Docsplainin' -- it's what I do

Docsplainin'--it's what I do.
After all, I'm a doc, aren't I?

Monday, July 15, 2013

Poor Trayvon

Well, the George Zimmerman verdict is out, and I suppose every Blogger worth her salt will have to have something to say about it today.

I'm not a lawyer, so I don't have an opinion about the evidence or the jury, or the conduct of either the prosecution or the defense, or even about the Stand Your Ground law. Well, yeah, I do have something to say about that, but it's not a legal opinion, strictly speaking.

These kinds of laws spring from a state of mind peculiar to regions that historically were made up of scattered, rural, generally agricultural or herding societies who did have to protect their own land/livestock/homes/families because there was no law close enough around to do it. Pro-actively, the successful men in these societies projected an über-male, physically over-bearing persona in order to cause potential criminals to steer off for other parts where presumably they might find easier pickings. It was a matter of honor to be able to protect your boundaries, to be able to project that sort of image, and by extension if somebody messed with you or your stuff, well, then, your honor was at stake until you could even up the score. 

I can't say anything psychological specifically about George Zimmerman because I have not evaluated him, and I don't have access to anybody else's evaluation of him. Heck, I haven't even watched the non-stop coverage of the trial. But I can say, as a disinterested citizen observer, that George appears to the naked eye to be a bit like the fence-rider of old, ever on the lookout for rustlers who, if you will remember your US history, along with horse thieves back in the day could be hung on sight by whoever caught them in the act. This is, I suspect, partly why it looked so much like it was Trayvon rather than George who was on trial this past week. Indeed, I could not help but notice, some commentators persisted in referring to it as "the Trayvon Martin trial". The mentality is still that pervasive.

We don't need those kinds of laws any more, but they and the personalities they serve persevere. As does the gun violence that goes with them. 

If you see yourself as a victim, which, weirdly, an increasing number of white males in this country do, or if you merely fantasize yourself engaging in various make-my-day type heroics, you may find like-minded folk in the gun and prepper communities (there's a lot of overlap between the two). Stand-your-ground laws were written for you. And so you may end up going about your daily business locked and loaded, spoiling for a fight. You don't even have to be part of a neighborhood watch or other, similar, organization. You can self-appoint. Your real-world perceptions are filtered through the movies running through your head, which in turn are heavily influenced by the paranoid poppycock you read on prepper and gun websites and in their magazines and newsletters, to the detriment of your grip on reality. You would be what the American Rifle Association calls an Armed Citizen. They even have a monthly column called "The Armed Citizen" in which they congratulate each other for shooting alleged criminals. 

But I digress. 

Anyway, one day you find yourself in a situation which seems to you to call for a violent response. Instead of the dozen other things you could do, or not do, in this situation, you draw your weapon. You're not reluctant. You're not saddened by it. You are justified. This is, after all, the fulfillment of a long-cherished fantasy. You genuinely don't 'get' why anybody else would be horrified at what you've done.

This would happen even if there were no stand-your-ground laws, but at least then there might be some justice for your victim afterwards.

But I am not a lawyer, so no, my only real opinion is from my point of view as a mother, and that is that justice was not done here. It seems to me that part of the whole point of the USA is that a person -- most especially a child -- should be able to walk the streets of his or her community in peace and safety. And anyone who violates that is in violation of some law. Be it written or ethical or moral, he is in violation. He has violated the peace of the community, and the safety of all of its citizens. He has violated the faith and trust that we have in our neighbors.  

I don't see how Trayvon's parents can have any peace at all until we as a nation stand up and say this. 

Sunday, June 23, 2013

On Humility, and the Limits of Formal Education, or More on Arrogance

I know everybody's watched it, but have any of you read the series A Song of Ice and Fire? I'm on Book Four, A Feast for Crows. When I'm not working, I think, I live more in Westeros than I do in America. It's that intriguing, enchanting, absorbing. And the other night, I came across this passage, in the Prologue: 

"The night before an acolyte says his vows, he must stand a vigil in the vault. No lantern is permitted him, no torch, no lamp, no taper . . . only a candle of obsidian. He must spend the night in darkness, unless he can light that candle. Some will try. The foolish and the stubborn, those who have made a study of these so-called higher mysteries. Often they cut their fingers, for the ridges on the candles are said to be as sharp as razors. Then, with bloody hands, they must wait upon the dawn, brooding on their failure. Wiser men simply go to sleep, or spend their night in prayer, but every year there are always a few who must try."  

". . . what's the use of a candle that casts no light?"

"It is a lesson," Armen said, "the last lesson we must learn before we don our
maestcr's chains. The glass candle is meant to represent truth and learning,
rare and beautiful and fragile things. It is made in the shape of a candle to
remind us that a maester must cast light wherever he serves, and it is sharp to
remind us that knowledge can be dangerous. Wise men may grow arrogant in their wisdom, but a maester must alwavs remain humble. The glass candle reminds us of that as well. Even after he has said his vow and donned his chain and gone forth to serve, a maester will think back on the darkness of his vigil and remember how nothing that he did could make the candle burn. . . for even with knowledge, some things are not possible."
That stopped me in my tracks. I read it again. And then once more. And I wished that (or something like it, since we have neither dragons nor dragon glass in 21st-century America) had been our last lesson, perhaps the night before our hooding ceremony, since we don't don chains like the maesters of Westeros.

How I wish they'd taught us how to simply sit with the dark. 

I have been a therapist for 33 years, and in that time I have seen many who have grown arrogant--in their knowledge, if not their wisdom. I have seen a few use their knowledge in dangerous ways. And I have seen not a few who think that because they have the terminal degree, they must know everything. I have known psychologists trained in the scientist/practitioner tradition who abandoned all pretense at critical thinking the evening of the day they defended their dissertations. I have known psychologists who thought they had nothing else to learn and shut their minds to new ideas and new data. And I've met very few who didn't hold themselves above the less-educated. The whole profession has come to think of itself as wholly superior to masters-level practitioners, and spends a lot of time dissing them and expending energy defending turf from them that might be put to better use elsewhere. But that is another rant for another day.

Worse, and there is another rant coming on this one in a future post, psychology has come to believe that they have the power to change people. Therapy has become and "intervention" to be "delivered" as if to a  retail consumer and its success is to be measured in "behavioral outcomes".

Our clients believe this, too, and will say to us, "What do we do about it?" or, "I am ready to be fixed, now." And when we can't, they ask us, "What is the use of a candle that casts no light?" So we are seduced into trying, only to bloody our fingers once more.

As the next passage in the Prologue to A Feast for Crows makes plain, the obsidian candle can give off light -- but that's not under our control.
 "I know what I saw. The light was queer and bright, much brighter than any
beeswax or tallow- candle. It cast strange shadows and the flame never
flickered, not even when a draft blew through the open door behind me."

Armen crossed his arms. "Obsidian does not burn."

"Dragonglass.'' Pate said. "The smallfolk call it dragonglass." Somehow that seemed important.

"They do," mused Alleras, the Sphinx, "and if there are dragons in the world
again . . ."

"Dragons and darker things,'' said Leo.
The dragonglass candle is in this sense a metaphor for healing, and gives another bit to the lesson Armen describes. Illness, unhappiness, neurosis--whatever you may wish to call it--is contained within us, and so is healing. There are things we may say or do, or not say or do in a session, things that grew out of our learning (not all of which is formal, by the way) that enter into a person in the same way that a maester's antidote enters the body to combat a poison, and we may contribute to a person's healing in that way. But in the same way that the antidote and the poison do battle inside the victim's body, with the body itself as one of the combatants, so, too, is psychological healing an inside job. We have very little power compared to what resides in you.

And powers far greater than either of us may determine whether that candle burns.
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Monday, June 17, 2013

From the In Box

The most recent edition of Professional Psychology: Research and Practice landed in my In Box this week, and in it was an interesting study on a multifamily group program for vets with PTSD at the Oklahoma City Veterans Affairs Medical Center (VAMC). 

It has long been known that while good family support helps people recover from PTSD, the PTSD itself can alienate the sufferer from family members, depriving them of support. Bad family relationships actually interfere with treatment. With this in mind, the Oklahoma City VAMC set out to adapt a multi-family group approach to the specific needs of veterans. They call it REACH, for Reaching out to Educate and Assist Caring, Healthy families. 

They've collected data from about 95% of their participants, over a period of a little over four years, and they believe that it works. But it's the first such study specifically with veterans diagnosed with PTSD, and it's a small study so these results are very preliminary.

This was a longitudinal study with no control group, meaning there were no vets wait-listed for it or in some other form of treatment (comparison groups of both types would have been ideal). And the data on improvement was reported by the study participants themselves, to the therapists who both provided the treatment and conducted the research. As with any study of this nature, it may appear to work better than it apparently does, for a couple of reasons:
  1. People can get better over time, either because 'time heals all wounds,' or due to other things occurring in their lives during the course of the study. The authors performed a statistical test for this, but still, a control group would have helped to tease out how much improvement is due to the program itself, and how much due just to life going on. And since some study participants were receiving other treatments at the same time, there's no telling exactly what improvements are due exclusively to REACH.
  2. It is well known that when people invest a lot of time and energy in something, there's a psychological bias towards finding it worthwhile. This is true for researchers and participants, and is bound, in this kind of study, to influence the reporting and interpreting of results.
One thing that makes the results stronger in this case than in some studies to come out of the VA system in recent years is that the researchers didn't "cherry-pick" their participants, which is to say that nearly everybody who wanted in, got in. Cherry-picking is frequently a problem with treatment efficacy studies, as anyone with co-existing conditions, or who is taking medications, is ruled out, and definitions of the diagnoses that get you into the study are very narrowly defined. This results in the study population not looking much like a typical clinical population. For the purposes of this study, persons with active addictions or who were suicidal or homicidal were screened out, but these are criteria that are almost universally applied in clinical practice as well, so does not much affect the applicability of the results. 

Even better, their definition of "family" was open and welcoming: A veteran could bring her or his adult significant other of nearly any description -- a lover, a spouse, a parent, a sibling, an adult child, or even a friend. 

Veterans ranged in age from 22 to 85, which would include the Korean War if not World War II, and that both adds to and detracts from the strength of the study. Different "cohorts" (age groups) serving in different wars could have widely varying backgrounds and combat experiences and therefore respond very differently to a treatment. Also, older vets, by definition, have a more chronic form of PTSD. An average age, as in this study, of 55.8 years means that this is something that may not work as well for very young folk just back from Afghanistan or Iraq with their differing upbringings, combat experiences, and acute onset of PTSD as it does for VietNam-era or Persian Gulf veterans.

Unfortunately, the study population wound up being almost all white (non-Hispanic) straight males, so we don't know, pending further study, whether this program would be equally helpful to people of color, women, LGBTQQI folk -- never mind veterans or family members who fall into all three categories at once! 

Of course, there's no reason to believe that it wouldn't work for a wider range of folk, since groups in general have been studied for over half a century now and the results are consistent. It works for nearly everybody, for nearly every problem. It's just that with this study, the authors could not claim with any certainty that this particular protocol would work for other than adult, straight, white males of a certain age.

From the description, REACH appears to be a nicely-structured program, with a generous time allowance for assessment and engagement with the program, and a nice consolidation/follow-up phase to help families maintain and elaborate on their gains. At the same time, it does not appear to be so structured as to be a cook-book-y, overly technical approach. And folks liked it! Some of them reported that the meetings were the high point of their weeks. Participants knew more about PTSD when it ended than they had when it began, and some of their symptoms improved. They learned coping skills, and their relationships improved. 

The authors note that in a study of this sort, while you can say you're pretty sure the program helps, it's hard to say exactly what components of the program are most -- or least -- effective. That makes it a bit of a crapshoot whether you can replicate the results elsewhere. What if, for example, one of the only four psychologists running the study is just especially talented, and no matter what she did, her people would get better? On the other hand, if the standard curative factors of all effective groups were in operation here, you could do REACH or any other variation of multifamily group and get the same results anywhere. This is why we like to see multi-center studies, or studies replicated elsewhere producing similar results. However, when you are running only 4-6 vets and their families through at a time, and the whole process takes nine months, as this one does, we'd be waiting a minimum of four more years for the next study -- and that's not counting the time to organize and fund a study, write it up, and get it into print! So I think you will see a lot of psychologists running with this one, and soon. 

Although VA is mandated to provide some form of family education, the REACH program specifically does not appear to be available at our local (Atlanta) VAMC yet. However, the study's authors will make the materials needed to conduct the group available to any psychologist who wishes to lead one. If a half-a-dozen or so of you are interested, I think we could have one up and running by the end of summer. Just let me know!
Fischer, E. P., Sherman, M. D., Han, X., & Owen, R. R. (2013). Outcomes of
    participation in the REACH multifamily group program for veterans with PTSD and
    their families. Professional Psychology: Research and Practice (44), 127-134.
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Monday, June 10, 2013

Think With Your Whole Body

We like, in Western society at least, to think of our mental or spiritual selves as "me" and our embodied selves as separate, an "it". One effect of that is that we get out of touch with what's going on with and in our bodies, and wander off in our minds--into the future, the past, or some parallel universe that is neither past nor future, but which is certainly not here or now either. And the primary effect of that, I have found, is bodily neglect and abuse along with a good deal of unnecessary tension and stress. 

But what if we treated our minds and bodies as the unified experience that they are? What if we thought of our minds as one with our bodies, and rested and fed it like the organism it is? What if we treated our bodies like part of our minds and attended to what it was telling us about our selves and the world all of the time? Our bodies are powerful sources of constant streams of information and wisdom, and when we only think with the frontal lobes, we're only using a fraction of the potential available to us. 

Next time you are, say, eating breakfast, and notice that your mind is wandering, try bringing it back. Take a nice, normal breath in and attend to it -- really attend to it. Notice what it feels like coming in -- how the air feels passing over your upper lip, into your nostrils, down your throat. Notice the rise of your chest. Can you scent your breakfast? Taste it? Bet you hadn't even noticed your breakfast while you were doing all that wool-gathering!

When you breathe out gently, slowly, naturally, also notice what that's like. Then, what do you see? If you are like me, you might have been completely blind for some time to the look of the morning sun slanting through the trees in your yard, or to activity of animals or people around you. What have you not been hearing that you can become aware of now?  The refrigerator humming? The dog's toenails on the kitchen linoleum? Or perhaps you were numb to the warmth of the mug in your hands, the feel of the chair under your butt or your elbows on the table.

And as you do all this, notice how your body relaxes. I'll bet where your mind was before wasn't fun. You were missing someone or something from the past, regretting something you had done or failed to do, planning your workday, or worrying about something in the future that might not even come to pass. And your body was responding by becoming tense. (All that tension, over time, besides not being much fun is rough on your health.) You may find that 99 times out of 100 when you check in using this technique, your mind was yelling that the sky is falling but when you listen to your body it will tell you that right this two seconds it's actually all quite good. 

And while you were in that place that is neither here nor now, you may have neglected to notice that your body was stiffening in its current position and needed to adjust, or that you were tired, or cold, or needed to pee. That kind of neglect leads to abuse. We don't rest our bodies, or feed us, or clothe us warmly enough, or move ourselves around to keep limber and strong. Or if we do feed ourselves, we eat stuff we don't even enjoy because we're not paying attention to what we have a taste for or when we're full. We put ourselves and leave ourselves in situations we don't like, with people who are not good for us, in the meantime bypassing or at least not fully attending to good relationships and pleasurable activities because we are trying to think our way through life with our frontal lobes and ignoring what our bodies are telling us. We're where we think we should be, doing what we think we should, and we've doped that out with a fraction of the data we need to make genuinely good decisions.

It's a really powerful skill, thinking with your whole body. And although the daily practice of sitting meditation or yoga helps you get better at it, neither is absolutely necessary. You can do it any time you notice that you are all in your head and someplace else: Just take a nice, normal, gentle breath in, following it, and then let it out, again simply being aware of it. And then become mindful of the rest of your body as well. Mindful -- as in, fill your mind with this and kind of let all the thinking activity go for a minute. What's your belly doing, saying? Your feet? Your hands? Your skin? and so forth until you have developed an awareness of all of your senses and parts and systems. Hold all of that in your mind at the same time for a bit. If you do it often during the day, you'll find it becoming more natural to do more of the time. 

Try it. You'll like it.
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Monday, May 6, 2013

International No Diet Day

In honor of International No Diet Day, I thought I'd share my own diet history. 

My mother was a dieter, which is kind of ironic considering that she was so skinny when she was little (the story was, she'd been sick with something) that the family doctor told my grandmother to give her a beer every day to plump her up a little. Even in her teens and early adulthood, the photographs show a slender, athletic build. But that's how the diet industry works -- according to that old sales adage, create a need then fill it. By the 1960s, she was convinced she was fat, and for decades went on every crazy diet that came out, including, once, The Drinking Man's Diet. So dieting, self-hate, and alienation from my own internal signals of hunger and satiety were modeled for me from an early age.

The sixties also, not coincidentally, was the decade in which I hit puberty and Twiggy became an international sensation. I turned 15 the year she began her career. My friends and I were all soon on diets, as our bodies began to fill out in the way nature intended and we wanted them to look like Twiggy's. I remember at 13 skipping lunch to lose weight, when I had very little to lose (I think back then I hovered around 105 lbs) and at some point in there learning to count calories: I had my intake down to 800 calories a day some days. God only knows what kind of damage I did to my growing body during those years, all supported by the messages we were all getting from Seventeen Magazine, television ads, and just about everywhere else in the media, and my own mother. 

That began the weight cycling. I was never fat, hovering around 125 pounds by the time I got out of college, but I was convinced I was. 

By the time I'd got married and started into my first round of graduate school, I'd discovered feminism, along with their take on the objectification of women and diets. For a time, I was free of dieting, learning to eat intuitively, and loving it. But the diet industry is seductive, and by the eighties they'd learned to associate health with weight loss to not only scare us into dieting but convince us that we were actually doing something good for ourselves.

It was in the eighties that I quit drinking. Of course, I lost a little weight right off, and somehow that triggered another round of dieting. I became a little (okay, maybe more than a little) obsessive about it -- there's page after page after page of wasted journal space taken up with little more than calorie counts and daily records of my weight. I lost 30 pounds, which was probably 25 pounds more than I "needed" to. I started passing out and falling, and my friends began to express concern. I was a size 10, struggling to get into an 8, because I had some vague memory of wearing an 8 in middle school and thought that was where I "should" be.

I started graduate school again, and my weight began to creep up as I didn't lift anything heavier than a textbook, I wasn't in charge of the cooking at home any more, and I was under massive stress. By the time I graduated I was, for me, positively huge, weighing in at nearly 185 pounds. And somewhere in there, I got, for the second time, the message that dieting was not the solution, but the problem. When it was relevant to the topic in my psychology classes, I would spin around in front of the class and tell my students, "This is the body you get with dieting." 

But the diet industry is seductive. Somehow, between the fifties and the year 2000, when I was diagnosed "pre-diabetic" ("pre" anything is a whole 'nother problem, more to do with the pharmaceutical industry, and we'll save that rant for another day), the diet mentality had thoroughly infiltrated the medical profession. Doctors were convinced that it was weight gain that led to diabetes, for example, and not the other way 'round, as recent research suggests, and I was placed on a medical diet. Off came the pounds. Back came the obsessive behavior. Until Mr. Wood got sick and had to go out of state for treatment. 

Because here's one of the things about diets. They can call them 'lifestyle changes' all they want, but they're not. Because if they were, they'd be pleasurable and sustainable. But they're not. Instead, they're onerous and unnatural, and when you get busy having a life, there's not time for all that obsessive behavior, and the diet -- because that is what it is -- goes by the wayside. 

Feminists, by the way, would say that is part of the point. The Incredible Shrinking Woman has been used as a metaphor (I wish I could remember by whom, so I could cite her appropriately, but unfortunately I cannot) for what all patriarchal societies, ours not excepted, would like to do to all women -- make us smaller, and smaller, and smaller, and less visible, less powerful, until we disappear entirely. And occupy us with silly things like our hair and our makeup and our pants size so that we don't have time or energy (or money) left over to be intentional actors in the world outside our own skins. 

Anyway, back came some of the weight. Interestingly, however, the diabetes did not come back. Why? Because I actually had, in and around the diet crap, made some actual lifestyle changes. More complex carbs, more fiber, for example. Less stress. Which is what research over the last decade has been showing more and more -- that if you make a lifestyle change having nothing to do with cutting calories or losing weight, a real lifestyle change like more exercise, or more fiber, or less salt, well then. Your health improves. Imagine that! And those are achievable goals, whereas anything more than temporary weight loss is a chimera.

Fortunately, before I could go on my next diet, I discovered Health At Every Size (HAES) and re-discovered intuitive eating. I have not dieted a day in my life for the past two years, and -- surprise! -- my weight is absolutely stable. My labs are fine, too. My blood pressure is fine. My total cholesterol ain't so hot, but that's mainly because my good cholesterol is too low (and my heart attack risk remains rock-bottom for a woman my age, according to the Framingham tables).  My blood glucose is fine. As for my mental health, I have finally divorced food choices from morality, from character. I have no guilt about my eating any more. I don't criticize or dislike my own body but am coming to appreciate what an intricate marvel it is, and to appreciate it for what it can do. No obsessive-compulsive behavior: What I eat or don't eat doesn't rent the best spaces in my head any more. 

The third time, as they say, is the charm. I am experimenting with new foods, eating intuitively and meditatively and enjoying my meals as the sensual experience they are intended to be. And the funny thing is, this business of learning to think with my whole body instead of just my head is expanding into other areas of my life and I'm learning to take care of myself in other ways as well as feeding myself better, learning to enjoy other experiences more. 

This is International No Diet Day. Try it. Just say "no" to food rules today. Say "no" to moral judgments on your eating. Say "no" to character assassination based on your appearance. Just for one day, don't police other women's bodies, either, or tell them what to eat or not eat. Just for today, listen to your body. Eat what you are hungry for. Stop when you're not. 

Try it. You'll like it.
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Monday, April 1, 2013

Fat and your health

This is an odd little piece that doesn't have anything to do with anything other than that these two stories have been on my mind a lot lately.

Some time ago I read an article on ethics that took a dying man to task for not making arrangements for his practice, not telling his colleagues and clients he was sick, continuing to work after he was probably no longer competent to, etc. The writer never addressed what to me was the most poignant part of the whole story, that as he lost more and more weight, becoming thinner and thinner as he dwindled away to nothing, his colleagues congratulated him and told him how wonderful he looked. Only in our culture would drastic weight loss not be an alarm signal that something was drastically wrong. But nobody in his practice, apparently, ever thought to ask him if he were ill. My heart aches when I imagine how each of those well-meaning compliments must have only increased his isolation, and what a lonely death his must have been in the end.

The other story I have for you today is of a woman who had a tumor growing in her belly. It went undiagnosed for a long time because everybody--including her weight loss doctor--assumed it was because she was fat. She'd even complained at the weight loss clinic that no matter how much she dieted, no matter how much weight she lost, her belly wasn't shrinking. It was uncomfortable. It finally got so big that it was about to burst, as I understand it, but it wasn't until she started throwing up green bile that she went to the local Emergency Department. Surgery to remove it nearly cost her her colon, and complications from surgery to repair that almost cost her her life. It did all together cost her 15 months off work, so sick she was unable to walk around her own house. 

Only in our culture could we be so out of touch with our own bodies. 

As I wrote this, Zemanta threw up article after article, photo after photo for me to select from to illustrate my stories or to link to. Every one of them was about diets--most for useless junk like green coffee. Not one article, not one graphic raised concerns about weight loss being a sign of illness. Not one. And yet among wild animals and human cultures of the past, that's universally what it was. A nice, healthy layer of fat has always been a sign of plenty, and of well-being. Bears put on fat before they hibernate. Hummingbirds put on weight before they migrate. Old horsemen used to talk about 'good keepers', that is, horses that could maintain their weight.

But beyond that, I suspect that prior to the last 50 years or so, we've been in better touch with our own bodies. Surely people are born knowing how to eat--half a million years of evolution would have seen to that--but over the last half-century we've let the "experts" and the diet industry tell us what, how, and when we should eat. Signals that should come from within now get ignored in favor of arbitrary directions from without. It's no surprise that few of us know when we're hungry any more, never mind what for, or when we're satisfied. And it would not surprise me if that, in turn, led us to be out of touch with other internal signals, from signals that we are getting tired and need to rest to signals that we might be getting sick. 

If that is so, then might not mindful eating be the start of a path back to a lot more mindfulness, toward getting to know many aspects of our internal experience, and perhaps even a step toward approaching others' experiences free of erroneous assumptions about weight and diet?
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Monday, March 25, 2013

On Best-Laid Plans

English: Wood mouse (Apodemus sylvaticus) – wr...
English: Wood mouse (Apodemus sylvaticus) –  (Photo credit: Wikipedia)
And how they really do "gang aft agley". 

I had planned to post to the blog today. And before that, I'd planned to do my taxes this weekend. And before that, I'd simply planned to go to work on Friday, like millions of other ordinary working folk around the country. 

But events conspired to disrupt all that. One thing led to another and more piled on top of that until by Friday I was going to have to be the one to deal with a household crisis. It couldn't be delegated, and it couldn't be put off. More dealing ensued, and continued throughout the weekend, so that here we are, on Monday morning, without a post. 

 When we are used to making and executing plans with ease and regularity, it can be astonishing to learn how little our intentions matter to an indifferent universe. Still, I consider myself blessed that my particular circumstances could be resolved with the application of a little cash and elbow grease, and that we were able to just roll with it. Others, like Mr. Burns's little mousie, are not always so lucky.

Clients and friends had their plans disrupted, too, with family members going into hospitals around the country with problems of varying seriousness. And every day we turn on the news or pick up the paper and see how sadly things have gone south on others, promised joy turning to ashes in their mouths. My thoughts are with all of those people this week, as I pick up my plans where I left off, and resume my normal routines--which should include a real post next Monday.
The best laid schemes o' Mice an' Men,
Gang aft agley,
An' lea'e us nought but grief an' pain,
For promis'd joy! 
Robert Burns, To a Mouse (Poem, November, 1785)
Scottish national poet (1759 - 1796) 
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Monday, March 18, 2013

Jimmy was right

Jimmy Carter, former President of the United S...
Jimmy Carter, former President of the United States. (Photo credit: Wikipedia)
"There are many things in life that are not fair." 
-Jimmy Carter
When he said that, I was young enough and naïve enough to expect that life should be fair, and so to be appalled at his comment. I loved Mr. Jimmy, but he broke my heart with that line.

In the intervening years, though, I have learned that life is, indeed, manifestly not fair and that when we persist in demanding that it should be (there's that word again), we set ourselves up for all sorts of misery.

I am not saying that we should not be willing to step up to address inequities when it is in our power to do so, only that in expecting the universe to operate along some sort of moral lines we add to the unhappiness that is already there. And sometimes we create the unhappiness.

I have come to believe that the sooner and more fully we can embrace the notion that we need to be able to accept life on life's terms in order to live happily, the better off we'll be. Harsh as it may sound, then, the real question becomes not "Why is this happening?" but "What do I intend to do about it?"

I suspect that when bad things happen, this is nobody's instant response. We all need a little time to wrap our heads around the new state of affairs, to take stock of things and begin to see where we stand now. But then we need to dust our butts off and get back up on that horse and ride it. Wise old horsemen would tell you that if you don't, the horse understands that he just got the better of you, and he'll remember that next time. In life, the message is the same except that you're the one getting it. Be sure the message you send your self is that you can cope, you can deal. 
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Sunday, March 10, 2013

Words to Live By

The Writing Life
The Writing Life (Photo credit: Simply Bike)
I've never before worked in a place that had graffiti on the bathroom walls, but this one does. 

"How we spend our days," I read as I sit, "is, of course, how we spend our lives." Annie Dillard said it, possibly in The Writing Life. It's a beautiful wall. The woman who did it spends her days making walls beautiful, and those days add up to a life creating beautiful spaces for people to live and work in. 

We don't all have lots of choices in how we spend our days, but all of us have some choice. Choose wisely, when you can.
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Sunday, March 3, 2013

On Gratitude

joy! (Photo credit: atomicity)
I always feel funny talking to clients about gratitude, although I do it often. I worry that it sounds Pollyanna-ish, that flying in the face of their very real (and often truly insurmountable) difficulties, I am, in effect, advising them to whistle past the graveyard. I suspect that the only reason I'm able to do it is that I try to practice "an attitude of gratitude" myself and I know that it works. 

There are all sorts of How-To instructions out there. One of my favorites is Kathleen Adams's Pockets of Joy.  The expression comes from her childhood, when her mother would be emptying the pockets of her jeans before throwing them in the wash. There were always in them the cool things that kids collect during an adventurous day outside--pretty rocks, dead bugs and the like. And her mother would remark that she must have had another wonderful day, because she had her "pockets of joy" again. Adams advises journaling three things every day that you have in your Pockets of Joy. Sometimes when we think we've had a tough day, we can surprise ourselves, discovering that we actually had a pretty amazing one, too. And if we can hold those two views in our minds at once, we can feel better about ourselves and our days.

I've learned that there are dozens of things, often tiny ones, that we can be grateful for in any moment of a given day--or night. I may be lying awake anxious and frustrated because I'm not sleeping, worrying about the day gone by or the day to come, but I can be grateful that I have my nice warm waterbed with my nice soft sheets to lie and worry in. I can be grateful for a roof over my head, and central heating and air, and the dog at the foot of the bed and the partner by my side. And if I focus on those, then lying awake at 2 a.m. can actually become a pleasant experience.  

In a recent post on Tiny Buddha, guest blogger Alexandra Hope Flood advised listing things in your head that you are grateful for from your day as you lie in bed waiting to fall asleep every night. And in the morning, she says, while you're brushing your teeth, list ten things that you are grateful for to start your day. If you're having trouble thinking of anything, begin with having teeth to brush, and being able to stand there and brush them. From there, I might go on to being grateful for meaningful work to do, and a place to go and do it in.

I like that one, and I'm going to start prescribing it.  

The practice applies to far more serious problem states, too, than a little insomnia. Are you sick? injured? possibly even dying? Still. As Jon Kabat Zinn says in Full Catastrophe Living, "as long as you are breathing, there is more right with you than wrong with you, even if you are sick or troubled or in pain and things in your life feel dark and out of control." So start your gratitude list with the fact that you are breathing, if you can't think of anything else. And while you're at it you can send a smile, as Thich Nhat Hanh advises, to every body part that's working. This is something you can practice at any time throughout your day. Right now, for example, you can smile to your eyes that they see these letters, and to that part of your brain that comprehends the words. Smile to your eyelids that blink, to your tear ducts that moisturize, and to your lashes that keep junk out of your eyes. And then direct your attention back to your breathing. Put a half-smile on your face as you do, on the principle that "neurons that fire together wire together," to paraphrase Hebb. In this way, over time, you develop a habit of being happy.

Gratitude is one way I deploy Wood's Rule #4, and its corollary, #5. Focusing on what you can be grateful for in the moment is a mindfulness practice that is the perfect antidote to worry about what is not happening now, may never happen, in fact, and which, in any case, you can do nothing about right now. 

Now mind you, I'm not saying not to worry, period. That would be Pollyanna-ish. And it wouldn't do any good to try, because we're hard-wired for worry. I mean, think about it: The Pollyannas of the savannahs would have been eaten by sabre-toothed tigers before they ever got old enough to reproduce. What I am saying is that we are all so good at worrying that it tends to crowd other things out. We lose sight of the big picture. Cultivating an attitude of gratitude is just remembering to add our assets to our bottom line before we hit "Print" on the balance sheet of life. No matter what else is going on in my day, right now it's spitting snow, the birds are mobbing the feeders outside my window, my dog is lying beside my chair, and I am writing. There are problems, yes, and I am happy. No reason both can't be true for you, too. As one client said recently, "That's the power of 'and'."

When you are in a seriously foul mood, I think it's best to make a written list.  I advise people to use their journals for this, because you can look back over your  lists when you are making the cognitive error of thinking, "Oh, this has been such a bad week!" or some such. Read your lists and it will give you a more balanced perspective. Don't limit your list to a prescribed number, but keep writing until you run out of steam. It's ok to repeat things from previous lists: The dog and the sky and my mate go on nearly every list. And you can list the same thing multiple times from various points in time or points of view on the same list: Mine might, for example, include the way my dog's silky coat feels under my hand, the warmth of her body curled up next to mine during our afternoon nap, and something cute she did this morning, all on one day's list. I guarantee your mood will be improved when you're done, if only by a few percentage points. And that's good. At least while you are writing this list, you definitely feel better. So if nothing else, you've given yourself a break for five, or ten, or fifteen minutes from your unhappiness, and those breaks are essential for all of us. One thing we are often guilty of as humans is 100% thinking, as in "This is a bad day." Stopping and making a list proves to us that no day is 100% bad, including this one.

So hop to it. Unhappy? Get out your pen and paper!
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Sunday, February 24, 2013


Physical bullying at school, as depicted in th...
Physical bullying at school, as depicted in the film Rebecca of Sunnybrook Farm. (Photo credit: Wikipedia)
Bullied as a kid? Does it still bug you? Then you will be not the least surprised at the results of a study published in JAMA last week. This study is being touted in the media  as demonstrating that the effects persist into adulthood ("Scarred for life", says the Standard, a UK paper), which I suppose any adult bullied as a kid could have told you. After following over 1400 kids from 11 North Carolina counties for nearly 20 years, researchers found that victims had a higher prevalence of agoraphobia, generalized anxiety, and panic disorder in young adulthood than kids who were not bullied. 

A search of the American Psychological Association's database turned up only one--one!--other study of long-term effects, a retrospective study asking gay and lesbian adults about their experiences in school and checking for any correlations with mental health concerns in adulthood. Their results suggested that as many as 17% of gays and lesbians bullied in school might have at least some symptoms of posttraumatic stress disorder in adulthood.

An author of the first study has been quoted as being surprised by the results. I am not.  Therapists are exquisitely attuned to the verbal messages our clients received from their parents about who they were, their place in the family and in the world, their value as human beings. And we all know, and have known for nearly 100 years that clients who were told, just as one example, that they were stupid will continue to believe that right into their dotage. Anything smart they do will be seen either as a fluke, as dumb luck, or as not smart at all--something anyone could do. Our peers have less influence on us, but not by much. And they have nearly as much access to us, seeing us five days of every week, nine months out of every year, throughout some of the most formative years of our lives. They have plenty of opportunity to beat us down.

One very damaging aspect is the response of the people in charge. Bullying victims get doubly traumatized when teachers, administrators, and parents do nothing: This is experienced as a betrayal, an abandonment, or as further abuse--and sometimes, as all three. For example, a boy who was physically assaulted in front of a raft of teachers who did nothing reported it both the assault and the faculty's inaction to the principal. That worthy's response was that this would not have happened had the student not chosen to come out. In actual point of fact the boy had been outed by one of the bullies some months previously in a separate incident, and he had reported it at the time. So the victim gets the message that nobody cares, nobody's going to do anything, and it's his fault anyway. I suspect that, as studies of childhood sexual abuse have demonstrated, this kind of response on the part of adults is a risk factor for some of the more negative outcomes for the child.

Nor, as far as I can tell, are long-term effects limited to childhood experiences: I know one fellow, retired about four years now, who still has regular nightmares about workplace bullying he suffered. And I have worked with several veterans who count abuse by their superiors as among the worst experiences of their careers.

So am I surprised by the results of this study? Not hardly.
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Sunday, February 17, 2013

If Everybody Did

In honor of Tax DayImage by swanksalot via Flickr
Tax day is coming, the W-2s and 1099s are rolling in, and in the midst of the usual bitching about paying them, I heard one fella actually brag that he did not report cash income. Which put me in mind of people I have known who claim bogus deductions. I myself, while reporting honestly, am more often late than not: Indeed, I would venture to say that I have probably filed nearly as many requests for extensions as I have actual returns. What is all this resistance about?

The tax complainers seem to see taxes as some kind of terrible, unfair imposition, as if (a) they had nothing to do with electing the governments that assess them, and (b) they never use the services the taxes pay for. They complain about how the money is spent, without much actual awareness of where it really goes. About a fifth, for example, goes for Social Security and Medicare, both of which these folks will apply for the day they become eligible. They elect a government that takes us on military excursions overseas and then resent ponying up their share (almost another fifth of the national budget, not including veterans' benefits) every April. These same people send their kids to public schools and will not hesitate to call the police if their office is burgled, while resenting paying their fair share for these services via sales, property, and other local taxes.

A couple of years ago, the IRS released results of a survey in which about 84% of us said it was never ok to lie on your returns. From that, researchers assumed that about 16% of us cheat. I would bet that there's another few percentage points at least comprised of those who say one thing and do another. Add those together, and you get at least a $345 billion (yes, that's billion) shortfall in any given year. Approximately 3/4 of government borrowing goes to make up this shortfall, adding to the deficit every year. Is it any wonder that early in the wars we saw stories about soldiers' parents having to purchase and ship body armor out of their own pockets? Or that programs and services are being cut or terminated because of lack of funding?

Besides being illogical and selfish, it's unethical to lie on your tax return.

When I was a little girl, someone gave me a book on ethics called If everybody did. The gist of it was that there were some things one person could do once that had small(ish) consequences, but if everybody did it, well, then. . .
Kant for short people

That question has been an ethical touchstone for me all my life. When I remember to ask the question and really listen to the answer, I rarely make a false step. When I don't,  the results are about what you'd expect.

I've been thinking a lot about that little book lately.

What if everybody who ever accepted cash for their work did not report it? What if everybody put their personal dry-cleaning bills, club memberships, and even church pledges down as business expenses? What if everybody claimed everything they bought at the drugstore, from magazines to shaving cream, as medical expenses in order to get the itemized deduction? And before you ask, yes, I've personally known people who've done every one of these things. Where do you think the the money would come from to treat injured veterans?  to pay for your Daddy's nursing home?  to upgrade the armor on that HUMVEE your cousin's riding around Afghanistan in?

When you cheat on your taxes, you are not cheating the IRS. You are, in effect, cheating your fellow citizens. Your coworkers. Your neighbors. Your children. Your parents.

The irony is that none of these people think of themselves as illogical, selfish, and unethical, or as liars, cheats, or criminals, despite the fact that they are every one of these things.

The whole system is based on self-reporting, on trust. If everybody lied and cheated, it would collapse. If everybody dragged their feet like I've been doing, we'd have to borrow even more every year to keep the government running (10% of the budget every year goes to interest payments as it is). The IRS would have to audit everybody, or maybe they would require all our patients, customers, clients, etc. to start issuing us 1099s at the end of the year. Or maybe we'd just go back to the system of old, when the government just showed up at your front door and took what it needed at the point of a spear. How would you like that?

So you just think about that the next time you are tempted, as a former colleague liked to put it, to "round things off at the corners". I know I'll be thinking about it this spring when the temptation to procrastinate arises.

What if everybody did?
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