My way or the highway.

I am a serious fan of perspectives. I had a high school history teacher who was fond of saying that “truth is increasing complexity”, and in both my personal and professional lives, I have found this to be, well, true.

When a client presents me with a truth, about themselves, about an experience, we work to increase complexity. Are you sure that’s true? Has it always been true? What else might be true? What do others in your life believe to be true? Often, in this way, we are able to triangulate, and to move in the direction of deeper knowing, of more true, but also to open space for subjectivity, and breathe some light or humor or next questions into that space.

It is in the spirit of that kind of inquiry that I offer the following blog post by Holly Glenn Whitaker: http://www.hipsobriety.com/home/2015/2/18/why-aa-didnt-work-for-me-my-story-part-1

This is not a prescription. This is not an indictment of AA. It is also not an endorsement of Holly’s sobriety coaching program. It is, however, a perspective. There’s this Buddhist expression, “If you meet the Buddha on the road, kill him!” It speaks to the dangers of making something or someone your god, which is easy to do when you feel as though you have been saved, but the reification of any one concept or any one guru or organization can be fraught with peril.

I work with a lot of clients who struggle with substance abuse because when the world offers you its misogyny, its transphobia, its racisim and its fat phobia (amongst others) to internalize, numbness and escape often sound like the loveliest of sirens. I have folks who come to my office who have found a sober life working an AA program, and it’s glorious. I also work with clients who have found that the language of powerlessness and surrender was inaccessible to them in the context of a history of sexual trauma or internalized hatred and disempowerment, and who echo Holly’s statement that in fact, making the choice to let go of alcohol because you can’t use it and be well is profoundly powerful, and profoundly empowering.

You can’t get sober by yourself, but you’re also the only one who can get you sober. The rooms of AA are one available community within which to do that work, but they are not the only one: could this be a truth?

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Answering this Question is Key to Recovery

Today’s Food for Thought, from Anne Cuthbert, M.A. of http://www.foodisnottheenemy.com

“What does disordered eating and body image protect you from? Do the constant thoughts distract you from thinking about or feeling about other parts of your life? Does it keep you in a safe world that you can control? Does it give you a good excuse to not go somewhere or be with someone in which you feel uncomfortable? There is always a reason for it. What is it for you?”

Coping isn’t a five letter word (it has six).

In my last post, I referenced having a long list of things to do to distract and calm myself “that I actually use.” While the list is personal, the concept and potentially some of my options are universal, and so I offer them here.

Marsha Linehan’s DBT manual features a list of “Adult Pleasant Events” in the Emotion Regulation curriculum, and I have often poked fun at the suggestion therein to chop wood, but the reality is that for the right person, that’s a great idea. When you’re overcome by either an overwhelming, extreme emotion or an intense urge to make what my preschool aged son calls “not a safe choice”, finding the right distraction, alternative outlet or self-soothing strategy is key to making it to the other side of the experience without making your life worse.

Before I get to my own list, there’s another DBT concept worth mentioning called Willingness, which is part of Linehan’s Radical Acceptance module in the Distress Tolerance portion of the DBT curriculum. Willingness is set in opposition to Willfulness, and it basically means you have to actually give recovery strategies an open-minded, whole-hearted chance. Example: refusing to try an alternative coping strategy because your special, special pain could never be helped by something as simple as taking a walk. That’s willfulness. Example: sticking to your commitment to actively engage in  15 minutes of a self-soothing strategy that sounds stupid and pointless at the outset before reassessing your desire to give into an urge to binge. That’s willingness. I’m not a huge believer in the magic of the cosmos, but I will say that the number of times I’ve gotten a phone call from a supportive friend at minute 14 of the aforementioned scenario is uncanny. In other words, it’s often not just the calming or uplifting properties of the strategy that gets you through, but rather, the shift in mindset to being willing to make space for recovery that makes the difference.

So, without further ado, here is my (partial) go-to list of Adult Pleasant Events. I’ve chosen my top few tried and true because this post is brought to you by a napping infant who is likely to wake up soon.

  • Leave my current space. Like it’s on fire. I have often found that making the choice to leave the place where I’m upset or triggered opens a fresh perspective. Sometimes this means going outside for a walk, other times it means going into my mother-in-law’s bathroom to cry with the sink running.
  • Serenity (it’s an essential oil blend, not an ephemeral concept). Because the olfactory nerves terminate near the amygdala in the brain, scents are highly evocative of emotion and memory. I have found that Serenity consistently evokes feelings of peace and contentment for me, as well as now being associated with memories of previously having coped well.
  • Making and drinking a cup of tea (usually decaf jasmine green because it reminds me of my sister). This one is multi-faceted. A watched pot never boils, and I use that to my own advantage and stand with the kettle while it heats, which forces me to slow down and opens an opportunity for mindfully observing my thinking. The warm steam and aroma as the tea steeps offer a soothing sensory experience, and also evoke memories that calm and uplift me. 
  • Drinking 20 oz of cold water out of a Mason jar. The Mason jar evokes memories of the supportive friend who first introduced me to the joys of vintage jars, as well as humorous ones of the various clients who have seen my jar and accused me of drinking moonshine in my office. The coldness of the water forces me to slow down and pay attention because I’ll be rewarded with brain freeze if I don’t. Also, I associate water with cleansing, which can work as a metaphor in moments where I’m working through a difficult emotion like shame or toxic anger.

Just drink a glass of water and your eating disorder or depression will be cured forever! sounds like an obnoxious article in a self-help magazine, but it’s not the strategies themselves that do the heavy lifting. Yes, it’s useful to find strategies that speak to you and tap into your particular set of memories and preferences, but the real magic comes with cultivating willingness to employ them.

This isn’t exactly the most dramatic “I’m back!” post, but…

here I am.

Elizabeth Alice was born 7 weeks ago this past weekend, and early motherhood (now of two, which is challenging squared, not challenging multiplied by two) has been beautiful, messy, occasionally heart-breaking and totally worth it.

Also, I’m tired.

Which is what got me thinking about this post – the experiences of birth and early motherhood are a profound reminder of the immense impact that physical health and self-care (or lack thereof) can have on emotional well-being.

I’ve been through this before with my son in his infancy, but the interruption of sleep several times a night for the first few months, combined with the body’s recovery from any birth trauma, the re-organizing of hormones, and never having two hands free at the same time (well, almost never) can seriously undermine two things: your emotional well-being, and your ability to do anything about it.

How is this all related to eating disorder recovery? (Because it so is.)

The collection of behaviors associated with any eating disorder, be it severe restriction, binge eating or purging are similarly destabilizing to the body, and therefore to the mind. And as I think I’ve mentioned before, your brain is connected to your body at the neck. Malnutrition, wacky electrolyte balances, dehydration, type two diabetes, impaired digestive health… All of these are common results of disordered eating, and all of them can pretty severely impair your functioning.  In a way, that makes having an eating disorder a lot like postpartum depression. A brain in a sleep-deprived, malnourished, or otherwise compromised body is not a happy brain.

In many cases I’ve seen in my practice, the depression and anxiety a person is experiencing along with their eating disorder are either caused by, or at least deeply exacerbated by, what they’re doing with food. Additionally, the physical sequelae of the disorder directly impair the ability to recover. Dr. James Greenblatt, whose article I’ve just linked to, is the Chief Medical Officer at Walden Behavioral Care and a solid resource for information about these connections.

Example: gut health. Anorexia, bulimia and binge eating can all do a number on the intestinal flora that allow for happy digestion, or may be in part caused or exacerbated by gut microbe issues (for a good overview, check out this article). So what? Screwy gut health can make you gassy, bloated, malnourished or overweight, as well as depressed, all of which make recovery way harder.

If my anorexic client is faced with the task of learning to eat again, and she’s depressed, and every time she eats she feels bloated and therefore “fat” because her belly bugs are out of wack, how’s that going to go?

If a binge eater has done solid work to decrease binge episodes and is enjoying food in moderation again, but  his gut flora are keeping him both depressed and overweight, how will that impact his motivation?

Luckily, we can make lifestyle and supplementation choices that may right the ship, in terms of gut health, and could thereby have a profound impact on (linking to Dr. Greenblatt again) recovery. In my own experience, the use of a probiotic supplement and digestive enzymes made the early phases of recovery, as well as maintenance, far more bearable. When my body was better able to handle the food I needed to eat, and eating gave me energy rather than a distended stomach, trusting the process was more of a possibility.

So, in summary because apparently I’ve missed writing and gave you all a novel here: the postpartum period has been an important reminder to me about the intricate links between physical and emotional wellness. You can’t feel good if you don’t feel good, if that makes any sense. I’ll be returning to my practice with renewed empathy for why this link makes eating disorder recovery so extra challenging, but also a renewed belief in the importance of supporting my clients in tending to the bodies their minds are trying to live in.

(I’m not a doctor, so this isn’t medical advice, but rather for information purposes only. Please consult your doctor before making the decision to try any supplement.)

Perfect.

This may very well be my last blog post before I head off on maternity leave, so I thought I’d address something I need to be reminded of myself – the absolute fallacy of perfectionism, which is a trap many people who struggle with disordered eating fall into (as well as many mothers).

When we approach our lives from the perfectionist perspective, anything that is not “perfect” is a failure. This eliminates the vast majority of how most people function from day to day from the success category. For example, it’s an important goal of mine not to snap at my son. If he’s having a very mischievous morning, and I make it through almost the whole thing using the kind of measured tone I’m aiming for, but eventually get so exasperated that I bark at him about putting his boots on, what kind of mother am I? Perfectionism suggests I have failed. A more balanced perspective notes that if I said 100 things to him, and 99 of them were on target, I’ve just gotten a very good Mama grade.

This isn’t just semantics – our emotional health and efficacy as people in the world are at stake when we choose the perspective from which to view and experience our actions. In the above example, if I take the perfectionist route and castigate myself for failing as a mother that morning, a number of nasty things will happen. First, my self esteem will tank, and so then I’ll be in a lousy mood, which means my temper will be rubbish and I’ll actually be far more vulnerable to engaging in exactly the sort of behavior I’m trying to avoid – snapping at my son.

When perfectionism is a part of disordered eating, it often plays strongly into a vicious cycle of restricting and binge eating. “I don’t know what happened, I was doing so well” is a phrase I hear often, and it usually comes from an individual who has set themselves up with an unrealistic and/or inflexible eating plan. If I’m “supposed” to eat only whole grains, and at a work breakfast, the only options are more processed, and I function best when I don’t skip breakfast, and have a bagel with cream cheese, how am I doing? Perfectionism says I’ve failed (and if you’re a failure today, you might as well go ahead and have a muffin and a Danish and…), but a more balanced perspective means I can pat myself on the back for making the best of the choices in front of me and move the heck on with my self esteem and motivation intact, far more likely to continue to be successful-ish for the rest of my day.

This is the important part, which is why it is in capital letters: YOU WILL ACTUALLY BE MORE COMPLIANT AND CONSISTENT IF YOU’RE NOT TRYING TO BE PERFECT.

Perfectionism is the enemy of success because it is demoralizing and leaves no room for learning from mistakes, or even making them. I’m not suggesting you adopt a sloppy, anything goes attitude. Goals and setting expectations for oneself are very useful tools, but only if wielded with some sanity. If my goal is to exercise 4 times a week, and I exercise 3 times, have I failed? (Hint: NO.) No. How can that be a failure if 3/4 of the time I did what I set out to do? If I reject this as a failure, I also lose the opportunity to celebrate and reflect on what made my success happen the 3/4 of the time that I did meet my goal, or to explore what the obstacles were on the day when I wasn’t as successful.

This stands out in the article I linked to above: “Wouldn’t it be good if your surgeon, or your lawyer or financial advisor, is a perfectionist?” said Thomas S. Greenspon, a psychologist and author of a recent paper on an “antidote to perfectionism,” published in Psychology in the Schools. “Actually, no. Research confirms that the most successful people in any given field are less likely to be perfectionistic, because the anxiety about making mistakes gets in your way,” he continued. “Waiting for the surgeon to be absolutely sure the correct decision is being made could allow me to bleed to death.”

And now, if you’ll excuse me, I’m going to go have a baby. She’ll probably be perfect.

Everyone is TOTALLY FREAKING OUT ABOUT HOLIDAY COOKIES.

This morning, I got an email from one of my favorite nutrition writers, John Berardi of Precision Nutrition, which sounded an awful lot like what I’ve been saying to clients for the last few weeks when they come to me TOTALLY FREAKING OUT ABOUT HOLIDAY COOKIES. These are stressed people. Seriously unhappy people. Not exactly holiday cheerful. Because COOKIES. I had people TOTALLY FREAKING OUT ABOUT HOLIDAY COOKIES starting in early November, and I will continue to hear about COOKIES well into January. I’ve shared Dr. Berardi’s words below, but first, my take on this state of affairs.

As evidenced by my egregious use of capital letters, these are high volume, high intensity, high anxiety, high angst concerns. And I’m not trying to be mean about it: people are seriously suffering, and it’s very real. The problem is that we’re talking about cookies. In my mental landscape, a cookie is a palm-sized (or smaller, like those little round ones with the nuts inside and the powdered sugar – I love those) baked good that takes one to three minutes to eat depending on the size. However, for my friends of the freaking out, COOKIES are stomping through their mental landscapes crushing hopes and dreams like Godzilla having a very bad hair day.

The fear is real. It’s real, but it’s also a construction and a self-fulfilling prophecy. If a person starts thinking in November about how hard it’s going to be not to eat a certain food item in two months, and keeps thinking about how “bad” that food item is, and how she can’t control herself around that food item, it gives the damn thing an enormous amount of power. (It also ruins her November.) COOKIES are going to destroy her, she’s sure of it, and ensuring it. And of course, when late December rolls around, she’s going to eat them. How could you not eat something you’ve been debating about for two months? Will she enjoy the cookie? Survey says no. Because the minute it reaches her mouth, she’ll already be berating herself for how weak and bad and lazy and gross she is to have been subjugated by a COOKIE, rather than savoring its tasty flavor, reflecting on the family heritage the recipe represents or something else, you know, nice.

Because holiday cookies are nice. That’s about it. Some are tastier than others, some have memories associated with them, and some are kinda lame and taste like their cardboard box. But they really, really are a pretty minor, albeit pleasant, occurrence if you treat them as such.

Try this mindset on for size: Imagine yourself not thinking about holiday cookies until you’re actually faced with a plate of holiday cookies, perhaps at a party, perhaps on the table in the break room at work. Like, how you don’t think much about getting an oil change until it’s time to get an oil change. Now, assess the plate of cookies. Do you like this kind? Were they prepared by someone special? Are they appealing? Now, assess your level of hunger and your emotional state. Are you fairly full because you just ate a satisfying meal? Are you starting to feel that little nudge in the tummy that suggests it might be snack time soon? Are you bummed out and overwhelmed, or perhaps feeling a little festive? If you’re not too full, and not in an unpleasant emotional state where you’re more likely to be self-medicating than enjoying a treat, and there are cookies on the plate that are truly appealing to you, select the cookie that looks the best and eat it.  Feel free to take a bow.

Then walk away. Because you are not the cookie you just ate. You’re a mature adult human who, on occasion, when the moment is right, chooses to eat foods from the “treat” category because they are fun and nourishing in their own way. You’re not going to get fat. You’re going to get awesome. Because when COOKIES become just cookies, you get the power back, and you get to spend a lot more of your life thinking about other things that are a lot more interesting. Like, what to get your mother-in-law for Christmas. Or world peace. Or really anything.

(And, as a side note, if you are maybe still a little worried about the cookies: you’re much more likely to overeat the things if you treat them as a diet smashing super power, rather than a moderately enjoyable sometimes treat, because that’s how the restrict, binge, rinse, repeat cycle works. I promise, promise, promise you that you will eat fewer cookies if you allow yourself to enjoy them now and again than if you try to avoid all baked goods for two months and then go to your Nana’s house on December 25th.)

Now for the other guy’s take on things:

“My three little ones have been helping my wife and I with the usual chores: decorating the tree, creating cards with construction paper, preparing canned food donations for the local food pantry, and…making delicious cookies. But before you ask for my killer “healthy” cookie recipe, I have a confession: We’re not making not some low-fat, gluten-free, protein-packed, artificially sweetened, possibly-hiding-beets, “healthy” version of a cookie. Nope, we’re making the REAL THING. The kind of cookie that contains butter, sugar, and flour. The kind of cookie where you want a tall glass of milk to help wash it down. The kind of cookie most “nutrition experts” will tell you to avoid completely this year… Just dip some kale leaves into lemon juice with a splash of stevia and it’s exactly the same thing.

Anyway, when people learn that my family and I sometimes make treats like cookies…or go out for ice cream…or don’t eat 100% protein and vegetables all the time…they get a little confused. “But isn’t Precision Nutrition all about eating good foods and avoiding bad foods?” The answer, I’m proud to say, is no. Precision Nutrition is NOT all about eating “good” foods and avoiding “bad” foods. (I don’t even like those labels.) In a minute, I’ll share what Precision Nutrition is really about. But first I’m going to encourage you to enjoy some sort of cookie, cake, or cocktail this holiday season, too. In addition to songs, and friendship, and holiday cheer…

You see, every time you choose to eat one thing over another, you’re voting for what’s really important to you right now. Of course, you may not realize you’re doing that. But every decision IS a calculation. Of what really matters to you, in that moment. So, with the holidays here for most of us, what DOES matter to you right now?Is it… Feeling good? Connecting with loved ones? Truly nourishing your body? Feeding your soul? Remembering your heritage or family traditions? No judgement here. YOU get to decide your priorities. And  sometimes other things SHOULD win out over “nutrition”.

So I’m not here to tell you what to do, think, or feel. Or to make you feel guilty, ashamed, anxious, or deprived. Instead, I’m here to help you think through the question. To help you choose more consciously, with awareness and intention… Because shortbread and latkes taste great when made with love and shared with friends and family. They just do. And, while some people in fitness have a hard time with this notion, I think that feeling good is part of enjoying life and being healthy…

Here’s my first prescription: Enjoy a real cookie or two this holiday season! Or some other thing you enjoy but think is “off limits”. Just do it consciously, mindfully, and – as we teach in our coaching programs – slowly. Instead of scarfing it down and waiting for the guilt, taste what you enjoy. With intention. Then move on…

But even if you’re not ready to embrace this mindset yet because restricting is your only way to feel in control… Because you can’t believe that enjoying certain foods guilt-free is possible… Because you’re stuck in the middle of a nasty cycle of restrict, collapse, guilt, repeat… My family and I will still share some laughs, shed some tears, and nosh a few cookies this holiday season. We might even raise a glass of egg nog in your honor. Because, around here, we know that connection, love, and enjoyment CAN exist while working toward better health together. And we’re hoping that somewhere along they way you’ll discover the same thing.”