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For this brain surgeon, the operating room is 'the ultimate in mindful meditation'

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For this brain surgeon, the operating room is 'the ultimate in mindful meditation'

“Everything that we are as human beings is in our brain,” Dr. Theodore Schwartz says.

Brian Marcus
/Penguin Randomhouse


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Brian Marcus
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Neurosurgeon Theodore Schwartz still remembers the first time he witnessed brain surgery in person. He was in medical school, and the surgeon sat in a special chair that was designed to hold the arms up while they worked under a microscope.

It reminded Schwartz of the way an astronaut looked in the cockpit of a spaceship — except, he says, “[The surgeons] were traveling into the microcosm of the brain instead of traveling into the macrocosm of another planet.”

“When I first saw that, it was nothing but awe and excitement and the fact that they were doing it to help another human being and going into the brain and the mind,” Schwartz says. “Everything that we are as human beings is in our brain.”

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Schwartz has since spent nearly 30 years treating people with neurological illnesses. When he was first getting started, he worried about keeping his hands and body steady during long surgical procedures that might stretch on for hours. But he says over time he’s trained his body to enter what he describes as a surgical “flow state.”

“It’s sort of the ultimate in mindful meditation,” he says. “The external world does not exist for that period of time. And the same is true of your bladder. … And then at the end of the operation, You kind of realize, ‘Oh my goodness, I have to go to the bathroom. I’m tired, my neck hurts, my back hurts.’”

Schwartz writes about the past, present and future of neurosurgery in his book, Gray Matters: A Biography of Brain Surgery. He notes that while traditional brain surgery involves opening up the side of the skull, the practice of “minimally invasive brain surgery” — whereby the brain is accessed via the nose or by the eye socket — has become more mainstream over the course of his career.

“We can do surgeries now by making a small incision in the eyelid or the eyebrow and working our way around the orbit in order to get to the skull base,” he says. “And that allows us to get to these very delicate parts of the brain much more quickly, and without disrupting as much of the patient’s anatomy so that they heal much faster.”

When it comes to brain health, Schwartz recommends the basics: exercise, a healthy diet and plenty of sleep. “And besides that, I don’t know that we really know what we can do to keep our brains healthy. So that’s the recommendation I would give,” he says.

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Gray Matters, by Theodore Schwartz

Gray Matters, by Theodore Schwartz

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Interview highlights

On the need for power tools for such delicate surgery

We think of brain surgery as something that’s very fine and delicate … but the brain is housed in the skull, and the skull is very, very strong. And that’s what protects our brains from injury. And so part of what we have to do as brain surgeons is first get through the skull. And that work is often very physical and involves drills and saws in order to get through the bone. We obviously do it very carefully, because the trick is to get through the bone and not damage the underlying contents. But we have to use power tools, and that’s how we start out every operation, with saws whirring and buzzing and making noise and sort of bone smoke going in the air before we transition to the careful, delicate microsurgery that we do after that.

On trying a new method of surgery when the stakes are so high

You realize the gravity and the importance and the significance of the fact that this other person’s life is in your hands and you’re trying something on them that you think will be better, for sure, but you’re not sure yourself of your own ability because you haven’t done it 100 times. And that’s really terrifying. And it’s something that we have to deal with as neurosurgeons. Not just when we try something new, but essentially every time we do an operation, we’re taking on that enormous responsibility of another human being’s life.

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While the majority of our surgeries go extremely well, occasionally they don’t. And when that happens, it weighs on you tremendously. And it affects how you think about all the subsequent cases that you’re going to do that are similar, because you never forget those cases that didn’t go quite the way you wanted them to go.

On relieving pressure in brain by cutting a hole in the skull

One of the most common surgeries that neurosurgeons do is head trauma. And head traumas are very common. But these are neurosurgical emergencies. Anyone who has hit their head severely enough, they will have swelling in their brain. And we can now save these people’s lives just by opening up the skull. Because as the brain swells, if it has nowhere to go, that’s when the pressure goes up. So neurosurgeons can go in very quickly and remove part of the skull, and let that pressure out and then put the skull back, maybe, two or three weeks later, or maybe even a few months later when the swelling has gone down and we can save lots and lots of lives that way.

On how the field of neurosurgery is changing

One of the things I love is that, some days or weeks I’ll come in and I’ll be training a fellow and we’ll go through six, seven, eight operations and I’ll tell them, all these operations that we just did together, I didn’t learn how to do any of these in my training 25 years ago. They’re all completely new operations. And that’s a wonderful thing about a field like brain surgery, is that we are constantly applying new technology and the field is changing and you have to stay up to date, but it also keeps you active. It keeps you thinking. You’re constantly working with engineers and people in other fields to figure out what’s the latest technology going on in, you know, oncology and orthopedics and OB/GYN that we can apply to neurosurgery? To try to make what we do better.

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On seeing his father’s stroke and aphasia when he was in residency

It was just this profound moment of seeing my father’s brain appear before me and fearing I was going to see a problem. And sure enough, there was this sort of dark spot which I know to be a stroke, and he had had a horrible stroke that took away his ability to speak. As a result of the surgery he had, and unfortunately passed away a few weeks later. But it was just [a] devastating experience for me. And as much as I know about the brain, I knew too much about what was going on. I also knew that at that moment in time, there was nothing we could do for him.

On the union of the brain and the mind

I think everything that a human being experiences, in the external world and the internal world is all your brain. I think that’s all that there is. I don’t think there’s some mystical second substance called “mind.” … We think the mind and the brain are different things because it’s built into our language. It’s how we talk about the mental world around us. We were raised speaking a language with words that refer to things that may not exist in the real world — and one of those things is mind. … I do not think we have as much agency over what we do, if any. And I think the brain is processing information, below our radar, unconsciously, subconsciously, whatever you want to call it, and creating behaviors. And we are just along for the ride to some extent.

Sam Briger and Joel Wolfram produced and edited this interview for broadcast. Bridget Bentz, Molly Seavy-Nesper and Carmel Wroth adapted it for the web.

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Racist 'Hanging Tree' Viral Video Sparks Police Investigation in Nevada

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Colman Domingo's 'Sing Sing' is a rare empathetic prison drama : Pop Culture Happy Hour

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Colman Domingo's 'Sing Sing' is a rare empathetic prison drama : Pop Culture Happy Hour

(l-r) Colman Domingo and Clarence Maclin in Sing Sing.

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(l-r) Colman Domingo and Clarence Maclin in Sing Sing.

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The moving drama Sing Sing stars Colman Domingo as the leader of a tight-knit theatre ensemble within one of the most notorious maximum-security prisons in the United States. Most of the cast are alumni of the actual program who had input on the filmmaking process. The movie showcases the ups and downs of putting on a show without being overly sentimental or cliché.

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How to accept being 'a fat person' and quiet your inner critic

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How to accept being 'a fat person' and quiet your inner critic

As an only child who moved around a lot, Emma Specter learned to comfort herself, as a lot of kids do, with familiar foods — whether it was the Dunkin Donuts she sought out in Rome or the candy bars she stock-piled from Manhattan bodegas. By the time she entered high school, she’d begun using food as more than just a source of soothing, but as a kind of numbing agent she’d administer in secret. Mindlessly eating cookie dough to the point of physical discomfort, she discovered, could help ease the pain of life’s most unpleasant moments — that is, until the shame set in, followed by an urge to count calories.

Shelf Help is a new wellness column where we interview researchers, thinkers and writers about their latest books — all with the aim of learning how to live a more complete life.

Specter eventually came to identify this behavior as bingeing, an eating disorder she describes viscerally in her memoir, “More Pease: On Food, Fat, Bingeing, Longing, and the Lust for ‘Enough’” (HarperCollins). Bingeing can look different for different people, but for Specter, it involves “shoving food furtively into my mouth as quickly and passively” as possible, she writes. Her debut book, which pairs a deeply personal (and often humorous) narrative with academic research and journalistic inquiry, explores the origins of her disordered eating while also searching for a motive: “Why do I do this?” Specter said in an interview.

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The Los Angeles-based Vogue culture writer is still trying to answer that question. In addition to lots of therapy and introspective writing, her process so far has been to interview writers, scholars and fat activists about diet culture and its societal underpinnings.

The Times spoke to Specter about how she realized she had an eating disorder, why she decided to ditch dieting and what happened when she began to reframe her thinking about her body.

This interview has been edited and condensed for clarity.

In your book, you describe how any sort of event in your life — no matter how big or small — could trigger a binge. What did this pattern look like for you and how did you recognize that it was part of a disorder?

I definitely was and still am more likely to binge on a bad day than a good one, but sometimes something very minor would go wrong and I would react by bingeing. When I’m in a bad mood or bored or lonely or tired, it’s hard for me to self-regulate without food. I think a lot of us use food for comfort and that doesn’t have to look like a disordered attachment. But for me, it was very much about shutting out the world with food.

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I think that’s the tricky thing, too, is that obviously everyone eats food for survival, for comfort, for all of these things. Was there a moment where you recognized, ‘Oh, what I’m doing is maybe a little bit destructive,’ if that’s how you see it?

Absolutely, that is how I see it. When I was in my early to mid-20s, I started to recognize that something was off. A lot of things that I had desperately wanted came to fruition. I had jobs in media, I had a big group of friends, I came out [as queer], dating was better and more exciting, or at least existent. But I felt like there was this real disconnect where I started bingeing almost more once I had more in my life. I was more fulfilled and happy, but still bingeing and then realizing, ‘What function is this playing for me? And is it an escape when I’m feeling overwhelmed or scared or stressed about the stakes of my new life?’

Right. How do you work toward not relying on food so much as an escape from your feelings?

I’ve found a lot of beauty in communal meal-making and eating together with my partner and their roommates and my friends and just reminding myself that food can absolutely be this huge source of comfort when I’m feeling overwhelmed, and it doesn’t have to go along with solitude and hiding.

When I was in the diet-binge cycle that I was in for so long, I was very concerned about ‘How am I going to have a group dinner with friends and still stick to my Weight Watchers points?’ I’m thrilled to say that I haven’t dieted in a long time, but that lizard brain mentality is still with me sometimes telling me what I should and shouldn’t be eating or enjoying. The more that I can come together with other people around food, the less I feel like it has to be this solitary kind of respite that I only engage in in a disordered way.

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So the journey you describe in the book is twofold: You’re recognizing that you’re bingeing and figuring out what’s behind it and how to manage it, but you’re also learning to abandon diet culture. Do you feel like those two things go hand in hand?

Absolutely. I do think giving up dieting was really crucial to getting to a place where I can just accept myself as a fat person. It was truly one of the most ingrained habits of my life to the point where — I think as so many people, and especially women — do, I still know the caloric value for foods and I’m trying to chase that out of my brain. It doesn’t hurt to know what’s in your food, but I’m trying to chase away the sense of “Oh, my god, this banana has so-and-so calories, I can’t have it.” I think saying goodbye to dieting has really been crucial in just accepting the body that I have now and not the body that I could have if I cut out carbs and worked out for two hours every day.

I was a little disappointed that quitting dieting didn’t fix my bingeing, which maybe should have been obvious to me because bingeing is a very ingrained habit that I’ve been engaging in over the course of my life. But part of me thought that if I’m not dieting anymore then I won’t ever have the urge to overindulge. It can be demoralizing to feel like I’m doing all this work [toward having a positive relationship with food] and still I find myself bingeing, but I think that’s just part of the balance — especially in the place that I’m at in my recovery, which centers very much around harm reduction. I’ve made a tenuous peace with the idea that bingeing is going to be a part of my life.

You write about your bingeing as a form of self-harm, about the way it caused you shame and embarrassment, nausea and indigestion. Could you talk about some of the other ways it affected and still affects your life?

Something I want to highlight is just the amount of money that I spent on binge food. Obviously it was not a ton — an individual binge could be a thing of ice cream, which costs $7, but that stuff adds up — and it’s not my favorite use of money. It’s not my favorite use of how to engage with the world and the economy, especially through the use of food delivery apps. Being dependent on somebody else’s precarious labor to bring you food you don’t even want doesn’t feel great and it isn’t the way that I want to engage with my community.

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I also think for a long time, I felt like my consequences, for lack of a better word, were fatness. I remember at a certain point catching a glimpse of myself in the mirror after I gained weight and thinking, ‘Look what you’ve done to yourself.’ You know, just really unkind self thoughts that I try really hard not to harbor anymore, but they sneak in ‘cause we live in a fat-phobic society. But I do think it has been a really beautiful reframe to just be like, my body is not a negative outcome and it’s not a consequence of anything. It’s just my body and it can do a lot of incredible things.

TAKEAWAYS

from “More, Please”

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Reading your book, it’s obvious that you didn’t arrive at body acceptance overnight, and that it’s still a work-in-progress. Can you talk about what has helped you become kinder to yourself along the way?

I can’t think of something that has had a bigger impact on me than having fat friends. Just being surrounded by fat people who love each other and are loved — which sounds so corny — but I just think it gives me a script every day for my own self-acceptance. I can’t overstate the importance of having fat community in my life, and I really hope that for every fat person.

I know that being fat can be tricky because it can often feel like it’s your rest stop on the road to thinness, but I have felt so deeply that if I want to live in my body happily as it is, I need to surround myself with other people who do that and who accept themselves and who still have difficult moments and who have journeys that I might not necessarily even know about because every single person is going through their own world and journey in their own meat suit.

What advice would you give to someone who wants to start re-evaluating their relationship with food or with their body?

Try not to be alone with it. “It” being your fear and your anxiety over what you’re eating or not eating or what your body looks like or doesn’t look like. Sometimes that means talking to people in your life, but I think people dealing with disordered eating and binge eating in particular can often feel so much shame that it’s really hard to start that conversation. In your Notes app or your Google Docs is as good as any place to start a conversation, even just with yourself while you’re figuring out what another level of help might look like for you.

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I just hope, as corny as this sounds, that you’re as nice to yourself as you can summon the ability to be in the process of finding your version of therapy, or writing about your issues, or talking to your loved ones about what’s going on with you. None of that is possible without this little glimmer of self-compassion, and the self-compassion has to be first.

Three friendly figures underneath leaves making a heart shape.

(Maggie Chiang / For The Times)

Shelf Help is a wellness column where we interview researchers, thinkers and writers about their latest books — all with the aim of learning how to live a more complete life. Want to pitch us? Email alyssa.bereznak@latimes.com.

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