Hunger

This brief commentary will in no way do justice to Roxane Gay’s memoir, Hunger; therefore, I urge anyone who reads this blog post (and is at all intrigued) to also read the book.

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Gay is a critically-acclaimed author and professor, raised in the US by parents of Haitian descent. She also lives in a very large body, that which Gay describes as the protective fortress she created in response to a sexual assault experience at age 12. Now in her 40’s, Gay acknowledges the pain of knowing she no longer needs such protection; she depicts the incessant challenges of living in an “unruly” body in a world bent on disciplining such bodies.

She expresses contempt and frustration toward her body albeit a genuine liking for herself - for her weirdness, sense of humor, how she loves and how she writes. Stated in reverse, Gay articulates that we might love ourselves, who we are as people, while not necessarily loving our bodies.* Our body’s appearance and how we feel about it is not who we are; it is but one part of who we are.

To be clear, the fat acceptance movement is important, affirming, and profoundly necessary, but I also believe that part of fat acceptance is accepting that some of us struggle with body image and haven’t reached a place of peace and unconditional self-acceptance. (Hunger, p. 153)

In reference to the quote above, Gay offers an expanded definition of fat acceptance -- one that, I have no doubt, captures the real lived experience of many people. I thought of how important this more human definition is, and how many times my clients express confusing and conflicting thoughts about concepts like fat acceptance and especially, body positivity.

Gay writes of hunger. Hunger in the form of envy for all the things her body cannot do. Hunger for real relationships in which she does not have to apologize or somehow make up for her size. Hunger to feel pretty and to wear clothes with beautiful, colorful patterns -- to shed her chameleon-like “uniform” of jeans and a dark t-shirt.

My father believes that hunger is in the mind. I know differently. I know that hunger is in the mind and the body and the heart and the soul. (p. 193)

When the response to hunger and appetite is one of shame, a disordered relationship with food is a possible, if not likely, consequence (see also previous blog post). And yet, our proclivity to care for our body is in our blood. Among other things, Gay chronicles the healing power of learning to cook, in large part inspired by Ina Garten of Barefoot Contessa. For Gay, Ina symbolizes a “plump," confident woman who celebrates her love of food and good ingredients. In doing so, Ina gives Gay permission to both acknowledge and satisfy her hunger in healthy, not destructive, ways.

It did not occur to me that to cook for myself was to care for myself or that I was allowed to care for myself amidst the ruin I had let myself become. (p. 215)

And maybe that’s where it starts: Small, consistent acts of self-care, one Contessa at a time.

 

*Gay notes that her body contempt is inextricably intertwined with societal contempt for bodies like hers. She depicts the many challenges faced, from airplane rides to fashion options (or lack thereof) to the humiliation and often lasting physical pain of sitting in too-small seats at restaurants, theaters, and professional events -- in short, to face the world as a SSBBW (super-sized big beautiful woman).

 

A Kinder 2018

Recently, a client told me that he’d been reading about self-compassion in the context of healing from the cycle of restrictive/binge eating; it seemed so radically opposite his own experience. He wondered aloud, 'How is self-compassion different from self-indulgence -- from giving myself permission to eat whatever appeals to me because I deserve it?' For as long as this client can remember (and he is not alone), he has been motivated by a harsh, self-critical voice.

So how is being self-compassionate not simply letting oneself “off the hook?”

As a healthcare practitioner, it’s easy to urge a client to be ‘kind’ to himself without addressing the inner dialogue (or outright confusion and fear) this idea brings up. As a human, I certainly understand my client’s questions.

Self-compassion or self-indulgence?

According to Dr. Kristin Neff, a pioneer researcher in the field of self-compassion and Professor of Psychology at the University of Texas at Austin, self-indulgence involves choosing short-term pleasure at the cost of long-term harm. In contrast, self-compassion aims to alleviate harm.1 Neff uses a parenting analogy to illustrate. Compassionate parents wouldn’t (typically) allow their children to stay up all night watching television and eating bottomless bowls of ice cream; they know that allowing this behavior would ultimately prove harmful for their kids. Instead, compassionate parents set healthy boundaries for their children, asking them to complete their homework and get to bed at a reasonable hour.

This logic isn’t as easy to apply to ourselves but the idea is the same: When we practice self-compassion, we naturally want the best for ourselves, too.

Additionally, research suggests that practicing self-compassion may lend to forgiving ourselves more easily in the face of an undesirable event; and, far from being an excuse to "let oneself go," self-compassion actually increases personal responsibility surrounding an event.2

Choosing New Year’s resolutions motivated by compassion

Neff believes that if criticizing ourselves seems to work as a motivator, it’s often because we’re driven by a desire to avoid self-judgment when we fail. Yet, what if failing didn’t have to mean an endless barrage of self-punishing thoughts? For starters, it might be a little easier not only to set challenging goals (i.e., less frightening to try), but also to keep working towards these goals when obstacles arise. As Neff articulates, “Self-compassionate people set high standards for themselves, but they aren’t as upset when they don’t meet their goals.”1

Approaching our 2018 resolutions with compassion sets the stage for curiosity when things don't go perfectly (newsflash = things won't go perfectly!). If the voice in our head is kinder, we can honestly examine what's not going well and why -- and adjust our goals rather than discarding them altogether.

References

1. Neff, K. (2015, November). Self-compassion: Why it makes us happier, more resilient, and kinder to others. Shambala Sun, 58-63.

2. Leary, M. R., Tate, E. B., Adams, C. E., Allen, A. B., & Hancock, J. (2007). Self-compassion and reactions to unpleasant self-relevant events: The implications of treating oneself kindly. Journal of Personality and Social Psychology, 92, 887-904.

See also: self-compassion.org/the-research/#

On Mindfulness

There are two main theoretical frameworks defining mindfulness. The first of these, developed by Jon Kabat-Zinn, relies on paying attention to the present moment, non-judgmentally and therefore free of emotional and moral assessment. Meditation is an important tool for mindfulness in this approach.1 In contrast, Ellen Langer’s concept of mindfulness does not rely on nor promote meditation. Rather to be mindful is to actively notice novelty and the full context of a situation, guarding against repetitive thought patterns and habitual  categorizations from the past (e.g., How does my spouse’s face look different across the breakfast table this morning as compared with yesterday morning?).

I find that more often when we talk about mindfulness, we implicitly refer to Kabat-Zinn’s concept, equating mindfulness with meditation.

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This summer, TIME Magazine issued a Special Edition: Mindfulness: The New Science of Health and Happiness. In an article titled Can You Shed Pounds on a Mindfulness Diet?, Kathleen Mulpeter describes research investigating the effects of mindfulness on health outcomes and weight status. In one study, participants asked to answer a set of mindful questions while eating fared better at maintaining weight loss than those who practiced  self-compassion meditation.2 These mindful questions included “How does this meal taste?” but also “How kind are you to yourself now that you ate this meal?” While participants in this group were instructed to record their answers in a food diary, benefits extended to those who chose not to write anything but simply kept the diary open while they ate. In short, the journal’s sheer presence was a reminder to approach the meal with a little more thoughtfulness, and a little more kindness.

To me, these findings suggest how truly accessible mindfulness can be. In the above study, mealtime mindfulness involved focusing the mind on what research refers to as concrete construals (e.g., How am I eating?) versus abstract construals (e.g., Why am I eating?). As much as mindfulness could be about counting the folds on the raisin or meditating for 40 minutes before picking up the fork, it doesn’t have to be. We need not feel guilty that our monkey minds jump around instead of settle as we sit down to eat. In fact, rather than judging our busy thoughts, could we use them in a mindful way? That is, can we keep asking questions especially when we think we know the answers?*

[*According to Ellen Langer, the reason we often don’t notice things is that we assume we already know them. And yet we’re more apt to enjoy an experience when we notice its newness!! Well, the thing is, it’s always new. Every time we sit down to eat. Even if we’ve warmed up the same leftovers for the past five nights -- or always order the same dish, cooked the same way, sitting with the same person, at the our favorite restaurant. When we think we know the taste already or how it will our make our body feel, we fail to really taste and really feel.]

References

1 Pagnini, F., & Philips, D. (2015). Being Mindful about Mindfulness. The Lancet, 2. Retrieved from www.thelancet.com/psychiatry

2 Mantzios, M., & Wilson, J. C. (2014). Making concrete construals mindful: A novel approach for developing mindfulness and self-compassion for assisting weight loss. Psychol Health, 29(4), 422-41.

...Like Gifts from the Universe

Appetites, a memoir by Caroline Knapp, is an astute observation on the late-20th century female experience.

In Knapp’s view, the emergence of disordered eating and body dissatisfaction in the U.S. coincided with the end of the second-wave Feminist movement in the late 1970’s. Knapp writes, “The second wave, after all, was in so many respects about appetite, about demanding the freedom to take in … the freedom to hunger and to satisfy hunger in all its varied forms.*” Coming of age as feminist activism quieted, Knapp describes feeling the movement intellectually -- and yet its transformative potential, its radicalizing power, did not have the time to reach “gut level.”

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There you have it: intellectual belief without the corollary emotional roots; feminist power understood in the mind but not known, somehow, in the body. (p. 124)

As feminist momentum slowed, the rise of an externalizing consumer mindset occurred in lockstep: “A powerful combination, and also a powerful loss," writes Knapp. During the Feminist movement, the female ‘appetite’ was one to feel entitled and to be heard; as consumer culture took hold however, appetite began to center around the right product or substance. At once, the pursuit of happiness and wholeness reduced--to the pursuit of “things.”

If something was missing in the air back then, if something’s missing still, it was a sense of broad alternative vision, a language that might have encouraged women to talk not about new things to want but about new ways to want. (p. 153)

For many women, a significant part of consumerism was directed toward outward appearance and image--in essence toward ”fixing” the body. In a paragraph that really struck me, Knapp writes of the seduction of taking such vast and varied forms of hunger (e.g., one’s desire to feel connected, or competent) and distilling these to a single hunger to be managed: One’s hunger for food.  

Throughout Appetites, Knapp writes candidly of a time in her life when she wanted more than she knew how to ask for. She lends compassion to her younger self by setting the historical context--depicting decades that many readers may only know through books or parent’s stories. Knapp walks us through her recovery: A gradual, nonlinear process of satisfying an appetite for life, a recognition of the less literal forms of hunger.

For there is no unequivocal answer, no final resting place, no pinnacle reached, all appetites understood and sated at last. Instead, there are moments of contentment, moments of sudden alignment between body and mind and spirit, moments of feeling fed that arrive unexpectedly, like gifts from the universe. (p. 192)

*at the time, a hunger for economic, legal and/or sexual freedom among other forms.

 

[Note: After any good book, I find myself researching its author... Having felt Caroline Knapp’s aliveness in each written word, I was shocked and saddened to learn that she passed away from lung cancer in 2002 (age 42), one year before Appetites was published. Above, I felt compelled to share Knapp's words, which no doubt have touched many individuals across gender and generation.]

Sensing the Beat

Earlier this year, Evelyn Tribole and Elyse Resch released The Intuitive Eating Workbook: Ten Principles to Nourish a Healthy Relationship with Food.

Tribole and Resch describe intuitive eating (IE) as a process of relearning instincts we once knew. They write, “We are born intuitive eaters, but cultural messages to diet and lose weight often infiltrate our minds and sway us away from listening to our bodies.” Intuitive eating therefore stands in direct opposition to dieting. While the latter relies on external rules to dictate what, when, and how much to eat, intuitive eating honors the importance of nutrition knowledge (especially if you have certain health conditions) yet puts your inner experience front and center.

The workbook includes an entire section devoted to discerning our inner experience, an ability more technically referred to as interoceptive awareness. Of all the workbook’s self-assessments and activities, my favorite was: “Can You Perceive Your Heart Rate?,” summarized below in three parts:

Part 1. Physically Monitor Your Pulse (Warm-up). By placing your right index & middle finger on the wrist of your left hand, count your heartbeats for 60 seconds.

Part 2. Perceive Your Heart Rate (Note: This may take time and practice). From a calm and comfortable position, and without manually finding your pulse, silently count your heartbeats for 60 seconds.

Part 3. Reflection. e.g., “What was your self-talk like when you were trying to perceive your heart beating (especially if this took a great deal of patience)?” If your thoughts were harsh and critical, what would it be like to do this exercise from a curious place instead?

The practice of perceiving our beating heart is one way to build interoceptive awareness. To be clear, the authors argue that the more awareness we have of our inner sensations (such as hunger, taste preferences, and fullness -- or the unique physical manifestations of our emotions), the more effective we are in determining what we need. At once logical and revolutionary, Tribole and Resch remind us that building inner attunement (though no small feat) may be our guide to self care.

Recommended for clinicians: 5/5

Recommended for individuals trying to make a change: 5/5

(i.e., Recommended :)

Motivational Interviewing vs Diet Mentality

Thoughts on Motivational Interviewing in Nutrition and Fitness by Dawn Clifford, PhD, RD, and Laura Curtis, MS, RD

Motivational Interviewing (MI) is a goal-oriented, client-centered counseling approach around since the 1980’s. I’ve been exposed to it throughout my career and it has certainly influenced my counseling style. And yet, only upon reading this book has it occurred to me how helpful MI may be in freeing us from preconceived mindsets. As used in nutrition counseling specifically, MI could be seen as an antidote to the diet mindset.

In essence, diets involve looking outside of the self for what (and sometimes when) to eat. I’ve often wondered if the help-seeking process can inadvertently mirror or perpetuate this outward-based “quick fix” mentality. That is, if a client has spent a lifetime trying one and then another diet, am I not offering more of the same if I give him a new detailed plan to follow the day he arrives to my office?

MI assumes that clients come to the office already bogged down with knowledge and awareness of what to do -- yet, for many reasons, have been unsuccessful in making changes. While a nutrition counselor who uses MI may be the “expert” in nutrition, this counselor regards their clients as the expert in well, themselves. MI seeks to empower clients to trust this self-knowledge whilst wholeheartedly supporting their autonomy. In contrast, rigid diet plans do little to support self-knowledge and autonomy and may indeed erode these over time.

Motivational Interviewing in Nutrition and Fitness is an invaluable resource for  “professionals who care about the success of their clients, not just the day, week, or month after their visits, but for years to come (p. 4).” This book devotes entire chapters to each MI microskill: Asking open-ended questions, giving strategic reflections and summaries, and perhaps most important, avoiding the “righting reflex.”

In my counseling practice and in this gem of a book, I am continuously reminded that what I know is only as valuable as how I share this information; and if a client is not ready for it, information can do more harm than good.

After all, with MI, “The purpose is not to give advice. The purpose is to cultivate change (p. 177).” As revolutionary as it sounds, only after the client has been given time and space to come up with their own ideas, does the practitioner offer hers -- and in true MI spirit, they ask permission before doing so!

Recommended for clinicians: 5/5 (designed with the clinician in mind: almost every concept is followed by examples of clinician-client dialogues)
Recommended for individuals trying to make a change: 2/5 (the concepts in this book might be more useful if formatted as a workbook)