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These issues are on my mind because I have an appointment with a dermatologist tomorrow and I haven't seen this doctor before. These articles explain why every fat patient is apprehensive when they encounter a new doctor. I've even read about the concerns of a fat medical student who encounters bias in her studies. Doctors are part of the same fat-hating culture as the rest of us and are subject to the same conditioning regarding race, weight, disability, gender, age and sexual orientation. I've read that this isn't being addressed in medical school (perhaps that differs from school to school, I don't know). It should be.

I've written before about other types of medical bias. In particular, studies show that black people--even children--are under-medicated for pain in the ER or after surgery. There's a stereotype that they feel less pain or are tougher in some way--all unconscious. I have no words for how much this horrifies me.

Is My Doctor Fat Phobic

Excerpt:

Just like the rest of Americans, healthcare providers carry weight biases. That means that your physician, nurse, dietician, psychologist, and fitness professional may hold discriminatory attitudes about fat people. Studies consistently document weight bias in healthcare providers, including the tendency to view obese* patients as lazy, lacking in self-control, undisciplined, and noncompliant with treatment.

I Had Cancer – And Medical Fat-Shaming Could Have Killed Me

Excerpt:

When my surgeon told me a diagnosis five years prior could’ve saved my lung, I remember a feeling of complete and utter rage. Because I remembered the five years I spent looking for some kind of reason why I was always coughing, always sick. Most of all, I remembered being consistently told that the reason I was sick was because I was fat.

My doctors treated my fat, rather than investigating the real reason I was sick, and it could’ve killed me.

Many therapists and health professionals hold hidden biases toward their obese patients, studies find.

Excerpt:

Also, it appears that weight influences patient diagnosis and treatment. In one study, Davis-Coelho found that therapists were more likely to diagnose an eating disorder for fat clients and cite "improve body image" and "increase sexual satisfaction" as treatment goals--even when the clients did not mention sexual difficulties--than for average-weight clients.

NAAFA: Healthcare Discrimination

NAAFA: Guidelines for Healthcare Providers--PDF

https://www.naafaonline.com/dev2/about/Brochures/NAAFA_Guidelines_for_Healthcare_Providers.pdf

Excerpt:

DIAGNOSING MEDICAL PROBLEMS
• Respect the patient’s health care priorities and address their chief complaint.
• Avoid offering unsolicited weight loss information.
• Remember to perform the same diagnostic tests on your fat patients you would on any other patients for a suspected condition.
• Counsel patients about exercise without linking it to weight. Increased activity improves blood pressure and glucose control, decreases arthritis symptoms and increases overall well-being.

TREATING MEDICAL PROBLEMS
• Do not assume that weight is the cause of all symptoms.
• Do not delay treatment or insist that your patient lose weight prior to receiving treatment.
• Demonstrate care in ordering medication dosages. Some patients react sensitively to small dosages of some drugs, while other drugs require a higher dosage, due to the patient’s higher weight.
• Offer to revisit medication decisions if needed, and explain that treatment can prevent long-term complications.

As society grew more aware of eating disorders, those of us who were fat or very thin began to hear that we MUST have an eating disorder. Meanwhile the average-sized person with an eating disorder went unnoticed. It's not our place to diagnose other people.

For those of you who are genuinely concerned about a friend, there are lists of observed behaviors you might consult but don't base your talk on their body size. Not if you want to keep them as a friend.

Why You Can’t Tell If Someone Has An Eating Disorder Just By Looking At Them

See also

Lindy West on How Eating as a Woman Is Like Being Under “Surveillance”

and
http://everydayfeminism.com/2015/08/size-discrimination-facts/

People talk a lot about science denial in terms of climate change or vaccinations but few realize that the assumptions about weight regain and willpower are contradicted by obesity research.

It all makes sense if you realize evolution equipped our ancestors to survive drought and resulting famines and then was reinforced by war and sieges. Modern starvation dieting mimics these real life starvation scenarios and we can't explain to our bodies that they shouldn't invoke these valuable protections against severe food shortages.

The difference is, when we stop our self induced starvation we are surrounded by plenty of food and our body is increasing hunger-related hormones to get us to replace the lost weight and protect us from the next famine. We have also divorced eating from its connection with hunger cues when we learned to ignore those cues while dieting.

If you wanted to end up at a high weight, you couldn't design a better program than repeated low calorie diets over decades. Only by stopping this cycle and recovering from dieting can you finally stop the loss/gain cycle at whatever set point range you arrived at while dieting repeatedly.

The basis of recovery from dieting are:

Eat only when you are hungry (you have to tune back in to the signs of hunger you learned to ignore).

Eat exactly what you want to. (To break down the psychological conditioning that tells you deprivation is around the corner so you'd better eat ALL the cookies NOW and made you hate foods associated with dieting.)

Stop when you are full. (Not over-full. Requires you to get in touch with your body's cues that you are full just like recognizing when you are hungry.) No guilt.

It took time to learn to ignore those cues and it will take time to reverse the process. If you decide to try this, be kind to yourself.

I found that for a few months I sought out the "forbidden" foods. This is normal. This is how you finally learn to relax. You are establishing trust with yourself, trust that there will be no more deprivation. One day I reflexively reached for a candy bar, looked at it and realized I didn't really want it. There was no urgency--I realized it would still be there if I wanted it in the future. I had finally convinced myself that the days of starvation and denial was over. I also began to find that sometimes I really craved raw vegetables because I was no longer using them as a form of penance. I was free to appreciate them rather than see them as a reminder of an aching, mostly empty stomach.

I also had to deal with my poor-person's inhibitions against throwing away the remaining food on my plate. It was a crime in our household to be so wasteful. You might deliberately not fill your plate while dieting, but if you did you ate every bit. As in repeat-dieting, there was an anxiety that food would be scarce again, later in the month. There was an urgent sense that you had to eat food while you had access to it. I was no longer at that level of poverty but that sense stayed with me. I still maintain a full pantry as if poverty is just around the corner.

To be clear, this is not a weight-loss program. It's a sanity-around-food program. It's hear if you ever decide you'd like to try it.

CW: recognizes the research on the problem, doesn't question if diets have actually been making us fatter as some other research has indicated. Also involves references to weight loss surgery. I'd prefer that we intervene with young people before they start low calorie diets.

Ref.: http://www.cbsnews.com/news/diet-exercise-treatment-for-obese-patients/

[Note: This is a frank discussion of being in relationship with someone whose personality disorder hasn't been treated and I make assumptions about our newly minted president's mental health based on the obvious behaviors he's displayed and the opinions of experts. They might be wrong if his behaviors were only displayed in private but the whole world has noticed some of the most obvious symptoms of Narcissistic Personality Disorder. My POV is that while I deplore the stereotypes and stigmas associated with mental illness, I've seen what happens when mental illness is ignored because people don't want to talk about it. POTUS works for the American people and his denial of reality among other behaviors is potentially dangerous to others. If we don't call it as we see it and put pressure on our leaders to confront the elephant in the room there is a potential for disaster. Not every person with every mental illness is capable of doing every job--which is no more ableist than to say that I, an older person with heart disease and damaged knee can't run a marathon. A person with his same disorder who learned to manage it well could be very successful as a POTUS. But DJT has been shielded from the consequences of his condition and so never sought the treatment he could have easily afforded. That's the saddest part--he could afford it while so many can't.]

CW: mental illness, politics

I was trying to describe relating to someone with personality disorder (untreated, not managed) to a friend on twitter & came up with an analogy.

Since personality disorders can affect thinking and fundamental world view in a way that is more pervasive than other types of mental illness, it can be disorienting to interact closely with such a person. You think you're both on the same page but their reactions seem off in ways that startle or unsettle you. Sometimes it's closer to what you expect and you think you're approaching a relationship you can be comfortable with--and then it changes suddenly.

My analogy is it's like you're in a play but you have two entirely different scripts and the director has given you different instructions about motivation and the end of the play. You both keep stumbling along trying to assert YOUR understanding of the play (reality) and the words you use mean different things to each of you. Worse, the other person sometimes gets upset out of proportion to what is happening and takes it out on you. These upsets come suddenly like a storm appearing out of a blue sky and when they recede the other person can't understand why you still want to discuss it.

Applying this to Donald Trump, everyone expected him to "pivot" (behave like presidents usually do within a range of variation) and he continues to act out and tweet about every minor slight he perceives. His ego is paper thin, his insecurities are enormous and now the White House press secretary is called upon to shore up his shaky self esteem. Both the press and other politicians don't know how to react to his erratic behavior.

Trump wants to feel and look strong like the authoritarian leaders he admires, and woe unto you if you don't agree that his decisions and even his inauguration audience is HUGE and wonderful. If there is an inconvenient truth that pierces his wished-for identity as awesome leader, it must be denied and his preferred reality re-asserted--even in his own mind. Who are you going to believe, the president or your lying eyes?

You will feel off balance, like you are walking through quicksand. You keep talking with people who agree--yes THIS is reality and what he says isn't. But his lies are repeated constantly and you don't have the megaphone he's been given to dispute them. We rely on the press for this and our president is trying to discredit them every day.

Hold on to your reality and support your friends and family in affirming it. Support your press in challenging his lies and if they try to go along with him, challenge them.

The urge to deny that this problem exists is strong. We want to have a president who is sensible and rational. We want to feel safe. It's tempting to say he's just eccentric. I saw this dynamic in my own family who didn't understand my mom's illness (not much was known about personality disorders and we're still learning a lot). My mother held my half-sister's hands under scalding water and sent her to the hospital and it was swept under the rug. No one seemed to think she might not be able to raise me. (Both my mother and sister had borderline personality disorder.)

Mom admitted later she thought about killing us both. We hasten to say that most people with mental illness don't harm others--and statistically that's true. We don't want you all to fear us (I have depression and PTSD). But we can't deny it when someone DOES have a potential to harm others. Giving an unstable man the nuclear codes and the ability to make decisions that can end lives is a huge risk and we need to talk about it.

As I write this the press secretary is back defending the president's ego and spouting more lies while saying he won't ever lie to the press. His proximity and representation of someone with NPD requires him to take on the reality of the president and substitute it for his own. He has launched into an impassioned speech about how unfairly Donald J. Trump is being talked about by the mainstream media. He's bought into Trump's reality 100%.

Here's an excellent example of someone who has had great personal and professional success by managing and treating her personality disorder (and coming out about it):

Marsha Linehan, the founder of Dialectical Behavior Therapy (DBT) talks about her own diagnosis of Borderline Personality Disorder.

You might also find this interesting: Trump's Lies vs. Your Brain: here’s what psychology tells us about life under a leader totally indifferent to the truth.

Finally, Propane Jane's excellent article from the POV of a professional in the field: Instability-in-Chief

All over the internet I see sentiments such as "Give Trump a chance" and "Pray for him to do well."

My faith in prayer is not so robust that I think it will change his plans and ideas and make him more capable, first off, because that would interfere with free will. Donald J. Trump has already told us what he's decided to do with his free will.

I don't WANT him to be a bad president. But if he does the things he planned and swore he'd do, Americans will die. He's already had his staff get rid of the climate change info on the .gov website, as well as the lgbt info and the criminal justice reform info--replaced with a page that seems to indicate that police are supported no matter what they might do because we've been too negative. I guess it's open season on black people pulled over by officers then. I can't let that stand without standing up for vulnerable people and holding officers who use excessive or deadly force accountable.

If he carries out his discriminatory agenda that targets some Americans (Muslims, immigrants and others) I see it as my duty to speak out against what he's planning and putting into action.

He has done nothing but mock and accuse the press of lying (when he lies regularly) and came close to kicking them out of their space in the West Wing to another building. It was people speaking out that nixed that plan for now. At times during his campaign he got his followers so riled up at the press that they felt unsafe and one young woman needed an escort to her car.

It would be awesome if he had an epiphany along the way that he's supposed to honor and protect all Americans including the press. I'd love it if he took responsibility for his sexual predatory behavior. I have seen no evidence that he ever will. He's 70 and unlikely to change.

https://www.facebook.com/deathnography/photos/a.1141055039269518.1073741828.1141048949270127/1368268639881489/?type=3&permPage=1

I also question whether you can do therapy without considering the mechanisms of oppression and how they affect your client (as target or perpetrator).

If it weren't so late I would get into that more but I'll have to come back to it.

“We must always take sides. Neutrality helps the oppressor, never the victim. Silence encourages the tormentor, never the tormented.” Wiesel

https://www.theguardian.com/commentisfree/2016/mar/28/hillary-clinton-honest-transparency-jill-abramson?

Excerpts:

As an editor I’ve launched investigations into her business dealings, her fundraising, her foundation and her marriage. As a reporter my stories stretch back to Whitewater. I’m not a favorite in Hillaryland. That makes what I want to say next surprising.

Hillary Clinton is fundamentally honest and trustworthy.

The yardsticks I use for measuring a politician’s honesty are pretty simple. Ever since I was an investigative reporter covering the nexus of money and politics, I’ve looked for connections between money (including campaign donations, loans, Super Pac funds, speaking fees, foundation ties) and official actions. I’m on the lookout for lies, scrutinizing statements candidates make in the heat of an election.

The connection between money and action is often fuzzy. Many investigative articles about Clinton end up “raising serious questions” about “potential” conflicts of interest or lapses in her judgment. Of course, she should be held accountable. It was bad judgment, as she has said, to use a private email server. It was colossally stupid to take those hefty speaking fees, but not corrupt. There are no instances I know of where Clinton was doing the bidding of a donor or benefactor.

As for her statements on issues, Politifact, a Pulitzer prize-winning fact-checking organization, gives Clinton the best truth-telling record of any of the 2016 presidential candidates. She beats Sanders and Kasich and crushes Cruz and Trump, who has the biggest “pants on fire” rating and has told whoppers about basic economics that are embarrassing for anyone aiming to be president. (He falsely claimed GDP has dropped the last two quarters and claimed the national unemployment rate was as high as 35%).

As I post this, however, several scandals and evidence of fraud have been or are being uncovered concerning Donald Trump. Perhaps he assumes Hillary has behaved the way he would in her place.