It's Not Alright
for Me Either

A client said it to me recently. We were discussing her diet, her training, her sleep — or the lack of it — and somewhere in the middle of the conversation she gestured at me and said: "It's alright for you, though." She meant it kindly. She meant: you're thin, you're in this field, you know what to do, you probably sail through the parts of this that I find impossibly hard.

I did not argue with her. There was a consulting session to run and it was her health we were there to discuss, not mine. But I have thought about that comment many times since, because it contains an assumption I hear constantly — from clients, from people I meet socially, from the general idea that practitioners who work in health are somehow operating from a position of easy advantage.

Let me be clear about what my life actually looks like.

The actual picture

I built the bulk of this website — 105 blog posts, 8 clinical diagrams, 4 published books, the full clinical programme structure — between roughly 10pm and 2am, after the consulting day was done and the household was quiet. Not because I am heroic or indefatigable, but because that is the only window that exists. The hours before that belong to clients, to family, to the dog, to the functional obligations of a life that is already full before the work that needs doing after hours begins.

My eldest daughter is currently at Camp America and then travelling for the rest of the summer. She is strong, independent, and entirely capable. She is also on the other side of the Atlantic, and I am in Scotland, and that particular combination — the capability you know your child has and the distance you cannot close if something goes wrong — produces a specific kind of low-grade background stress that does not appear in any blood panel but is present every single day.

My mother died two years ago. That is still sad. It does not go away in the way that people who haven't lost a parent yet sometimes imagine it might. It recedes and returns and catches you unexpectedly on an ordinary Tuesday. Her family were Italian — her parents ran a restaurant in Ayr looking out over Ailsa Craig and the Isle of Arran — and there are moments in the kitchen, or walking through a market, or tasting something that hits a particular register, when she is simply there and then not there. Grief does not have a discharge date.

My father has advancing dementia, a history of significant cardiac events, loneliness, and the particular kind of depression that comes from outliving the person you built your life around. He is more than an hour away. That distance is a clinical variable I cannot optimise. When he has a crisis — and he does have crises — the calculation of how quickly I can get there, what I will find when I do, and what the trajectory of that situation looks like over the coming months is a cognitive and emotional load that sits underneath everything else I do, permanently.

My father-in-law is now dealing with a significant health diagnosis of his own. My wife Linsey carries that. I carry it with her. These are not minor inconveniences — they are the actual texture of a life at this stage, with parents at the age they are at and the conditions they have.

Dexter — my dog, who appears in more of my clinical writing than is probably dignified — sleeps in our bed. Some people think this is strange. Some people who work in sleep medicine would have thoughts about it. I do not care. He is good company and he is there every morning for the walk through the woods that keeps me sane. He is also occasionally awake during the night, which means I am occasionally awake during the night, which means my sleep data is not the pristine eight-hour pattern that would appear in a textbook on sleep hygiene.

The consulting reality nobody discusses

I work with clients when they are free. This is how consulting works when you are not in a clinic or gym with fixed appointment slots. It means working across the full range of the day — early morning, lunchtime, evening. It means that Monday to Friday, the window for eating a proper meal at a proper time and training without a clock running does not reliably exist.

Someone who has not run a consulting practice sometimes assumes that working from home means flexibility. It means a different kind of constraint. The lunchtime appointment does not move because I am hungry. The late afternoon call does not shorten because I want to train. And the constraints on the food itself are specific in a way that is rarely discussed: if I am sitting across from a client — or on a screen in front of them — talking about their health, I need to have eaten something that does not smell, that does not require a thirty-minute preparation window, that I could consume in ten minutes between one call ending and another beginning. Cold food. Easy-to-chew food. Food that did not involve garlic at any stage of its preparation.

Training has a similar constraint. The length and intensity of a session is partly determined by whether I have time for a shower before a client sees me. This is not a complaint. It is a real variable that affects the decisions I make about what to do, when, and for how long.

The "always eating" observation

Clients sometimes comment that I am always eating. I am, in the sense that when a window opens, I take it. A handful of something between calls. A proper meal at an unusual time. The calorie total by the end of the day is what it needs to be; it just arrives in an irregular pattern that does not resemble the breakfast-lunch-dinner structure that a nine-to-five working day permits.

The observation is usually made with a subtext: you can afford to eat freely because you're thin. And it contains within it something worth examining directly — the assumption that thinness is evidence of easy virtue or easy circumstances, and that the person watching me eat is in a harder position because they are managing a weight concern.

I would gently suggest that the harder position might actually be the guilt-and-abstinence cycle that many people with a fat-loss primary goal are running. The restriction followed by the breaking of restriction followed by the guilt about breaking it — the framework where food is something to be earned or managed or feared rather than chosen and enjoyed and apportioned to need. That framework is exhausting and it is counterproductive and it is not what I am doing when I eat between clients. I am eating because I am hungry and because there is five minutes before the next call and because my blood sugar does not benefit from a four-hour gap between anything.

The rescuer pattern — and what it costs

There is a character style in clinical psychology called the rescuer. It is not a pejorative — it describes someone who is orientated toward solving problems, who finds it genuinely difficult to leave a situation without attempting to help, who gives more of themselves in a clinical relationship than the strict parameters of the role require. I know this is my pattern. Thirty-seven years of clinical practice and a personality that finds it very hard to hear someone's difficulty and not try to address it means I routinely give more than I am paid for — more follow-up, more thinking time after the session ends, more engagement with the complexity of a situation than a more boundaried practitioner would permit themselves.

This is not a virtue. It is a character trait with clinical consequences, and one of those consequences is that the emotional and cognitive load of clinical work — absorbing other people's difficulties, thinking about their situations outside consulting hours, caring about outcomes in a way that takes up real mental bandwidth — is higher than it might be for someone with a different style.

That load is real. It does not appear in any blood panel either.

Why I test — and what it tells me

I do not tell you this to invite sympathy. There is always someone with a more difficult situation. One person's difficult week is another person's ordinary Tuesday, and stress is genuinely a matter of perception and resource. What I find difficult, someone else would manage without blinking. What someone else finds straightforward, I might find genuinely hard. That is not a hierarchy. That is biology meeting biography.

What I do with the list above is test. I test my cortisol pattern — the DUTCH gives me the diurnal rhythm, the cortisol awakening response, the metabolite picture that tells me whether I am in early HPA compensation or moving toward depletion. I test my blood chemistry — the fasting insulin that tells me whether the irregular eating and the late hours are affecting my glucose regulation more than my weight suggests, the ferritin that tells me whether the training load is eroding my iron stores, the thyroid panel that tells me whether the chronic background stress load is suppressing my T4 to T3 conversion. I test when my circumstances change — when a parent's health deteriorates, when a major project ends, when a long period of late nights has run its course.

The testing does not make the stressors go away. My father still has dementia. My daughter is still in America. The late nights still happen. But the testing tells me where I am in the physiological consequence of all of it — whether my cortisol pattern is intact or disrupted, whether my nutritional status is holding or depleting, whether I need to do less or differently or more carefully for a period.

That is the point of the TDG framework applied to my own life: not the elimination of stress, which is not available to anyone living a real life with real relationships and real responsibilities — but the precision to know what the stress is doing, and the ability to address the actual biological consequence rather than guessing.

It is not alright for me. It is managed. Those are different things.