Chronic Illnesses and Diet part 3

Visualization and Chronic Disease

To the ten steps of the Body Clock Prescription, I'd suggest adding visualization, another powerful tool for controlling chronic disease. Life consists of moving forward into images. You get to the dry cleaners to pick up your laundry by making a mental picture of the journey and moving forward into that picture. No picture, no laundry. With visualization, you are going to create an inner picture in order to realize your intention, not just in the outside world of the dry cleaner but in the inside world of your immune system.

The first step is to get the knack of meditation so that your mind and body are in a receptive posture for visualization. Let's assume that you've learned to enter a meditative state; riding on the letter M, your mind can enter a new space within your consciousness. From here, you can take one step forward into your imagination and make a picture of what you want to accomplish in your body.

The effectiveness of this approach was initially proven in an experiment conducted with doctors suffering from terminal or advanced cancer. They were shown accurate images of their own cancer cells and of their immune system cells and were asked to create a realistic visualization of the immune system cells attacking the cancer cells. Most of the doctors successfully curbed their cancer — not to the extent of actually curing it, but in most cases there was measurable improvement. Since then, numerous experiments have shown that a less accurate image of the enemy is just as effective.²

About twenty years ago I used to meet one evening every month with a group of other doctors, including Dr. Bernie Siegel, one of the pioneers of visualization. Bernie shared fascinating examples of the kinds of imagery cancer patients chose to promote healing of their illnesses. It seemed important that the image be accurate in its intent; it was disconcerting when patients chose wimpy defensive images that were the imaginary equivalent of trying to beat their cancer with a wet noodle. People who chose aggressive images did better; lions, tigers, sharks, polar bears and knights in shining armor do better work than a little girl gathering up cancer cells into snowballs and throwing them over the fence.

But what's a good image if you have chronic inflammatory disease? In this case, redness, heat, swelling and pain afflict some part of your body as it reacts to an enemy that the doctor hasn't been able to discover or that has disappeared from the scene of the crime, leaving your immune system in a perpetual dither. You need a picture that is soothing but not self-defeating by way of quieting your immune reactions to the point of defenselessness. This is where a chemical or an abstract image may be more appropriate. By chemical image, I mean something along the lines of `Let's put out the fire'. Remember that inflammation is an expression of your body's fire burning out of control. Whether it is in the skin, the digestive tract, the lungs, the heart, the nose or the eyes or, for that matter, whether or not it is producing palpable heat, some kind of uncontrolled fire is at the bottom of a lot of chronic illness. Parkinson's disease, for example, has been characterized as a fire in the brain. And the oxidative damage in the chemistry of autistic children constitutes a kind of fiery injury to their RNA and DNA.

If you are going to employ visual imagery to quench the fire, then why not use pictures that are more effective than merely aiming a fire hose or throwing ice water at it? Instead, try mobilizing your body's powerful natural resources for quenching the inflammation, calling on your body's clouds to release rainwater on the brush fires of the prairie where the inflammation resides. This could be your intestine if you have colitis, your joints if you have arthritis, your skin if you have dermatitis, your lungs if you have bronchitis and so on. You can even get technical and make your raindrops into vitamin C, vitamin E, beta-carotene and other potent antioxidants. Communication between your meditating-visualizing brain and the resources of your body is more dynamic and more specific then you know.

When Bernie Siegel began talking about people's responsibility for their own health and healing in the face of serious illnesses such as cancer, people accused him of 'blaming the victim' by placing an unreasonable burden of guilt on the sick person. But you can't really take control of your health without believing that your health is to some extent under your control. Even a person who has been a victim of some catastrophic accident must believe that he or she can exercise control over healing, to at least a small but critical degree, through the expression of intention in prayer or visualization or by the exercise of sheer willpower.

For people with chronic illness, the lines of causation are more ambiguous than they are in an accident. However irrational it may be, all of us feel guilt for things that happen, like the ill-timed flareup of cold sores just before an important public appearance. Feeling guilty won't get you anywhere, but feeling responsible is the key to taking charge. If you feel like you're the passive victim of the event, you may miss a chance to engage your body's resources for healing. Only by feeling that you can take responsibility for your own health will you be able to make the changes that are necessary for regaining that health in the face of chronic illness.

Effects of dieting on eating control

Dieting causes problems with the control of food intake. Attempting to diet results in increased calorie consumption in certain situations. Dieters feel more out of control than non- dieters, and experience chaotic eating patterns.

Dieters aim to eat less and to control their food intake. Women often attribute their perceived 'large size' to their inability to eat appropriately, believing that the reason why they are over their desired weight is because they overeat. Women look at other people's eating behaviour and believe that they eat less and at different times and understand their own behaviour in terms of loss of control. Dieting is regarded as a means to impose self- control and an external structure on their food intake. However, there is no evidence to suggest that, before dieting, women who are over their desired weight eat any differently or experience more episodes of loss of control than women who are at their desired weight. There is no evidence to suggest that larger women are more out of control than their thinner counterparts, or that women who decide to diet have experienced more overeating than those who don't.

However, there is evidence to suggest that dieting increases episodes of both perceived and actual loss of control. Imposing the dieting structure on food intake appears to have the opposite to the desired effect.

Perceived loss of control

Because of the limitations set by the diet, any food which is eaten beyond these limits is regarded as overeating and attributed to loss of control. Eating which would usually be seen as a large meal, a special occasion or a treat is regarded as overeating and indicative of lost control. The urge to eat which would usually be regarded as hunger is registered in terms of craving, and giving in to this urge is regarded as a weakness.

One woman said: 'When I start to diet I want to eat things I shouldn't eat. I want to buy fattening foods when I know I am on a diet.' She did not eat any more than before she began to diet; however, desires to eat certain foods are perceived as being a problem.

Actual loss of control

One of the main effects of dieting is that it contributes to actual loss of control over eating. Dieting causes increases in the preoccupation with food, making food more attractive, it alters responses to food, resulting in certain foods becoming 'forbidden', which triggers specific states of mind, and it causes mood changes. All these contribute to actual loss of control and result in the dieter eating more than she would have if she hadn't dieted in the first place.

One woman said that she found the diet very difficult. 'I feel depressed about dieting. I overate to start off with, felt depressed and then ate more. I felt that eating would make me happier, but I just felt guilty and wanted more to eat.' Dieting resulted in her eating more than if she had not tried to diet in the first place.

Another woman said: 'I can't cope at the moment with the feelings of deprivation that I get when I go on a diet. It wells up inside me and I panic and eat.' The diet made her feel deprived, and so even though she wasn't eating less, she then ate more to compensate.

Dieting aims to control food intake and to reduce food consumption. It aims to impose a structure on the dieter's behaviour and to result in weight loss. It doesn't appear to achieve either of these aims. The cognitive and emotional changes which occur as a response to dieting undermine attempts at eating less, and cause overeating, the very behaviour dieters are trying to avoid.

Men and dieting part 1

A couple of years ago I was explaining my area of research at a job interview. After I had given what I considered a clear and full account of my work, the only man in the room said 'There is an obvious logical error in your work'. I was totally taken aback and meekly asked what it was. 'What about men?' he said. I had never really considered men in relation to dieting before. My interest in the area stems from being a woman myself, and I always felt that it was nice to work on something that men hadn't managed to monopolise yet. This post is a concession to that male interviewer, and to the many other men who have told me 'it's just as bad for men'.

Men also have role models and heroes. Over the centuries, literature has been full of ever changing images of the ideal man. In 1813 Jane Austen wrote in Pride and Prejudice:

Mr Darcy soon drew the attention of the room by his fine, tall person, handsome features, noble mien; and the report which was in general circulation within five minutes after his entrance, of his having ten thousand a year.

Attractive men were tall, straight and rich.

In the 1950s Charles Atlas used to be the ideal man. Men were sold work-out kits and body-building equipment. They had to be large, powerful and strong. They were men of few words and lots of muscles. But what is the message now? Do men have an image that they have to conform to?

It is often assumed that the media focus only on women's bodies in their attempts to sell a wide variety of products. Most adverts still have women modelling anything from clothes to cars

to cleaning fluid. I asked several men if they felt there were pressures on men to look a certain way.

One 25-year-old NHS manager immediately replied: 'Definitely' and proceeded to provide a detailed description of the ideal man:

You have to be tall, in a sharp suit (casual but smart), exuding money. The ideal body is well built, wide shoulders, a v-shaped back tapering to a firm bottom with dimples and a flat stomach.

He felt that men used to be proud of their beer guts but now they were ashamed and hid them.

Another 25-year-old man said that the ideal man was summed up by the actor Richard Gere: 'Not over-muscular, fit and at fighting weight. So that you don't really notice his body, but it is capable of doing what it's supposed to do without impairing itself' He felt that the ideal body was to do with fitness and health. He felt that the ideal body was one that was not noticeable because it was 'how a man's body should be'. Another felt that the ideal man was 'lithe, fit, stubbly and dark haired'.

I also asked several men what these images meant to them. The most common answer was that being tall, thin and fit meant that you were in control, and control was central to the 1990s' image of the ideal man. It also meant that you were healthy and confident and therefore capable of being a success in all other areas of life.

With the rise of the 1980s' work ethic, men in the media have become leaner; they look hard working and healthy. The ideal man does not self-indulge, he is in control and in command of his life. Hedonism seems to be becoming a thing of the past and this is illustrated by the contemporary ideal man.

So where do these images come from? These pressures seem to come from three sources: other men, women and the media.

One man said: 'Other men joke about putting on weight. They say "you're letting yourself go a bit" or suggest that you should take up squash at lunchtime.'

Another said, 'You overhear women talking about firm bottoms and flat stomachs and you realise that that's what they expect.' He also said: 'You know that women find certain film stars attractive. You also realise that they know nothing about them apart from how they look and what their bodies are like, so you realise that it is their bodies that make them attractive.'

The pressure also comes from the media. Over recent years there has been an increase in men used in advertising, all of whom are thin and stereotypically attractive. Media men have become less hedonistic and increasingly in control and reserved. In a recent television advert, a young man is used to advertise healthy pre-cooked meals. He is thin, healthy and represents clean living and self-control. He looks sensible. Male heroes of the 1960s and 1970s had an air of excess and debauchery about them. Now men are tame and controlled. The only media man that any of the men I interviewed could think of who was outside this image was Jack Nicholson who personifies total hedonism, self- indulgence and pleasure. Perhaps his attractiveness comes from his obvious rejection of social norms, and his ability not to conform, not to use tricks and not to be influenced by what other people expect.

Women tend to assume that men can get away with a greater variety of looks, sizes and shapes than women. It is believed that the male personality can compensate for many (but not all) physical characteristics. Woody Allen is a sex symbol; the female equivalent would never have even made it through the studio door. However, the media do seem to present an image of the ideal man of the 1980s and 1990s. How do men respond to these images? Do men feel dissatisfied with their bodies?

In 1968 Diabiase and Hjelle carried out a study to evaluate men's idea of the ideal body size. Groups of fat, average and thin men were shown silhouettes of male bodies which were also fat, thin and of average weight. The men were then asked to say which size they preferred and why. All the male subjects regardless of their own size preferred the average weight. They felt that both the thin and fat bodies represented qualities such as being shy, dependent and withdrawn, whereas the average-size body represented being active, energetic and dominant.

The men in the study showed a preference for a particular size. But was this reflected in a dissatisfaction with their own size?

Men and women were asked to rate their ideal size and their actual size. All the women subjects showed a large discrepancy between how they felt they looked and how they wanted to look, but the young men in the study did not. Regardless of their actual size, they felt satisfied with their weight.

Although men may report an ideal size and a preference for a particular body size this does not seem to be reflected in a dissatisfaction with their own size. It would seem that men are not directly affected with worries about their weight.

Why continue to diet? continue...

Dieting as a Means of Change

Women's lives vary enormously. No two individuals have the same expectations, the same aspirations, the same struggles and the same problems. We all have different backgrounds, different histories and different futures. But we all have things in our lives that we would like to change. This need for change can vary from a niggling wish for a new washing machine to a desire to meet new people to a desperate yearning for a new and more challenging career. And most of us also want to change something about ourselves.

Below is a list of things that people often say about their lives and themselves. They are all to do with change. Some of these changes are more possible than others, some are dreams and others are goals. But they are all important factors in the way we perceive ourselves and our futures.

I wish. .. .

I were rich

I had more friends

I had someone to talk to I had a partner

I were loved

I did not have a partner I had a job

I had a better job

I were successful

I had somewhere nice to live I had more time to myself

I were more attractive I were more intelligent

People would notice me

My boss would appreciate me

I could stand up for myself I could control my anger

I were happier

I were more organised I were thinner

Some of these wishes are to do with changing what happens around us; some of them are to do with changing ourselves; and some of them are an interaction of the two. Most of them involve effort, help, support and a bit of luck to achieve; the rest may feel like impossibilities.

What has this got to do with dieting? Sometimes losing weight may seem to be the only thing in a woman's life which she feels capable of changing.

Imagine waking up on January 1st and deciding on your New Year's resolutions. You decide that this year:

1 I will get promoted.

2 I will find myself a nice new partner.

3 I will broaden my social circle.

4 I will be a nicer person.

5 I will lose weight.

These resolutions, like the wishes above, are all difficult to attain. And to an extent they may feel beyond your control. You might feel 'My boss decides if I get promoted or not' and 'I can't just decide to walk down the road and find a new partner'. But you may feel 'At least I can try and lose weight'.

Women live in a society which is still controlled by men. The average woman earns 63 per cent of the salary of the average man. Most top jobs are occupied by men; occupations such as teachers, nurses and secretaries are still predominantly female whereas lecturers, doctors and company managers are still predominantly male. Women have fewer options open to them. It is difficult to get promoted because it is still assumed that women will leave to have children, that women are not as dedicated to their work and that they are less capable.

As a result of this women feel that their lives are out of their control. They may make decisions about their futures and their lives but the realisation of these decisions is dependent upon society's response. Women may strive to fulfil their potential but are subjected to social norms and expectations which counteract their attempts.

In addition to these social barriers to self-fulfilment, women are not encouraged to understand where their potential lies. Nor are they expected to take control of their lives. Women's role has always been that of the passive receiver of whatever life might throw in their direction. Women are taught to accept and not to challenge whatever happens to them.

Ultimately women feel out of control of their lives.

And dieting offers a means at least to attempt to change something. It presents a way to regain control and to change one disagreeable aspect of life. We all have dreams and goals. If we cannot achieve most of them, at least we can try and change something: our weight.

Dieting Takes on a Life of its own

Dieting becomes a habit and offers change and because of this dieting also takes on a life of its own. Thinness offers success, love, control and stability, and dieting takes on all these qualities.

We believe that if we diet we will regain control over our lives. We feel that we are dieting for ourselves and that it is a way to create change when so many aspects of our lives feel unchangeable. A successful diet compensates for other areas in our lives in which success eludes us. And focusing on losing weight compensates for a life without focus.

Dieting is seen as a way to change not only your weight but also your life. Dieting becomes an end in itself rather than a means to an end. Although the initial aim may be to lose weight, the aim becomes to diet. Women continue to diet in the face of failure because even if there is no weight loss, dieting becomes a way of life and a goal within itself. And there is no final goal dictating how thin we should be. The aim is to be thinner. Everyone wants to be thinner. The process of getting thinner is what dieting is all about.

If I were thinner everything would be all right

Dieters diet to become thinner, and being thinner is seen as the way to make life better.

Thinness has many meanings beyond that of simply weighing less. On the following page is a questionnaire to identify what being thin means to you.

Circle the answer that best applies to you.

How often do you think, If I were thinner...

• I would be happier NEVER/SOMETIMES/OFTEN
• I would be more attractive NEVER/SOMETIMES/OFTEN
• I would be more popular NEVER/SOMETIMES/OFTEN
• I would be more confident NEVER/SOMETIMES/OFTEN
• I would be better at my job NEVER/SOMETIMES/OFTEN
• I would be more successful NEVER/SOMETIMES/OFTEN
• I would be more outgoing NEVER/SOMETIMES/OFTEN
• I would feel more in control NEVER/SOMETIMES/OFTEN
• I could show the world that Ihave will-power NEVER/SOMETIMES/OFTEN
• I would feel more assertive NEVER/SOMETIMES/OFTEN

Score the questions by awarding yourself one point for each 'never', two points for each 'sometimes' and three points for each 'often', then add up all your scores. The highest score possible is thirty and the lowest is ten.

The questionnaire illustrates how important being thin is, and how many other changes you expect from thinness other than simply weighing less. A high score suggests that you expect many changes.

If you diet because you feel that being thin offers a solution to many of life's problems, then it is necessary to put being thin into perspective. If you think that being thinner will change your life, then challenge these thoughts.

This is difficult because the association between thinness and a good life is intrinsic to our perception of ourselves. However, with a degree of effort and dedication it is possible to realise how ridiculous this association is.

The following exercise aims to highlight how it is possible to dissociate thinness from all the other supposedly related qualities.

Think of all the things you, would be able to achieve or feel if you could weigh less. To do this, picture yourself as you are at the moment and then as you would be if you were thinner and try and evaluate what the difference would be. Make a list of these differences, and next to each item write down all the possible reasons why this may not be the case.

Overleaf is a list of some of the possible meanings of being thinner and a reason why thinness does not have to have this meaning.

Thinness and attractiveness

We believe that if only we were thinner we would be more attractive. But how thin do we have to be before suddenly becoming attractive? Most women who diet would be considered as thin by everyone else anyway. But they still feel that being thinner would be an advantage. Dieting makes you miserable, preoccupied with food and weight, feel a failure — none of which are attractive qualities. A failed dieter can feel useless and lacking in will-power. Attractiveness is about liking yourself and presenting a likeable person to the outside world. Dieting detracts, not adds, to your attractiveness.

If you do lose weight, will this make you more attractive? What weight will this be, or will you always feel that if only you could be that bit thinner you could be more attractive? Look at the people around you. Are the thinner people more attractive? Do your thinner friends feel more attractive? Attractiveness is about using your body in a positive way and it's about feeling confident with your body. Being thinner does not create this, but your attitude to yourself does.

Thinness and success

Seeing weight loss as the way to success is self-defeating. Trying to diet undermines any feelings of success because weight loss is so difficult. Dieting is associated with feelings of failure which generalise to other areas of your life. Feeling a failure is not the way to succeed. Constant attempts at dieting can contribute to low self-esteem which can actively prevent success. Why spend so much time trying to lose weight, and feeling bad when it does not happen? Success in dieting is very difficult, so why chose weight loss as the area for success?

And if you do lose weight, will you be more successful? Or will you simply be thinner?

Thinness and happiness

We are sold the message that thinness is happiness, so we try to become thin. Whatever size we are to start with we still want to be thinner. But getting thinner is difficult, it is depressing and can be a miserable way of life. If we never achieve the goal of gettingthinner, we are constantly disappointed and annoyed with ourselves. Being disappointed and annoyed is not the way to be happy. And even if we achieve the desired weight loss, thin people are no happier than their larger counterparts because thin people still want to be thinner.

Happiness is about liking ourselves and not being constantly critical. It is about feeling positive and in control and proud of what we have to offer. Dieting is about the opposite. Trying to be thin creates a state of constant self-criticism, it is a difficult task and generates a negative view of who we are at the present while focusing on who we could be in the elusive future.

Thinness and control

We believe that 'If only I could control my weight then I would be able to control my life'. But weight naturally controls itself and is regulated around a fairly stable set point. Dieting imposes an unnatural form of control upon something which is self- regulating. Constantly trying to eat less, sometimes succeeding and sometimes overeating, undermines this control and can leave the dieter less in control than she was before she started to diet. In the short term dieting may provide a structure, but in the long term constantly trying to limit your food intake can create chaos. And feeling out of control of your eating can generalise to other areas of your life. Trying to be thin can undermine, not add to, your sense of control.

So if we realise why we diet, and can find a substitute for dieting, we can stop dieting.