Monday, October 31, 2011

Self-stroking: part 2

Sometimes when I am feeling frightened or insecure, I ask my husband if he will always take care of me. He always tells me that he will. At those times, my fear is that I can't make my way in life and if I fall, I'm afraid no one will be there to catch me. I need to know that he will be there, just in case I fall.

On an objective level, there's no reason to believe that I am incapable of making my way in life. For 12 years, I worked full-time and was the primary support while my husband worked part-time and was a househusband. I also worked full-time at various other jobs concurrently with my husband working full-time. About 6 years ago, after about a year of undiagnosed clinical depression (or nearly so) I went part-time, he went full-time, and I took over the household work. I have far more of my adult life under my belt being responsible for myself, but I don't think my fears are really about money or jobs.

I think my anxiety about being cared for is more generalized and I think it stems from the insecurity I spent my formative years dwelling in. Though I had a roof over my head and there was food on the table, my parents were constantly speaking about us being on the edge of insolvency. Money problems were always on the table and nothing was ever hidden from my sister and I. What was more, my parents were very absorbed in their own issues. They spent their days arguing about my father's alcoholism, my mother's spendthrift nature, and complaining about whatever trivial issues perturbed them. Neither of them was an adult in any way.

I know it may sound like an exaggeration to say neither was an adult, but they truly were not. My father refused to do anything that required even minimal interacting with other people if it didn't happen in a bar or a garage. He wouldn't go into a bank, shop in a market for food, go to my sister's and my school, or shop for clothes (not even his own). He abdicated all responsibility and my mother used the power that came with that to indulge her shopaholism and to live beyond our means. She created a loop in which she medicated her unhappiness with food and spending money and, in turn, created her unhappiness by being fat and being forced into bill juggling and loan consolidation to handle her debts. Her failure to be an adult was not in her refusal to take on responsibility, as she had it all, but it was in her inability to control her temper and the way in which she battered my sister's and my esteem to elevate her own. She heaped responsibility on us too young, shared her problems with us when we were incapable of understanding them or helping, and verbally abused us. Her failure was in not acting emotionally like a grown-up to her children.

In retrospect, I know that my mother created all of my family's financial suffering through her issues with spending. She had a vision of the life she wanted to live, and part of that was "keeping up with the Joneses". She was devastated when her siblings, especially her 3 sisters, lived a material lifestyle that was clearly superior to hers. Had my mother practiced moderate fiscal control, we would have been alright. We wouldn't have been rich, but we could have been secure and stable. Unfortunately, both of my parents were more interested in using what money we had to do what they wanted (my mother to buy junk and my father to drink alcohol and smoke everyday) than in providing a stable life for their family.

I mentioned in the previous post that food was the co-parent in my childhood, and the support that I carried with me into adulthood. It is the way I "stroke" (comfort, validate, reward, etc.) myself. Unlike my parents, food never hurt me, abandoned me, or disappointed me. It always gave pleasure and asked nothing in return. While my parents were inconsistent and my mother so mercurial at random intervals that I was driven to extreme nervousness and tension at times because of my fear of her wrath, food was the "good parent".

I realize now that my husband has taken on some of the role of a "parent" for me. I ask if he will take care of me because I was never taken care of by anyone as a child and I need to feel cared for and secure. No, I was not abused physically, nor did I starve, but I never felt secure, loved, or worthwhile. Neither of my parents gave me those things because of their own damage and immaturity. I don't blame them for it and this post is not about holding them responsible for my problems. That being said, ignoring the connection would undermine my ability to heal myself. I have to understand the roots so I know where to start tearing out the damaging weeds of my problems and planting more psychologically healthy "plants". Too many people think that "blame the parents" is what excavating your childhood issues is all about and that it's about finding reasons to be mad at them rather than change your life. It is not. It's about finding out what went wrong so that you can figure out how to make it right. My parents messed up. I forgive them. However, if someone breaks a complex mechanism (such as the human psyche), it really helps to know exactly how and where they broke it if you want to repair the damage as quickly and effectively as possible.

While my husband is functioning in part in the role my parents failed at, I know that he can't do it all and that is where the "self-stroking" that I mentioned in the previous post comes in. It's not wrong for him to do some of it because, after all, we all validate, comfort, and soothe our mates. It's part of the role they play. However, the fact that being separated from him for a finite period of time is so difficult for me means that I need to develop certain coping skills in this regard. As I mentioned previously, I used to have food to stroke me in his absence, and now I don't, so I need other things.

After yesterday's realization, I figured out, much to my chagrin, that I still use food to stroke myself and not terribly infrequently. The main difference between how I used it before and how I use it now is that I use extremely tiny portions now. Instead of eating a bag of chips, I eat 2 or 3 nuts. I don't eat a whole candy bar, but might eat 6 M & M's or a mini-candy bar. The calories are low enough to not be an issue, but the comforting still goes on.

That is not to say that every small treat I eat is an act of food-based stroking. Sometimes, it's merely that I want to enjoy these foods. Sometimes, it's a craving for a dessert after a meal (which is common for me anyway). However, there are definitely times when it is an act of stroking. It's not compulsive, but it is an act that tells me that "I'm okay". The food tells me, I'm going to be okay. Everything will be okay. This connection was forged in my childhood, and now I have to work to unravel it. This is the next stage in the evolution of my relationship with food, and I am not looking forward to the emotional fall-out which is certain to follow.

My approach to this is going to be relatively unstructured. That is, I don't plan to forever give up treats or even to swear off of them on a particular day. Rather than take some sort of rigid or Draconian view of food (which I believe is ultimately destructive and untenable), I plan to practice concrete self-stroking exercises at times when I feel I'm grabbing a tiny bite of a treat for self-stroking purposes. I'm also going to try and develop conditioning techniques to self-stroke in a higher order fashion. This is not an easy transition for someone like me, because it involves positive messages about myself to myself. This comes with difficulty because of my feelings of worthlessness, fear of narcissism or self-aggrandizement, and modesty. My mother reinforced again and again that I shouldn't form too high an opinion of myself to make sure I never thought too much of myself. For instance, when I got excellent grades and pushed myself hard in school, she made sure to tell me that I was "book smart", but lacked common sense or other intelligence. Even when I excelled academically and should have felt I was smart, she let me know that I was dumb and shouldn't be too proud no matter what I accomplished. She bragged to her friends about my sister and I, then told us we weren't so hot.

I'm also not the type of person who subscribes to hollow affirmations of my own awesomeness. A lot of people practicing self-acceptance resort to pat mantras about how "good" they are, but this simply does not work for me. My issue is not that I think I'm a really "bad" person and need to tell myself that I'm a "good" one. It is that I feel that I'm in no way special and that my value is less than that of others because my needs are less important than theirs (my mother always told me that it was selfish to put myself before others). Without my husband telling me regularly that I'm important, I can't keep the idea in my mind. I haven't internalized the notion that I am a person of particular value to anyone but him. If I am not with him, I cease to be anything because I am nothing to others. If they see me as anything, it is my feeling that they only do so because they view me as useful in some particular regard. If I cease to be of use, they will not care for me because I'm nothing special to anyone but my husband. I believe that he is the only person who will ever love me, the only one who ever could.

So, what I tell myself in affirmation has to be specific, important, and have deep relevance to me. It can't merely be that I say, "I don't need this chocolate because I'm a good person". I'm not sure what I need to say, just that I need to say some things which strike at the heart of the shortcomings of my childhood. One of those things might be simply to say, "everything will be okay," whether I eat this or not. I doubt that that will be all it takes, but it's a starting point after so many years of my youth being spent being told everything was not okay and I was not okay. As I explore this, I will post more about the process.

Saturday, October 29, 2011


"Stroking", as it is referred to in psychological terms, can be a fairly inclusive term. It means comforting, soothing, rewarding, or validating yourself. Humans need it, more than they often like to admit. It's why we enjoy compliments or feel better after we get a good grade on a test. It's why people want to be an "inspiration" to others or receive positive and supportive comments on their blogs.

It is not a weakness to desire strokes, though people often view the need for them as a reflection of neuroses. The idea that we should receive all of our stroking from internal means is a reflection of the Western mentality that we should be 100% independent in all respects. Obviously, some forms of "self-stroking" are carried out as we grow older and find higher level means of feeling good about ourselves. People can feel good about a job they know they did well rather than rely on others to constantly tell them. We do grow more comfortable and capable of assessing our value in various respects and "complimenting" ourselves through time, but it's a peculiarly occidental notion that we should never need anyone else to be psychologically whole.

I will be the first to admit that I am extremely poor at "self-stroking". This is something that I have come to realize rather acutely over the last week or so while my husband has been abroad and I have been alone. He has gone on such trips before, and it has always been difficult for me, but this time has been much harder. I realized that this is largely because of my changed relationship with food.

My parents were not particularly good at raising my sister and I. They got married too young and for less than positive reasons. Both were psychologically damaged. My father was not demonstrative at all because he was so uncomfortable with his positive feelings. My mother offered conditional affection and had self-esteem issues which caused her to condemn, judge and criticize and she was prone to emotionally unstable reactions. Neither provided a very good environment for young psyches, and what "stroking" they offered was unpredictable and often related to concrete rewards, especially food. When you are very poor and can't express your feelings because of your own issues, buying your kids bags of chips, candy bars, and cheap sugary soda is the easiest path to giving them strokes at the lowest overall "cost" (psychological and otherwise) to yourself.

For my parents, food was a co-parent. When they couldn't say "I love you", food did it. When they wanted us to settle down or give us something to make us go away and leave them alone, food did the job nicely. I have come to realize that food took on a great importance because of the way they used it. It was the parent I carried with me into adulthood, fulfilling needs that were supposed to be filled by family.

One of the emotional transitions that I had to make when I changed my habits was transferring "stroking" myself with food to other things. This is not an easy transition. Most people know that they "reward themselves" (a shallow and inaccurate description of stroking) with food. They know they need to stop doing it, but they fail to recognize that they need to replace it with something else. While it'd be great if realizing you were doing something destructive meant you could simply choose to stop doing it, people don't work that way. You can't simply conjure up a means of self-stroking instantly to replace how you deal with food.

For me, a lot of the burden of giving me strokes has fallen on my husband. As time has gone by, I have attempted to cultivate a greater internal integrity in this regard. To do this, I've done more things which help me feel better about myself like working outside of my home and deriving satisfaction from my ability to do the job well. I've also focused more on productive behaviors and tried to gain satisfaction from accomplishing them. These include moderate exercise and writing for my other blogs (which are independent of this one and unrelated to body or food issues). I've also found that FaceBook can serve a small role in this process by acting as a social conduit. It can be gratifying to post about your life and have people express happiness at what you offer.

Unfortunately, the current progress of the internal stroking cultivation as well as the very weak stroking from other sources is quite inadequate. Either these sources are too small or the neural connections which are being built aren't strong enough yet to substitute for the far more potent strokes that I receive from my husband's presence and food. Though the ties to food as a source of stroking are much weaker than they used to be, they still whisper at me from the darkness and beckon me back. It's easy. It's instant. And, it is so satisfying on a sensory level. It also does not impose upon anyone else. I often feel terribly guilty because of the burden I place on my husband to support me.

The problem during my husband's absence hasn't been that I've gone running to the pantry for comfort, but rather than I've suffered terribly during his absence. I've had crushing sadness and the sort of depression that put me on the edge of being incapable of taking pleasure in anything. This has been hard on him because my pain manifests itself in accusations that he doesn't really want to spend time with me, didn't consider my needs before making his plans and that he is, at least in part, responsible for my suffering. This is not what I mean to convey to him, but it is how he feels. For me, this is all a reflection of my self-worth issues. I feel abandoned, and then I feel I deserve it. My anger and aggression as I act on my pain only confirms more fiercely that I am unworthy of love or care and my self-estimation plummets even lower as I hate myself more for how I act. Losing weight and adjusting my relationship with food has improved my mobility and external quality of life, but it has wrecked havoc with my esteem because I never derived my sense of value from my body. A better body didn't equate to happiness for me, just less unhappiness.

It may seem incredibly unfair to place this burden on my husband to those who are not living in my skin, but this is a reflection of my particular "sickness". My needs and the demands I place on him are no different than those of a someone who has a physical illness and needs support. The fact that they are mental changes nothing. As I have said before, if I were in a wheelchair and needed help, no one would blame me for holding him accountable for my hardship if he left for a week. We seem to think that mental issues are simply something people can choose to get over. If only it were that simple. I'm doing the best I can as quickly as I can, but it's not something I can magically grab out of thin air or pop a pill to cure.

The realization that I need to continue to develop more potent and various forms of self-stroking is a part of the solution. However, that is only a starting point. Developing them and not resorting to any form of instant gratification (like buying something) is not an easy thing. It's not only that I can't predict what actions will be effective (and I can't) but also that they lack the expediency of food. People often think that the desire for instant gratification is a reflection of childishness, impatience, and weak character, but, at least for me, it's a way of ending psychological pain. Without those emotional analgesics, I am left to suffer. The long term efforts to find and carry out higher order means of self-stroking heal the wounds at a glacial pace.

I am making progress toward being less reliant on my husband, but losing food as a way of supporting myself emotionally took away a lot. My improved physical condition didn't do much for my mental state because that was made when I was a child. My sense that I am worthless, despicable, and unlovable is recorded first and forever in my brain. Those recordings can be answered differently (refuted or supported), but they cannot be erased. I will always have to fight them. It's just a matter of finding other (effective) weapons than food.

Thursday, October 27, 2011

The Bleeding Obvious

Some time ago, I read an exchange between several people attempting to lose weight. One of them said that she couldn't get through the whole thing without having treats so she enjoyed a little everyday. To this, another said, 'if you can't get through the day without a piece of chocolate, you've got bigger issues.' I didn't say it, but I thought, "no kidding, Sherlock."

People who want to lose weight, but haven't had severe issues with food don't approach food the same way as those who have. Many of us are like alcoholics that were drinking several six packs a day. Getting down to one beer a day is a monumental accomplishment. In fact, as long as quality of life is not compromised by that one beer, there is no reason to extinguish it from our lives, particularly if having that one keeps us from having 12.

Perfectionists, absolutists, and people who measure their self-worth in body weight, calories or the nutritional composition of their diet are one of the single most destructive elements in dealing with obesity. For those people, "good" is never "good enough", and they cannot accept that any other viewpoints other than their own are valid. For them, the trivial, such as whether you have 4 Hershey's Kisses a day to help you mentally deal with the changes to your lifestyle, is a springboard for a smug sense of superiority. They are "stronger" than you because they don't need this little emotional crutch.

My response to this thinking is that if your self-worth and valuation of others is measured by the composition of your respective diets or a number on the scale, then you have bigger issues. Such a shallow definition of self will ultimately undo you far faster than a few bites of chocolate to help you get through the day.

Monday, October 17, 2011

quality of life

Quite some time ago, I was talking with a friend who has suffered from depression, at times quite debilitatingly so, during most of her life. She is one of the few people with whom I have discussed my weight loss clearly and frankly and we talked about how I made the mental changes to get where I have. I told her some of the things that I've written about in this blog, but the process has been so vast and complex that it was hard to encapsulate for discussion.

One of the things which we spoke about was the general notion of using psychological techniques or intervention to improve quality of life. I told her that this all started when I modified my emotional state a very long time ago. That experience, in which I went from someone who was prone to angry outbursts, haranguing my husband when we fought, and raising my voice to being relatively calm, constructive, and moving past the issue far faster, was an object lesson for other changes in my life including my current situation with food. I learned that you can forge a new mental pathway and build a bridge from who you are now to who you want to be. I think it was helpful that I benefited from this technique twice (the second time had to do with reducing materialism) in situations unrelated to food. I had a template for making mental changes over a long period of time and transforming who I was in a fundamental manner.

As we discussed this, I said that one thing I realized was that we all have the capacity to be happier and maximize our satisfaction with ourselves. People often view the person they are as inevitable and concentrate mainly on improving the mechanics of their life. They focus on objective aspects such as schooling, skills, money, and possessions. They see "improvement" as it is reflected in these things and reject that they can or need to improve their mental capabilities. I told her that I saw this as sad because I believe people can be much happier if they focus on making mental transitions rather than believing they are locked into their mindsets. My friend said, quite correctly, that most people don't realize that they can be happier. It's not even on their radar to strive for such an improved state of being.

A big part of the problem is that people are always telling us what is required to be happy, and we believe them. They tell us we need cars, houses, certain jobs, kids, spouses, or to look a certain way. No one tells us to be better people by not getting so pissed off at the guy who cuts us off on the highway. No one tells us that building empathy for our enemies can be a path to reduced personal suffering. What is more, no one tells us how to manage these things even if we want to.

A lot of what I've endeavored to do with this blog, and perhaps failed in my efforts, is to demonstrate that one can make the transition mentally and that psychological change is a slow process with many failures and successes along the way. If you make that journey, through self-reflection, deliberate, but slow behavior modification and discussion with yourself about your thought patterns such that you direct them more toward who you want to be, you can bridge the gap between who you are now and your ideal image of yourself. It's not about your body. It's about your mind, but I think a lot of people miss that message and just see what I'm saying as being about losing weight. If that's what comes across, then I've not communicated my message as well as I'd hoped. But then again, half of understanding is the message that I put out there, and the other half is what other people hear. I think a lot of people hear only what they want to hear rather than what I'm actually saying, and there's nothing I can do about it.

The Lady Bits Inspection

Today I had my second round of long-neglected medical tests. The first round consisted of a standard battery of tests on blood, urine, and stool samples as well as an EKG, blood pressure, and a cursory exam by a doctor ("open up and say, "ah"). The results of those tests were all in the normal range. The one disease that most obese people fear, type 2 diabetes, was not an issue. My blood sugar was normal and my HbA1C test was 4.4 (and 4-6 is "normal"). 

The tests I took today were for "lady's problems", as my mother would so quaintly put it. I had a pelvic ultrasound, a pap smear was taken, a mammogram, and a breast exam. The pelvic ultrasound revealed nothing but a benign cyst on one of my ovaries which I suspect has been there all of my life based on a certain pain I feel during ovulation. The doctor said it's no problem and is the sort of thing which changes in size based on menstrual cycles. The breast exam also revealed no abnormalities. The mammogram and pap smear have to be developed and examined by physicians and the results will come in two to three weeks, but my husband was in the room during the mammography and saw the images. While he's no doctor, he saw nothing strange on the images (no dark spots or shadows).

My sense is that all of the tests will come back fine. My last pap smear was about a decade or so ago, and I know how foolish it was to put off the test for so long. However, I'm a virgin who married a virgin and there's zero risk of HPV so I'm on the lower risk side for cervical cancer. Also, I've never taken birth control pills so there's little risk of hormonal contamination affecting my reproductive health.

The reason I resisted the test for so long was my weight, though not because of the weight itself. One of the last two pap tests I took resulted in a doctor trying to use an mechanical table to elevate me and I was too heavy for the motor to work. The doctor angrily asked me what I weighed and then scolded me because I might damage their table before scoffing in disgust and moving me to an old-fashioned table. She then hastily did the test and scurried away after an experience which she obviously viewed with distaste. I could not bear the humiliation again, so I put off the test until my weight was in a range that I felt would not yield a similar experience. 

I had another bad pap test experience at a clinic in which I struggled to get there with terrible back pain only to have the doctor refuse to give the test because the speculum wasn't big enough and caused me pain. I told her to just go ahead and do the damn test and get it over with and I'd put up with the pain for the brief time she did it. She said she had to order a bigger one rather than pinch and hurt me with one that was too small. I was extremely angry that she wouldn't do the test, and even madder that the clinic attempted to charge me for the office visit when the doctor was the one who refused to follow through and do it. I refused to pay and I never went back. 

This time, the experience was fine. The doctor was kind and the chair, which was different this time and incredibly comfortable, had no problems moving my 182 lb. body into position. A standard speculum was used with no pain or problem and, while not the most comfortable experience, it was not painful or negative. After reading so many horror stories on the internet from people who were harassed about their weight by gynecologists, I had myself practically whipped into a nervous wreck thinking that I might get derided for my BMI. No one said anything, though my husband did mention to the gynecologist that I had lost a lot of weight so that she would not be alarmed by the extra skin hanging off of my body. 

Having this generally positive experience is the first step in healing the damage done to me from my bad experiences in the past. When all of the tests are done and (what I am sure will be) normal results are in, I feel like I can start over with my relationship with the health care system. Part of what happens when you avoid getting routine care is that the longer you avoid it, the harder it becomes to face it. You develop a mindset through time that makes you think that going to the doctor will confirm your worst fears so you live in denial of the truth about your health. You believe that finding a problem on a medical test makes it real, rather than deal with the fact it was real all along. You imagine all sorts of things, and just keep avoiding "confirmation." If you did routine checking, you'd catch them at an earlier time, but the fear of humiliation and degradation keeps you away from that and the fear compounds as the years go by. 

I'm absolutely certain that if I regained weight and exceeded 250 lbs. again (or got near 400 as I was before), that I would find the experience of these health check-ups far more difficult and very likely traumatizing. People who have lost weight like to say that people treat you better because you change your outlook, but I will never believe that. I am the same except for my body. I was regarded as an object of disgust before, and now I'm treated like a human being. 

These tests, which I have avoided nearly all of my life, are the next leg along the path to "normality" that I'm attempting to tread down. It's extremely hard emotionally for me to do what I'm doing even though it's the sort of thing people without my fears take for granted as necessary and an undesirable but routine task. I asked a work acquaintance how she felt approaching her annual physical (which all people in the country I currently reside in can take part in for free) and she said she felt nothing at all about them. That is, she experienced no stress, anxiety or fear because she didn't form a set of neurotic responses from being treated poorly at such times. It was just what she did as part of her normal life to catch health problems and deal with them. This is "normal", and I have to desensitize myself to the experiences of having medical tests if I want to keep moving in this direction. I'm two steps in, and have one more to go when I finally take the thyroid test that was recommended during my initial check-up.

Friday, October 14, 2011

Is it mental?

One of my cousins was born with type 1 diabetes. That's the kind which reflects an innate deficiency in ones body's ability to regulate insulin rather than the type which is brought on by lifestyle. In terms of current thinking about health, it is the kind which one for which a person cannot be "blamed".

I didn't know this particular cousin especially well, but I did see him occasionally. He was about 5 years older than me and was always thin. He also seemed to have some emotional or mental difficulties. Though he wasn't in any sort of special education classes, he was not particularly bright and had some temper issues. He was capable of doing certain types of work and eventually married and had children.

Despite having grown up with his illness, my cousin was never capable of regulating his diet. In particular, he consumed candy bars and other sweets such that his diabetes was not under control. Though he never gained weight or got fat, his body was constantly being damaged by his diabetes as a result of a poor diet. In the end, he died young as a result of his inability to control his eating. He wasn't fat, but he literally ate himself to death.

There is no doubt in my mind that my cousin experienced a certain biological pressure to consume sweets. However, my uncle (not the father of this particular cousin) also was born with type 1 diabetes which he has kept under control for his entire life through medication and a controlled diet. The main difference between the two was emotional. One could not control his relationship with food and the other could.

The question that I'm throwing out there for myself after pondering their respective situations is whether or not the inability to regulate your diet when you have a life-threatening health issue is a question of mental health. Very often people approach diet as if there were a single "best" way to eat which would result in all people experiencing optimal health. Bodies don't work like that. There are people who can eat a candy bar (or two) everyday and experience no ill effects. There are those who can eat bread all day and those who can't tolerate a single slice. All processing of food by a particular body is individual with varying consequences.

This fact is one I realized long before I thought about my cousin's situation. Some time ago, I finally internalized the fact that there are people out there who can gorge on junk food and not get fat while I am likely going to have to be very careful about what I eat to simply avoid being morbidly obese. Some people will remain or get fat on 2000 calories. Some will stay thin on over 3000. That's the way it is and railing against it and the unfairness of it doesn't change the biological reality. Just as my cousin's reasonable desire to indulge in sweets that he likely saw his sister and others consuming resulted in his death, my diet, "healthy" or "reasonable" though it might be in some eyes, can result in a physical state which will make me miserable.

Getting back to the main point, however, if my cousin could not adhere to a diet which was stricter than most, was it a matter of mental health? Is the inability to control your behavior above and beyond what "average" folks are required to do because of your particular special circumstances an issue of psychology? My answer would be, "yes." Psychology isn't a matter of averages anymore than biology is. Maximum quality of life cannot be achieved by applying a template of actions or thinking patterns according to what everyone believes is best, but rather what is best for the individual. My cousin could not do what was best for him, even though similar actions would not have been destructive to someone lacking his health issues. If there had been behavioral intervention to help him master his destructive urges, he may have lived a lot longer.

There is a lot of debate about whether or not obesity is the result of a mental health problem and there are vociferous folks who rail mightily against the idea. However, I think context is very important. If someone washes their hands 30 times a day, do they have a disorder? They do, unless that person is a doctor who sees a lot of different people and washes his hands between patients and for regular routine hygiene. If someone becomes so fat that their mobility, joint health, or blood sugar are affected and their quality of life compromised by their weight and they cannot alter their habits to affect a positive change, is it a mental health issue? I say it is. If you can't make behavioral changes in your life to be happier, then it is a matter of psychology and it doesn't matter that only you need to make those changes. It's about mastering your own life, not living as an "average" person. That goes for everything, not just weight and food. If you can't control your temper, concentrate long enough to study, etc. and these conditions are particular to you, they are issues of mental health.

Note that I am in no way saying that these are psychological issues which must be dealt with. No one is obliged to deal with their particular problems at all. Just as I do not believe physical health is an obligation, I do not believe mental health is one either. People have the right to live as they please, even to their own detriment. However, I increasingly believe that thinking about our lives and choices in a relative fashion (i.e., "everyone does it and I should be able to as well") is a big part of what erodes quality of life for people. We often say fatalistically that "life isn't fair", but we don't internalize that reality and consider it when making choices in our lives. We still compare ourselves to others and feel that similar choices should yield similar results, and more so when it comes to health than many other areas. I think it's time to develop more sophisticated thinking in this regard and work out that "life isn't fair" isn't a pessimistic conclusion, but the starting point for understanding how to make the best choices for each of us as individuals.

Thursday, October 6, 2011

The Acquisition of Health

Unless you live under a rock, you have heard the news that former head of Apple Computer, Steve Jobs, passed away. I'm not going to turn this post into an off-topic homage to Mr. Jobs, despite the fact that I was once a Mac enthusiast and an Apple devotee and am still a dual-platform user (I use both Windows and Mac, favoring neither). There are likely thousands, possibly millions, of writers of all stripes who are doing just that, and I see no value in adding to the pile. Those who care, will say something. Those who do not, will close the browser window or tab.

What I want to talk about is Mr. Jobs's lifestyle. From all external observation and by reading what insider's said about him, he lived an exemplary lifestyle. He has been a vegetarian for nearly all of his adult life, practiced meditation, exercised regularly, and was trim and fit in appearance. Even after his liver transplant and treatment for pancreatic cancer, he walked every day and had incremental goals to improve his fitness and stamina. What is more, Mr. Jobs was someone who could afford the best medical care in the world and certainly received regular check-ups and attention for any and all health problems. Mr. Jobs did everything "right" in his life in terms of supporting good health, but he still died at the relatively young age 56.

Since fat people are constantly having their lifestyles scrutinized and they are blamed for any and all health problems they have, I think it is valuable to look at the life of someone who one might arguably be viewed as a paragon of lifestyle choices. People so often look at others and believe that, "if only" they did the right things, they would be healthy. It is absolutely true that there are lifestyle diseases which can be improved or eliminated if one makes choices which are more conducive to good health. However, we must accept that health is not something everyone can acquire with a "better" lifestyle. What is more, the degree of change necessary to improve health is not equal across individuals. One person may improve by making small changes and another may improve marginally making huge changes. Every body is different and it is only the illusion that we can control our destiny through making the "right" choices that makes people so keen to judge. If they believe Fatty McFats over there could be healthy by eating better and moving more, then they can believe that they can also acquire health by making the "right" choices.

Unfortunately, as Mr. Jobs's unfortunate and premature death illustrates, good, even stellar, lifestyle choices don't always result in the acquisition of health. We all have a different genetic make-up which influences how healthy we can be. Sometimes, it means we get cancer at a young age no matter what we do. Sometimes it means we get diabetes even if we eat well and are exercising regularly. It's important not to view sickness and disease as something people buy with their choices, and to understand that life and being healthy are a good deal more complicated than we'd like to believe.

Sunday, October 2, 2011

Finding balance, but still having extremes

These days, I'm so incredibly busy that I have little time to write about things which I believe are important to note on this blog. One of the things I hadn't had time to talk about was the recurrence over successive weeks of one evening of binge eating. I've written before that I had stopped binge eating for the most part, and when I did do so, it was nothing like before. However, I developed an almost routine return to compulsive eating over the past month or so. This situation, which has now abated, is important to remark upon because I want people to know that progress is not a straight line, and that this was not the end of the world or the beginning of the end of my ability to manage my relationship with food.

The fact that this occurred at all is no surprise. As I've written before, it is a biological impulse to gorge when stressed. All animals have this desire and it's one of the reasons that people often turn to food in modern life. We deal more with stress that cannot be relieved than ever before. Unlike the past when we could fight or run, we often have little choice but to stand and take it.

In my case, the stress has been brought on by various life changes. My husband has taken on more professional training work so he is around less. In the past, his commitment to these activities set off a rather scary disconnected binge incident, but this time I felt much better prepared to cope with his absence. And, honestly, I have been coping much better with it and feel less emotionally dependent on him than I have been in a very long time. However, all change is hard, and beyond his absence (which is a loss of a strong positive influence), I've been working a lot more and it has upset the schedule I have lived for awhile now. I am "catching up", so to speak, with the adjustments, but sometimes it feels like I'm tied to the back of a car and running as fast as I can as it pulls me along just a little faster than I can manage at my top speed. Occasionally, I fall (compulsive eat) and get dragged along the ground for awhile until I can scramble back up again (return to form the next day).

The "binges" I had were on Thursday evenings, one of the two nights when my husband comes home quite late due to the work he's doing. I would eat up to around 2500 calories, which isn't a monstrous binge, but often what I'd do is eat according to my usual plan and habits to around 1500-1700 calories, then binge a further 800-1000 on things like pretzels, animal crackers, lean ham or chicken, and cheese. I felt like I just couldn't manage feeling hungry at the end of the day on such days, and just gave in and ate and ate to a point of fullness (not simply satiety). The thing is, I knew what I was doing and I did it anyway. This wasn't like the aforementioned incident where I was mentally split from my actions. I knowingly did this as a pressure release valve. It was the equivalent of people cutting themselves and knowing it is destructive but desiring the release enough to do it anyway. I knew it would set me back a day or two in losing weight, but the relief was so emotionally necessary that I did it anyway.

I decided after the second time that I needed to take control of the pattern that was emerging, but it had nothing to do with losing weight or fear that I was going to set off a new pattern of behavior in which I'd habitually overeat on a daily basis. Mainly, I was concerned with using food in this manner and creating a stronger psychological link between stress and eating. The actions weren't really the problem, but the repetition of them and the way in which they would reinforce and condition future compulsive eating patterns was.

To be perfectly honest, there is a bit of success that I took away from all of this, and, no, it was not that I stopped the pattern, though I did do that. The success was that I didn't freak out or think that I was going to gain weight because of this. It is an immense triumph to me that I was able to, for the most part, objectify the experience and treat it as a behavioral condition to be handled rather than lapse into an "oh my God, it's the end of the world" mentality. I knew that if I did it one day a week, I wasn't going to do it again for at least another week. I knew this wasn't going to be everyday, and I was confident that I could eventually get it under control. I also know that flagellating myself for this behavior or panicking would only make it harder to deal with.

The truth is that I'd be shocked if this pattern didn't re-emerge in the future from time to time, and I'm okay with that. It's not because I think compulsive moderate overeating in times of stress is a "good" thing which is to be blithely disregarded, but rather because I know it is a natural thing which many people do. It's not a cause for panic unless it becomes absolutely habitual, excessive, or overly frequent. If overeating is the one and only "solution", then it is a problem. If it is an occasional stress release valve, then it is natural animal behavior.

A big part of "balance" in all things is knowing that excess is as much a part of finding it as minimalism. Sometimes, you're going to do as little as possible and sometimes as much. Most of the time, you are going to stick around a range in the middle. That's what I'm looking for, not hitting some particular mark every single day under every conceivable circumstance. So, one of these days, I'm going to get into a stressful situation again and may find that I'm using food as a release valve. Some people get drunk. Some people get mad and scream at their loved ones who don't deserve such behavior. Some people sleep with strangers. Some people smoke pot. None of these things are "good" things, but if you expect to be "good" all of the time, then you're fooling yourself and setting a standard which most ordinary people cannot live up to. We're none of us paragons, and part of striking a reasonable balance in life is knowing that.