Do You Have What It Takes To Succeed?

Bob L posted this in the Gluttony thread, and I thought it would be great to open it up in a new thread all its own. Here is what he said:

Question??? Do you think that pre-op the psychiatric apt. should be more thorough in order to uncover things that maybe we do or don't know about our eating habits. Would this give the WLS patient a better advantage. I'm sorry but right now I can't remember who it was but they had been denied WLS due to their psychiatric evaluation and they continued to work with her on issues she had. I thought that was one of the most remarkable post. You know when she finally has WLS she will have a real chance for success. I hear so many people that were rubber stamped through this process and I think its a disservice to them. This was the one requirement that I looked forward to, sounds weird I know but I wanted to make sure (or as sure as anyone can ever know) that I had the make up to succeed before I allowed someone to rearrange my insides. Interested in your opinion. C'ya Bob

 

I do have thoughts but due to time constraints this morning, I will post them later. Please feel free to give your ideas, thoughts, concerns. Now I will add, do I think that many pass the psych part and don't have a clue as to what it will take to be successful? Heck yes! I see them all the time. But are those people (and even many of us) imbalanced and psychologically unhealthy? I don't think this is the case. Though, I have been accused of having a few screws loose at times! LOL.

In doing my psychiatric eval pre-op I was so afraid I would say something to get denied. I was honest non the less because I felt I did not want to cheat myself or the system to get surgery. If I failed the eval that would have been a sign to me that I was not ready to have the surgery. I do think it should be more thorough and matters should be addressed before surgery and after as well. I was told by Karen Star who did my eval that I was wlecome to return after surgery to address any issues or concerns relating to the WLS or otherwise. Did I go? No and that is my fault. I think most of us could go back after surgery but don't. I think with me I had the mentality that now that I had surgery it would "fix" my addiction or that I could make it with out therapy. I am re- thinking that now. I am 2 years post op and I am still not at goal. This depresses me sometimes especially when I see others reach goal in less than a year. I get depressed and I sabbatage myself and what do I do? I turn back to my old friend or enemy I should say. i start eating again. I was thinking yesterday it is so strange. Before weighing at over 400 lbs I always felt there was a thinner person inside wanting to come out, wanting to live and be free. Now that I am healthier, because I am by no means thin it is the other way around. I feel like that 400 lb person is trying to take over again. I ask myself why I sabbatage myself. For me my weight was very much a securiy blanket. I did not care about myself therefore I did not want others to care for me either and I thought to resolve that by getting so big that no one would want to be around me. This is a issue I still struggle with. My perserverance is weakening. I used to be so strong and always advised others not to give up when they fell off track and would encourage to get up and try again. I now have to tell myself this. I recently had a episode of depression worse than I have ever had before. I did not post here for almost 2 weeks maybe more. I withdrew into myself and started eating things I shouldn't have been eating and in doing so yes I sabbataged myself once again and gained almost 10 lbs. I am now having to start all over and go back to basics but along with that I am thinking it would benefit me to go back and seek therapy to address the issues I have with food and issue of self sabbatage. The resources are there we just have to grab them and make use of them. 

I believe that the phyc evel should be more throughal  I know I still have eating issues and I am working on them but I think that I would be better if I had a better eval and an opp. to work on the issues before the surgery,  I thought I was better equiped to handle them when I had surgery but now I know if I had worked through why I have the issues then I wouldnt be struggling as much now.... this is just my oppinion for my self.
Annrenee

I feel that when it all comes down to it, nothing really can prepare you for wls. You have to deal with it as issues arise. I read several books, asked postops questions, and more questions, and more questions, took a 3 month class in order to prepare... but once that day finally comes, its like the deer in the headlights look... and then buyer's remorse, then grieving food, dealing with things we have been taught in our families such as :

*eat everything on your plate

*a meal consists of meat, vegetable, bread and dessert

*drink with your meals

There is just too much to prepare for. And, its all so overwhelming. Throw in the factor that you may be puking up your food just at having one bite too much, well it just has to be learned as you go. I don't think psychological evals can prepare us truly for how wls will change us.

 THERAPY as we go...  now that will help us.

That makes sense, that is what I am trying to do now, but had it stuck in my head that I should of been more prepared forthe eating struggles...
Annrenee

I used to work for a mental health practice.  They issued the MMPI-II (the one that many of us had to take, over 500 questions long) to police officers as it was mandated by TN regulations.  Did you know that the test has a built in lie scale?  And, many police officers FAILED the lie scale.  These are men who we trust with our lives, to save and protect us.  They failed a part of their psychological test.  Does this mean that they are crazy?  Unfit to do their jobs?  Not at all.  It just means that they have a personality trait that strives to make themselves look better. 

Many of the questions they fail to answer correctly (or up to par with what some mental health committee BELIEVES they should have answered in a certain way) are the questions where a person attempts to make themselves look better to the interviewing counselor.  Such as:  "I read every editorial in the newspaper every day."  Now come on, chances are, there COULD be one single individual *****ads every single article, cartoon, death notice, but what are the chances?  Question number two:  "I never tell a lie."  WRONG! YOU JUST DID BUDDY!  Another question goes something like this:  "If the backdoor of a movie theatre were open and I could sneak in, I would not."  Here is the kicker. Those who created the MMPI-II believe that everyone WOULD sneak in to the movies.  So if you are an extremely moral and honest person, you would answer that you would not sneak in, thus YOU LIED on this answer.  It's all in the eyes of the person doing the reviewing, and sometimes, he/she has to make a judgment call.

The same is true for wls folk.  Do we have issues? YES. If that was the determining factor of passing our evals, probably none of us if we would be honest with ourselves would have had gastric bypass.  But, our physical health warranted the medical necessity of the procedure.  In other words, just as the city hired the police officers who lied on their test (they did require a second interview, however just to ensure that they would be honest if confronted), so we were placed with a stamp of approval from our counselors that we were healthy enough to understand what was required of us after surgery, that we have the cognition and ability to learn what we need to change, and that we are willing to change it.  Hopefully we will dig deep into our psyches and find out "why am I overweight in the first place?"  I don't think it was because our plates were just simply overfilled.  

 

I have said it many times.  If a person is going to be a longterm success, meaning that they can keep the weight off for 5, 6, 7 years or more, then they must do the mental work necessary.  It has to be a battle that is fought and WON in their minds...  that's why it is so important for us to visit and REvisit these topics that we have discussed this week...  being every mindful of where we are not just on the weight scale, but in our emotional and psychological well being.  

If doctors waited on us to resolve our issues FIRST, many of us would become so discouraged that we would never have the surgery.  We would do just as we have done on our many diets:  fail out of discouragement and fall right back into the old habits.  And also, even if we did deal with those issues, we would have them aggravated once again after surgery (if anyone should make it that far!) as our bodies change, people react and respond to our weight loss...  I'm glad that I got to do it all as it happened... and still continue to work on ME. 

You know, I don't think that the psychological evaluation is the missing link.  An assessment is not meant to be anything other than a snapshot of that particular day for that particular individual.  Perhaps before and after classes would have painted a more accurate picture of a person's state of mind.  I would have benefitted from a class (similar to how new mothers learn what to expect when their first baby arrives.) 

By the way, at my psych. eval. I found several errors on the copy of the test I was administered.  I corrected them and also offered to put the evaluator touch with the good folks at NCS Pearson to hook them up with a desktop OMR scanner to make the task more efficient. 

:)  Freddie

Freddie, you said, "an assessment is not meant to be anything other than a snapshot of that particular day for that particular individual."  You are so right.  If a person is having a horrible day, and feels rejected, hurt, angry, chances are they are going to mark "True" for the question that asks, "I feel like people are out to get me."  "Most days I feel lonely." or whatever those types of questions are.  I don't remember them all...  but if they answer those questions on how they FEEL, then possibly they could be viewed as paranoid.  When really, they just had a bad day.   Now if they are having a great day, life is good, they would be seen as incredibly trusting and optimistic.  The test results can vary depending on attitude and emotion.  I never answer them based on how I feel.  I answer them after thinking a moment...and asking "Do I really think this to be true always, in general?"  And make the best possible answer for how I logically and rationally view things.

I really like the way Vanderbilt has built into its program the emphasis of support groups and the need for the person to have shown proof of ongoing support BEFORE approval. I think this helps to show the persons ability to take on personal responsibility and interest while being directed in the program.
 I do also think it would be an added benifit if they required the psych appointments just as they do the dietician appointments.  
I am going to speculate that the reason they dont is the psych appointments to be paid upfront would be much more than the dietician appointments.


For job reasons and personal  reasons I have had to take psych tests. Each time my evaluators have told me the tests do nothing that you couldnt get covered in an in depth interview. So why use it?
The way they explained it to me was they use it as a tool to gauge, and they must be familiar with the test in order to address specific encounters --problems or otherwise.
The fact  there are so many different psych tests only emphasizes  the fact that it has to be given by a professional.
Just as it was said earlier the test questions are geared from specific points of view and do not evaluate the specific reasons someone might answer, however the questions are based on statistics.
Anyone who has taken statistics course would understand what to think of that :) . They have their purpose but its a theory only, a theory to go by, not a true measure of nature of any type of individual-- and thats what statistics give you.

  Im not familiar with the 600 question tests that some of the others had to go through. I was interviewed by Karen Starr. Her questioning and expertise did help me understand how I viewed food. And what specifics may have gotten me to the point I am at now.
  I asked her what  the necessity of these types of exams was. She point blank told me that many times people miss use thier surgery and end up killing themselves..some on purpose.

I was floored that anyone would kill themselves on purpose by exploding the pouch. But, second thoughts about it I could see that it could be a possiblility for someone *****ally needed extra mental support and help.  So I say keep testing, and add in some mandetory psych follow up.



   

I am all for psych testing for sure.  I was mandated by insurance to also take an IQ test.  Which means, Evidently I might be crazy IF I indeed should have failed the psych test, but at least I'm smart enough to pass the psych test! LOL

 

BC has since dropped that reqruiement.