Wednesday, March 30, 2016

No Matter Where You Go, There You Are

Twice this week, I watched people I care about struggle as they changed location or environment in hopes of “feeling better” only to find themselves feeling pretty much exactly the same in the new location as the old one.  Which is to say, not very good.

My father-in-law passed away about two months ago after a long illness, and my mother-in-law has struggled as one might expect of anyone who was married for more than 50 years, was his primary caregiver for nearly four years and suddenly finds herself without her partner and full-time job.  My husband and I took her down to Florida to stay with my brother-in-law; I think she felt perhaps the change of scenery would be helpful.  Yet, over lunch the other day, she confessed to me, “I feel just as out of place here as back home. I just thought it would feel different here.”

Similarly, my daughter Daisy Mae, who has struggled with an eating disorder, related addictions, and frighteningly unresolved anger issues from her early childhood, has changed her living arrangement four times over the last year – most recently a week ago. Some of these relocations were voluntary; others were at the request/insistence of others.  And the refrain at each and every change has been the same, “I’m so frustrated with all this bullshit.”  She simply doesn’t see the one constant in all this.

Sometimes, it’s human nature to believe that our circumstance or feelings are dictated largely by forces outside ourselves.  “This place…these people…this job…the way you hog the bathroom…I can’t handle it.  That’s why I’m sad/angry/failing/drinking/getting fired.  I just need to change it/you/them and then it’ll be okay.”

But here’s the thing: when your discomfort and your sadness and your loneliness and your anger are inside you, it doesn’t matter where you are or who is around you, because it all goes with you.  They’re always present. Same thing with depression:  if you’re depressed at home or at the library or at work, and you go to the beach, guess what goes with you?

One of my favorite short films is called “Demons on the Boat”.  You can see it here.  It’s about Radical Acceptance and Commitment and it’s a corollary to a piece I wrote right after Kiersten died called “Leaning into the Pain”.  It’s worth watching.  (The one immediately after, called "Passengers on the Bus" is also pretty awesome.)

Most people don’t realize…until they’ve had the “I’m still struggling” conversation more than once…or a dozen times for some people…that feeling better and finding happiness needs to start from the inside.  That takes a lot of work, and usually a lot of pain. Because sometimes the things that make us struggle inside are pretty damned overwhelming and sometimes they can feel tremendously unfair and we’d really rather pretend they’re not there. And often, getting through all that junk means finding a therapist and oh it's such a pain in the ass to break in a new therapist and tell that story AGAIN, and...I get it.  Believe me. Even if it doesn't take a lot of therapy (like when a loved one dies) it just takes a really long time. And sometimes, even with all the work and all the pain, the discomfort and sadness and loneliness and self-loathing don’t completely go away.  So it can feel pretty daunting. Changing the external can feel easier.  It rarely helps, though… at least not for very long.

It’s not that you can’t help to improve your situation through a change in environment or company, especially if you are making those changes in a planful way with an understanding of what and who you are seeking. The old proverb “lie down with dogs; get up with fleas” is a truth, to be certain, and choosing to surround yourself with healthy people if you are fighting addiction is always better than to keep re-infesting yourself by hanging around with a bunch of drunks and addicts.  But that external change only helps if you are ready/willing/able to work on the inside stuff.

And the payoff is enormous. Because if you can find peace inside, it doesn’t matter WHAT is going on outside, it’s not going to damage your success or happiness. (This is within reason, of course – if you’re being abused, all bets are off).  If you can teach yourself to accept the Demons on your own boat, give them a place to hang out and see with clarity the options and future that lay before you, you can make those mindful, planful decisions about where you want to be and who you want to be with.

In time...who knows? "Right here, with myself" might even look like a good option.


Sunday, March 20, 2016

Three Yards of Fabric

This post is about body dysmorphia.  If you don’t know what that is, you will in a couple of paragraphs.  

One of the joys of being an adult woman over 35 is shopping in your own closet.

If you’re anything like me, you’ve been more than one size as an adult.  For my own part, I’ve been as much as 20 pounds lighter than this and as much as about 45 pounds heavier. So I have about six different sizes of clothes in my closet.

Something to know about me: While I have *never* been skinny, I’m genetically blessed, sort of.  My mother came from a long line of wasp-waisted women, and my father’s family all are what I would describe as “generous” in the bust and hips.  I sort of got the more extreme from both sides. The result is that I’m ridiculously curvy. Like, Sofia Vergara curvy… in fact, if I took off the last stubborn 20 pounds, she and I would seriously have about the same measurements (minus my bits of everlasting post-baby tummy flubber). I work very hard to maintain my figure at a healthy weight and to be honest, I’m a little bit proud of the way I look, even if it’s mostly the result of genetic luck. Gah!  This sounds like bragging – that's not it.. I’m saying this to demonstrate a point.  You’ll see in a minute. 

Ok, so back to closet shopping…I have some travel coming up to warmer climes and was looking for things to take with me.  I lost the aforementioned 45 pounds pretty recently and so I have a whole section of the closet available to me that I haven’t worn in about 20 years.  I took out a couple dresses that I remember buying back in the 90’s and tried them on…and verily swam in them. There must be three yards of fabric in each of them. They were easily a full size too big, and ballooned to my ankles. I remember thinking they were really nice at the time.  Now they are so big as to be unwearable.

Now here’s the thing.  I remember buying these dresses. I bought them back in my pre-baby days when I was easily 15 pounds lighter than I am now. 

Read back up two paragraphs. Now do that math.

I asked my husband, “Was this dress this big on me when I bought it?”
He looked at me appraisingly.  “You were…shall we say…very busy hiding your body back then.  I call it the Frump Ages. You’re not considering putting that thing back in circulation, are you?”

I remember now that at the time I thought I was fat. I remember looking at my “embarrassing” breasts and “huge” ass and being ashamed by my curves. I remember thinking that I really, seriously needed to lose at least another 20 pounds if I was ever going to look attractive. I really did do everything I could to hide my body at the time it was at its full bloom.  

And I think now, “What. The. Actual. Fuck??” What was I so ashamed of?

What, indeed? Body Dysmorphic Disorder is the preoccupation with flaws in our body that results in a constant, unfavorable comparison of that flaw/those flaws with others and with our perception of ourselves.  About 2.5% of the population is afflicted with body dysmorphia, which makes it in the top three mental illnesses in the nation. It affects men and women equally, with most men thinking they are too skinny and scrawny and most women thinking they are fat. It is categorized as an obsessive-compulsive disorder, rather than an eating disorder like anorexia.  You very likely know someone who suffers from body dysmorphia; most people who suffer from it are self-aware enough that they don’t want to appear self-absorbed, so they hide their obsession well. 

While that 2.5% of the population suffers from body dismorphic disorder at a level that rates a DSM-V sort of diagnosis, there are a LOT MORE of us who suffer from varying degrees of body shame and unrealistic views about our bodies. We as a society can become so hung up on our skinny legs, or flabby arms, or funny butt, or acne scars or tummy flubber that it takes away from our joy, our inherent sexiness as humans or our ability to truly relax and enjoy ourselves.  And that's really a tragic thing.  Ladies, how many times have you heard a man say, "OMG, will you women please stop starving yourselves and let us see all those beautiful, squeezable curves you're supposed to have?"  Guys; heads up: We love you exactly the way you are. We really wouldn't know what to do with Joe Manganiello if you handed him to us.

I’ve been through a lot of therapy in the last six years.  Some of it has been focused on teaching me to love my body for the way it feels, rather than the way it looks, and eating and exercising based on how I feel. And now, I feel good. Better than good, in fact. I’m not playing college volleyball or anything, but I can hike 15 miles in a day and I can do 25 push-ups at a crack and I can climb 6 flights of stairs without supplemental oxygen and I can belly dance (ok, I look like a wounded wildebeest doing it, but I still have fun). And I’m not afraid to dress in things that cling just a little and I don’t hide those curves anymore.  

Ladies, gentlemen, if you are reading this, I have a message for you. You. Are. Beautiful. I mean it. If you want to lose weight or gain weight or work out more, do it because it makes your body strong and healthy and able to carry you to all the places you want to go, not because you don't feel good about how you look. And if you really don’t feel good about how you look, go talk to someone about it. You can learn to look past your flaws and see all the wonderfulness that is you.  If you learn to love your body, guaranteed you’re going to look more attractive to the rest of the world, too.

Life is short. Love every inch of yourself.

For more information about Body Dysmorphic Disorder, look here.

Wednesday, March 16, 2016

Why I Started Blogging Again

...and why I stopped to begin with…

I’ve had a lot of people ask me why I stopped blogging a couple years ago.  Honestly, I didn’t think anyone was reading my blog, so I was really surprised that anyone missed it.

So anyway, why I stopped?  Let’s just get it out there to begin with:  The last 18 months have been the toughest, worst of my life.  And if you’ve read beyond the first page of this blog, you know that’s saying a lot.  

The deaths of my father, father-in-law and uncle,  loved ones battling addiction, depression, and suicide attempts, financial crisis related to the aforementioned, as well as a flood that left me without a kitchen for 5 months, incredibly strained family relations and finally the discovery of several pounds of tumors in my lady parts, necessitating their removal and a five-week recuperation.

Yeah, it sucked.

So here’s the thing: That kind of stuff is really hard to write about. Now I know what you're going to say: I pretty fearlessly blogged through Kiersten’s death and the aftermath…how could anything be harder than THAT? But that was a personal journey. That was all about my feelings and my thoughts and my experiences.  By contrast, while I was really profoundly affected by what has happened in the last 18 months or so, very little of it was actually about me. This has been about other people whose story wasn’t mine to tell.  Let’s combine that with a new job that I really, seriously didn’t think I would ever learn to do well, and the associated panic and angst that went with that and really, there’s not a lot left to write about that’s anywhere near safe. Even if I could collect my thoughts long enough to write.

And as I said elsewhere earlier this week, sometimes our voices need to go quiet for awhile so we can hear the rest of the world and figure out where we belong in it.

Are things perfect now?  No.  But they’re better.  And I have enough of a sense of myself on my own terms again that I can start to write. I’m loving my job and doing it well, I think. While the family situation hasn’t been idyllic, it’s at least stable for now. And I have a working kitchen!

And there’s so much interesting stuff to write about again, stuff that takes more than the 30 words or so that make up a Facebook entry. Politics are as nail-biting as anything I can remember in my lifetime, I’m really digging on a lot of changes in healthcare policy, and there’s some really juicy science that is the foundation of all that and it’s really fun to debate and talk about. I’m not as actively grieving as I was for those first couple years after we lost K, (so Dear Readers, you don’t have to worry about the constant emotional ambush). Mostly, I’m not just treading water anymore and there’s time to reflect and think about what I think about now.

I’ll try not to be as preachy as I’ve been this past week, but good gravy there was a lot of material to work with in so few days! :-)  And I’ll try to sprinkle in the occasional cooking post and silly story when they happen (because Christy wants more cooking posts). 

So here we go again.  Thanks for being here.

Monday, March 14, 2016

Out with the Old

I saw a thing on PBS the other day about “Gray Divorces” – people who have been married more than 20 years who decide to split up and get divorced. They give a lot of reasons why it happens and some things to do to keep it from happening. It hit home for me in a really current and personal way. I personally know three couples – friends for decades, all of them – who are in the process of divorcing.  It can be a bit unsettling to watch. In many ways, the long-term friendships we form as couple are as strong as any family bond, and watching those bonds unravel can cause really significant distress and grief for more than just the couple involved. I can't judge the people who choose to divorce -- if you don't see a way forward, sometimes the better way is out. But importantly for the rest of us, it does raise the question of “why stay together?” when so many around you are splitting apart. In a lot of cases, it seems that the stresses that push one marriage over the edge are so close to the ones the rest of us face in our own relationships.

Mr. and I have certainly teetered along that edge more than once.  Sometimes more than once a month.  Makes me question sometimes why we haven’t split up the way so many others have, especially when you look at the statistics on what usually breaks up a marriage and we pretty much have 8 of the top 10 in our wheelhouse. 

So it begs the question: what DOES make some couples stay together? 

I think the answer is super-simple, at its root:  They choose to. 

The implementation of that choice can be a more complicated matter, to be certain.

The secret to a good marriage is, at its core, simply choosing to put the relationship first: in cases when the needs of one partner tread on the needs of another, it’s a choice to talk, to compromise, to find a place where both parties can feel satisfied and nurtured. 

In short: it’s a matter of a lot of really, really fucking hard work.

But more importantly, it’s a matter of being really, really aware of who you are and liking that person enough to be fully present and a little vulnerable and willing to do a lot of communicating.  It’s about not shutting down or walking away when it gets hard (and it does…sometimes several times a day).  It’s about keeping your mind and body healthy.  Really healthy, inside and out.  It’s about putting yourself in the place of your partner and thinking about how he/she feels when things get tough.  All of these things require understanding ourselves and liking the person we come to understand.  It requires forgiving yourself for all the stupid shit you’ve done in the past and making the decision to let yourself do it differently from now on. 

Because if you hate yourself, guaranteed you won’t be able to love your partner.

I think a lot of us, as we head into our 50’s especially, are in a place where we are making a critical assessment about how we have lived our lives thus far, and many of us find that assessment wanting.  And I think that often times, we are trapped in the mode of “I live this way because I live this way and there’s not a lot I can do about it” until we become so suffocated by our own inertia that we feel like we have to blow the whole thing up and start over. 

I’m not sure it has to be like that.  

With some mindful introspection, each of us has it within us to find those things that, if we changed them, would boost that self-love score a lot.  And here’s a hint: if you’re looking outside yourself for the sources of your unhappiness and inertia, you’re probably not focusing in the right place.  Look inside:  how do you spend your free time? If most of it is in front of a screen, that might be a really good place to start making changes. How much do you reach out with loving intent to others? There are a bunch of studies (and I mean a BUNCH) that indicate that if we are conscientiously nice to other people -- like, way nicer than we have to be -- we feel happier and more satisfied with ourselves. How about the way you talk to yourself? Have you ever taken time to really forgive yourself for all the selfish crap you did as a 20-something? If we can make a determined effort to give some attention and affection to that most important relationship -- the one we have with ourselves -- it can’t help but strengthen each and every other relationship we have, including with our life partners.

This is not to say that liking yourself is enough.  If your partner is in active self-loathing over the long haul, or suffers from uncontrolled behavioral illness or is otherwise an abusive douchebag, then you can like yourself all you want and it’s not going to work. Get out before you get damaged. But assuming all that stuff isn’t true, the best way to stay married is, in my opinion, to spend some quality time nurturing and loving the person in the mirror.

Because you both deserve it.

Friday, March 11, 2016

"Why Not Me?"

I work in a large academic medical center, and many of my friends and colleagues are involved in research – specifically research into how to treat human diseases and conditions.

This week, the nation saw the success – and subsequent failure – of its first uterus transplant. I think we all felt sadness for the brave woman who underwent the procedure, as well as for her family and her doctors. It takes someone special to be the first, because being first at anything usually means failing.

And as is usually the case when a “first” is announced, the debate over the use of medical research money has resurfaced.  I have written about this before, back when the first face transplant was performed here in the US.  I am a great believer that experimental transplants – and medical research more generally – is as important to improving the quality of life as it is to extending the duration of it. And as I’ll explain below, I have a hidden agenda here.

I’ve run research centers before and have seen first-hand that it’s a difficult rubric, trying to determine who gets funded and for what research. I think sometimes, as Americans, we have this sense that every problem is solvable, if only we throw enough time and money at it. In medicine, I see daily that this simply isn’t the case. There is just some stuff we can’t solve yet, because it’s just too multi-faceted or we haven’t found the magic bean yet. Beyond that, making a decision about what is studied and what isn’t – and by extension, what projects receive funding for study and which ones don’t – takes some magical combination “How much?”, “How many?”, “What are the chances of success?”, “Is the scientific foundation in place to make a leap?” and perhaps most controversially, “Who cares?”

This last one is a toughie; no doubt about it. 

The Who Cares equation itself is multi-faceted: The list of stakeholders includes the researcher him/herself (who needs to feel so much passion for the problem that s/he is willing to get kicked in the shorts for years trying to solve it), the institution (which even in funded research provides a lot more support than most folks appreciate), industry (who needs to be able to commercialize the outcomes in the case of a drug or device, to justify the huge investment in development), and yes…the media and the American public.  I’d be a bald-faced liar if I told you there wasn’t a sexiness factor involved.

Last year, I gritted my teeth and smiled through everyone making a big stir over Ebola and the truly obscene amount of money spent by the government, pacifying a panicked and shockingly mis-informed legislature and public, to build multi-million-dollar Ebola containment units.  I gritted my teeth because the chances of an Ebola pandemic here are somewhat lower than our country being wiped out by an apocalyptic meteor shower, but an infectious disease unit and procedures that can contain an Ebola outbreak will be equally effective to contain a really horrific influenza outbreak, too, and we are totally due for one of those.  Sometimes, we take advantage of the sexy to fund the decidedly un-sexy.

So uterus transplants?  Right now, they totally rank on the Who Cares list. Totally sexy. And important to quality of life for some – so important that they’re willing to take the risk of death to fulfill their needs. Who am I to say what makes a life worth living and what risks are acceptable or unacceptable to another human? Believe me, the people who sign up for experimental transplants are absolutely aware of the overwhelming risk of failure and death and disfigurement.  I’ve sat on the IRBs and the ethics reviews for these.  I’ve seen first-hand the consent process. I’ve reviewed the psych testing procedures. If they and their doctors are willing to take those risks, then I’m not going to castigate them for it. 

If it makes you all feel better, here’s the bigger, harder and less sexy pay-off.  Every time we push the boundary in transplant, the attention to anti-rejection medications takes center-stage, too. The community gets a little closer to completing the break-throughs that will make all transplants safer and improve the quality of life for those who receive them. We are really close now – less than ten years away, by my reckoning.  (maybe I’ll explain the process in another post) And that?  That will not only improve lives – it’ll save them. 

If your condition, or the condition of a loved one, isn’t on the list of what’s sexy this year, this can feel so unfair. We all know someone who suffers from cancer, rheumatoid arthritis, Lupus, asthma, congenital heart failure, type one diabetes…the list is endless.  It’s hard not to say, “Why them?  Why not me?  Why not my brother/sister/friend/mother?” My answer is that it’s not so much “not you” as “not yet”.  But someday.  I know what doesn’t sound fair, and it isn’t. If they ever put me in charge of the universe I’m putting “alleviating human suffering” on the top of the list.  Pinky-promise.  In the meantime, I think we will all imperfectly do our best to make good decisions.