Susan Kolod, Ph. D

By Susan Kolod, Ph.D.

If you want to lose weight, the solution is simple: eat less and move more, right? Everyone one knows that. But eating less and moving more is a lot easier for some people than others. It is easiest for people who are in the normal weight range and have perhaps gained a few pounds over the holidays. New research explains why this approach often fails with obese individuals. And why some calories are better than others when seeking to lose weight.

The role of hormones

Feeling full or hungry, energetic or lethargic, can be traced to certain hormones—in particular, leptin and insulin. Normally, when a body’s fat cells are filled with stored fat they release the hormone Leptin, which tells the brain to eat less and move more. However, when a person becomes obese this “signaling” goes awry. Leptin is not longer released and the message to the brain becomes “eat more and move less.” Thus eating more and moving less, thought to cause obesity, may actually be the RESULT of obesity.

Sean Lucan, M.D., M.P.H, Albert Einstein College of Medicine in New York City and James DiNicolatonio, Pharm.D., Mid-America Heart Institute of St. Luke’s Hospital, Kansas City Mo., conduct research on weight loss, obesity and public health issues. They suggest that the culprit in the perpetuation of obesity is refined sugar, rapidly absorbable carbohydrates and the hormone Insulin. Refined sugar and starches cause blood sugar to rise. The rapid elevations in Insulin results in a precipitous drop in blood sugar. This causes food cravings, especially for sweets.

Over time, the overconsumption of refined sugars and starches can result in “Leptin resistance,” which leads to an inability to determine fullness. Thus, the result of a dietheavy on refined sugar and starches is increased appetite and decreased activity—a dangerous cycle, and difficult to reverse. The researchers conclude that it’s not the number of calories consumed that accounts for obesity, but rather the type of food consumed—refined sugars and starches in particular. These foods can make changes to the brain that interfere with the ability to determine fullness and cause lethargy.

The problem with “eat less, move more”

Lucan and DiNicolantonio explain why an approach that advocates eating fewer calories is inadequate and simplistic, “By this thinking, a calorie’s worth of salmon, olive oil, white rice or vodka would each be equivalent and each expected to have the same implications for body weight and body fatness.” In fact, proteins, fats, carbohydrates and alcohol each have different effects on hormones relevant to feeling full. Lucan and DiNicolantonio suggest more nuanced thinking about weight loss. That is, some calories satisfy appetite and promote energy while others promote hunger and energy storage—in other words, not all calories are the same.

In addition, if you simply eat less food and consume fewer calories, you will become more tired and hungry—therefore, less likely to want to move more. The cravings for high-calorie foods increases with deprivation, making it more likely that binge eating will occur.

What foods make you want to eat less and move more?

It is more important to consider the type of food than the number of calories consumed. Some foods make you want to eat less and move more—other foods make you want to eat more and move less.

For example, fat, which is high in calories, can satisfy the appetite and promote activity. Nuts, dairy products, oily fish and olive oil are high in fat and calories. But these foods make you feel full and energetic. This makes is possible to eat less and move more, which leads to sustaining weight loss.

Diets that simply restrict calories and pay no attention to the types of food consumed can backfire especially among obese individuals who have become leptin resistant.

In order to reverse leptin resistance, it is necessary to change the types of food to those that will re-calibrate the signaling to the brain—and will promote a feeling of fullness and energy.

A public health issue

It does very little good to blame over-consuming inactive adolescents for getting fat. The advice to simply consume fewer calories and increase exercise is counter-productive. New research suggests that overconsumption and inactivity are caused by neurohormonal changes related to a diet filled with refined sugar, starches and processed food. Promotion of whole/minimally processed food with plenty of “good” fats such as olive oil, oily fish and nuts address the cause, rather than the effect. And may also address the sense of failure and hopelessness many obese people experience when they are told to simply, “eat less and move more.”

Volume 50:3, 484-491

2014

READING THE FEMININE MYSTIQUE ON THE 50th ANNIVERSARY OF ITS PUBLICATION

By Susan Kolod, Ph.D.

Young women are becoming equal partners in the hookup culture, often just as willing as young men to venture into sexual relationships without emotional ties.  But research suggests hookup regret is twice as common among women as men.

Is that because women are “hard-wired” to be monogamous? Researchers say no—it has more to do with sexual satisfaction. Or lack thereof.

The “Hookup Culture” has generated a wealth of research on how both men and women respond to casual sex. These studies conclude women are much less likely to orgasm in a hookup as in a committed relationship, and that hookup regret is often linked to an unsatisfying sexual experience.

Justin R. Garcia, an evolutionary biologist at the Kinsey Institute at Indiana University, studied 600 college students and found women were twice as likely to reach orgasm in serious relationships as in hookups. Both men and women sometimes experience hookup regret, but Garcia found women are twice as likely to have a negative reaction later on.

Likewise, Paula England, a sociologist at New York University, in a study of 24,000 college students over the course of 5 years, found only approximately 40 percent of women had an orgasm during their last hookup involving intercourse, while 80 percent of men did. By contrast, roughly three quarters of women in the survey said they had an orgasm the last time they had sex in a committed relationship.

England suggests that for women, practice makes perfect—in other words practicing sex with a partner is far more important for a woman to achieve sexual satisfaction than for men. Communication, which is a key element in a woman’s sexual satisfaction, is less likely in hookups.  “Women are not feeling very free in these casual contexts to say what they want and need.” Another problem, according to England, is that women may still be stigmatized for having casual sex.

Most of subjects in these studies were heterosexual. But Terri Conley, a research psychologist at the University of Michigan, did a study involving bisexual women. She found that if a bisexual woman was approached by both a man and a woman for casual sex, she would be more likely to accept the offer from the woman. Why? Less likelihood of disease, violence or stigmatization and greater likliho0d of sexual satisfaction with a female stranger than a male stranger.

Conley challenges the argument that gender differences relating to casual sex are “hardwired” i.e. biological or evolutionary in nature. She examined the following assumptions:

1. Men think about sex more than women
2. Women orgasm less frequently than men
3. Men like casual sex more than women
4. Women are choosier than men

She suggests that these gender differences have more to do with societal factors: prohibition against women expressing sexual desire, and the greater risk of being subjected to sexual assault and disease. According to Conley, when these conditions are factored out of the equation, women and men appear to enjoy casual sex similarly.

Furthermore, if a woman finds her sex partner attractive, sexually skilled and non-judgmental she is just as likely to engage in and enjoy a hookup as a man. And she will most likely not regret the experience.

But before a woman can communicate what she wants, she has to know what she wants. Sex education does not teach women how to have good sex, let alone ask for what they need.

In a recent New York Times article on this subject, In Hookups, Inequality Still Reigns (November 11, 2013) a young woman reports sex education in her school was aimed at stopping teenagers from having sex entirely; there wasn’t any discussion of how to achieve satisfaction. She noted thatporn can be a great source of sex education but in porn people don’t tell each other things like, ‘Oh, my foot’s falling asleep, we need to move.”

Men’s sexual anatomy makes it is easier to achieve orgasm, whether the sex occurs within a committed relationship or not. Women’s sexual responsiveness is more complicated and requires the woman know what she wants and be willing to ask for it. Her partner must be mindful of the time and attention required to ensure the woman achieves orgasm.

It is quite common for women to disconnect from sexual experiences in hookups, particularly if they are drunk or high. It is just too difficult to stop things once they get started. As one female patient reports, “I just decided to pretend it wasn’t happening.”  She describes being in a trance-like state during a casual sexual encounter and regretting it afterwards.

An unsatisfying sexual experience like this can have lasting negative consequences, resulting in feelings of shame, depression and low self worth.

In taking sexual histories of women who were having problems with arousal as they went through menopause, I found regret over unsatisfying or risky sexual encounters could linger. During the “Sexual Revolution” of the 60’s and 70’s, as now, there was considerable peer pressure to be sexually adventurous. Some of the sexual experiences women reported occurred under the influence of drugs and alcohol, and with multiple partners. While these experiences may have felt adventurous at the time, they are now recalled as painful, humiliating and even traumatic. This may be due to the fact that the woman was not really enjoying herself—just pretending and going through the motions in a very disconnected way.

What is the takeaway for young women today?   Know what you like and want sexually and make sure to communicate this to your partner. It is never a good idea to disconnect and pretend you are enjoying sex if you are not. These reactions lead to feeling “used.”  Hookups aren’t for everyone, but they don’t have to be a source of dissatisfaction, shame or trauma. If you have a great time with a casual sex partner, you are less likely to regret the experience afterwards!

Susan Kolod, Ph.D. is a Supervising and Training Analyst and co-Editor of the blog, Contemporary Psychoanalysis in Action at the William Alanson White Institute. She has lectured and written about the impact ofhormones on the psyche with a particular focus on sexuality, menopause and the menstrual cycle. She is in private practice in Brooklyn and Manhattan.

Dr. Kolod will be speaking at the Division 39 Meeting in New York City at the Sheraton Hotel on April 24^th, 2014. The topic is The Female Body in Psychoanalytic Treatment.

What makes scandals so interesting? A good scandal can be titillating, outrageous, entertaining, satisfying and edifying—it allows us to feel superior, to pity or despise the transgressor and to get vicarious pleasure, all at the same time. It becomes a “feeding frenzy.” People can’t get enough of it—every morsel is chewed and devoured like delicious rich cake.

Scandal allows us to fantasize about the lives we don’t lead. In Adam Phillip’s new book, Missing Out: In Praise of the Unlived Life he makes the point that everyone lives several parallel lives—the life we actually live and the lives we feel we SHOULD or COULD have been living. Depression, anxiety and other types of dissatisfaction result from the frustration one feels that he or she should be living a different, more exciting, more daring, sexier life. Scandals allow us, through fantasy, to vicariously experience an “other” life, while leaving us reassured that we are better off in our ordinary, non-scandalous existence.

What exactly is scandal? Scandal derives from a Greek word for “snare,” implying that one is “snared” into moral failure.  Scandal was originally a term used to denote a discredit brought upon religion by “unseemly conduct in a religious person,” especially if it encourages a lapse of faith in another (Merriam Webster).

Today, scandal has a spectrum of meanings, including discreditable or immoral conduct, damage to reputation caused by such misconduct, and malicious or defamatory gossip, whether or not well founded. “Scandal” and “Slander” share the same root.

Scandal is relative. What causes a scandal at one time or in one place might not in another. There can be no scandal without a scandalized public. Former Prime Minister of Italy Silvio Berlusconi’s solicitation of underage prostitutes resulted in his arrest, but apparently, no significant scandal. According to Italian filmmaker Paolo Sorrentino, that is because, in Italy everyone loves a party. (New York Times, Sept 8, 2013).

On the other hand, the scandal of former Congressman Anthony Weiner who ran and lost the primary election for Mayor of New York City is remarkable for what he did NOT do. “He did not commit adultery. He did not break up a marriage. He did not employ the services of a prostitute. He did not stalk. He did not misuse public funds…He did not have inappropriate physical contact—or any physical contact—with any person.” His scandal resulted solely from “pixels on a screen.”  Herzberg (New Yorker Magazine, August 28, 2013).  Or, perhaps, from his persistent lying and acting foolishly in public.

Scandal takes on a life of its own, and, sometimes, the actual facts of the matter are of little importance. As the dictionary definition above implies, the gossip may be more enthralling than the details of what really occurred.

Every person struggles with impulses to break the rules, to violate boundaries. These unacceptable attributes are rejected in oneself but are embodied in the scandalous person, who becomes larger than life. Similar to watching porn or a horror film, one can experience terror, outrage, extreme anxiety, sexual excitement and relief, without having to engage in risky behavior.

Here are 5 reasons we love scandal:

1. Vicarious pleasure in the rule-breaking of another. Transgression is titillating. Every person is tempted to break rules and boundaries but for the most part, resists. The scandalous person has given into temptation.
2. Pleasure at the punishment of the transgressor. There is a sense of moral satisfaction when the scandalous person is humiliated or punished. It restores faith in the orderliness of the moral universe. Scandals exaggerate the sense that there are good and bad people.
3. Pleasure at watching someone “get away with it.”  In Missing Out, Phillips writes that “getting away with it” occurs when you obtain the forbidden object of desire without paying penalty. The unpunished transgressor allows us to imagine this (potentially thrilling) experience.
4. Pleasure at being asked to forgive. This elicits a feeling of power and triumph in the person to whom the request is made. The transgressor has to grovel, and forgiveness can either be granted or denied. This provides the non-transgressor a feeling of superiority, however fleeting.
5. And perhaps most importantly, distraction from the tedium of one’s own difficult everyday problems. Reading about the scandals that have beset others is a great distraction. Not only does it take our minds off our problems, it also assures us that our problems are small and manageable in comparison.

We all have parts of ourselves we don’t want to acknowledge that wish to do harm. These disowned parts are easily projected onto the alleged perpetrator who is experienced as repellent and alien. Abby Stein, Professor of Interdisciplinary Studies at John Jay College of Criminal Justice notes, “In the presence of perpetration we may be repelled but we are also excited. In an odd way, people who have done awful lurid sexual things to others are not just interesting—they are downright sexy.”

When someone breaks the rules, violates boundaries, it can be upsetting to observe. But reactions to scandal are more complicated than simple moral outrage. If it were just outrage, people would not become so fascinated and involved. It is the combined reactions of outrage and disgust on the one hand, and fascination and titillation on the other, that makes scandal exciting. That’s where fantasy and vicarious pleasure take center stage.

Fifty years after its publication, Betty Friedan’s The Feminine Mystique continues to influence how women think about what “makes them tick.”  Friedan got a lot right, but with decades of hindsight, it’s easy to see she got some things wrong, particularly her outright rejection of the impact of hormonal shifts on female experience.

Friedan’s book catapulted the Women’s Movement into the public eye. She identified the “problem that has no name”: the boredom, depression and empty lives of educated women who had given up careers to care for home and children. Post-war generation wives and mothers responded powerfully to Friedan’s observations.

Friedan raised challenging questions about psychoanalytic views of female development and psychology, then in vogue, and the ways these views kept women “in their place.”  She was instrumental in setting female psychology on a different course–in some good ways, as well in others that have been less helpful.

When The Feminine Mystique was published in 1963, the classical Freudian view of female development was still the accepted wisdom: anatomy is destiny, and normal female development includes penis envy, faulty super-ego development, masochism and passivity. Friedan correctly pointed out how these theories kept women in a submissive role relative to men.

However, Friedan went on to dismiss the importance of ovarian hormones and the menstrual cycle on a woman’s identity, mood and thought processes. Friedan’s mission, or one of her missions, was to assert there was no meaningful difference between men and women, that anatomy is immaterial.

Betty Friedan’s work became very relevant to me while I was researching the topic of menopause, an endeavor prompted by the onset of my own.  I noticed how little was written on the subject, and that women rarely spoke about their physical and psychological suffering.

Surprisingly, Friedan thought menopause inconsequential.  If a woman has a meaningful life, menopause should be a non-event. She believed that only women whose identity and self-worth were tied to being a wife and mother, and for whom, therefore, youth and sexual attractiveness are all-important, would find menopause difficult. Other hormonal emotional experiences, such as pre-menstrual tension and post-partum depression, she similarly refused to recognize as physiologically determined.

Friedan, and many other feminists who are now in their 70’s, 80’s and 90’s, espoused the view that the miseries of menopause are solely a consequence of the repressive Freudian environment Friedan detailed in The Feminine Mystique. Friedan went so far as to say that menopause didn’t really exist—it was invented by the pharmaceutical companies!

What was wrong with me, I wondered? I had a career and meaningful relationships but found menopause disorienting and painful. The changes in body image, the physical discomfort, mood swings, insomnia all made me wonder, “Who am I?” and “What am I becoming?”  According to Friedan, I should have been immune to this distress because of career and meaningful interests outside the home.

I invited Friedan in 2005 to speak at a conference on the topic “Is There Menopause?” to explain her views.   Friedan initially agreed, but her failing health prevented this. She did, however, allow me to videotape an interview to be screened for attendees. She died soon after the interview. Click to view video.

On January 12, 2005 I went to Friedan’s apartment. I had sent her a list of questions in advance of the interview: Have women’s reactions to menopause changed since you wrote The Feminine Mystique?  Do women experience it the same now as they did in 1963?  Do you think menopause changes the way a woman sees herself?  Does it change her identity?

Friedan became increasingly annoyed, and even hostile, as I asked my questions.  The very word “menopause” irritated her. Menopause does not exist—and shouldn’t be talked about.  I persisted with my questions until she finally yelled, “What the fuck are you asking me?” Questions about “aging” were OK with her, so long as I didn’t use the word “menopause.” Men and women both age, but only women are alleged to go through menopause.

At the conference, along with the Friedan interview videotape, I presented my own paper on the impact of menopause on a woman’s identity. Much to my surprise, several feminist psychoanalysts, 10 to 15 years older than I, approached me afterwards warning me that this was a dangerous topic, a slippery slope and that I should perhaps discontinue talking about it.

The dangerous topic is not menopause—it is the acknowledgement that female hormones make women feel and behave differently from men.  Historically, a focus on the female body, ovarian hormones and the menstrual cycle has been used to stigmatize women as moody, flighty, and unfocussed. As such, they should not hold positions of power. If a woman was president, she might start a nuclear attack while suffering from PMS!

My female friends and I, all Baby Boomers, were the benefactors of the changes brought about by the Women’s Movement. We assumed we’d have careers, or at least imagined the possibility. Now in our 60s, most of us do have careers and families.  We’ve gone through menopause, but didn’t sail through it the way Friedan predicted. Not at all!

So while we should be immensely grateful for Friedan’s potent critique of that which oppressed women, I believe it is important that a complete understanding of the female experience include recognition of the significant effect of hormones on a woman’s body and psychological functioning. Rather than denying or dismissing the impact, let’s acknowledge and appreciate the range of experience with which hormones endow women.

Hormones and menstrual cycle affect eating and body image: by Susan Kolod, Ph.D.

Published on February 28, 2013 by The Contemporary Psychoanalysis Group in Contemporary Psychoanalysis in Action

The fact that she aimed the gun at Tarnower and not herself made her case unique

Published on January 14, 2013 by The Contemporary Psychoanalysis Group in Contemporary Psychoanalysis in Action

The Jean Harris story was a compelling erotic fantasy: seduction, humiliation, abandonment and retribution.  It captured our attention in 1980, but if you are under 50 you may not know much of the private school headmistress who killed her philandering lover, Herman Tarnower, the “Scarsdale Diet Doctor.”  Jean Harris died on December 23^rd at age 89. (Headmistress, Jilted Love, Killer, Then a Force for Good in Jail; New York Times December 28, 2012).

What made her snap?  Was it an accident or murder?  Was she justified? Public debate raged. Harris evoked vastly different thoughts and feelings about women, love, fidelity and aggression. To Diana Trilling, the literary critic, Harris was a modern-day Anna Karenina, to Betty Friedan, the famous feminist, a pathetic masochist.

Jean Harris took the pistol out of her small purse and plugged Tarnower 4 times. Was it an accident, as she claimed?  Did he have it coming, as the female murderers sing in the “Chicago” musical number “The Cell-Block Tango”?

Unlike the “merry mistresses of mayhem” in “Chicago”, Mrs. Harris was a petite, lady-like, Smith-educated, 56-year old woman with no prior criminal record. A woman of wit and intelligence, she testified she went to her lover’s home with a gun, not to kill him, but to ask him to kill her. If he refused, she planned to kill herself. Tarnower, asleep in bed when she arrived, must have reacted inappropriately, because he ended up with 4 bullets in him.

Much of the debate that ensued over this case reflected the feminist challenge to theories about “normal” female development that stigmatized women during that period. Classical Freudian theory, still the prevailing authority in 1980 but since abandoned by contemporary psychoanalysts, postulated that passivity and masochism are part of normal female development.  The fact that a woman as “normal” as Harris aimed the gun at Tarnower rather than at herself made her case unique.

Ann Jones had just finished writing her seminal text on female murders, “Women Who Kill” when the Tarnower murder occurred. Jones found the case to be so note-worthy that she added a new chapter to her book.

Women perpetrate a very small percentage of the killings in this country—figures range from 7 to 15%.  Jones writes that “The so-called classic murder of jealous passion, like every other murder, is far more likely to be committed by a man who murders ‘his’ woman in a fit of possessiveness”. Women, on the other hand, are taught not to become angry about such things as infidelity. Instead, they often become depressed and self-destructive. Women like Harris, according to Jones, are programmed to commit suicide, not homicide.

At the same time, The “Battered Woman Syndrome” was being debated in the courts as a defense in cases where a woman killed her abusing partner.  Lenore Walker described this syndrome in her book “The Battered Woman” (1979). but Jean Harris didn’t fit that mold, since she had never been physically abused by Tarnower.

He had taken up with a younger woman, Lynn Tryforos, and the two were quite public about their affair. Harris testified at the trial that she discovered a birthday greeting from Tryforos to Tarnover in an advertisement on the front page of the New York Times. She commented to Tarnower, “Herman, why don’t you use the Goodyear blimp next time? I think it’s available.”

In a letter Harris sent Tarnower the day of the murder, she revealed her deeply wounded self-image and recounted that “to be jeered at and called ‘old and pathetic’ made me seriously consider borrowing $5000 and telling a doctor to make me young again—anything but make me not feel like discarded trash.”

Humiliation, abandonment, methamphetamine and barbiturates (prescribed by Tarnower), exhaustion and possibly menopausal hormones—were too much for a woman like Harris, who was already unable to express anger. She kept it to herself, until she exploded in rage. And then there was the gun.

Harris was undoubtedly confused, distraught and furious as she got into the car that day to drive to Tarnower’s house. Her sense of reality  shaken, she wasn’t clear whether she intended to kill him, herself or just threaten him. If she hadn’t had a gun, there would have been a scene, maybe even a physical fight, but he would not have died and she would not have gone to prison for half of the rest of her life.

Harris had purchased the gun two years prior for “self-protection.”  That aspect of the case, the fact that she bought a gun in the first place, was ignored in the public debate. A single comment made by Harris’s son, James, who was 27 years old and a marine lieutenant at the time, made reference to the weapon. At the bail hearing he commented to a New York Times photographer, “This is a very sad thing—perhaps your paper should write a good story on gun control ”(Gun Used in Slaying of Doctor is Tie to Suspect, New York Times, March 12, 1980).

Or perhaps the paper should have written a good story about psychotherapy.  Harris had never sought psychotherapy or psychiatric medication, according to her biographer, Shana Alexander (Very Much a Lady, 1983) relying instead on Tarnower’s amphetamine and barbiturate prescriptions.  There is no question that therapy, perhaps with appropriate medication, would have helped her to cope with her distress and likely find a way out of it.

Repressed anger is a problem therapists encounter frequently in practice. I find it particularly prevalent among female patients anxious about expressing anger directly towards a loved one for fear of losing the relationship. If untreated, repressed anger may become self-directed rage and can take the form of eating disorders, physical symptoms, depression and suicidal thoughts.

Treatment focuses on helping the patient first to become aware of angry thoughts and then to start to express them. As the patient becomes more aware of and comfortable with anger, the physical symptoms and depression start to lift.

In Harris’ case, the repressed anger was complicated by her intense dependency on Tarnower. She appears to have been drug addicted and was dependent on him both emotionally and for drugs, calling him her “life-line”.  Although not physically abused by Tarnower, the cycle of humiliation and reconciliation, amplified by drug dependency, may have rendered her helpless to leave. Had she sought psychotherapy, it could have helped disentangle her from this abusive relationship.

In 1980 I was a young woman and Harris symbolized a different way for women to express rage—take it out on the person who humiliated you! But Harris was not a fantasy or a symbol. She was a woman pushed to the edge, deeply remorseful afterward; she killed her lover and companion of 14 years and was sentenced to 15 years in prison. Today, I wonder what might have been different if the form of self-protection she had opted for had been psychotherapy rather than a gun.

Aging sperm is linked to children’s developmental and psychiatric conditions

Published on December 3, 2012 by The Contemporary Psychoanalysis Group in Contemporary Psychoanalysis in Action

Men, as well as women, are advised to attend to the tick-tock of the biological clock.

New research, reported in the NY Times (August 22, 2012) confirms that as men age, they are more likely to father a child who develops autism and schizophrenia. Although previous studies strongly suggested a link, this new study actually quantifies the effect as it builds each year. The study, published online in Nature (August 22, 2012) by Kari Stefansson and his team at Decode Genetics in Iceland, demonstrated that 97% of the rate of new mutations, accidental changes in DNA that can prevent a gene from functioning properly, can be attributed to the age of the father.

Learning to know your partner in a crisis

Published on November 9, 2012 by The Contemporary Psychoanalysis Group in Contemporary Psychoanalysis in Action