The Strange Behavior Of Anorexia – Part 2

I ended Part 1 of this series by asking when someone might WANT to have anorexia.

When might you actually want to be repulsed by the thought of eating food?

Put another way, could anorexia ever be “useful”?

Well it is a standard question that I have asked of every so-called problem that I have been told about or come across over the years.

In what way might the presenting problem or symptom or complaint actually be “useful” to the person?

How might depression be useful, or phobias, grief, alcoholism, self-sabotage, low self-esteem, narcissism, or whatever?

This is where you get the idea of “secondary gain”.

Secondary gain is when there is a second or hidden motive for an action. For example being sick can also be a way of avoiding dealing with an issue, as in a child not wanting to go to school or a worker not wanting to face their boss.

This is often implied as a bad way to deal with things.

We’re meant to be upfront, have no secrets, face our fears, not keep hidden agendas.

However the reality is that humans are complex, and being indirect in going after an outcome is an important choice to have.

Some things are quite well dealt with in a secondary way.

Could there be some useful but secondary gain in having anorexia perhaps as a way of attracting sympathy, gaining attention, getting control of emotions of fear or anger, etc etc?

I suppose yes.

Every problem can have secondary gains.

Personally however I don’t think these questions generally lead to useful therapy. When I have explored secondary gains they have often opened up really fascinating stories with many twists and turns, but in the end the problem is no better for having done so.

Secondary gain inevitably happens, but it almost always remains secondary.

Let’s go back to the question with a different emphasis.

WHEN or WHERE might a particular problem be useful?

In the case of anorexia I have only one suggestion for a context.

If I was drifting on a small life raft in the middle of the ocean for days or weeks, and all I had to eat was food that I knew to be contaminated and fatally poisonous, then in this extremely limited situation I could imagine being much happier to have anorexia.

Instead of wishing I had food or being tempted to eat the poisonous stuff around me, I would be happy that I finally had no one pressuring me to eat. Bliss!

But most people with anorexia are not stranded at sea with poisonous food, so in Part 3 I will move on to what else might be going on.

-Dr Martin Russell

Self Help For Your Financial Future

This website is about taking what I do in my counseling practice and bringing it out to a wider audience.

It also gives me a chance to cover topics that I only rarely get to mention for people who come to see me.

One such topic is self help for your financial future.

If you are going to help yourself in your psychological outlook, your physical health, and your ability to contribute to the world, you need to take care of your own financial future.

I’m no expert in the financial area, but many people who have come to me with the diagnosis of “Depression” have one of their biggest depressing worries as finances.

Almost always I find that their finances are in fact depressing. They aren’t making it up, their finances are actually bad. They are in fact going backwards and/or bankrupt, or they have no ability to create safety and stability into the future.

My take is that with the aging of Western populations, and the extensive systems of welfare and healthcare support, and with the spending of successive governments on largely short-term outcomes rather than thinking over many generations, the world’s financial future is very bleak.

You can be seeming to do very well for yourself, but the world can still swamp you.

See my post about the cost of health care turning into the entire government budget by 2026-2032.

Be Darwinian, or Richard Dawkinsian, about it.

But if you are serious about self help, don’t bury your head in the sand.

If you want a wake up call then take the time to watch the 2008 Predictions videos, in particular the last one with Mike Maloney, at…

This information is for more than just 2008. They are the next 5-15 years predictions.

-Dr Martin

Depression Solutions… Can You Help?

With the recent studies showing antidepressants to be far less effective than previously reported, this leaves a big gap in the field.

What can take the place of antidepressants?

What solutions are already out there for depression?

What books, courses, websites, resources of any type are there for “curing” people who have been given the label “Depression”?

I’d like to know of ones you think work, and any you don’t think work as well, with enough details for me to find the resource, and what thoughts you have about it.

Yes. Self promotion is allowed. If you’ve got something good enough then great!

It will be interesting to know whether there is anything that might fill the therapeutic vacuum.

You can put your thoughts as a comment below.

Much appreciated.

-Dr Martin Russell

How To Get Better Results From Treatment

Fake pills and treatments are such wonderful things.

They work roughly 30% of the time, on almost anything.

With the technical term of ‘placebos’ they are the gold standard treatment against which every other treatment is measured.

And the whole field is shrouded in mystery.

Why do blue placebos make people more sleepy, while red placebos keep people more awake?

How can fake pills work even when you know there is no active ingredient in them?

How can they work no matter what level of intelligence you do or don’t have?

Well it’s still largely guesswork, because we don’t know why or how they work but they certainly do. Study after study has shown the effectiveness of variations of placebos.

Here is one more thing that has been recently uncovered about placebos – they work better if they cost more!

Dr. Ariely, a behavioral economist at MIT’s Media Lab, and his colleagues had two groups of people receive electrical shocks to their wrists.

They were told this was for a research into a new painkiller called Velodone.

When they were given the medication one group was told the price of the medication was $2.50 a pill and others were told the cost was discounted to just 10 cents a pill.

Those who got the “more expensive” pill had significantly better pain reduction than those who thought they were getting the discounted version.

This is actually important.

Drug companies often bring out drugs that besides being new, are often more expensive too. How much of the patient’s results is simply based on the added expense, rather than having a better chemical.

Also, this effect may indeed make brand-name medications more powerful than generic brands.

So one way to get better results from your treatment is to pay more for it.

As a side note, Dr Dan Ariely has a book just published about these and other psycho-illogical phenomena. It’s called “Predictably Irrational: The Hidden Forces That Shape Our Decisions”.

My main thought is whether people who buy the more expensive hardcover version will rate the book better than those who buy the cheaper paperback.

It wouldn’t surprise me, or Dan I suspect, in the least.

-Dr Martin Russell

National Sleep Awareness Week 2008… Yes Really!

This week March 3-8 the National Sleep Foundation (NSF) is holding National Sleep Awareness Week (NSAW, but SNAW would have sounded so much better.)

Had you hear about this week?

Each year it seems to be getting bigger so eventually you might.

Let me quote from the NSF’s “Sleep in America Poll 2008 – Summary of Findings”

“Long work days that often extend late into the night are causing Americans to doze on the job, at the wheel, and on their spouses, according to NSF’s 2008 Sleep in America poll. Among the poll respondents, 29% fell asleep or became very sleepy at work in the past month, 36% have fallen asleep or nodded off while driving in the past year, and 20% have lost interest in sex because they are too sleepy.”

Okay let me get straight to the point.

The Gold Sponsors of this event are:

  • Boehringer Ingelheim – makers of pramipexole known by the names Mirapexin®, Sifrol®, Pexola®, Mirapex®, which is a treatment for a sleeping disorder called Restless Legs Syndrome
  • Sanofi Aventis: makers of zolpidem known by the names Ambien®, Ambien CR®, Stilnox®, Myslee®, which is one of the world’s most popular sleeping medications.

The promotion of sleep awareness means the promotion of the awareness of sleep disorders, and of course, their treatments. It is hardly surprising that these companies are footing a big chunk of the bill.

It is hard for me to assess such an arrangement and it’s effects.

At least the evidence is that sleeping medication is more effective than anti-depressants at doing the job they are named for.

Except you need to consider whether they are effective long-term.

Certainly sleeping medication is not authorized for long-term use, even though that is how many, many people end up using them.

So how much is “awareness” based on marketing and “disease-mongering”, and how much on community benefit.

The NSF has a similar paradox to the one I find myself in when I talk about the system I have for helping people use sleeping pills safely and for as little time as possible.

By making sleeping pills safer to take, am I encouraging more people to take sleeping pills rather than fear them?

Am I contributing to the over-medicalization of something that is simply a part of being human?


Overall I hope I am contributing to your ability to make your own choice. After all that’s what self-help is all about.

-Dr Martin Russell

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Shake-up Or Wake-Up

The commotion over the study that said anti-depressants are a waste of time for all but the most severely depressed people, has continued to escalate.

It hit the middle editorial pages of my local city’s newspaper, and that means the story is big!

Much of the criticism that I have read of this study has been badly unscientific. A number of medical authorities seem to have come out with rather rash and half-baked defenses of their position.

Meanwhile there is a small debate building around the actual study itself which was published online in a format that allows comments.

For reference you can find the original study here:

Initial Severity and Antidepressant Benefits: A Meta-Analysis of Data Submitted to the Food and Drug Administration

This is an excerpt from my comments on the site:

It is interesting to see the commotion this study has caused, and rightly so.

Even more interesting has been the media reporting. They have been talking about the biological description of depression (eg biochemical imbalance in the brain) even as they are reporting that the drugs don’t work to anywhere near the level previously promoted.

The media is brainwashed to parrot what it has been told, even when there is a gaping hole in the theory.

Brain chemistry is not like insulin for diabetics.

It is also interesting to hear people who have received anti-depressants, and clinicians who prescribed them, somehow thinking they could not be responding to a placebo.

“All this evidence I have seen with my own eyes can’t be wrong” had been the catch-cry of quacks and the quasi-scientific, but it seems it is just the same here. Too many doctors, and patients, are not going about this scientifically.

If this paper is right then it says these drugs should not have gotten onto the market in the first place…

… We can’t offer talk therapy to all of the 5-15% of the western world that is supposedly “depressed”, but it’s no value overstating the benefits of medication either.

Far from being a step backwards I would like to see medicine, and psychiatry in particular, take this as a giant wake-up call for the 21st Century.

Hey, well I’m a wishful thinker 🙂

You can find all the direct comments on this landmark study here.

-Dr Martin Russell