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July 12, 2011



I don’t have a particular message or idea that I want to convey in reference to these two videos. I just knew that both of those videos, viewed together, struck a chord. I couldn’t resist posting them here, and then letting my stream of consciousness guide me.

The intensity of the positive outlook in the first one is shocking, delightful and entertaining. It’s funny that it stands out as unusual that anyone, even a little girl, might feel so ecstatic about everything in her life. (Despite the childish, you might say naive, overly idealistic outlook of the first video,) I found myself wishing that my child, my patients, my loved ones could also have the experience of appreciating everything in their lives to this degree.

The second video, which is a dramatic commentary on the first, struck closer to home. Even though this one was only an actor’s spoof on the first video, it felt so real to me- it better represented the inner thoughts of the patients that I treat. The mirror experience for many women, particularly women who have body image and eating issues, can be harrowing to the point of triggering a deluge of negative evaluations of self and other. Even though this video makes you laugh, you can imagine that when a person hates everything in her life, she is truly suffering.

Some patients wonder about positive visualization/affirmation/thinking as a technique to improve mood and self-worth. I have many thoughts on this strategy, and sometimes believe that many people use it as yet another way to deny their feelings (-I’ll post thoughts on this in another blog). However, in certain cases, I believe that positive thinking can be VERY powerful! Often people forget to appreciate everything they have in their lives. People tend to magnify their problems and focus on those. They engage in a host of what some therapists call cognitive distortions. Here are some examples of distortions that people typically engage in:

1) Catastrophizing- Focusing on worst case scenario for a given situation

2) Minimizing/Magnifying- minimizing the importance of positive traits or events, and magnifying negative ones

3) Overgeneralizations- Reaching a general conclusion based on an isolated incident. (i.e. after one bad haircut, concluding that all my haircuts are bad. Doing poorly on one exam, and concluding that I’m a generally bad student)

Ceratinly, the 20 year old Jessica of the second video is guilty of these cognitive distortions. Are you guilty of these kinds of distortions as well?

It’s important to identify problems, and then try to solve them. However, overemphasis on the negative is itself a distortion of reality. Let’s not forget to attend to and express gratitude for what is working- let’s notice some good things too.

In terms of body image and self image, it can be invaluable to point out the positives! Body IMAGE has more to do with how you IMAGINE your body than how it actually is. Thinking positive thoughts about yourself, and how good you look can make you feel better. When a woman has positive thoughts about herself, and feels confident, she radiates that- her body movement, gestures, smile all reflect that confidence. If she’s focused on all her worst qualities all of the time, the varicose veins, the cellulite, the large arms, she will appear less magnetic and beautiful.

In conclusion, perhaps a good dose of positive affirmations in front of the mirror, a la Jessica style (of the first video!) might go a long way to improve your self worth? I don’t know!!!- that might be a bit of a stretch for some of you who are feeling rather down. Alternatively, maybe it’s just enough to watch the first video and marvel at this young girl’s self-acceptance and aspire to it, making a little room for that attitude to slowly creep into your life. Why not? you deserve it, or don’t you think so?

Perchance to Dream?

March 9, 2011

Dreamers at the Rubin Museum of Art

On Saturday I had the honor of participating in the Rubin Museum’s ( special event, THE DREAM OVER. This event was featured as part of a month long series, entitled BRAIN WAVES, which includes lectures and events that explore the science and art of dreams. For the DREAM OVER the museum invited the public to sleep in the space under a piece of art that was chosen for them based on a series of 3 questions: 1) why would you like to participate in the Dream Over 2) what are the three most significant events of your life and 3) What color resonates with you most. I was not among those who slept at the museum. Rather, I was part of a group of volunteers who who arrived early in the morning to wake up the sleepers, and to engage them in a conversation about their dreams and their chosen object of art.

I spoke to 5 people that morning, and listened to them recount a dream or speak of the surreal experience of sleeping in a museum. I tried to get a sense of how the art work or experience influenced the dream imagery. Members of the New York Psychoanalytic Institute will be studying the material more closely.
From a personal and professional standpoint, I was interested in the dreamer’s psyches and the significance of the event and the dream in their lives. However, the nature of the event did not allow the kind of probing and deepening that I am accustomed to in the therapy room. Hopefully, some of the dreamers will be curious enough to explore further what was revealed to them through their dream.

Why should I bother with my dreams?

There are many different theories about dreams. Some theories posit that dreams are mere expressions of random neuronal firing in the brain, and that reading into them is like trying to make sense of chaos or noise. However, many traditions see dreams as prophetic, potentially healing, almost oracular. From a psychological standpoint, dreams are a portal into a person’s psyche or unconscious. Freud saw dreams as wish-fulfillment, and Jung saw them as potentially facilitating transcendence. You can learn quite a bit about a person by engaging them in a discussion of their dreams.

In my clinical work with patients, I borrow heavily from the person’s dream imagery to move the work forward. I believe that dream images are constellated around certain emotions that are otherwise dissociated (outside of awareness), vague, and often too daunting for the patient to deal with. The images allow the person to begin to talk about these difficult feelings. I rarely interpret a dream outright. Instead, I ask a series of questions about the dream that stimulate thoughts and feelings, always maintaining an air of wonder and awe at the psyche’s creativity. Here are some of the questions that I draw on to begin this dialogue. Try these simple questions and see where they lead you:

1. Describe your actions in the dream. List them here:

2. Describe the feeling in the dream. List them here:

3. How are these actions or feelings different or similar to actions and feelings that you experience in your waking life?

4. What are the major contrasts and/or similarities in the dream? (i.e. distance/closeness, cold/hot)

5. Do any of the above themes/conflict (contrasts or similarities) pop up in waking life?

6. What are the major symbols/images/figures in the dream? List them here:

7. What are your associations to the different images/figures/symbols in the dream. Start with the one that stands out most.

There’s A LOT more to explore beyond these 7 questions- but answering those would be a good start. You’d get the most out of your dreams if you followed a series of dreams and saw how the imagery changed over time. You can trace certain recurring themes and images and track your psyche’s unfolding narrative and ongoing commentary on your life. The goal is to begin to strike an active dialogue with your unconscious, not to let it completely take over and become the arbiter of your truth….in other words, if you don’t like what the unconscious reveals, you have every right to talk back and disagree!

Good luck in your explorations and feel free to ask me questions. Eventually, I’d like to create an on-line journal for people who would like to keep track of their dreams, and the recurring themes and images therein. Dream On for now.

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National Eating Disorder Awareness Week

February 24, 2011

National Eating Disorder Awareness Week

As a clinician who works with eating disorders, on the occasion of national eating disorders week,  my heart goes out to the many patients and their families who are struggling with an eating disorder.   For the general public’s behalf, I’d like to point your attention to the following Promo for the movie THIN.  It captures the devastation and despair of a struggle with eating disorders.

Eating disorders can be misleading.  People think that they  are a disease about food and weight, and the pursuit of beauty.  In reality, the obsession with food and weight is merely a manifestation of  underlying feelings, feelings as complex as  self-hatred, lack of control, obsession with perfection, fear of dependence and independence, and unresolved anger towards self and others.   The focus on food and weight is actually the attempt to COPE with complicated feelings.  Yes, the focusing on eating is actually the COPING MECHANISM.  I will try to explain: the person struggling with an eating disorder does not know how to deal with her feelings and instead she focuses her attention on food and weight.  Why? unlike emotions, food and weight are concrete and can be reduced to numbers.  A person who struggles with anorexia nervosa, for example, devises a simple system whereby she feels better if she is in control of  her appetite.  The scale then becomes a gauge of her level of control- seeing her weight go down gives her a self-esteem boost.  Recovering from an eating disorder involves learning new ways of coping with feelings and relationships, and new ways of building self-esteem, mastery, and pleasure.  Confronting previously avoided feelings is the reason recovery is so difficult.  At times it feels like opening Pandora’s box, many patients prefer to keep the lid on.  They’d rather obsess in the mirror than go open that box.

As you’ll see in the movie clip, those diagnosed with anorexia or bulimia do not perceive their bodies accurately.  There’s something heart-wrenching about listening to a woman complain about how fat she is, when she appears skeletal to you.  How do you say to her: my perception of your body is more accurate than yours, when in actuality you are trying to help her trust herself more.  Unfortunately, one of the problems with patients who are underweight/malnourished is that they suffer from cognitive deficits; they are not thinking clearly.  Also, family members often notice personality changes that accompany weight loss.  This adds another order of complexity to the disease, and makes weight restoration even more critical.

If  you or a family member suffer from an eating disorder, contact a clinician near you and get acquainted with local and national resources.

The Body Blues

July 8, 2010

I’ve been promising some of you that I’d write about women’s bodies, but have delayed doing so.  This is not an easy topic to COVER or PENETRATE, especially in words.

How does a woman reclaim her body, love it, communicate through it, poeticize it….how does a woman fully live in herself, occupy her own space, her own chasm, explore and guard her own orifices?  How does a woman feel beautiful…How does a woman show herself, how does she hide, how does she move?  Well, let’s say that if you begin to answer these questions, the answer CANNOT be boiled down to a number or a specific weight.  This is not pounds of meat that we are talking about here, and therefore reaching a certain number is not the answer to feeling good about your body.

Many of you are at war with your bodies.  You yell at your body daily, you hiss at it, you avoid it in the mirror, or you spend countless hours scrutinizing it.  As a result, your body is mad at you and it rebels.  It doesn’t cooperate with you.  It deliberately taunts you with its appetites.  You see a fold, a wrinkle, a cellulite indentation in your thigh and you cringe- your body is offended.  Do women who love their bodies have none of these?  Of course not.   They just find the grace, the power, the irony, the dance in their own flesh.

First off, I like to remind people that it is not only thin women who have lovers or who are married.  No.  Look around you. There are so many factors involved in having a relationship, appearance is only one.  But let’s take appearance. Let’s say that men like beautiful women.  Well what constitutes beauty then?  If we take superficial beauty then we need to look at the contour of a woman’s body, her facial features, her colors, her textures etc.  There are so many factors just on this level that don’t only have to do with weight.  Then there’s how a woman moves her body.  Some women move with poise and grace, others clunk around, others are always moving in a way that hides different parts of their bodies.  Try this trick: close your eyes and imagine what it would feel like to be the most beautiful woman alive.  How would you hold your body, how would you move, how would you walk and talk?  Then compare this to how you move in your body, how you walk and talk.  There are so many things that go into what makes a woman beautiful, and confidence is one of the most attractive traits- I’m sure you’ve heard this before.  Now let’s move to attraction.  People aren’t always just attracted to the most beautiful person around.  Chemistry, like beauty has it’s own mysterious set of requirements.  Have you’ve ever been attracted to someone that you didn’t think was particularly good looking?  YES!  How complex.  Now if you’re fooling yourself into thinking that the only thing you need to do to control this whole attraction mayhem is lose weight, then you’re deluded!

One of my favorite books of poetry that happens to address this topic is Grace Nichol’s Fat Black Women’s Poems.  The poems are sensual, inviting, subversive, all at once.  Grace Nichols truly endows words with flesh and redeems a woman’s body from the realm of misogyny.  Here’s her moving take on the female body.  Enjoy this poem, as you would enjoy pinching a bit of the flesh in your thighs or stomach..with relish….

The Divine Body in Grace Nichols’s The Fat Black Woman’s Poems

I am not your Venus de Milo perfectly sculptured from marble
To be carefully pedestal placed
My name is not Eve
I offer no temptation
I am not your concubine by night
Transformed by memory by day
I am not the milk you thirst for
Now dry in your mother’s breast
. . . I am no slave to a promise written in ink
When there is no master
There are no chains to be broken
Bondage is no glory
I am Woman
Bone of your Bones
Flesh of your Flesh
When I lay sleeping in your rib
You called me no name
I am that I am

— Faybiene, from “I Am”

Feeling Depressed? Don’t know why?

April 18, 2010

Sometimes people feel depressed and they can easily count the ways in which life is not going their way.  They know why they are depressed and can articulate what led to their recent drop in mood.  That doesn’t necessarily mean that they can pull themselves out of the depression, but at least they are beginning to put words to feelings, which is a good start.

Other people come into therapy and truly have no idea.  They might suspect a possible chemical imbalance that may have led to a change in mood, sudden crying spells, a sense of hopelessness, low self-worth, and difficulty going out and performing  day to day activities.  Perhaps medication is needed to jump start the neurotransmitters once again to produce serotonin to restore mood balance.  Even if medication is indicated, in most cases, therapy can help one begin a process to deepen awareness and slowly lead one out of the doldrums.

Even though the symptoms of depression are similar for all people (since they all meet the diagnostic criteria for this category), everyone has a very different and unique story.   It is in the telling of the story that recovery can begin. Feelings that the person did not have time or courage to experience suddenly resurface.  Reexperiencing the feelings and understanding the events that led to these feelings can be very beneficial.  Also, often times certain negative and faulty beliefs are internalized as a result of life events- these beliefs then lead to a host of negative feelings.  It is helpful to have a clinician guide you to reexamine some of these strongly held beliefs and begin to challenge them. For example, some people very early on internalize the belief “others will reject me” or “I am unloveable” and they continue to operate as though it is true across all situations.  Of course you’re going to be depressed if you walk around thinking that all the time!  Sometimes these beliefs are so strong that the person always looks for the evidence to prove their beliefs true, and they overlook incidents where the belief is actually false.  Does this sound familiar?

Another interesting phenomenon, which I find prevalent in depressed patients is their tendency to blame themselves for everything.  When they begin to explore the nature of their self-blame they often find that in fact they were initially angry at someone else  but were unable to tolerate being angry at this person.  Instead, they opt to take the anger and turn it against themselves.  I can’t tell you how often I see this.  Usually, the person finds anger so threatening that it is easier to hide it from others and even from themselves.  It then comes out in an unexpected way, as an unhealthy or self-destructive behavior.  In these cases, it is important to discuss the role that anger has played in your life, and your relationship to it.  Hopefully, you can have a new appreciation for anger and realize that anger has energy (unlike depression) and purpose  when it is used constructively rather than destructively. Try to understand why you might be angry, and see if there is something constructive that you can do about the anger…

Beyond the erroneous beliefs, and the internalized anger which often accompany depression, remember that depression can deepen,humble, and transform you.  It takes you to the darkest places within yourself, and forces you to confront yourself, your worst fears and anxieties.  If you let it guide you, you will find glints of light that will slowly lead you to a brighter place with a renewed sense of self and an increased sense of mastery.  What I find most fascinating is that the way out of a depression is different for each person, and there is always a sense that the psyche is guiding them wisely to their own unique discoveries and opening doorways into new psychological territories.

What happens to people when they starve their bodies?: Implications for eating disorders

March 10, 2010

During the end of WWII, an important study was conducted to determine the physiological and psychological impact of starvation on the human body.  There were vast implications to the study for the political climate of the times, such as how to rehabilitate those that had been starved by the war conditions.  This study was referred to as the Starvation Study, and it’s findings were published by Ancel Keys and colleagues in 1950.

The study in short

36 young men who met criteria for psychological and physical health standards were selected from a pool of 400.  After a control period in which subjects ate 3200kcal daily, their intake was then cut in half for 12 weeks.  This was considered the semi-starvation phase, in which the subjects were monitored for their behaviors under the starvation conditions.  Finally, they paricipated in an 8 week long rehabilitation stage in which they could eat whatever they wanted.

These are the behaviors they observed among the participants:

preoccupation with food, and eating rituals

increased dysphoria, depression, mood shifts, irritability, apathy

decreased libido

Binge episodes during rehabilitation stage

increased social isolation, less interest in others

impaired concentration and cognitive function

“feeling fat” during rehabilitation phase, as they focused on regaining the 25% weight loss

physiological changes: edema, hair loss, decreased metabolism, decreased hear rate, fatigue, dizziness

Do these symptoms sound familiar?

Yes!  Women who suffer from eating disorders often experience the very same host of symptoms.  They are preoccupied with food, they engage in food rituals that prolong the amount of time that they can eat, they have impaired judgment and other cognitive difficulties, they lose interest in socializing and in sex, and they suffer from the gamut of medical risks mentioned, and more.

So, what can we conclude from this?   What is most striking to me is the fact that the symptoms associated with eating disorders are actual reactions to starvation that would impact any healthy person, male or female, in a state of starvation.  This means that the key to eliminating the symptoms rests in the restoration of healthy, balanced eating.  That’s why nutritional rehabilitation is such an essential part of a good treatment for an eating disorder client.  Many of the symptoms remit as clients begin to feed themselves: they can think more clearly, they are less food obsessed, they are less likely to binge, and some of the depression may lift.  However, obviously, that does no take care of the problem altogether.  Why not?   Because clearly there is a significant difference between a person who is malnourished as a result of the devastation of war and one who chooses to starve herself willingly.  When a person suffers from an eating disorder it is as though she is imposing war conditions on herself.  Or, she may describe it as a euphoric state of absolute control, in which the need for anything is brought under mastery, eliminating the possibility of becoming vulnerable.   There is usually a richly profound story here, a complex explanation as to why this person would choose to starve herself.  And in the telling of this story lies the crux of the therapy.   Each client must tell her unique story and be completely heard and understood in order to begin the recovery process.

Anorexia: My friends tell me I have an eating disorder but I don’t think so…..

March 5, 2010

Dear Reader,

If the above title resonates with you, then you’ve come to the right place.  It is difficult to be in the position of being confronted by friends and family about your eating and weight.  It can bring up many contradictory feelings.  On the one hand, you feel that others care about you and that’s why they’re concerned.   On the other hand you think everyone else is crazy, because if they could only see straight they’d be able to tell that you are NOT skinny.  You may also wish to keep your eating habits a secret, and you feel violated by their over concern.

Many of you might argue that everyone has an eating disorder.  You see your friends drinking a diet snapple or diet coke, they’re all dieting, watching their carb intake, reading about the latest diet fad.  You think you’re no different than anybody else.  But secretly maybe you might admit that the topic is a sensitive one for you, and maybe you wonder if food has taken too central a role in your life.  Maybe you think about food more than anything else in your life?  You plan all your meals in advance, as well as when you’ll exercise next, and you’ve become adept at counting calories, how much you take in and how much you’ve burnt.  You feel good when you’re in control of your caloric intake, and terrible when you’re not.  Does this sound familiar?

As a psychologist who specializes in eating disorders, I find it most challenging to appeal to women who are in the beginning stages of anorexia nervosa, those that don’t think they have a problem because they do not see themselves as too thin.  Here’s why.  Often, when in the beginning anorexic phases, some people actually feel high on life.  This term has aptly and simply been dubbed “the anorexic high”.  These young girls, women, or men are feeling great because they feel as though they are in absolute control of their appetite and  body weight.  In some cases, they might feel that they’ve improved their look.  Maybe they’ve even gotten positive feedback from parents or peers when they initially started to lose weight.  This anorexic high, in combination with the compliments can be so utterly confusing. Why would they seek help if all is seemingly going well?

There are many reasons why therapy is actually a smart move, despite this high.  First of all, the earlier you catch an eating disorder the easier it will be to beat it.  Then, it is important to understand that the anorexic high is just as it sounds: it’s like a drug high.  It is based on something that has a negative underbelly.  Like with a drug high, it is hard to sustain and there is withdrawal.  No one can maintain absolute control all of the time!  Here is a basic reality about controlling you food intake and weight:  even though some people control their caloric intake over a period of years, many of them eventually slip into “out of control” bingeing at times.  At some point, their bodies may become so malnourished it’s as if their body is begging  to eat- and then a binge occurs.  They then feel horrible about bingeing.  In fact we know that if you starve any human for a while, when you allow them to eat they will binge!  (see more on the Starvation Study in my next post).  It’s usually after a sustained period of bingeing, and attempts at compensating for the bingeing (through exercise, or vomiting, or laxative use, or fasting) that people eventually show up for therapy.  For instance, many of the women who come in with a diagnosis of bulimia had at one point met the criteria for a diagnosis of anorexia!  They find  the bingeing purging rituals more uncomfortable than the controlled restriction so they come to therapy in order to stop bingeing.  And they wince when they learn that the secret to stopping to binge is to stop to restrict!

There are many topics that come up in therapy that can be uncomfortable and contradict a world view that values control over the appetites.  But, your therapist is not just there to contradict your world view.  A good therapist will want to understand how you came to your world view, and why you started to engage in your specific eating patterns.  One thing I learned from my clients is that there is always a very good reason why a person has adopted certain beliefs and habits.  It’s almost always the best possible solution to surviving in their world.  And in fact their eating pattern and their beliefs actually worked for them, and were a viable way to survive and feel better in certain situations!  That’s why it is so hard to give up an eating disorder.    So, to then begin to rework daily eating habits, and beliefs will take some time, patience,  curiosity, and good therapy.

In conclusion, if your friends and family are concerned, it might be worthwhile to visit with an eating disorder specialist in your area to get an objective point of view.  Even if you don’t meet criteria for an eating disorder, you might discuss the pros and cons of starting a course of therapy with a professional.

Best of Luck,


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