Health and Fitness*

My blood glucose has been creeping up lately, and so I'm tracking health and fitness again. I do pretty well with the exercise, meds, drinking water, not at all well with sleep and relaxation, and I have to be sooo careful with eating, because of my compulsiveness.

Dieting is probably the most prescribed, ineffective, and harmful intervention ever in the history of medicine and physical health. Many dieters lose weight over the short term; most gain it back and more. Repeated dieting with weight loss and weight regain totally messes with your metabolism. And something like 2% of dieters keep off the weight they've lost for more than five years. What other industry is based on something which yields such poor results? The interaction in dieting of biology (which says when food is restricted--"whoa, we're in famine, I better shut down my metabolism to survive") and psychology (where food is connected to self-care, nurturing, safety, etc.) creates a veritable perfect storm of FAIL.

But, the blood glucose is creeping upward, despite an hour per day of exercise which makes me able to walk without pain, keeps my blood pressure at a manageable level, and makes me feel normal. I don't want to take meds yet, because that starts a whole other balancing act. I have lost weight before--about 20 lbs at a time--sometimes by cutting out fat and sometimes unintentionally by being in a different situation (walking more while traveling, no extra food available, an emotional crisis--although usually of course that's when I gain).

My main trouble is that I have an anxious and compulsive personality, and complex carbohydrates are both a great way to avoid work that is difficult or that I'm anxious about, and a sedative which makes me then able to get back to the work. A perfect self-perpetuating reinforcement circle. Like this: impending work (usually writing of some sort) --> anxiety relating to the work --> avoid (negative reinforcement [r-] of the avoidant behavior) while getting a carbohydrate snack (positive reinforcement [r+] of the avoidant behavior) (which because of its sedating effect is also negative reinforcement [r-] of the avoidant behavior because it decreases the felt anxiety) --> so that now, less anxious, I can go back to work and complete the task successfully (positive reinforcement [r+] of doing my work and staying in the cycle) --> until I have a new task, new day of work, which then elicits anxiety --> and so forth.

When I was younger, in bad jobs, getting through grad school, doing some really hard stuff, maybe I absolutely had to have this coping mechanism. Now, not so much. I love my work, I love my life, I'm just in the habit of being anxious. The anxiety from my regular life is perfectly manageable. But I know that if I start restricting my eating, all kinds of other psychological issues will kick in--"we're going to starve! nobody loves us! we hate you! you don't care if we die from starvation, so we'll show you--we'll die of overeating, and we don't care either!" Rationality does not live in that world.

But the blood glucose is inching upwards. Restricting backfires--always has. I gain weight when I restrict. Writing down what I eat backfires. Counting calories backfires. It doesn't work--maybe it does for some, but I'm one of the 98 out of 100 that it doesn't work for.

So instead I'm going for the gentle approach--a little nudging toward the vegetables, planning ahead and anticipating meals, allowing for a sweet when I want one, making sure I always get my 3-4 carb units per meal (but not more).

On my desktop I have an XL file with the following list:
Sleep (3 points): to bed by 10:30, up at 6:00, nap
Measurements (1 point): weight, blood pressure, blood glucose
Meds (1 point)
Water 8C (1 point)
Exercise (3-4 points): bike, back/stretch, weights, swim or walk
Relax/meditation (1 point)
Eating (3 points, 1/meal): 3-4 carb units [15 grams] (2 grain and/or starchy veg, 1 fruit, 1 dairy)/meal, 1 protein unit/meal, 5+ veg per day, 1 small sweet/day <--> fruit or carb unit.

That's it. I think about the food as I'm planning the meal--I don't write it down or anything, I just give myself a point if I was mindful and did it. My perfect goal would be to lose 1 lb per month, just so I know I'm losing, not gaining. If I do everything on the list I get 14 points MWF, 13 points T Th, 11 points on the weekend. I'm already doing most of the list--things I have to work on are getting to bed, taking a 20-30 minute nap (yay!), walking 2-3/week in the evening, and doing daily relaxation/meditation (mostly because I'm seeing a lot of anxiety clients now, and I need to remember how it works).

And just a little nudge with the eating. I plan to enjoy eating--recipes, cooking, eating out, salads, fish, pasta, breads, desserts.

That's all. I'll report later.

*Definitely skip this post if you think it looks boring--because it IS.

Brief Psychotherapy

I was going to post this on my professional blog, but thought better of it. It is pretty funny! Mary S. (another therapist) and I saw it at a marital therapy conference the day before Valentine's. She reminded me of it at our writers group last night.

Psych Website

I got my Dreamweaver upgrade, and Rob has been teaching me how to modify my website. Mostly I've been inserting links and putting pictures of flowers on it (which doesn't intuitively have a lot to do with psychotherapy, but oh well). It's a work in progress. Check it out and give me feedback.

The Problem of Sex in Marriage

There's a great post and discussion in comments over on feminist Mormon housewives about how wives and husbands handle differing expectations/needs for sex. In my therapy practice I have gotten to the point of wondering if every couple faces this issue. And it can go either way, I must say, although it seems like approximately eight husbands want more sex (at least after the first year or two of marriage) to every one wife who wants more sex. I've seen couples in both predicaments.

I really like the comment thread because I think every possible view and experience is represented. As a therapist, it is a hugely intractible problem with a lot of heat and very little light shed on it. So many people suffering, and all thinking there's something uniquely wrong with them (or their partner).

By the way, I wonder why it is that so many marriages start off full speed ahead on sex, or even with the wife saying she'd like more, but then ten or twenty years down the road he's feeling deprived and she's avoiding it whenever possible?

Why I Love My Job v.2

I just posted to my psych blog on something that happened yesterday at the ethics workshop I went to with Tammy, my office partner. In the post I wasn't able to get across the power of the experience, as this gentle, elderly lady, in her quiet voice, talked about what must have been an existentially challenging experience. As the Israel/Palestine conflict erupts into massacre, I can only remember that [some] individuals can come to solutions that states seem unable to. Hope comes in small packages. Sometimes my liberal nanny-state inclinations lead me to hope and push for big solutions, but they won't happen without many small changes of hearts.

Hooray for Dave and what he's trying to do. And hooray for my psychotherapist colleages, who are courageous and smart and a continual inspiration to me.

Treatment of OCD

One of the things I do as part of my volunteer work for the Utah Psychological Association is organize periodic brown bag luncheons where psychologists and others present to their colleagues for an hour on their topics of expertise. Here is a link to one of the most interesting recently. Mandi and Dr. Owens came and both talked about the long and arduous process of recovering from severe OCD--it has been her idea to go public, as another way of confronting her fears.

An admirable young woman. I mentioned here how inspirational her presentation was.

Amy noticed...

...that I haven't been posting much lately. Part of that is because I've been actually working, but part of it is also that I've started two new blogs and begun working on my psych website. You're invited to check them out:

Beowulf to Virginia Woolf: Walking the UK for past, present, and future students;

Claire R. Wallace, PhD, Preternatural Psychologist relating to my (ahem) other career, and

Karla Bennion, PhD., Psychotherapy and Evaluation, my professional website, which also contains a blog.

You are welcome to leave comments and suggestions on any of them.

Not to Snark on Only ONE Facet of the Legal Drug Industry

...I am also not a fan of our Utah home-grown network-marketing Orrin Hatch-protected "natural" "organic" "alternative" "homeopathic" "dietary supplement" drug-producing cottage industry. Not sure why I wouldn't be, since it's free of those interfering governmental regulations like "scientific testing for efficacy and safety" as well as "knowing the actual content of what it is you're selling people to take into their bodies." Like cocaine and steroids, to give only two examples from the workshop yesterday. And sorry for the lack of corroborating links to supporting evidence, but anecdote and testimonial are the highest form of proof, right? So take my word for it!

Things I Learned At My Psychopharmacology Workshop

...yesterday:
1. Adverse drug reactions (ADRs) are the estimated 4th leading cause of death in the USA.
2. An estimated 11% of hospitalized patients experience an ADR.
3. New drugs are often sold originally as a racemic mixture until the 14 year patent expires, and then re-released as an enantiomer or a metabolite--usually under a slightly different name--to take advantage of another 14 years of patented profits. Actual differences from the original are usually minimal.
4. Contrary to popular belief, all medications are habituating to some degree, as the body attempts to achieve homeostasis.
5. Anxiety often increases with SSRIs (antidepressants) before it decreases.
6. The number of new diagnoses of a particular disorder goes up in direct relation to the recent release of a new (patented, i.e., expensive) medication treating that disorder: e.g., Abilify-->Bipolar Disorder.
7. Current scientific opinion is that anxiety is a function of either an excess or a deficit of serotonin. (!)
8. Atypical antipsychotics may be the best drug treatment for OCD, when used in conjunction with antidepressants.
9. Antidepressants may be the best treament for anxiety.
10. Anticonvulsants and atypical antipsychotics may be the best treatment for mania.
11. The Next! New! Miracle! Drug! is likely to be a glutamatergic antagonist and/or a drug which reduces corticotrophin releasing hormone (CHR).
12. Most psychotropic medications--no matter their original treatment focus--operate on the dopamine, serotonin, glutamate and norepinephrine systems in various proportions. This includes antidepressants, antipsychotics, anticonvulsants, etc., etc.
13. Listen to us! We're doctors and scientists! We know what we're doing!
14. I wish I was a prescriber and could get me some of that yummy drug rep action.
...and, last but not least:
15. Rats are physiologically unable to vomit.

No More Dodging the Bullet

When I first heard of Proposition 8, the ballot initiative to rescind the legality of same-sex marriage in the state of California, I felt fortunate that I don't live there. I thought I wouldn't have to face, in any kind of personal way, the Church's reaction and involvement. When I heard of people in LDS wards in Washington and Oregon asked to volunteer time and donate money to the cause, I began to worry.

Last week we got the call in our ward in the Mormon heartland, Utah County. By now I'm not surprised. Instead I'm sad and sick about it. I passed on the sign-up sheet to make phone calls to California (along with information for where to get the talking points and answers to questions and objections people might have). Some of my friends and neighbors talked excitedly about the last days, sifting the chaff from the wheat, and fighting the battles of righteousness. I was heartened, however, to sense a bit of unease, even embarrassment, in others.

My sweet neighbor from across the street--at the time my visiting teacher--said not long ago, "it doesn't seem fair, and it seems like prejudice and discrimination, but the Prophet says it, so it must be right."

Ultimately, that's what it comes down to, for most of my Church brothers and sisters. I could talk about the benefits of chastity, marriage, and monogamy (which I believe in) for gay people as well as straight; I could talk about tolerance and charity and Christ-like love; I could even tell of the phone calls at two a.m., the midnight rush to my office or the homes of my patients, holding the hand of a sobbing young man or young woman, or worse, the hand of a white-faced mother or father in the emergency room while their child is behind the curtain gagging down the charcoal after an overdose.

But what it comes down to is "the Prophet says."

Many years ago during the ERA controversy, I realized that the leaders of the Church were willing to sacrifice individuals for what they perceive as the good of the whole. At that time I also realized there was nothing about me that Church leaders would find particularly valuable--if push came to shove, I could be sacrificed too. And I backed down. It was a womens' issue, I was a woman, if I had to I could live with it. Inequity based on sex had been around for a long time, maybe it would all take longer than I thought, but surely, the changes would come in my lifetime--

It was probably my first suicidal young gay Mormon patient who pushed me past this position of cowardice and accommodation. He said, "Why shouldn't I die? Why, really? I can live closeted and dying inside, or come out and lose everything and everyone I love. I might as well be dead. I have no hope of love and no hope of heaven."

At that moment I realized whose side I was on. Suicide makes me frantic, desperate. Maybe it's a weakness in a therapist. I scan the obituaries daily, morbidly, for faces of former patients, just as I scan the photos accompaning police reports. I look for a long time at the faces of young men and women for whom no cause of death is given, the ones described as "exhausted by the struggle here" or "gone to a better life." Early in my graduate training, two of my former patients killed themselves after their release from the State Hospital. I dream about it sometimes. I keep my cell phone charged and next to me day and night.

The Prophet says. But the call to obedience works only up to a point, and for me the point has been reached. I will not participate in a project that even indirectly, kills my patients. This is a life-and-death matter. I haven't yet decided what I must do, as well as not do, but I have a feeling that my low-profile, camouflage days are over. I feel scared and angry that it has come to this. What was merely irritating and exasperating about the Church's stance on women now violates my conscience and goes against my faith as a follower of Jesus as it applies to my gay and lesbian clients. I don't know what will happen when I go to Church day after tomorrow, or when I teach my Relief Society lesson in a couple of weeks. Silent acquiescence is no longer acceptable.

I love my job

Last night after a long day of psychotherapy (only six sessions, but seemed long), I thought, "why did I go into this field again?" It was a question I asked myself a lot back in the old days, when it felt like I just didn't know enough, wasn't compassionate enough, wasn't tough enough, wasn't confident enough, didn't have the right personality for, etc. etc. actually helping anybody with the unmanageable problems of their lives. But today I remembered why, again.

I organize a (sort-of) monthly Brown Bag series for psychologists to share insights and interests related to therapy. It is a way for me to get to know my colleagues and facilitate the dissemination of practical information--a professional public service (I inveigle people into presenting for free, at their own place, and sometimes even bringing refreshments). Anyway, today, the presentation by Mark Owens was on exposure and response prevention treatment of Obsessive Compulsive Disorder. Dr. Owens' client had herself suggested presenting as a sort of counter-phobic activity, and a public service of her own. It was great! There are ways to help people, and they are hard (oh my gosh is therapy hard) but they actually work. That's why I do it. Because it is down and dirty hard fighting with people's demons, and you can succeed. I love it.

News of the Week 7/20/08

The summer is flying by. Amy and Jamison moved into his mom Debbie's new house in Lindon this week, and we were sad to see them go. They will be able to stretch out a little there, I think, and more easily visit with Jamison's brothers from back east who are here on holiday. It was great to get to know Jamison better, and he certainly saw us at our normal condition, whatever that is (bathrobes, messy house, kitty crises, and all). Amy's working hard on the Chicago move. We're both so busy that we don't see or talk to each other much--I'm really going to miss her when she leaves next month.

Chris bought a used PlayStation and Guitar Hero III, and he so far hasn't done anything else this week. He says he's getting tired of it and might trade it back at GameStop at the mall for the money minus 20 percent. His way-cool pedal came, but he's still waiting impatiently for the guitar and amp to show up. He has to make up a foods class online before school starts (August 18), but he just growls at me when I mention it. Actually I think it would be fun. He is a good cook and interested in eating well. Maybe after he trades in Guitar Hero... I made him a copy of the car key, which he carries around on his belt loop, and uses to start the car if I leave him alone in it for a second. He is excited for drivers ed. I tried to warn him

but he doesn't listen.

John spent the end of the week at the Green Jacket ranch, cowsitting for Liz and Alan. He said it's still beautiful and green, because of the slow start to the season. He came back sunburned and tired, and said it was harder than he thought but he enjoyed it. I shouldn't complain about our little garden--what a huge job the Mitchell's have!

Chris and I missed the Vernon reunion last night, mostly because I am trying to finish the six psych evals I must send off before we leave for London on Friday. At least I've already done all the testing. I only have two more feedback sessions and then the writeups--oh, and a collatoral phone interview tomorrow with a family member for one of them. Five of the evals are for Voc Rehab and one is for the care center in Lindon. I am a slow report writer. Any kind of writing is a nervous business for me. I bite my cuticles and jiggle my feet and get up and pace and am very easily distracted away from actual work.

Dave and Devon sent photos around of their new loft in Philadelphia, where they will move on Sept 1. Maybe since Dave doesn't have a family blog, I will have to post the pictures here:

Dave is starting up a law practice and (as he said in his last message) blogging as the immigration specialist at this site beginning next month. Pretty exciting.

Rob and Nicolle are still deciding what exactly to do, I think. Last time I spoke on the phone with Rob, Nicolle was working at Tocanos in SLC, but I'm not sure how permanent that will be. Rob helped me build a new web site, Karla Bennion PhD, which is still sort of in the beta-phase until I get some photos and more text.

Next thing on my tech list is to invite J.Lynn over for lunch and have him help me order a new desktop, as my poor little 6-year-old Dell Inspiron laptop is totally outdated. The monitor went out, and I have it hooked up to a $10 used monitor from DI. My 2" by 4 and 1/2" external hard drive has more storage space than my main computer. (But the ASUS is sure fun. I took it to my office the other day and got onto somebody's unsecured wireless--should I feel guilty about that? is it dangerous? I take my 2 gb data stick with me and have every text file I've ever written in my life with 99% of the room to spare.)

Well, speaking of text files, I'd better get to the psych reports. My RS lesson went well today--this time I only had four questions and by pushing it a little got to three of them before the meeting was over. We do have a talkative congregation, which is good of course. Makes my job easier.

News of the Week 7/13/08

Not too much drastic has happened this week, which is good. John goes into his office MWF to read independent study lessons and graduate theses, as well as (most importantly) play basketball with his faculty group at noon. He also goes swimming with me--three times this week!--at the RB pool. I'm only up to 12 laps (1/3 mile), but he does 18 and has time to sit in the sauna before I get out of the locker room. What a patient man.

I'm riding my exercise bike every weekday morning, since the big scary ultimatum from my MD. Jamison rides it too--I'm glad we have it for both our sakes. I work two mornings a week (well, noons, actually, about 11:30 to 1:30) at the Alpine Valley Care Center in Lindon, doing evals and visiting with elderly patients with various problems, from strokes to MS to dementia. It has been much more interesting than I anticipated at first. The end of life is in many ways as important and varied as the beginning, and, since it happens to all of us, there's no reason to avoid talking or thinking about it. I remember after Lucy died how differently I felt about death. I think a lot of my reaction then was due to the blow of her death, but this time it feels like I'm regaining some of that objectivity, or maybe just increasing my comfort level with the idea of getting old, dying, and then being dead. The patients I visit with talk about their own deaths with equanimity and often impatience.

I see private patients at my office in Orem on Tuesday and Thursday afternoons and evenings, with sometimes an emergency appointment on another day. Betsy has helped me get on more insurance panels, and I'm doing a lot of testing and therapy for the Utah State Office of Rehabilitation. Right now I have plenty of work, and I'm trying to figure out how to do it more efficiently. Especially the report-writing. Not taking time out for blog posts might help.

I'm also still going to my weekly SFF (science fiction/fantasy) writers group on Tuesday nights. I haven't really worked on my vampire novel for ages, however. I know what needs to be done, I just haven't figured out how to write the way John does, in between and around everything else. I'm excited about the next story, which is Mormon werewolves. Betsy helped me order a new mini-laptop online (an ASUS ordered through Costco, 9" monitor, 12 Gb, Windows XP loaded, 2.18 lbs, but I'll spare you the photo) and I'm looking forward to spending time writing during our trip to England in a couple of weeks, while John's at his Hardy conference. I have a little portable 26 Gb hard drive and a bunch of 2-4 gig data sticks to go with it, so I should be able to take all the photos I want. It can do internet too, so I'm hoping to figure out how to blog from there. Maybe our B&B or wherever we're staying will have Internet access. John wants to go to Cornwall and the fen country (maybe stay in Cambridge, Coventry,and/or Nottingham) as well as Dorset on this trip, rather than spending any time in London. It looks like we might be deciding what we'll do after we get there.

Yesterday we went up to SLC, the Aves, to visit Brett & Betsy and Rob & Nicolle, and I forgot my camera! The babies were sleepy anyway, but with them living so far away, any chance at photos should not be missed. Rob is building me a psych blog. I bought 5 years of website server and 4 years of domain name (or the other way around, I can't remember) for a little over $200. We looked at a few local psychologists' web sites, and Rob was not impressed. That's the other thing I should be doing instead of blogging--getting the info together to send him. Oh well.

John, Chris, and I went to Hell Boy 2 yesterday, and it was a lot of fun. I can't resist sending you the Barry Manilow video that goes along with it. If you are into demons, fairies, elves, governmental bureaucracies, and Armageddon, this movie is for you.