Dietary Extremism

This is a sensitive topic, as many people feel badly about their weight, body image, and dietary habits. And many people have eating disorders, in which difficult relationships with food and with body image lead to a variety of behaviours that can do severe physical and emotional harm.
In this post, I wanted to address the specific phenomenon of what I call "dietary extremism". I consider the phenomenon to be similar to dogmatic religious belief.

Dietary extremism occurs as a result of people struggling to find some change in their lives that truly makes a difference for the better. They may have tried a wide variety of "standard routes" but continue to struggle with the same problems.

Extremism can often yield results for people, because it involves a radical change in lifestyle. It is something like joining a monastery. The lifestyle becomes more sustainable because of the community of fellow extremists (the other "monks in the monastery"), and because the community sets itself apart from the mainstream. The extremist beliefs are entrenched within the community, especially when members of the community are seeing significant changes within themselves for the first time.

Yet, the beliefs themselves are often extremely dogmatic and inaccurate. While I am a fan of permanent, positive life change, I believe that we must always stay attuned with the truth, always be open-minded to hear the facts, always be willing to question and challenge, always be wary of being told what to do by a guru-like figure (who, incidentally, may be making a lot of money and enjoying a lot of attention from fans, by selling books or running retreats).

A specific example that has come to my attention is the "raw food diet". Adherents have made substantial changes to their lifestyle. And, in my opinion, they are usually healthier for it. There is quite a bit of evidence that eating more fruits & vegetables, eating less meat, eating fewer animal products, etc. is part of good self-care. Furthermore, it is better for the environment, better to address world hunger (since raising animals instead of plants on agricultural land produces less nutritional energy per acre), and more humane (fewer sentient creatures need to be killed).

But most informational tracts about "raw food" are filled with claims that sound "scientific". The use of false or misleading pseudo-scientific claims is a typical tool used in charlatanism. This is one of the pathways that makes this potentially healthy dietary idea stultified by dogma. If you encounter statements about various types of nutritional degradation caused by heating, or about the miraculous virtues of some kind of oil (e.g. coconut oil), or about the advantages of choosing foods that are "less acidic", etc. I encourage you to be aware that there may be some dogmatic, charismatic salesmanship going on. The fact that these statements sound "scientific" may simply be fooling you. If you really want to know the truth, or what the evidence shows, then I think it is important to look closely yourself, at primary sources in reputable research journals.

The concern I have about the dogma doesn't necessarily mean that I think "raw food" (or some other diet) is a bad thing. I think it is a cultural practice, which has healthy aspects to it. Like other cultural practices, there may be a well-developed estheticism within it, leading, for example, to some really good recipes with raw food ingredients. The cultural practice crosses the line, though, into dogmatism, when it pronounces itself better than all other practices, and starts to support this claim using spurious or misleading information. All the while, many people are probably making quite a profit by marketing these ideas.

One of the phenomena often described in extremist groups is a collection of testimonial accounts from people whose lives have been radically changed for the better (e.g. cured of cancer, reached their ideal weight, felt healthy for the first time in their lives, etc.). While it may well be true that these individuals are genuinely thriving as a result of their new cultural practice, the mechanism of this change may be the result of very different factors than what they believe. Most any radical life change that leads to a sense of purpose, community, consistency, and meaning can have a transformative positive effect on an individual's health. I encourage such quests for purpose, community, and meaning -- but I encourage people to keep an open mind and to avoid dogma.

There are some good journals of scientific nutrition, such as the American Journal of Clinical Nutrition, and others. Abstracts are available on-line for free, and you can search on medical databases for information. Once again I encourage you to explore the evidence first-hand. When you read a claim about the nutritional virtues about this or that food, or this or that diet, be aware that you may be reading an ad, or an "info-mercial", and be prepared to search further yourself to clarify this kind of information before you make a needless change in your health behaviours.

Music

The intersection between music and emotion is complex.

Musical preferences or predilections are often very personal and individual, and are often coloured by a person's past history (e.g. some songs may be associated with positive or negative past life events). Of course, the musical styles that you grow up with often become those you permanently prefer.

I've noticed quite often that patients of mine who struggle with sadness or anger may choose music that has a sad or angry emotional tone. In these situations I worry sometimes about whether the music itself is "feeding" the negative emotion. An extreme example of this would be music in which the performer is screaming, often about how bad life is, where the listener--often using headphones that are socially isolative--is absorbed for hours every day.

But I think that music is an external experience that can touch us, or resonate with emotions. In this way a musical experience can help us feel less alone, more understood, more "in synchrony" with something outside of ourselves, even if the music is laden with the same kind of sadness that we may experience internally.

Therapeutically, I have to acknowledge the value and power of this kind of "synchrony". So I generally would never try to dissuade the fan of "screaming angry music" from continuing their choice of genre (besides, I would be just one more person unsuccessfully attempting such subjectively intrusive and unwelcome advice). Yet I encourage people to gently explore types of music outside of their familiar territory, and to search for music which goes further than emotional synchrony alone, but also soothes, calms, inspires, provides hope, gives energy, or gives a thrill of joy. Some of the great works of music can touch us in our sadness, and therefore "resonate", while also guiding us towards hope or even making us smile with delight.

Here are some specific examples (off the top of my head) which work for me (everyone will have different tastes, of course, but if you're looking for something different, give these a try) :

-anything by W.A. Mozart. the piano sonatas (exquisite, sweet); the piano concertos (poignant and sometimes sad but always ending with hope and joy -- and the tunes stay in your mind); the wind concertos (clarinet & oboe).

And very specifically a vocal piece by Mozart called "Exsultate, Jubilate"; the piece in its entirety is a distillation of the joy of life. The last item in this piece is the perfectly beautiful and energetic "Alleluia". In fact, I would go so far as to make this whole piece--including the composition itself as well as the performers and their backgrounds--a metaphor for joy in life: to have joy, one must work at it for years (as the performers have done). One must hear others and learn from others. One must pursue poignancy as well as virtuosity. One must have moments of tension and dissonance, but they must always be relieved imaginatively and beautifully. Some of the joyous moments may be brief, but they stay with us forever even after they are literally over. My favourite performer of this piece is now Carolyn Sampson. Kiri Te Kanawa was my previous favourite. I'd recommend listening to it on the best possible stereo system available to you.

Another specific selection is the Goldberg Variations by J.S. Bach as played by Glenn Gould (who made two recordings of this piece, in 1955 and in 1980 -- I'd recommend hearing them both, starting with the 1955 version; the final aria at the end of the 1980 version is like a sweetly beautiful farewell from one of the great musical geniuses of the century). Also there's a version by Murray Perahia which is extremely good too, in case you find Glenn Gould's playing too eccentric. This piece is another metaphor for life: it starts with something simple and beautiful; it moves through many variations with different degrees of motion, emotion, and energy, yet always with the same underlying grounding theme; then it ends beautifully and serenely, almost just as it began. Implying a cycle that continues yet changes, beginning and ending at peace, but with lots of work and tension and playfulness and growth in-between.

Other specific suggestions:
1) Chopin, Piano Concerto #1 in E minor, Opus 11. The second movement is an example of sublime beauty.
2) Beethoven: Violin Concerto. Beethoven had a difficult life as a result of his own inner emotional problems (lots of depression, irritability, anger, relationship disappointment) in conjunction with various external sorrows, especially the total loss of his hearing. His music is full of emotion and power; underneath the sorrow there is sweetly touching beauty and joy, and I think the violin concerto is one of my favourite examples. Anne-Sophie Mutter is a great performer of this piece.
3) Beethoven: slow movements from many of the piano sonatas, such as "Pathetique" and "Moonlight".

With all of these suggestions, I realize that for some people, they would just rather listen to something else (musical taste is such a personal thing). Also, when feeling very unwell in any way (emotionally or physically), sometimes even your favourite music can feel irritating or can make you feel worse (it may remind you, for example, of how much you could be enjoying it if you were feeling well; your lack of enjoyment when ill could then remind you again of your illness and make you feel worse).

OCD

Obsessive-compulsive disorder (OCD) is a common anxiety disorder. It is characterized by recurrent, bothersome mental or behavioural habits. "Obsessions" are recurrent, unwelcome thoughts or images, and "compulsions" are habitual behaviours (physical actions or sequences of thoughts) which often relieve the anxiety induced by obsessions. The symptoms can arise at almost any time in life, but often begin during childhood or during young adulthood. The symptoms often wax and wane over time, sometimes changing slightly from one type to another, sometimes becoming worse during stressful situations.

There are certain types of symptoms that are most common:
1) obsessive concern about germs or dirt, leading to compulsive washing
-this pattern can become so extreme that hours of the day can be spent cleaning, hands getting badly chapped from overwashing; there can be a lot of avoidance of situations (e.g. crowds, public transit, washrooms, shaking hands with people) where there may be a perceived abundance of germs

2) obsessive doubt, leading to compulsive checking
-those with this symptom frequently feel that they have made a mistake--sometimes a catastrophic mistake such as having left the oven on, or having hit someone with their car--leading to a compulsive need to go back and check to make sure this hasn't happened. A lot of time can be wasted going back to check and re-check. Often times people with this symptom realize their behaviour is irrational or excessive, but the feelings are so strong that they can't stop the pattern.

3) obsessive or compulsive symmetry: a need to assess the symmetry of things, or to make things symmetric. Sometimes there may be a need to do an activity (e.g. brushing teeth, or tying shoes) in a very particular way, and if something interrupts the behaviour, the symptom makes the person want to go back and start again from the beginning. A related symptom is a feeling of needing to count things in multiples, or do things a certain number of times (e.g. things have to be in threes).

4) obsessional thoughts: often these are thoughts about doing something forbidden or inappropriate; they often have a violent or sexual nature, and can be hard for people to talk about (people can be embarrassed or ashamed at having the thoughts). Symptomatic people often will interpret their thoughts as evidence that they are not safe or that they are losing their mind. The symptom can lead to avoidance of many situations (e.g. if the obsessional thought is about doing something aggressive, it may lead to avoidance of being around other people).

There are many other varieties of obsessions & compulsions, and it can be helpful to read an educational book on the subject. The OCD Workbook by Bruce Hyman is a good example.

There are two types of therapy that help most with OCD:

Cognitive-behavioural therapy is extremely important and has been shown to work. The main principles here are to educate oneself about OCD, to be able to recognize and pronounce the symptoms as they occur (i.e. to recognize in one's mind that "this is an OCD symptom, not a sign of insanity or dangerousness"), to stop oneself from doing the compulsive behaviours, and to practice exposure to situations that induce the symptoms (e.g. for the germ phobic person, the exposure therapy may be spending time with bare hands scooping soil in a garden).

Antidepressant medications which act on the serotonin system in the brain also reduce OCD symptoms.

Typically, any treatment for OCD reduces symptoms by about 30%. For some people the treatments work much better. Often times, combinations of therapy techniques, continued for longer periods of time, are needed to tame the symptoms more completely.

Projective Identification

This is an idea introduced by psychoanalysts. I think it is a wise illustration of a common emotional and behavioural pathway that we all experience.

Here's an example:

Person 1 (in an irritable mood): "You're angry at me!"
Person 2 (in an neutral mood): "No, I'm not angry."
Person 1 (more angry): "Yes you are, I can hear it in your voice."
Person 2 (defensively): "I think I'm speaking the same as always."
Person 1 (more angry): "Now you're denying it!"
Person 2 (getting upset): "I'm not angry!"
Person 1: "Now you're shouting!"
etc. (the point here is that initially calm person 2 is becoming angry, due to projective identification originating from person 1)

In various emotional states, our emotions may strongly colour our perception of social exchanges. In "projective identification" our own emotion (most commonly anger) can cause us to perceive others as threatening. This perception may lead to an action. The action, especially if repeated, may cause the other person to actually become angry or irritated. From the initially angry person's point of view, the exchange appears to prove that his or her angry belief was correct all along.

This phenomenon causes the emotionally upset person to inaccurately attribute emotions to external events. Also it can lead to a vicious cycle in which stronger and stronger negative emotions are generated, "projected out" into the environment, then bolstered further by the consequences which follow. Also the upset person is bound to have more and more negative experiences, which further entrench the feeling of upset.

One of the tasks in a therapy environment is to gently consider the possibility of projective identification going on, and to prevent the vicious cycle from happening. This requires understanding, empathy, and a trusting therapy relationship. I think many such phenomena have to be pronounced, described, and discussed, in the here and now, in order for them to lose their power.

Reasons for Psychiatric Hospitalization

A psychiatric hospital stay often begins with an emergency room visit, though sometimes can be arranged in advance.

There are different reasons for a hospital stay:
-a high or immediate risk of suicide
-inability to safely care for self at home
-diagnostic uncertainty with serious symptoms requiring a more urgent, comprehensive medical evaluation (e.g. delirium)
-behaving dangerously due to psychiatric symptoms (e.g. a manic state)
-initiating a treatment that is difficult as an outpatient (e.g. ECT, major medication changes)
-respite for self and for other caregivers
-a comprehensive inpatient reassessment of complex or chronic problems (e.g. refractory depression or psychosis)

Many psychiatric hospital stays nowadays are brief--perhaps a few days-- with an aim to be just long enough to help someone through an immediate crisis, while quickly ensuring that there is some kind of follow-up outside the hospital.

Other stays average 2 weeks, allowing for a more thorough evaluation and change in treatments.

Sometimes there are longer stay hospitalizations, which can last for months. Manic states often require longer stays of this type.

There are chronic psychiatric hospitals for those who have severe, active, long-lasting illness and who cannot manage outside the hospital. In general, chronic psychiatric hospitalization is becoming much more uncommon, partly due to a philosophy of trying to optimize outpatient help and community resources, but partly due to budget cutting. It may be that some persons who may benefit from chronic inpatient care, and who are not doing well with other community resources, may be at risk of "falling through the cracks" in the system, and may end up struggling with a very poor quality of life, often in a homeless state.