Thursday, August 5, 2010

Notes to Shi No Ubi, Change

My friend Shi No Ubi is battling for his life. If he loses, he'll live, but with chronic illness until he dies, with a massive dose of meds until he dies, with limited mobility until he dies, with poor sleep quality until he dies, with depressed mood compared to what it should and could be (until he dies), and with the eventual risk of amputations depending upon how far and how fast his metabolic derangement becomes full blown diabetes. Maybe even worse, my friend likes to do things. He likes to impact the lives of others. He wants to sustain the intense relationships he's cultivated with his sons. He wants to live well enough and long enough that his legacy outlives him. All of these driving forces in his life are compromised by the metabolic derangement that is wrecking his life.
That's the bad news. The good news is he loves a good fight and we were able to visit this weekend and work out a plan for his dietary future. There's every reason to hope that he can completely interrupt his disease simply by correcting his diet. He knows what to do and why it is important.
However, we all know that life change is not easy, or normal. People do what they do for a couple of simple reasons. We are either seeking pleasure, or avoiding pain. We'll do more to avoid pain than to seek pleasure. But the real kicker is - the conscious mind is not in charge of this process. The unconscious mind is in charge. Another kicker - we'll sometimes engage a very painful activity if the underlying belief is that it will lead to reduced pain or increased pleasure. We'll engage, for example, a painful workout or martial arts training session for the pleasure we experience afterward. So, it's not a simple formula after all - but still a useful one.
How so? To make a change, we have to reduce any element of the change that is effortful - keeping good food on hand, while reducing or eliminating those things which we know don't support good health - and increase the difficulty of doing things which we want to stop doing. To illustrate that idea, let me tell you short story. An old friend was determined to stop smoking. He engaged the services of a behavior therapist. One of the strategies was that he would not smoke in the places and times he most enjoyed the smoking - for example, when driving a car. So, whilst winding his way up the mountain road to his employment one day, he stopped on the road side and applied the fire to his 'grette' - from the back seat. A police office happened by, and seeing the vehicle on the side of the road, stopped and asked if my friend required any assistance. Sitting in the back seat, window rolled down, smoke billowing from the vehicle, my friend replied, "no, I'm just quitting smoking." You can imagine the police officer's puzzled look. But you can also imagine how over time the association to stopping, getting out and sitting in the back would reduce the appeal of smoking - one would start to associate pain to the process, vice pleasure. That's an example of how we can change a behavior.
With my friend, I'm hoping for early success. We have to get a week of good food into the man's body, and help him to notice the pleasure that will result (this won't be easy - he's travelling with friends, the pressure to eat what they are eating will be intense. He has to pay attention and celebrate at every pleasurable milestone, whatever, that may be. Better sleep, looser fitting clothes, fewer aches and pains, and any victory in weight lost or just fat lost. We have to find ways that will help him associate pain and death to the foods that will kill him. In short - the success will only take if the unconscious mind associates pain with eating low quality foods, and pleasure with eating high quality foods. If that happens, it's a done deal. When he wins, he can lose the statins and blood pressure meds. He will have less physical pain, and more mobility and for many more years. He will drastically slow the degradation of his body (diabetics age about ten year faster than the rest of us). The stakes could hardly be higher.

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