Poorly Pics And B-Eat: The Truth Might Set You Free.

There is a movement to persuade the TV and the poular press to stop using "poorly pictures" of people with anorexia. Even I was gently chided by my colleague Susan Ringwood at B-Eat for appearing on a TV programme with an anorexic male alongside some photos of him when he was at his lowest weight. The pictures are usually quite shocking and show people in a very ill and skeletal state. If they didn't catch the eye, why then print them? Clearly there are some very thin people around who dont have anorexia and no-one says much about them. So what is this fuss all about?

Perhaps such pictures are deemed to add to the stigma of the illness. The public often regards people with eating disorders as vain, self obsessed and attention seeking.  If only they would just get a life and eat something. But, would it be more helpful to regard a person with anorexia as mentally ill or temporarily insane; that is hardly better either.

Then, might such pictures do harm by encouraging some vulnerable people to start losing weight too? I don't think so, nooooo. Perhaps you disagree?

Does this paint the wrong picture (to use a pun) of the typical anorexic?  Many are not very thin but the ones we worry about are very thin indeed. Anorexia is a starving, restricting illness whether we couch the restriction as a quest for health, control or purity or whatever justification comes to mind.

Some severely ill people are so thin that they scare the life out of us, drive parents insane with worry and hide their emaciation as best they can from others. And some are so fiercely proud of their emaciation that no one dares to talk about it. Carers and loved ones stand mute and silent for fear of bringing forth anorexic aggression. This IS what anorexia does to perfect souls.

So why not show it as it is? In all its skinny, wasted and emaciated glory. The truth may set you free.

On Orthorexia

From someone’s diary before treatment.

“Everyone around me from the employees or the customers who spent hundreds of dollars on nutritional supplements and organic goods believed that eating in this way represented a healthy lifestyle which then would ensure a healthy outlook on life, There was a sense in that environment that the outside world was toxic and contaminated and that by controlling what we put in our mouths and on our bodies we could cleanse ourselves internally and spiritually".

Result: bizarre special diets, food allergies, food sensitivities, raw diets, low fat diets, low carb. diets, weight loss diets, intestinal cleaning and detoxing, vegetarian and vegan diets, food phobias and compulsive food rituals.

Will you really live longer, be healthier, be happier, be an inspiration to others, love, go to heaven? Is this really being in control?

Some Thoughts About Counselling

Writing as a psychologist who reads the BACP Journal to keep in touch with the world of counselling, I was left perturbed by an article named Who Is This Man? March 2012.

The client C.W. in this article ruminates about the wish to know more about her therapist and thinks that after 3 years of therapy it is “not fair” for disclosures to go only from her to her therapist. She manages to extract from him a confession that he has once lost his temper with a mobile phone as did she. Thereafter the client begins to quest for other ways of getting information from him (along the lines of you show me yours and I’ll show you mine) so that she can feel that her therapist is “real”.

Perhaps it is normal for a client to start wondering about the personality/life of a counsellor. It is more sinister to think it isn’t fair for disclosures to go one way (why not?) and to use the counselling space to manipulate information from the therapist – instead of attending to the process of growth and change. Where does it stop? The client seems to be showing all of the signs of narcissism, the effects of which presumably have got her into therapy in the first place. Why is the counsellor not bringing this into the room? And when a therapy extends 3 years, what on earth is going on?

In an earlier version of the BACP Journal, a similar process was taking place where the client wittered on to the point of indigestion (mine) about whether her therapist would think about her while he was on his holiday. I hope that he did not, but why is this stuff published without comment?

Congruence is important, and I may use some of my own emotional reactions judiciously to help the client validate and develop their emotional vocabulary, to build resilience. But the narcissism/dependency of client submissions in the BACP Journal read distastefully. Does anyone else feel this?

If I want my health addressed, I would choose an expert who knows their job; There is no concern to know the details of their private life. Nor do I mind whether the physician thinks about me once I have left the room. Perhaps counsellors should give their clients an introductory booklet in which conditions of the counselling relationship are laid bare. Disclosures DO go one way; the counsellor does not and maybe should not give the client mental space once the session is finished, the notes are written and the supervision is under wraps. Would that be too difficult to bear?

Ghrelin Or Gremlin - To Coin A Phrase

Title with acknowledgement to Richard Robinson
Did anyone see last nights Horizon Programme about Obesity .... the ultimate facts?

The programme pointed to some distinct differences between people in terms of their suceptibility to overweight, with focus on two hunger and satiety hormones, ghrelin and Pyy3-36. The programme suggested that bariatric surgery would correct the appetitive brain and make fatty sugary foods unattractive.

Having watched the programme, I feel that it was unduly reductionist. For example the distinct differences between the hunger and satiety hormones ghrelin and Pyy may have been caused by overeating and may not be endogenous. There are many other less well understood appetitive hormones which play a role in eating.behaviour.


The brain changes in bariatric patients affecting reward systems and the drive to eat high fat/sugar foods might well be influenced by gut function. Bariatric patients do tell me that they feel transformed by their operations. However the programme did not inform us about the cons of surgery.

I have sought the opinion of someone who is overweight and not an obesity professional, who didn't find this programme very useful. He said, I don't want surgery, is this the only thing that I can do?

It might be useful to have people believe that obesity is "not their fault". There are differences between individuals in terms of genes, life experiences, cognitive function, maternal eating habits in pregnancy, emotional resilience, environment and physiologcal makeup. So obesity treatment will remain complex and personal. One day there may well be a brave new world where each child showing risks for obesity can be fitted with a gut implant to control their appetitive brain. Until then, the battle against our fat cells continues.

Anger

Reproduced with permission by Sally Brampton; Expanded slightly by Deanne

Have you been really hurt by someone who should have known better? Do you have a client who has been emotionally abused and cannot move on? Do you know someone who wants revenge and retribution, and it is justified? Is there a person who is going to make you angry for the rest of your life and you are sick and tired of it?

Here are some thoughts.

“Holding on to anger is like grasping a hot coal with the intention of throwing it at someone else; you are the one who gets bunt”

“Resentment is like swallowing poison and waiting for the other person to die.”

We know all that, which is why so many of us want to be rid of our anger but it keeps coming back and talking about it makes it even worse not better. It brings back all those old memories.

If we have bad feelings, we are often also guilty about our rage, and guilt leads to shame which in turn feed the anger and resentment. It is a never ending cycle. Grief sets in and becomes well rehearsed when we realize what we have lost. At one time or another we are all familiar with it.

Let’s begin with the guilt, which is often misplaced. You do not have to like the person who violated your values. You can even dislike them very much whoever they are, a parent even or someone who used to be your friend. What we do have to do is learn how to tolerate them in our head and be at peace with our own feelings. We cannot change people, all we can do is to learn how to change our response to them. It can be very hard.

Some people are emotionally flawed when we are engaged with them either through our choice or an accident of birth. Perhaps we have moved on while they have not. We might accept an apology but we will never get it and that hurts more than the behaviour we were subjected to which may have broken our heart at the time. Some people never grow up and accept what they have done. Perhaps this person has hurt someone close to you like your parent or your children and the person who feels the pain most of all is you.

The bottom line about such people is: they are what they are. We can call them names, they are cruel, mad, psychopathic or ill, the damage they can do is much the same whatever the explanation you foist on them to try and make yourself feel better, to reduce the confusion you face. It is normal to try and explain the confusion you feel about what you have suffered.

They are what they are, and repeatedly asking them for help or trying to remake a relationship with them on better terms is like banging you r head on a brick wall and all that will do is give you brain damage. You might as well shout at a tree and expect it to respond; it is not going to happen. If you can rid yourself of expectations, you rid yourself of disappointment and its bedfellow, resentment., one baby step at a time.

As for the rest of the time, if you have to continue with some sort of relationship with someone who gives you pain, you run the risk of experiencing continuous corrosive anger. How can you deal with this? No easy answer, try letting it go, dropping the hot coal and not swallowing its poison. Each time you clutch at the hot coal or ingest the poison you taint the relationships you have right now as well as the one you wish you didn’t have. Oh, this is easier said than done. It doesn’t mean that you accept the person and do not judge their actions. It might take all kinds of practice, such as taking a deep breath when the heat comes up and saying to yourself “I am really truly OK, I let the anger go for now.” It might be as simple as going to put on your favourite perfume or listening to music which makes you smile.

If we can let it be, rather than roll snowballs of anger and grief around in our memory stores, we can feel stronger and move toward a sense of peace.

There is a method of acceptance practiced by Buddhists that you might find helpful. It is called the art of loving kindness. This HAS to start with yourself; too many angry, grieving people take our their rage upon themselves, with drink, drugs, overeating, purging or self starvation. It is only when we find compassion for ourselves that we can extend it to others. We can forgive people one per cent at a time. Here is one of the many Buddhist sayings- repeat it daily or whenever anger raises its ugly head.

“May I be held in compassion. May my pain and sorrow be ceased. May I be at peace.”

It may feel awkward and foolish at first but after a while it becomes familiar. Once it feels natural, extend it to those you love. The final step is to extend it to the one you find difficult. It helps.

Read: The Art of Forgiveness, Loving Kindness and Peace. Jack Kornfield, Bantam Press.
Visit http://www.eating-disorders.org.uk/

Eating Disorder Awareness Week. Time To Go.

It is about to hit us. Or did it come and go? Whatever, I think it is time to be banned.

Years ago, no one knew anything about eating disorders.  No one understood and knew how to recognise the signs and symptoms in either themselves or other people. This is no longer true.

The net result is that people with eating disorders are stigmatized. That hasn't changed. Even doctors regard people with bulimia as at least unfortunate and possibly weak willed. They regard anorexia as a vanity illness suffered by willful and irrational people. Even some experts regard compulsive eaters as weak. The new rash of articles about men with eating disorders is helping perhaps but not changing the general image of people with eating disorders as being somehow lesser, sicker beings than other people. You wouldn't want to ask them home for tea.

Well meaning people in their hundreds, go into schools to teach Health and Education studies about eating disorders. This does little to change the incidence of problems and in some cases made the situation worse by sensitizing vulnerable girls and boys about issues of food and weight. These do-gooders don't like to hear this. I once had to argue against a former anorexia sufferer going into schools to warn pupils about the dangers of self-starvation. If you tell someone not to do something, chances are they will.

When people with eating disorders pass through the sieve of investigative journalism they are portrayed in sensationalist ways, which often only enhance a sense of disgust and revulsion among onlookers.  You even get a chance to see vomit in 3D.  Lets face it, the symptoms of an eating disorder are unpleasant and people do terrible, unbelievable things to themselves because of their apparent fears of fatness.

It’s time to stop doing the very thing central to eating disorders, the sense that somehow this condition is special. Even putting eating disordered people on Supersize/Superskinny is unethical.  Why not have Depression Awareness Week or Borderline Personality Disorder Awareness week? Why not have a different Awareness Week every year; surely all the walking wounded deserve their mention.

Lets have an informed debate about what it is helpful to communicate – such as which kind of therapists are to be avoided because their training is partial, or inadequate; or, how to help schools develop an eating disorder policy to protect the healthy as well as the ill.  The rest, I believe is a disservice to the sufferers.

If you like or don't like what I have written contact me on Deanne@ncfed,com  and at least THINK before you leap!

Get A Grip: Love, Cherish And Protect Fat Children

Two articles in The Times Saturday 11 February 2012; the first worrying about children who consider themselves fat when they aren’t. The second, a cry for help from Lucy Cavendish, mother of a fat child who doesn't understand her son’s fatness and doesn't know what to do about it.

Lets take the former first which deserves a blog to itself. God (or whatever) save our children from parents who make comments about weight, their own willpower or lack of it and who flaunt their own obsessive attachment to the gym, pilates or running marathons.

The second article resonated with me more, having it on good authority that being the Parent Of A Child Fatter Than Other Children (PFOC) has its challenges.

I understand that Lucy, like many other PFOCS, will first try to figure out why her child is fat. Is it the genes, is it something she has done, or something about the character of the child. She seems to be blaming all of the above. She once cooked like Nigella and now one of her children is paying the price. Or perhaps he just is lazy or is having a love affair with food. There was a fat ancestor somewhere in the past.

Even if it isn’t her fault, it is her responsibility to do something about it. Everyone tells her so. Some people are telling her to put her son on a diet. HORRORS! Please find her and warn her that dieted children are more likely to gain weight even faster than before the diet. It doesn't work to put children on diets.

When you have a fat child, people think you are a bad mother or at least an irresponsible mother. People will say how can you let your child get like that. Lucy feels guilty when she buys fattening foods and is bending over backwards to put everyone at home on a healthy eating programme. That sounds fine and will convince her that she is being a good mum.  But, Lucy, if you are reading this, that doesn't work either.  For every PCFOC buying normal foods in a supermarket there are a dozen parents buying ordinary food with normal skinny children. Many children just don't gain weight.

The Government has decided to wage war on the fat child with warnings about health risks and risks to emotional well-being. In some ways they are right and Lisa is correctly afraid that a fat child is probably going to be a fat adult. But many adults are fat who were never fat as children.  I think it is these adults who find it hardest to manage their eating habits, since they were never called into question when they were young.

The days of bad interventions are gone. Doctors no longer give slimming pills to children as they did but rest assured, they don't know what else to do. Obesity is the physician’s Achilles heel.  Instead we have do-gooding, Jamie Oliver, bless him, and earnest strategies trying to foster healthy eating for our kids. We have the dreaded “fat letter” and a fat lot of good that is going to do. We even have a MEND child obesity programme which appears to have failed Lisa and her son. Although MEND received a gazillion pound grant, I would love to meet just one cured-fat success story, a fat child made thin. I haven’t yet.

There is no doubt that there are some lazy, irresponsible and unknowledgeable parents who stuff their children full of junk. There are parents who simply do not know that their child is fat, because they do not know how to interpret what they see. Despite what we are led to think, I believe that these are in the minority.

The rest of us have to do daily battle, with our need to defend ourselves from criticism, and with the unending responsibility to conduct a battle, which we cannot win. There is a limit to the control we can exert and limit to the miles we can force these little ones to run. We risk doing damage in the process; a child deprived of treats will only want them more. We stop just appreciating our fat children and envelop them in the pall of our own anxiety, always wondering what to do that will work this time.

To the mother of a fat child I would say this.  Really there is nothing you can do. This is a child who above all needs to be loved and celebrated, learn to view their difference as a gift to help you to rise above yourself. Let them eat all they want; do not try to convince them that they cannot be hungry; do not scrutinize their portion sizes; they really do need more than thin children.

Above all, deprive the child of nothing that you would not let them eat if they were thin. By all means take them out for a walk for fun, but do not heed the advice to deprive them of their TV and to force them onto the football pitch.

The child who is fully accepted and loved at home will be better able to overcome the difficulties they will face outside. To any young and vulnerable person, teasing and bullying is the worst thing that can happen. Above all it mustn’t happen at home with guarded comments such as “You would look better in that if you were a bit thinner.”  A zero tolerance policy of teasing among siblings should also be in place.

Instead of trying to fix the child’s weight, fix their ability to manage these torments and to overcome them. You may need to call on professional help to keep their self esteem intact.  Above all, you must find a way to let them know that it is not their fault. Nor, when they are children is it their responsibility to do something about it. Nor, strangely enough is it yours for now.

Having worked unceasingly with fat people for decades, I am now convinced that fatness is a disease that can only be managed, never cured. The best chance a fat child has of losing weight is to do it for themselves, when they are older, in time and in the best way for them.  They have a far better chance of managing their weight in the future if you are able to give them a solid sense of self worth and self respect in early life.

So, if you are going to stop trying to manage their weight, what can you do? If I did have a checklist, it would contain some of the following;

Adore and be proud of your fat child, give them loads of hugs and listen to their problems.

Engage the school, make sure you let them know that your strategy for your child is long term and alert them to let you know if there are problems.

Make sure he knows that weight is not his fault. You might need help to put this in the right words. If he thinks it isn’t fair, he is right.

 Ignore comments or assumed comments from others. Make sure that everyone in the family reads this blog.

Tell well-meaning others that diets make fat children fatter. Tell the child that missing meals is fattening.

 Do not diet yourself, or make weight comments about yourself or others, do not praise beautiful children, do not use the child to compete with you in a weight loss programme.

 Help your child to love a large range of foods.

Teach your fat child how to cook (all foods including treats).

Do not ban any food, under any circumstances including visits to Macdonalds, do not make comments, but use substitutions, like sorbet rather than ice cream for the family.

 Get help if necessary to teach her how to combat teasing including Facebook bullying.

 Make sure she is doing things she enjoys, from ice skating to dancing or tweeting.

 If your child wants to diet, do NOT quickly agree and I advise some expert help, such as from me!

If she is bingeing or secretly eating, she is deeply alone and unhappy. Spend time with her and find out what she is feeling.

If you have any questions or concerns, email me at admin@ncfed.com and meanwhile, celebrate your fat and hungry child.