Friday, 21 May 2010

Devolved Responsibility and the Medical Model

I was in the children's ward at the hospital earlier this week where my littlest girl had just had an operation. I overheard another mum talking to her daughter who had also been in surgery, and the language she used attracted my attention. She talked about what they were allowed to do and when they were allowed to go home. This is the kind of language I notice when clients use it and challenge them about whose decision this is to make. And here I was just a few feet from where my clients often make those decisions, listening to a mum use this language and I realised that I was resisting doing the same thing. I knew that the medical staff wanted my daughter to have a wee before she left and she was resisting this. When she asked if we could go home, I could have said "We're not allowed to go home until you've had a wee" but I chose to say "We're not going home until you've had a wee". Did it make much difference? Yes, I think it did.

If I said that we were not allowed to go home, then I would be saying that the decision about when we go was to be made by a doctor or a nurse, which is clearly not the case. If I chose to leave the hospital without this consent, no-one would be able to stop me. But I would have devolved the responsibility for this decision, at least in my daughter's mind, to the medical staff. It's not my fault we can't go home, it's the doctor/nurse's fault.

This made me think about something that has been on my mind for a while. My recent shift in teaching method has involved a deeper understanding of the effect of my words on my mind and the minds of those hearing them - Neuro-Linguistic Programming. I used to say that I wanted to have my second baby at home but I had to be induced, so I had her in hospital. This wasn't true, was it? I was strongly advised to be induced but in the end, it was my decision to make. How could I tell clients that all these decisions are theirs to make and then imply that I had no choice about my induction of labour? Well, this is all old news to me but this new experience in the children's ward helped me to realise why I chose those words. If I said "I wanted to have my baby at home but I chose to have an induction" it gives me the responsibilty for this possibly unnecessary and potentially harmful intervention.

So when a couple tell me their labour story and say they had to have a caesarean, are they deliberately avoiding responsibility for the decision they took, or did they not hear or understand what I had said about it being their decision to make? And how does this start to their parenting life affect their sense of personal power around their child? And what precedent does this set for the woman's future belief about her body's ability to give birth? And how much bearing does this have on our blame culture? If a woman feels that she 'had to' have forceps to birth her baby, how does she feel if her baby has bruises? Does she automatically blame the doctor as it was his/her decision? And what if the effect is more serious or longterm? How different would have be if the couple were empowered to make the decision for themselves? Would they be so quick to blame the doctor for any repurcussions?

So, I guess I am saying that in taking control of decisions away from the labouring woman, obstetricians have helped to bring about the litigation culture that causes them so much angst.

Saturday, 24 April 2010

It's all looking up

My despair culminated in a massive aggressive outburst yesterday morning. This made it clear to me that dairy intake is at least a factor in my emotional problems. I spent a lot of yesterday morning writing - a new habit I started last week. I got up at 6am from Tuesday to Friday and sat at my computer writing. I splurged out everything I was thinking and feeling, even the tiny stuff I wouldn't bother Dave or any of my friends with. I have written more than 1,000 words each day and on Friday it was nearly 3,000!

The big session of writing cleared the air a bit and I started to improve straight away. I had my hair cut in the afternoon and this made a big difference as well. My hair has been getting out of control for a few weeks and it has affected my self-esteem. As is often the case, I didn't realise how much it was bringing me down until the situation resolved and I felt much better.

So, lots of factors combined and last night I was back on form. I was resourceful and positive, I made 3 different meals for the girls' tea without shouting, I didn't eat because I wasn't hungry but had a candlelit dinner with Dave when the girls had gone upstairs. I stopped drinking wine when I had had enough, and gave what was left in my glass to Dave. Then I had a cup of camomile tea and went to bed at a reasonable hour. All very positive.

So, a friend from the Beyond Chocolate forum has been doing a programme from a book called The No Diet Diet (Fletcher, B., Pine, K. & Penman D.) and blogging about it. I have been reading with great interest because I love that kind of thing. The concept is that diets don't work - well, I already knew that. It says that in order to change the way you think, you change the way you behave. Break habits that are tying you into certain behaviours and hence change the way you behave and then think. Not very well explained, and one of the authors writes for the Daily Mail so it is a bit tabloidy, but the message is sound and I have decided to give it a go. More excitingly, Dave is going to do it with me.

I don't think I will start a seperate blog for this, or even get around to blogging every day, but I will write about what is happening with the No Diet Diet (NDD) as often as I can. The programme is broken into 5 phases and Phase 1 starts today. The task is not to watch TV all day. That isn't going to be very difficult for me as I don't like TV but we will see how it goes. There are some extra little tasks to do during the first week as well, but as I am assessing a teacher this afternoon and out with friends later I don't expect to do any of those, but I will keep them in my mind. Examples of things I might try are paint or draw, read something you wouldn't normally consider, write a story, contact a long-lost friend, ride a bike, learn to meditate. The creative things appeal to me most - drawing and writing a story.

I feel quite excited about the new programme. It says you are guaranteed to lose weight while doing it, which I don't believe or expect, but I will enjoy shaking up my life a little.

So, thank you to all of you lovely people who have expressed concern and empathy for my emotional struggles. It is the support of my wonderful friends that gets me through these troughs and I only hope I can repay your kindness when you have your own troughs.

Saturday, 10 April 2010

Feeling out of control

I have decided to blog this to try and get my thoughts together. Over the last week or so, since the school holidays started, I have been out of control with my eating and particularly my drinking. It's always been a bit like that with me, as most of my friends know, but this is getting serious. It's come to a head today because I have totally shot myself in the foot. I had a candlelit dinner with Dave planned for tonight, the food was chosen and bought, and I really enjoyed it when we did this last weekend.

But then at lunch my sister-in-law wanted a glass of wine and I didn't fancy red so I opened a bottle of Cava, thinking I could finish it this evening with our dinner. In true alcoholic fashion, the bottle was finished off by me and my SIL at lunch and then I spent the afternoon drinking cocktails with Dave and by the time it came to the evening, I was tired and headachey. That was the end of our evening plans.

So in the end, we ate our carefully planned food in front of the TV and I have gone up to bed with my knitting feeling really cross with myself.

I have put a bit of weight on since Xmas which isn't a problem in itself, but it's another sign that I am not in control of what I am consuming. So, I have to stop this but how? I'm not into the rules and new starts and strict regimes that I thought used to 'work' for me, so how do I start getting myself back on the rails? I don't think that going back to the BC daily blog is going to help - it's gone a bit beyond that. I think I need to ask myself not to drink any alcohol for a few days and see where it takes me.

The silly thing is, I am enjoying my knitting so much at the moment that I can quite happily focus on that rather than the booze. And the project I am most enjoying I can't do when I have had a drink because it's too difficult to take it back if I make a mistake. So it's in my own best interest on the night not to drink, so I am shooting myself in the foot again. I am running out of feet.

I think there might be something more to this. After all, it's spring which is my favourite time of the year, the sun has been shining, I have enjoyed being outdoors, I am getting more personal fulfilment from my work and my knitting/crochet than I could have imagined 12 months ago, our finances are good and we are considering some really exciting changes to the house, and yet I am struggling emotionally. What is going on?

Well if anyone has any ideas, please feel free to comment but in the meantime, I will probably share my continued angst with you all until it eases.

Tuesday, 23 March 2010

Day 6 - Be your own guru

I decided to jump to this principle when I had a couple of good ideas in the shower.

I have been drinking quite a lot of Cava recently. When I applied Beyond Chocolate principles to my alcohol use, everything changed and I was comfortable with myself in that area for the first time in years. I don't create rules for myself any more, I just follow my instinct. This means that most days I have some wine of some kind, although I often don't and not because of any rules. So, I realised this morning that I am still feeling the slightly tight feeling in my head that I get when I am dehydrated. So I decided to do more of the things that hydrate my body and less of the things that dehydrate. That was it - no firm rules, no commitment or timescales. Just that decision without pressure.

My digestive system tends to be quite slow and without giving TMI, I need to keep it moving. Lately I haven't been eating as much veg as usual and it has had an effect. So, I decided to make smoothies in the mornings to get a couple of pieces of fruit into me before the day starts. For some reason, I just can't be bothered to eat fruit most of the time. Drinking it is a lot less effort!

So, two ideas under my belt I started my day. It did not go as I expected and I ended up spending the whole morning supporting friends and ex-clients with their problems. This was just where I want to be, and I was happy to do it. However, it left me with no time to do what I had intended, which is a source of stress for me. My first thought was to abandon my plans to go to knitting group this afternoon to do the things I hadn't done, but then I decided that I needed some time for me so I went. I regretted it on the way as I felt so tired driving and could have had a nap at home, but I did enjoy it and it was good to do something for myself.

The rest of the day went very pear-shaped and I ended up extremely stressed and unhappy. I decided to do the things I needed to do and leave as much as possible till tomorrow. I have just been up to my youngest who appears to have wet her bed quite deliberately, while sitting up. I ended up so angry with her that I have come down and cut myself off from the rest of humanity until I can be trusted to be nice.

There is so much going on for us at the moment and a big will we/won't we thing is hanging over us, making plans and expectations very fluid, which is not a comfortable place for me to be in. I can see what is happening and I am going to scale back everything I can. I will make sure I make time for me and what I want to do, and be good to myself. I ate tons earlier and it felt like a binge but I don't even feel too full now so I guess it wasn't as bad as it seemed at the time.

So, what have I learned?

- that I have some great ideas and that framing them in BC speak, without pressure or judgement, makes them much easier to work with. (I haven't had any alcohol today and I know I won't, but not because I shouldn't)
- that I need to work out why I am getting so stressed and take appropriate action
- that I need to remember that just because I planned to do something, doesn't mean that it needs to be done today. When something happens to change my plans, I can reprioritise.

It's 'stop when you are satisfied' tomorrow. I am looking forward to that one as it's one of the hardest things for me.

Day 5 - Put it on a plate, sit down and focus

"When we make time to eat with enjoyment and focus, food becomes a delicious, nurturing experience. Why deprive ourselves of this pleasure?" Beyond Chocolate

This was a good day to look at this principle as I was teaching and I find it very hard to focus on my food when I am still working. Breakfast was rushed as usual and ended up as a sharon fruit eaten stood at the door waiting for the children to get their coats on. I ate again when the class was about to start and it was a cup cake, eaten stood up talking to clients. Not ideal, but probably unavoidable on teaching days. It seems to me that the main benefits of this principle are that I enjoy my food more and that I don't overeat. I can't really help the first one but if I make sure that what I eat in this unfocused way is very small amounts, I can at least mitigate that part of it.

When I got home I reheated the second half of the bacon and brie bagel from the previous day and ate that slowly and mindfully, sat at the dining room table. I made a point of putting the food down while eating, and focusing on each individual taste and texture. It was enjoyable and I didn't feel the need to eat anything else.

I ate with the girls at tea time and really enjoyed the pasta. So much so that I had a second helping. We were sat at the dining room table but I can't say I focused on the food as much as earlier. With the 3 girls there, all talking at once, competing for my attention, wanting help with things and stuff getting from the kitchen. We then made some cookies together and I enjoyed them so much I ate seconds again. Felt very full. But I think I did focus on eating it and loved every minute.

So what have I learned from today?

- Making time to sit when I am alone is very enjoyable.
- When I am not able to sit and focus, ensuring portions are small mitigates the issues.

That's about it really.

Sunday, 21 March 2010

Day 4 - Eat whatver you want

"It is only when we legalise all foods and give ourselves the possibility to eat everything that we can make choices and have a truly healthy approach to weight loss" Beyond Chocolate

This was a principle that I 'got' fairly quickly when I first read BC despite 10 years of dieting and the attendant demonising of whole food types. I do struggle with being true to it, though, because I live in a village 20 minutes drive from the shops and if I find I want something that I don't have, I can't have it! So, I tend to choose from the available foods, and that is only one small step from choosing from the convenient and readily available foods, then to the foods that need eating up, and suddenly choice is gone. So I work hard on this one. One method I use it to imagine walking into a restaurant and sitting down. There is no menu to look at, and after a while a waiter comes over and asks what I would like to eat. I know that whatever I ask for, they will be able to cook for me. Sometimes this works, sometimes it doesn't! So how did it go today?

I woke late and knitted for a while so when I finally came downstairs, it was late morning. I felt the first tickle of appetite around 10am and at 11.30am I was making our lunch. It was roast beef so it would be a while before it was ready so I knew I wanted to take the edge off my appetite to get me comfortably through to 1pm. I asked DD2 to hand me a banana but then I stopped and tuned in. I was in the restaurant and asking for.... .... not something sweet.... something savoury and quite bland. I opted for 1/4 of a tortilla. It was almost completely right - it was certainly the right amount and better than the banana would have been but it wasn't exactly right. More practice needed, I think.

At 1pm we had what I had been looking foward to since I bought it on Thursday: roast rib of beef, yorkshire puddings, roast parsnips, buttered boiled potatoes, cabbage and carrots, with Dave's awesome gravy and some hot horseradish sauce. I filled my tiny plate and did have a little more parsnip and another yorkshire. It was good! For pudding, I wanted a leftover mud cake with cream and ice cream. In the event, I had two and really enjoyed them.

Not long after lunch I left for an NCT reunion - a meet-up with 7 couples and their babies in a cafe/restaurant. I had a latte on arrival and some of them ordered cakes and puddings, but I wasn't at all interested. I was aware, however, that in my dieting days I would have been in a dilemma - I know I shouldn't have any cake, but I want some. But today I just knew that I didn't want any, so there was no issue of 'should' involved.

When I got home I was just starting to feel the first feelings of emptiness again and by 7.3pm I was ready to eat. But what? I looked in the fridge at the things that were immediately available and none of them were what I wanted to eat. I looked in the bread bin and saw (and smelled) bagels. That was the first thing of interest so I took one out. I looked for ham, but there was none in the fridge and I didn't want it enough to defrost any. I decided bacon was even better so got some out of the freezer and fried it. I put it into th bagel with some brie and sat down to eat it. I cut it in half and enjoyed every bite of the first half. I left the other half but instructed hubby not to touch it! I haven't been back for it, or eaten anything else tonight.

So, what have I learned today?

- I have come a long way with my eating habits
- Having food available but involving some effort (e.g. frozen) helps to focus my mind on whether I really want it
- Even if I can't put my finger on exactly what I want, I can get close by using the restaurant visualisation. To just find out if it's sweet or savoury, hot or cold helps with the level of satisfaction I get from eating the food.


I am delighted at how this 10-day focus is affecting me so far. I seem to be focusing better on all of the principles and finding I am back to my pre-Xmas state with intuitive eating. And I haven't felt like I am on a diet, either. It's not that I am doing this for 10 days then will go back to 'normal'. I am focusing again on what makes me feel good (emotionally and physically) and now that I am being more mindful, I will carry on this way. This blog has cured me of the effects of the winter depression I had this year. And it's only day 4. Imagine what I might achieve by day 10!

Tomorrow is "Put it on a plate, sit down and focus on it".

Saturday, 20 March 2010

Day 3 - Stop when you are satisfied

This was a tricky day because a lot of stuff was out of my control. I was on the road at 6am, arriving at a conference in Birmingham at 9am and getting home at 8.30pm. It is on these challenging days that it is easy to go with the flow, and I was determined to observe myself carefully despite being very nervous about presenting to 20 fellow teachers for the first time.

I wasn't hungry when I left home so took a stash of fruit and a flask of tea and left the house. When we arrived I was hungry so I had a banana. I later realised that there were croissants available but I didn't fancy them so that was fine. By the time we got to the coffee break at 11.30am I was pretty hungry. I found myself a pack of biscuits, which was what I fancied (and I had left the bag with my fruit in somewhere else) and had one of the two in the pack. That was enough to satisfy me and the other one is still lost in the bottom of my handbag!

At lunchtime, I'm not sure if I was hungry or not. It was the only meal I was going to get before 6pm so it was fairly academic. I saw the salad bar and there were prawns and I didn't even look at the hot food. I helped myself to prawns, smoked salmon and some salad. It was a bigger plate than I usually eat from and I had chosen 6 or so different things. I was reminded while eating of a lesson I learned fairly early on in my BC journey: I tend to eat the things on my plate that I like the least first, then work up to my favourite things. With this habit, it's no wonder I always finish my food because if I stop before it's all gone, I will be missing my favourite things. So, I spotted this and made sure I ate what I wanted to eat and when I had finished the salmon and prawns, I was satisfied. I left the rest.

But there was still room for pudding. There was a chocolate torte, a carrot cake and a very liquidy fruit salad. I fancied the chocolate, of course, but the slices were too big. I took half a slice and added cream. It was nice, but I didn't go back for the other half.

At the afternoon coffee break I scarcely had time to get myself a hot drink so food didn't figure so I clearly wasn't hungry. By the end of the conference, though, I was hungry. I ate a sharon fruit, a satsuma and a few grapes in the car and by the time we stopped at services for food, my stomach was not happy. Not sure why. I bought a prawn and chicken salad with noodles, but what really took my fancy was prawns on their own and smoked salmon on its own. This was what I had eaten at lunch and clearly I wanted more, but it was expensive so I opted for the salad. A mistake, as it turned out. The prawns in the salad were tasteless, as were the noodles. There was a lovely coconut sauce with it, but this only just made a bland dish bearable. I sat there eating it, realising that I was no longer hungry, and thinking "Am I going to eat all of this anyway?" Because I had paid for it, and the packaging meant that I couldn't take it home I was tempted, but in the end, I finished the prawns, for the texture only, and left about half of the salad and some of the chicken. Throwing it in the bin made me feel strong and powerful.

I finished the smoothie I had bought at the services after we left and that pushed my stomach too far. I felt too full for a lot of the way home. When I got home, I wasn't hungry at all but I had the chocolate egg I had bought at the services for pudding but not eaten. It made my teeth hurt but I still finished it.

So, what have I learned today?

- I tend to leave my favourite parts of the meal to the end, which makes it very difficult for me to stop when I am satisfied. When I eat the bits I want to eat, I am eating intuitively and making it possible for me to stop before the plate is clear.

- Even in difficult circumstances, I can eat intuitively. Choosing a banana over a croissant (albeit retrospectively) made me realise that I knew what I needed at that time.

- I can eat one of a two-pack of biscuits!

- I can throw away M&S food that I have paid over the odds for.

It was a very good day, in many ways. Tomorrow I think I will go back one of the principles I missed out: Eat whatever you want.