Sunday, May 19, 2013

"Disease" as Identity

"Although ADHD is becoming commonplace in our society..." begins the opening sentence in an article I recently read in a popular psychology blog. It says much more than the writer realizes. The real question is why is ADHD becoming commonplace? Is there an epidemic? Is it viral? In the water? In the air? Or, perhaps, it's another triumph of marketing for BigPharma. Perhaps the epidemic is one of over-diagnosis based on the broadening of diagnostic criteria to include just about every difficulty in attention, concentration, and behavioral focus?

I have long been concerned with the pathologizing of normal human experience and the over-simplification of human problems into “brain disease.” The notion that distressing emotions are always indicative of a “chemical imbalance” is brilliant marketing rather than brilliant science. The epidemic of what I call “identity diseases” – ADHD and bipolar disorder most prominently – reflects BigPharma advertising and insurance company profit seeking. I frequently encounter people who have taken on these diagnoses as a core part of their identities, see themselves as “their disease,” and use it, to their great detriment, to explain everything in their lives and behavior. “My bipolar made me do it.” “My ADHD keeps me from doing the work.” They often sincerely believe, as they have been taught, that they cannot change their behavior themselves and the only solution is the latest, highly profitable medication. Psychiatry has a vested economic interest in reinforcing this belief. It is both tragic and immoral that other mental health professions have bought into this idea and promote it to an unsuspecting public.

The risk of dependency and addiction with some of the medications used to treat these “diseases” has been well demonstrated empirically and in practice. Even more concerning is the use of these medications in children as young as four or five. The use of amphetamines and, increasingly, antipsychotics in developing brains to control mood and behavior has not been established as safe. The long term effects are simply not known. There is strong, replicated, cumulative evidence (see Whitaker, Angell, et al) that the use of these medications alters the brain and creates or exacerbates the very conditions it purports to treat.

This is not to say that ADHD or true bipolar disorders do not exist. It is clear that there are some people whose ability to attend, focus, concentrate, and sit still, or to regulate their mood and behavior, is impaired, some to the point where their lives are greatly disrupted. What is not clear is the cause, despite the overblown and unsupported ads for "brain disease" and "chemical imbalance.” It is also clear that many people diagnosed with ADHD and bipolar disorders have normal range problems with these behaviors. Convincing them their brains are incapable of self-regulation and turning them into lifelong patients forever in need of medication is both disenfranchising and disempowering. Not all behavioral or emotional problems reflect a "disease” and the pathologizing of all normal variations in ability is both dangerous and a disservice to us all.

Saturday, February 2, 2013

Health Care's Trick Coin

Here's yet another article demonstrating the corruption rampant in the research that determines the medications we take. It shows how we are lulled into believing the meds we take are effective when they may not be or superior to usually less expensive medications when they aren't.

Monday, January 28, 2013

Flacking For Big Pharma

I've written before about BigPharma and its marketing practices, especially of psychiatric medications. Here's something even scarier: the research that eventually gets drugs to market is often fatally flawed. That means that the drugs you are prescribed are increasingly likely to be ineffective or harmful. Why? Because much of the research used to establish a drug's safety and efficacy comes in the form of studies sponsored by the pharmaceutical company itself. Funny thing, as you'll see in the link below. Studies funded by the drug company are four to twenty times as likely to produce positive results as independently funded research. In a 2006 review of articles about psychiatric meds in academic journals, industry sponsors got favorable results 78% of the time while independently funded trails got positive results only 48% of the time. Drugs competing against the sponsor's drug were favorably rated only 28% of the time. So, there's clear bias toward the sponsor's drug in industry funded trials compared to independent trials. There's another, potentially more dangerous bias: the failure to report negative results and side effects. Often, when industry sponsored  studies produce negative results or unacceptable side effects, they simply aren't published. The data is suppressed. So, you and your physician are fed biased information without ever knowing it. And it's all perfectly legal! Does this scare you? It should. 

Saturday, January 26, 2013

Fat to Fit, Part V - Lessons Learned

I've written about my decision to get healthy, what I did to make it happen, the tools I’ve used, and the obstacles encountered (see links below.)  Here's what I've learned.

1.   Decide to Get Healthy Despite Your Feelings
The decision to get healthy has to be independent of how you happen to feel.  Why?  Desire is never sufficient by itself.  No matter how strong at any given moment, desire is just a feeling and, like all feelings, it will pass.  You will not always feel like being healthy and you will often feel like acting unhealthy.  So, if you depend on your feelings to keep you on the right track, you are setting yourself up for failure the next time you feel like over eating or not exercising.  Getting healthy requires a decision to get healthy no matter what, including and especially no matter what you happen to feel.  That decision includes a commitment to do whatever it takes whether you happen to feel like it or not at any given moment. 

2.   Act on What You Know, Not on What You Feel
Developing this habit is essential.  If we act on what we feel or want, we will do what we have always done and get what we have always gotten.  Why?  Because feelings reinforce the status quo.  If the habit is unhealthy and you try and change it, you will feel uncomfortable.  The function of the feeling is to elicit the expected behavior.  When I first started to exercise and eat healthier, it felt all wrong and I had to act not on what I felt or wanted – basically to eat everything and remain sedentary – but what I knew and needed – to be healthy I had to eat right and exercise.  This is a choice that must be made repeatedly, despite sometimes great discomfort, until it becomes the new normal.  Since old habits die hard, or not at all, the new normal must be vigilantly maintained through being mindful of the choices made in each moment.  How is this done?  It’s simple but not easy.  It involves the following steps:

Acknowledge Your Feelings without Judgment.  
      I feel like eating that candy bar, I feel like staying in bed rather than go to the gym.  The feelings are there – but they’re not me.
Acknowledge What You Know.  
      If I eat the candy, I will not be satisfied for longer than five minutes, I will want more, and the cravings will start.  If I stay in bed, I cannot strengthen the habit of exercise and will feel bad later.  If I exercise, I will feel good physically and mentally – afterwards.
Given What You Know, Identify Your Need in This Specific Situation.  
      It’s clear.  My need is to stick to my plan and eat nothing or eat something healthy.  My need is to go to the gym as planned.
Identify What You Can Do to Meet That Need.  
      Lots of things.  Do a breathing meditation and understand the desire behind the feeling.  Drink a large glass of cold water.  Put my left foot on the floor, then my right, then get up and get going; don’t second guess, just move.
Take Deliberate, Purposeful Action.  
      Take action now to meet my needs whether I feel like it or not. It’s the doing of the thing that gets it done.
It’s simple.  It isn’t easy.  It takes discipline, basically doing what you don’t feel like doing when you don’t feel like doing it.  Repetition develops the habit of acting on what you know and need not what you feel or want.  It is the single best gift you can give yourself.  This foundation skill makes it possible to do everything else.

3.   Embrace Your Discomfort
When we first try to change anything, it’s uncomfortable.  When I first started to get healthy and exercise, I felt awkward, stupid, hopeless, old, overwhelmed, and generally uncomfortable as hell.  This discomfort can be avoided only by not changing, by doing the same old things over and over again (and expecting different results each time.)  I learned to not just tolerate my discomfort but to embrace it.  Change your attitude towards discomfort.  Discomfort is not your enemy, it’s your ally.  It’s telling you this is the road to health.  This is the road to change.  Do this, not that!  I learned to seek out and do the uncomfortable thing, e.g., using the gym’s universal equipment at incredibly low, almost embarrassing weights at first, or eating a salad rather than whatever comfort food I wanted, or not taking the first bite because I knew it would lead to a binge.  I began to view my discomfort as a good thing, not a bad thing, because it was signaling me that I was actually changing rather than just hoping to change.  Feel good about your discomfort. 

4.  Feeling Follows Action
The biggest obstacle to change is the belief that you must feel better before you can act better.  Most people tell themselves they would lose weight, get healthy, exercise, etc. if they only felt like it or felt like it more of the time.  Here is a simple truth: if you wait to feel better before you act better, you will neither feel better nor act better.  If you wait to feel like changing before you change, you will never change. Why?  Because feelings reinforce the status quo (see 2 above.)  Because feeling follows action, not the other way around.  Having exercised regularly for 15 months, I now feel like exercising.  In fact, I feel lousy when I can’t exercise!  Having practiced eating healthy for 16 months, I now feel like eating healthy most of the time.  My feelings now reinforce the “new normal.”  Feeling follows action.

5.   Practice, Practice, Practice
The perfect really is the enemy of the good.  I don’t do any of this perfectly.  I just do it.  I screw up, make mistakes, sometimes make lousy choices, etc.  I keep at it.  I keep trying.  I keep on keeping on as we used to say in the 60’s.  I don’t allow the failure to be perfect prevent me from being good enough.  Every day I make the effort to exercise and eat healthy, including and especially the days after I fail at that effort.  The result is that eating right and exercising are now habits, now the “new normal.”  I keep practicing.  I keep vigilant because I am mindful that the old habits are there, lurking in the recesses of my brain (quite literally,) patiently awaiting activation. There’s an old joke about an out of town violinist asking a New Yorker how to get to Carnegie Hall. The New Yorker looks at him and simply says: “Practice.  Practice.  Practice.” That applies to pretty much everything, including getting healthy.  Just remember, practice makes permanent, not perfect.

6. Treat Problems As Building Blocks, Not Stumbling Blocks
The Scottish poet Robert Burns famously said “The best laid plans of mice and men oft go astray.” Each of us finds – or makes – our own problems in trying to get healthy. That’s really not important.  What is important is how we respond to them. If I use a problem as a stumbling block, I sit on it and go nowhere, except maybe backwards. If I use it as a building block, I stand on it and look beyond to a path forward.  Adjust my exercise routine (the body adapts quickly and we get less calorie-burn bang for the same exercise buck) to more aerobics and less weight training or maybe different weight training and different aerobics.  Adjust my food plan, perhaps more protein, and fewer carbs.  Adjust my stress management to more frequent brief meditation exercises.  In this way, problems become opportunities, not obstacles. They become less intimidating, less discouraging.  They become opportunities for growth rather than regression.  It is all in the attitude you take and the choices you make.

7. Use All The Tools and Don’t Try to Do It Alone.
My tools have been web based and technological.  You will need to find what works for you.  Don’t hesitate to experiment and discard until you find what does.  Above all, find a support community, virtual and/or real life.  The kind of fundamental, difficult, long term changes involved in getting healthy are best and most easily done in community with others trying to do the same. is what I use and it’s been vital to my efforts.  Enlist the support, where possible, of your spouse, partner, family, and friends.  Make a public commitment to getting healthy and hold yourself accountable to both yourself and others for doing so.  All of these things enhance the likelihood of success. Trying to do it alone increases the probability of failure.

8. One BiteOne MealOne StepOne Day at a Time.
Here’s another simple truth.  I cannot get healthy forever.  I can only be healthy in the present, in this very moment.  While it is my intent to stay as healthy as I can for the rest of my life, I cannot make that happen.  I can only live healthy today.  Understanding this simple truth is, paradoxically, life changing.  Understanding this, I no longer have to concern myself with whether I will make the right choices next week, next month, next year, or even tomorrow.  (Worrying about the future or whether we’ll be able to do something long term discourages us from doing something now.)  Since I can’t make those choices today, I am not responsible for them.  Since I’m not responsible for them, I don’t need to worry about them or even be the slightest bit concerned about them.  I need only concern myself with the choices I make today and, in reality, right this very moment. That is empowering and liberating.  I can control what I do right this moment and I have the power to make the right choice.  I need not concern myself with any future – or past – choice. I belong in the here and now, not the there or then.

Staying in this very moment empowers me. It’s also a lot more manageable than trying to be healthy forever! I don’t know if I can do that. I do know that I am capable of making a healthy choice right now. Staying in the now also is a way of being mindful about the choices I do have. If I am in the present, I pay attention to this bite, this meal, this step, this day. If I am alert and aware, as a friend of mine used to say, I am less likely to take the mindless bite that leads to a binge, more likely to enjoy my meal as it is, less likely to want another helping, and more likely to move my body because I am aware of how good it feels.

9.  PersistencePersistencePersistence.
      Winston Churchill was once asked to address a group of school boys. The legend is that he was feeling a bit under the weather as he was known to be quite fond of whiskey and simply was not up to his usual oratory in these situations. His speech was brief and the message was simple: “Never. Never. Never. Never give up.”  I don’t know whether the story is completely accurate but the exhortation is certainly sound. The journey to health - or any other major change - is filled with difficulties, setbacks, and discouragement. So what! The difficulty is resolved, the setbacks are overcome, and the discouragement fades. All that matters is to keep going. That’s what I’ve had to do. That’s what I will continue to do. So, if you haven't yet started, get going. If you’re on your way, stay in the moment and do the next healthy thing. See you at the goal line.

I hope you’ve enjoyed these postings and perhaps benefitted from them. Any feedback, positive or otherwise, is appreciated.

Thursday, January 10, 2013

Fat to Fit, Part IV - Obstacles

In previous posts (see links below) I described the decision to become healthy, the commitments made, and the tools used to achieve my goals. In this post I'll discuss some of the obstacles I've encountered.

The most difficult by far is the staying power of unhealthy habits. I developed a lot of very unhealthy habits over the years. See, for example Night Eating. Trying to break undesireable habits is futile. They must instead be replaced by new habits. 

Maintaining a daily habit of exercise means I have to really push myself many mornings to get out of bed and go to the gym.  I have to continuously remind myself why I’m doing it. When I want to eat more than I’ve planned or something really unhealthy but tempting I have to very deliberately - and repeatedly - go through the cognitive and behavioral process of acting on what I know and need (I’ll describe this in Part V). It’s simple but not easy and I don’t always succeed. When I give in to the temptation I must resist the urge to throw in the towel and say the hell with it. I just remind myself the goal is progress, not perfection and that practice makes permanent, not perfect. This all takes deliberate, purposeful action - over and over again. Habit is not glamorous. It is destiny.

A second obstacle is other people. People offer you food you don’t need or even want, encouraging what for me at least is addictive behavior. They tell you to have “just a little.” If I knew how to have “just a little” I wouldn’t have gotten to 350 pounds! The offer is well meaning but the results are quite negative. As much as possible, each morning I try to plan what I will eat for the entire day. Sticking to that plan ensures success. When I don’t plan or at least have a very good idea of what I will eat throughout the day, I am much more likely to grab the extra helping or take “just a little” of something I don’t need or really even want. It all adds up, just like exercise, only in a harmful way. By the way, that is solely my responsibility and if I eat what people offer, that is completely on me and not at all on them.

Another people problem is more subtle. I've been told to stop losing weight, that I’m too thin already, maybe anorexic. This said to someone who has been a food addict and overweight his entire life! I really didn’t understand it at first. I know that at my current weight, BMI, and body fat percentage I am neither too thin nor anorexic. 

What I have come to see is that these comments come mainly from difficulty in adjusting to the “new me.” I look entirely different than I did 15 months ago, much less four years ago. Hell, at times I still am shocked . It takes some getting used to for me so why wouldn’t it be more difficult for others? When people haven’t seen me in a long time, after the initial shock they often ask if I’m ok, i.e., if the loss is deliberate or the result of a disease, mainly cancer. At first taken aback by the reactions I have learned to simply accept the compliments, appreciate the concern, and answer the questions. One thing I don’t do is try to persuade. I know I’m ok. That’s what matters. 

A third obstacle is political. We’ve lost our connection with food - it’s just another product to consume. We live in a culture that encourages and depends upon excess. We emphasize fast, easy food and lots of it. Just look at how average portion sizes have changed! Our agricultural-industrial food system promotes the consumption of huge portions of highly processed, highly fattening food. It’s cheaper, often because of subsidies, and readily available everywhere. 

Delicious, healthy food is more expensive and takes more time. I started cooking in part to develop a healthy, grounded relationship with food. Cooking, I become aware of food in a different way - where it came from, who grew it, how to be creative with it, the pleasure in preparing, presenting, and sharing it. It’s no longer about having as much as I can until I can have even more. It’s more about the complete experience, physical, emotional, cognitive, and, yes, spiritual. It’s tough to have that kind of experience when you’re just stuffing your face!

This is an ongoing learning experience. I still stuff my face and often am not mindful of what I’m eating - it’s hard to enjoy food and easy to eat more than you need when you’re not paying attention to the experience - but this is still a new skill and I expect it to take much practice over time. I believe it is essential to my long term health and enjoyment.

In the next post, I’ll discuss lessons learned over the last 15 months.