Posts in Category: Minds

Hungry For The Holidays

star katy

One population dreads the time from Thanksgiving to New Year’s: people with eating disorders.  

Consumerism explodes at the holidays, so, too, does literal consumption. People with eating disorders, often students returning home from college, are faced with a double-whammy. They have to navigate the usual regression to family dynamics we all feel but also, have to figure out food.

I’ve spent hours these past 10 years planning someone to get through cracker-and-cheese time without binging. Guiding and wondering and counseling someone who has not eaten dessert in years and faces a buffet piled high with pies and cakes.

For a few years I worked on at a psychiatric unit for the holidays. I loved Christmas there; we kept the spirit of it well in that old wooden-raftered building in the woods. Surrounded by snow and bowed evergreens, the small group of patients and staff were polite and hushed on Christmas Eve or New Year’s Day. Insanity seemed to have taken a small vacation. We were an isolated group out there, needing the containment of the hospital or the distance from our families to stay sane.

The lines between patient and doctor changed as we clustered in the snow for a rushed cigarette or marveled to see our footprints appear in each luminous dusting of the night. Fellow travelers, we were all at this inn for the night.

I’ve frequently thought about renting an inn for the holiday season. We crave community but one that is compatible. What if we could be assured that behavior,) around food at least, will be regular? What if the focus were on talking, thinking and doing rather than consuming?

Hiding food, eating leftovers, doing the dishes, midnight refrigerator raids can turn holidays into a desperate time. Patients return in January like tired anthropologists out in the field for too long. They often want to punish themselves by binging and purging relentlessly; some are worn from trying to appear  cogent when they are starving in plain sight of their families.

From where I sit, holidays haven’t changed much in 20 years.

Few people in America eat because they are hungry. We eat because we are bored, sad, angry or anxious. We browse the bright refrigerator shelves looking for something that will not be found there. Food is everywhere–now in pictures on Instagram, Facebook, Pinterest and more. Surrounded by this overload to the senses we are supposed to buy ‘zen’ or ‘mindfulness’ as easily as purchasing a yoga mat. It’s not that simple nor that easy.

Breaking bread with people with love is wonderful. Proust knew that a Madeline brought back childhood. Holiday smells and tastes are the same. But hungering for childhood is not the same as eating it. Whatever we want will be there today, tomorrow and next week. Remind yourself as you eat:

Do I want this or is this rather a socially condoned binge?

We confuse feeling full with filling ourselves. Try connection instead. Interview your grandparent. Pretend you are an anthropologist visiting our culture. Observe the family traditions and taboos. Stay in touch with your outside life. Use the nearest Starbucks or the public library in your town as place to regain perspective. Step outside your family into nature and be absorbed in something larger.

Invite a family member to make a new tradition with you. My brother and I started going for a walk after a particular tense Thanksgiving. We stopped at a lovely hotel with a piano bar not far from where the Boston Marathon ends. We went inside and sat down. Two newly-minted adults breaking free.

Holidays are not a cage that holds your family rules and a bowl of food. They must be recreated and reinvented to hold meaning.

The most cherished Christmas holidays I made was in Mexico. All I had in that tiny town was a Walmart and my ATM card. But I had my then-husband and our daughter. The small village was thrilled by the new Walmart and buzzed with activity on Dec. 24. Dazzled by the sequins on the swimsuits, the toothbrushes that lit up, the candy in exotic flavors I went up and down the escalators in a daze. We scattered mango chips and guava candies that night for the reindeer.  Christmas morning we opened stockings on the roof in the morning after our daughter trundled up the spiral staircase.

We ate that day, of course, but it was the newness of Mexico that drew my small family close like a small silk sack. I was reminded of the holidays at the psychiatric hospital. We make our happiness when we can and where we find it. We cannot capture it with things and we cannot consume it. Make it new.

Hunger To Read

I identified myself as a reader at the same time I understood I was a self. I was at a sunny day camp which seemed quite far away from the city though it was not. I remember holding a book open before me under the sheltering high pine trees. Suddenly the words made sense. I saw pictures where I had seen dark code.

Now my daughter struggles to read. After waiting for her to catch fire, I realize that reading may not be her thing. Not that she can’t, or often won’t read, but at any moment the sheer delight of dipping into a a book does not compel her. Like dipping into a perfect body of water. I watch the laborious unnatural training of her mind and it surprises me. I find myself revisiting the lifelong companionship, luxury, addiction and pure pleasure of reading.

I want to open the world of my childhood. I want to introduce her to the families I knew. The words unfurl as I read to her, stored in the place age has not decayed. I cannot remember this morning’s ride but I can remember what comes next in Rush’s “First Saturday” or how the “All of A Kind Family” slept in cracker crumbs traded in the dark. She does, however, love for me to tell her stories. And so I grow with her. We create a new language, the Oliver stories. Marissa and Melissa, good and bad mermaids, Yoshi. a Japanese girl with a penchant for mischief.

The hunger to read has been, for me, like the hunger to practice medicine or be in nature. Only in the books of childhood do I see plots free of the romance tale. Girls are thinking and talking and feeling; they are using all their senses to become known in the world and explore history, cities, fields, cattle, spiders, farms.

Before “happily ever after” looms, featuring a princess and prince, or king and queen. run these stories. Many childrens books remind me of a time when my deepest being was absorbed in an enterprise of pure imagination. As I read I see girls wondering what they will be, or dancing on desks, or bossing their brothers. It is all about what we can be or do.

When I wait online at the school she attends, my daughter bursts out of the line with excitement. I wonder how long it will be before she peppers her definite needs with “like,” before she asks friends if she looks “fat” in her clothes, before she finds her anger terrifying. These books which guide girls quickly turn from exploration of self, other and the world into one story: a romance quest. The Holy Grail.

If there were one thing I wish she could grasp, it is that she is already complete. Everything which comes next will be misunderstanding. Books deepen and enrich us, they mirror and extend the understanding we already have. They also distort our goals, and our sense of an ending. Perhaps her body and dextrous hands will give her more pleasure than her imagining.

Perhaps she will be freer than I was. I could not imagine having a book and choosing to sew a satchel or go rock climbing. Her own extroverted nature may force her away from the distortions of introspection. She has so many friends she does not hide behind a book. Perhaps her knowledge will serve her better; she will grow like a tree, with stronger roots.

Piercing, Cutting and Tattoos: The Body Speaks


I started small, noticing and ignoring body art. One girl with a small diamond stud in her nose had a huge diamond engagement band on her finger. We spent a lot of time discussing the enormity of her ring. No mention of the nose stud. Then came a girl from outside the city, a suburb so conservative that I’d imagined it as filled with horses. Her therapy was long and complicated, involving many family members. Somewhere during therapy she got a tattoo- the most popular sort at that time. Chinese characters were inscribed in black at the base of her spine. They showed only when you might bend over to give a customer change, or if you were scooping ice cream for a summer job. 

Then an artist came to see me with forearms decorated like a Minoan snake goddess from Crete. We discussed the tattoos. The why, the when (a break-up), the choice of subject matter.

Later I saw a drug addict in remission- a girl with a straight spine and a pierced tongue which flicked like a snake, in and out as she talked. I had to ask. The piercing was unnerving to me. She had chosen to pierce the visible juncture between speech and silence. Not to ask her about this  choice seemed like denying part of therapy. Then I began to ask more, much more. The foot covered with henna that looked like a fortuneteller’s palm. 

The second recovered addict saved her money working retail to tattoo installments of Alice in Wonderland all over her body. Not somewhere subtle, the nape of her neck, a shoulder blade wing. She was writing on her body- the body as slate, the body as book. She said it was a constant reminder ” not to fall down the rabbit hole.”

 All signs have meaning. If someone shifts and exhales- I ask. I shied away from discussing piercing and tattoos- though I had always asked directly if a patient cut or burned themselves. As the world spins on its axis the culture changes. I can make no assumptions. To assume that body art is culturally neutral is, itself, a convenient assumption. So I ask. Everyone wants to be known. What they inscribe, what they cut, what they pierce, needs translation. Use your words, we teach our children.

Make no assumptions. Do no harm.      

The oath of the psychologist.

Anxiety and Children’s Books: Or Fear Itself

miss clavell

Waking one morning with a feeling of alarm. I suddenly remembered the image of Miss Clavell who ran the orphanage in which the insouciant Madeline was tucked.

Hair straying from her bun. Miss Clavell sits upright in a white nightdress—the emblem of maternal terror. In that old house in Paris, one stately with rhyming lines, children have returned for decades to enjoy Madeline who is not “afraid of mice, winter snow and ice and to the tiger in the zoo…says pooh-pooh.
Both children and parents seek and order there. The children are numbered and cared for. Madeline makes every fear comes out right.
I identify with Miss Clavell. She who wakes in the night and knows “something is not right.” She doesn’t think this, she knows it. That is the feeling of true anxiety. It is not a feeling—it feels like a truth on the border of consciousness. Something terrible about to be remembered.
Similarly my daughter re-read a book about three gophers trying to find their home approximately several hundred times. There was nothing spectacular about the book (“May We Sleep Here Tonight“).  It was a prolonged tale of suspense as rabbits, raccoon, gophers all open the door to a snug cavt of person will this be and systematically pile into bed, seeking shelter from a storm. But the question looms whose house is this? 
Each time the door opens, the bell rings, the whiskers twitch or noses quiver.
And, indeed, it turns out to be the home of a huge bear. Fears are confirmed. Animals that had snuggled now scuttle to the bottom of the bear’s huge bed in hiding. But the bear, because this is a children’s book, turns out to be jolly and comforting. After preparing hot soup all around the final page of the book shows the bear in bed with all the animals, enormous paws wrapped round them. Even the bear needs comfort too.
Who wants to be Miss Clavell in the middle of the night, who wants as John Berryman said, to wake up wondering who is missing? Recently my daughter told me she didn’t want to grow up. At first I feared as mother—therapist too—this was she start of some pathology. But then I realized, who does?
If children are afraid the outside world may be frightening and practice at mastering it—adults continue this. The fear of losing a precious person, the fear of feeling that fear holds many people in its paws. That is, as Delmore Schwartz wrote, “the heavy bear who goes with me.” The mother’s fear that something essential is missing; the daughter’s fear that she is not good enough—the fear of feeling a fear we cannot withstand links so many patients that I see. And I, as Miss Clavell, fear that ‘something is not right’ and count the days or times or tasks. To miss that fear would be a consequential relief. MY hope for my child and others is that they are not accompanied by that early morning call to arms. That fall into the preverbal state of aloneness where we need our mother but have only a cry to bring her forth.
A lifetime of anxiety has left me quite aware of waking to a world, which seems suddenly not level. Perhaps this experience drew me to become a psychologist, feeling that the need to reassure or undo the ravages anxiety causes is a great gift.

Who, What, Why? : The Questions of Suicide

I’ve been asked to write about suicide. Can you write about something that makes us speechless?. The news of a suicide intrudes into our lives suddenly, like an iceberg looming in front of our small unsteady boat. What is true about suicide?  A few facts but none of them answer the questions that underlie essays about suicide prevention and statistics:  Why her? Why him?  Why not me?
What should I have done to help?
Copycat suicides do exist. The contagion effect does exist.  Asking for help does help. Depression can cause suicide. People who  feel a little better after depression often get a surge of energy to kill themselves. Sometimes there are clues. Statistically, the person most at risk for killing himself is a middle-aged man with no community, a history of mental illness and a completed suicide in his family. Patients discharged from the hospital who are chronically depressed or suicidal are most at risk within the first 48 hours of discharge.  And the ability to talk to others truly can help change our thinking.
Sometimes, however, there are no clues.  I have patients who live securely with a plan for suicide tucked into their back pocket. I have had many patients who kept knives or razorblades in their cabinets ; living with a Plan B felt safe. They were in control. My own father, a lanky oncologist, told me he had cyanide pills from WWII in his basement workshop. Although he joked “they probably wouldn’t work by now,” he wanted to be able kill himself if circumstances or his pride dictated. My mother told me in a rash confidence that she continued smoking so that she would die before my father. She died suddenly of a cerebral aneurysm-  leaving us dumbfounded.  She got her wish. My dad lingered for nine years in the stupefying air of Alzheimer’s Disease, listening to Schubert. 
Teenagers tell me stories of walking out onto the roofs of the tallest buildings in Boston “just to see.” To see what? Whether their dizzying fear of heights will overcome their desire not to feel? I have called the caretakers of hotels to tell them to raise their security access to roofdecks.
The desire to stop pain is not the same as wanting to die.
 I saw one patient  every week for nine years. One day after a New Year’s holiday, he tried to kill himself. I  thought I knew him well. My hubris.  After I  returned from a vacation, I waited for him in the office at a church where I worked. Snow piled up beautifully on the brick church while I waited.  When he did not show, I was mildly surprised and picked up the phone.  I began making calls to find out where he was but I was not worried.
In fact, he had taken an enormous overdose of his psychotropic medicine after living tortured by schizoaffective illness. He was saved by the odd fact that his blood thinners diffused the toxicity of his overdose. This man was lovely, tall and funny; he tried to overpower his aloneness and psychosis with joy. He wrote poems.  He chanted gregorian chants.  He longed for and feared intimate connection with equal force.  I’m not sure his life was any better for having survived. The morning I discovered his overdose, I cried and shook.  Foolishly I had believed that our connection,  only of therapist and patient, was enough. But it was a gold thread thrown across an abyss of darkness. 
Mostly, I wanted to rush to the hospital. Lawyers stopped me in case his family would blame me for the overdose and sue the clinic. It’s true. I would have been a terrible witness. I wanted to confess and be absolved. I sought help. I realized that my vow as a psychologist was ” to do no harm,” not to keep people alive.  For my career I had confounded these intentions and they had to be untwined.
 I reduce my understanding of suicide to one truth. We underestimate the “otherness” of other people. They are not thinking what we are thinking. They are not feeling what we feel. When their minds wander they do not go where ours might. A woman drops her childhood friend like a dress that is too tight. Partners turn on a dime. A child we thought wouldn’t make it, suddenly finds a passion and launches on their own. Someone we shared a life with, a team with, a class with, kills themselves. It happens again. And again.  We wonder.
 Do they see something that we don’t?
In my own family there has been one completed suicide. I was told it was a heart attack. My grandfather, embezzled out of his money in his own shop, stormed out of a family dinner on Riverside Drive and checked into a hotel. His body was found the next morning and my own father was called to identify it. Cause of death = heart attack. Actual cause = overdue of barbiturates.
Recently I heard three wildly divergent responses to a suicide. The first: “If she could do that could I?.” The second: “I can’t imagine this. I never could imagine. Can you?” And the third: “Who among us hasn’t imagined this before – or at least said it?” None of these responses were insensitive.  None were wrong. They all came from people reasonably attuned to the range of feelings in life.  Some people will never kill themselves.  Some will.  And some people can walk a middle line, wondering what would tip the balance.
But the assumption that we can truly know what it is like to be another person – that we walk along next to someone assuming they are  like us- that assumption is inevitable but wrong. In the car last week, I asked my daughter what she ( at twelve)  was thinking about. “Candy,” she replied. The next day I asked her the same question. “I just remembered I have a math test.” When I asked her if she was nervous she replied: “No, Not at all. Just don’t be late.”
I am always grateful for health. Both kinds. All kinds.