Depletion

I've been away for a very long time and I'm sure many readers I had have given up on me. My life has been very difficult on many levels, as I'm sure it has been for many people. I haven't been focusing on weight issues and have largely been treading water. For me, this is success because of all of the emotional problems I've been dealing with since returning to the U.S. I apologize sincerely to the people who have had comments that have been languishing in moderation for months and months as I simply did not have the wherewithal to come to this blog in any way for quite some time.

One of the things I've come up against is something which I know many other people with weight problems have dealt with and that is an increased loss of control as the day wears on. That is, night-time binging (or, as is often the case for me, "mini binging" - enough to sabotage losses, but not enough to bring on much in the way of gains). I've become frustrated at the holding pattern I'm in and with how it makes me feel when I succumb to this sense. For me, as is so often the case, it is as much or more about the behaviors and what they mean in a larger sense than how they impact my body.

My study lead me to look into the topic of what is referred to in psychology as "depletion". This links directly to the concept of "willpower" and the erroneous idea that you can do anything if you "try" hard enough. Depletion (or more properly, ego-depletion) has been studied extensively and the bottom line is that we all have a finite capacity to exercise self-control on a daily basis. Those who live lives with significant stress will become depleted and be unable to control themselves as the day wears on and those with less stress will have a better time of it. In particular, those who have to exercise constant conscious control (called "vigilance"), like resisting food, will deplete their resolve reserves more rapidly than those who only occasionally need to resist throughout the day. This is why it is so common for dieters to have problems resisting eating at night.

Studies have shown that those who are on a diet and are placed in a room with appealing food and resist it are far more likely to indulge afterwards. The act of resisting now depletes the ability to resist later. This, unfortunately, indicates something to me which I have not wanted to embrace for other reasons. That is, that it is important to resist temptation and not keep such food in your presence if you are trying to improve your eating habits. That being said, I have found that keeping such food around doesn't tend to "tempt" me, but rather does give me a focal point when I want to mini binge for emotional soothing purposes. The cookies in the cabinet do not call my name. I am actually pretty indifferent to them, but I think that's due to how I've carried on with my eating (as outlined in this blog). As is always the case, "YMMV" (your mileage may vary). The results of the studies in this case are something to keep in mind if you find that tasty food tempts you. If you don't feel its siren song, then it may not be a problem. 

While researching depletion, I was disappointed in the lack of information on how to avoid it or to manage it. As is so often the case with psychological research, there has been much more done into why and how it occurs than how to deal with it. The only research that seemed to address overcoming it was conducted with cash bribes to keep working once one had been depleted. It showed that someone who was relatively tapped out could work at the same level if you paid them to keep trying. This is, unfortunately, a pretty impractical solution. No one is going to pay you to avoid eating.

As has often been the case, I had to explore the possible solutions on my own. I am at the beginning of this process and it may yet be refined, but I have found that I have a tendency to tap myself out repeatedly throughout the day. Things like thinking a lot about serious topics, processing emotional issues, doing tasks you don't enjoy, etc. are a part of what depletes one. After reading the causes of depletion in a wide variety of studies, I was actually relieved because I could see that I have been inundated with nearly every factor that they list over the last few years. Frankly, I'm proud that, after two years of constant adjustment and upheaval and being depressed for much of that time, I haven't put on a 100 lbs. by now. The fact that I'm holding relatively steady is a miracle, but I do want to work on this issue and move ahead.

I came up with a behavioral plan to manage depletion. I have to say that it is not the least bit easy. Coping with a moment of weakness and overcoming the desires it brought on took a full 40 minutes the first time I dealt with it. The second wave (about 4 hours later) was much easier. It is often said, and I strongly believe it is true, that psychological strength is like a muscle. The more you use it, the stronger it gets. I do believe that this is so with depletion as well as everything else that I've worked on. My main focus from this time forward is to manage my time better and insert more breaks into my day in order to reduce the state of depletion later in the day. I am using some of the techniques in the list to follow, but it really comes down to take a moment to notice my fatigue and sit down, close my eyes, and do nothing mentally or physically engaging for a few minutes in order to step out of the pattern I'm in. My mind is always running fast and furious and I need to force myself to disengage. I'm hoping that will improve my situation. Only time will tell.

I also realize, rather sadly, that one of the reasons that I had to set this blog aside was that I was so badly depleted that I just couldn't reflect on such things anymore. I am not actually "gone" as I don't intend to abandon this blog, but I am also not actually "back". If I have something new to say, I will say it, but I won't be pushing to add content.

My apologies to all of the kind people who have wished me well by leaving kind comments and inquiring after my well-being. It is so appreciated that you care enough to drop in on me and think about me. These are things that matter in the world. The energy you put out is important and graciously accepted by me. Thank you so much for your warm and beautiful hearts and sharing them with me.

*****

Depletion

1. Depletion is real.

Many people believe that they are “weak” and lacking in “willpower” but the inner resources of an individual are neither infinite nor equal. As our inner resources are consumed by stress – both physical and mental – our capacity to make difficult choices is reduced. Resistance to temptation goes down as the amount of stress and effort one expends goes up. The first step in improving the capacity to make better choices is understanding the the difficulty is absolutely real not just for the individual facing what feels like a failure in “willpower”, but for every person on this planet.

2. Depletion is temporary.

Once you accept that the temptation you are nearly succumbing to is based on a real lack of inner resources (and not personal failing), then you can find a way to manage more productively in that moment. Knowing that depletion exists means you can face it. The first step in facing it is to know that it is temporary. That means that there are techniques for avoiding the choice you don't want to make (eating, drinking, taking drugs, etc.) long enough for the temporary state of depletion to pass. These are meant to give your resolve a chance to re-establish itself.

Possible steps:

1. Talk to someone/engage in social contact.

One of the reasons that alcoholics in AA will call a sponsor in a moment of temptation is that it allows him or her to not act at a moment in which inner resources are depleted. The social contact as well as the disruption of the moment allow inner resources to refill both by allowing time to pass and providing contact with an empathic and sympathetic person. Even if you don't have someone who you can call in a moment of weakness, you can improve your chances of succumbing to temptation by having a social experience such as calling a friend, family member, etc - even chatting online may be helpful.

2. Sidetrack/distract yourself long enough to allow resolve to improve.

Look at the clock at the moment that you want to succumb. Tell yourself that you will not act on your impulse for at least five minutes. When that time has passed, ask yourself if you can wait another five minutes. If you cannot, allow yourself to give in a little (one sip of a drink, one bite of a treat, etc.) and wait five more minutes before partaking again. Ask if you can wait longer to give in a second time.

3. Self-soothe.

Many addictions are tried and true forms of making yourself feel better when you are worn out. It is an unfortunate fact of life that few addicts can find as much comfort in other activities as they find in their addiction. They are quick and easy and generally quite satisfying compared to any other choice you can make. However, those other soothing activities don't have to be "as good" as the addictive behavior, they only have to be helpful to the extent that they allow you to build up your resolve and avoid the choice you don't want to make.

While such choices are highly individual, some possibilities include: taking a walk, meditation, watching video that you enjoy (YouTube is good for temporary diversion/refreshment), eating a hard candy that is very flavorful while fully attending to the experience (close your eyes and really savor it), taking a bath/shower, hugging or stroking a stuffed toy, looking at pictures that you love/enjoy from the past, listening to music, daydreaming, tapping your feet or fingers, rocking in a rocking chair, lighting and enjoying the aroma of a scented candle, playing a game (including computer games that can be played alone), breathing exercises/progressive relaxation, drinking coffee or tea*, etc.

3. Depletion can be reduced if you are aware.

Understand and reduce factors that contribute to depletion.

A great many factors can cause depletion including:

• exercising emotional control (e.g., not showing temper, sadness, frustration)
• physical exertion
• thinking about difficult or complex tasks (concentrating, studying, etc.)
• dealing with difficult people
• contemplating an uncertain future or reflecting on past difficulties
• resisting temptation
• engaging in positive but tiring behaviors vocationally over an extended time (e.g., exercising, cleaning, preparing healthy meals, etc.)
• being around people, noise, lights
• social isolation
• low blood sugar (being hungry)
• lack of sleep
• uncomfortable weather (too hot/too cold/too humid)
• health problems
• random stressors (noise, unpredictable relationship problems, etc.)

Beyond reducing exposure to known factors which cause depletion, it is also important to attend to your body's internal state and gain further awareness of what is causing you tension and tiring you. Many people furrow their brows, tense their muscles, and clench their jaws in situations, but don't realize they are having stress responses. Bodily awareness increases your ability to identify and manage depleting factors.

4. The act of attempting to reduce depletion will itself be depleting!

Changing habits and establishing new patterns of behavior will tire you out and consume inner resources. This means that, until you have a well-established pattern of inner resource replenishment, your ability to manage depletion and resist temptation will be spotty. You may find that your are hit and miss with your success. This is to be expected as part of the process. This is not failure. It is simply part of adaptation. The point it to build to a state in which you can resist and cope better more often than not, not to be “perfect” and never succumb. Everyone succumbs to temptation on occasion. No one is a paragon of self-control or possessing of infinite willpower and those who present themselves in such a fashion are likely lying. “Better” is the goal, not “perfect”.

5. The carrot and the stick play a role in the ability to overcome depletion.

Studies have shown that punishment and reward improve motivation to endure a depleted state and push past an urge. Avoiding depletion by succumbing to an easy self-soothing temptation is seen as a form of survival as it allows enough inner resources to remain for a person to function in a true emergency. When a strong incentive is provided, most people in a depleted state will do better than they do without that incentive. If you offer yourself a suitable reward or punishment, you may be able to transcend your sense of being unable to resist and use some of your minimal inner resources to make the preferred choice. For example, “If I don't eat that piece of chocolate cake, I will put a quarter in a jar and when the jar is full, I will go out and buy something special for myself with the money.” Placing the quarter in the jar is an immediate reward (as it is a record of successful efforts to resist temptation) and the long-term reward is buying some desired item. The choice of reward is very individual, but it must be a significant motivator to be successful. If you choose a reward or punishment and find it isn't helping you when depleted, it is not motivating enough. For many people, there is no sufficiently strong reward or punishment to stop them from making the preferred choice in a depleted state. This is not a failure.

*Drinking coffee or tea is to be used as a self-soothing or replenishing mechanism with caution. It can be fortifying in various ways, but it is also a form of “biological energy borrowing”. It is often followed by a subsequent caffeine crash depending on ones tolerance levels. However, the act of drinking coffee or tea is often associated with relaxation and slowing down to drink either of these beverages can allow for an replenishing of ones resolve.

The Stages of Weight Loss

Before I get to the point of my post, let me say that I appreciate the folks who have left comments or sent messages asking after me. The truth is that I've been depressed and exhausted, though absolutely not idle. I have remarked to my husband on more than one occasion that I sometimes feel like I'm tied to the back of a car and am running as fast as I can to keep up with it. Most of the time, I barely manage to stay on my feet, and sometimes, I stumble and fall. When things are "good", I get back up again. When things are bad, I just get dragged along behind in a state of exhaustion and defeat. I've been dragged along a lot since coming back "home". It's been a rough road and it's not looking a lot smoother. However, I just keep going along.

Recently, I've been reading some things and one thing that I found has detailed the stages of weight loss pretty well and I'd like to share it with you. Perhaps this has verisimilitude for you, perhaps it does not. I can only say that it rang very true for me.

Step 1: Deciding to lose weight.

A crisis occurs which motivates one to take steps to get their weight under control. This can be reading about or experiencing the death of someone who had a weight-related illness, some sort of humiliation (an unflattering photo, inability to fit in an amusement park ride seat, etc.), or discovering that one can no longer fit into any of ones clothes comfortably. It can be a big "crisis" or a small one, but it is a turning point which motivates.

Step 2: Recognition and starting to make changes.

At this point, one starts to look at ones life and lifestyle and attempt to gain insight into what needs to be changed and then make what are deemed to be necessary changes to achieve ones goal of weight loss. Recognition can include the idea that one does not move or exercise enough, eats too many sweets, eats too much processed food, or simply eats too much healthy food. Once recognition of the underlying issues occur, plans to change are started and weight loss begins.

Commercial weight loss programs and forums are full of active losers at this stage.

Step 3: Changes in appearance with concurrent identity alterations

As one loses weight and appearance changes, there is a concurrent change in self-image and identity. Someone who formerly was not particularly athletic may now identity as a "runner" or "gym rat" as such activities are now part of their routine. A person who is on a particular diet may identify as "Paleo", "raw", "vegan", etc. Deeper changes may also occur such as seeing oneself as sexual, attractive, or more valuable.

Many people never get beyond this step. They tend to vacillate between this step and returning to being overweight as they cannot maintain this type of lifestyle long enough. It takes too great an investment. They will cycle between Step 1 and 3 until they tire or manage to move on. Commercial weight loss programs and forums are full of "success stories" at this level.

Step 4: Transition to a more concrete sense of self

At this point, depending on how long one has been overweight, the old sense of self as invisible, worthless, asexual, etc. may be memories and the novelty of relatively superficial identifiers is wearing off. A deeper sense of who one is comes about if a continuation of lifestyle changes and maintenance of weight loss occurs. This is where people tend to develop an understanding that losing weight doesn't solve all of their problems.

Few manage this step as well since it means that one is able to maintain weight and practices that keep the weight off in order to reach such realizations. 

Step 5: Addressing underlying problems

With the new sense of self and the loss of the rewards that come with success, one has to start facing life on the whole and the underlying issues that were making them unhappy. Sometimes those issues contributed to weight gain. Sometimes, they did not, but since "happiness" was not magically manufactured with weight loss, this is a time of larger introspection and analysis.

Many return to their old ways at this stage because they have not developed ways to manage their lives without falling back into old habits. Some people will bounce between step 3 and 5 for years because it is so difficult to fully change in this fashion.

Step 6: Long-term maintenance

Statistics tell us this is the rarest of things. This is when people have fully adopted and integrated changes such that they can continue to have a healthy relationship with food and maintain a healthy weight. Since so few get past step 3, very few ever reach a level at which they can fully integrate the changes into their life logistically, psychologically, and physically.

Does this seem far-fetched or does it seem realistic as a common pattern for people who lose weight? Well, for me, it seemed very realistic and I see myself as being step 5, and am currently bouncing between 3 and 5. This keeps me from losing a lot more weight, but also keeps me from gaining much either.

Did I make all of this up? No, actually, I did not. This is an adaptation of the 5 steps of recovery for alcoholics and substance abuse addict (Gorski and Miller, 1986). I've been studying addiction, but it has become crystal clear to me that I am food addicted by any definition of the word "addict". What is more, many people are like me, but resist the idea that they are actually addicts because of the lack of control that the word implies.

In no way am I saying that everyone who is fat is food-addicted. However, it is clear to me that I am, and also that a lot of other people are as well. Just as is the case with substance addictions, fat people are looked at in terms of moral failures and character flaws for their "choices". They are viewed as weak. They go through periods of relapse (weight gain) and recovery (weight loss).

A lot of smart people insist that you cannot be addicted to food. They believe you can only be addicted to substances which create a particular neurological situation, but they ignore the fact that there are actually two types of addictions. They are substance and process. Process addictions include things like gambling and sex addiction.

My feeling is that food is a combination of both process and substance addiction because it stimulates pleasure centers as well as the act of having it creates a sense of well-being. One of the more well-known food bloggers who has been struggling with a cycle of loss and regain once said that she was not satisfied with small portions. She needed to have "an experience" in which she ate a lot. This is a sign of process addiction. She derived comfort from the act of eating as much as she wanted, not from the pleasure she got from tasting the food or having a full stomach. In fact, those who have such issues, and I am one of them, will eat until physically ill or uncomfortable because the action of eating is what one requires, not the food itself.

The reason I'm talking about this is because I think that knowing that this is, at least in part, an addiction means that managing it is a permanent process. Addiction is forever. All you can do is be in a state of remission. There is no cure. The best you can hope for is to stave off relapse or to not relapse too often or too copiously. Like other types of addictions, relapse is the more common experience and total remission is extremely uncommon. I think that, once I realized this, I felt a sense of relief. It's not because I think this makes things easier, because it has never been "easy", but rather because the path is clearer.

My father is an alcoholic. He is addicted to alcohol. Addiction is often genetic, generational and a family issue. I may or may not have "inherited" addiction, learned it, or reacted to one addiction in the family with another. The only way for me to live from now on is look at this as a disease that I'll have to battle forever. The best I can hope for is to "manage" it, not cure it.

On the Sidelines

I started to seriously pick up weight around the time that I entered the 3rd grade. Before then, I was a fairly average kid. By the age of 11, my life in school was a daily hell of bullying by kids who loved nothing more than to say ugly things to both my sister and me about our bodies.

There was nothing I hated worse than riding the school bus. As the first kids on and the last kids off, we were subjected to a total of an hour and a half of potential teasing, tormenting, and abuse five days a week. School was no great shakes, but riding the bus, in which kids were rarely monitored for anything other than standing up or getting loud enough to annoy the driver, was far worse.

One day, after a particularly brutal session of bullying by the kids riding the bus with us, I snapped. As the two of us were ready to disembark the soon to be empty bus, I started screaming at the driver in frustration for his failure to protect me from the suffering I endured day after day. At that point, I had spent at least 3 years being tormented and I could not fathom why an adult in a position of authority would do nothing while that went on so openly and blatantly.

My sister stood behind me as I laid into him in the manner that a 12 year-old can do. When I was done and stepped off the bus in tears, he essentially said something to her which was tantamount to, 'what's her problem?' I'm not sure if he genuinely had no idea what went on on that bus, or if he simply felt that I had no reason to expect him as the only adult  present to look out for my welfare, but he seemed perplexed at how upset I was.

The truth is that many adults stood on the sidelines as I moved from being a child to a young adult and did nothing to stop the suffering being inflicted upon me. Teachers knew I was being teased mercilessly about my weight. A few of them did a little extra nurturing of me by praising me in class for my artistic ability or my intelligence, but none ever tried to step between me and the abuse or to put a stop to it.

I don't know if things would be different in this day and age in schools. The repercussions of being the responsible adult and not stepping in while a kid is abused in some fashion may be enough of a threat to get an adult to step in nowadays, but I somehow doubt it. There was a news story in the last year or so about a fat boy in Australia who was being tormented by a smaller boy (including being hit) who got fed up and picked his tormenter up and dropped him on his head (in a move he emulated from a pro wrestler). The internet applauded the tormented boy while some parents fretted that the bigger boy could have harmed the smaller one.

It has seemed to me all too often that the world has stood by while I was hurt by people because of my body. I spent many years of my life full of anger because of this. Starting at a young age, I felt vulnerable and like someone should be protecting me. When no one did, and, indeed, when I was often told by various "caring" adults that I wouldn't be teased if I lost weight, I just felt more hostile and resentful. They were blaming me for my pain, rather than placing the fault on those who inflicted it.

As a kid, and even as a teen, I didn't know why I was so fat in light of the fact that I never ate the sorts of food believed to make you fat back then (cookies, chips, soda, pastries). I saw skinny people eat that sort of stuff and they never gained weight. I ate boring food that poor people ate like potatoes, white bread that cost 30 cents a loaf, cheap cuts of meat, and pasta. None of that stuff was the stereotypical stuff of fatness. Of course, now I know better about the factors that contributed to my childhood obesity. Then, I just was a poor kid being fed what my parents provided me and being criticized for not eating what was cooked simultaneously with being taken to task for being fat.

Emotionally, I felt vulnerable on all fronts. Kids hurt me. Adults validated the manner in which they hurt me by saying it was my fault. If I just conformed, they would leave me alone. The seeds of self-loathing and world-hating were being planted every day in deep soil. They would grow for many more years than they would lie fallow.

I realize how profound an effect the situation in which I grew up had on me. If you put an animal in a cage and poke at it repeatedly with sticks or shock it with cattle prods, it will grow increasingly hostile and defensive. If even the most caring of individuals tries to approach such an animal, it will attack first as a defensive measure. In a world that hates fat people and isn't afraid to let them know it, I think we're going to see a lot more people developing a personality in line with the constant abuse they suffer. That will be the subject of my next post.

Not mentally ill, just big-boned

In my previous post, I talked about "normal" and "abnormal" and how such things impact how we are treated. People tend to think that the purpose of psychological treatment is to target "abnormal" and to make it "normal". That is not the of purpose psychological intervention or study. It has never been and never will be about reshaping people to some sort of acceptable average or filing off their quirks and character traits so that we are all the same.

In fact, there are critical rules for when something is considered pathological as opposed to merely "different". Unless you are demonstrably and clearly a danger to yourself or others, there is actually no way in which someone can force you to be treated. Most people who see therapists are going to them because they have problems they want help with. No one is making them change. They want to change. It's not about forcing "normal" on them, but rather their desire to find a new "normal" for themselves.

"Normal", as I said in my previous post, is a relative state within a system, but it also can be a reflection of where one falls in a statistical range. Recently, it was announced that narcissistic personality disorder was being removed from the "bible" of psychological disorder diagnoses, the DSM. In the DSM V (currently, the DSM-IV-TR is in use), narcissistic personality disorder will not appear. The reason for this is that self-absorption and self-involvement are so prevalent in society in the internet age that these are no longer considered atypical behaviors. What is more, and this is critical, they are no longer considered personality aspects which lead to functional impairment in the current social order. When everyone is self-involved, it is seen as  "normal" within the system and those who display such traits are accepted rather than rejected when it comes to jobs and relationships.

I mention this situation because it is important to remember that what is considered "disordered" and "normal" are fluid. Just as a mental state that was once considered a problem can disappear when the zeitgeist catches up with it, a mental state which wasn't a problem in the past can become one now. Changes in society can erase the idea of abnormality, and they can create new abnormal states.

The two core aspects, statistics and functionality, are important to consider when thinking about whether something should be considered a psychological disease. The former is not enough to consider a behavior or state a disease that one would do well to treat. Statistically, there may be few people who are hearing the voice of God in their heads on a regular basis, but their state is not of concern until it interferes with their functioning. If such a person can live a life as a productive member of society or at (least a non-disruptive and independent member) regardless of their atypical state, it does not matter whether they receive treatment. No one will force someone who is capable of self-care and who is not interfering with others to be treated no matter what their mental condition.

Of course, people who hear voices are often unable to function because their impairment is so great that they cannot survive in society. Indeed, there is an extremely high rate (50%) of self-injury (either suicide or self-mutilation ) among people with psychotic disorders such as schizophrenia. They are not only distracted and troubled by the voices they hear, but they are driven to harm. However, it is not unheard of that extraordinary people who suffer such disorders can develop the capacity to cope with their problems without psychiatric or pharmacological intervention.

This was the subject of the movie, "A Beautiful Mind". However, such people are extremely rare and their anecdotal cases cannot be used as reasons to fail to treat others with their condition or as an excuse to "depatholigize" a pathological condition. If you are one among thousands who has a condition and does not suffer functionally for it, that is not a reason to expect that others will manage in the same manner as you. Such exceptions are inspiring, but are nearly meaningless is the greater scheme of things.

So, while a handful of critically mentally ill people are capable of functioning despite their atypical life circumstances, the vast majority will require treatment to improve their quality of life and be functional. A necessary precursor to treatment is diagnosis, and that's why things like the DSM exist. It's also why obesity is currently being considered for insertion as a mental disorder into the DSM V.

The idea that obesity is a mental health issue is hotly debated both by laymen and experts. Personally, I think that obesity is a physical state and a symptom of a potential mental disorder or a set of disorders. The state of being obese is not, in and of itself, anything other than a reflection of body composition in regards to fat percentage. Sometimes it has an organic basis and sometimes it has a mental one. Whether you are super skinny or super fat, your functioning in life is impeded and the underlying issue, whether medical or psychological or both, could be improved if treated.

Just as an anorectic's skeletal appearance reflects deep emotional problems, the super fat person's body size also very likely reflects deep problems. The notion that one extreme is a mental disorder and the other is not seems absurd. Starving yourself to dysfunction and possible death is a mental health issue. Why isn't eating yourself to dysfunction and death one as well? This seems illogical and hypocritical.

The answer to why being super obese isn't a sign that someone has a mental disorder is, my opinion, because of both prejudice and a lot of denial. The prejudice comes from people who think that fat people are gluttons who lack self-control and if they merely exercised some restraint and moved around more, they wouldn't be fat. This is an oversimplification which is gratifying to those who need to elevate their self-worth at the expense of others. It's not seen as a mental health issue, it's a deficiency of character.

The aforementioned denial comes from the very people who could be helped by a DSM V classification of obesity or an obesity-related mental state diagnosis. The claim is that 'they're not mentally ill, they're just big-boned'. There are numerous assertions about the compositions of their diets, homeostasis, exercise habits, health issues, etc. as ways of explaining being super fat.

I have no doubt that some people are naturally fat, just as some people are naturally thin. I also have little doubt that most women of average height and build (excluding the very tall, very short, and very muscular) are not naturally at a homeostatic point over 200 lbs. and most men at a point over 250 lbs. Even if you were born to be fat, chances are you weren't born to be super fat. There is either an underlying biological issue that needs some attention or a psychological one (or both).

Without a doubt, there are many organic disorders and medications that can make someone obese. No small number of drugs are known to induce metabolic syndrome and taking them requires a concurrent change in lifestyle which can be seen as "unfair." People on such drugs have to eat far fewer calories and often limit carbohydrates compared to an average person. Emotionally and physically, this can be very hard, but such restriction does not result in a loss of health due to poor nutrition. It just is very, very hard to accept that you eat 1500 calories a day and struggle not to gain weight while another person can eat 2500 a day and not worry. It's also terribly difficult to be hungry all of the time because of this type of restriction.

That being said, I personally believe the inability to comply with such restricted diets is largely (but not entirely) psychological for most people. I've been researching a lot of underweight people's lifestyles and behaviors and what I have found is that such people actually don't eat much. Many quite thin people really do just "go hungry" for so long that they learn to ignore hunger.

There's a BBC television show called "Supersize Vs. Super Skinny" that can be viewed for free on YouTube which gives a lot of anecdotal examples of the differences in eating habits between very  heavy and very thin people. It goes some way toward showing different mindsets as well as different habits. People who don't have eating disorders view food and hunger differently than those of us who do. While I don't think someone who has been fat will ever tolerate hunger as well as someone who has never been fat (because having been fat, especially for a lot of your life fundamentally changes biochemistry), I do believe one can use behavioral techniques to stretch their tolerance levels and re-frame the role of food in their lives to help improve their relationship with food. 

The fact that obesity can be brought on by drugs or organic conditions does not negate treating it or regarding it as a pathological condition. There are many organic disorders that can create psychoses, anxiety, depression, and antisocial behavior. These include brain tumors, cancers, thyroid problems, and hormonal imbalances. All of those disorders when brought on by organic or pharmacological agents are treated with concurrent medical intervention and therapy. Why should obesity, especially super obese states, be regarded differently than these other conditions? Why is it simply explained away by fat activists as being a natural state of being for some people? Well, because fat people don't want to see themselves as "sick". They just want to see themselves as fat.

Here's the thing, crazy people often don't think they're sick either. It often takes significant pressure or serious difficulty in functioning for them to come to terms with their illness. Even for those who are seriously ill, and they might be cutting themselves, drinking cleaning fluids, and beheading people on buses, they are sure they are behaving rationally.

Weighing 300+ pounds at average or near average height and saying you are in no way sick borders on the absurd. Something is wrong somewhere. Such a body will not function well in the long run and many are not performing optimally in the short haul either. Sure, there are some cases of very heavy people who are extraordinarily healthy and mobile. They are the stuff of an obesity-based version of "A Beautiful Mind", but their cases are not typical and cannot be generalized to everyone who is morbidly obese or super obese.

I'm not saying fat people are crazy, but I am saying there's a mental health issue in many cases (along with an accompanying physical one in most cases as well) and denying it doesn't change the fact that functionality is impeded, quality of life is degraded, and relationships with food are disordered. Anorectics, incidentally, similarly feel (off and on) that there is nothing wrong with their weight or relationship with food. It's not them that has a problem, it's the rest of the world. These days, fat advocates say the same thing. It's not them that has a problem, it's the rest of the world.

The question of whether obesity is a sign of a mental disorder is a tricky one because the media so often focuses on the symptoms rather than the causes. Just as being skinny (not mentally ill) isn't the same as being anorexic (mentally ill), being obese isn't the same as being super obese and engaging in the behaviors that made one so. What is more, anorexia is not a bodily state. It is a set of behaviors and thinking that result in a bodily state. Classifying obesity as a mental disorder is wrong, but classifying the set of behaviors that lead to a level of obesity that creates functional impairment would be a step toward dealing with the problem productively and without political and judgmental statements.

The bottom line is that I believe that there is a set of behaviors that lead to super obesity. A new term, I might suggest "redundorexia" (excess appetite, which is the opposite of anorexia or no appetite), might be in order. The term would not refer to body size, though body size would be one of the symptoms. It would refer to a set of behaviors that result in obesity that functionally impairs someone. Now I will say that, if such a disorder existed, I would be diagnosed with it (possibly with it being seen as being in a state of remission at present, possibly not). The characteristics would be as follows:

• high body weight (at least obese, if not class 1 or 2 obesity)
• strong identification with body size
• restriction of social or work activities due to feelings related to body size
• feelings of dissociation of mind from body (e.g., the sense that the body has betrayed one or that one exists separately from ones body)
• inability to operate in the world due to body size (e.g., inability to use public facilities like stall-size toilets, ride on airplanes due to seat size, etc.)
• physical impairment due to comorbid health issues brought on by body size (e.g., back pain, type 2 diabetes, joint pain, edema, etc.)
• impairment of relationships due to body size (including conflict over weight with significant others, inability to be physically intimate for physical or psychological reasons, misdirected anger or paranoia about being judged because of ones weight, etc.)
• preoccupation with food or dietary habits
• anxiety about eating in front of others
• inability to moderate eating habits despite repeated attempts (e.g., repeated attempts at "dieting")
• hidden eating/hiding food
• moralizing of food and changes in self-esteem in line with what sort of food one eats ("good food"/"bad food")

This is not a complete list of potential issues, and certain other disorders (comorbidities) would be common. In particular, anxiety and depression would often accompany a diagnosis with an obesity-related mental disorder.As is the case with all DSM disorders, one would have to meet all or a certain high number of these criteria in order to be considered to have such a disorder and those behaviors would have to persist over a long period of time (at least a year, if not longer). Merely having several would not be enough and engaging in them only occasionally would also not be enough. Most people have experienced some of these attributes, if not all of them, on occasion in their lives. Persistent suffering is always a part of whether or not someone has an actual disorder.

Why am I talking about diagnosing obesity-related behaviors as a mental health disorder? Well, I'm talking about it because it would be a significant step forward in dealing with the problem in a manner which does not blame the sufferer as well as create a system which would facilitate treatment. Before there was a term for H.I.V., there wasn't a treatment system. There was just labeling and blame, especially in the gay community.

Beyond the fact that a diagnosis will create a system for research and treatment, it also creates an economic avenue for receiving help. Insurance companies won't pay for things which are not officially called diseases. If you are obese and want therapy for your condition, it's harder to get your insurance company to pay for it than something like bariatric surgery. They recognize that being fat is a health issue, but not a mental health issue. If you want CBT (cognitive behavioral therapy) to deal with your food relationship, you may or may not get insurance coverage for it.

Mental disorders come and go with the times as we can see by the removal of narcissistic personality disorder from the DSM. Given modern lifestyles, I think it's more than past the time that "redundorexia" or something to that effect was added to the list of possible mental health disorders. In my next post, there is another related disorder which I have noticed has evolved as a result of the obesity epidemic and the manner in which fat people are treated.

What "Normal" Is

As some of my readers may recall, I've been taking a graduate school class with my husband over the past couple of months. I'm able to do this because his school graciously allows partners to audit (take part, but receive no official credit) one class per year. The experience has been an emotional one for me on many levels, but has failed to significantly challenge me intellectually for the most part.

The "emotional" aspect has come from being faced with the various personalities of the participants (of which there are about a dozen) and the perspectives they present. All of them are younger than me, and have significantly different (and more limited) life experiences. Sometimes, I'm very frustrated at the myopia they exhibit, but much more frustration is elicited by the lack of critical thinking that is displayed.

The dearth of critical thinking is shown in a variety of areas, but one in which many psychology students struggle is with the notion of normality. At my husband's school in particular, an institution which is more expansive, open-minded, and embraces a holistic approach to living, healing, and mental illness, the idea that "normal" can be defined is more resisted than among the population at large. These are people who are in that place because they reject conventional thinking on multiple levels, and that means they do not want to pigeonhole or embrace concepts that are as limited as a notion of "normal".

While I think it is important not to try to reshape everyone into a round shape so they can be placed in the corresponding round hole, the notion of "normal" is of value and embracing it should not be viewed as a destructive pattern of thought. The idea of defining it should not be seen as an effort to marginalize, isolate, or pathologize people, but rather to understand states which create the greatest functionality and healing.

I'm talking about the concept of "normal" here because, in terms of body weight, the idea of "normal" is very controversial. Often, it is medically determined in a manner which simplifies rather than rationally explains why body size matters. That being said, I don't believe the concept of a "normal" weight has to be considered a toxic means of straitjacketing the populace into fitting into socially or medically determined forms. A more complex and nuanced notion of "normal" in terms of all things, not just weight, is of value. To that end, I have been pondering the idea of "normal" as of late.

The first thing that is important to keep in mind is that "normal" is a relative state. What is more, it is relative within various "systems". For example, hearing voices, taking hallucinogenic compounds, and sacrificing animals is normal within some tribal systems that have shamanistic practices. That being said, though these activities and experiences are generally normal, they are only appropriate (and therefore "normal") in certain settings. Even in societies in which hearing voices is a normal part of ritual experiences, it is not a normal part of everyday life. A person who is actively psychotic and hears voices outside of the ritual setting (and who is not an appointed individual for whom such experiences are considered part of their role) are definitively deemed abnormal and will be socially isolated, rejected, or marginalized.

Similarly, certain types of dress are utterly normal within a certain system, but would be considered inappropriate and "abnormal" in more mundane ones. If I were to wear an evening gown to an orchestral performance, it would be seen as "normal". If I were to wear one to work, it would be considered "abnormal". Context matters. The system you are operating within determines whether or not you are "normal".

This leads me to talk of body size and appearance. Part of what got me intro trouble recently on Facebook was talking about one of the more zealous fat activists and how she looks. I asserted that her appearance, which is far outside the mainstream in ways unrelated to her weight, muddles her ability to represent the oppression that fat people endure. In no way did I say that the obese and especially the super obese (so-called "death fats", of which I have been a part of for the vast majority of my life) are not treated abysmally and with great cruelty. However, what I said was that her extremely atypical choice of style of appearance muddled the picture significantly and made her a poor choice of example for how fat people are publicly humiliated.

The truth is all people who appear "strange" will elicit abuse, and I cited an article in a psychology journal in support of this notion. Unfortunately, I can't link to it here because it's an academic article behind a pay wall that I could only access via my husband's academic account, but you'll have to trust me when I say the study exists and that what I say about it is true. That study was conducted with normal weight people who dressed, styled their hair, etc. in highly atypical fashion. They wore large polka dot prints or other "loud" patterns and displayed unusual hair coloring. The purpose of the study was to measure the responses of strangers who encountered these unusually groomed and attired people in public. The results showed that, quite overwhelmingly, "abnormal" appearance elicited aggression. This happened when weight was not a factor.

So, I think if you are going to hold your treatment out there as a fat person and say that you are abused, you have to "control" for this factor. It muddles the picture if you are both very fat and dress in a manner which the society you are operating in deems "abnormal". If your clothing and style choices are far outside the norm, it will be very difficult to tell whether you are treated poorly because you are fat or because of your unusual style. Beyond confusing the true motivation among bystanders for their negative attention, it also undermines the sympathy of others when hearing your story. They will look at the strangely dressed person and not think, "she's abused because she's fat," but rather, "she's abused because she dresses so weirdly." It undercuts the potential for empathy and harms the cause of fat activism.

My talking about this is not to be confused with condoning the abuse of anyone based on appearance. I don't care what people dress like or look like. I spent more than enough years of my life being treated like a walking pile of fat garbage to condone the abusive behavior people heap on others for their appearance. What I'm doing here is talking about the reality, not making an excuse for it.

The reality, very likely, is informed by evolutionary forces. Our distant ancestors that responded aggressively to those who appeared markedly different very likely survived. Those who were tolerant and accepted likely did not. Conformity promotes recognition among the tribe and means that you will see the enemy as the enemy and a friend as a friend. Bystanders who see a stranger who looks weird (or acts strangely) are therefore fearful and become aggressive and they probably don't give a second thought to whether or not the response is rational.

There's probably some part of their brain in the amygdala (the home of our aggressive and fearful responses for the most part) that activates. In order not to have those feelings, they must engage in active suppression and process cognitively. Such processing requires awareness, energy, and the taking of an advanced perspective that people are unlikely to do simply to benefit a random stranger. The question of whether they "should" do it is another one entirely. Of course, they "should", but we do not yet live in a world in which children are taught to question and mitigate this response at a young age, and that is where the process should start.

My purpose in broaching this topic is not to explain what happened on Facebook and upset someone else. This is actually only part of the picture and, as I said before, I was at fault because of how I characterized the individual in question (in a manner which was uncharacteristically derogatory and which I apologized for twice). This is just the start of my talking about conclusions I've reached about the "fat mindset" and my feelings about obesity as a mental disorder. The reason I'm talking about "normal" and how "abnormal" is to set the stage for what will no doubt be a series of posts about the topic that will lead up to my conclusions.

The bottom line is that being super fat is not "normal" within the current systems in most societies. Aggressive responses to abnormal appearance are, unfortunately, a part of human nature regardless of the reasons or shape of that "abnormality". Well-meaning and self-serving attempts to "normalize" atypical behavior across the board will not change the reality of human biochemical responses to that which is markedly different and one cannot control the behavior of others, particularly when they are operating in line with societal norms and biochemical responses beyond their control. Just as they cannot easily regulate their heart beat, they cannot stop the rush of chemicals that create an aggressive response when they experience something which is not normal within their system. This is, in essence, where the seeds of what is considered pathological are sown.

Tribe-less

Me at age 12, wearing the sort of stretch pants my mother bought for me which helped make me even more of a social pariah than I already was as a result of my weight.

Recently, in an exchange on Facebook in which I was frankly at least somewhat (if not greatly) out of line, one of my friends by way of the internet seemed to be saying that, since I'm no longer living in the "death fat" range of weight, I can't understand or appreciate the value of fat activists. I cannot say whether or not this is true. The truth is that I wasn't in the fat activism camp even when I was in the super morbidly obese weight range. I always had problems with the skewed manner in which many of them frame their world and the denial of the health problems that come along with being super morbidly obese.

I can't speak to how having lost weight may have impacted my view of the value of fat activists. I can only say that, the implication that I can't relate to the pain of being dramatically overweight and what it is like to live like that upset me. I felt as if my experiences and knowledge were being invalidated because I've not been in that weight range for the last few years.

Me at age 14, trying to hustle out of camera range because I loathed having my picture taken because I was so disgusted by my appearance. Note the double chin which I hated.

That being said, perhaps the fault lies with me because I haven't spent enough time talking about my history and what I grew up like. It's one thing to follow my recovery process. It's another to know very clearly how little of my life has been spent in any mental or physical space that can be considered in the ballpark of "recovered". To that end, I'm offering this post.

Me at 17, at my high school graduation sporting the sort of body that insured that I'd never get a date, go to a prom, or be seen as anything but an ugly mass of flesh. This was in 1982, and I was the only fat girl in my entire class. The world was not yet full of super obese people.

I have lost significant amounts of weight twice in my life. The first time I remained at various weights under 200 lbs. for approximately 3-4 years before regaining. Most recently, in the past 3 1/2 years, I've lost weight and maintained around 180-190 lbs. in the last year only. Note that I choose the sub-200-pound range because I have learned that that is the point at which you tend to not be treated as in incredible fat freak in my experience. I'm speaking of the perceptions of that weight range at this time in history only. When I was growing up, I was tormented for weighing less than that.

Keeping in mind that I had to go down from 380 to my current weight and spent many of my "losing" years at extremely high weights and totaling the years of my adult life, here are some numbers:

lowest weight ever: approx 160 lbs.
time spent at lowest weight ever: approx. 1 year

highest healthy weight for someone my height: 145 lbs.
number of adult years spent at a "normal" weight: 0

Current age: 48
number of adult years spent at under 200 lbs.: approx. 5
number of childhood years spent at a "normal" weight: 8
number of years spent in the obese or super obese range: 35

Me before my wedding (age 24), having regained a lot of the weight I lost at the end of college. This was hardly the end of it. Much more was to come.

That means that I've spent 35 years of my life and all but about 5 of my adult years grossly overweight and in a state of self-loathing, social isolation and torment, and physical difficulty. The 8 years I spent as a child (from birth to some point in 3rd grade) were hardly ones in which I was aware enough to appreciate not being fat.

And just for the record, the pic on the left was me in 2009 (age 46) after having already lost about 30 lbs. I looked like that for at least 10 years. A line can be drawn from how I looked at my wedding in 1989 to 2009 to show how my weight escalated.There aren't any pictures, because I wouldn't let them be taken at that weight.

My point is that I could hardly have forgotten what it is like to live in the world as a super fat person given that I spent 35 years mired in such a state. That means I've been obese or super obese longer than some overzealous fat activists have been alive! I have spent a lot more time being afraid to leave the house for fear of mocking, afraid of not fitting in chairs, afraid of the physical pain that came with walking in that body, and afraid of not being able to two squeeze into narrow spaces than I've spent not thinking about such things.

Sometimes, I still think about them, to be honest. Ridding myself of that mindset doesn't come easy. I still think about whether or not I'll fit in a bathroom stall, squeeze my fat ass past a narrow gap between chairs in a  restaurant, or if people are staring and pointing at my gut and laughing at me. If people look in my direction and say something to a friend and laugh, I still think it's about my body. I still suffer from fat PTSD.

Also, it's not like I'm all skinny and trim now. I'm 5' 4" (164 cm) and weigh on average 185 lbs. (84 kg.) I'm still technically obese.I still have a huge flap of skin hanging down from my stomach as well as a large belly. I'm still fat, just not fat enough to prohibit me from walking, getting on public transportation, or going to a restaurant. I'm not complaining about my current weight, but I am still fat. There's no mistaking that.

What I'm realizing is that my voice is now doubly not taken seriously because of where I'm at. I'm not fat enough to be taken seriously as someone who has experienced life as a "death fat" (despite spending an overwhelming amount of my life in that range) and I'm not thin enough to be taken seriously as a person who has successfully lost weight.

Neither of these tribes would welcome me as a member because I'm a betrayer to both. By losing weight, my years and years of experience suffering as a super fat person appear to have lost all validity. By not losing enough weight, the manner in which I have lost has no validity. Frankly, while I find it upsetting that anyone could think I've forgotten how horrible it is to be super fat in a world which hates you, I've also figured out a few other things about the "fat mindset" as a result of this which are setting me along an entirely new path of thinking. I'm sure I'll share it here when I'm ready. And I'm nearly as sure that it'll get me in a lot of trouble.

Brightening the Lights

Recently, I've been learning more about the brain's reward system pathway. I don't want to go too deeply into it because, frankly, even people who know a little about it get frustrated and irritated when I go deep into the details. It's pretty dense stuff, and only those who want to know the science very well need to know about it. So, I'm going to speak in general terms, and entertain questions about details should my readers want more concrete answers.

What I've learned recently enhances what I talked about in the previous several posts, and it has mainly applied to substance use and abuse. In particular, I've learned a thing or two about how drugs that affect the parts of your brain that experience pleasure mess up your ability to take joy in anything else. The woman who was teaching the class I was sitting in on told us a story which, after hearing it, ran a bell very strongly with my experience with food.

This woman has a PhD, is a registered nurse, and a practicing licensed therapist as well as a teacher at a private graduate school. One can conclude she has a lot of practical as well as book-oriented knowledge. She told us about a client that she had who had spent several years using cocaine. Prior to his cocaine use, he used to enjoy music greatly. After using cocaine, music no longer could offer him the same joy, not even long after he'd stopped using the drug.

What had happened to this man was that the parts of his brain that were stimulated by the drug were the same ones that allowed him to take pleasure in other things. By abusing the drug to hyper-stimulate those areas, he changed the way they experienced the world forever. That's right. Forever. They were permanently changed such that nothing would ever give him pleasure in the same way again.

The reason this story really hit home with me was that, when I started changing my relationship with food, I wrote about how my life was changing. In this post (12th paragraph), "I should note that there is very much an aspect of this which is “duller” than things used to be. That is, the lights were more brilliant and the colors were brighter when food was fully centralized". This was a reflection of the fact that food was the thing that lit up the pleasure centers in my brain in a way nothing else could.

A lifetime of using food for comfort has almost certainly altered my brain's reward pathways just as those in the cocaine addict were altered. The highs were rarely as high for me as they were when I was fully invested in partaking in food with not restriction. However, I do believe that there is a difference between what happened to me and what happened to the cocaine addict. He was damaged and can't be repaired. I am damaged and am in the process of being repaired.

It continues to be a long and complex  path. Due to the psychological processing I've done, I can never regard food as the end all and be all of pleasure. The "buzz" I got from it died and I can't honestly say that anything has replaced it in intensity. I can say that things have slowly gotten better as I've tried to replace that pleasure with other types of pleasure, but it's more about collecting little bits of thing to enjoy then one whopper that delivered it's payload of joy in one sitting.

I don't know about the biology for certain, but I'd be shocked if people like me didn't see their reward pathways light up like a Christmas tree from food and provide dim lighting from other sources of pleasure. I think that this could be part of the complex picture of why people who lose weight regain. Just as the cocaine addict goes back to the drug because life becomes dim and joyless without it, the addicted eater may similarly find that the lights need some brightening when they try to abandon their drug of choice.

I know that it has taken me years to decouple destructive pleasure seeking in food and it's still there to some extent (as my last few posts illustrate) and similarly has taken years to elevate other pleasures to a meaningful status in terms of my response. I'm not saying every fat person does this, but I do think that for those of us who became fat as children and continue to be fat as adults, there's a good chance that our brains are built around this way of deriving pleasure from our world.