This week we’ll talk about bargaining, from the perspective of how bargaining plays out in relationship to our PCOS, and the sadness and grief that are often parts of PCOS. Bargaining is part of the DABDA (denial, anger, bargaining, depression, and acceptance) model that is typically applied to chronic/terminal illness. In the dying process, bargaining looks quite similar to what it looks like in PCOS, although it tends towards making deals with god, or trying to manipulate doctors. In PCOS, it looks more like this:
• Making a deal with god to be more attentive to him/her, if only the PCOS will go away • Trying to negotiate with doctors – “Okay, so I’ll take the metformin like you said, but I’m still going to keep eating fast food, and it should all balance out, right?” • Negotiating with your dietician, personal trainer, etc. – “I’ll do the cardio, but then I don’t have to do weights today.” Or, “I’ll come in three times a week, but only if you cut your fee in half.” Or, “Look, I know that dark green leafy vegetables are really good for me, but they give me gas, so can’t I just have a (pre-sweetened, sugar-laden, actually junk food) yogurt instead?” (HUH?! As you can see, we get very creative with our attempts to avoid what we don’t want, and get what we do want instead.) • Over-exercising in order to compensate for eating badly – we develop a strange, twisted, internal logic that allows us to, essentially, do whatever we want. We convince ourselves that there are no consequences. • Eating badly but taking lots of medication or supplements – this is another favorite form of a secret internal balancing plan that absolutely has no scientific or logical merit. It doesn’t just apply to food. • Figuring, I’m young, I can do what I want until ___ age, then I’ll behave – the damage is occurring now, the bad habits are just getting more cemented as daily behavior, etc.
And here’s the thing about these games that we play with ourselves, our partners, and the professionals who try to help us – who’s it hurting? Really? You know the answer to this one. It’s only hurting you. I know reality is uncomfortable, but you’re spending so much energy on this bogus bargaining practice. What if you applied all of that energy to grounding yourself in reality, and taking small, manageable steps towards getting your self-care practices in line with what you know (or at least believe) to be true?
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 recent inCYST post on grief really resonated with me. Perhaps it’s because I’m a Certified Bereavement Facilitator, so a lot of the work I do is directly related to grief, particularly “out of order” deaths such as suicide, homicide, and miscarriage loss. Or perhaps it’s because there’s so much sadness and loss surrounding chronic illness that, for me, the issue of PCOS cannot be addressed without looking at the issues of loss. In any case, I want to introduce a commonly used model for grieving, since I’ll be talking in more detail about it over the next few weeks, and relating the elements back to PCOS.
Elizabeth Kubler Ross was a physician who worked with terminally ill patients. The model was first described in relationship to terminal illness, and the process that patients go through as they struggle to reach acceptance of their situation. It has come to be applied extensively to grief therapy work. The model is known as DABDA, which stands for denial, anger, bargaining, depression, and acceptance. I’ll be devoting a post to each of these five items.
The first thing to know about grieving is that grieving is a non-linear process, with unpredictable timelines and variables, and that no two people grieve the same way. It’s estimated that most people grieve adequately and appropriately on their own, but about 30% would benefit from the assistance of a professional grief counselor. All of those phases of grieving – denial, anger, bargaining, depression, and acceptance – may occur in order, out of order, simultaneously, repeatedly, in an overlapping fashion, or perhaps not at all before you finally reach a state of peaceful resolution around the loss.
Also, the “normal” grieving process may go awry if you have multiple losses, too many losses occur in a short period of time, or you’re not permitted to grieve openly. For example, your mother dies, and then three months later your sister and brother-in-law are killed in a car crash. Or you’re close to 40, and end up having five IVF cycles in the space of eight months, and five miscarriages. Then you have something called “complicated bereavement.” Complicated bereavement typically needs some outside help to work through.
Grieving doesn’t just take place in the context of death or a diagnosis of terminal illness. Grieving can occur in relationship to chronic illness, loss of finances, sexuality, spouse, freedom of movement, employment, and even in response to seemingly positive situations, such as the birth of a child, which also means leaving something else behind. There may be grief associated with graduating from school, leaving a job or a neighborhood, or a myriad of other situations.
In reference to PCOS, losses may include loss of femininity, loss of reproductive capacity (infertility, miscarriage), loss of health or the illusion of health, loss of freedom (all of the things you can’t or shouldn’t do if you want to be healthy), finances (the money spent on non-covered health practitioners, supplements, special dietary items, personal trainers, etc.), sexuality, relationships, and many other things. There is often a great deal to be grieved, which contributes to the chronic low-level sadness that accompanies many PCOS patients. You may not have labeled what your feeling as grief, but that may in fact be precisely what you’re feeling and doing.
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.
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.
For the last few weeks, we’ve been looking at the grief process through the lens of DABDA (a model that focuses on the stages of grief – denial, anger, bargaining, depression, and acceptance). When it comes to dying, acceptance is important¸ but not necessarily critical – if you’re terminally ill, you may die before you reach a place of acceptance. With PCOS though, you’ve got a life-long condition. If you don’t accept it, you’re likely not taking care of it properly. The good news is that acceptance is something you can learn.
Acceptance looks like:
• Generally being pretty okay with what’s going on, even when it’s unpleasant (so you don’t like hearing that you’ve got pre-diabetes, but you’re going to do the recommended diet consistently) • Eating, sleeping, and exercising appropriately, even when you don’t feel like it • Practicing good self-care, even when it’s inconvenient • Having a stress reduction practice, such as meditation, yoga, or therapy • Being grateful for what you do have (if you can’t quickly create a list of at least ten items, you may be dealing with low self-esteem or depression, which can be helped through therapy) • Being genuinely happy about the positives of your life – kind of like being grateful, it’s about having a balanced perspective, rather than just focusing on the negatives • Treating others with kindness, because it’s the right thing to do, and you’re not so angry about where you are and what you’ve got that you’re taking it out on them • Not constantly comparing yourself to others, because you don’t need to – you know you’re not perfect, but you’re okay with it, and you’re working on what you can In other words, happiness is about balance, perspective, equanimity, self-respect, and self-care, all coming together to remind you on a regular basis that you’re actually pretty okay, in spite of your PCOS – and even though the PCOS is a drag¸ you believe you can manage it.
Although this concludes our review of the DABDA process, we’ll look at bringing it all together (remember, grief is a non-linear process, and these emotions can pop up at any time, or repeatedly) and incorporating it as a permanent point of reference.
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.
Over the last couple of months, I’ve written extensively about the grief process, and how it applies to PCOS. There is so much to grieve – loss of health, femininity, children, old unhealthy lifestyle choices, even perhaps one’s obesity or body shape. If you missed any of the posts about the grief process, discussing the DABDA model (denial, anger, bargaining, depression, and acceptance), you can find them archived on the inCYST.com site.
Here are my thoughts on what comes after the grief. When you have a death in your life, there’s typically a funeral, or sometimes a life celebration. This celebration occurs while you’re in the depths of your grief, not when you’ve finished grieving. Grieving can be a lengthy and recurrent process, depending upon the circumstances of your life. Events like a new diagnosis, a miscarriage, or simply the arrival of your period if you’re trying to conceive might all feel like losses. Interspersed with the grief, there are still moments of happiness, humor, and even full-blown joy.
If you’ve started to grieve the losses associated with PCOS, I encourage you to also start your own private life celebration, in concurrence with your grieving. Capitalizing on the bright moments is part of an overall strategy of improving your mood by focusing on the positive. Life celebrations usually include music, food, and the company of people that you love. My life celebration is a constantly evolving practice that focuses on the things I’m grateful for, that support my health and give me deep pleasure. For example, today is my day of rest. I got to sleep in, have a cup of chai with my honey, enjoy some lap time with my cat, practice yoga under my favorite tree, enjoy a delicious, healthy and satisfying breakfast of homemade huevos rancheros and mixed berries, and even get in a short walk at the beach. To cap off the decadence, I’m going for a mani/pedi, and will indulge in my one pointless and naughty hour of serious television watching this evening. Swwwwweeeeeeeet! I feel GOOD, and even though I still have some minor pain due to an ankle injury, I’m celebrating my life. It’s rich and satisfying in many ways. Making this list makes me appreciate it even more.
When I focus on the fabulousness of this list, I’m not focusing on the fact that every day can’t be Sunday, that I need to get up to an alarm clock tomorrow, or that I have to make some unpleasant calls to an insurance company, plus go straighten out something at the bank. I’m just focused on enjoying and celebrating my life – my life with 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.
I've never experienced infertility. I was overweight as a child/teen, but I've been the same weight for most of my adult life. I'm relatively healthy. I'm not saying this to intimidate anyone, but rather to share an insecurity I've had about what I do for a living.
I always wonder how in the world women who have those issues can even find me relevant and helpful if I've never had to experience them?
The last two months have presented me with a situation that, even though it may not be apparent on the outside, has very much changed me on the inside. I've learned a lot about control, gratitude, and what is truly important in life.
And I feel like this journey, challenging as it is, is molding me into someone better equipped to help the people who come to inCYST for help.
Regular readers of the blog will remember that I wrote about my sick kitty in October. I thought I was dealing with a simple urine crystal issue that a diet change would fix. I'm a dietitian, I know how to change diets. This was simple, or so I thought.
Well, Rodeo simply never recovered from the crystal incident. He would not eat. He became lethargic. About a month after the vet visit, I noticed, he just wasn't breathing well. Being the data fiend that I am, I started monitoring his respirations. They seemed stable, so I figured maybe he was allergic to the new diet he'd been prescribed for his urine crystals. I changed back to the old diet and waited to see if he responded.
Then he crashed. I got the last appointment on a Friday evening with his vet, and learned that he was dealing with one of four potential diagnoses. One was a fungal infection (no problem), one of those was a 100% fatal virus (that would require euthanasia), one was cancer (fatal over time), one was heart disease (manageable but life-shortening).
I had to wait almost a week for the pathology report to come back, and to get an appointment for an ultrasound with a cardiologist. (Yes, my cat has more specialists in his Rolodex than I do at this point).
The good news is, it's not the fatal virus, and it's not cancer, but it is heart disease, and it's a serious problem. There is no cure, but there is a lot I can do to manage the situation.
Sound familiar?
I told the vet,"If you can give me heart disease, I'll take heart disease. I can do that." Two sentences I never, ever envisioned coming out of my mouth at any point in my life.
I can tell you this. I have a reputation for being pretty even-keeled in even the most adversarial of situations. During my eating disorder treatment center gig, it was not uncommon for cans of Ensure to be flung my way after a tough counseling session. Nothing phases me after that!
But the night I came home from the vet with a couple of medications and no idea what was happening, I laid on my bed and cried my heart out. I didn't even notice that Rodeo had jumped up on the bed. He felt like crap, and he was sitting there trying to take care of me. I realized, of my two kitties, he is the one most affected by my emotions. And here he was, more concerned about me than about the X-ray, the aspiration, and all the poking and prodding he'd been through.
That was reality check #1. I knew I needed to allow myself to feel what I was feeling, but I needed to learn how to do it in a way that didn't turn itself back on the problem in a negative way.
As I imagine has happened with many of you, my life changed in a mere instant. I became hyper aware of respiratory rates, fluid intake, food intake, urine output, medication times…my life was filled with new details I had no choice but to learn to live with.
Even though I run a business, it's the holidays, and I had committed to coordinating vendors for a huge market here in Phoenix. Even though my five major plans for December revenue pretty much collapsed within days of getting the kitty diagnosis. Somehow, I had to figure out how to make it all work.
This is where I started thinking of all of you. How many of you readers are busy, successful women, juggling a million different responsibilities, happily living out your lives…when you're told you have to start monitoring what you eat, when you eat it, when you ovulate, when you menstruate, what your blood glucose number is…and on top of it all, every expert on the planet expects you to figure out when to work out, to plan the perfect meal combination, each and every meal, to buy the supplements, and on top of it, manage your anxiety, frustration, and anger over the situation?
Do these health professionals even have a clue? Did I ever have a clue with any of my clients I thought I was helping with inCYST? That's what's been going on in my head in the two months since Rodeo's diagnosis.
Reality check #2 for me was realizing what I was doing any time I had a free moment, especially during the week when I didn't know what I was dealing with. I found myself surfing the Internet, Googling symptoms, reading everything I could find about lymphoma and cardiomyopathy, looking for the worst in kitty, looking for anyone, anyone at all, who could tell me that there was a supplement or pill I could give him that would just make this all go away.
That behavior is known as magical thinking. It is a very common thing to do when faced with a situation that leaves you feeling cornered. Getting older. Cancer. Weight that won't come off. Infertility. It's about trying to find something, anything at all, that can give you the illusion that you're in control of something. Note that I used the word illusion. You're really not in control. You've transferred your need to be in control of outcome to a concrete, more manageable option. That's all. The only thing magical thinking succeeds at, is allowing us to avoid the pain of a situation. In many cases, it keeps us distracted from constructive and helpful things we can be doing.
So…knowing from working with all of you that this is what I was doing, I told Rodeo's vet what I do for a living, that I'm a real biochem nerd, and that I was probably dealing with my stress by reading waaay too much about cardiomyopathy. I told him at any time I was becoming annoying and intefering with his treatment plan and Rodeo's progress, he had permission to put me in my place. We negotiated a few things I wanted to try, one we're using, most we're not.
And I am adhering completely to what the doctor ordered. Even if it means staying up past my bedtime to get a med in, even if it means passing on a social invitation if it interferes with the treatment plan, even if it means using money I wanted to spend on something else to buy medication. The vet is not cheap. But he's incredibly smart. If kitty is going to get better, I can't be bargaining with him because of the inconvenience the instructions impose on my life as I wish it was.
Reality check #3 has been about how much control issues can be triggered when life throws a curve ball. We can do everything exactly perfectly. And Rodeo has a bad day. Or Rodeo can go dumpster diving, eat a fish head, throw it up, and be perfectly fine. At least for a day. How Rodeo feels today, is not at all about what I did for him this morning. It is about the consistency of what we do over time.
Oh, I'm so embarrassed to even be saying this, but this simple reality took me awhile to"get". I wanted him to always breathe perfectly. To eat when I gave him the food. To love the deli turkey. It doesn't happen that way. Some days he eats like he's the size of Zenyatta, other days, nothing strikes his fancy. I have had to learn to roll with it, and to not view one incident as failure, but as a challenge to figure out what another option might be.
On the days when things don't go as planned, I have to adjust my life. Yesterday morning, for example, meds did not go in at 8 am as scheduled. I spent 4 hours getting them in, but realizing that the four hours it took to make that happen was four hours I'd planned to spend making my contribution for a holiday potluck I was to attend tonight…I made the choice to cancel my attendance, focus on medication, and spend the evening tonight taking care of myself here at home.
Reality check #4. You know what happened when I stopped stressing about how I was going to do both the medications and the potluck and OMG what happens if I'm at the potluck and he bottoms out?!?!?! Rodeo settled in to one of the absolute best respiratory patterns and ate better for me than he did all week. I suspect he picked up on my more relaxed demeanor and was able to put energy into himself that he was putting into me. Some of the things I am inadvertently doing affect kitty as much, if not more, than the things I am supposed to be doing.
Reality check #5. I sometimes find myself getting annoyed at people complaining about things that now seem minor in the big scheme of things. All these people complaining about having to much to do for Christmas? In my eyes they are lucky they are able to participate. I have to remind myself, their situations are different and even though I might envy them, in their own scenarios are lessons from the Universe in action that may not include a cat. Still working on that one.
There are many early Christmas gifts this situation has brought me.
First of all, I have kitty happily sleeping on the bed today. He doesn't fit into a stocking and probably wouldn't consent to it if he did…but he's here compliments of two of Santa's finest elves…er…angels in elves' clothing, Dr. Oyan and Dr. Paige.
Secondly, my priorities, as healthy as I thought they were, needed some addressing. I have been able to let go of situations that I simply have no time to accommodate. I have more time to myself, since I'm home more, and that has given me quiet time to think about what inCYST will be for all of you in 2011. I hope you like the inspirations you'll see in the next 12 months.
Thirdly, I feel like I have a much better idea of what it is that you all need from inCYST in the first place. I am still at a disadvantage for not having experience every single thing you all have exactly as you have, but I have been humbled, I'm dealing with a challenge, and it cause me to consider every inCYST choice I make in an entirely different fashion. Humility is never a bad thing on which to base intention.
Fourthly, I've learned that it's not always bad if success has to be redefined. Of course I'd love it if there was a cure for cardiomyopathy. But there isn't. I can be angry about it, not follow the vet's instructions because I managed to find an obscure website on the Internet that contradicted them, turn to supplements which would put more control in my hands than his, or do nothing and hope the Calgon cardiomyopathy fairy will just swoop in and whisk us away to Kitty Tahiti.
None of that is going to happen. I got over it, decided to listen to the vet, and to redefine success as staying informed, being proactive and communicative with new information, and to the best of my ability, prioritize my life so that I can enact the recommendations I've been provided with. It's slowly turning things around. Not curing them. But, gratefully, allowing kitty to breathe. Oxygen in heart cells…is a lot more important than a complete and total cure. We have learned to think simply.
Finally, I still don't know what it is like to be infertile, not be able to lose weight, or live with insulin resistance. But at least I am more aware of how important it is to always remember that no matter who are you are, when you look to inCYST for help, guidance, support, inspiration, your story, especially the part we don't know about, or cannot immediately relate to, is important to consider in everything we say and do.
I hope all of you are enjoying your holiday season, whatever customs you practice.
One last thing. To all of my friends who are tired of hearing me talk endlessly about the cat, now that he's stabilizing I can get back to the gym and put the stress there. I appreciate all of your ears and support.
I recently mentioned that I was embarking on a mini-series of blog posts about the grief process, and how it relates to PCOS. I talked about a handy summary term known as DABDA, which stands for denial, anger, bargaining, depression, and acceptance. Denial is present in our lives in many ways, and it’s actually a very helpful defense – sometimes our minds go into denial, because unconsciously, they know that we’re not quite ready to handle a crisis, trauma, or issue yet. For example, the woman who sees signs of cheating in her marriage, yet overlooks the hints, bypasses opportunities to question her husband, and insists that her neighbor can’t be right – yet she KNOWS in her heart that it’s true. That’s denial.
In death, denial is often quite literally a failure to recognize or believe that a person is dead, that they died a certain way (i.e., suicide), that the death was unavoidable, or that they are not at fault in the death. While one is in the process of dying, the denial may simply be a belief that it is not possible to be dying from THIS – not me, not now.
Specific to PCOS, denial looks: • “I don’t have PCOS – it’s something else – they just haven’t come up with the right diagnosis for me.” • “PCOS is no big deal – I mean, I had to have an IVF and all, but whatever – I got my baby, and now I can ignore it.” J • “PCOS isn’t like a terminal disease or anything, so why do I have to deal with it?” • “Having a baby will fix it. That’s 10 years away, but in any case, I don’t have to deal with it now.” • “Those medications don’t really work (so I’m not going to take them).” • “If I just can find the right combination of supplements, this will all be okay.” • “If I go gluten-free, I’ll be cured – but that’s so impossible, I won’t even try.” • “I’m pretty sure that dark chocolate is a health food, so I’m going to have this entire 3.4 ounce bar.” • “Exercise is overrated – I’ll just gain weight if I gain muscle mass, right?”
Denial’s great when it really is needed and protects you, like the child who is being molested and denies it until she’s an adult, when it’s actually safe for her to tell someone. Or when you just got a cancer diagnosis, and you don’t quite get that your particular cancer has a 75% mortality rate – and maybe if you realized that before you got a chance to explore treatment, you’d consider suicide to be a good option. Sometimes it’s protective.
Yet, as adults, most of the time, denial is working against us. It prevents us from seeing the real picture of what’s happening with our bodies, our lives, and our relationships. It prevents us from grieving. It keeps us from making decisions that will improve or protect our future. It stops us from eating better, or exercising more, or getting enough sleep (another favorite form of denial that I hear all the time is “I don’t know how I do it, but I can totally get along on five hours of sleep” – to which I say, BALONEY!). It stops us from spending money on the help we really need. It allows us to continue engaging in damaging behaviors, poor self-care, and unhealthy relationships.
If reading this gives you a little stinging sensation of recognition, there’s good news. You can start to acknowledge reality. Talking to someone who cares about you, sharing your fears and the thoughts you’ve been hiding, is a good start. If you can’t do that, put it in writing – it’s amazing how seeing it in black and white can help to bring clarity to your random thoughts.
Next week, I’ll address anger, and the insidious impacts that it has on your health.
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.
This week continues our discussion about PCOS and the grief process, through the DABDA (denial, anger, bargaining, depression, and acceptance) model. Depression is so common among PCOS patients that I write about it quite often. It’s important for you to remain conscious of the clues that you may have depression. Many, if not most of my PCOS patients have some form of depression.
When we’re talking about depression in the context of death and dying, it looks like it does in PCOS too. If you’re suffering from depression, PCOS-related or not, it might look like:
• Sleeping too much or not enough • Eating too much or not nearly enough • Being irritable, snappish, and short-tempered • Feeling suicidal • Feeling hopeless about your future • Feeling helpless to do anything to make things better • Having an overall gloomy, pessimistic perspective on life
It is certainly easy to feel down when you think about the fact that PCOS is so challenging, misunderstood, and often misdiagnosed, and mistreated. It is one of those conditions that benefit less from standard medical treatment and more from diet, exercise, and good self-care. It comes with embarrassing physical symptoms that are time-consuming and costly to manage. There’s not a lot of research being focused on the condition. All of that is definitely overwhelming.
Not to mention, the hormonal imbalance inherent to PCOS can cause depression, even if you manage to maintain a positive attitude, take good care of yourself, and have a good support system. Sometimes, depression invades your mind and soul, because your body’s overwhelmed your coping mechanisms. Depression is best-treated by a professional therapist, sometimes with the assistance of a medical doctor known as a psychiatrist (a specialist in psychotropic medications – medications for mental health conditions).
Next week, we’ll talk about the final stage of the DABDA process – acceptance.
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.
