Revealing Weaknesses of Mental Health Professionals & Diagnoses

The other morning I was enjoying my morning routine of coffee and news when I came upon Dr. Frances‘ (psychiatrist and former chair of the DSM-IV Task Force) comments on Trump.  If you don’t know, there’s been a ton of debate among psychiatrists, psychologists and other therapists on whether or not we have a duty to comment upon the perceived mental health of public figures who are in positions of power.  Frances’ comments addressed this topic as it relates to Trump and I found two sources.  The first was a short piece he wrote in Psychology Today months ago and the other is from an interview with the Verge, which was what I found on this particular morning.  As a regular person and as a Clinical Psychologist, I was frustrated but more disturbed than anything.  I’ve witnessed many mental health professionals that are in leadership positions get a lot wrong, and in some big ways.  Frances’ comments are concerning to me because he’s been heavily involved in the development of the DSM.  While this article focuses primarily on Frances, I also want to raise issues related to therapists needing to improve their level of psychological insight and health regarding themselves, and also point out that the DSM does not diagnose relationships.  I find both of these extremely problematic and upsetting.

1 |  Rejecting a Diagnosis is to Diagnose Someone

Those who use the DSM are advised to not diagnose at random, not to diagnose people whom they have not met, not to diagnose people who are not their clients, and that a diagnosis should not be publicly made unless it is the client disclosing this information.  When a diagnosis occurs, a process called “Ruling Out” happens at the same time.  “Ruling Out” is when a clinician (e.g., psychologist, psychiatrist) determines that a client does not meet the criteria for a specific diagnosis.  In order to do this the clinician has to know the person well enough or have enough information about them in order to say, for certain, that the diagnostic criteria are definitely not met.  In this way, to say that someone does not have a diagnosis is to diagnose them, which is exactly what Frances did.

Frances said, “The psychiatrists and psychologists who are now publicly diagnosing Trump feel compelled by the higher call of national interest to break any restrictions against diagnosis at a distance.  But the argument fails because their diagnosis is poorly informed and simply wrong.”  Yet, Frances says directly that Trump does not meet the criteria for Narcissistic Personality Disorder.  How can he say that when he’s not supposed to diagnose anyone publicly, from a distance and without adequate information about the person?  He can’t but does so anyway.  As a result, Frances contradicts himself and has grossly misled the public.  But this isn’t the most concerning thing about Frances’ statements.  But before I continue picking apart his comments I think it’s important to note that he has some good points in these two publications.  Given the outrage, they could go unnoticed.

2 |  Not All Bad

First, Frances’ comments seem to be complex and nuanced, which is what I would hope to see from any clinician.  As much as the human brain wants to over-simplify facts or reality, it’s always infinitely nuanced.  Consequently, not all of Frances’ statements are bad or without merit.  From my perspective, about half of what he says is worth considering, is accurate or possibly helpful.

First, diagnosing from afar is dangerous and our egos often have more to do with this than a desire to protect others (though Trump may be a very real exception to this for some clinicians).  The average person generally doesn’t understand the many layers of thought that go into the process for diagnosing.  This isn’t because people are dumb but rather, they just haven’t gone through the extensive education and training that it takes to adequately consider a diagnosis.  No amount of personal reading or Google searches can equal this training.  This is why diagnosing should be left to the professionals.  Everyone should know that such an exercise, though seemingly simple, can be very complex.  Professionals can also have different opinions or diagnoses that are often valid, and this can confuse the average person but for the professional it makes perfect sense.  While Frances is right that clinicians should avoid diagnosing from afar, he violates this himself.  I’m interested to know how he didn’t catch that or if he did, did he think that the rest of us wouldn’t notice it?  Obviously I’m just guessing here in an attempt to understand his large error.  Regardless, I think that there’s also something to be said for professionals to taking action when someone is acting in abusive and manipulative ways.  As I see it, Trump (like many other politicians) is abusing the American people and manipulating them in so many different ways.  If there isn’t something unhealthy or diagnosable about these behaviors then I think that there’s something very wrong with the DSM and those who support it.

Frances made another good point and it had to do with scapegoating.  He said that we need to be cautious about pointing the finger at one person, Trump, who is supposedly the source of all of our problems.  On this point I definitely agree.  Humans prefer simple answers and when things go bad, they (we) want something and someone to blame.  Interestingly enough, this is our own narcissism at play because by dumping the blame onto someone else allows us to walk away from the situation squeaky clean.  So when Frances says that Trump isn’t causing the world’s problems, I believe he’s partially right.  Where he’s wrong is that Trump is causing some major problems and making a variety of social issues much worse.  The fact that there were enough people to put Trump into office shows us that there are much bigger societal issues at play.

These involve the dominant societal definitions and approaches to mental, physical, social and environmental health.  Right now I would say that our definitions and approaches are weak, often misguided and that our country has always struggled with excessive arrogance and narcissism.  Unfortunately, doing what is healthy for us, on an individual and collective level, is generally not very popular (unless it increases our narcissism) and as a result, the rate of improvement in these areas is painfully slow.  Trump seems to be the ultimate expression and symbol of the selfie, our social media tendencies, our greed, our abuse of others, our racism, our ignorance, our misogyny, our admiration of narcissists and abusive people, and the privilege of white men, Christians, the wealthy and conservative people, and so on.  So yes, let’s not scapegoat Trump.  He’s one problem and then we have all of the problems that I just mentioned.  These are the sicknesses that are present in each of us and throughout our society.

3 |  Politics Over Truth, Mental Health & Public Welfare

For me, the most disturbing thing that Frances says to the Verge is, “We [made] the decision to introduce narcissistic personality disorder in DSM-III and I wrote the version that’s still used now.  The decision to include it was purely for clinical purposes and we never dreamed it would result in the diagnosis of NPD being used in political warfare now.  I think that if we’d had that thought along the way, we would have thought twice about including it.”  Wow.  Those who meet the criteria for NPD and hold leadership positions cause so many of the problems in the world, in our communities and in our families.  They can take advantage of others, they belittle them, they disregard anything that others say, they’re greedy, they’re manipulative, they destroy, they’re without regret or remorse, they lack empathy, they distort reality, they destroy the environment and they are deeply, deeply troubled.  Yes, there are problems with the misuse of diagnoses within the general population but this DOES NOT mean that we should prioritize politics over accurate diagnoses.  We shouldn’t hold back from labeling an unhealthy behavior because people in the public eye might be slandered.  We should work to counter slander but we shouldn’t sacrifice truth for it.  Yet, if this is truly what Frances believes then what about all of the other disorders that are tossed around or slapped on so many?  NPD is much more prevalent in men and he didn’t make any comments about those disorders that are overused and misused for women and children.  Does he wish to change all of them to avoid possible slander, public misperception and consequently degrade the validity of a diagnostic label?  Or is his particular focus on NPD revealing his privilege, bias or blindspot?

4 | Privilege Revealed

Another sizeable problem with Frances’ comments is that he seems to approach the subject of mental health as though he has the final word on the subject and its definitions.  His statements are presented in a way that seem to suggest that he has or believes he has the absolute right to define mental health…for all of us.  For me, it comes across as a bit self-aggrandizing and this is quite ironic given the topic of conversation.  To say that someone is not disordered “because these traits don’t cause him distress” is absolutely absurd.  From the looks of it, many serial killers and criminals aren’t distressed by their actions.  Does this mean that they don’t have serious mental health issues?  Of course not.  So how can Frances, someone who’s influenced the DSM significantly, maintain these views and expect us (psychologists and other clinicians) to use his definitions and diagnositic book?  Why wouldn’t we begin to question the whole system to ensure that there aren’t more distorted influences on the core resources that other clinicians use?  Regardless of whether or not Trump’s public personna is real or not, I believe that a person who chooses to conduct themselves as he has should not be considered mentally and emotionally sound.

Though we hold advanced degrees in our fields, Frances and I (or anyone else else for that matter) are not in the position to establish, absolutely for all people and cultures in the world, a definition of mental health and that of mental illness.  We are not the final authorities because we cannot speak for everyone, every culture, every country and every related field.  Yet, some of those is our field believe that they have the right to make such declarations.  Why?  Because of privilege.  Even though I believe that there are many issues of privilege present in Frances comments, I’d like to focus on his declaration.  This is because people could run with this and they have the potential to use his statements to support their own biases and perspectives.

While I don’t believe that any of us can claim something absolutely, I do believe that we should voice our views on a given subject matter, especially when its within our profession.  I think if we’ve studied and worked within a field for a long time that it’s important for us to throw our views out there for people to consider.  This is one of the primary ways in which we advance and mature as a species.  But we have to be careful when we toss things into the ring and this is where Frances went wrong; he didn’t “IMO” enough.  Though this phrase seems so overused, I believe it’s a good trend because it emphasizes that no one is the ultimate authority over a thing.  It recognizes that a person’s view is one of many.  If it is sincerely meant, then it is a humble acknowledgment of our collective or socially constructed reality.  Frances would have faired much better had his contributions embodied this philosophical and social position.  From my perspective (aka, IMO) and as a person who’s studied psychology for over 30 years, our individual level of mental health is largely determined by our ability to adapt, handle stress and how we conduct ourselves in relationship to the world (i.e., people, animals, environment).  And yet, this is where the weaknesses of the DSM are revealed because it has no diagnosis for relationship patterns.

5 | The DSM Lacks Relationship Diagnoses

This is probably where eyes will start to glaze over, if they haven’t already, but I’m going to make this short so hang in there with me.

The DSM is a narrow in its focus and extremely biased in its approach to diagnosing.  It’s based upon the conditions of an individual and a diagnosis is determined by observed behaviors or traits and statements the individual reports about how they feel about themselves, others, etc.  Simply put, a diagnosis from the DSM is viewed as medical diagnosis (though that’s in theory…but I won’t get into that).  One of its huge weaknesses is that it has failed to derive relationship-based diagnoses.  If an individual physically, sexually or psychologically abuses other people, there’s no diagnosis for this.  What a clinician will try to do is to give them an individual diagnosis such as Antia-Social Personality Disorder or something to that effect.  So if a person is an abusive predator of others but it never bothers them, disrupts their life or if it fails to meet existing criteria in the DSM, then they won’t have a diagnosis.  Of course, this is if we follow Frances’ example and his reasoning.  This would be like us saying that Jeffrey Dahmer wouldn’t have received a diagnosis until he went to prison because his behaviors finally disrupted his work-life balance.

We still have a lot of work to do in this field and despite issues such as these, I’m glad to be a part of it.  All of us, and I mean all of us, just need to work hard at being better for ourselves and others.  The culture in the U.S. rewards some of the most troubled people and even puts them on a pedastal.  I can only hope that Trump’s example will show all of us just how destructive, mean and hurtful such traits are and then we can alter this trend.  Who knows, being humble and psychologically healthy might actually become popular one day!  Well, I can always hope.

What Meditation & Mindfulness are Really About

 

As a long-time meditator and Buddhist, I am increasingly concerned about the level of appropriation of meditation practices.  I am especially frightened by people and professionals who claim to others that they are knowledgeable on the subject, to the point of calling themselves teachers, but who clearly promote a harmful and grossly misguided version of meditation.  What concerns me the most about this situation is the harm that these unqualified individuals can do to those who aspire to learn.  Not only can it result in the worsening of people’s internal difficulties, but it has the potential to turn them off to something that could otherwise be immensely beneficial.  Consequently, this article is going to be corrective and informative in nature, and it’s my attempt to counter the harmful information that too many are promoting.

Our Addiction to Happiness is the Problem

One of the biggest mistakes that people make coming in to meditation is that they believe that it’s all about feeling amazing…but it’s not.  Meditation is about developing certain mental capacities and this sets the stage for us to, possibly, experience greater satisfaction in our life.  I can’t say it enough, meditation is not about sitting and being happy…but we have the potential for feeling positive and uplifted during or after a meditation session.  Though, we might end up feeling scared, sad or even angry.  In the end, it doesn’t matter how we feel as a result of the meditation session because it’s like exercise.  Sometimes we don’t have a “good” workout or feel like exercising, but we know it’s good for us, right?!  Meditation is the same way.  Meditation is not about our addiction to happiness, it’s about learning how to fully utilize our human abilities and to enhance them.

When we have an addiction to happiness, we are constantly trying to experience higher and higher levels of it.  This is akin to an addict, and addicts have a very hard time experiencing or tolerating what they don’t want or like.  The stronger our addiction is to happiness, the greater our unhappiness will be and the more we’ll experience it.  As is taught in many traditions from the East that utilize meditation, this addiction is highly problematic and the source of the problem.  So when I see or hear of people promoting meditation and espousing that we should be addicted to happiness I feel disgusted.  My first thought is, “You’re poisoning them by telling them that the source of the problem is the solution!”  When I see and hear these messages, I cringe and wince with a deep disappointment and sadness, and I urge you to reject them or at the very least, question them thoroughly.

Contentment is the New Happiness

Happiness is typically thought of, at least within the dominant culture of the U.S., as a constant state of elation or joy.  We imagine people always smiling, engaging in life with energy and intensity, and they never experience any problems that shake their ever present good-mood or positive view.  We see this depicted in television and people often present themselves this way on Facebook.  Unfortunately, all of it’s a big fat fiction, and we would all do well to disregard it all.  However, we shouldn’t swing to the other end and become completely cynical or crotchety.  The middle ground is what we need…and this is where we find contentment.

Contentment is amazing.  It’s not only very possible to experience a state of contentment, but it’s better than elation and joy because it has immense staying power.  This is because contentment doesn’t require anything or any energy.  In fact, it can be quite rejuvenating.  Joy and elation are peak experiences in response to changing internal or external conditions.  Contentment, on the other hand, is based on nothing except for our consciousness and it requires no energy.  Yep, all you need to be is alive and have the capacity to be aware.  The reason that meditation can help you experience contentment is because it’s practices are deliberately aimed at doing things so that you can hang out in your most basic awareness.  The natural by-product of our basic awareness is contentment and a sense of feeling spacious, warm with a cool mist, light as a feather and even subtly fluffy.  But be aware that these sensations aren’t the goal and that meditation is not about contentment, but we may experience it as a side-benefit.

At this point you might be thinking, “but I can’t meditate all of the time, so what’s the point?”  Exactly, and great question.  There are many different meditation methods that are aimed at helping people improve the relationship that they have with their own mind, body and emotions.  Through meditation and various contemplations, we come to understand how the human mind works, how we get caught in our mind’s BS and how we can continue to hang out in our basic awareness while we go about our day.  This means that meditation takes some effort.  The better we are at focusing our awareness, learning and growing, and hanging out in contentment, the better able we are to birng our practice into our entire life.  So the ultimate point of meditation is to always meditate, regardless of what you’re doing.

 

It Takes a Little Work in the Beginning

All of this may have popped your bubble, but hopefully it doesn’t discourage you from going down the meditative road because it’s well worth it.  In the beginning, meditation can be tough and it’s important to be curious about your practice and your experiences (on and off the cushion).  As meditation becomes more familiar to you, it’ll be a place that you’ll want to go more frequently.  Initially, it can be uncomfortable and very confusing, but everyone gets the hang of it if they keep with it and maintain an open mind.  Just be careful not to assume that you know everything about meditation and yourself.  The finer points and deeper insights (even into simple things) can take some time to get down.  As a therapist and meditator, I’ve experienced many people who claim to know everything about meditation and their own mind…these are typically the people who are the most ignorant, poorly practiced, misguided and unaware.  So don’t fall into the trap of arrogance, but don’t go to the other extreme.  Lastly, remembered that it’s called practice and like exercise, you should always do at least a little every day to maintain your health.

Clarifying Mindfulness  |  It’s not Meditation

Mindfulness is only one aspect of consciousness and simply put, it’s our natural ability to be self-aware.  To use it to the fullest potential we need to max out our ability to concentrate and deliberately pay attention to a specific thing.  The most effective way to do this is to concentrate on something that is extremely simple, small, boring and constantly moving.  This is why the breath is the wisest choice.  Our breathing is extremely simple and it is ever flowing, which requires us to maintain our focus from moment-to-moment.  So when people say that they practice Mindfulness, I always ask about their specific practices because too many people use it as an avoidant technique.  In fact, people are taught to use it as a way to avoid…which I strongly discourage.  Yet the question remains, how can we recognize mindfulness or the lack of it in our own experience?

Imagine that you’re sitting and meditating.  You just started and your awareness is on your breathing and various thoughts are coming and going.  You continue to practice but then all of a sudden you realize that for the past few minutes you were off in some though, fantasy or even falling asleep.  Where did you go?  Where you went was the realm of the automaton (aka, automatic human being).  You were physically there…but you weren’t mentally there.  Then there was a flash of mindfulness where you were “fully” aware of what was happening.  In that instant, you recognized that your attention had drifted away.  At the same time, you recalled your meditation method (e.g., posture, breathing) and re-engaged it.  In this example we can see where mindfulness was and where it was not.  The trouble is noticing when you’re away during the day.  The hardest part is noticing when we’re acting on habit but our mind tricks us into thinking that everything is deliberate…that’s a tough one!  And so you know, nearly all humans are not completely mindful throughout the day and this is because we, like other animals, run on habit and automatic in order to conserve energy.  We often trick ourselves into thinking that we’re mindful but that’s usually because it’s psychologically scary to think that we don’t do a lot of things for very specific reasons and within our awareness.

Final Thoughts

So as you approach a possible meditation practice, equate it to an exercise regimen.  Ease in to it, learn as much as you can, and try to make it a lifestyle change rather than a temporary thing you do.  Keep in mind that sometimes it’ll be great and feel really good, but that there will be plenty of times where it might really suck.  The biggest difference between exercise and meditation is that your underlying psychological stuff can creep up and potentially freak you out when you meditate.  If you’ve experienced traumas in your life, tread lightly and get some good support before you venture into it.  This just ensures that you have a bit of a safety net before you decide to jump in, and it can’t hurt to have it.  Even if you haven’t experienced any traumas it can be extremely helpful to enlist the help of a seasoned and knowledgeable meditation practitioner.   And finally, remember that meditation is not about forcing happiness.  Rather, it’s a way to tap into your innate human potential and when you do this, you just might experience a greater amount of contentment and enjoyment that’s only based on living.

5 Months Without Carbs: A Personal Account

For those of you contemplating dropping carbs and processed foods to give the Ketogenic Diet a crack, I thought I’d offer my experiences.  To give you a back drop, I’ve been on a few different diets through the years.  Generally, my goal has been to try out a new way of eating to see if it helped me lose weight and if it was something that I could adopt as a lifestyle.  In fact, adopting it as a lifestyle was my biggest hope.  I’ve tried Atkins, South Beach, the 6-Day Body Make Over, and now the Ketogenic Diet.  Atkins and the 6-Day Body Make Over were initially used to quickly drop weight, but I wanted to see if the core principles could be combined with other diets.  This is the longest stretch that I’ve ever gone with one of these diets, and I’m starting to think about how and when I might move toward a diet that includes carbs.

Ketogenic Diet Basics

Fat…this is your main source of energy.  Protein is next, and then carbs.  The goal is to to keep the total number of net carbs (carbs that are not fiber or sugar-alcohols) no more than 20-30 grams a day.  This way your body burns through all of its sugar stores.  Your sugar stores  consist of blood sugar and glycogen stores (often in water weight).  Once your body has burned through these, it switches gears.  This is when your liver starts converting fat (consumed fat and body fat) into energy.  Thus, it produces ketones that your body uses for energy (ketosis).  However, because your brain needs a tiny bit of glucose each day, your body will convert a small amount of protein (your muscle or protein you consume) into a replacement carb.  Regardless, it’s much easier to lose fat on this diet because you’re constantly burning fat.  If you keep your caloric intake slightly below your daily allowance, losing weight is pretty easy and consistent.  At first, your weight loss is water loss, but after a week of 20g of carbs or less a day, you should be in ketosis and the fat starts to get used.

Learning to Eat Differently

It wasn’t too bad in the beginning because I was very motivated, but I had to watch everything I ate like a hawk because I wasn’t used to eating in this limited way.  Most diets involve a great deal of carbs so it can be a bit tough, but doable.  As time went on, it became easier because everything became a habit.  Sure, there were tendencies to go toward carbs, but my high motivation made it easier to stay away.  If your motivation is lower, it’ll be tougher.  After a while, I quickly knew what I need to stay away from or limit.  As with any diet that is contrary to the mainstream diet, it requires us to cook a lot for ourselves, and that’s what I’ve needed to do.  To make it easier on myself, I focused on how to cook on the weekend and use left overs for much of the week (dinners and lunches).  Fatty meats, cheeses, oils, butter, cream in my coffee, and lots of carefully chosen veggies are typically found in my meals.  However, if you’re not a meat eater, this diet may pose some additional challenges for you.  If you’re vegan, well, I have a hard time seeing this diet working for you.  Regardless, it is possible to adjust to, but you’ll need to cook.

Feeling Hungry is Different

When I get hungry…I’m just hungry.  There isn’t a madness the comes up in me where I have to get food.  And when I’ve become really hungry and eat, I don’t eat much more than I normally would.  I used to go overboard when I ate carbs, but I don’t now.  Also, it seems to take a little bit longer before my hunger goes away.  My guess (this is totally a guess) is that it takes my body longer to process what I’m eating.  Therefore, I’m thinking that there might be a delay between eating and the nutrients getting into my system.  So, the hunger can linger a bit but it does go down quickly.  Also, my emotional eating has really gone way down, which is awesome.

Emotional Eating and Our Brain

When we eat, especially higher carb meals, our brain gets much higher doses of dopamine and serotonin.  Both of these neurotransmitters are “feel good” chemicals.  I think the real reason that Americans are so overweight is because our mental health is poorer.  Anxiety, depression, and too much stress bring our “feel good” chemicals down.  As a result, food becomes a natural anti-depressant…but then we feel depressed again as we gain weight.  This is a very sick cycle and one to be cautious of.  Now, I’m definitely an emotional eater and so I’ve been known to binge, which I’ve loved and hated, but with this diet I have never binged.  I have emotionally eaten a little, but I don’t get the same neurological benefit (increases in serotonin and dopamine) as I used to.  Consequently, eating doesn’t reinforce feeling better.  Instead, eating is to eat, and then I’m done.  I really love this diet for this reason because I was really tired of the intense ups and downs.

Lots of Veggies and Keeping Regular

One thing that I love about this diet is that I am forced to eat a lot more veggies.  It’s pretty awesome.  Roasted Brussels sprouts with bacon, broccoli with some cheese, creamed spinach, etc.  There’s so much you can do.  Now, some veggies are higher in carbs, and this is where people who take this diet on have to watch their consumption and choices.  Especially if your focus is to drop weight.  And sadly, when you’re trying to keep the carbs super low, fruits are really an option, unless you have….maybe….one bite.  But I tell ya, you can make stir-fries like crazy.  What’s more, veggies help you stay super regular and this will help things move through your system and make you feel thinner.  Some people have complained that this kind of diet isn’t good for your digestive tract, but I’m not so sure this is true.  Mine feels great.

Better Energy and Water

When I was eating any and all carbs, my hunger would frequently spike and sugar cravings were intense and frequent (I can be a bit of an emotional eater, so that never helped).  However, when I cut out sugars and ate only brown rice and quinoa, the spikes of hunger and cravings were less, but kinda still there.  After a couple of weeks on this diet, my cravings totally tanked and my energy became level and enjoyable.  I don’t have severe dips in my energy and I don’t need my afternoon caffeine to help me deal with my post-lunch hangover.  Now I don’t feel supercharged, but my energy is very steady.  When I exercise (which need to happen more frequently), it’s a little bit of an adjustment.  However, I can’t give you a full report because I have yet to get to the gym on a regular basis and exercise like I used to.  But if you do a search, I’m sure you’ll find others who report their experiences.

Also, my water intake is awesome and you need to keep the water flowing.  This helps keep your energy higher, your blood cleansed so the ketones don’t build up too high (if you have extra ketones that are being used for energy), and as with any diet, water will help digestion.  I’ve found that I can consume about 50-70 ounces a day and I’m good.  I’ve consumed less, but don’t feel as good.  I’ve consumed more and don’t feel any different compared to my 50-70 ounce average.  Now, this doesn’t count the water that I get from my veggies or the coffee that I have in the morning.

Calories Still Count…They Always Do

Some people have been under the impression that this sort of diet gives us permission to be gluttons, but this is not the case.  Calories still count and if you over eat, you’ll gain weight, but it’s a little harder.  Too much protein will especially screw you up because the body will convert excess protein into a sugar and then use that for energy while storing (aka, gaining) fat.  So be aware of your caloric intake and remember that the more weight you lose, the less your daily intake will be.  If you exercise, then you can burn off a bit more and give yourself a little more leeway with your portions.

How Fast Do you Lose Weight?

I started this diet December 1 2015 and I was at 216 lbs (I’m 6′ tall by the way).  Within the first month, I went down to 210.  Over the course of the next four months, I lost 15 more pounds and am now at 195.  My ultimate goal is to reach 180.  I’m sure that I could have lost this weight quicker, but I was purposefully trying to make this a lifestyle change and as a result, I haven’t restricted my eating or caloric intake too much.  I eat what I eat and when I’m hungry.  So the weight loss has been gradually and there have been times when I’ve stalled with weight loss.  There are a lot of different factors that go into losing weight so there isn’t a way for me to tell you how quickly you’ll lose it.  Obviously, if you’re exercising the weight loss will go quicker.  But if you haven’t been working out, you may see your weight loss stall because you’re gaining muscle while losing fat, and muscle is heavier than fat.  If you’re in this situation, it’s better to go by how your clothes fit rather than what the scale says.  However, I would recommend getting a scale that does a full body scan.  This way you can see your fat and muscle percentages change.  I’ve purposely not worked out because I wanted to see how my weight would change without gaining muscle.  Now that I’m 5 months in, it’s time for me to start working out again…and this will help me reach my goal quicker.

Eat Earlier in the Day

One thing that I’ve found that really helps me drop weight again after stalling a bit is to make sure that I eat my last meal as early as I can.  I generally wake up at 5:30am and am hope around 4:30 pm.  I’ve made it a point to eat right when I get home so I have a solid 12 hours before consuming anything of consequence.  When I’ve done this, it helps my body burn more fat because it has a longer period of time without food.  If you try this, you’ll see a noticeable different in how slim you are the next day.  This is because things have moved through your body and then it starts to chip away at your fat stores.  When I wake up, I get some calories from cream in my coffee but I don’t have my morning snack until 7:45am.  This means that my body has gone 12-14 hours without food.  But what’s awesome is that I’m still not crazy hungry.  Of course, I miss eating with my fiancee, but sometimes I’ll snack with her when she has dinner at 8pm.  I don’t eat anything too big, mostly low calorie veggies.  And having veggies so often, especially things like broccoli, helps the food move through.  This also leads to us feeling thinner because we don’t have 2 days worth of food hanging out in our intestines.

Is the Keto Diet Hard on Your Liver?

First off, I haven’t conducted research or combed through various articles, so know that my thoughts are speculative, but I believe informed.  When we’re eating processed carbs and sugars, our pancreas gets hammered because it has to produce so much insulin.  At the extremes and over many years of abuse, diabetes sets in.  With ketosis, our liver is doing all of the work.  So, might the liver get a bit overwhelmed?  Sure, it might but I’m not sure.  If we approach this logically, then my guess is that it would after a while because it’s doing all of the work to process fat.  The Keto Diet is the extreme opposite of a high carb diet.  The ideal diet, which is my long-term goal, is to eat some carbs but to refrain from processed carbs (pasta, breads, etc.) and stick with brown rice, beans, and quinoa like carbs.  I think this is the ideal balance and probably the healthiest for our bodies.  Additionally, portions always need to remain balanced.  Too much of anything taxes our system and will surely lead to problems over time.

What About Alcohol?

I love wine, beer, creative cocktails, and liquor.  The variety of flavors and experiences in all of these are awesome.  However, if you’re going on the Keto Diet or plan to stick with it as a lifestyle, you have to make some pretty big adjustments.  With wine, beer and cocktails, you’ll get sugar and this isn’t good.  However, if you drink straight liquor (I’m a bourbon and rye whiskey kinda guy), you’ll fair much better.  However, ketosis will be interrupted as your body and your liver process the alcohol.  And alcohol does get used as energy first when you consume it.  If you haven’t eaten recently and you go for a drink, your buzz will be stronger but your body will burn through it quicker.  So, there are pros and cons to this.  Just know that ketosis will be paused until the alcohol is gone.

Headaches and Including Carbs Again

Last but not least we need to talk about headaches.  A few months into this I made a batch of cream cheese frosting for a coworker and as an avid cook, I try what I make to ensure that it’s good enough.  I debated on what to do here…and I ended up deciding to take a small spoonful to taste the frosting.  Wow was that a mistake.  Within five minutes I experienced the worst headache in my life.  My head was pounding like mad and my whole body felt completely off.  So not only was I in pain, but I felt slightly lightheaded.  What was really cool about this experience was that it helped me change my relationship to sugar.  Before this, sugar and fat together was the most delicious thing ever.  Now, it meant pain.  Talk about reducing your desire for sweets!  I also did a little test about a month ago where I tried some carbs, just to see how it felt.  I had a few falafels while at work and felt a little light-headed within an hour.  It wasn’t that bad but I did feel different.  To be clear, I’m not saying that this was a bad thing.  My purpose in trying the falafel was to see how my body would react and if I could jump to something like that when I start to incorporate carbs again.

What This Taught Me…

… is that reincorporating carbs needs to be a slow, deliberate, and a well thought out process.  Especially if I don’t want to return to having big cravings.  In fact, I think it’s important for everyone to pay more attention to how their body feels when they consume certain foods.  And I strongly recommend that you pay attention to how you feel, regardless of what diet you try.  And as always, check in with your doctor to make sure you’re not in danger of having some major problems.  Chances are they won’t like the Keto Diet, but it can’t hurt to check in with them and use their knowledge as a resource.

 

What Does It Mean To Get To Know Yourself?

As someone who was in therapy for 10 years during my youth and is now a psychotherapist, the notion of “getting to know ourselves” has always been vital.  But recently, as I’ve been speaking with some of my clients, it’s occurred to me that many of us don’t know what this statement means, exactly.  Some of us might think, “I already know myself, what more is there to do?”  Others might be completely mystified by such a statement or even scared about the endeavor to know oneself.  Having such a long history with psychology, personally and professionally, this task of knowing myself is automatic and intuitive for me…but it’s important to lay it out for those of us who are new to emotional and psychological explorations.  Consequently, this is the goal of this post.

Getting to Know Myself & The Basics

Humans, like all other animals, are all about patterns and this is the most important concept to keep in mind, regardless of how you’re working to know yourself.  However, because humans are so complex the task of seeing the patterns can be quite difficult and it can be rather overwhelming to find a starting point.  To make this task more manageable, we need to identify some major areas in our lives that we can turn our focus and attention to in order to learn about how we are.  These major areas consist of emotional responses, thoughts and beliefs, behaviors, preferences, interpersonal dynamics, and communication styles.  The tricky part is that each of these overlap and influence each other.  For those who are knew to what therapists call “psychological mindedness,” it’s best to take these one at a time.  As we learn to master our ability to observe our mind and body, we can start to look at how the patterns intertwine.  But again, this task will likely be too complicated for the beginner.

Where to Start

Get a journal.  Yes, many people wince at the idea of journaling, but it is vital to in making headway. If you’re working with a therapist, journaling will deepen your sessions because you will have reflected upon yourself and your life in a concentrated outside of sessions.  If you’re not working with a therapist, it will enable you to do the work that’s needed to learn about yourself.  What is it about journaling that’s so beneficial?  It’s an activity that supports a mental shift that doesn’t occur throughout our typical day.  All of us are active through the day and inevitably doing something.  Working, interacting, commuting, checking our phones, watching tv, etc.  Most of us don’t set aside time to reflect upon ourselves and our life.  Sure, we have passing thoughts but they are, passing thoughts.  Journaling is psychological and emotional exercise.  We walk throughout your day but to keep up your health, we often designate time to exercise at the gym or in some other way (or we at least know that doing so is good for us).  Journaling and therapy is our psychological and emotional exercise.  We won’t make gains without them.  Even meditation has it’s limitations and often isn’t very appealing to many of us.

What to Journal About

This is a tricky question because each of us approaches situations differently.  However, in an attempt to account for as many people as possible, I’m going to divide this into two ways.  On the one hand, you can journal about Anything and this is probably best for those who have a very negative reaction to too much structure and prefer to approach things openly in order to learn and explore.  Some people work better with structure because it helps them focus and have a plan.  If this is the case, choose one or two areas, mentioned above, and stay within those to start.  Another approach for structure is to write or talk about situations.  This way we can address all of the areas but the situation keeps us focus and grounded.  These are some good starting points but be open to how your journaling and therapeutic conversations develop and are most helpful.

Important Intentions to Have

Whether you’re journaling or in a therapy session, your motivation and intentions about the activity are very important.  Why?  Because they determine whether the activities are of benefit to you, both in the short-term and long-term.

Curiosity

Maintaining or developing a deep curiosity about any and all aspects of ourselves and of life is vital if we’re going to get to know ourselves.  If we find ourselves saying, “I know,” a lot, then chances are you’re not that open to possibilities and learning.  “I don’t know” is a really wonderful view to maintain because it means that you’re open to knowing and learning.  When journaling or in therapy, Curiosity shows up when we pause and wonder about something.  It shows up when we ask a question of ourselves or to our therapist and genuinely wish to understand.  If we have the habit of putting the period on everything, we won’t learn that much.

A Desire to Understand & Consider Alternative Perspectives

We are always getting feedback from he world, directly or indirectly.  We may ask others for their perspective or simply observe how they react to us.  To understand someone else’s perspective is good because we learn of different options, views, or ways of relating to things.  If we are focused on interpersonal dynamics, observing patterns in many people in response to us is very helpful.  Each person relates to and sees things differently and to learn of their perspectives is to identify possible options for ourselves.

Emphasizing Truth and Being Humble

Learning what’s true and real requires that we accept the fact that we might be wrong about many things that we think.  All of us do our best to make sense of ourselves and the world, but if we’re not open to realizing the truth then we run the risk of believing in a fiction rather than truly knowing ourselves and the world.  To arrive at the truth, we need to reflect, think, consider and even analyze what we know while becoming aware of what we don’t know.  Being wrong is actually a very good thing because it provides us with the opportunity to grow, learn, and adapt.

There’s More But…

I could inundate you with a great deal more because there are so many subtle things that happen for each of us during a journaling or meditation session, and when in therapy, I don’t believe more would be helpful.  For those who are beginners, this is enough and if you want and need more, this is where a good therapist that you connect well with is invaluable.  Just remember that as you begin this adventure and exploration, there’s nothing that needs to be rigid about the process.  In fact, being playful with your experience and to experiment are both helpful and support an open mind.  If you tend toward perfectionism or  the obsessive-compulsive approach, these tendencies will serve as your initial topics to explore.