One of my favorite movie lines comes from “Little Big Man” when Chief Dan George’s character comes down after the mountain after going there to die and says, “Sometimes the magic works, sometimes it doesn’t.” This line comes to mind when I see the magical thinking in much of what many believe will make everything different for fat people.
For everything problematic, and much which is not problematic, in fat people’s lives the universal remedy is to lose weight. Lose weight and there will no longer be any of the stares or other negative emotional effects of being fat.Therapists routinely urge fat patients to lose weight in order to be “healthy”. And given the massive stigma, common sense would seem to suggest that losing weight would make people happier. Except for one little thing. New research suggests that losing weight does not improve mental health, a finding entirely unexpected by the researchers Sarah Jackson and colleagues. In their study, they found for fat people who are otherwise healthy and not depressed, at the end of 4 years the proportion of participants with depressed mood increased by almost 300% in the group that lost weight (about 15% of participants) compared to a rather modest 85% and 62% increase in mood problems in the weight stable or weight gain groups, respectively. This flies directly in the face of what is commonly believed and in fact what most therapists would believe to be the case. These researchers suggest that these findings arise from:
Taking the summer off from blogging was not the plan but it does seem to have happened anyway. I didn’t go anywhere. I spent my summer here in Maine enjoying our short but glorious season. This year we had not even one day above 90F — that kind of heat is not the stuff of a Maine summer any year but usually we have a few hot days but this year, we had a lot of rain and nice days in the 70’s and 80’s. Heavenly. This is what greeted me this morning — and even now, at 3 pm, we are pretty much socked in and it is a bit chilly and very very muggy.
Not a great day for sailing. And it feels to me a signal that summer really is over.
This summer I learned that an essay I wrote, “The Fat Lady Sings” was accepted by the Jungian journal Spring and can be read in the fall 2014 issue on Women’s Voices.
And the book I have been working on for 4 years? This summer I completed the first draft and this past week the second draft. By the first of the year I plan to have submitted it to a couple of places for publication. And if they reject it, I’ll try a couple more. And if push comes to shove and no conventional publisher accepts it, I think I would self-publish via Amazon. It feels huge just to have completed it. And still feel pretty good about it. I have several trusted people reading it now and will use their feedback for draft 3.
I have been working a lot on my book this past week, reorganizing, revising, editing, writing. Energized and excited about this project that I have been laboring on for over 3 years. I came to editing this portion:
"For a fat person, for me, to be whole as I am, I have to come to terms with the body I have — embrace it, inhabit it, cherish it, live fully in it — and do the work of minimizing the negative effects of those complexes. The complexes Marion Woodman writes about are not unique to fat people, though being fat brings another dimension to them because of cultural stigma attached to it.
I write these words and I feel brave and full of hope that I can have freedom, wholeness in a combination of fat acceptance and working through my complexes. And I have moments of patting myself on the back. Then I bump into it all again and I find myself feeling ugly, ashamed of my body, outside of life. All it takes is an instant of terrible self-consciousness and there I am. In my head I hear Leonard Cohen singing "Everybody knows...". Everybody knows fat women are ridiculous, ugly, undesirable. Everybody knows that.”
I have always been interested in the hows and whys of therapists’ offices. How and why they decorate them s they do. Where they locate the office. Home vs office away from home. Even what they call it — office, consulting room or as I have seen at least one Italian analyst describe as his studio. I played with collecting data to write about this very thing some years ago and sent a survey to around 20 therapists of different theoretical persuasions. Other things came along to catch my attention but I did learn from my small sample that depth therapists thought about their offices interns of how the space feels to be in and those more behaviorally oriented expressed more concern about parking and access to public transportation. I have strived to have my own office be a calm inviting space. soothing and comfortable. This is how it looks now:
This week the film Fed Up has been everywhere in the news.
Fed Up is a 2014 American documentary film directed, written and produced by Stephanie Soechtig. American journalist and TV personality Katie Couric also produced and narrates the documentary. The film premiered in competition category of U.S. Documentary Competition program at the 2014 Sundance Film Festival on January 19, 2014...The film explains how, since the U.S. government issued its first dietary guidelines 30 years ago, the rate of obesity has skyrocketed. Generations of kids will live shorter lives than their parents.
And I am fed up with Fed Up! So I went looking for reviews of the film that look at it with even a slightly critical eye. I found none in the available newspaper film reviews that I could locate. This did not surprise me because I expect for the most part such reviews to align with the dominant paradigm which is to see fat as the root of much evil afflicting us.
Fat has been medicalized into “obesity”. But this does not remove it from also being seen as a moral issue. To be fat is to be identified as gluttonous and slothful, guilty of two of the seven deadly sins as well as being emblematic of pathology, both psychological and physical. Francine Prose in her little book from The Seeven Deadly Sins series writes:
our fixation on health, our quasi-obscene fascination with illness and death, and our fond, impossible hope that diet and exercise will enable us to live forever have demonized eating in general and overeating in particular. Health consciousness and a culture fixated on death have transformed gluttony from a sin that leads to other sins into an illness that leads to other illnesses.
That there are gluttonous thin people and slothful thin people matters not at all as they do not wear their “sins” as fat people appear to. The operative assumption seems to be that slender people are slender because the ways they eat and exercise are the right ways to maintain their body size. And this means that fat people must eat differently or different foods and not exercise because otherwise they too would be slender. This assumption is fixed and seemingly unchangeable. How often have you heard that if a fat person would only eat 100 fewer calories each day, then by year’s end she would weigh 10 pounds less, as if the oft quoted 3500 calories = 1 pound is absolutely and always true? Get those fat people to reign in their appetites, eat less and move more and then they too could be slender. In an article in the New England Journal of Medicine examining common myths about obesity, the authors state:
In her most recent book, The Mystery of Analytical Work, Barbara Stevens Sullivan brings together Jung and Bion. In my own practice I have tried for many years to hew to Bion's dictum to approach each patient, each hour without memory, desire or understanding. Sullivan does a lovely job of explicating what this means in practice. I find eschewing desire to be especially important. This means setting aside any agenda for the patient, any wish that I have about the patient. To quote her:
"A desire to help the patient is similar: is the patient inducing in me a subjective sense of helplessness or weakness? Is he bringing up a savior complex or sadistically rubbing my nose in the “helplessness” I feel when faced with his “extraordinary” pain? In wanting to help, am I unconsciously striving to exclude some level of suffering that is trying to enter the room? The desire to help the patient will mean something slightly different every time it comes up, even with the same patient, let alone with different people. But whatever its precipitant, the desire blinds the analyst to the ways the patient needs to be seen and accepted in his wounded condition, as is, before he can begin to let it go (Sullivan, 1989). This desire to help is a particularly seductive one. Our patients want us to help them and most therapists entered the field out of a conscious wish to help people. But it is important to let go of the wish because, as far as we can tell, it is usually not helpful to try to help. Trying to understand the patient as he is generally loosens his character structure and begins or reinforces a growth process inside him that leads to positive (“helpful”) developments in his inner world."
Most therapists fall prey to the same bias against fat that we see in other health professionals, thus are unable to set aside their own agenda about weight and simply listen to the patient and her experience.
"Therapists are easily or subtly prey to the cultural mandates for the female body...This mandate is...fat phobic, obsessed with bodily control, in revolt against aging and it's concomitant bodily changes, outraged at and contemptuous of the imperfect out-of-control body and repulsed by immodest female appetites and hunger.”*
Many, if not most therapists hold a deeply held conviction that their agenda about weight is the correct agenda when it comes to dealing with a fat patient — i.e. the belief that the only way for such a patient to be healthy is to lose weight and that losing weight is a worthy and important goal in therapy no matter what the patient wants or believes. In this approach, where is there room for that patient to give voice to her feelings, her desires, her complicated feelings about her body, her weight, dieting, being policed and always under scrutiny? Can she even be a “good” patient if she departs from the therapists’s view? How can she get support in finding what is truly best for her or what she herself wants if her therapist cannot be without desire?
Nearly every turn in the road turns up a new wrinkle in fat acceptance for me. While I have been able to come to terms with my body, still I wished for my daughter that she not have to contend with being fat, not because I feel fat is bad but because I know how hard it is to be out of step with the culture.
You see that beautiful little girl in that photo? She was 2 years old there. I was delighted beyond measure when she was born. I always wanted a daughter, in part I'm sure to redeem my experience with my mother. To me she was and is the most wonderful daughter ever -- smart, funny, and beautiful -- everything I could hope for.
Remember all the efforts Sleeping Beauty's parents made to keep her from the curse placed on her at birth, that she would prick her finger on a spindle? Well, knowing my body and how like the Fuller women I am, I was afraid that my daughter faced the curse of having to battle her weight all of her life. And I was determined to do anything and everything I could to protect her from it.
Most therapists that I know will say they entered the field at least partly out of a desire to help people. It’s hard to sit with someone who is crying or angry or yearning and not want to do something to make them feel better. But most of the time if that desire to do something is acted upon, the outcome is not what we hope. For me, this is a lesson I have had to learn again and again.
I have been thinking about this a lot lately. What comes to me was the image of an infant in the throes of colic. You try everything to make them stop because that cry is distressing, because it makes you feel impotent and frustrated and even angry. Rock the baby. Pat the baby. Sing. Take her for a ride in the car. Anything and everything that you hope will soothe her and end that crying. Really none of those things is magic — she stops when she stops. Finally you just have to be able to be with the baby, to be a steady presence without acting out your own distress. You have to be with her, hold her and hold the feelings. I remember coming to that place with my babies and recognize that really that is what I need to do with my distressed patients. I can’t make the hurt go away. I can’t give them the magic interpretation that will solve everything. I can’t make it all better. I have to sit with them in their feelings, be with them in those feelings.
Recently I read again two excellent posts on Obesity Timebomb -- Rad Fatty: Corinna Tomrley and Susie Orbach at ASDAH. In both, some justified angry swipes at Orbach are taken but I keep feeling that in rejecting everything Orbach says, the baby is thrown out with the bathwater.
Charlotte Cooper makes a legitimate point when she says, "What makes the psychological pathologising of fat people particularly pernicious is that although it is based on nothing but speculation, it is very difficult to refute, indeed denial only strengthens its grip." This is at the heart of a lot of my arguments with Marion Woodman, even though I cannot avoid seeing some truth in what she writes.
Or consider this by Sam Keen:
Till the Fat Lady Sings.
I was just coming out of the men’s room in the San Francisco airport when she waddled toward me. Her two hundred and fifty plus pounds was distributed over her short frame in way that made her appear nearly round, but her loosely draped, dappled paisley silk lent a hint of elegance to her movement. All by herself she was a parade of mammoth and grotesque proportions
For the last several weeks it seems my muse has been away on vacation, or at least not urging me here. This happens sometimes. This blog is now seven years old and the likelihood that I will have something new and/or interesting to say every day or even three or four times a week has decreased.
But some of this I realized as I thought about it this morning is what I see as a widening gap between what I do and believe in and what mainstream mental health is about these days. I read Mad in America regularly and I cheer on those who are advocating alternative treatment for those with serious mental illness. I read articles like The Antidepressant Generation which ran recently in the New York Times. Yes, yes and yes, I say again and again.
I still get email from readers who find me because of my writing about HBO’s In Treatment. People like Paul and the way he works with his patients. But they don’t see that he is not having to get insurance authorization or be concerned about which diagnosis will allow his patients to see him for as long as he and they believe is needed vs what the insurance company wants to pay for or what happens when a new year and having to again meet the deductible comes. They don’t see patients on multiple psychotropic drugs being seen for 15 minute medication checks. Or the delays in payments from insurance companies that most therapists accepting third party payment experience regularly. What they see is a basically good therapist doing his best to deal with issues in his life while also being as present as he can be to his patients.