Wednesday, June 27, 2012


Recently, I had a conversation with my father-in-law in which he asserted that it has never been proven that therapy helps anyone. He also said that many people go to counselors just to talk and don't want help. As one might imagine, I disagreed with this perspective, and I found it frustrating and somewhat insulting since both my husband and I are trying to work in a counseling profession in the future.

Nonetheless, one thing I realize is that these biases reflect his personal experience as well as his desires. He went to therapy while he was going to college as an undergraduate because of an obsession with death which started when he was 4 years old. His aim in going was to understand why he was so preoccupied with it from such a young age and the therapist did not help him. Therefore, he believes that, aside from cathartic talk, therapy is not very effective for most people.

This discussion taught me a lot of useful things, and one irony of it is that, at the end, I knew why he was obsessed with death at a young age and in his early adulthood (and he may yet be).* I didn't tell him why because he didn't ask, and he believes no one can help him with their psychological intervention anyway. I don't tell people things they don't want to hear, even if I believe I can offer them assistance. Suffice it to say, even if I gave him "the answer", I don't think he could benefit from it.

Before I get too much further, let me say that I believe that therapy is not the answer for every problem and that, for some problems, merely venting about your issues is all that therapy needs to accomplish. People do benefit from simply talking, but I think there are limits and that much more can be done if people really want to gain better tools for coping with life's difficulties.

There are many grades of psychological problems, and nearly everyone has some issues, particularly low-level neurotic behavior, that they can function quite well with. My father-in-law is what I would term "functionally neurotic". That's not a negative label. I would also call myself by that same term. That means that there is something about my thinking and emotions which degrades quality of life which I'd be better off trying to change. The difference between us is that I am working to decrease my neuroses and he doesn't seem to think his can be changed or that change is possible or necessary.

Most people with functional neuroses are what would be seen as "normal". They tend to go through life navigating as best they can around various obstacles that are put in their way due to their anxiety, fear, small obsessions and compulsions, or other troublesome behaviors. Sometimes, their issues cause their friends and family some level of grief, but never enough to destroy relationships in most cases. It simply is a case of quality of life. They could be happier, less annoying, more fulfilled, more productive, etc., but they do get by.

The thing about people with functional neuroses is that they rarely seek treatment because they have other outlets to help them cope. Often, they do what my father-in-law does and find a way to "burn off" the anxiety or mitigate the depression (in his case, through exercise), distract themselves from their ruminating (in his case, T.V. and reading), or purge their issues (in his case, through talking to others about how he feels).

One thing I realized, and I'm not going into the details of a protracted talk I had with my father-in-law here, is that one of the reasons that people do not benefit from therapy is that they have other resources which are easier to access and tap into. If he truly  had no other recourse, he'd probably work harder to solve his issues rather than simply burn off, distract, or purge. When we were talking about therapy and whether or not it could help people, both my husband and I talked about doing the work involved and that few people are willing to do it. I realized that they don't do it because they don't have to.

In weight loss terms, and I use this as an analogy, not because I'm applying this to weight loss, it is like exercising like a maniac to burn off calories from eating large meals rather than reducing the meal size. You cope with one issue (overeating) by finding another outlet, but the core problem remains. If you lose access to that resource (exercise) by becoming injured, you will then suffer the consequences of your core problem. It's much better to solve the actual problem than to find ways to work around it.

When I mentioned that fact that people like my father-in-law don't have to push themselves to benefit from therapy, he paused and said that, if he could no longer exercise (a big outlet for his depression since his wife passed away late last year), he'd have some serious problems. Then he went back to essentially asserting his core belief that therapy wasn't proven to work anyway. Attempts to have a more meaningful discussion with him were essentially derailed by his sliding around about how things like "happiness" are defined and arguing that psychology was a "soft science". Every time we closed in on a point, he moved the goal post or topic.

At the end of the day, I realized that people with functional neuroses go to therapists for help, but as long as they have access to other resources, they are unlikely to push themselves to do the hard work it takes to actually get better. It's immensely difficult to change yourself and it's just easier to do what is comfortable rather than face the work of mentally reprogramming yourself. It's not that it is so elusive as people seem to think, but rather than people who are anywhere but at the end of their rope with exhausted or non-existent resources aren't likely to try very hard.

In terms of weight loss, I think this is a huge part of the core issue people have. They don't deal with their real problems, but rather find a path to becoming more functional. It's far easier to exercise, eat diet foods, and reshape your environment than to deal with the core issue, the inability to develop a relationship with food which leads ones particular body to a state of health and well-being. Unfortunately, when those resources no longer become available because one is injured, schedules change, finances are altered, or the control over ones environment is lost, people regain because their problematic relationship with their eating and all that drives it is still there. So, just as my father-in-law may have to finally deal with his depression if he cannot exercise, the person who loses weight by devoting significant energy and time to weight control practices will regain when that ability is lost.

*For the curious, one thing which I understood after all of his discussion about science and "soft science" as well as having an overview of his lifestyle and choices is that he has an uncommonly high intolerance for uncertainty. This is so deeply rooted that he won't try even minor variations in food and has a very low desire for novelty in daily life. I can't go into all of the evidence here, but it is clear that his fear of death at a young age that came from a strong core character trait which makes him desire very precise and certain answers. 

Death is the ultimate uncertainty. He can't process the outcome in any meaningful way, but he can't avoid the ultimate nature of it. The obsession is like a program loop for him. He needs certainty, but will never get it. Had I had access to him at a younger age, I believe I could have helped him by systematically making him more comfortable with uncertainty by encouraging him to slowly take steps into various situations that were uncertain and becoming acclimated to existing in that state or seeing that the outcome may not always be negative. 

Though I don't believe he would ever be comfortable with the idea of dying (who is?), I believe the obsession could have been ameliorated. However, now that he is 75 and has no belief in the effectiveness of therapy anyway, it's essentially an academic exercise for me to ponder treatment.

Friday, June 22, 2012

A roadmap to changing

People talk a lot about choices in life as if we made them under black and white conditions. Eat this, not that. Move more, sit less. In fact, in the weight loss world, there are many people who enjoy indulging in “Yoda-isms”. They say, “do or not do, there is no try.”

This sort of absolutism makes it very difficult for people who cannot make the “right” choices to feel that they will ever succeed. Every morning they get up with a laundry list of choices they hope to make and every night they go to bed feeling like failures for not having made them. They don't understand why they simply don't make the best choices and point to their character flaws as the reason. It's about a lack of “willpower” or being “weak”. They see others around them who seem capable of making the changes they want to make, and feel demoralized and deflated at the fact that they can't do so as well.

I've often said and truly believe that talk of “choice” in stark terms helps no one. It's not about inspiration, motivation, or intestinal fortitude, but about a complex array of extremely personal factors. Environment, temperament, socioeconomic status, and psychology (among other things) all play into the ability to make particular choices. Change is about knowing what choices you personally can and cannot make and about expanding your range of choices slowly and with the establishment of new routines.

I drew a graphic to explain this more clearly. In the center, we have choices that are easy for us to make. They tend to be the most gratifying and convenient options. For most people, but not all, they include resting, being entertained, and eating very tasty food. The extent to which we rely on the easy choices is often based on how hard our life is. This can be seen as the most comfortable zone to operate in and people who are stressed, tired, or physically or psychologically ill will tend to operate in this space most of the time. They do this not because they are lazy or weak, but rather because they don't have the stamina to go outside of that range of choices.

Beyond the easiest range of choices are the “less easy” ones. We tend to operate sporadically in this space throughout the day, generally based on being pushed by various factors into doing so. For many, these would include moderately taxing activities such as taking a brief walk instead of watching T.V., eating a carrot instead of a potato, or reading an educating non-fiction book instead of a fiction book. It also includes doing your tax forms or dealing with other unpleasant, but necessary societal requirements.

Making less easy choices seems like it shouldn't over-tax anyone's resolve, but it's not so simple as that. The stress incurred and energy spent on each individual "less easy" choice may not seem like much, but making a multitude of them adds up. It becomes harder and harder to make more of such choices throughout the day. There is exhaustion when you spend most of your day operating by making choices in this space. It makes it harder to operate in the next space and to make "difficult choices". It's one of the reasons mothers are so overwhelmed. They aren't doing one thing which is so hard, but many, many things which are not easy.

Regarding, “difficult choices”, it's important to keep in mind that what is “difficult” for one may be “easy” for another. I will speak in generalities to illustrate the point, but it's imperative to know that such things are highly personalized. “Difficult” choices for many may include getting up and going to the gym instead of sleeping in, preparing a healthy meal which includes time-consuming processes  like chopping and cooking vegetables or fruit instead of eating out, or studying for a test instead of playing a video game. Most people cannot make choices in this space too often without being worn out. This is why it is important not to make a great many choices in this space for too long or too often.

When I was in college, I used to come home every day and sleep because studying constantly was my operating in the "difficult choice" space a great deal of the time. I had no choice but to do those things, but it decimated my quality of life outside of school until I became acclimated to the level of study and the process dropped down to the status of a "less easy" choice. Mastery of the process as well as the establishment of a routine helped make it less difficult, though it would never be easy.

Finally, there is the range of “impossible” choices. This is perhaps the hardest category to speak in general about because it is the most personal territory. For a poor person, signing up for and going to a gym for swimming falls into the range of “impossible”, whereas for a financially comfortable person, it is “difficult”. For a wealthy person with a pool in the backyard, it is “less easy” or “easy” if that person enjoys swimming or lives in a hot environment. For me, in 2009, taking a long walk fell into the “impossible” category because of crippling back pain. The me in 2012 finds taking a long walk “less easy” or even “easy” depending on my health condition, responsibilities, and free time. 

The individual nature of how hard or easy a choice is cannot be stressed enough. One of the mistakes people make is in assuming that what is easy for them should be easy for others (and vice versa) and that it is only through personal shortcomings such as laziness, gluttony, immaturity, or a lack of responsibility that others cannot make the same choices that they can. They do this out of ignorance, but also because elevating oneself at the expense of others is very ego-gratifying. Criticizing others is a means for such people to feel better about themselves. Unfortunately, we accept this criticism when we want to change because we don't want to “let ourselves off the hook” for not making the “right” choices.

This need to self-criticize likely stems from the way in which we were raised. Children will operate in the "easy" space as much as possible and their parents constantly admonish them for their poor choices and inability or lack of desire to do what is constructive, but difficult. Often, you find people who want to make positive changes in their lives talking about how they need someone to "kick their asses". These people are, essentially, looking for someone to assume the parental role with them. They feel that they will not or cannot make hard choices without pressure from an authority figure. However, as adults, surrendering ourselves to authority in this way and seeking the approval of outsiders as a motivational tool in accomplishing our goals is not a good choice. When we do this, we are placing control outside of ourselves as well as placing the credit for success on those who push us rather than on ourselves for successfully changing.

Successful change comes from inside, and I absolutely do not embrace the idea of seeking any sort of external critical voice when trying to truly change. Beyond the aforementioned reason of placing control and credit outside of yourself, there is also the strong possibility that judgment will be attached to your choices. You will be "good" or "bad" based on how you behave in the eyes of your mentor, disciplinarian,  master,  mother, father, etc. Words like "right" and "wrong" and "good" and "bad" have no positive role in psychological change.

It's important to understand that morality does not play into choice-making unless the choices are being made about true matters of right and wrong such as choosing to harm others. The first step in moving closer to who you want to be by making the choices you want is to stop that critical inner voice that says you are making “bad” or “good” choices and that doing so reflects your value or character strength. The productive and constructive thing to do is to analyze your particular situation and know what you personally can and cannot do.

To this end, I recommend people look carefully at their lives and consider what are easy, less easy, difficult, and impossible choices for them. In fact, I would recommend writing it all out so that you know where you are starting from before making a change. I didn't do this specifically, but I did do it mentally. I knew that I would not be able to give up 100% food that people saw as "bad". While this was not an "impossible" choice for me, it did fall into the space of "very, very difficult" and would have taxed my ability to make a multitude of more meaningful "less easy" choices that would propel me closer to my goals more rapidly than such a hard choice.

It's imperative not to look at it through anyone's eyes but your own. You should not say, “this shouldn't be impossible for me,” but rather honestly determine without judgment whether or not it is. I was taken to task and personally attacked by another blogger for not giving up chocolate. I'm sure he saw this as a fatal weakness of my character, but I did not accept that judgment and followed my own path because I know what I can and cannot do based on living my life in my skin. I also know that he regained weight that he lost despite making more difficult choices than me, and I have not.

I chose not to burn out my ability to change by making choices too close to what was  psychologically "impossible" for me. And make no mistake, what is emotionally possible is just as if not more important than what is physically possible. At this moment, you may be physically capable of jogging for a half hour everyday, but that doesn't mean that you have the time, inclination, or mental ability to do it. It's okay if things other people can do are “impossible” for you for whatever reason. You need to plot the choices graph accurately, honestly, and without judgment for you. This is the beginning of the process.

Once you know where choices fall for you in this range, you can start to work on making less easy choices which move in the direction you'd like to go and try to do them more often as you feel more capable of doing so. For me, this began with eating a little less at every meal. I couldn't dramatically reduce what and how much I ate immediately, but I could put back two spoonfuls. This was a “less easy” but very doable choice. I couldn't endure hunger for an hour in order to stretch my biological and psychological stamina for not eating, but I could endure 5 minutes and later stretch that to 10 then 15, then a half hour. I couldn't walk for an hour, but I could walk for 3 minutes and then sit down. I couldn't make all of my food from scratch for maximum health and minimum calorie density at first, but I could spend some time once a week making a large pot of tomato soup. 

By practicing expanding your choices such that you make more of them from the “less easy” range, you gradually make the “easy” range wider. Routine behaviors become easier both because the mental barriers become lower and you develop stamina for them. Expanding the range of “easy” is the first step. Once you start this expansion, formerly “difficult” or “impossible” choices may start to fall into the “less easy” and “difficult” range. It depends upon personal limitations, and it's very important not to become angry at yourself for an inability to expand beyond a certain point.

The mistake people often make when attempting to make any change in their lives, including losing weight, is that they want to jump right to making “difficult” or, for them, “impossible” choices right away. They fail to recognize their personal limits by comparing their choices to those of others or operating from the “should” mindset rather than the “are capable of” frame of thinking. Sometimes what is easy for others is hard for you. There is absolutely nothing wrong with that. For people with particular mental or physical health issues, there may be little or no overlap between "easy" choices. For instance, a person with a severe eating disorder such as anorexia may find it impossible to eat a cupcake, whereas the vast majority of people would find it "easy". I personally find it "impossible" to drink alcohol of any kind, but many people find that easy.

Many times, women who are working their particular weight loss program will say that you have to “make the time” to exercise, prepare healthy meals, etc. They tell exhausted people who say they simply can't do everything and look after their bodies in the way they like that they aren't making it enough of a priority and need to “just do it.” This sort of thinking stems from an inability to understand a critical concept and that is that all choices are not the same for everyone. The circle of options for some people overlap greatly, but for others, very few options overlap. We tend to believe that everyone operates similarly to us, but this is extreme egotism.

The reality is that we are all very different for a variety of reasons and we need to be kind and patient with ourselves in accepting what choices we can and cannot make at a given time. For lasting and effective change, largely operating within our limits until we can slowly and consistently expand them is essential.

It's also important to know that, when times are hard, it's okay to live within the comfortable range of “easy choices” for periods of time while we try to regain our stamina either emotionally or physically. We need to be patient and keep confidence that we will work to expand into other ranges of difficult choice-making when we have that capacity. It is not a failure to do this. Failure will come only if you overtax yourself such that you are too exhausted or demoralized to work slowly toward making other choices.

Wednesday, June 20, 2012


For the past 2 weeks, I've been living in a suburb in California and in a situation which is vastly different from the cabin on the island I was on before. This makes the second big transition for me in about two and a half months. First, I left the Asian country I had been living in for over two decades and returned to the U.S. and stayed in an isolated rural area. Now, life has kicked up a notch and is more stimulating, but is also moving ahead.

It is the moving ahead part which has been daunting. I've been happy with the ability to walk around and see new places and things. The environment I'm in is closer to the one I was in for most of my adult life. That is, there are people around, places to see, and things to do. However, I'm also living in a huge house after living in two tiny spaces and have to face the steps that most people take for granted and view as normal.

It's hard to convey how complicated life in America feels to someone who hasn't encountered the changes that have happened. It's a little like stepping out of a time machine. Debit cards? Never used one. Driver's license? Haven't driven for about 24 years and it's long expired. Supermarket self-check-out? Never heard of it. Cell phone? Never owned one. All of these things require that I take a deep breath and go through the processes that others are completely accustomed to. In doing so, I feel stupid, naive, and disconnected from this reality. My sense of being an alien in my own culture is more profound here than it was in a bucolic setting, even though my satisfaction with suburban life is much higher.

All of the stress of adjustment has taken a toll on my eating. I have twice now done what I call "wobbling". That is, I eat more than I should for a period of time (a hard wobble), then I start to eat better about every other day (a less shaky wobble), and then I reach a point close to stability. When I was on the island, I wobbled hard for at least two weeks and was shaky for nearly another 3 weeks. It was only toward the end that I felt a return to normality. Here, I have also been wobbling pretty hard for about 10 days, and have started to regain my footing a little faster.

One of the things about this wobbling with my eating is that I never mistake it for the start of falling down. It is inevitable during difficult times and particularly with a complete loss of routine to wobble. I haven't panicked or felt that I'm a terrible person for this. I don't see myself as weak or a failure. I know I can recover and I will find my old equilibrium back. Even though I've gone through two intensely stressful changes and there is really no end in sight for the foreseeable future, I know this is temporary. I give myself the time to adjust and the luxury of not living everyday to my personal standards because I deserve it during this time.

A lot of people feel that it's "wrong" to "cut themselves some slack" during stressful or hard times. I should make it clear that this is not me letting myself go on some sort of eating free-for-all in which I gorge and make myself sick. I don't do that. Part of the benefit of using portion control and not denying myself any food is that there really is zero appeal to going on a all-out food binging marathon. I tend to serial graze too much at these times, though there are also out and out occasions in which I binge a small amount as conscious stress reduction. I know what I'm doing. It is like a cutter cutting herself. The relief is completely real, like a drowning person coming up for air. Even though the behavior is self-destructive, I can't deny that it is effective. It's something I have not yet extinguished, but I do less of and with less collateral damage than before. It's an ongoing process and getting worked up about it isn't going to help anything so I just try to do better the next day (and usually do).

The situation has mainly been my eating more than I need and not tolerating hunger for very long. It's the difference between buying a bar of chocolate and saying "I'll eat one square a day" and ending up eating two, or eating at night before bed rather than going to bed a little hungry. I may or may not be gaining a little weight from it, but I'm not overly concerned as I'm sure it'll stabilize and go back down again in the coming weeks. I think that attaching drama to stressful times and the subsequent changes in eating habits only makes it harder to recover.

Interestingly, people worry horribly if they overeat when stressed, but not when they don't eat enough when stressed. They know that, eventually, their appetite will return and they'll eat enough again. I know that, eventually, my appetite will abate and I'll eat "enough" again. Having confidence that normal will return is having already won most of the battle.