreversible & Chronic)

∙ "Primary disorders of energy metabolism are those in which the primary insult affects the cellular machinery required for energy metabolism. A typical example would be a defect in a gene coding for a mitochondrial protein.320
∙ "All mitochondrial DNA in a cell is derived from the unfertilized ovum (sperm have virtually no mitochondria), and hence all characteristics encoded by the mitochondrial DNA are maternally inherited641". "Pyridine nucleotides are mostly stored within mitochondria where they are involved in different functions ranging from energy metabolism to cellular signalling. Here we discuss the mechanisms of mitochondrial NAD(+) metabolism and release that may contribute to the crucial roles played by these organelles as triggers or amplifiers of physiological and pathological events".687

∙ "Mitochondrial diseases are a group of disorders characterized by morphological or functional defects of the mitochondria, the organelles producing most of our cellular energy. As the only extranuclear site carrying genetic information, the mitochondria add an important chapter into the inheritance patterns of genetic diseases. Mitochondrial DNA (mtDNA) is exclusively maternally inherited in humans, but a mitochondrial disorder may follow either maternal or Mendelian inheritance, depending on the site of the primary gene defect.359

4.5.2 Acquired EMD (Irreversible & Chronic)

∙ "Secondary disorders are those in which the derangements of energy metabolism are presumably secondary to some other insult but may still be important for the cellular pathophysiology".320"
∙ A number of acquired conditions including infections, severe catabolic states, tissue anoxia, severe dehydration and poisoning can give rise to hyperlactacidaemia. All these causes should be ruled out before considering inborn errors of metabolism".436
4.5.3 Induced EMD (Reversible & Temporary)

∙ "The ratio of lactate/pyruvate was elevated in both sexes after the 25% fat-calorie period".542
∙ We have reported a case of lactic acidosis induced by ingestion of sustained-release nicotinic acid".314
∙ "Several tumor-therapeutic drugs reduce NAD and NADH levels, thereby inhibiting glycolytic energy production."631
∙ "In the case of hypoxia, or other causes of inhibition of the electron transport chain, NADH accumulates and the supply of NAD is depleted. This pushes the balance between pyruvate and lactate dramatically in favour of lactate further exacerbating its production in these circumstances. This change also occurs with alcohol abuse with alcohol dehydrogenase depleting NAD and producing NADH.642"

4.6 CHRONIC NATURE OF EMD

Research shows that EMD is most often genetic and chronic in nature and, if it is not treated effectively, continuously and appropriately, it will have a progressive and destructive course. Like chronic diseases, EMD is characterized by sociomedical and psychological characteristics. EMD must therefore be managed continuously from a multiprofessional approach. There are no "quick-fix" solutions in the short-term, because although it is treatable it is not curable. EMD shares the characteristics of chronic diseases which can be summarized as follows134:

∙ The condition is, or seems to be, irreversible.
∙ Patients with chronic diseases place a great demand on the available healthcare resources.
∙ Chronic conditions are often treatable, but not curable.
∙ The multidimensional nature of chronic diseases often demands major adjustments to the lifestyle of the patient and his family.
∙ In contrast to patients with acute diseases, which are treated in particular by medical and nursing staff, patients with chronic diseases are more generally treated by their family and resources in their community.
∙ Chronic diseases often rob patients of their familiar and identity-related roles, and demand that they must develop an alternative lifestyle.
∙ Many chronic diseases in the long term require incorporation of and adaptation to special regimes of treatment.

4.7 GENDER AND EMD

The rate of fatigue among women has been reported to be higher than among men. Life events such as childbirth, menopause, and socially imposed roles may confer unique vulnerability272. Chronic fatigue was the primary and most commonly mentioned health concern by 153 women participating in one study. Fatigue was ranked first by 27.5% women and as one of the top 10 complaints by 80.4% women. They ascribed their fatigue to a combination of home and work activities (63.4%), poor sleep (38.2%), lack of time for themselves (34.1%), lack of exercise (32.5%), financial worries (28.5%), relationship problems (22.0%), emotional causes (17.9%), taking care of ill or frail family members (13.8%), lack of social or individual support (9.8%), poor physical health (8.9%), working in home or child care (3.3%), or gender bias/harassment (2.4%)271.

4.8 PLEAS FOR ENERGY

"I finally reached the point where I felt that everything was too much for me. I felt as if I were no longer able to deal with even the smallest things. I had a flat in the city and lived alone. I reached the stage where I would come home from work in the evenings and simply close the door behind me. I didn't talk to anyone. I didn't go out or visit friends. By eight in the evening I was already in bed, waking up only at seven the next morning, barely in time to go to work. I experienced a complete withdrawal from society... People either feel okay or they don't. I never felt okay. I was extremely depressed and I basically felt that there is nothing worth living for. When I came to Alkogen, I was considering suicide on a daily basis. It was the one thing I thought of all the time, more so than anything else"247.

These pleas for physical energy to be able to go on with a meaningful life, are echoed by thousands of patients every day in consulting rooms. Due to various reasons few people really understand the actual role of energy, and specifically the chemical energy processes in our bodies. Despite the teaching of biology to millions of children and students, most patients think of energy as something mystical and out of reach of ordinary man. They view the restoration of energy, by applicable supplementation, as unthinkable and too simple a remedy for a long-lasting and debilitating problem affecting their whole being. This and other reasons keep them tied down in their destructive state of continuous suffering.

Although becoming tired is normal, staying tired for prolonged periods is abnormal as is to be chronically and untimeously plagued by EMD. Most people revitalise their physical energy by means of nutrition, rest and sleep. There is however a group of people (including children even at birth) that experience severe problems in revitalising their energy levels through these natural means. If the body has a sufficient and regular supply of energy in an accessible and usable form at its disposal, it can perform activities, like eating, regulating temperature, sleeping, praying, laughing, grieving, working, cellular life and making love.

All human activities except dying, on all levels of being, require physical energy to be performed. If too little or irregular physical energy is available, due to any of a variety of possible factors, various bridging mechanisms (ie substances and or behaviour) are used to cope with the EMD. Some of these bridging mechanisms can develop into full-blown disorders. To discuss the disorders associated with EMD for clarification purposes, one can broadly refer to them as EMDRS. The concept "EMD" serves only as an umbrella description and is not a diagnostic entity in itself. It is only offered as a possible concept to facilitate comprehensive treatment and understanding.

4.9 COPING MECHANISMS WITH EMD

Coping strategies with EMD include energy conservation, energy restoring efforts, enhancing resistance to fatigue, and temperature control320. It is a natural phenomenon to immediately and subconsciously revert to one or other form of recovery when we experience problems. At Alkogen it is observed that people, unaware of their underlying EMD, desperately try to manage their EMD by adopting one or more of the following coping mechanisms:

Active coping styles: this can be viewed as an active approach (restoring energy) to deal with the underlying EMD. These persons respond very well to the treatment approach discussed in this book.

∙ Using chemical substances and behaviour (legal, illegal and natural) to increase their energy levels, or to suppress the symptoms of EMD. Examples of this are substance dependency, obesity, bulimia, workaholism, insomnia, sex or love addiction and the abuse of certain prescribed drugs.
∙ Attempting to address and deal with the trigger, by means of therapy and counselling. The prerequisite for achieving success with this process, is that sufficient energy must be available to facilitate change. The patient can draw the wrong conclusion, that neither counselling nor therapy works. An example of this is the "revolving door syndrome" where patients constantly change therapists and treatment regimes.
∙ Attempting to increase stamina, in other words, an attempt is made to accomplish more with the little energy that is available. Examples of this are excessive exercising and exercise dependency.

Passive coping styles: this can be viewed as a passive approach (conserving energy) to deal with the underlying problem. These persons initially experience problems to comply with the treatment approach outlined in this book. However, when their energy levels stabilises they too benefit from treatment to become actively involved in treatment.

∙ Reducing activities that require energy, or adapting to low energy levels. Examples of this are lower productivity, depression, chronic fatigue syndrome, sexual anorexia and excessive sleeping.
∙ Using inappropriate energy to deal with energy related problems on another dimension of being. For example using only spiritual interventions (waiting or relying on miracles alone) to alleviate physical problems for which effective treatment exists.
∙ Substituting one form of coping mechanism with another and wrongly believing that the underlying EMD is effectively dealt with. Various treatment approaches set "positive" addictions (eg lifelong support groups) as the treatment goal for chronic disorders.
∙ Living only on one dimension of being and neglecting or ignoring the existence of the other dimensions of being and refraining from being a fully integrated human being. Religious addiction and co-dependency are possible examples of this coping mechanism.

4.10 PATIENTS' VIEWS OF EMD

If we as therapists listen carefully to what our patients are saying, we will be able to hear these energy deficiencies and also the pain and shame revealed to us. To illustrate this point the following abstracts from published interviews, with patients treated for various disorders, are provided.

"Very tired, completely exhausted. I could not concentrate. By noon I was completely exhausted. I could not sleep at night - I was too tired to sleep. You are too tired to lift your arms. I think I had other symptoms like pain in the legs and in my lower back. I don't know what caused them... I didn't have any energy. When a piece of paper landed on my desk, I felt like tearing it up, whereas in the past, I found it very rewarding to create order. I am very meticulous. Things have to be done in a certain way, filed in a certain way, and balanced in the same way. It started getting to me. I didn't have the energy or the drive to do all these things. I struggled to do things that used to be easy. It was a matter of "I cannot work one minute longer". By twelve o' clock my work day was over. I tried to hide it from my management team"181.

"You start to neglect your relationship with God and with your family. You don't rest properly. Finally I realised that I was such a devoted minister that I almost destroyed myself, simply because I kept on giving of myself. I kept on giving, and did not receive anything in return from God or my family. It is a vicious cycle. I realised that there was a certain day in the week that I didn't have much to do. I considered it my "day off". I would drink quite heavily to drown the tiredness, the desperation, the depression, because I didn't have the energy, or inner strength left, for I had given my all for other people. I had nothing left, I ended up a frustrated person, angry with everybody, and drinking was all that was left to do"35.

"My marriage ended in divorce about 13 years ago. I received custody of the children. My life virtually fell apart. I couldn't get my life together and became depressed. About eight years ago I started seeing the psychologist. Before the time I kept thinking there had to be more to life than what I was experiencing at that stage. Nothing made me happy. I didn't know what happiness meant and I didn't know myself. All I knew was that God had to have something better in mind for me. That was when I went for help, and the psychologist and I have come a long way since"127.

"I always had a hard time at school. I never took part in physical activities such as football, and that definitely had an effect. You know, when you take part in a sport where you exert yourself physically with other people, you make friends more easily. Not being able to keep up, affects many areas of your life ... for one thing it is very difficult to concentrate. A lack of energy affects everything you do. You just do less. Even your state of mind is affected. What I mean is that you may feel down when there is absolutely no reason to feel that way. The more energy you have, the more you give, the better you feel, the more you can do. I mean, the experience you had ... you are what you have achieved. It gives you a chance to experience things"60.

"My family did not see me for almost four years, because of my involvement with her. She could not socialise and talk to people. So we both became withdrawn. I lost my friends. Then it was only she and I. Then I felt I could not take it any more. This was after I got divorced from her. A deadly tired feeling came over me. I did not want to live anymore. I did not want to work anymore. I did not want anything. Nothing in life could cheer me up anymore"255.

4.11 THE PAIN AND SHAME OF EMD

EMD (expressed as fatigue) is a common symptom reported by patients. For both professionals and patients, discussions related to the subject of fatigue are frustrating and unsatisfying, because of differences in expectations, a narrow focus in therapeutic approach or solutions and management269. In the process to unravel the mysterious cause of alcoholism, the important role of sufficient energy for effective living in general was noticed by the author. Patients generally describe EMD, irrespective of the presenting disorder, as fatigue, tiredness, weariness, depression, lack of physical energy, failure to cope, powerless, exhaustion, stress, feeling strained, feeling empty, helplessness, feeling drained and various other symptoms and signs.

"In addition to arising from multiple etiologies, fatigue is also multidimensional in its manifestation and impact. Its effect on the quality of life of the patient is comparable to that of pain. Experienced by most patients as an extremely frustrating state of chronic energy depletion, it leads to loss of productivity which can reduce self-esteem. As a subtle and chronic symptom, it also places people at risk for being questioned about the authenticity of their complaints, particularly during the post-treatment, disease-free survival period. Patients themselves are reluctant to complain of fatigue, perhaps because they believe little can be done about it"569.

Research shows that 77% of subjects with chronic fatigue syndrome (CFS), the lack of energy for sensible living, were called "psychological cases" by one or more of the physicians consulted. Most of these CFS sufferers were experiencing problems with stigmatization as expressed by estrangement (95%), attribution of CFS to psychological causes by others (77%), using an educational disclosure coping strategy (77%) and had to be secretive about their symptoms (39%)267. This stigmatization is not limited to CFS alone but applies to all other forms of EMD.

4.12 PSYCHOLOGICAL INDICATORS OF EMD

EMD has a negative or inhibitory effect on the psychological functioning of the sufferer. Objective psychometric testing with the 16 Personality Factor Test (16PF SA92) indicates that the following five personality factors are most often found amongst EMD-sufferers.

4.12.1 Ego Strength: Immature (C-)

Approximately 56% of EMD sufferers will probably be irritated rapidly by people and issues and are dissatisfied with their earthly existence and family. They become frustrated quickly and are often overwhelmed by the limitations in their life. They feel inadequate to deal with the demands of life. They are unpredictable with regard to their interests and attitudes. They become upset easily, avoid their duties and tend to leave projects in a state of non-completion. They are prone to worry about issues and are comfortable to interact with others in a confrontational manner. Their lack of energy makes it difficult for them, to complete their daily tasks successfully. They also find it difficult to utilise their egostrength and are therefore very dependant on other for assistance and guidance. They often experience problems with handling emotion, frustration and impulses, or with finding a realistic outlet for it. At times they are overwhelmed by it and this leads to emotional outbursts and other immature actions. They brag about the many projects, which they complete at work and for others, but the most important project, namely the quality of their life, remains undealt with. They ignore the important message, which Jesus broadcast: "Then the foolish ones said to the wise ones, "Let us have some of your oil, because our lamps are going out.' "No, indeed,' the wise ones answered, "there is not enough for you and for us. Go to the store and buy some for yourselves.'" (Matt 25:8-9).

4.12.2 Impulsivity: Serious (F-)

They set themselves difficult targets and react with hostility, if these targets are not achieved. They are quiet, introspective, pessimistic and obsessed with correctness. They are able to engross themselves in boring work and often become very upset by change and unexpected events. They often suffer from symptoms, like headache, phobias, worrying, depression and/or nightmares. They are perceived by others, as very serious persons. This factor was found amongst 46% of persons, who suffer from EMD. This characteristic of EMD sufferers, makes it practically impossible for them to accommodate humour, which on its own can be a healing function. Humour is often belittled, as irresponsible and sinful. They do not yet understand, that the path to the kingdom of God can never be achieved by suffering and that only the saving nature of Jesus' love leads to that path. The person, who is saved by Jesus' love, lives without care and with happiness in God's hand.

4.12.3 Insecurity: Worrying (O+)

They tend to belittle themselves and prefer to be broody over everything. They are emotionally very sensitive and easily become worried and scared. They are subjected to feelings of inferiority and inadequacy. They often feel excessively exhausted, avoid stimulation and tend to be emotionally unstable. They normally exhibit an excessive level of morality and commitment to duty, which causes them a lot of anxiety. They experience their serious feelings of guilt as a vague internal conflict, which they cannot control easily. This factor was found, amongst 46% of persons, who suffer from EMD. Jesus' instruction not to be worried, does not always make sense to EMD sufferers, and they devote themselves to their daily worries, which once again waste the limited amount of energy which is available for stability and for performing the Lord's work.

4.12.4 Tension: Driven (Q4+)

They are tense and irritable persons, who become upset easily by small issues. They are excessively tense and restless. Furthermore, they are very impatient and easily lose their temper. Irrespective of how exhausted they feel, they still experience an obligation to do things. They feel dissatisfied with themselves, because none of their numerous projects are completed successfully. They experience intense feelings of rejection and suffer from a lot of sexual frustration. As a result of the above-mentioned characteristics, they tend to exhibit anxiety-related disorders. Their psychological energy is often inadequate for dealing with situations and this leads to great anxiety and irrational concerns. This factor was found amongst 41% of persons, who suffer from EMD.

4.12.5 Boldness: Restrained (H-)

The person is usually very shy, suffers from an unusually poor self-concept and experiences problems expressing himself. The person avoids careers requiring intimate interpersonal contact and prefers to have one or two intimate friends. Frequently he displays a pronounced and prolonged reaction to threats and trepidation. His greater sense of duty, dedication to work and regard for authority leads to panic-stricken reactivity. In the presence of the opposite sex he is very inhibited and quiet. His withdrawn nature and hostile privacy are often the result of previous experience of human contact being exhaustive.

4.13 SPIRITUAL INDICATORS OF EMD

EMD sufferers are characterised by various spiritual factors, because they often do not distinguish between the spiritual, psychological and physical dimensions of human existence. It is difficult for them, to understand that one may be saved spiritually by Jesus' love and your soul may be freed by God's truth, but that you nevertheless battle with a seriously unstable body, in spite of being saved and freed. Take Lazarus as an example. He was saved and on his way to heaven, but his body failed and he ended up in the street, where dogs of life licked him. Rahab is also an example of a saved person, who sacrificed her unstable body to prostitution. The prevailing perception is, that if you are saved, life will thereafter only be moonlight and roses. Even Elijah had to learn this expensive lesson, which is that the body also has to be taken care of. "Elijah walked a whole day into the wilderness. He stopped and sat down in the shade of a tree and wished he would die. "It's too much, Lord," he prayed. "Take away my life; I might as well be dead!" He lay down under the tree and fell asleep. Suddenly an angel touched him and said, "Wake up and eat." He looked around and saw a loaf of bread and a jar of water near his head. He ate and drank, and lay down again." (1 Kings 19:4-6).

4.13.1 Feelings of Guilt

This spiritual characteristic is exhibited to a great degree by EMD sufferers. They are consumed by feelings of guilt, particularly in respect of their relatives, because they feel that they are a burden to everyone and that they cannot meet their commitments, to the extent that they would like to. What aggravates it, is that everyone normally implies that the condition of the EMD sufferer will improve, if they simply have stronger faith and pray more. The physical component is denied; so too the fact that God heals in a different way in every person. Jesus, for example, healed the blind in various ways, like saying a word and smearing clay on the eyes. He did not heal in just one way. The relatives of EMD sufferers are often caught up in addiction to religion and still believe, like Naaman, that God always heals, by simply saying a word. "Elisha sent a servant out to tell him to go and wash himself seven times in the Jordan River, and he would be completely cured of his disease. But Naaman left in a rage, saying, "I thought that he would at least come out to me, pray to the Lord his God, wave his hand over the diseased spot, and cure me!" (2 Kings 5:10-11).

4.13.2 Feelings of Inferiority

A second characteristic, which is found in particular amongst EMD sufferers, is a sense of inferiority, which manifests itself as a feeling of having failed and which they try to hide under the pretence of humility. Dr Bingle wrote the following about humility: "You do not have to apologise for living and for being whom you are. If God gave you the gift of life, you mercifully have the right to be and nobody may disgrace or belittle that. Humility is indeed a desirable characteristic and one must also know what one is capable of, what one's limits are and what one's place in life is. You must however also realise that: you are you and I am I. It is God’s will. God the father has created each person unique and unrepeatable... “when my bones were being formed, carefully put together in my mother's womb” (Ps 139:13-16). You are also not a replica of your mother or father, even if there are similarities between you and them. You are unique! God specifically calls you, as a unique being, to fulfil your calling as God's instrument, in a particular place, at a particular time and amongst particular people. One normally sins, by being conceited. It is however just as much of a sin, if one thinks too little of oneself. Of course one must not think too highly of oneself, but by the same token one must not think too lowly of oneself either. If God has a calling for you, if you are God's instrument, it is a sin to deny it, even if you deny it as a result of humility. Also never let anyone treat your old age, young age or limits disrespectfully, if these things were imposed on you by God. God, after all, thought so highly of you, that he created you and created you as an unique being and specifically called on you to fulfil a particular task. Do what you have to. Do not remain a mere spectator or passenger and watch how others play the game and do what they have to. Get onto the field. Blossom where you were planted. The moral of the story is therefore, that you must use your talents, opportunities, time and the ability which God endowed you with faithfully. Fulfil your task, because you can!"

4.13.3 Over-eagerness

One often also finds amongst EMD sufferers that they want to do more than they are called on to do, or than they have energy for. They do not want to be the small finger on God's body, but the hand or arm. Some of them then use their EMD as an excuse for not even doing the work, which was in the first instance assigned to their small finger. Such over-keenness is also hidden by their condition, which leads them to do nothing or belittle whatever they are supposed to do. "One of the twenty-one types of behaviour and transgressions, which are deemed to be sin in the New Testament, is the habit of wanting to do too much. Jesus said in John 8:28 that he did not go further or did more than his father had ordered him to do. He never did too much, nor too little. Ultimately he could claim, that the work had been completed. It is, in other words, just as much of transgression if one wants to do too much, as it is if one wants to do too little or give up. Brotherly love, indeed any love, turns sinful when it entails not knowing how to lead your life, because you are too concerned about others’ needs. Then you cannot deny anybody, including yourself, anything and encase and protect yourself with self-respect and responsibility for your actions. Jesus could do that. He could set limits and seek peace for himself. "Curse those who do not do the Lord's work with all their heart!" (Jer. 48:10).

4.13.4 Religious Addiction

At Alkogen we found that religious addiction is the most common indicator of a probable EMD on spiritual level. Religious addiction is characterised by the following symptoms636:

∙ A fear-based belief system believing or following a religion out of fear, not out of understanding and love and suffering from excessive guilty feelings.
∙ Inability to think, doubt, or question religious information and/or authority
∙ Black-and-white, good or bad, all or nothing way of thinking
∙ Shame-based belief that you aren't good enough or you aren't doing it right
∙ Magical thinking that God will fix you or do it all, without serious inputs on your part
∙ Scrupulosity: rigid obsessive adherence to rules, codes of ethics, or guidelines
∙ Uncompromising judgmental attitudes: readiness to find fault or evil out there
∙ Compulsive or obsessive praying, going to church or crusades and quoting scripture
∙ Unrealistic financial contributions or the rejection of financial support
∙ Believing that sex is dirty; believing our bodies or physical pleasures are evil or using sex as a way of love to fill the severe feeling of emptiness
∙ Compulsive overeating and/or excessive fasting
∙ Conflict with and rejection of science, medicine, and education
∙ Progressive detachment from the real world, isolation and breakdown of healthy relationships
∙ Psychophysical illness: back pains, sleeplessness, headaches, hypertension or chronic fatigue
∙ Manipulating scripture or texts, feeling specially chosen, claiming to receive special messages from God
∙ Maintaining a religious "high", trance-like state, keeping a happy face (or the belief that one should)
∙ Attitude of righteousness or superiority: "we versus the world," including the denial of one's humanness as a whole being with a spirit, soul or body.
∙ Confusion, great doubts, mental, physical or emotional breakdown, cries for help
∙ Fear of success or quality of life and clinging to the believe that only suffering can purify one's soul and spirit.

4.14 THE PURPOSE OF DISEASE?

Persons suffering from chronic disorders, such as EMD, are often obsessed to find the meaning of there disease on the spiritual level of their existence. Often even their loved ones and friends, in a similar manner as with Job's friends, argued that disease and suffering are proof of sinfulness. Job, however, faithfully affirmed and believed in his innocence. There are various purposes of diseases or suffering according to the Bible630:

∙ To end physical life so that we can receive eternal life (Gen 3:19; John 11:4).
∙ To promote the glory of God (John 9:1-3; 11:3,4; 21:18,19). Jesus healed Lazarus for the glory of God. God heals us many times in our lifetimes for His glory.
∙ To humble us (Deut 8:3,16; 2 Chr 7:13,14; Lam 3:19,20; 2 Cor 12:7). To keep Paul humble, because of the great revelations given to him, he was given a thorn in the flesh.
∙ To exhibit the power and faithfulness of God (Ps 34:19,20; 2 Cor 4:8-11)
∙ To teach us the will of God (Ps 119:71; Isa 26:9; Mic 6:9)
∙ To turn us to God (Deut 4:30,31; Neh 1:8,9; Ps 78:34; Isa 10:20,21; Hos 2:6,7)
∙ To keep us from again departing from God (Job 34:31,32; Isa 10:20; Eze 14:10,11)
∙ To lead us to seek God in prayer (Jud 4:3; Jer 31:18; Lam 2:17-19; Hos 5:14,15; Jon 2:1)
∙ To convince us of sin (Job 36:8,9; Ps 119:67; Luk 15:16-18)
∙ To lead us to confession of sin (Num 21:7; Ps 32:5; 51:3,5)
∙ To test and exhibit our sincerity (Job 23:10; Ps 66:10; Prov 17:3)
∙ To test our faith and obedience (Gen 22:1,2; Heb 11:17; Exo 15:23-25; Deut 8:2,16; 1 Pet 1:7; Rev2:10)
∙ To purify us (Ecc 7:2,3; Isa 1:25,26; 48:10; Jer 9:6,7; Zec 13:9; Mal 3:2,3)
∙ To exercise our patience (Ps 40:1; Rom 5:3; Jam 1:3; 1 Pet 2:20)
∙ To render us fruitful in good works (John 15:2; Heb 12:10,11)
∙ To further the gospel (Acts 8:3,4; 11:19-21; Phil 1:12; 2 Tim 2:9,10; 4:16,17)

"Jesus met sickness and affliction with unfailing sympathy, never with condemnation, even when some connection with sin might be assumed. He did pronounce forgiveness for a paralytic before healing him (Mark 2:5), possibly to remove from the sufferer's mind the obstacle, based on received doctrine, that healing could not begin until the sin that caused it was pardoned. Or he may have diagnosed that patient's spiritual condition as clearly as his physical need."629

4.15 HUMAN FUNCTIONING AND EMD

The well-known psychologist, Maslow, had already compiled his hierarchical model of needs many years ago. We can extend it, by linking it to energy. Maslow's postulated integrated model of needs will be considered as a basis to illustrate human functioning. It represents a good example of the various needs that humans experience and that require sufficient energy to be met and maintained. As can be seen clearly in the following table, it also integrates all three the dimensions of being, i.e. spirit, soul and body.

Furthermore, one can suggest the possibility that the energy, required to satisfy the need meaningfully, increases in proportion to the level of the need. In other words the progress to the next level requires a certain amount of energy to achieve satisfaction. All human activity and needs require energy to be performed or not to be performed. No behaviour is possible, without the body. One cannot walk or sit without a body, nor can one speak, think, pray or subscribe to religious faith without a body. According to this model we would require the most energy to reach and maintain the transcendental level. Furthermore if there is a decrease in energy it follows that the person will revert to a lower level of functioning. Although this is merely an idea which warrants further investigation, it is daily observed in practice.

4.16 HIERARCHY OF NEEDS ACCORDING TO MASLOW108

According to Maslow, transcendence is the highest need, which can be satisfied, and it can only be satisfied satisfactorily if the other seven needs are satisfied. Transcendence is the ability of a person, to succeed in spite of limited ability and unfavourable circumstances, and to help others to achieve self-fulfilment. If someone's energy level declines, it firstly exerts a negative influence on one's transcendental need, then on self-actualisation, thereafter on the aesthetic needs then the cognitive needs, then respect, then love and intimacy, then safety and security and lastly the physiological needs of eg nutrition, sleep, sex etc. In other words, persons who suffer from serious EMD function mostly on the bodily level.

4.16 HIERARCHY OF NEEDS ACCORDING TO MASLOW108

According to Maslow, transcendence is the highest need, which can be satisfied, and it can only be satisfied satisfactorily if the other seven needs are satisfied. Transcendence is the ability of a person, to succeed in spite of limited ability and unfavourable circumstances, and to help others to achieve self-fulfilment. If someone's energy level declines, it firstly exerts a negative influence on one's transcendental need, then on self-actualisation, thereafter on the aesthetic needs then the cognitive needs, then respect, then love and intimacy, then safety and security and lastly the physiological needs of eg nutrition, sleep, sex etc. In other words, persons who suffer from serious EMD function mostly on the bodily level.