"Obesity"

 "Obesity"

Brian Lynch

It is certainly not as simple as having to do with food. It has almost nothing to do with food.

The reason most of us are overweight is, in fact, well-known but oddly avoided. We come upon the concept that it might have something to do with our feelings, but for the most part, quickly set this possibility aside.

True enough, our culture offers many reasons to help us avoid: Plenty of food, and even if poor plenty of empty and innutritious calories, “not enough time for activity” and “the fat gene.” In short, we throw up our hands in despair.

It is confusing and the reasons we do not act fold in on each other causing more despair and worsening the emotional turmoil.

The bottom line is much of our eating is to self-medicate. Much of our weight has to do with shame, the shame in the sense that I have wanted something other than food and not gotten it. My desire has been thwarted. It hurts and I do something about it, I eat.

As has often been pointed out we do not need to smoke or drink or use drugs but we have to eat.

And we now know so much more about how to articulate what happens to us.

One easily elicited reason for our state of girth is the shame that comes with the pounds. As I said we eat due to shame but then are thrown into a shame spiral or “bind.” We feel shame for our very weight. This alone can increase the eating but we also now isolate ourselves so as not to be seen. It is a vicious circle. Shame begets shame and eating begets eating. 

This is often exacerbated by our self-image which we now know is so much determined by our social status and family. We often, that is, will not surpass our family; to do better than my parents would shame them and myself. My mother is big I cannot lose more than her or I will shame her.

True enough, there are all kinds of exceptions and genes do play a role. Adopted thin kids in large families tend not to be large! It takes discipline to read and learn from various sources. But if the shoe fits, wear it. I am not discounting genes. I am saying a hundred years ago we probably had much the same genes what we didn’t have was the same activity and eating habits. 

What then in this society where well over half of adults are overweight? Being overweight becomes “normal.” It becomes a family emblem, “the way to be.” Again, if I lose weight and take care of myself it will be shaming to all those that are not doing it! Thus, this ignites another vicious cycle. Those that shame will oh so subtly or viscously sabotage my every effort to be different: To lose weight, to be healthy.

Then there is the painful logic of the 30-40-year-olds who have “just gone to the doctor” and been told that they are in perfect health. Yet they are 100 lbs overweight. This is what I call “disavow.” Disavowal of any thought of the disaster that might and probably will come in ten years of heart disease, diabetes, and stroke or out-and-out death. It simply reminds me of the patient I saw the other day that I had long worried about who had been doing well on one long-term contract that I knew had to end someday, and so it did, and now he is in shock in this poor economy. So we hope as doctors that our overweight patients will have a “minor” stroke or heart attack before a major one to see if they might take the hint.

A confession dear reader; so was I about ten years ago in terms of my weight. I was much over the mark.

Yes, being overweight has little to do with food.

Humiliation

Humiliation 

Brian Lynch

This is to clarify; at some level; the difference between shame and humiliation. I follow Silvan Tomkins in his view of these themes. As elsewhere in these writings I have said that shame is the gap between the desired and acquired. The state of pleasant emotion was now interrupted.

But how is it that shame and humiliation are near the same? That is Tomkins says that shame and humiliation lie on a continuum going from shame to humiliation. It is an idea, a concept to consider, a way to describe what we do experience. We could say that we feel lesser and more shame. Is “shame” the same as “humiliation” in the sense of our desire being blocked their only difference being one of intensity? We are saying yes, that is the case.

Let me be clear, this is not an exact science. Language is imprecise and one rich benefit of understanding what “Affect Psychology” has to offer is understanding how vague and how personal our emotional language is and how much more we should pay attention to it.

So, for any given person intense “shame” can and does have the same meaning that intense “humiliation” has for someone else? For our purposes, we are going to purposefully make the distinction that humiliation is more intense than shame.

But then there is the problem that, it is hard to remove “humiliation” from the image of any external force acting on us. My point is and will be does “shaming” and “humiliating” always have to come from “outside?” I have said already that it does not. This is to clarify and parse the words and dynamics a bit more. If there is an outside force, a person, or a situation that “humiliates” me it can also “shame” me. Again, it is an internal assessment on my part. It is what I feel. What I feel will be based on my emotional biography and what I have learned to label this feeling. “I was humiliated or I was shamed.”

So to humiliate is to shame and or humiliate all depending on the internal environment of the person humiliated. One defense against humiliation, of course, is simply to become acutely aware of this feeling. That said, I am never offering the idea that therefore it is ok to suffer it and we should just “toughen up.”

The contrary is being suggested the very act of humiliation or shaming (it works both ways, that is you can call humiliating “shaming.” ) is in effect a physical assault on the brain tissue, a preemptive strike from which the brain first has to recover. The brain has to first recover from cognitive shock; this puts anyone at a disadvantage and raises the chances of a dangerous or at least an inappropriate response manyfold. 

Humiliation

[This was written 13 years ago. Nothing has changed and only gotten worse. See the linked contemporary video commentary at the end.]

Humiliation 

Brian Lynch

Recently I was subjected to a frequent form of humiliation that I fear so many do not recognize and feel that they “deserve.” Of course, that is the whole point of humiliation those that have the power certainly think you deserve it and should take your just desserts and for the most part, know who they can and cannot dish it out to. All of this is mostly on a subconscious level until it is not. Let’s try and bring a bit of it into consciousness.

I was talking to someone who will remain and nameless about my income who I had not seen in a long time. l am a physician. I am supposed to have a very comfortable living. I have the income I have. The range of physician incomes is from the very low to the very high. Low incomes happen more often than you would expect. And low incomes are not something physicians often chose like most. Most people don’t choose them.

 It is also true that high incomes come at a high price. But I don’t believe I have chosen my status. I have perused what I think is good medicine and caring for a population of my choosing that deserve medical care like everyone else and I should in return make a good living. Now, I have also learned that “a good living” is certainly a slippery thing. To repeat, if we have lived at all, we know that “good” living can come, as I say, at a very high price.

I take this moment to note an institutional form of humiliation built into capitalism, a sleight of hand that teaches us to have a Pavlovian response to the gross yearly income instead of a balanced quality of life. It was pointed out to me once that Europeans sensibly tend to talk about actual take-home pay whereas we talk about gross pay. We also talk about gross pay and hours worked and workload be dammed. To me, 100,000 dollars and 60 hrs a week is not 100,000 dollars a year, but 75,000 a year as far as your quality of life as you worked a year and a half in a year. I have seen many job offers supposedly for 180,000 a year. As I would assuredly believe that would entail at least 60 hours a week, which would only be 120,000 thousand a year and I have seen ads intimating that one should be raring to go to see 45 patients a day. As far as the workload that could often be considered double workload so now we are up to two and half years' worth of work in one year or equivalent. That is, you are seeing twice the number of patients and working 60 hours a week. To be sure many people “like” doing this. I believe this to be mostly a type of “avoidance” of other areas of life or what some people call an “ism.” But it is whatever it is out and out promoted as normal.

 I try and keep these pieces very general and I hesitated to mention the specifics of physician incomes as that in itself can be humiliating. Although the point is many primary care physicians do not make more than an average income. Still many, will think I am whining about an income that is well above average, at times. I could have done it without mentioning the numbers, but I wanted to take the opportunity to educate about the real numbers and precisely to point out that it is all relative. That if you are making 40,000 and really like your job and working 40 hours a week instead of hating your job and making 60k and working 60 hours a week who is better off?

So with that background I was trying to chat with this person, let’s say an old “financial advisor” and I let him know that since the recent downturn in the economy, I had received almost no offers for work outside the office to supplement my income. He looked at me, mentioning nothing of the financial crisis. “Only that many days of work, huh.” He then repeated the phrase a few times and said “There must be something wrong, must be something wrong for a doctor not to be working more than that?” Here in the light of the prior pieces on humiliation, I suggest to the reader that I was now suffering from cognitive shock or that I was in a state of humiliation. I did realize it at the time, but not fully until I was in the car was I able to assess the full extent of the damage. So we are and so we tolerate such put-downs even when we deal with these themes daily. He then informed me of doctors making in the million category and at least 250,000. Of course, the big guys were specialists.

But of course, the point is this was supposed to be a friendly chat with an advisor after a long hiatus. He might catch up on who I was first. But of course, even then you might guess I am not into humiliating people. No, he had pigeonholed me a long time ago as such and such a person, especially I am in the category of “doctor.” And any self-respecting doctor has to make money.

Woe was I also when I emphasized my caring for “addicts” and the wonderful new treatments available. I said I nevertheless lacked access to patients for some reason. This was an ill-advised move. Now, out came what I took was an obvious prejudice towards addicts. I assured this person that it was certainly my belief that every addicted person wanted off drugs. He retreated into mumbles of “I don’t, I don’t know, not my area.”

Doctor Burnout and Depression

“Back Pain”

Brian Lynch

This is pretty dangerous territory. Back pain is a problem for many people including doctors. The good news is that nine out of ten people do get over back pain. Besides doing psychotherapy I do, do general medicine and there is a lot of back pain in general medicine. There is just a lot of pain in medicine. 

One reason I do psychotherapy and general medicine is that I do not believe that there is a great difference between the mind and the body. Some people say “Oh the pain is in your head” meaning it is not “real.” Well, where is your head? Where is your brain? Is it not part of your body? 

We now know that our emotional pain and what we call physical pain or “ouch” pain come from much the same places in the brain. Back pain has to do with a lot with the spinal column. Where does the spine start? It starts in the brain. Back pain also has to do a lot with muscle pain.

We have known, for a very long time, that if we take 200 people and take all their X-rays, cat scans, and MRIs we find that we cannot tell who has pain and who does not have pain based on their studies. We find 100 of people that do not have back pain and 100 that do have back pain, but all of them have things out of place on their studies that look like they should have pain and mix all their studies and give them to radiologists to read. The experts cannot tell who has pain and who does not have pain.

Now this is very interesting. One hundred have pain and one hundred do not, but their studies are the same.

This is where people will get upset and I do not want people to get upset. I believe people have pain. They do have pain. Maybe their pain is not caused by what we see in the studies. Maybe the pain is much more complex. Maybe we should think differently?

When people go to surgery for these conditions only about one in three get better, but often not completely better, what is going on? 

In this short space, I want to suggest Dr. John Sarno of Columbia University. After studying many patients he has discovered that the patterns of the pain of many people just do not fit what is seen on their MRIs and x-rays. He, again, is not saying they do not have pain. He is suggesting that since our emotional and other nervous systems are so intertwined, and so connected that we channel our negative emotions into, mostly our muscles, and this usually is in our upper back and upper hips. I think it is a bit more complex than Sarno is suggesting but he is on the right track. He talks mostly of our problems with anger. I think our problems are with a more broad range of feelings such as distress, fear, shame, and disgust but it is a start. I would suggest any of his books such as “The Mindbody Prescription.”

"Accept the things I cannot change and change the things I can."

Brian Lynch

This is a short version of Reinhold  Niebuhr’s prayer that is used in the “AA” or alcoholics Anonymous movement.

The other day the meaning of the prayer became much clearer to me in terms of how I try and help people go about clarifying their daily lives.

It seems that many of the serious problems people have are precisely because of issues in their life that cannot be solved. We all have them. We all, for example, know we are going to die. We all know we have to pay taxes. We all know others will die. What we are not fully aware of is how we handle this knowledge. We do not realize that we might be wasting our lives trying to avoid death and not living. We might not realize that because we lost, for example, a parent when we were eight years old that we are still trying to “solve” that problem and that is  taking up almost every moment of our life even though we are fifty.  Since the problems are unsolvable it is “beating ones head against the wall” and yet we just do not realize what we are doing and since it is unsolvable we do something else: we  get angry at the world, destroy our business, family, take drugs, just “give up.”

So the point is the “prayer” points out a very important truth. What can we do? I think it begs us to work very hard to see our lives in a new light; that which is possible and that which is not.

Sometimes something can be done. A toxic relationship with a parent or sibling just might be able to be healed. If things have gone on for years and they have consumed your life take steps to test the waters. If, however, the other party is unable to respond, and continues to hurt you, evaluate. There are two ways to go. You can now go back to old habits which will continue to magnify. Things will get worse as things feed on themselves or through a window of opportunity, that you are now creating, one might realize that we can change albeit the other might not be ready to. Is all hope lost for the other? No. Why? Because often, when we really change others often change but this takes time and commitment. This becomes a new life of sorts, not the “old life” not the old dynamic.

Brian Lynch