Fasting

The Kotel, Western Wall

It was a fast day yesterday, meaning no food or water from sunrise to sunset (we have 25-hour fasts, but this one, the 17th of Tammuz is considered a "minor" fast, less intense). FD and I woke up at 3:45 am to get in some breakfast before sunrise.

This helps tremendously, a pancake or two, a cup of coffee, a couple of preventive Advil. But when you're fasting until 9:15 pm on a summer day, you get more than a little thirsty.  I traditionally tease my children with a text, a reminder of the joke about the old Jewish guy on a train in Europe. He continuously bemoans aloud, "I'm so toisty," until someone finally listens to him. (There are variations, all with the same punchline.). It is my final text of the long day.

Anyway by 9:00 that day I'm at work, where people are often talking about food, and their diets, how cutting out certain foods, white flour or sugar especially, helps them lose a couple of pounds and improves their state of mind. Abstaining from anything is empowerment, imho, in moderation.

A Jewish fast is an empowerment opportunity of a different sort, however. It is thought that the Old Mighty (my grandfather's nickname for Her) is more accessible, a little closer on these set days, that She's really listening, hoping we'll connect sincerely, and more often. And when we fast, we're more likely to tune into that side of ourselves, the side that communes with a higher power, people say. I like to call this part of us our religious life. We have many lives, all tucked inside, and this can be one of them, or not.

When we're depressed it can go missing.

As it is also the Muslim month of Ramadan; Jews are not the only ones fasting this day. This has to be an interesting month, psychologically, for the cousins, and the world over their effort is both baffling and admired.

There are two summer fasts for Jews, one the 17th of Tammuz, then another, more compulsory, on the 9th of Av, three weeks apart. The fasts remind us not only of the destruction of the Holy Temples of Jerusalem by the Babylonians (586 BCE) and the Romans (59 CE), but also the many bloody initiatives of other nations intent upon destroying the Jewish people.

mass grave in Belson

Since the experience with Germany in World War II is so close to us, and because there are still survivors of the war, some of whom are still around to speak about it, and cinematic footage of them in dirty striped prisoner pajamas, blank-eyed living skeletons, and footage of the dead, too, ominous mountains of real skeletons, mass graves, thousands of confused, terrified men, women, and children shoved onto trains for days, no food, no water, no toilets, on their way to the ovens, and death marches, miles in the snow in those thin pajamas, sub-zero weather, those who stumble and fall, if they aren't already dead, shot on sight. The Holocaust reduced the population of Jews in Europe dramatically from almost 17 million to less than 11 million. But what is 6 million Jewish people, after all. What do Jews even contribute to society?

Oh, never mind. It wasn't my intention to go here. It is too sad. For a look at photos of the Holocaust, mountains of Jewish shoes and eye-glasses, maps of concentration camps, emaciated bodies, look at Shamash.org or better, visit a Holocaust memorial museum, like the Simon Wiesenthal Center's Museum of Tolerance  in person. Any Holocaust museum will do. Anytime.

Fasting, if you do it six times a year, for many years, is still likely to be dreaded each and every time. But it isn't really that bad, and those of us who wouldn't, couldn't, miss a fast, know it. The less spiritual can point to the benefits, purging the body of all the garbage we've eaten the week before. When the fast is over, if we don't eat too much in breaking it, if we keep dinner moderate and healthy, we feel great, assuming we haven't a "caffeine headache." (Hence the early wake up before dawn for coffee).

And even the next day, today, at the pool at 6:30 in the morning, when the body has adjusted to the cool water, the jump in serotonin in this therapydoc's brain is measurable, words for this post swimming in the brain with every stroke.

It is paradoxical that the anorexia of depression functions to increase depression, makes it worse, denies a good state of mind. The treatment is to increase appetite, and certainly, make sure the patient sleeps a solid six, at least, which is one of the benefits of medication. Sleep and food are healing.

So unless fasting is one of those things your doctor tells you to do before a procedure, or your clergyperson really recommends as a traditional way to connect to certain events and your Higher Power (assuming the pri-care has signed off on it), take all this talk of fasting from food and water for many hours at a time with a grain of salt.

Preferably on a no-yoke omelet, half a bagel on the side. With butter, thank you, and at least a quarter of a cantaloupe. They're in season it just so happens.

therapydoc 

New Ways of Seeing: The Art of Therapeutic Reframing

Monopoly

We've talked about looking for the big personal or family theme, a generalization that feeds a person's history and worldview, a belief that might hold the patient, maybe the whole family, back.  A well-placed reframe, usually with a metaphor, teases away the old way of thinking. No turning back. 

Board games are making a comeback, but Monopoly never did go away.

I stopped playing for a third of a century, but on a visit to hang out with my grandkids (their parents trusted us to take care of them while they took a work vacation) revisited the game again.

Is there anything worse than losing at this?  Losing fair and square? To a six-year old? Early in the game there is a sinking feeling that the outcome is obvious, the game is over. For the very first time you learn the true meaning of Connecticut Avenue. You never valued it before. Now, landing on a hotel, you are shelling out six hundred Monopoly dollars. He has shattered your world view about how to win (buy everything). Three out of four railroads is meaningless in the big picture when you keep landing on his stinking hotels.

How do play therapists do it? They must not play Monopoly.

This is a metaphor, you tell yourself, for losing in life. Over half your patients think they are losers. Although you think you are, too, in random moments, now you relate in a different way. Being a loser is a hopeless place to be, a self-loathing, self-blaming place, and when we lose at a game it is so obvious. We have been outplayed. This time.

Losing at a game we have a sinking, negative feeling of inevitability. But the good news is that you have a new metaphor, and the metaphor by its very nature has the power to paradox, to tweak thinking in a direction that is not hopeless. Laughing at ourselves, it turns out, is the best medicine.

You think you're a loser? Have you ever lost at Monopoly, lost to a person who has yet to graduate kindergarten? Huh?

It has to make a person laugh, which is one of the more curative features of good therapy.

Mark Tyrrell would second that opinion. I had the pleasure of meeting him (via Skype, which is aggravating but does the job, unless you keep trying to move the tablet as far away as possible to look better but your arms don't stretch that far).

By Mark Tyrrell, MD

New Ways of Seeing

Mark is shirt-sleeved, and from the accent, British. His publicist sent me the book and it cost ten pounds to mail it from the United Kingdom, so I'm especially flattered. I had automatically assumed him to be older, because his book has so much wisdom packed into these short blurbs of hypnotic suggestion.

That is what a metaphor really is, a hypnotic suggestion. It reaches into our head and we find it either funny, or calming, or more sensible than the negative ideas we've had about things that are sometimes remotely related.

Many of us understand, for example, the idea of learned helplessness. A woman endures various hardships in life, foster homes, abusive relationships, and is wired to be anxious all the time, unhappy. She finally meets a kind, gentle man and knows he will be good to her, but she is terrified that the future will surely end up wrong, as if she doesn't deserve to be happy.

Her therapist has her imagine a young bird, set free for the first few days of life, then captured and locked up in a cage. The bird is beautiful and has a wonderful song but cannot sing or fly free. Then one day, through sheer hard work and some luck, the cage door is open. At last she can fly and sing as much as she wishes. But she won't. She just stays in the cage.

The doctor then asks the patient: If you could speak to the bird, what would you say?"

The patient answers: "Well, I would tell it to fly free, of course. . .because now it can, only it just doesn't know it."

Dozens of gems like this in New Ways of Seeing.

"Must one study hypnosis to do this?" I ask Mark, knowing full well that at the Chicago Family Institute we learned about the metaphor and that have been using it for thirty years, but most of us don't consider ourselves hypnotists.

"No, but it helps.  It is really the relationship that makes the difference, the trust in the doctor is key. We relax automatically when we are in a trusting relationship, and what is hypnosis if not deep relaxation?"

Thanks Mark.

The Amazon link to New Ways of Seeing: The Art of Therapeutic Reframe

To read other things about this prolific therapydoc check out his website.

therapydoc

Don't Super-Size Me: The push for calories on menus

I didn't see the movie Super Size Me, to tell you the truth. The thought of watching someone gorge on super-sized portions just didn't appeal.

IMDb (where I get all of my movie facts) tells us that movie filmmaker Morgan Spurlock embarks on the most perilous journey of his life. He can't eat or drink anything that isn't on McDonald's menu; he must wolf down three squares a day. He must consume everything on the menu at least once and super size his meal if asked.

Just not pretty.

In my two dozen plus years as a therapist, I've shied away from specializing in eating disorders. By not specializing, I do very well in this area, weirdly enough. I won't specialize because frankly, everyone is sensitive about weight (everyone). And weight is very hard to treat, even with "specialist" written before or after your name.

Because it's such a universal, when people tell me that they want to work on their eating I say, "You'll have to find another therapist if that's all you want to work on. I'll work with you on everything else, your behavior, your thoughts, your relationships, your organizational skill, your emotional management, anything almost, except for eating, and certainly not eating disorders. I won't set out to treat those. If they happen to change over our time together, great, but we're not setting out to cure them."

Why? (a) I like success in my work, prefer to see change fast, and (b) These are the hardest disorders to "cure." So put (a) together with (b) and you get my drift. Oh, and did I mention the paradox in all this?*

The truth? Eating really is an emotional affair. How can it not be emotional? It's about how we look and feel; it's so emotional that no matter how you slice it (all puns in this post may be intentional, I'm not sure yet) until you get yourself emotionally grounded, which can take years, it can be very hard, excruciatingly hard to control one's eating.

This is the essence of anorexia, by the way, control. You can't make anybody eat.

And far be it from me to try.

And you can't make anyone lose weight, either.

My patients lose weight, there's no question about it, without focusing on food as a therapeutic issue, perhaps by not focusing on food as an issue. When we spend a year (okay, more) on the emotional stuff, the pounds tend to peel off slowly, but still. It is a lovely thing to see. Two of my patients in the past year have lost over a hundred pounds each. Both had seen me for nearly three years before they started to lose.

No, it's not science, but it does seem to be a pattern in my practice, maybe is for others, too. Get therapy, take it seriously, and you'll get a handle on your life. Eating is a part of life.

I haven't tackled this topic on the blog until now because it's so huge, and I have so much to say about it. The only way is to begin a discussion is to focus on something in particular, and since WSJ offered me the perfect entree, let's start with Page 2, July 10, 2008, The Wall Street Journal, The Push for Calories on Menus.

Apparently some states are passing laws (or trying) to force restaurant chains to list the caloric and nutritional value of items they serve on their menus. Stu Woo tells us that the California and New York state legislatures have joined a movement approved by health advocacy groups such as the Center for Science in the Public Interest. Other advocates for content disclosure include the American Cancer Society and the American Heart Association.

These organizations agree that if we tell consumers what they're eating, they'll be less likely to eat as much.

Menus with caloric and nutritional information might make some foods less tempting, obviously, something restaurateurs are leery about. And they pay taxes, too, which is why state legislatures are keeping their sights low, only targeting large chains with 8 or more restaurants. Advocates believe these measures, posting calories on walls and menus, are a step towards addressing the country's obesity problems.

A May report by the Los Angeles County Department of Health indicates, based upon "conservative assumptions" that posting calories on menus might result in approximately 10% of restaurant patrons ordering reduced-calorie meals. Changing the eating habits of ten percent of anything is amazing.

And it sounds cheaper than years of therapy, so I'm all for it.

Because at the end of the day, weight control is all about calories in, calories out. If you eat more food than you use in a day, the rest goes to the thighs; or wherever your body feels most comfortable storing it.

But wait a minute! Here's another novel idea (not so novel, okay). What about learning the caloric content of food, cooking for yourself, eating from your own kitchen?

I realize it's easier to pick up the Weight Watchers meals (the only diet I ever recommend when pushed to opine). But there's really something very satisfying about seasoning your own food, sauteing those lean meats or vegetables in just a little olive oil, tossing out the egg yokes. Who cares how rich they are in vitamins?

But when I talk like this in therapy, when patients get me to talk weight control, to talk about exercise (they see my bike) and healthy eating (my sandwich), all I get back are blank looks that say, Why would I ever do that?!

Exercise regularly? Cook? Prepare food? Insane!

Which is why I don't treat eating disorders. Although I could steer away conversation about my bicycle, it would be impossible for me to not talk food, not to impose my palate, not to suggest the ideal sandwich. And a patient might think I'm not empathetic to the situation, which is totally not true, patently unfair.

And yet, just a little olive oil and some garlic, throw in a half-inch of fresh ginger, but don't forget to discard it before you eat. . .it's such a good thing. . .


therapydoc
*a paradox works paradoxically, meaning if I say I refuse to work on this with you, you're probably really going to want me to work on this with you.