{credit prettystuff; via pinterest}

I used to wear glasses, and when I did you could frequently find me running frantically around my house, late for work as usual, as I searched for them. If you were looking in the window during this charade, you would undoubtedly laugh, as I would estimate at least forty percent of the time they were on my face or folded on to my shirt. To me, this demonstrates just how disconnected I was from my own body. I could have glasses resting on my skin, making my vision clearer, and have no awareness in the moment of what was, literally, right in front of me.

Thanks to LASIK and mindfulness practice, I am much more connected to myself these days and don’t lose any glasses. I know that I’m haven’t been alone in this disconnection, however. Every day I see individuals who are utterly unaware of their bodies unique signals, and I see how this unawareness wrecks havoc on their ability to properly care for themselves.

When it comes to feeding ourselves, our bodies have an absolutely incredible system for keeping us healthy. Many of us believe that if we really listen to our bodies, it will tell us to eat Hostess cupcakes all day long and send us spiraling into a state of obesity. In fact, our bodies just don’t work like that. That belief itself is worth exploring, and is often tied to messages that we’ve gotten throughout our lives about how bodies just can’t be trusted. We’re told this by our parents growing up (“You can’t be hungry yet – you just ate!”), by our friends (“Watch out or your Twinkee addiction is going to catch up to you.”) and by the diet industry (“Trick your body into losing weight!”), and even by the government and food industry, (“Follow these food pyramid guidelines, not your hunger! Don’t worry that they are the result of dairy and beef industry’s advice to the USDA.”).

What we often fail to hear through all the white noise is the sound of our Inner Nutritionist, despite the fact that he or she is wailing to get our attention. Our Inner Nutritionist is comprised of all of the internal wisdom that resides in our amazing bodies. It’s built on millions of years of collective evolution and decades of your own personal experience. To put it frankly, it knows what it’s doing – a heck of a lot better than your Aunt Sally, Slim-Fast, or the USDA.

Our Inner Nutritionist tells us things like when we are hungry and when we are full. The Inner Nutritionist even has cool hormones at his or her disposal that can make certain foods more or less appealing.  Linda Bacon talks about the restrained eater, the subject of many studies, in her book, Health at Every Size. The restrained eater is someone who has kicked their Inner Nutritionist to the curb, and instead responds to external cues to determine their eating. The restrained eater responds to things like the amount of food available, peer behavior, and their emotions to determine how much and what they eat. While these things can influence all of us to some degree, those with a tight relationship with their Inner Nutritionist are able to observe and acknowledge these factors and return to their own sense of what’s right for their body in the moment.

Utilizing this resource can take a lot of practice, particularly for someone who has long ago fired the Inner Nutritionist. Bringing it back happens when we can practice mindful eating and develop a more balanced relationship with our bodies. An Inner Nutritionist packs his or her bags when her boss doesn’t believe she exists, ignores her, or, worse, berates her.  Just for today, practice being curious as to where your own Inner Nutritionist might be.

Do you believe you can trust your body for your food choices?

Having lived sans cable for the past five years or so, when I’m in the mood for some network entertainment I usually turn to Netflix and usually delve head first into a series. Mad Men, the hit AMC series about advertising men in the 60s, is my latest vice, and I’ve been going gang-busters through the first few seasons recently. I never knew I would be so fascinated by the lifestyles of the 1960s, but I can’t get enough! While keeping in mind the fact that everything is amplified for television, I’m riveted by the complicated gendered relationships between men and women, the parenting styles, the political climate, and, of course, the portrayal of mental health. Oh, and the hairstyles. I love those.

What’s so fascinating about Mad Men is that it offers a glimpse into how far we’ve come – and haven’t come – in our social development. Mental health is no exception. When Betty Draper notices numbness in her hands and discovers that this could be psychosomatic, she urges her husband Don to allow her to attend therapy. Don is at first incredulous about the idea of his wife confiding in a stranger to solve her seemingly physical ailment, but when the problems continue he relents. What we soon discover, however, is that Don is keeping close tabs on his wife’s sessions, getting a full report from her psychiatrist after each meeting.

My jaw literally dropped when I saw this exchange transpire, but then I reminded myself just how long fifty years is in the world of mental health. It was only in 1996 that former President Clinton enacted the Health Information Portability and Accountability Act – HIPPA – that provided protection for individuals’ health information being communicated. Just to be clear, in today’s world, one would need to give explicit permission for a partner to receive information about one’s treatment. And detailed information about one’s sessions would virtually never be revealed.

In fact, a lot has changed in the world of mental health since the days of Betty and Don Draper. To put in context, here are some of the developments in the past fifty years:

1966 – Alcohol abuse and dependence were finally recognized as a major public health issue, and federally-funded organizations were developed to research these illnesses. We’re still trying to establish the the exact causes of alcoholism, and genetic research is helping us understand it’s biological roots.

1970 – The FDA approved the use of lithium to treat mania. This revolutionary drug drastically reduced the number of days spent in inpatient hospital. It’s also credited with sharply reducing the number of suicides in areas where it was prescribed.

1976 – The number of people in psychiatric hospitals was dropping dramatically as an emphasis on treating individuals in their own communities developed. While giving individuals tools for community-living was important, many patients were pushed out on to the streets still ill-equipped to manage their illness. Some became victims of trauma – individual and institutionalized.

1978 – Many people still claimed that autism was caused by refrigerator mothers, parents that offered a “genuine lack of maternal warmth.” While we still aren’t clear on the causes of autism today, we’re generally agree cold moms are not to blame.

1986 – Homosexuality was removed from the Diagnostic and Statistical Manual (the Bible for mental health practitioners) as a diagnosis. It took this long despite compelling research in the 1940 and 1950s by the likes of Alfred Kinsey, Evelyn Hooker, and others. No one ever claimed that the American Psychiatric Association was speedy on these things.

1989 – Former President Bush signed a proclamation establishing the 1990s as the Decade of the Brain. The 90s saw an enormous boon in research on genetics and the brain. By 2000, genetic researchers had finished mapping human genes. The goal is to help identify specific genes and how they are associated with various illnesses. [Are eating disorders brain disorders?]

2002 – New Mexico allows psychologists (not, psychiatrists – click here if you’re not sure of the difference), to prescribe psychotropic medication. Hotly debated, but the future may hold more prescription privileges for appropriately trained psychologists.

2008 – The Mental Health Parity and Addiction Equity Act was passed. This landmark legislation required  insurance companies that offer mental health benefits to provide coverage on-par with medical coverage. Unfortunately there are still many insurance companies that are trying to sneak around this, and eating disorders are often not covered.

2010 – Nourishing the Soul was born! (Sorry, had to add that in there!)

As you can see, while advances in mental health may seem to progress at a snail’s pace in real time, in the context of our history we’ve made great strides in this field. And what has universally propelled this forward movement has been the willingness of invested parties to speak up. Whether as a clinician speaking up on behalf of your patients, as a concerned family member advocating for your loved one, or as a consumer of mental health services sharing your struggle, putting these issues at the forefront has meant everything.

So on World Mental Health Day 2011, I urge you to use your voice to keep the momentum going. This week, write a blog post about the role of mental health services in your life, share your story with a friend who might need to hear it, or even lobby in Washington. Whatever you do, remember that mental health is health, and it takes our voices make sure it gets the respect and recognition that it deserves.

For more World Mental Health Day posts, head over to PsychCentral. How are you recognizing the importance of mental health in your life today?

{Natalie Dee Comics}

A few weeks ago I had the pleasure of attending a two-day training in Palo Alto (um, who can beat the location? really…) on Family-Based Treatment (FBT) for eating disorders, sometimes called the Maudsley Approach. The experience was incredibly rich and this will hopefully be only the first of many posts based on what I took away from it.

When I left California, I took with me a deeper understanding of how parents and caregivers can be helpful, or rather, vital, in the process of recovery.

You may be thinking, “Wow, that’s not rocket science. You don’t have to do an intensive training to figure that out.” But in fact for many of us, clinicians included, this is a new concept.

This is not to say that in my own practice I don’t incorporate family support and even do family therapy. But do I rely on the parents of the individual with the eating disorder to do the therapy? In a word, no.

Proponents of FBT would suggest that parents are, in fact, the best possible people to do the intense work of treatment. In short, this means that FBT teaches caregivers the skills they need to implement re-nourishment at home. Parents initially take control of restoring the individual’s weight, gradually turning over appropriate control to their child after a period of time.

If this seems foreign to you, you are not alone. The radical-ness of this idea is radical in part because our society has readily adopted the notion that parents are the root of all of our problems and thus cannot be the source of our solutions.

Putting aside the question of whether that’s a valid argument for a moment, here’s another question: How did we start blaming parents for, well, everything?

Looking back at nearly every public tragedy in history, we find questions about the parentage of the individual responsible. We want to know the background of Adolf Hitler, and from where his brutality might have stemmed. We wonder, who exactly did raise Bernie Madoff? An article in the Philadelphia Daily News recently asked about the shootings in Arizona, “At the risk of sounding harsh, how could the parents of accused shooter Jared Lee Loughner have missed so many signs that their son was a major safety threat?”

And when it comes to individuals with severe mental health or developmental issues, the history of parent blame is perhaps even more striking. And, as Dr. James Lock, one of the major investigators and proponents of FBT said in our recent training, “And let’s be honest, when we say ‘parent blame,’ what we really mean is ‘mom blame’.”

Indeed, the term “refrigerator mother” has plagued the moms of mentally ill and developmental delayed individuals since the mid-20th century. The idea was that the mothers of children with schizophrenia and autism were emotionally cold and distant. In the first paper to describe autism, Leo Kanner described a cause being “genuine lack of maternal warmth,” and parents of these children as “just happening to defrost enough to produce a child.”

Ouch.

Similarly, parents have historically been blamed for eating disorders as well. In the ground-breaking 1978 book, Golden Cage, psychiatrist Hilde Bruch suggested that narcissistic and unloving parents, or hypercritical and over-involved parents, actually caused these illnesses. Now most experts agree that parents do not cause anorexia or other eating disorders. When experts talk about parental contributions today, they are more often talking about the genes that they pass down. Scientists suggest that over 50% of a person’s risk for developing an eating disorder is attributed to genetics.

Does this mean that parents don’t contribute to the development of an eating disorder? I would say no. Parents comments, personalities, own mental health issues, and modeling can in fact influence the development of a disorder. And yes, in many cases those struggling need to better understand the development of their beliefs around food, shape, and weight and, at times, to even redefine what family means.

When things “go wrong” our instinct is to look to the parents; we believe that some answer lies in their egregious errors. Why do we do this? Perhaps it makes us feel safe. We need to know that the man with schizophrenia screaming at the wall couldn’t be our son – we wouldn’t let it get to that. Or that the girl starving herself to an emaciated death – we’re better parents than that. If the cause is genetic or, worse, unknown, then we’re all at risk.

But what we lose in blaming parents is the opportunity to enlist an incredible ally – people who (at least usually) truly know and love the individuals suffering. These are the people who at the end are making the hard sacrifices and praying to whatever entity they believe in for that individual’s safety and protection. When we riddle parents with blame, blame that they often all too easily take upon themselves, we’re might be colluding with the illness.

What role do you think parents might play or not play in mental health issues?

ALERT!!!! It’s Change the Way You See, Not the Way You Look Week! This week is the the brainchild of Caitlin at Operation Beautiful, a website (and now book!) that aims to help individuals change the way they see themselves “one post-it note at a time.” Check out the website for more information on this mission. It’s cool stuff!

Speaking of changing the way that we see… Do you ever wonder why you can’t seem to move past those disparaging thoughts about your hips or belly? Your weight may be less to blame than your brain, according to recent research on body image.

While body image admittedly has many sources of influence (such as parental commentary and the media, to name a few), scientists have discovered that there may be biological bases for distortions of our actual body shape and size. These misrepresentations are characteristic of those with eating disorders (and in fact are part of the diagnostic criteria), but are also a struggle for those of us who, say, live on Planet Earth… Thus, this new understanding of how we perceive ourselves is particularly relevant.

First, let’s establish how our brains perceive our bodies. Obviously it’s important for our brains to understand both where our bodies are in space (called proprioception) and our relative size in order to make judgments related to movement. For example, we need this information to decide if we can squeeze behind the chair of that jerk who is clearly not moving his seat for us… Or how hard we can plop down on the couch without scaring the cat. People with extremely distorted body image have an extremely difficult time with these seemingly simple decisions.

Research tells us that these individuals’ difficulties may actually be related to brains that are functioning differently. Perceptions of our body size require a fairly complex process that’s completed by the posterior parietal cortex (there will NOT be a test!). Neurologist Henrik Ehrsson actually conducted a study in which he created the illusion of a shrinking waist (No, you can longer sign up to be a participant in the study!) utilizing the Pinocchio Illusion. What he found was that not everyone experienced the shrinking sensation in the same way or to the same degree. This indicated to Ehrsson that our brains might all be slightly different in how we calculate our own size, an important factor in considering what might be contributing to body image issues.  

A newer study by one of Ehrsson’s colleagues at the University College London, Matthew Longo, also delved into the roots of body perception. Longo and his buddies asked participants to estimate the location of their knuckles and fingertips while their hands were hidden under a board.  They found that the participants misjudged their hands, thinking that their hands were wider and their fingers were shorter than they actually were, despite being able to pick their hands out of a “line-up” of photographs. Longo called the distortions “dramatic” and explained that visual image of ourselves seem not to be used for position or feeling sense.

To take this a step further, a severely underweight boy could thus look in the mirror, and despite the visual cue, “feel” much larger than he physically is. People of average or greater-than-average weight can also have a distorted body image, calling their bodies “fat” when others fail to see the basis for their criticisms. Thanks to researchers (and their willing participants), we are starting to develop a more scientific understanding for why. And once we have a richer understanding, we may be able to develop new ways to address our negative body feelings.

What ways have you discovered to address your negative body feelings?

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