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?

On Best-Laid Plans

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) 

Jimmy was right

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. 

Words to Live By

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.

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!

Bullying

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.

If Everybody Did

Image 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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