FAT LOSS – EATING DISORDERS: BULIMIA

The desire to maintain a sub-optimal weight also frequently underlies the condition of bulimia, although bulimia sufferers are usually dose to normal weight for height. Bulimia is defined as a behaviour involving a variety of techniques for purging after binge-eating. Unlike those who suffer from obesity or anorexia with associated body size, there are few clues to the condition of bulimia for the observer. For this reason its prevalence is probably much higher than estimated, and its diagnosis is more difficult. Its prevalence (1-3 per cent amongst adolescent and young females) is thought to have significantly increased during the last 20 years, with surveys in the US indicating possibly as many as 15 per cent of college aged women experiencing some form of bulimia. Many bulimia sufferers seek treatment only after years of binge-eating and vomiting, feeling both responsible for and guilty and ashamed of their disorder. On the other hand, clients may seek help for weight loss without ever disclosing the underlying condition.

Diagnostic criteria.

The following symptoms are considered to be characteristic of bulimia:

• usually normal weight-for-height—but may be slightly over or under weight

• morbid fear of fatness

• extreme sensitivity to weight gain

• recurrent episodes of bingeing (characterised by the feeling of loss of control over eating) followed by self-induced vomiting—at least twice a week for three months

• purgative abuse—may be in addition to vomiting

• excessive exercise or fasting

• depressive symptoms.

Non-purging type bulimia may also occur, involving bingeing together with inappropriate compensatory behaviours such as fasting or excessive exercise, but not vomiting or laxative abuse. Possible medical complications of bulimia include dehydration, electrolyte abnormalities, salivary gland swelling, possible kidney disease, gastrointestinal problems, possible endocrine abnormalities, dental caries and erosion of tooth enamel.

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THE G.I. FACTOR: THE HIGH CARBOHYDRATE DIET

Our bodies burn fuel all the time and the fuel our bodies like best is carbohydrate. Just as you would never try to run your car without petrol—its essential energy source—you should not try to run your body without carbohydrate—your body’s preferred energy source. Carbohydrate is the main fuel we use when we walk, talk, think, move, scratch, sneeze, jump, or sleep. Everything!

You might think of carbohydrate as the all important ingredient that makes foods taste sweet. It is also the starchy part of foods like rice, bread, potatoes and pasta. In fact, carbohydrate is the most widely consumed nutrient in the world, after water. It’s important to the human body because it yields glucose. Glucose is so important that if your diet doesn’t provide enough carbohydrate, your brain signals a shortage of glucose, and muscle tissue will be broken down to supply the shortfall. This basically means that you lose body muscle to feed your brain. Carbohydrate also displaces fat from the diet. While not all fats are bad (monounsaturated and polyunsaturated are fine), they are all easy to overconsume, i.e. eat in excess of your requirements. It’s easy to put on excess weight if your diet is dominated by fats. Ideally, 50 to 60 per cent of your daily kilojoule intake should come from carbohydrate.

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EXERCISES IN DISCOMFORT FOR THE SELF-MANAGEMENT OF PAIN: DISCOMFORT AND RELAXATION

In order to condition our mind to be less disturbed by pain, we are deliberately going to expose ourselves to some degree of discomfort; at the same time we shall keep our mind calm and relaxed so that the discomfort simply does not disturb us. And because it does not disturb us, we do not really perceive it as discomfort at all.

You suffer from pain. And I suggest to you that you expose yourself to further discomfort. I can see your reaction. “No, I have enough suffering. I don’t want any more. I could not bear any more.” This reaction is understandable. But just remember two things. You will not experience any feeling of discomfort; you will merely place yourself in a situation which under ordinary circumstances would be uncomfortable, but because of your relaxed state of mind, you do not feel as uncomfortable. And, secondly, remember that this is an important step in the

self-management of pain, just as exposure to the phobic situation was in the relief of phobic anxiety.

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DISEASES OF THE SPLEEN

The spleen has its area in the left iris, 20′-25′ in the sixth minor zone. A lighter colour in the spleen area is found with inflammation of the spleen (splenitis), and also in diseases of stomach and intestine. A darkened spleen area indicates a diminished function of this organ. This is found with blood stasis following myocardial weakness, and with liver complaints.

The spleen and liver have a close connection to one another. Patients in whom spleen and liver areas are darkened cannot sleep at night. A very dark spleen area enables one to diagnose the tendency to feverish illnesses.

An enlarged spleen is suggested when the spleen area in the iris is enlarged, when the

iris-wreath is contracted in towards the intestinal zone, or any existing cramp-rings are displaced inwards towards the iris-wreath.

At first, the tumour-signs in the spleen area are lighter, from the overactivity, but with functional insufficiency of the spleen, the spleen area becomes darkened and black points develop.

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MENSTRUAL PROBLEMS: HOW TO COPE-IN VARIOUS SITUATIONSC-AT SCHOOL:

INTERACTING WITH OTHERS

One of the difficulties about being depressed, irritable or angry at school is that, so often, you’re not the only one. We know from Dr Dalton’s researches that groups of females who spend a lot of time together seem to trigger one another’s periods off, so that some of them have periods within one or two days of each other. If you and your particular group of friends have that effect on one another, many of you could be suffering from the miseries at the same time. And if that’s so, it’s very likely that far from helping one another you’ll actually be making one another worse. The rows or the blues can be really prodigious when you’re all out of balance at the same time.

What’s to be done about it? One way of coping is to work out when your aching miseries are due and then spend more time with other people who aren’t off-balance and a lot less with your particular friends on those days when you’re all at risk. Failing that, you and your friends could make a pact (when you were all safely through the miseries and happy again) that whatever any of you said before your periods the rest would ignore, and that no decision made at the time would be taken seriously and could be reversed a fortnight later anyway. If you are all learning how to relax together and noticing from your charts that the time when you’re off-balance is getting shorter and shorter month by month, the whole thing will get easier as you go along anyway.

Another rotten thing about periods is that as well as being able to trigger one another, you can also trigger yourself off, even though it’s certainly not intentional and you often don’t want to at all. If you are in an emotional state, because you have just split up with your boyfriend, for example, or you have had a row with your mother, your body may react to your emotions by starting a period whether it’s due or not. This is really adding insult to injury, because you probably feel bad enough already without that.

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THE ACHING MISERIES (CONGESTIVE DYSMENORRHOEA): IT HELPS TO RELAX

Because the aching miseries don’t knock you out as the cramps do, but just go grumbling away for days and days, they are more difficult to deal with. You can’t just take to bed and relax for a fortnight, nor would you want to. But regular relaxation can help, particularly if you practise it at least once a day for twenty minutes to half an hour from the moment your first symptoms appear (or just before they do, if you can work out when that will be) and carry on until your period is under way. Last thing at night is a good time to choose, particularly if you are too uncomfortable to sleep well: Relaxation is a great help if you suffer from insomnia.

If you keep your chart for several months and practise relaxation at the same time, you may find that you are gradually shortening the time when you have all your unpleasant symptoms. It’s very heartening to watch a cure gradually taking effect. But don’t be alarmed if you suddenly have a period which is much worse than you had hoped. All sorts of things can throw the body off balance and upset one’s periods —moving house, hearing bad news, even sudden good news, working far too hard, a family Christmas, a hectic holiday, a row. Although we are physically a lot tougher (as opposed to stronger) than men, in this respect we are like expensive watches: our mechanism is extremely delicate.

Even the number of cigarettes a woman smokes has an effect on period pain. Often the more you smoke, the worse it is. So if you’re a smoker, you should cut down on cigarettes just before your period. If you don’t smoke, don’t be tempted by well-meaning friends who offer you a cigarette when you’re under the weather with period pain, ‘because it’ll pick you up’. It won’t. It will make you feel worse.

It seems possible that the symptoms of the aching miseries are caused by a shortage of the sex hormone progesterone, a shortage which not only gives one those particular aches and pains low down in the abdomen but also throws the rest of one’s body out of balance too. We are also emotionally off-balance, so we become irritable or depressed or angry. Fortunately, deliberate relaxation can help, but with this kind of pain it’s a slow process, and it usually takes several months to be really effective. So in the following sections of this chapter I shall be dealing with as many of the symptoms of the miseries as I can, and suggest some other practical ways of coping with them; but please continue your regular relaxation.

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SIGNS, HOME CARE, PRECAUTIONS AND TREATMENT OF ULCERS IN CHILDREN

Signs and symptoms

An older child with ulcers has upper abdominal pain before meals or at night, and the pain is often relieved by eating. Preschoolers with ulcers have pain near the navel; the pain comes and goes and is aggravated by eating. Children of any age may vomit bright red or dark brown blood or have blood in the stools (appearing as tarry stools). Ulcers are seldom the cause of ordinary stomachaches in children – although they often get blamed for such pains. The diagnosis of an ulcer can be made only by X rays (upper gastrointestinal series) or, less commonly, by endoscopy which involves viewing the stomach directly by means of an instrument passed down the oesophagus, the passageway from the mouth to the stomach.

Home care

Temporary relief for pain can be provided by giving the child an antacid by mouth. Other home treatment is not recommended. The child should be under a doctor’s care.

Precautions

• Not all black (tarry) stools contain blood. Iron supplements and some foods can cause black stools. The stool should be tested.

• Abdominal pain in a child who is under emotional stress is more likely to be caused by the stress than by an ulcer.

• Several members of a family may have ulcers because they share the family’s lifestyle and tensions, not because ulcers are hereditary.

Medical treatment

Your doctor will take a careful health history of your child, perform a physical examination, and may order X rays. Your child’s stools will be tested for blood, and a blood count will reveal any evidence of secondary anaemia. The doctor will probably prescribe antacids between meals and at bedtime or antispasmodic drugs before meals. The doctor will also advise you on changes in the diet and ways to relieve the child’s emotional stress.

Changes in the diet usually involve avoiding caffeine in cola drinks, tea, and coffee, and aspirin (including cold remedies that contain aspirin). Treatment usually can be discontinued in a few weeks or months.

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IDENTIFICATION BRACELET OR CARD FOR DIABETIC CHILDREN

Your child should always carry some identification

It is wise for your child to wear some means of identification at all times.

It is perhaps most unlikely that an emergency will arise when no one that knows him is with your child, but as the possibility does exist, you should be prepared.

Accidents can happen on the way to school or visiting friends, or perhaps he may have a hypo while he is away from home. In either event he may not be able to tell anyone he has diabetes, and this could mean he is not given the appropriate treatment promptly.

Most children now wear identification as a bracelet on the wrist or on a chain. You may have your own engraved or use one supplied by organizations such as the S.O.S. Talisman or Medic Alert bracelet.

Teenagers may carry a card

Teenagers may prefer to have a card giving full information.

It is suggested that you have your child’s name, address and telephone number, the word ‘Diabetes’ and the name and telephone number of his own doctor or hospital to be called in an emergency.

If your child carries this information at all times you will have the security of knowing he would be properly cared for in the unlikely event of a severe hypo reaction or accident when away from home.

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WAYS OF COPING WITH STRESS: DRUGS AND STRESS

In different cases, different factors operate in precipitating an individual into the habit of drug-taking. It may be simply a matter of relentless pressure of one’s peers, or nothing more than the desire to explore new fields. To experiment. ‘How can you evaluate something that you have never experienced?’ Nevertheless, stress plays an important part in bringing many people to take drugs for the first time, and in maintaining use of the drug before actual addiction has set in.

People under stress hear that marijuana brings a feeling of relaxed well-being and counteracts the anxiety and nervous tension of stress. There are usually friends who say, ‘I take it. You can see it has no ill effect on me. What do you lose by giving it a trial?’ So he tries it, and discovers it does bring a feeling of relaxation, and dispels some of the anxiety of stress. So he repeats it, and soon becomes a regular user.

It helps a lot, but maybe it does not relieve all the tension. Then one day the tension is more severe than usual. ‘Perhaps I need something a bit stronger. Just once, or a couple of times to settle me down.’ And he is off on heroin.

But in more than forty years of psychiatry, I have seen enough to know that those who do not go beyond marijuana may still suffer terrible consequences. Even old hands at the game may suddenly have a bad trip. This may occur after starting some orthodox medication, after an unaccustomed amount of alcohol, after some additional stress or in the incubation period of some virus illness. Perhaps, more commonly, the sudden bad trip appears without any discernible cause. In the bad trip the individual may injure himself or others, or even commit some antisocial act of which he may have no subsequent recollection.

I have seen several young introverts precipitated into schizophrenia by their experience of the dreamy unreality that often goes with the taking of marijuana. But distinct from the schizophrenic reactions, others have developed a toxic psychosis requiring hospitalization in a psychiatric institution.

There is another, less spectacular and less well-publicized reaction which may follow the use of marijuana. This is chronic marijuana intoxication. It occurs in people who have been taking the drug for some time. It is the counterpart of chronic alcoholism, but the clinical signs are slightly different. In chronic marijuana intoxication there is a general falling off the individual’s performance, both socially and at work. The person concerned is unable to accept this, even when it is pointed out to him. His typical reply is, ‘I am all right. You can see I’m all right.’ He is likely to repeat this statement several times, which in itself is evidence that he is not quite all right. Perhaps the most obvious feature of chronic marijuana intoxication is the individual’s lack of concern. The unconcern is all pervasive, extending not only into all aspects of his own life, but into the affairs of others and of the community in general.

We have discussed how stress may precipitate the individual into drug-taking, and how the effects of the drug may come to have a disastrous effect on his life. But there is another reaction which occurs in the early stages of drug-taking. There may come an awareness of increasing dependence on the drug. Then a panic: ‘Am I hooked? Have I become hooked without knowing it?’ The acute problem adds to the individual’s level of stress, and so makes withdrawal of the drug still more difficult.

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MAJOR PROBLEMS LEADING TO STRESS: CANCER

“I had the lump there. But sometimes you get bits of thickening. He said he thought it was OK but thought he had better do a biopsy. Then this report and he says I must have it off. Next week at the latest. So casual about it. Just an incident for him, but for me, my life. More, think of it! Fondling, loving. Oh, God. He’s sweet. Says he will love me just the same. But it can’t be. Says it’s me that he loves, not my body. But my body is me. Such an important part, for me and for him. Cuddling. Misshapen. I cannot think of it.

‘People talk about alternatives. He didn’t. But some people do. So little is known, could I take the risk?

‘The children. To grow up without a mother. So young. So different from what might have been. Deformed in their way. A child growing up without a mother becomes deformed in the spirit. Deformed, just as I shall be. Life, as I knew it, is at an end.”

The devastating problem, the effect of the cancer on herself, is made worse by the associated problems of its effect on her husband and children. Her brain is filled with so many nervous impulses that it ceases to function properly. She cannot think clearly. She does not know what to do.

She urgently needs to reduce her nervous tension. Of course, this can be achieved most effectively through simple meditation. If you should ever have the misfortune to find yourself in some such similar situation, don’t react by saying, ‘How can I meditate when I am distraught like this? You need to be calm to meditate.’ No. Just let it come, slowly, just slowly, and little by little calmness comes to our mind. And as we repeat the process, the effect of it gradually flows on into our life as a whole.

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