In love with your disease

In the old-fashioned freudian model, the pathological behavior of a mental illness is in many cases a symptom of, or compensation for, an underlying, causative problem. Once you find the cause, you’ve done the hard part. Examples: a man who is afraid of responsibility and drinks to absolve himself of it. A woman who cannot control her surroundings or her relationships, and starves herself to control her body.

The illness isn’t purely bad: it gives you something. You need it. Like the inflammatory response, or fever, it’s an immune system compensating or repairing. Like vomiting is how your body gets rid of bad food: it’s a helpful thing at first, and you do it again, and again, and then it’s not so helpful. And by then it’s too late to just stop, the nausea perpetuates itself.

You say things like “I feel that I’m fine the way I am. Which is the problem.”

I’ve been sad for longer than I’ve been anything else, I think. It’s always there, even when I’m well, which is most of the time these days. Months and months on end I feel fine. I feel great. I am happy and I know it and sometimes I even clap my hands and sing, seriously off-key, about life and its wonders. But I know it’s there waiting for me to slip. Waiting for an illness or a death in the family or a national disaster, and then it will pounce.

You ever read A Wizard of Earthsea, by Ursula K. LeGuin? That’s what it’s like. It’s always lurking. I may spend years free from it, but it will come back again, and I will have to fight it again. Eventually, I will die. Maybe it will kill me, maybe something else will. But I can never kill it. I can never truly win.

If there’s someone who would know about the relationship between the body and the mind, it’s Eliot “Follow Me Here” Gelwan. I wrote him asking about gastric bypass and mental illness, and his response was this:

In my experience, a responsible gastric bypass surgeon requires his patient to have a psychological evaluation before deciding whether to perform the procedure on a given patient. This is a little simplistic, but essentially the surgery works by reducing the volume of the stomach, producing a feeling of fullness and satiety sooner, and thereby helping the person control their eating. If someone, psychologically, eats compulsively despite feeling full, then not only will the surgery not work but it would be dangerous.

He also sent some abstracts and links to journal articles, which are included below.

Continue reading “In love with your disease”

When you have a hammer

Truism: When you have a hammer, every problem looks like a nail.
Application: Gastric bypass surgery.

What gets me about gastric bypass is that it’s a surgical problem to what is most often a psychological or behavioral problem. I’m sure that there are those for whom it is necessary, but it seems, in a lot of cases, that it’s (here’s my personal vendetta again) the easy way out. The solution to the wrong problem. These people have eating disorders, not enlargement of the stomach.

For example, one man’s son says that before the surgery, “All he did was watch videos, [but] now he can do stuff.” At a last-hurrah meal for one couple undergoing the surgery together, the woman ate until she vomited. Of course, she can still do that and lose weight– she’ll be full to sickness after a few bites. There are a lot of personal experience stories out there– blogs and so forth — that suggest a lot of food issues hidden behind the surgery. Look at Basil White’s description of what he ate at his last meal before surgery– or rather, his four or five last meals. It sounds like a junkie trying to kick. Only his last fix included a dozen donuts as an appetizer for a meal of chicken-fried steak, fries, and biscuits.

This FAQ downplays the possibility of becoming malnourished or losing too much weight, but it does point out that people who eat compulsively can gain weight even after gastric bypass, by eating constantly, by bingeing until they throw up again and again, or eventually just stretching their stomachs back out to full size.

Lots of information out there, though: recipe guides and of course suggestions for meal supplement, shakes, given that a diet of normal food would leave you malnourished. Not to mention discussion of different varieties of the surgery. The NIH site on gastric bypass seems pretty informative.

I’m not knocking it– it seems to work for a lot of people. Even proponents recognize that it’s a brute-force way of dealing with obesity, and most places require psychological screening beforehand. Still, I’m concerned that there doesn’t seem to be a lot of acknowledgement of the psychological issues behind the whole thing, at least not in media coverage and celebrity stories.

Pale

Been lying around moaning and feeling sorry for myself today. What fun.
Lyrics of the moment:

You better bring a fucking knife
till we see eye to eye
cause I’d rather cut your buttons off
than be caught in a lie.
Before I come to you I never wash my lips
cause when the music starts it goes right to my hips
and I break out in pale
–Kristin Hersh