Surviving in the social work field boils down to this single habit

Essy Knopf social work habit self care
Reading time: 4 minutes

What is your number one priority as a social worker? If self-care is not the answer, we need to have a chat.

Most Master of Social Work (MSW) programs will emphasize the importance of self-care upfront. It doesn’t take long, however, for this call-to-arms to butt up against reality. 

We as social workers must navigate many competing and conflicting priorities daily. This begins as early as school.

With so much to do during our relatively brief degree, our days are often dominated by assignments and course readings. 

Setting aside an extra hour for “you” time can come to resemble an unnecessary luxury. You may find yourself asking, “How can I afford to stop and relax when I have so much work left to do?” 

It’s a question I promise will continue to challenge you over the course of your career. For this reason, self-care is a habit you would be best served by building right now.

Here are some ways you can get started.

1. Make a commitment to self-care

If you can exercise enough discipline to study for multiple hours every day, you can certainly commit a minimum of one hour to self-care.

In strict cost-benefit analysis terms, your brain may try to argue with you about the necessity of relaxing.
It may feel good to have dedicated downtime. But time away from your desk may also put you behind in our work and feed your anxiety.

This can become a vicious circle: time anxiety persuades there is never enough, and while this might certainly feel like it’s the case, it’s not true.

The issue is not whether you have enough time to take care of your personal wellbeing. Rather, it’s your willingness to re-prioritize it. 

Let’s suppose you do. If you have time anxiety, this may worsen. But rest assured that over time, its death-grip on your psyche will weaken.

2. Block out downtime

Personally, I’ve found there are usually three windows each day in which most people can block out self-care time: 

  1. First thing, straight after waking up
  2. Midway during the day, such as during a lunch break
  3. Before bed, when one typically unwinds

The morning window works best for me (that is, supposing I get to bed early).

This period seems to afford me enough time to do a self-care activity such as meditation before my brain jumps aboard the “work ‘til you drop” train.

Another option is to dedicate a single day of the week such as Sunday to “you” time.

3. Permit yourself a personal life

Work is a hungry beast, and if we continue to encourage it, it will inevitably consume our personal lives. 

We may suspend social outings and quality time activities with our loved ones. Or we may sacrifice a hobby that previously enriched our lives.

Diligence and dedication in professional settings are admirable traits. But when taken to excess, they can lead to workaholism.

Having healthy boundaries quite simply means saying “yes” to all that is conducive to our welfare, and “no” to things that aren’t. And workaholism is definitely something that qualifies as the latter.

Don’t neglect your personal relationships for the sake of your calling. Refuse to become a martyr for your chosen social work cause. 

Instead, strive for a work-life balance. Schedule at least one social meetup a week. Revive that cherished hobby. 

Rather than constantly drawing from your well, take time out to replenish it.

Essy Knopf self-care social worker

4. Don’t go at it alone

Further to the last point, healthy relationships are like armored vans that can carry us through a warzone of difficult times. 

These relationships are thus crucial to our mental health and serve as an invaluable buffer during difficult times.

But they are only as helpful as we allow them to be. In times of need, don’t hesitate to reach out to coworkers, supervisors, partners, friends, and family members.

5. Self-care through the support of a therapist

None of us come to the social work field a clean slate. Each of us has a history, and the work we do can cause parts of it to resurface, both good and bad.

A therapist can help us with processing our experiences, as well as professional challenges like countertransference.

The insights of another professional can go a long way to supporting us in becoming better practitioners. 

6. Start meditating

Mindfulness-based strategies are an effective way to support mental resilience and ward off overwhelm and anxiety.

The most commonly known strategy is meditation.

Guided meditations can be found in person or online. UCLA Health for example has many recordings on its website, and there are subscription-based meditation apps such as Calm and Headspace.

An example of a self-guided meditation I use daily is breath counting. This is very simple to practice.

First, get into a meditation posture. A common one is sitting upright, with your feet planted on the floor, your hands resting on your lap, and your eyes either open or closed.

Next, count one, inhale, two exhale, three inhale, four exhale… Go right up to 10, before resetting to one. 

Every time your mind wanders or you become distracted, bring your attention back to the sensation of your breath and resume counting.

The breath counting meditation has the most beneficial effect for me when performed one to two times a day for 20 minutes at a time. 

If you are new to this kind of meditation, I would recommend beginning with a three-minute meditation, slowly work your way up to a longer session.

Whatever method you choose, know that finding your meditation groove can, at least, initially, be a struggle—especially if you’ve had no prior experience with mindfulness. 

For that reason, I would recommend starting with guided meditations or exploring free resources such as these five mindfulness-oriented phone apps.

7. Explore yoga or prayer as self-care

Another mindfulness-based strategy is yoga. If you can’t make it to a studio, try a virtual class. Many are available free to watch on YouTube.

Another mindfulness practice worth mentioning mention is prayer, which has been found to offer similar benefits to other forms of mindfulness. 

For these reasons, if you are spiritual or practice a religion, it may be worth incorporating a prayer practice into your daily self-care regimen.

Wrap up

If you’ve ever caught yourself saying “There is no way I can humanly do all of this,” know that you by far are not the first social worker to feel this way.

Feeling overwhelmed as we so often do in these instances is an opportunity to pause and check in with ourselves.

Are you getting enough time to recharge your batteries each day? If not, maybe it is time you carved out a slot in your daily schedule for a self-care activity.

Sure, it may not always seem practical. But let me ask you this: how much more practical is the alternative…professional burnout?

You can read more social work-related posts here.

11 ways not to crash and burn in social work school

Essy Knopf social work school
Reading time: 7 minutes

If there’s one experience that unites social work school students, it’s a feeling of chronic overwhelm.

The Master of Social Work (MSW) program is a generalist degree, meaning it covers a lot of ground, spanning clinical practice, research, and macro advocacy.

Jampacked curriculums are how social work schools prepare students for the reality they will most likely have to wear many hats throughout their careers. 

To fulfill our (well-earned) reputation as masters of resourcefulness, our teachers pile reading after reading upon us, leaving students buried under an ever-growing pile of work.

To make matters more difficult, within weeks of starting the degree students are thrown into the field placement deep end. 

The rationale here is that the best way to learn is by doing. Without practice, there’s a good chance that much of the coursework—often covered at a breakneck pace—won’t stick.

Struggling to keep up, we let our self-care activities fall by the wayside. Anxiety, study burnout, and maybe even a sense of professional insecurity often result.

But this doesn’t have to be the case. Here are 11 tips I believe will go a long way to helping you not only survive, but flourish.

1. Prioritize with the 1-2-3-4 method

Your workload as a social work student is formidable. The only way you can ever hope to get (and stay) on top of it is through organizing your priorities.

To do this, rank all your tasks according to the following categories:

  1. Do first 
  2. Schedule 
  3. Delegate 
  4. Don’t do

Next, complete each act accordingly. When another task is added to your list, assign it a number and an action (if applicable). 

More information on the 1-2-3-4 method can be found in this detailed guide.

2. Learn the value of strategic “nos”

If you’re a perfectionist, completionist, and/or a workaholic, you may struggle with assigning items to the final category, “Don’t do.” 

The problem is that refusing to say “no” can come at a considerable cost to your wellbeing, not only during your social work degree but your subsequent career as well.

Your social work school may for example bombard you with invitations to extracurricular events. But between attending class and field placement and writing essays, you’ll probably lack the mental bandwidth needed to fully participate.

My suggestion would be to say “yes” only a handful of events you are certain will advance your learning or professional goals. Everything else can be ignored.

Remember, even if you can’t attend, you can always ask the organizer in advance for access to a recording or slides. 

If neither is available, a peer who is attending the event may be willing to take notes on your behalf.

3. Calendarize

With so many responsibilities to juggle, the only way you can stay on top of it all is by making liberal use of your smartphone’s inbuilt calendar. 

When scheduling, only add items from categories 1 and 2. Consider using a free service like Google Calendar or Apple iCloud Calendar to help you keep all calendar items synced across all your devices.

This final point may seem obvious, but there’s no point adding things to your calendar if you don’t also set up some kind of reminder. 

My suggestions are to use both instant notifications and email reminders to ensure you never miss an assignment deadline or another commitment.

When calendarizing assessment due dates, you may find it helpful to break the task into baby steps and set mini-deadlines for each. 

Before you can write a paper, for example, you’ll need to complete some often lengthy “pre-work”. For example, conducting literature searches, doing necessary readings, and completing an outline.

Allocating time and due dates to each of these activities can help keep you on task while conveying a sense of progress and positively affirming your efforts. 

This brings us to point four…

4. Reward yourself

All human endeavors are ultimately driven by the promise of reward. It makes sense therefore that when setting out to accomplish a task, we have first identified our expected payoff.

Rewards can be intrinsic: completing the task may be in itself an affirming experience. They can also be extrinsic, such as buying yourself a small gift upon completing a school semester. 

This may sound like self-bribery, but everyone can benefit from a much-needed boost to our motivation levels from time to time. 

Rewards don’t have to be anything huge. They can be something as simple as treating yourself to a coffee. 

Just finished a grueling paper on social work policy? Go out for a walk. Spent the morning poring over a stack of readings? Take the rest of the afternoon off to relax in the park. You’ve earned it.

5. Maintain boundaries

Boundary setting is crucial to remaining sane in the social work field. This applies as much to interpersonal relationships as it does to managing your time, especially where schoolwork or your field placement is concerned.

As you plan out each day, don’t forget to set limits on the amount of time you dedicate each day to work. Make sure to pencil in time for unwinding.

Set a window each day to reply to all non-urgent emails, calls, or text messages that relate to school and your placement. Once that window closes, don’t reopen it.

Treat “you” time as sacrosanct. The only thing you should be prioritizing during downtime is rest and rejuvenation. 

Maintaining boundaries in this fashion can help protect you against burnout, both as a student and as a fledgling social work professional.

6. Self-advocate

MSW teachers drill into us the importance of self-advocating. Social work school and your field placement present numerous opportunities in which you can hone this invaluable skill. 

If there’s something you need to know or want to learn, speak to your lecturer or field supervisor.

Given you are paying for access to their expertise, either through school fees or your labor, you have a right to advocate for as many learning opportunities as you feel you need to become a competent social worker.

If you require an extension on an assessment due date, ask for it. Your lecturer will likely be more than willing to accommodate your request.

Should any of your requests go ignored, persist, but be sensitive to the reality that what you’ve asked for may not always be possible.

Exercise the fine art of picking your battles, and be prepared to switch gears should the situation call for it.

Essy Knopf social work school

7. Manage up 

Fieldwork supervisors are usually torn between many competing responsibilities. What can this mean for you? Inconsistent supervision.

Meetings may be rescheduled at the last minute, or supervision sessions interrupted and even canceled. For social work students, these situations can be frustrating and demoralizing.

In such instances, I recommend managing up. Keep reaching out, asking questions, and making requests. Send emails to your supervisor daily, outlining your priorities and any tasks or activities you plan to undertake. 

Solicit your supervisor’s input, but should you not get it, be prepared to take initiative.

Keep your appointed field liaison apprised of the situation. Be accountable by keeping a log of all your activities, interactions, and communications as proof you held up your end of the field placement bargain.

8. Live and breathe win-win

Like any situation in life, we should approach the social work profession as an opportunity to champion both our interests as well as that of others. 

Invite the input of all with whom you work. Collaborate to find solutions. Embrace differing viewpoints, and always disagree without being disagreeable. 

Never leave anyone feeling like they’re “one-down”. This is a sure way to breed resentment and burn bridges.

We have all at some point encountered difficult people. We have all seen firsthand how their behavior hinders their success. We can learn from this by striving to model our personal best. 

See it as your job to leave a positive impression with all whom you cross during your educational journey. 

You never know if you will rub shoulders with these folk again later on—or if you might find yourself in the position of asking for their help. 

9. Elevate your classmates

All social work students are united by a common struggle…to survive school!

Try to grow your social work community by performing acts of service for classmates. 

Lend a hand when needed. Celebrate other’s wins, praise their achievements, and give without expecting to receive.

Again, there may come a time when you have to call in a favor. Now’s the time to start collecting brownie points.

10. Raise your voice

Whether it’s conducting a one-on-one therapy session, facilitating a group, or advocating for social justice, confidence is key to our success as social workers.

If you think confidence is something we are all born with, think again. Confidence is a trait that can be cultivated through practice. You can get the ball rolling while still in social work school by speaking up.

Sharing our thoughts and experiences in front of our peers is an act of courage. It requires that we be emotionally vulnerable and open ourselves to the possibility of being ignored, judged, or criticized.

Given many of our classmates are little more than acquaintances, we may have little cause to trust that what we say will be heard and respected. 

Still, there’s no better forum in which to make mistakes than in school. Mistakes are, after all, how we best learn.

Consider the fact that you have a unique perspective that others may from hearing. Silencing yourself thus deprives others of the chance to grow and learn. 

Speak your passion, and chances are you’ll energize others to do the same.

11. Be a proactive learner

We are all ultimately responsible for our own professional development. So any time you identify a gap in your knowledge or skill set, think of ways you can close that gap.

If you don’t understand course content, approach your lecturer after class and get them to clarify.

If you need to brush up on your clinical skills, ask your field supervisor for more in-depth training. Reach out to faculty members to see if they have additional resources that they can share. 

Should your budget allow, purchase additional trainings from a reputable nonprofit organization like PESI and split the cost with your classmates.

Failing that, a quick Google search can yield an array of free manuals, demonstrations, and tutorials.

If you think you’d benefit from constructive feedback, don’t be afraid to request it from someone you trust and know has your best interests at heart. 

Finally, consider finding a mentor to help guide you on your journey. You can start by identifying someone you admire within your social work school. 

Cultivate a relationship with this staff member. Then seek out their insights and support.

Wrap up

Social work school is certainly a challenging experience. But engaging fully with that experience will pay dividends.

The degree to which you exercise curiosity, organization, dedication, and resourcefulness now can help determine your ability to overcome many of the obstacles you’ll encounter later in the field.

You should treat your MSW as a trial run; a chance to internalize and embody principles so often preached by this profession. You can do this by advocating for yourself, while striving to empower others.

By setting good habits and establishing best practices now, you’ll both ease your way and lay the groundwork for a happy—and healthy—career.

You can read more social work-related posts here.

Enough with the toxic culture of COVID-19 shaming

Essy Knopf coronavirus toxic covid-19 shaming
Reading time: 6 minutes

After 10 months of trying to evade COVID-19, the virus finally caught me. 

No—I had not been flagrantly breaking coronavirus restrictions. While others attended social gatherings, held parties, and failed to honor COVID-19 safety guidelines, I scrupulously stayed in my bedroom. 

When I did emerge, it was only to exercise, shop for food, and spend time with my partner. But wearing my face mask the minute I walked out the front door and keeping my distance was not, as it turns out, enough.

COVID-19 numbers in Los Angeles hit new highs in December 2020, and as an extra precaution, I took to avoiding my roommates and wearing a face mask whenever I stepped foot in communal areas.

My immediate social circle shrank from two to one. Seeing just my partner seemed like a fair compromise to make, even if it flew in the face of rules not to mix with members of other households.

Two weeks later, my partner came down with COVID-19. By the time we received the positive diagnosis, it was too late: I too had been infected.

Until this point, I had steadily nursed anger towards those whose reckless actions were fueling case spike after case spike—the same people, undoubtedly, I saw walking the streets without a mask.

But catching COVID-19, I found myself suddenly wondering if I was no different to those I had so harshly judged. 

Even as I succumbed to the tidal pull of illness, I was sliding down a spiral of another kind entirely: shame.

the thoughtful gay coronavirus toxic covid-19 shaming
Down-and-out with flu-like symptoms.

How ‘COVID fatigue’ is fueling a COVID boom

During the subsequent days spent in bed recovering, with only self-doubt for a companion, I began conducting a moral inventory of the (deeply questionable!) actions that had led me to this point (spending time with my partner).

But could I really be to blame for seeing a loved one, even when that decision was taken against the advice of health authorities?

As a Los Angeles resident, I had been living under a dark cloud of COVID-19 isolation, anxiety, and uncertainty for the better part of a year. 

Infection transmission and financial security remained a constant concern and watching the cyclical surges in case numbers was enough to leave most people stricken with helplessness.

For these surges were the product as much of a select few choosing to gather on holidays, as they were lax enforcement of rules.

If the public and the authorities weren’t willing to take the necessary measures to stem the tide of infection, then what hope did we ever have of getting the pandemic under control?

In my imagination, I saw these individuals poking holes in a liferaft the rest of us were frantically trying to bail out. 

Certainly, in refusing to get tested, communicate their status, social distance, and take all the other necessary precautions, these people were acting as saboteurs.

But after so long spent in lockdown amid a national and global climate of chronic risk and uncertainty, was it really fair to fault people for wanting to spend their holidays with family? 

Seeking soothing in a time of disaster stress

“COVID fatigue” (not to be confused with the actual COVID symptom) refers to a feeling of exhaustion with “being cooped up…being careful…being scared”. According to a UC Davis Health psychologist, it’s just another name for long-term disaster stress. 

As a passionate advocate for, and student of, the mental health field, I know that engaging with one’s social supports is a healthy means of coping and maintaining psychological wellbeing in times of crisis.

Polyvagal Theory argues that human beings’ autonomic nervous systems—the same system responsible for our fight-or-flight responses—are geared towards acting in service of their own survival through “co-regulation”.

Psychologist Deb Dana describes co-regulation as the “reciprocal regulation of our autonomic states” through social relationships.

It makes sense therefore that people burdened by disaster stress and long periods of isolation might want to seek the company of loved ones.

Video calls thus far have been the closest approximation for in-person companionship. Poor a substitute they may be, they are also a necessary evil when it comes to safeguarding loved ones against COVID-19 transmission. 

Even so, why are people still taking risks?

essy knopf gay toxic covid-19 shaming coronavirus

How ‘optimism’ grants immunity to COVID-19 shaming

For the better part of a year, Los Angeles residents have been in a holding pattern, care of the ever-shifting restrictions and lockdown conditions. 

Staying home and alone for such a long period is enough to exhaust anyone’s limited store of willpower. Given the high reward involved—reclaiming a former freedom—it’s no wonder some people might choose to stop adhering to COVID restrictions.

These people may be further motivated by optimism bias—that is, the belief that we individually are less likely than others to experience an adverse life event, like say, catching coronavirus.

There are also conflicting feelings around being told not to fulfill a personal right which, under any other circumstance, would be socially sanctioned. That is, spending time with family and friends.

As health authorities advised families against gathering on key holidays like Thanksgiving and Christmas, some may have chosen to deal with the resulting cognitive dissonance by seeking to justify or explain away their actions. 

The stress of dealing with two conflicting pieces of information doubtless led many to suspend critical thinking about the potential repercussion of their actions.

The rise of COVID-19 shaming

In May last year, a viral video emerged of shoppers at a Staten Island grocery store hurling abuse at a woman who refused to wear a face mask.

New York City was deep in the throes of the COVID pandemic, so residents were understandably angered by the selfish and potentially dangerous actions of this individual.

Shoppers at the time appeared to be trying to socially shame the woman into donning a face mask, but however justified they may have felt, their actions carried the whiff of mob behavior

Social shaming can be a powerful means of enforcing shared rules, especially those relating to the pandemic. In the words of shame researcher Dr. Daniel Sznycer, “The function of shame is to prevent us from damaging our social relationships, or to motivate us to repair them.”

The idea being that shaming—a response to other’s disregard for COVID-19 safety precautions—should compel offenders to abandon their antisocial ways in service of the collective good.

Yet so often social shaming turns into outright abuse. As the popularization of terms such as “covidiot” indicates, the discourse tends less towards leveraging guilt (“You did something bad”) to inflicting toxic shame (“You are bad”).

Author Brené Brown counsels against weaponizing shame, noting that “shame corrodes the part of us that believes we can change and do better”.

When COVID-19 shaming turns toxic, it creates defensiveness, disconnection, and sends the accused into fight-or-flight.

Looking at COVID-19 shaming through the lens of gay trauma

The gay community has also seen its share of toxic shaming in the wake of coronavirus.

The popular Instagram account, Gaysovercovid, for example, has worked to name-and-shame those responsible for flouting coronavirus regulations.

COVID-19 shaming accounts like this work to reinforce social norms, using the fear of being “outed” on social media to dissuade would-be attendees of international circuit parties.

What they fail to acknowledge though is the purpose such behaviors may be serving for those who engage in them. Namely, nervous system regulation.

Gay men have a unique legacy of trauma, and therefore a greater need for regulation. Some chose to meet this need through the party lifestyle—a lifestyle the current global situation has rendered difficult, if not impossible.

Those who self-medicate with substances, compulsive sex, and other forms of self-gratification, are being abruptly forced off their hedonic treadmill, and this can be enough to trigger a state of collapse.

Survival in this sense is tied to the endless pursuit of distraction. For without distraction, there is introspection, and realization of buried trauma and identity shame

When confronted by the condemnation of others from within our own community, we’ll feel only more compelled to seek distraction; to maintain our place atop the treadmill.

COVID-19 shaming in such instances is limited as a mechanism for change, and may in fact have the opposite effect.

the thoughtful gay coronavirus toxic covid-19 shaming

Seeking peace through compassion 

If this situation tells us anything, it’s that our anger over this kind of behavior is an attempt to regain some sense of control and fairness in a world that currently seems void of both.

Authorities have shown themselves to be incapable of adequately responding to the coronavirus pandemic and curbing its widespread impact.

The result has been an entrenched sense of uncertainty, helplessness, and pessimism. 

When we perceive our personal safety and financial security to be potentially threatened by others’ shortsightedness, we naturally turn to anger.

But that anger promises no peace of mind. Instead, we would be better served by engaging in self-reflection

If you find yourself hooked by the desire to shame, ask yourself: how are the actions of others triggering me? What emotions are they evoking, and why? What steps can I take to start feeling better?

Instead of giving in to COVID-19 shaming, consider building a self-compassion practice. Self-Compassion author Kristin Neff has provided the following exercises and guided meditations

Once self-compassion has been achieved, compassion towards others becomes truly possible.  The Buddhist meditation practice of tonglen (“taking and sending”) may prove a valuable aid here.

You can also consider following some of the steps I outlined in my previous article, “How to keep mentally well during the coronavirus pandemic“.

Our goal in striving for such mindfulness is not to accept others’ reckless actions, but rather to break the stranglehold of negative feelings.

What this global catastrophe calls for is not assigning blame, but a recognition of the universality of our suffering

It is only through such recognition that we can strive together towards a new social consciousness grounded not in self-interest, but concern for the collective.

How to live your best life after an irritable bowel syndrome diagnosis

Essy Knopf irritable bowel syndrome
Reading time: 8 minutes

Chronic health conditions like irritable bowel syndrome (IBS) may seem like a life sentence—that’s certainly how I felt in the first year after my diagnosis.

And yet after many nights spent doubled over on the floor, waiting for waves of agonizing gut cramps to subside, I was more than ready for a change.

Emptying out my pantry and throwing out common ingredients now identified as the culprit behind my many symptoms, I found myself wondering, “So what exactly am I supposed to eat now? Air?”

After a few weeks and a truckload of futility, I had formed a solid dependence on a sludgy meal replacement powder.

Choking down this sad substitute for food, it became apparent that if I was going to achieve anything approaching my pre-IBS quality of life, I would need to explore all my options.

What do we know about irritable bowel syndrome?

Irritable bowel syndrome is a chronic, disabling condition for which there is no definitive treatment. The condition reportedly accounts for half of all visits to gastroenterologists in the US.

IBS is classified as a Functional Somatic Syndrome (FSS), meaning it’s not unlike chronic fatigue or fibromyalgia syndromes.

A FSS in scientific terms is “characterized by the presence of one or multiple chronic symptoms that cannot be attributed to a known somatic [bodily] disease”.

The development of irritable bowel syndrome is believed to be multifactorial. That is, the condition has multiple contributing biological and psychological causes

One such cause is a disruption and impairment of communication between the brain and gut as a result of stress. More details on the specifics in this clinical review of irritable bowel syndrome

Living your best life after an IBS diagnosis

Typically after a diagnosis, you’ll work with a dietician to identify all your trigger foods, usually via the low-FODMAP diet. 

Together you’ll then reintroduce individual FODMAPS to test tolerance for each, a process that can take weeks, if not months.

An appointment at the gastroenterologist’s office may also need to be set up for you to be screened for other conditions, such as SIBO.

After these processes of elimination, the way forward however starts to get a little hazy.

Our knowledge about irritable bowel syndrome is far from complete. Symptom causes and treatment can vary from individual to individual. What works for some may not work for all.

Through my experience as a long-term IBS sufferer, however, I have found that symptom relief success is largely determined by three things: education, experimentation, and self-advocacy.

In the next few sections, I’ll list some of my hard-won personal insights, citing a range of publicly available studies.

It is important to note however that I am not a medical professional. Any statements made here regarding the efficacy of particular treatments pertain to my personal experience only.

All changes to your personal treatment protocol should be conducted with the support of your medical doctor, dietician, and/or gastroenterologist.

essy knopf irritable bowel syndrome

First stop: the low-FODMAPS diet

Food plays a key role in shaping symptoms among IBS sufferers, and the low-FODMAPS diet is a common go-to.

The low-FODMAP diet involves restricting the intake of certain carbohydrates known by the acronym FODMAP (fermentable oligosaccharides, disaccharides, monosaccharides, and polyols). 

FODMAPs are present in anything from bananas to yogurt, to tea and garlic. Consuming more than the recommended amount can cause unpleasant symptoms, including diarrhea, constipation, cramps, gas, and bloating.

Some of the more well-known FODMAPS such as fructose and lactose are even known to trigger reactions among those without IBS.

The prevalence of lactose intolerance, for example, has already given rise to an entire industry of dairy alternatives, with products ranging from soy-based cheese, nondairy butter, and nut milks.

Given the complexity involved in low-FODMAP eating, it’s was with great relief that I discovered a smartphone app designed by the diet’s creators.

The Monash University FODMAP Diet app provides measurements of the FODMAP content for individual ingredients, as well as serving size recommendations.

The app is updated regularly, and serving size recommendations are known to sometimes change; in some cases, the kind of FODMAP listed may shift to another entirely.

For this reason, it’s crucial to always check the app when planning your next meal.

While the low-FODMAPS diet can bring many with irritable bowel syndrome some relief, tolerances for each FODMAP, and other possible IBS trigger foods will still need to be monitored.

One effective way to identify one’s own triggers involves keeping a daily record of everything eaten, and the symptoms.

Not all IBS sufferers report resolution of symptoms while on the low-FODMAP diet, and so I must emphasize again the importance of working with a dietician to identify your triggers.

Other dietary suggestions for irritable bowel syndrome

Intermittent fasting: I have personally found that intermittent fasting (8 hours on, 16 hours off) can ease digestive distress by ensuring my gastrointestinal tract isn’t forced to work overtime. 

Three meals maximum within this period I have found to be usually sufficient at keeping my appetite sated. I try to evenly space the meals out, with one meal at the beginning of the eating window, one in the middle, and one at the end.

If you’re eating foods with moderate amounts of FODMAPs, be warned that eating overly large portions or snacking in between can slow the transit of food through your system, resulting in FODMAP build-up and symptoms.

A low-FODMAP tea is helpful with managing your appetite during “off” hours. White, green, peppermint, mint, rooibos, honeybush, and licorice are all listed as safe.

Consider also adding a sweetener such as stevia if required. It’s zero-calorie and won’t break your fast.

Resistant starch: Resistant starch (RS) is a naturally occurring fiber. Some IBS sufferers report finding it can help with symptoms.

RS can be found in some milled grains, legumes, underripe bananas, cooked and cooled bread, potatoes, rice, and pasta, to name a few.

RS ferments slowly in the large bowel, compared to the rapid fermentation that results from eating FODMAPS, leading to the usual symptoms.

There are multiple forms of RS and your tolerance to each kind can vary. RS has been known to produce symptoms in some IBS sufferers.

RS as it turns out is my personal nemesis; nevertheless, I have found I can mitigate some RS-related symptoms with the help of the herbal remedies listed below.

Spicy foods: Spicy foods are a well-known IBS trigger. Chile is completely out for me, though I’ve found I can tolerate pepper and mustard. 

Acidic foods: Vinegar is a big culprit here, to the extent that I’ve had to stop eating salad dressing.

Citric acid is another culprit that turns up in a variety of food, from candy to canned tomatoes. These days, I avoid it completely.

Caffeine: Caffeine is also a trigger. Even decaffeinated, it’s a no-go, probably due to the fact it contains compounds known to cause gastrointestinal upset.

Fat & oils: Eating anything high in fat or containing small amounts of oil I’ve found to be a major trigger. And apparently, I’m not the only one.

Note that cooking without fat and oil is possible, but requires some creativity. For example, I have found frying vegetables using a wok using a small amount of water can work.

When it comes to baking, you can also consider substituting oil with a low-FODMAP pumpkin variety or mashed unripe banana.

Medicine & supplements

Antispasmodics: Drugs such as dicyclomine (Bentyl) and hyoscyamine (Levsin) are commonly prescribed treatments for gut cramps. I make sure to carry a few pills with me at all times.

Antidepressants/Antianxiety medications: One meta-analysis found that tricyclic antidepressants can help soothe global IBS symptoms.

Another study concluded that selective serotonin reuptake inhibitors (SSRIs) are effective in treating co-occurring anxiety, depression, and psychological distress. This may in turn lead to improvements in global IBS symptoms.

A psychiatrist will be able to assist with determining whether this form of treatment is appropriate for you.

Fiber supplements: These can help ease IBS symptoms for some, although more studies are required.

One study recommends consuming no more than 5g of whole psyllium husk daily. I have found fiber supplements only exacerbate my symptoms.

Probiotics: A course of antibiotics is usually recommended when treating secondary conditions such as small intestinal bacterial overgrowth (SIBO).  Probiotics can help counteract the havoc these drugs wreak on your gut microbiome.

There is evidence multi-strain supplements taken over an eight-week period can improve IBS symptoms regardless of antibiotics, though I have not experienced much success in taking them.

(Interestingly, fecal microbiota transplants are being explored as a possible treatment for IBS.)

Peppermint oil: This product is available in capsule format and can treat IBS-related symptoms. On the rare occasion I dine out, I’ll take two pills to minimize the impact of eating high-FODMAP ingredients.

Carminative (anti-gas) herbs: A new study has found that a herbal compound containing essential oils derived from Shirazi thyme, ajwain, and dill can significantly improve IBS symptoms.

When consuming foods high in resistant starch I usually take half a teaspoon of a similar three-seed combination: ajwain, dill, and anise.

As Shirazi thyme is not widely available online, I decided to sub it with anise seed, another carminative.

Note that the exact FODMAP content of these seeds has not yet been measured. It is possible that consuming them could cause you to exceed your FODMAP limits.

Activated charcoal: There is some evidence that activated charcoal can help with the absorption of gas in the bowel. I take 3x 780mg charcoal pills, twice daily, along with the three-seed combo described above.

Digestive enzymes: Broad-spectrum enzymes may support digestion among some IBS sufferers, but again more studies are required

The good news is that there are commercially available enzymes targeting select FODMAPS: xylose isomerase (for fructose), alpha-galactosidase (for galactooligosaccharides, or GOS), and lactase (for lactose).

While I avoid dairy completely due to the fat content, lactase is an effective aid for those who suffer lactose intolerance. 

There is evidence that enzyme treatment using alpha-galactosidase enables IBS sufferers to consume nuts, legumes, and beans without any of the usual side effects. Taking one 400 GALU tablet with each meal has proven a godsend for me.

For a complete list of which food items the alpha-galactosidase enzyme targets, check out the Monash University FODMAP diet app. 

I have found taking a handful of highly concentrated lipase tablets can help mitigate some of the worst symptoms from eating fat.

Addendum: As the resistant starch and fat content of nuts, legumes, and beans can cause symptoms for me, I continue to limit my intake.

Exercise 

In one trial, increased physical activity over a 12-week period was shown to improve irritable bowel syndrome symptoms.

For those of us who spend too long sitting, the current recommendation is to get 30-40 minutes of vigorous exercise daily.

Exercise is also known to improve general mental health. Given many IBS sufferers experience anxiety and depression, there’s a strong argument as ever for getting your daily steps in.

Stress

Stress: IBS is a stress-sensitive disorder that can bring your GI tract to a standstill, triggering symptoms such as gas and bloating. 

I have found strenuous activities like hikes, traveling long distances, or attending an unfamiliar or anxiety-inducing setting can trigger tummy upset. 

Having a comfortable environment and routine can go a long way to ensuring healthy bowel activity. 

Seeking support with irritable bowel syndrome

Community: Reach out to friends you’ll know will be understanding and accommodating of your condition.

Find a community of fellow IBS sufferers online, or in your local city. Don’t go at it alone.

Psychotherapy: I can’t recommend this enough. You can find a list of effective psychotherapeutic interventions here.

Meditation: I have found 2x 20-minute meditation sessions a day helps ease stress and anxiety. Consider trying some of these free guided meditations.

Gut-directed hypnotherapy: This has been shown to have long-term benefits for irritable bowel syndrome sufferers.

A range of gut-directed hypnotherapy prerecorded tracks can be purchased online. (Alternatively, you can access several free general hypnotherapy tracks here.)

Moving forward

If you’re drowning in information right now, my suggestion would be to start small.

Trial run one or two of my suggestions. If, after a period of careful monitoring, your symptoms don’t improve, I would invite you to test another.

Pick and choose what works best for you, but always remember to seek professional insight into any new treatment protocol.

The National Center for Biotechnology Information website is a good place to explore studies regarding current, emerging, and possible future IBS treatments.

Finally, know that experimenting brings with it the possible reoccurrence of symptoms.

Demoralizing as this can be, take heart in the knowledge that every risk faced on the path towards healing, within reason, may ultimately prove a risk well taken.

How 2020 became the year of the introvert

Essy Knopf introvert COVID-19
Reading time: 4 minutes

One day, we may look back on 2020 as one of great turmoil—but also a moment in history in which the humble introvert came into his own.

Initially, it may be difficult to look past the frightening headlines: massive bushfires in Australia, a global COVID-19 pandemic, and Black Lives Matter protests, to name just a few.

Yes—coronavirus has cost many their livelihoods and lives. But in the West, as countries were locked down and stay-at-home orders were issued, the wheels of a “Quiet revolution”—to use the term coined by author Susan Cain—were turning.

While countless extroverts bemoaned the lockdowns and the loss of freedom, some introverts viewed social isolation not as deprivation, but rather an opportunity for quality time activities and peaceful reflection.

An introvert living in an extrovert world

In her celebrated book on introversion, Quiet, Cain notes that Western cultures tend to favor the Extrovert Ideal:

“the omnipresent belief that the ideal self is gregarious, alpha, and comfortable in the spotlight. The archetypal extrovert prefers action to contemplation, risk-taking to heed-taking, certainty to doubt. He favors quick decisions, even at the risk of being wrong. She works well in teams and socializes in groups.”

The extrovert for this reason is held in hallowed regard, in favor of the many quiet and invaluable achievements introverts have made to society.

Consequently, when we introverts are measured against the Extrovert Ideal, we are often found to be lacking:

“Introversion—along with its cousins sensitivity, seriousness, and shyness—is now a second-class personality trait, somewhere between a disappointment and a pathology. Introverts living under the Extrovert Ideal are like women in a man’s world, discounted because of a trait that goes to the core of who they are. Extroversion is an enormously appealing personality style, but we’ve turned it into an oppressive standard to which most of us feel we must conform.” (Cain, 2012)

Growing up in societies that celebrate the Extrovert Ideal and mislabel anyone who doesn’t subscribe to that Ideal as “antisocial” has left many of us with feelings of inferiority.

Despite the fact our brains are wired differently from birth, the introvert’s preference for contemplating life instead of diving headlong into it often earns us dismissal.

The ‘Quiet revolution’ is here

Under scrutiny, introverts have been long forced to conceal and overcompensate for their unique natures. 

Then, almost overnight, the coronavirus pandemic made social isolation the new norm, one infinitely more comfortable to the introvert. 

Those privileged enough to hold onto their jobs and allowed to work from home were granted a reprieve from open-plan offices and thus sensory and small talk bombardment.

Suddenly, we were allowed to attend Zoom meetings from the comfort of our bedrooms—often while wearing pajama bottoms, no less.

As someone myself who is on the autism spectrum and has sensory sensitivities, Zoom has become a cherished substitute for face-to-face interaction.

(And let’s not forget other fringe benefits for the socially anxious, such as having acquaintances’ names listed below video feeds, in the event we forget).

For introverts, remote working seems like a no-brainer evolution of our current, counterproductive workplace culture. We have, after all, known for a while now the many benefits of remote working—benefits that are by no means restricted to the introvert.

The rise in remote working has put a pause on the much-loathed commute. Where before we introverts may have felt forced to spend a lot of our downtime recuperating from these various stresses, we can now apply ourselves to our activities and interests with renewed energy.

Meanwhile, social lives that might have once entailed exposure to overstimulating circumstances have also been placed on hiatus. 

Introverts can now pick how and when they engage, measuring out social interactions in thimble-sized doses, over the phone, instant messages, or at a socially distanced hangout.

essy knopf introverts susan cain quiet

Extroverts living in an introvert’s world

Separated from the social contexts in which they have long excelled, many extroverts have understandably floundered.

Those who previously maintained their sense of self—and in turn their personal wellbeing—through social interactions have been forced to adopt a more solitary lifestyle.

The struggle of this transition is most visible in the endless parades of newfound skills on social media, the most prominent example being baking.

This phenomenon I believe is less an act of social performance than proof of the extrovert’s continued existence. It speaks as much to an existing sense of isolation that predated coronavirus (and which was accelerated by the rise of social media) as it does the degree to which that isolation has since grown.

But extroverts alone are not suffering from the side effects of our new lockdown culture.

Coronavirus has triggered a pandemic of a different kind altogether. Anxiety, depression, and suicidal ideation are reaching reached new highs.

One survey has even indicated that introverts have been suffering more as a result of the quarantine, though the reasons are not yet clear.

Being social creatures, it is safe to say that our collective need for companionship is arguably greater than ever. 

Introverts’ inherent tendency towards solitary activities must thus be tempered, lest our circumstances lead to a complete lapse in social interaction.

Toward an ‘Introvert Ideal’

The coronavirus pandemic has seen some promising steps taken towards a different status quo, one that is, in many regards, shaped towards the introvert’s need for less stimulation.

It’s not yet clear how much of this new introvert-friendly normal will endure, post-coronavirus.

The Extrovert Ideal won’t renounce its place on the pedestal any time soon. And yet if the pandemic has proved anything, it’s that we introverts are not in fact operating from a place of lack. 

Rather, we have unique strengths that have served us well in a time of great isolation and uncertainty.

There will come a time when an Introvert Ideal will receive its due. Until then, may the Quiet revolution continue. 

To find out if you’re an introvert, check out this quick quiz devised by Quiet author Susan Cain.

Can’t sleep? Here are some surefire steps to treat insomnia

Essy Knopf treating insomnia
Reading time: 7 minutes

As a teenager, I was anxious, isolated, and afflicted with insomnia.

Most days I spent indoors, indulging in geek interest escapism. Sometimes I would craft elaborate fantasy and science fiction stories. Other times I would voraciously consume books, movies, and video games.

Refuge could also be found, of all places, in hammering out essays at the computer. (That such projects could bring order to my otherwise unpredictable school and home life probably speaks to the systematizing nature of my autistic brain.)

The downside of my constant computer use was that relaxing became difficult. A day spent glued to my screen would inevitably leave my mind restless, my sleep broken. 

Still, I continued to return to my computer, until what had begun as escapism gradually turned into workaholism.

Developing insomnia

Without friends, family, and a community to ground me, my self-worth became proportional to my productivity. There was always more to do, one more task needing completion. 

Trapped in a vicious circle of feeling isolated, I sought reprieve in workaholism, which in turn only exacerbated my loneliness. 

Living with constant internal pressure was motivating and could even be affirming. Just look at how productive I was being! So what if my peers at school bullied me – just look at these shiny achievements, these notches in my academic belt!

Caught on a treadmill of what I would later recognize as grandiosity, and terrified of the fall that would follow the moment I stepped off it, I became mired in anxiety and depression.

But rather than slowing down, I ramped up my commitments. At the height of my workaholism, I found myself juggling a full-time job, a feature documentary, a web series, a novel, and organizing two research trips abroad. 

Getting to, and staying, asleep by this point had become an elaborate, multi-staged ritual, beginning with a double dose of Benadryl, followed by an hourlong walk around the neighborhood while I waited for it to take effect.

Sometimes I would end up at a 24-hour gym, working the elliptical until the fatigue hit me…unaware that all this activity was probably only making my objective all the more difficult.

When I got home, I’d pull my blackout curtains, slip on an eye mask, put in my earplugs, fit a pair of headphones, cue a soothing audio track, and lie down on a makeshift bed on the floor.

This, of all places, was the only place I was guaranteed to nod off, for reasons I still don’t understand. After many a tossing, turning and blanket adjustment, I’d doze off, only to wake a short while later.

Climbing into my real bed, I’d return to sleep, to rise the following morning, still tired but wired, ready to chip away at my ever-growing workload.

Some nights, however, I would doze off, only to be woken by a hypnic jerk, a kind of whole-body twitch typically preceded by the sensation of falling.

Again and again, I would doze off, only to be jerked wide awake. The steady background hum of anxiety would be cranked up into a shrill roar, putting sleep still further out of reach.

The journey towards recovery

Self-generated projects until this point had been the main source of meaning in my life, and yet they were as much a palliative as they were problematic.

The comparative ease with which others were able to accomplish sleeping – a basic bodily function – told me that something in my case had gone awry. Believing there was no recourse, however, I kept up my unwieldy sleep routine for years

My mother’s staunch opposition to any form of dependency made prescription medication seem like a false option. Sure, I was already relying on Benadryl, but then again antihistamines weren’t habit-forming drugs.

And even supposing I could scrape together enough money to get a proper diagnosis, I would have to contend first with the fear that the professional I saw might dismiss my problem outright.

The situation reached a tipping point one night while I was doing my regular insomnia shuffle around the neighborhood, I became caught in a rainstorm. 

Any sensible person would have run home, or at the very least ducked under the cover of a tree. But to return home before the Benadryl took effect would mean yet another sleepless night. So I pushed on.

The wind picked up, turning the rain horizontal. Next thing, it was inverting my umbrella, leaving me exposed to the elements.

After about half an hour of this, I surrendered and trudged home, sloughing off my dripping clothes and climbing into bed.

When sleep did not come, I grew increasingly anxious. The anxiety snowballed into hypnic jerks, which in turn fueled the anxiety.

The night stretched on, each hour punctuated by an anxious glance at my phone screen to check the time. Heavy with the dread of facing a new day unrested, I lay there, waiting for my morning alarm.

Come the following night, I still couldn’t sleep, and my insomnia ballooned into a record 50-hour spell that only ended with a no-refill script for Valium.

The doctor I saw granted me this small mercy on the condition I see a sleep specialist. The specialist in turn requested I visit a sleep clinic. 

Two weeks later, I packed my bags like someone preparing for a red-eye flight and drove through the dead of the night to the evening ghost town of a local business district.

Strolling through a deserted highrise lobby I was overtaken by the peculiar feeling I was participating in some secretive, perhaps even illicit activity.  

The elevator opened to the clinic’s front desk, where I was greeted by a man in scrubs who directed me to a sleeping cubicle.

After having changed into my pajamas, I stretched out on the bed as countless electrodes were attached to my head and chest until I resembled some primitive robot trailing electrical cables and hydraulic tubes.

Just how exactly did these people expect me to get to sleep? 

The thought of it alone caused my anxiety to surface. Palming a pill, I settled into bed and waited for the heavy embrace of drug-induced sleep.

Seven hours later, I woke to the nurse removing electrodes. Hollow-eyed, I dressed then shuffled like a zombie from the room.

Treating insomnia

“So far as I can see,” the sleep specialist said, poring over my results, “you have a perfectly normal sleep cycle.”

I frowned my disagreement.

“So why am I struggling to fall asleep?” I pressed. 

Alas, the specialist had no answer for me. Instead, he suggested an alternate treatment for my anxiety, something known as biofeedback

A round of treatment would cost something in the range of five thousand dollars – an expense my insurance company was unwilling to subsidize.

With my wallet still smarting from the cost of other, unrelated illnesses, I turned to my final recourse: pharmacological treatment.

Explaining my long-standing problem to my psychiatrist, I caught myself making excuses.

“I don’t want to rely on drugs,” I said, “but this problem has gotten way out of control.”

“Well, it sounds like you’ve tried everything else,” my psychiatrist replied. “Don’t you think you deserve some relief?”

“Maybe,” I thought, feeling nevertheless that I had, in some unexplainable way, compromised my integrity.

With there being no one-size-fits-all medication for anxiety, I would now have to navigate a gauntlet of medications.

The most popular option was selective serotonin reuptake inhibitors (SSRIs). Think Lexapro, Prozac, and Zoloft.  

Mainstream SSRIs however come with certain unpleasant side effects. After a couple of doses, my libido took a total nosedive.

The next recommendation was an antipsychotic medication that left me foggy-brained. One morning, while still under its spell, I pulled out into traffic, miscalculated my timing, and was almost hit by another car. 

Fearing I might not be so lucky next time, I switched to a combination of antidepressants and antianxiety drugs. Thirty minutes after taking my first dose, I fell into a deep sleep.

When I woke eight hours later, it was to the discovery that the insomnia problem I had been battling for more than 15 years was, more or less, gone.

No more frazzled nerves, poor concentration, and feeling dead on my feet. As for the constant companion that was my anxiety? His hands had now been prized from the steering well and his butt relegated to the backseat. 

Before, sitting down for 15 minutes to meditate had been an exercise in self-torture, my thoughts flinging themselves in every which way in a bid to escape any semblance of control. 

With the current chemical cocktail, however, I was suddenly able to achieve some degree of focus.

essy knopf treating insomnia

Insomnia is a modern epidemic

Sure, these pulls could put a cap on my anxiety and insomnia – but they couldn’t completely suppress it. 

In moments of stress and overcommitment, my mood disorder would flare up again, offering proof that if I wanted to truly get better, I would need to take a more holistic tack. 

This in short would involve psychotherapy, undertaking a regular meditation practice, and making daily relaxation time a priority.

It also meant addressing ongoing insomnia triggers, such as an overreliance on digital devices, and workaholism as a coping mechanism for social isolation.

My challenges as I quickly realized were not exclusive to me. Smartphone dependency and “the cult of busy” as we all know are almost universal features of modern life in the West

Some critics have even called our times an “age of distraction”, with obsessive work and device exposure creating conditions ripe for mental illness. 

Even when faced with the physical and psychological manifestations of our stress, we often try to ignore them – much to our detriment.

Finding a solution that works for you

If there’s anything my journey to overcome insomnia has taught me, it’s that we can’t ignore our problems or rely on Band-Aid fixes. 

Those of us who are looking to kick our sleep woes to the curb can find some relief by adopting one or more of the following changes:

Restricting device usage: Use the wellness feature on your Apple or Android devices (sometimes referred to as “night light”). This reduces the amount of blue light emitted around set times. This light can have the effect of keeping your brain in “awake” mode. It’s also worth turning on your phone’s do-not-disturb mode and enforcing a no-device usage rule around bedtime

Practice good sleep hygiene: Create ideal conditions for sleeping. Go to bed and get up at a regular time. Ensure your bedroom is quiet, dark, relaxing, and comfortable. As an addendum to the first point, try to remove electronic devices from your sleeping space. Employ blue-light-free bulbs. Avoid large meals, caffeine, and alcohol before rest. Use your bedroom exclusively for sleeping. More tips here.

Exercise regularly: Keep physically active during the day. Dispel depression, anxiety, and restlessness with a daily gym routine or aerobics workout.

Consider psychotherapy: Therapy can provide a safe outlet for pent-up emotional tension, which can in turn affect your ability to sleep. Therapy can also support your efforts to develop coping strategies.

Stop overworking yourself: Identify an eight-hour daily working window. Use hacks to enhance your productivity. Exercise self-discipline to stop work spilling over into “you” time. 

Make relaxation a priority: You can’t be productive if you’re feeling depleted. Replenish your inner reserves every day with fun and enriching activities. Catch up on your favorite TV show, take your dog to the park, or try a new recipe. Consider doing meditation, breathing exercises, or yoga to help you unwind. Adopt what Jon Kabat-Zinn calls a “non-striving” attitude.

Consider natural remedies: While Benadryl can assist with occasional insomnia, natural treatments like melatonin, valerian root, magnesium supplements, lavender, and passionflower extract may prove equally effective.

Explore additional help: Attend a sleep clinic. Explore alternate therapy options. Seek the guidance of a psychiatrist. Investigate prescription medication.

How to flourish in spite of chronic illness

Essy Knopf chronic illness
Reading time: 8 minutes

As the coronavirus pandemic wears on, stories have emerged of survivors who continue to suffer chronic illness weeks and even months after recovering.

As anyone living with ongoing symptoms can attest, the challenge is never strictly physical. Being sick often carries a psychological toll, fueling stress, anxiety, and isolation.

Having myself suffered a gut disorder since my early teens, I know firsthand the restrictive – if not crippling – effect ongoing health problems can have.

What these experiences ultimately taught me however is that even when overcoming illness might seem impossible, fighting your own definition of “betterness” certainly isn’t.

An ailment unknown

From the age of 12, my stomach became permanently bloated and tender, my digestion troubled.

After a family dinner, I’d usually wind up locked inside the bathroom as my gut purged itself. Sometimes the voices of my siblings would drift out of the kitchen, and I’d hear their complaints that I was deliberately shirking post-meal cleanup. How little they knew.

Stabbing pains came and went often at random. One moment I’d be sitting at my computer, and the next I’d be stricken, doubled over, or collapsed on the floor.

These spells of agony sometimes lasted for days. During a family cruise vacation, I was afflicted by fluctuating blood sugar levels, and caught myself returning to the buffet repeatedly, wolfing down one dish after another.

Then, halfway into the trip, my digestive tract gave out. For three days I lay in the fetus position in our windowless cabin in a cocoon of darkness split by red lightning-strikes of agony.

“It’s just the stomach flu,” my mother said when I asked to be taken to the onboard doctor.

“Mum, something’s really wrong,” I insisted. “My body isn’t digesting anything.”

“They’re going to charge me $100 and all they’ll do is give you an aspirin,” she complained. “Just rest. It’ll pass.”

But 72 hours later, the symptoms had failed to ease. The constant pain and nausea had robbed me of my appetite, and after three days of fasting, my mother’s seeming indifference turned to concern.

She thrust plates of salad in my face, insisted on feeding me forkfuls despite my protests.

Days later, back on solid ground and mostly recovered, I looked back on the hellish episode as a freak incident. But chronic illness persisted.

Sticking with self-diagnosis

For the next decade, the same symptoms came and went with the suddenness and ferocity of summer thunderstorms. Their cause, at first a mystery, was eventually identified as wheat.

The symptoms after all were on par with those of Coeliac disease. And when I indeed subtracted wheat products from my diet, the symptoms eased to the point of being manageable.

My doctor suggested I get an endoscopy so I could be formally diagnosed. She explained that in order to avoid a false negative, I would need to start eating wheat again.

Having already tasted freedom, I had no intention of going back into dietary bondage. Besides, what would the test prove, other than what I already knew for a fact?

My resistance to getting tested was in part due to my parents once dismissing my symptoms as psychosomatic. 

My antique distrust of authority figures, and the fact I alone had championed my own health, left me somewhat resistant to the doctor’s suggestion. 

It was I, after, all who had determinedly spent three hours Googling symptoms; I who had found the name for my chronic illness. 

It followed, therefore, that only I could determine what was best for my own health. 

“You have no way of knowing for certain,” the doctor said when I declined the offer of an endoscopy. “It could be Coeliac disease. Or it could be something else entirely.”

“I’m good,” I said. “Thank you.”

“Well, it’s your health,” she replied with a shake of the head.

“It is,” I snapped back. Just who did this woman think she was to question my judgment like this? A qualified medical professional?

No one and nothing was going to dissuade me. Defiant, I marched out of the doctor’s office, clutching my self-diagnosis to me with the kind of protectiveness reserved for a newborn.

The struggles of identifying chronic illness

Still, I never achieved complete symptom clearance. All it took was a handful of nuts or a glass of milk to kick off a round of wind and intestinal purging, while beans had the opposite effect, bringing digestion crashing to a halt.

A dietician suggested that maybe I was eating too much fiber. She proposed I try cutting back on certain trigger short-chain carbohydrates like lactose and fructose, known by the acronym “FODMAPs”. 

But by the following week, I was embarking on a month’s long trip overseas, and soon forgot the dietician’s proposal.

Later, believing I must be suffering some kind of allergy, I attended a leading clinic. If I was hoping to come away with a diagnosis, I was instead left only with a patch of irritation on my left forearm, something akin to a mosquito bite.

The allergen prick test revealed I was reactive to American dust mites, but not wheat and diary.

The clinic recommended nevertheless I switch to a diet low in certain naturally occurring food chemicals called salicylates, amines, and glutamates. 

These chemicals are present in anything from chocolate, to coffee to cheeses. Eliminating them completely naturally proved quite the chore, and even once I did, my condition scarcely improved. 

After a few months of attempting to be vegan, things only worsened, my belly swelling as tight as a drum.

When a rash surfaced on my back like an inflamed continent, I conceded that maybe my self-diagnosis was wrong.

Previous adversities had left me reluctant to ask for help, to trust that others really had my best interest in mind. Yet this same reluctance meant I had inadvertently prolonging my chronic illness.

chronic illness COVID coronavirus thoughtful gay

Seeking treatment

A somewhat lengthy and expensive battery of tests confirmed that I indeed had been wrong about having Coeliac disease. What I was actually suffering from was Irritable Bowel Syndrome (IBS).

While both conditions share common symptoms, what my body seemed to have been reacting to was not the wheat protein gluten, which typically causes the immune reaction in Coeliacs sufferers.

My triggers were in fact FODMAPs, the carbohydrates previously identified by my dietician. This explained why my body responded adversely to high-FODMAP foods such as wheat, milk, nuts, and beans.

Had I listened to the dietician and trialed the low FODMAP diet, I would have been spared not only my usual raft of symptoms but the development of a new, secondary condition: small intestinal bacterial overgrowth (SIBO).

If IBS could be at times unbearable, SIBO had the effect of only exacerbating the symptoms.

Treating the SIBO with antibiotics decimated my gut microbiota. It also triggered a secondary infection of a parasite known as blastocystis hominis, suspected of stowing away on my body during my trip abroad.

The blasto infection sent me running to the toilet every hour, and could only be bested with still more antibiotics. 

Suffice to say, it was months before I returned to any semblance of digestive normality.

Accepting what can be changed

Part of the problem was that IBS is a condition whose triggers vary from individual to individual. One person may digest a slice of cheesecake with ease, while another will be stricken by paroxysms of diarrhea.

When I expressed my desire to “get better” to my gastroenterologist, he laughed. IBS was a “functional” condition, quite unlike more serious conditions like Crohn’s disease. Expecting complete recovery simply wasn’t reasonable.

Was this, then, what I was paying this man for? A tidy response absolving him of any responsibility? Yet another “hypochondriac” dismissal

Certainly, chronic health conditions are often complex, and the problems they throw up insoluble. But if my gastroenterologist wasn’t interested in helping me explore the possibility at least of improved health, then it fell once more to me to try.

To this end, I explored all manner of remedies: antidepressants, antidiarrheals, antianxiety medications, fiber supplements, peppermint capsules, digestive enzymes, natural supplements, antispasmodics, probiotics, exercise, hot pads, meditation, acupressure, and hynotherapy.

By isolating potential trigger foods, I discovered that the recommended fiber supplements were actually making things worse.

Another contributing factor was a substance known as resistant starch, which can be found in many IBS-friendly staples. As it turned out, something as seemingly innocuous as reheated rice or potatoes often was more than enough to ruin my digestion. 

The modifications I eventually settled upon involved quitting coffee and curtailing fiber, fat, oil, sugar, and resistant starch. Intermittent fasting, which involved restricting my eating to an eight-hour daily window, proved infinitely helpful. 

Meals were kept to three in total and limited to reasonable portion sizes, taking the pressure off my admittedly delicate digestive tract. Adding peppermint supplements, enzymes, and anti-diarrhetics further supported my digestion.

Lifestyle changes were also in order. There was to be no more round-the-clock workaholism. Time would need to be made now for a regular exercise routine, daily meditation, and relaxation.

As it turned out, the gastroenterologist had indeed been wrong for laughing off my complaints. A better state of health was indeed possible.

While some health conditions may be in part or completely out of our control, management or easing of symptoms is always possible. Quality of life is never an unrealistic goal.

Identifying a key need and a strategy

“What do I need most?”, “Is it realistic?”, and “How do I achieve it?”

For those of us suffering from chronic illness, these three questions can be the determining factor for both our physical and psychological wellbeing.

In my case, my foremost need was being able to eat nourishing, delicious food without getting sick.

The dietary limitations imposed by IBS meant eating out was a fraught affair, so avoiding tummy upset going forward would require I make all my meals from scratch, going forward.

Even after I threw out all my current go-to recipes, many of the IBS-friendly alternatives I found online contained other foods that were triggers for me, such as oil. 

The only way I was going to fulfill my tasty food cravings therefore was by getting creative. So for the next year, I recipe tested like heck, substituting problem ingredients with symptom-free alternatives. 

Most meals I produced during this period were, for the most part, healthy, if a little bland. But by the second year, my culinary game was on the up, and I had at least four passable meals under my belt. Then suddenly they weren’t just passable – they were delicious.

As cooking IBS-friendly meals from scratch could be an expensive and time-consuming process, I began bulk-buying and batch-cooking.

This strategy ensured I spent less time in the kitchen carefully measuring ingredients. Instead of or shuffling through the supermarket, poring over the price tags of often more expensive low-FODMAP alternatives, I was now able to spend more of my time savoring the fruit of my labors.

Seeking support with chronic illness

Being forced to carefully monitor everything I eat, while managing occasional flare-ups can at times be stressful. 

Sometimes I’ll catch myself trying to “silver lining” the situation, reassuring myself of the benefits of having IBS. The forced dietary changes for example have rendered me permanently lean. 

Some fitness fanatics might consider this an ideal result, but practically speaking, not having “rainy day” body fat can be a problem during periods of illness when I’m most prone to rapidly dropping pounds.

Chronic illness has brought many periods of frustration and despair. Key to our endurance in such instances is having someone we can talk to about our difficulties. As the old adage goes, “A problem shared is a problem halved”.

While loved ones can ever truly know what it’s like to walk a day in your moccasins, they can certainly empathize. But if you find no respite in venting to friends and family members, a sympathetic-ear-for-hire may be another option. 

Therapists not only provide a supporting environment – they are specifically trained to help clients with identifying custom-fit coping mechanisms.

Therapy for some isn’t financially tenable, while others may not be comfortable opening up to a stranger. In such instances, it’s worth exploring other avenues, such as online communities or support groups for people with your condition.

Failing that, a daily “mood” diary is always a great fallback. In moments of stress or high emotion, consider jotting down in detail what you’re feeling, why, and the circumstances or situations surrounding these feelings.

Diary writing when suffering chronic illness can be cathartic for the sheer reason that it allows us to divest ourselves of burdensome thoughts and feelings. Without an outlet, they may otherwise continue to rattle around inside our brains, draining our strength and impeding our wellbeing.

Diary writing in this sense is preventative, acting as a pressure valve. It allows us to release what we are carrying in a safe and constructive way, offering us valuable perspective on our difficulties.

Takeaways

  • Be open to help – and self-advocacy.
  • Change what you can, accept what you can’t.
  • Identify one key need and how you can fulfill it.
  • Seek emotional support. Keep a diary.

Dogs are not tiny humans, OK? Now please just read ‘Cesar’s Way’

Essy Knopf Cesar Milan Cesar's Way Anxious Seeks Canine
Reading time: 5 minutes

My 18-part blog series on dog ownership, Anxious Seeks Canine, was, firstly, an admission of guilt, written before I had gotten my hands on such classics as Cesar’s Way

Between picking at my own stitches, I was also skewering the role my neuroses had played in my shaping relationship with my pup Cash.

Yet for all the self-awareness writing Anxious Seeks Canine demanded of me, one year on after giving up my dog, I was no closer to a better understanding of what exactly had gone wrong.

Sure, Cash had been an anxious dog; about as anxious, in fact, as I myself was. 

Sure, I had done the best according to what I knew at the time. And yet, walking away from the experience, I found myself wondering what exactly I could have done differently.

This is what ultimately led me to read celebrity expert Cesar Millan’s book, Cesar’s Way

Millan highlights the fundamental error owners commit when adopting dogs. Specifically, our habit of trying to understand them from a human-centric perspective.

Dogs may share our mammalian heritage, but their needs and priorities are inherently different from our own. 

And it’s when these needs and priorities clash with our own that problems develop.

Cesar’s Way: Exercise, discipline, affection – in that order

One of Millan’s key points can be distilled into the following statement: dogs require “exercise, discipline, affection – in that order”.

Too often these priorities are placed out of order, with affection first.

Consider the owner who matches their dog’s over-excited response upon returning home.

Believing that their dog has suffered through loneliness or even the perception of abandonment, s/he may over-empathize and lavish them with attention.

The problem of course is that this is a very human attempt to interpret a distinctly non-human thought process. 

anxious seeks canine cesar milan cesar's way dog ownership
Iz not human. Cannot do.

As Millan points out in Cesar’s Way, dogs don’t necessarily live in the past or future as we did, in remembering and anticipation. They don’t construct causal narratives about their relationships. 

Rather, they dwell in the present, responding less to memories than to prior conditioning.

As gay men, many of us have all experienced some measure of abandonment, if only as a result of our sexuality, be it from friends or family members. It stands to reason therefore why we act so lovingly towards our “fur babies”. 

Yet the downside of giving affection first is that you may be unwittingly reinforcing whatever behavior the pet is engaging in at the time.

In this case, the owner is conditioning the dog to work itself into a state every time they leave or return, thereby intensifying their emotional response and instilling greater and greater levels of separation anxiety.

Take for example my habit of greeting Cash with squeals and baby-talk. In time, my dog came to connect my response with his feelings. Very quickly, my infantilizing patter began setting him on edge.

Any wonder then I never made true headway with easing Cash’s separation anxiety.

The importance of being active

From day one, Cash was bursting with excess energy. When I stood up from my desk, he would rocket to his feet, n preparation for what, I never knew.

Our daily walks involved Cash tugging me behind him, like a freight train climbing a mountain.

Three 20-minute walks each day was, in my books, more than sufficient exercise. Not so in Cash’s. 

Even after hours-long hikes, my dog still somehow found the energy to chase me to the door.

Suffice to say, my largely sedentary lifestyle was not working for him. Being cooped up in my apartment went against his very genetics as a Husky-Corgi.

anxious seeks canine the thoughtful gay cesar's way
My high-maintenance pooch.

As a result, Cash remained perpetually anxious, freaking out when left by himself or exposed to other dogs, barking incessantly, snarling when they got too close, and trying to mount them.

If my squeals had only fuelled Cash’s anxiety, his anxiety only fuelled the conflict he’d anticipated fear, my dog’s aggression inevitably drawing retaliation. 

It didn’t help that during my visits to the dog park I was, as Millan terms it, “punching out”. Rather than actively monitoring my dog, watching his body language, intervening early, and correcting undesirable behaviors, my attention went instead to a book or laptop screen.

Suffice to say, adjusting my lifestyle to better accommodate my dog would have gone a long way to remedying the situation. 

Setting and following rules, boundaries and limitations

Shelter, food, and affection – none of this guarantees your dog will necessarily respect your place as head of the household.

However hopelessly dependent your dog may be upon you for their survival if given an inch, they most certainly will take a mile.

As Cesar Millan notes, dogs are pack animals. They seek to establish hierarchical relations. When human beings treat them as their equals, dogs may respond by attempting to assert dominance.

They may, for example, disobey you, or engage in other less obvious behaviors, like insisting they be the first to go through a doorway.

In Cesar’s Way, Millan argues that your dog doesn’t necessarily want to be the leader. Their response is simply an attempt to fill a perceived power vacuum. 

Feeling forced to take the job of “top dog” can have the effect of creating anxiety for your pet, not to mention frustration for you. 

By employing discipline – setting rules, boundaries, and limitations – however, we can avoid this situation entirely.

While regular obedience training can certainly help, if you fail to apply the same discipline to other facets of your dog’s life, there’s a good chance the training won’t take.

What’s important here is consistency. A dog is more likely to be happy and stable if it knows =what to expect to you. This means being firm with not just enforcing rules, but ensuring that you yourself uphold them. 

For example, Cash only dragged me during our walks because I had failed to set clear, consistent rules about his role and place in the pack.

By removing food bowls after a certain amount of time had elapsed, and always ensuring I was the first to eat, I managed to quickly communicate my role as pack leader.

A no-pull halter also had the effect of stopping all attempts to dive through doorways, while forcing my dog to walk at my pace. 

But most importantly, it communicated to Cash that he no longer needed to take the lead. 

And for all my dog’s dislike of the halter, I sensed immediate relief on his part, as he no longer felt compelled to play a role for which he was not able.

anxious seeks canine the thoughtful gay cesar's way
Infantilization. A case in point.

When to use positive reinforcement

According to Cesar’s Way, we should give attention only to those behaviors we want to positively reinforce.

As for undesirable behaviors? Millan says they should be corrected immediately, by providing a replacement activity indicating what it is you would rather your dog do instead.

Affection is a form of positive reinforcement and is best earned, for example, when the dog respects a rule or obeys a command. Even then, Millan says we should only offer it so long as our pet is calm and submissive. 

There are times as well when affection should be withheld: “When your dog is fearful, anxious, possessive, dominant, aggressive, whining, begging, barking – or breaking any rule of your household”.

By clarifying and reinforcing your expectations of them you condition your dog to behave in desirable ways. This not only encourages obedience but establishes your pet’s place in your household’s “pack”, thereby strengthening her/his sense of purpose and wellbeing. 

This is key to dispelling the anxiety Millan notes dogs can develop as a result of living with human beings and is the cause of many of our difficulties as owners.

For those of us with firsthand experience with highly-strung dogs, the Cesar’s Way philosophy thus offers a clear path to a more balanced and content life, not just for pets – but owners as well.