Quote from the ASDAH Statement in respond to the new AAP guidelines
The AAP’s Clinical Practice Guideline for the Evaluation and Treatment of Children and Adolescents With Ob*sity reflect the historical commitment of western and white-centric healthcare to kill all deemed ‘other.’ We call for the AAP to rescind these guidelines in light of the reality that they violate the primary directive of healthcare providers to first do no harm. Our children and adolescents deserve better.
Association for Size Diversity and Health Statement
Image from Flickr by JoanDragonfly; “Stress and Anxiety – A person is feeling anxious and stressed out.”
In light of current events (aaaaaaaaaaaaaaaaaah!), I thought I would share some thoughts about how I approach anxiety as a clinician and an acupuncturist.
When I am trying to diagnose or confirm a diagnosis of “anxiety” I want to first know how it shows up in people in their emotions and body and behaviors and interpersonal relationships, what triggers it and maintains it and settles it, and how it affects their day to day or season to season life.
One core question, when I query my patients, is whether their reaction to their environment is “proportional” or not and, separate from that, is whether the reaction is overwhelming or interfering whether it’s proportional or not.
Even five years ago when I was just starting my practice, there were some moments of acknowledging that there were bad circumstances but the reaction was disproportional and interfering with life. For example, taking unpaid leave from work to install safety hardware into your house in case of foreign invasion because a powerful politician was ramping up tensions with a foreign nuclear power; this has interfered in your work and your reputation, and turned out to be disproportionate as we never went to war with that nation.
But now, I want to validate that shit’s fucked. In the US and everywhere, climate change is here and weather events and environmental reactions like wildfires can and do kill people and render them homeless, and there are supply chain and infrastructure limitations to adequate cooling and ventilation filtration and evacuation locations. In the US, we are on the verge of a civil war because one “side” (what even is a “side” in a Civil War? this isn’t a softball game) really wants a war, and are just looking for an excuse to be violent to people, and is proving it by systematically taking away rights and effective citizenship and due process of more than half the population and downplaying the violence that has already happened. And the pandemic isn’t over and people are still becoming sick and dying. And global powers are starting wars with other nations for funsies and delusion and personal aggrandizement, and the response to the conflict is highlighting global practices of racism/colorism and overall dismissal of Global South or formerly colonized nations and focus on empathy for nations where the populace has light skin. And And And…
It’s real. Things are very tense. But are they tense inside your house right now? (I mean, maybe, depending on if you have net nourishing or net abusive relationships.)
But the thing is, when the greater environment was just gently steaming and you weren’t sure if the heat was even on under the pot, on the micro/interpersonal level it was still valid to ask if “anxiety” was in fact proportional. Because even then, microaggressions and interpersonal abuse, and the chaos of coping mechanisms of self or others like drug use or spending addition or whatever can in fact threaten safety and security. Humans are social species and things that threaten your connection and belonging in community are in fact existential threats.
Is it “anxiety” if you really are perceiving a threat and trying to plan around it or respond to it?
It’s just that the remedy for that anxiety isn’t to sedate and suppress a nervous system that is seeing a threat where one isn’t; the remedy is to SETTLE the body back into a state of resourcefulness so that you can address the threat.
It is entirely possible to be overwhelmed by the scope of what is before you, either because of the build up of past danger where you weren’t sufficiently helped or sufficiently safe, or because you are under-resourced and isolated now, or you’re not sure whether your resources should go to saving yourself or your community and so your actions are scattered and under-powered. Anxiety or stress-arousal can cause tunnel vision and hyper-focus where you can’t think outside a few possible options for next steps, so you may shoot down offers of help or creative solutions or even potential re-prioritization, but being settled can help you accept help and think outside the box. (It’s OK to eat food now, and then go to the protest.) Anxiety can make you feel shut down and paralyzed, unable to initiate the things that might reduce the stress or create more safety, and feeling settled can facilitate those steps or even asking for help to get you going. (See again eating. Also sleep, bathing or cleaning your home, making phone calls, etc. etc.)
Anxiety in the body can also shift everything else into the same emotional valence of “threat” and so might trigger misinterpreting a coworker, friend or loved one’s bid for connection as criticism or hostility, or might cause you to treat a “Might Be” or “Close One” as a “About To Happen” or “Did Just Happen” (I remember when I was feeling very anxious and had to ride my bike, and a car to my right didn’t slow clearly enough, I literally screamed out loud because of the possibility of being hit, even though we were both actually safe and navigating space well…. and then the anxiety didn’t let me stop and communicate with the driver so that we were both able to settle down and go on our ways but instead drove me to keep riding like an automaton until I got to my destination).
In an ideal physical state, we can phase back and forth between proportionate arousal to face a threat, and back into community and calm when the threat is managed if not gone. But that takes practice and reps and guidance and co-regulating with others.
I recommend the book The Quaking of America, where Resmaa Menakem is setting up exercises for this very purpose. But even discussing how this is important with your close circle of people is important. Setting up that it might happen (your anxiety might misinterpret everything as equally threatening as the dissolution of our legal status, including some dirty dishes on the counter) so we have patience with each other and language to talk through the emotions at hand, and have a structure to make amends and re-connect.
And, coming to an acupuncture visit is a way to practice that phasing. Because I will take seriously –I will hear and appreciate– the proportionate and disproportionate anxiety in response to the real world, but we can also confirm that my acupuncture space is safe and secure for a set time, and that if that changes, we will work together to navigate that situation. Acupuncture is an embodied conversation between your mind-body-soul and me and my tools (acupuncture needles, essential oils, moxa, acupressure or massage), and your body can access some calm repose while being guarded, allowing your cells to heal and hormone and neurotransmitter levels to normalize or metabolize and memories to sort themselves out. It is a “rep” that helps your body practice that shift in arousal. Acupuncture, unlike medications, is not truly sedating, and so if you need to go straight from the appointment into a protest march or a letter-writing campaign or back to your own healing profession shift, you will have that brain and body capability, but you will have had one layer of stress reactivity notched down, and a few more degrees of spaciousness and resourcefulness. (And if you’re not accessing that, it is diagnostic data that we can respond to.)
Additionally, because acupuncture is not just a handful of tools and a cookbook, but is an entire 2500-year-vetted way of conceptualizing your needs and patterns and how to leverage your strengths, you can build trust that my treatment for you will always shift in response to who you are and what you are going through and what is out in the world; the treatment I provide will be as responsive and as proportional as I can make it in the time/space allowed, and so that too is a “rep” in practicing phasing from state to state: the body-mind-soul learning that you can ask for help and receive a response, and then have a felt-memory of that experience, that’s a valuable thing.
Take care of yourself, and build that phasing resilience and response. If you’d like to get acupuncture from me, call text or email Amenda Clinic to make an appointment (see main page of this website)
Some days the weight loss and healthcare industries seem to work extra hard to make it clear to me that they want me thin at any cost, and they are happy kill me in the process, all while co-opting the language that my community has created to protect ourselves in order to profit from our harm. On those days it can be really difficult to wade through their muck and break down the harm they do piece by piece.
3. Insists that its worth risking fat people’s lives and quality of life in attempts to make them thin (again, hardly an anti-stigma position)
4. Suggests that the solution to weight-based oppression (which, remember, they are actively perpetuating) is for fat people to change themselves to suit their oppressors.
Yes. The medical establishment insisted that my husband risk his life to make them thin rather than investigate what he was concerned about. They risked his life over and over, and then his life was lost. After only 45 years of life. Congratulations, diet industry. You eradicated a fat person.
*pause to calm*
Regan Chastain’s post has links included and you should read it there and support her work directly.
I am a paid subscriber to her Substack newsletter, because it takes a lot of mental and emotional toil, which she describes here.
I have a lot I also want to say about my husband’s “case study” in particular and the emotional toll of using studies that pathologies him in order to glean the data to prove why they shouldn’t have is probably going to give me an ulcer and a broken hand from punching through a wall. So I deeply honor the literal work that Regan does to make this newsletter. The work of finding and paying for the journal articles, of summarizing them in a non-stigmatizing way being careful to not parrot diet culture language, and for calming and grounding herself in the face of both the things she has to read aiming to destroy her and then defensive or reactive critics trying to destroy her.
Honor her by reading her newsletters. Go back and read the other entries. Follow the links.
Honor her by subscribing. My latte every day costs $7.50 with the tip I include and a subscription can be less than that and they are both nourishing.
Honor her and the community by sharing and signal boosting wildly.
Of the school teaching me medicine, they quickly said to us Day One
From now until you’re licensed,
you can never ever say
“You should drink some water”
Or “get more sleep” off hand
Because –did you know– that’s medical advice now, as you’re a medical student and
YOUR WORDS CARRY WEIGHT
You have power and knowledge but you also have responsibility
Because you’re Practicing Medicine
Is that person your patient?
Have they consented to your care and do they know what it entails? Do they know what you do? Do they know why they’re there with you? Do they want your advice? Do they feel they can say no?
Have you taken a good history?
And done physical exams and labs?
For example, how are their kidneys? And what about their heart?
If they were to drink water, would it cause their organs to fail?
Or what if they have an eating disorder
And they drink it to feel full?
Have you just added to their malnourishment to the point that their heart stops?
And why do they not drink water? Why would they need you to recommend it?
Are they taking a medicine that makes them dry, that makes them thirsty but not quenched? How about one where they forget to drink? Or one that pees it out?
And do they have access to clean water? Can they get enough to drink?
What if soda is really safer because of toxic lead and benzene?
What is your medical assessment of why they need more water?
Is it chapped lips that you’re treating? Or heat stroke from exposure instead?
And when you give that treatment plan of drinking extra water
What is your follow up? What will the effects be?
Give a good PARQ conference:
Plan, Alternatives, Risks, Questions answered
For example, is tea good too? Should they be starting with IV fluids, or can chewing ice suffice?
When will they feel the difference? How much water is too much?
What are the risks of drinking water? What are the risks of not?
And if drinking water doesn’t help, what’s your plan for what comes next?
What differential diagnoses would cause this thirst to be?
Will drinking that water just disguise a deeper wrong that’s underneath?
What have you missed by saying that? What care are you delaying?
Do they need to see a specialist? Do they need some social work?
Do they need an act of Congress, to make sure the water is there?
From now until you’re licensed, and even after that, you can’t tell a person to just drink water
Or get sleep
Or try that OTC drug
Because you are Practicing Medicine and there are steps required
45 years and 30 minutes ago, the love of my life emerged into the world. He was a glorious kind and loving emergent consciousness embodying a big and strong complex system, amidst and sometimes the hub of a beautiful web of other Earth inhabitants. The dynamic “order” spun by his life force had resiliently resisted Entropy, appearing as accidents and societal harms and the delicate balance of the big medicine of our coping mechanisms having costs for using them, for decades and decades more, but Entropy had its way with him in the end, as it does with us all. This world has been forever and ever changed by his presence in it. He is at ease to phase back into Undifferentiated Oneness with the Everything.
