The Hemp Connection:
anger

This post continues our mini-series on PCOS and the grief process. Today, we’ll focus on anger, which is the second stage of the grief model known as DABDA (denial, anger, bargaining, depression, and acceptance). Anger is a tricky emotion. People often label anger as bad, or undesirable. They deny it, refute it, avoid it, hide it, and act out around it. Anger and sadness that feel unmanageable are two of the most common reasons people show up in my office.

In death and dying, the person who is dying may be angry at god, the doctors, herself, her family, the guy who gave her the disease, the environment, and a number of other things. Likewise, the loved ones who are losing someone may have the same types of anger. In chronic illness, we may have the same targets for our anger, which may result in self-hatred, low self-esteem, acting out, and damaged relationships.

There is SO much to be angry about when it comes to PCOS, I’m sometimes surprised that we’re not all raging, all the time. At various times in learning that you have PCOS, and then starting to deal with it, and then just living with it for a long time, you might experience anger towards:

• God, because you have it
• The universe, for creating this thing
• Doctors, because they can’t cure it
• Your parents, because they gave you the genes that cause it
• Any woman who doesn’t have it
• Men, because they can’t have it
• The medical industry, because they haven’t cured it either
• Your body, because it’s not working “right”
• Other people, for not understanding
• Anyone who has children, if you want them and don’t or can’t have them
• Anyone who seems to enjoy perfect health, in spite of living an obviously unhealthy lifestyle (think, daily consumer of fast food who still has a perfect cholesterol panel, and no weight issues)
• Yourself, for not doing your self-care better, or more perfectly
• Any other medical professional, personal trainer, or other well-meaning individual you’ve ever encountered who said something stupid, irrelevant, pointless, misdirected, or just generally lame, in an effort to get your body to behave
• Dieticians who tell you what to eat without understanding your particular brain chemistry

All of this anger might lead you to act out, which could look like:

• Eating whatever you want, whenever you want – in spite of knowing better
• Failure to exercise – again, in spite of knowing better
• Overspending – because if you’re going to be fat, you might as well look good
• Unhealthy sexual behavior – “I’ll take whatever I can get, since no one would want me otherwise.”
• Manifesting other illnesses that are stress-related
• Being verbally or emotionally abusive towards your spouse, your kids, or others

Note that these things are not purely related to anger; they may also be indicators of other conditions, including mental health disorders.

These are big lists, and you are absolutely right to have a lot of anger about a lot of things related to PCOS. But you can’t live in anger all the time. Well, you can, but it’s surely not a healthy choice. So, how do you deal with all this anger, and get it out of your system, so you can move on to something more productive? And why do you even need to do that in the first place? I believe you need to get over the anger for the simple reason that Freud was right on this count – anger turned inwards becomes depression, and we’ve already got enough trouble with that, given the hormonal set-up we’re dealing with. Also, it tends to lead to negativity, self-hatred, and a more pessimistic perspective, none of which is helpful.

You can get rid of your anger in a lot of ways. Journaling, talking to friends, and talk therapy are certainly good choices. Creative expressions may help as well – creating collages, photographs, movies, music, or poetry that express your feelings are all great. I don’t like to encourage violence, but some clients report that there can be some great satisfaction in doing things like playing one of those video games where things explode when you hit them.

In other words, anger is actually a healthy emotion, but you’ve got to handle it the right way. Next week, we’ll address the concept of bargaining, in the context of grieving your PCOS.

Gretchen Kubacky, Psy.D. is a Health Psychologist in private practice in West Los Angeles, California. She has completed the inCYST training. She specializes in counseling women and couples who are coping with infertility, PCOS, and related endocrine disorders and chronic illnesses.

If you would like to learn more about Dr. HOUSE or her practice, or obtain referrals in the Los Angeles area, please visit her website at www.drhousemd.com, or e-mail her at AskDrHouseMD@gmail.com. You can also follow her on Twitter @askdrhousemd.

Last week I posted this graphic describing the grief process on our Facebook page. It got enough comments that I thought it might be worthwhile to expand on it in a blog post.
If you haven’t miscarried, or lost a family member, or been through a tough breakup, perhaps you don’t think this pertains to you. But there are many, many things you can grieve. --Being told you can’t have children. --Not getting into grad school and having to change your career plans as a result. --Foreclosing on a home. --Getting older. --Being diagnosed with a chronic, non-lifethreatening illness, like PCOS or infertility. --Accepting that your body likely is never going to be sculpted or dieted into that of Gwyneth Paltrow.
Diets? Something to grieve?
Absolutely.
In most cases I listed, it’s easy to understand how grieving is the result. Let’s talk for a minute about why dieting and self-medicating are often signs you’re in a grief process.
Grieving, you see, is about change. Any time you have to move out of your comfort zone and adjust to life in a different world, your potential for entering a grief process is high. If the change involves a promotion and a substantial increase in income, it’s a whole lot easier to adjust and accept than one that involves having to accept news you’d rather not hear.
In the case of PCOS, the news, in general, is that choices you have been making in your lifestyle have been counterproductive to your health. And that if you want to regain your health, you’ll need to make different choices.
You’ll need to go to bed earlier.
You’ll need to delegate more.
You’ll need to get to the gym.
You’ll need to eat more vegetables and fewer corn chips.
Looking at the long list of things your husband, your caregiver, your health coach, and your dietitian are asking… and expecting you to do… can seem insurmountable.
I receive, on average, about 5 emails a week from women with PCOS, asking if some supplement (Dr. Oz’ recent show on supplements raised that average), or diet (think HCG), is going to work. I have come to think of those emails as indicators that the person who wrote them is cycling through grief. They just want the PCOS to go away. It won’t go away on its own, the necessary changes that are not user-friendly, and anything that seems like the easy answer seems like it’s worth a try.
It’s when your grief process and my expertise collide that we often butt heads. It is my job, as unpleasant as it may feel on the receiving end, to not allow you to succumb to magical thinking and detours that ultimately keep you grieving. It doesn’t feel good when I give you honest answers to your questions. I’m making you aware of something you’ve been working really hard to avoid, that you’re really needing to move out of your established behavioral comfort zone.
Am I a sadist? Not at all! I just know that the shortest way out of grief is to walk right through it. It is only when you confront the pain, maybe even get really, really angry about it… that you’ll consider a path that may actually work.
I spent an hour on the phone a couple of months ago, with a client who finally “blew” over the fact that her body doesn’t respond to diets, and that when she pushes the diet/exercise/binge/purge thing a bit too far, her body fights back and responds by giving her a weight she doesn’t like. All of the “maybe if I exercise an extra hour today… ” she’s been doing has no logic or science to support it. She’s been bargaining with her body, hoping it will finally give her the answer she wants, that you can use unhealthy means to force your body into being healthy.
The reason the conversation lasted so long is because I sensed she really, really wanted me to just tell her that her way of doing things would eventually be right, and she could avoid the reality of living with PCOS if she could get me to say that. Of course, I couldn’t do that. And she became angry. Really, really angry. And we stayed on the phone as long as she needed to vent.
Dr. Gretchen has written about anger before, and the importance of not ignoring it in order to move into health. If you don’t allow yourself to get angry… you are highly likely to stay stuck in your grief, bouncing back and forth between overdoing the healthy behaviors and overdoing the unhealthy ones and even worse, exhausting yourself into doing absolutely nothing at all.
And because the health-related behaviors you’ve tried have let you down, when you do reach out for help, you’re skeptical of what we at inCYST have to offer you that might be helpful. In addition to the questions I get about supplements, diets, etc., each week, I have at any given time, two or three email threads with women who kind of sort of reach out, but who have already decided that if I don’t give them promises of what they want to hear, that they’re not going to give us a try.
If you’re one of those women, and you’ve felt frustrated, perhaps that my response was curt or not compassionate, I hope this blog post helps you to understand. It’s not that at all. I just know, from over 30 years of doing this work, that if someone comes and they’re still doing a lot of bargaining with themselves, their health, and their bodies, that what they’re asking for is not what I can provide. If I become involved too early in the grief process, I stand to become part of the problem, not the guide to the solution.
I could actually prolong your grief by keeping you stuck thinking there is an easy way out.
I haven’t had PCOS or infertility. But I had a serious athletic injury that took my active life from me for almost two years. My business has hit some really hard times over the years. I’ve lost more than one person in my life, who meant the world to me. I’ve been through all of the emotions and stages in this cycle, more than once, sometimes managing several grief processes and their different stages, simultaneously! Every single time I felt like I couldn’t get up to face the day, or that what I was needing to do to get through that day, was inconceivable and insurmountable, and I challenged myself to get out of bed anyway and do exactly what I didn’t feel like doing… I felt myself move a little further along in the grief. In each case, it’s made me a better person for accepting the challenge.
I wouldn’t be the person I am with the experience, perspective, tolerance, compassion, and motivation that I have, if I had not been challenged to face some really horrible situations. If anyone had come along who tried to remove any of the life events I encountered while dealing with my own grief, I don’t think I would have gotten over it. They would have kept me stuck, as well-intended as they might have been.
My job, the job of all of us here at inCYST, is to understand what it is that you are grieving, to be aware of where you are in the process of grieving it, and to respect that process. Sometimes we have concrete solutions, and sometimes it’s best to step back while you do some things on your own.
It’s called respecting the dignity of the struggle.
I do promise you, there is a light at the end of the tunnel if you accept the challenge. But you’ll probably need to struggle.
One of my friends who knew the most detail of how much I had on my plate and how hard I was fighting to keep that plate from tipping over and crashing to the ground, used to always tell me the best way to eat an elephant was one bit at a time.
I have a special love for elephants now that I have conquered most of the circumstances that had me overwhelmed. Sometimes I think we should include one in our logo design!
I guess the point I want to make here, is that really, a very small part of what we can do for you is prescribe a diet or exercise plan. The biggest part of it, is actually more in Dr. Gretchen’s domain. I think most of you know what you need to do. Understanding why you aren’t doing it, may have a lot to do with grieving.
If you look at that graphic and feel like you’re going around in circles, perhaps spending sometime with Dr. Gretchen, or someone else who can help you step outside of yourself and understand the process without self-judgment, is the next most important investment you can make in your PCOS care and your overall health.

‘Tis the time of year when blogs, magazines, and radio broadcasts are full of tips for combating overeating, over-drinking, and the kind of carousing that leaves you tired, bloated, overly full, and generally disgusted with yourself. They’re often repetitive, and not all that useful. I’m full of tips, techniques, and strategies myself, actually! One that I DO think is useful and easy to remember is HALT, which stands for Hungry, Angry, Lonely, and Tired.

If you’re one of those things – hungry, angry, lonely, or tired – the risk of over-indulging rises. If you’re two, three of those things, the risk of losing control is much greater. And if you’re all four of those things, watch out world, because almost nothing’s going to stand in the way of the oncoming binge, bad behavior, or acting out.

But what’s the first aspect of change? Awareness. HALT is a way to bring yourself back to a place of awareness, so you can reign in your behavior before it becomes self-destructive. Let’s talk about the specifics:

Hungry: When you’re hungry – really hungry – your blood sugar starts to drop, and you feel tired, confused, and irritable. And did we mention, hungry? Really, really hungry. Like, so hungry you could the entire contents of a small refrigerator. Or the buffet table. Or as much as you can load up on at the drive-through. Yeah, that kind of hungry. Women with PCOS are more subject to the vagaries of blood sugar dysregulation (it’s the insulin resistance thing, AGAIN) than other people. We’re more vulnerable. Accept it, and plan for it.

Strategy: Have a little healthy snack with you at all times. Know that shopping is hard work and frequently results in blood sugar drops because you’re walking more than you think. Plan ahead. Decide: “If I get hungry, I’m going to Subway for a turkey sandwich loaded up with vegetables and skip the mayo.” This will prevent you from going to McDonald’s and getting a Big Mac, large fries, and a shake.

Angry: The traffic, the crowds, the prices, the shopping for people you don’t even care about, the time pressure, and the social obligations, your spouse who still expects home-cooked meals when you’re in the middle of SHOPPING!, can all lead to a build-up of anger.

Strategy: Do not shop when you’re angry. Do not expose yourself to challenging foods or social situations when you’re angry. Take five to twenty minutes to meditate, walk around the block, drink a glass of cool water, and practice forgiveness and compassion. Now engage in your usual activities.

Lonely: So often, it’s assumed that we’re off with our friends, families, and other loved ones at the holidays, but some of us are sitting home alone, without an invitation, a thought, or a concern.

Strategy: If you’re alone, embrace it. Don’t take a shower until 3:00 p.m. Spend all day on FaceBook. Eat breakfast for dinner. Revel in your ability to live precisely how you want to live today, without judgment or interference. It can be utterly rejuvenating. If you don’t like being alone, and really do feel lonely, make a point of issuing invitations to other people, or showing up at every group event you know about, and don’t tell me it’s unfair that you have to do all the asking. Life is like that sometimes, and if you want to undo this loneliness, you will have to take action. Tell people you don’t have any plans for Christmas, and you don’t have any invitations either. Quite often, one will be forthcoming. People are feeling generous this time of year. In any case, again, avoid whatever triggers you to behave uncharacteristically. This is not a good time to shop the web, bake a cake, or order enough take-out for six people. Remind yourself that this is a temporary, and repairable, condition.

Tired: Tiredness connects to hunger quite often. Drops or dips in blood sugar can leave you feeling exhausted, confused, and overwhelmed. When you’re tired, your decision-making capacity is impaired. See where I’m going with this theme?

Strategy: If you’ve been running around like a maniac, trying to get it all done (The shopping! The cooking! The baking! The cards! The decorating! The parties! OH MY!), slash and burn. You are NOT Superwoman. I repeat, you are NOT Superwoman. No one will notice. Seriously. I used to send upwards of 100 handwritten (and often handmade) greeting cards. A few years ago, I only sent a few. Now I don’t send any, except to my mother, and that’s a maybe. Not one single person has called me out for it. Wow, what a relief!

If you feel strongly, pick a few critical priorities (i.e., my husband will definitely die, or at least pout for days, if he doesn’t get a homemade peppermint cake by Christmas, my children will be ostracized if they don’t get Chanukah gifts like everyone else, and my staff assistant is going to “lose” my messages for the rest of the year if I don’t buy her a great present) and lose the rest. Children are important; adults will have to understand. Your budget, your sanity, and your ability to get the rest you need are the most important things. The rest is not. HALT. And be well.

Gretchen Kubacky, Psy.D. is a Health Psychologist in private practice in West Los Angeles, California. She has completed the inCYST training. She specializes in counseling women and couples who are coping with infertility, PCOS, and related endocrine disorders and chronic illnesses.

If you would like to learn more about Dr. HOUSE or her practice, or obtain referrals in the Los Angeles area, please visit her website at www.drhousemd.com, or e-mail her at AskDrHouseMD@gmail.com. You can also follow her on Twitter @askdrhousemd.

A friend of mine is a two-time survivor of breast cancer. She is a single woman, diagnosed at age 40, who chose a double mastectomy and reconstructive surgery. Along the way, she’s had a lot of challenging medical procedures, fears, and unpleasant side effects. After dealing with the immediate medical issues, she realized she was depressed, and turned to the internet for help.

She found numerous online resources for cancer, and breast cancer specifically. She was steeped in depression, lethargic at best, but that’s when she got angry! Her anger pleased me as a therapist, by the way, because getting angry often leads to action, and she needed to take some serious action to get out of her depression. She found that there were a lot of people saying “Why me?” about cancer. (As an aside, there are two very helpful organizations online called www.whyme.org for pediatric cancer and www.y-me.org for breast cancer.). But what she said to me is “Why NOT me?! Who am I to be so special that I escape a very common disease?” She found “why-ing” to be pointless and actually an impediment to her getting well. And here I’d been thinking that it was a perfectly reasonable question!

I’d venture a guess that you’ve said “Why me?” more than a few times when it comes to your PCOS. I know I have. There are many questions and thoughts that come along with that first thought, and all of them have the underlying subtext of “THIS IS SO UNFAIR”:

• Why do other women get to go on a diet and lose weight with relative ease?
• Why do other women get pregnant by accident, and I tried for a decade and it never happened?
• Why do I have to shave my face every day (or spend thousands of dollars on laser hair removal and electrolysis)?
• Who is ever going to love me/want to have sex with me when I look like this?
• Why do I have to take all these supplements?
• Why can’t I eat carbs like normal people?
• WHAT is happening with my hair?
• Why do I need an endocrinologist? And a cardiologist? And, and, and…

It IS unfair. It’s expensive, inconvenient, awkward, uncomfortable, scary, humiliating, enraging, and a whole lot of other things. And yet, the reality is, 10 – 20% of women have PCOS. You are fortunate enough to know that you’ve got it, so you can start dealing with it proactively. You found this blog, and hopefully some other resources. As http://en.wikipedia.org/wiki/Wilhelm_von_Humboldt Karl Wilhelm von Humboldt says, “How a person masters his fate is more important than what his fate is.”

So your fate is PCOS. I know it’s a hard thing to accept. But once you can move to acceptance you can take action. Mastery of your fate means taking control, and making choices that support your good health. It means understanding that, although genetics dealt you a bad hand, there are many things you can do to positively affect the daily quality of your life, and your long-term health, well-being, and longevity.

Instead of saying “Why Me?” (and really, it IS okay to say it every now and then – you’re not perfect, you’re human, and a little self-pity may be a necessary step along the road to further and fuller acceptance), see if you can feel a shift in your mental landscape by saying “Why not me? Yeah, why not me?” Then move forward from there with something more productive.

Gretchen Kubacky, Psy.D. is a Health Psychologist in private practice in West Los Angeles, California. She specializes in counseling women and couples who are coping with infertility, PCOS, and related endocrine disorders and chronic illnesses.

If you would like to learn more about Dr. HOUSE or her practice, or obtain referrals in the Los Angeles area, please visit her website at www.drhousemd.com, or e-mail her at Gretchen@drhousemd.com. You can also follow her on Twitter @askdrhousemd.

I've had two different clients share a similar observation in the last couple of weeks, and I thought I'd write about it since it's not uncommon to feel this way in early recovery.

First of all, I want to share with you an article on depression that was recently in the Boston Globe.

This article presents the argument that depression is not about a deficiency of neurotransmitters that need to be balanced with medication, but rather, a condition in which neurons are dying a slow death and gradually losing their function. I've had this premise for awhile; it is the basis of my treatment philosophy for PCOS. Fish oil is the best compound nature has for restoring life to neurons, and when you put it into your diet, the brain begins to function again.

My two clients have both observed that as they began taking fish oil, they felt more alert and their memory and concentration seemed to be better. Signs that Elvis is back in the building!

These two clients also observed, though, that they were feeling more emotional. Not all emotions, especially anger and sadness, are easy to feel. So when you begin to feel these emotions, it can feel like things are getting"worse", not better.

Keep in mind, when neurons are malnourished, that means ALL neurons stop functioning, not just the ones affecting memory. The ones affecting emotion, the ones affecting appetite, and the ones affecting hormones.

If you've had PCOS, your hormones have not been functioning as they should, perhaps for a very long time. And that means you've not had the experience other women have, of fluctuating energy, emotions, you name it. Those fluctuations are normal!

So I often get the question,"What can I do?" The most important advice I can give is, be patient with yourself. Become used to what it means to truly cycle. Get to know what a healthy body feels like. It means it is normal to feel bloated, even constipated, just before your period. Your weight might fluctuate. The cycle should be around 28 days when you're back on track, and every single day within that 28 days may feel different. There may be no such thing as getting on the scale and weighing the same thing every single day.

With regard to your emotions, perhaps as your brain becomes more aware, this is an opportunity to experience what emotions might be about. Emotions are messages from the brain, telling you how you are with regard to balance, and what you need to do to restore balance if it isn't there. Anger is often a clue that a boundary has been violated. Loneliness means you need to seek companionship of some sort. Fear suggests that you need to remove yourself from danger. If they didn't feel uncomfortable, you would not be motivated to engage in behaviors that keep you healthy and safe. So rather than running from emotions, embrace them! They're telling you that your health is returning and things are getting back to normal.

PCOS is so hormone driven that emotions end up on the back burner. Excesses of androgens and stress hormones put anxiety and anger in control. But if you find that these feelings are persistent and do not wane after time, or that they seem to be there even when nothing in your life can explain them, they may be signs of hormone excesses and not really environmentally or event-stimulated emotions. When your hormones have you constantly revved up, it can feel strange to not have that kind of energy rush.

I couldn't figure out why, when I first started recommending yoga to clients, they would come back after one class and tell me they hated it. I figured out eventually, that yoga slowed their bodies down but their heads were still spinning. And being pinned to the floor in a yoga pose while your head is thinking angry thoughts can be a very uncomfortable place to be. Those clients got the same advice I'm giving you. Give the new changes some time. Don't abandon your new lifestyle because it initially feels uncomfortable. It's been a long time since your body has felt normal. Be gentle with your self and get to know/understand that"normal" involves hourly, daily, weekly, and monthly cycles. There is no such thing as being the same weight, temperature, size, or temperament every single minute of every single day.

Our philosophy is a little different than what many physicians will have you do. We're not trying to control your hormones, your weight, or even your diet. We're not trying to force a cycle, a pregnancy, or a clothing size. We're guiding you toward healthy choices that allow your body to be in balance. Sometimes giving up control, and letting the body speak to you instead of the other way around, is the absolute best way to get there.

So if things seem a little chaotic and you feel like you're charting uncharted territory, welcome to the world of female physiology! Ask questions, observe, and embrace the wonderful lesson you're learning, that your body will heal if you let it. There is no such thing as being past the point of no return or"stuck" where you are.

If you have PCOS, and you’ve tried to get pregnant, you may have already discovered that you can add infertility to the list of “what’s wrong with my body.” Infertility often feels like one more failure of your body to perform as expected, and one more thing that feels out of control. There are actions you can pursue to shift your mind and shift your body, however:

1) Get out of denial – know the timeframes for diagnosing infertility (generally six months of trying without a successful pregnancy if you’re over 40; one year if you’re under 40). Know that infertility isn’t just a matter of stress or bad timing – although those can be contributing factors. Know that infertility is a treatable condition, but it takes finding the right medical team, and that may include some highly specialized people, like a reproductive endocrinologist.

2) Have your anger – infertility is definitely something to be angry about. You’re mad, you’re frustrated, you’re irritable, you feel deprived, you want what you want – something other people manage to have without even trying – and you are entitled to rant and rave about it. But don’t let anger become your primary way of experiencing your infertility. Take the energy that powers that anger and turn it towards a more productive experience.

3) Fully experience your regrets – as much as you can understand them in the moment, experience your regrets. These might include the fact that the romance and private experience of love and sexuality are separated from the process of reproduction. Perhaps it means acknowledging that you won’t have a biological child. Or it might even mean deciding that children are not part of your future, at least not right now.

4) Grieve what you need to grieve – this might include some of the regrets mentioned above, or whatever else you feel or define – loss of womanhood, loss of health, loss of a specific type of relationship. Get support for this grieving if you need it, from other women in the same situation, or from a professional counselor.

5) Refocus your dreams – now that you’ve moved out of the hope or fantasy of “accidental” or sort-of-planned pregnancy, cried, had your rage, and gathered some support, decide what’s next – assisted reproductive technology, adoption, surrogacy, or a child-free life.

6) Take action to achieve that dream – make sure you’re on the same page with your spouse or partner, if you have one. Do the research to find a great reproductive endocrinologist, a supportive counselor, a knowledgeable dietician, and any other resources you need. Join online support communities that are specific to infertility, just as you joined this PCOS-specific community. Make a plan – give yourself some general timeframes and budgets for what you are willing to do.

With luck, planning, focus, and support, you may well be able to achieve the family you’ve been dreaming of, in spite of infertility.