Jung At Heart Archive May 2009

Fat Betty

A few days ago a friend reminded me of  an essay written by Irving Yalom, "Fat Lady". I read it when the book, Love's Executioner back in 1989. The essay bothered me then and now it has surfaced in my consciousness again, still bothering me. A Google search tells me that this piece is used in a variety of training programs and it seems usually there is praise that Yalom admitted his bias. But I have a different thought.  

The following passage opens Yalom's story, ‚"Fat Lady". In this story, Yalom, a psychiatrist, tells how he treated his obese patient, Betty, and how this process helped her lose nearly 100 pounds.  

“The day Betty entered my office, the instant I saw her steering her ponderous two-hundred-fifty-pound, five-foot-two-inch frame toward my trim, high-tech office chair, I knew that a great trial of countertransference was in store for me.  

I have always been repelled by fat women. I find them disgusting: their absurd sidewise waddle, their absence of body contour ‚ breasts, laps, buttocks, shoulders, jawlines, cheekbones, everything, everything I like to see in a woman, obscured in an avalanche of flesh. And I hate their clothes ‚ the shapeless, baggy dresses or, worse, the stiff elephantine blue jeans with the barrel thighs. How dare they impose that body on the rest of us?  

The origins of these sorry feelings? I have never thought to inquire. So deep do they run that I never considered them prejudice. But were an explanation demanded of me, I suppose I could point to the family of fat, controlling women, including ‚ featuring  my mother, who peopled my early life. Obesity, endemic in my family, was a part of what I had to leave behind when I, a driven, ambitious, first-generation American-born, decided to shake forever from my feet the dust of the Russian shtetl.  

I can take other guesses. I have always admired, perhaps more than many men, the woman’s body. No, not just admired: I have elevated, idealized, ecstacized it to a level and a goal that exceeds all reason. Do I resent the fat woman for her desecration of my desire, for bloating and profaning each lovely feature that I cherish? For stripping away my sweet illusion and revealing its base of flesh, flesh on the rampage?  

I grew up in racially segregated Washington, D.C., the only son of the only white family in the midst of a black neighborhood. In the streets, the black attacked me for my whiteness, and in school, the white attacked me for my Jewishness. But there was always fatness, the fat kids, the big asses, the butts of jokes, those last chosen for athletic teams, those unable to run the circle of the athletic track. I needed someone to hate, too. Maybe that was where I learned it.  

Of course, I am not alone in my bias. Cultural reinforcement is everywhere. Who ever has a kind word for the fat lady? But my contempt surpasses all cultural norms. Early in my career, I worked in a maximum security prison where the least heinous offense committed by any of my patients was a simple, single murder. Yet I had little difficulty accepting those patients, attempting to understand them, and finding ways to be supportive.  

But when I see a fat lady eat, I move down a couple of rungs on the ladder of human understanding. I want to tear the food away. To push her face into the ice cream. “Stop stuffing yourself! Haven’t you had enough, for Chrissakes?‚” I’d like to wire her jaws shut!  

Poor Betty, thank God, thank God, knew none of this as she innocently continued her course toward my chair, slowly lowered her body, arranged her folds and, with her feet not quite reaching the floor, looked up at me expectantly.”  

From Ivin Yalom, Love's Executioner Basic Books, 1989 pp.94-95  

There is no question that openly admitting such strong prejudice, such clear countertransference, takes some courage. But then again, it is acceptable to hate fat and to think ill of fat people so there was little chance of serious criticism except from the fat acceptance folks who could be dismissed as defensive. Nevertheless, I do hand it to Yalom for saying out loud what I am quite certain that many therapists feel and never speak.  

The essay goes on to talk about the process of therapy, of Betty's depression, and her weight loss, which by the time treatment ends amounts to 100 pounds. And of course the consensus is that because she lost so much weight, this therapy was spectacularly successful.  

At the end of the essay, Yalom writes:  

“It’s the same with me, Betty. I’ll miss our meetings. But I’m changed as a result of knowing you .”  

She had been crying, her eyes downcast, but at my words she stopped sobbing and looked toward me, expectantly.  

"And, even though we won’t meet again, I’ll still retain that change.”  

“What change?”  

“Well, as I mentioned to you, I hadn’t had much professional experience with the problem of obesity.” I noted Betty’s eyes drop with disappointment and silently berated myself for being so impersonal.  

“Well, what I mean is that I hadn’t worked before with heavy patients, and I’ve gotten a new appreciation for the problems of.. “ I could see from her expression that she was sinking even deeper into disappointment. “What I mean is that my attitude about obesity has changed a lot. When we started I personally didn’t feel comfortable with obese people.” In unusually feisty terms, Betty interrupted me. “Ho! ho! ho! Didn’t feel comfortable. that’s putting it mildly. Do you know that for the first six months you hardly ever looked at me? And in a whole year and a half you’ve never, not once, touched me? Not even for a handshake!”  

My heart sank. My God, she’s right! I have never touched her. I simply hadn’t realized it. And I guess I didn’t look at her very often either. I hadn’t expected her to notice!”  

From Love's Executioner, p. 123.  

How naive for Yalom to think that Betty hadn't known all along of his distaste, for having lived in world of people who shared his feelings of disgust, she was an expert at detecting it and doing what she could to minimize herself as a target for their scorn. And in her rebuke, she points out that in fact he has changed far less than he imagines.  

I wonder what Betty is like now, 20 years later. The chances are very good that she has gained back all 100 pounds and maybe added more, because that's what happens with repeated dieting as each diet  leads to gaining more than was lost in a cruel slap at the efforts to tame the flesh. Or maybe she has now had bariatric surgery. Or maybe she is in that tiny minority who succeeded in maintaining that weight loss. But no one ever questioned why she would lose weight and what the effect of a therapist filled with contempt and disgust for her body would have on her feelings about herself. If even one's therapist finds one repulsive, what hope is there after all?  

Honesty compels me to acknowledge that I am a fat woman. So I know what it is like to sit in Betty's place and I also know, as a therapist, what it is like to be confronted by one's shadow in the person of the patient who has come to see me.  

How is a fat person, who, no matter the reasons for being fat, certainly has a whole host of emotional issues about her size and her body -- how is such a person to find the courage to talk about those feelings in the presence of someone who finds her as disgusting as she herself often does? How can she roar her anger at the prejudice she encounters? How is she to arrive at being able to care about her body and for herself lovingly rather than with contempt and hatred? And supposing she doesn't want to devote herself to losing all that weight? Supposing she wants to get off the diet merry-go-round and concentrate on being healthy and fat (and yes, that is possible)?  

The operative assumption is that in a room with a normal weight therapist and a fat patient, that only the patient has a problem is, it seems to me, a very weak one. And I wonder what other unchecked assumptions that we therapists have need to be taken out into the open and wrestled with? 


A Medea or A Saint?

Let me start this post by saying that I am and have been a great admirer of Elizabeth Edwards since the 2004 campaign. And, while he was in the race, I was a supporter of John Edwards also, because of his willingness to speak for the poor. But something has been nagging at me since the flurry of interviews with Elizabeth has been appearing. And that something crystallized for me when I watched the first part of Charlie Rose's interview with her Thursday night. I did my dissertation on Medea and the Medea complex, which I believe is often in play when a woman feels betrayed. And I believe that there is an element of it in play now with John and Elizabeth Edwards.

What brought this into focus for me was the following:

"I believed we had a marriage in which this could not happen" -- Elizabeth Edwards on Charlie Rose, May 14

So let's look at Elizabeth Edwards' book in light of Medea.

The pattern Medea follows to get her man—the woman who falls in love with the heroic man and gives up her independent life to serve her lover’s life—is a familiar theme among women, To Medea, the promise Jason makes to her in return for her assistance in gaining the Golden Fleece is binding. Medea is a foreigner, from Colchis. In her culture, oaths have the strength of law whereas Jason, the Greek, is from a culture of law. In essence they speak the same words with different meanings. “Medea and Jason are not members of the same speech community; coming from different communities and even different strata of history, it seems likely that they never shared the same assumptions about oaths—hence the impossibility of their successfully swearing an oath together”(Rabinowitz, p. 138).  For her, the sacrifice of her home and family  in exchange for marriage to Jason is binding and permanent and any deviance from it is betrayal of an immeasurable kind. “The oldest doctrine was that oath-breaking was twin to kin murder, these two being initially the only crimes of interest to the pre-Olympian divinities”(Burnett,  p. 13).

"We can be truly betrayed only where we truly trust – by brothers, lovers, wives, husbands, not by enemies, not by strangers. The greater the love and loyalty, the involvement and commitment, the greater the betrayal. Trust has in it the seed of betrayal; the serpent was in the garden from the beginning…Trust and the possibility of betrayal come into the world at the same moment" (Hillman,  p. 66).

The depth of the betrayal is directly related to the importance of the relationship and the degree to which one trusts the other. Medea has told us she believed in, trusted in the integrity and strength of the oaths that she and Jason swore to each other, and having fulfilled her part of the bargain, assumed and expected that Jason would also, not only while it was convenient but for the rest of their lives.

To believe that one can count on another to never hurt or betray or violate trust in any way is naïve and is to live in a bubble of unreality. Primal trust, arising from the relationship between infant and mother, even that trust, gets broken as the mother does not come immediately to soothe the infant or fails to correctly identify the source of difficulty. Development requires betrayal in order to develop tolerance for the frustration of ordinary failures in relationship and the resilience to not only survive but learn from them. “The broken promise is a breakthrough of life in the world of Logos security, where the order of everything can be depended upon and the past guarantees the future.” (Hillman, p. 71) Medea’s belief in the inviolability of the oath sworn by Jason is her own Apollonian aspect come into play, a vesting of power in word. It calls forth the chaos of Dionysus in Jason with his betrayal, which smashes open the fragile vessel of their marriage.

Edwards, in her conversation with Rose, talks about the reality that some 70% of marriages do not survive the death of a child and that she thought because they had, they did not have to worry, that they were over the worst thing that could happen.

Betrayal, in breaking trust and breaking open the vessel, affords an opportunity for increased consciousness and understanding. However, we cannot assume that betrayal alone brings increased awareness as “marriages are full of betrayals committed but not comprehended—in which case, there can be no transformation.” (Carotenuto, 1996, p. 76). Marriage offers the opportunity, through the process of engaging with another and dealing with the negotiation of differences, to retrieve and make conscious that which has been projected out onto the partner. This is a painful and deflating process, as it requires the increasing awareness of one’s own dark side or shadow. 

Neither Medea nor Jason changes much in their marriage, except that they become more of what they were to begin with. Rather than becoming deeper and fuller through the process of being married, they each become more one-sided. Jason becomes even more ambitious, more out of touch with his feelings and the feelings of others, as we see in his response to Medea. While the deeds committed by Medea for him were hers, she did them explicitly for Jason and thus, they belong to him as well as to her, though he claims no responsibility for them. Jason, through his willful blindness, remains unaware of his own shadow and believes himself unsullied by his wife’s actions. Medea, though more aware of herself than Jason, changes only in that the enchantment with her hero is broken and her trust in their oaths shattered. There is no indication that she learns from this experience that at the point of choosing Jason, the wanting to be wanted by him, is the beginning of her responsibility for what has happened. Blinded by her rage at having been betrayed, she sees only Jason’s guilt and none of her own.

In his play, Medea, Brendan Kennelly has her say:

Do you believe that men and women

are now living under a new heartless, mindless morality?

Unhappiness is the willful forsaking of the proven ways.

An oath is an oath.

Break an oath and the agile demons

of unhappiness leap through your

eyes and mind

and consume your soul.


As Carotenuto (1996) points out, a near-inevitable point in the process of dealing with betrayal is “Why did he do it?” or “What did I do wrong?” The betrayed feels that the act was personal, aimed directly at the one betrayed, a deliberate attempt to wound in a most vulnerable place. Medea is no different. In her mind, Jason’s betrayal is personal because she does not want to see that foremost for him all along has been his ambition, his quest, that the oath was sworn to achieve his goals, the marriage made because of business more than desire. The impact of betrayal is devastating, shattering the foundation of the relationship. The betrayer and the betrayed have been locked into an impossible relationship, a state of fusion in which each is expected to remain perfectly true. The one betrayed is as one abandoned. The pain is visceral – Medea laments, “A lost woman is a problem. Jason, answer me this. Where am I to turn?”(Kennelly, 1991, p. 37). For Jason, that Medea would experience his choice to marry Glauke as a betrayal, as pain never entered the equation. In this, as in all of his choices, benefit to Jason has been the determining factor, not love. “All things considered, having asked everything of our partner, we are also convinced we have given everything. We do not realize that it is precisely in that request and the absolute surrender of ourselves that the seed of imminent abandonment lies, one of the possible forms of which is betrayal.” (Carotenuto, p. 88)   

"Every psychological extreme secretly contains its own opposite or stands in some sort of intimate and essential relation to it. Indeed it is from this tension that it derives its peculiar dynamism. There is no hallowed custom that cannot on occasion turn into its opposite, and the more extreme a position is, the more easily may we expect an enantiodromia, a conversion of something into its opposite" (Jung, para. 581).

Certainly, we can see this in Medea, as her love for Jason turns to hatred and rage. Even in this, the potential for forgiveness is not lost, if the partners, in confronting their own previously hidden dark and negative feelings, can own them and integrate them into the relationship. However, to do so is to forever forego the paradise of the idealized relationship, where love and harmony are valued above all else and where hatred and rage are experienced as alien and demonic. The confrontation with what has previously been projected outward – which means becoming aware of and owning shadow aspects that have been projected onto the partner – expands consciousness and offers the potential for the kind of marriage that Jung envisioned as the coniunctio. Neither Medea nor Jason succeeds in this.

There can be no doubt that revenge is the path that Medea’s response to betrayal takes.  In her final encounter with Jason, after the deaths of the children, Medea shoots her last arrows at him.

                                                I have done it: because I loathed you more

        Than I loved them. Mine is the triumph. 


     I would still laugh…I’d still be joyful

     To know that every bone of your life is broken; you are left

hopeless, friendless, mateless, childless.


        Go down to your ship Argo and weep

beside it, that rotting hulk on the harbor –beach

Drawn dry astrand, never to be launched again – even the weeds

and barnacles on the warped keel

Are dead and stink: --that’s your last companion—

    And only hope: for some time one of the rotting timbers

Will fall on your head and kill you—meanwhile sit there

and mourn, remembering the infinite evil, and the good

That has turned evil... 


You had love

and betrayed it; now of all men

You are utterly the most miserable. As I of women.

     But I, a woman, a foreigner, alone

Against you and the might of Corinth—have met you throat

      for throat, evil for evil. Now I go forth

Under the cold eyes of the weakness-despising stars: --not me   

  they scorn. (Jeffers, p. 189- 191)



Revenge can be quite satisfying because it allows one to feel that a score has been settled. However, revenge does not lead to anything new or to expanded consciousness or relationship. Medea wants to even the score with Jason, to strike him where he will hurt, as she has been hurt.  Kennelly tells us, “Medea, as I imagined her, plans to educate Jason in the consciousness of horror; she destroys his world but leaves him intact; and she instructs him very calmly and lucidly in the appalling consequences of this intactness…Medea, as I see her, inflicts on Jason the ultimate cruelty: she sentences him to life.”(Kennelly, p.8) In not leaving John but choosing to remain married to him and in talking about what a good man he is at the same time that she reveals with a surgical precision the details of what happened in their marriage, Elizabeth, like Medea, destroys his world while leaving him intact. 

Jason’s part of Medea’s story ends with him sitting on the beach under the hulk of the Argo, now wrecked and decaying. Unlike other Greek heroes – Herakles for example—Jason does not become an immortal but instead dies when the oak timber which was carved into a figurehead from his ship falls upon his head (Graves, 1944, p. 370). Jason’s failure to move out of his one-sidedness and commitment to his ambitions leads finally to his death.

There is no question that Elizabeth Edwards' anger is justified. But in making this sad chapter in their marriage a focal point in her book, she manages to step into the web of the Medea complex. Though she told Charlie Rose she wrote the book because she wants her children to know about her marriage and her husband from her, that really doesn't work as a reason given that she could have written about it all just for them. But in publishing it, she opens them to having to deal with gossip and innuendo in addition to the death of their mother, which may well occur before the children are old enough to apprehend any of this. And the book conclusively eliminates all but the remotest possibility of a political future for John, no matter how far in the future he might try. So in her way she leaves John sitting on the beach next to the wreckage of his career much as Medea left Jason. And much of the public will see his fate as deserved and her as the innocent. But is it ever that simple?




Burnett, A. (1973). Medea and the Tragedy of Revenge. Classical Philology, 68, 1-24.

Carotenuto, A. (1996). To Love, To Betray. Evanston, IL: Chiron Books.

Hillman, J. (1976). Loose Ends. Dallas Spring Publications.

Jeffers, R. (1970). Medea. NY: New Directions Books.

Jung, C. G. (1967). Collected Works of C.G. Jung, Vol. 5 2nd ed. Princeton, NJ: Princeton University Press.

Kennelly, B. (1991). Euripides' Medea, a New Version. Newcastle upon Tyne, UK: Bloodaxe Books.

Rabinowitz, N. S. (1993). Anxiety Veiled. Ithaca, NY Cornell University Press.

Vaughan, D. (1986). Uncoupling. Oxford, UK: Oxford University Press.



Rules

I have received a number of comments and emails about Paul, of In Treatment, accompanying April to her first chemotherapy session. Most of the questions and comments seemed concerned with whether or not this constituted a breaking of the rules of therapy.

Many years ago when I first started in analysis, my analyst used to tell me that there were no rules. Now I was absolutely certain there were rules and further I wanted to know them so that I could follow them or at least know when I was breaking them. We went round and round on this because I could not then wrap my mind around what he meant.

Jung, in a letter to J.H. van der Hoop, wrote:

I can only hope and wish that no one becomes "Jungian." I stand for no doctrine, bt describe facts and put forth certain views which I hold worthy of discussion. I criticize Freudian psychology for a certain rigid, sectarian spirit of intolerance and fanaticism. I proclaim a cut-and-dried doctrine and I abhor "blind adherents." I leave everyone free to deal with the fact in his own way, since I also claim this freedom for myself. (Jung, CW, Vol. 1, p. 405)

This does not mean that rules should be abandoned or that they have no value, only that they must not become what analysis is all about. In the Freudian world over the years there has been concern about "wild analysis", that is analysis which deviates from Freud's methods and theory and done by those who were not trained as analysts. But Freud himself did not always adhere to the technique we regard as Freudian -- i.e. on the couch with analyst behind the patient. Indeed with one of his first patients, Freud conducted the analysis while he and his patient were on long walks through the city of Vienna!

Carotenuto says,

On occasion, when reading clinical reports, I have the distinct impression that I am reading lies, because expounding rather than describing what has actually been done is in fact stating what should have been done. (Carotenuto, The Difficult Art,p. 25)

Earlier in the discussion about note taking, I noted how risk management evolves to become the standard of care. Here again we have an example of a rule becoming not a guideline or point of measurement but a rigid structure. Having a fixed frame, meaning that the setting, fee and time remain constant, means having that structure available in order to have something to measure deviations against. And any such deviations need to be considered in light of what is best for the patient, though of course, that too can be a tricky area. However, if we accept that Paul has the April's best interests in mind, both generally and in terms of the therapy, then it begins to make sense that he chooses to take her to that first treatment.

In the very strictest sense of the frame, in the world of rigid rules, then what he did was a violation. But in the world he is operating in, with a patient with a life-threatening illness, then taking her becomes a reasonable action. It does open the risk of a complaint against him for acting outside the realm of the usual -- if April becomes unhappy with him and the therapy for some reason, for example -- but sometimes that is a risk worth taking. If one practices always with risk management in mind, then one certainly is far less likely to be sued or have complaints made, but that does not mean that such therapists are necessarily taking into account the best interests of the patient, unless they assume that those interests are coincident with their own.

It's tricky. It's a judgment call. And one that will require be willing to talk about it with the patient and work through whatever comes up because of this deviation. Fortunately, we are very very seldom faced with a dilemma like that Paul has with April. 

There are certain behaviors which must be fenced off and rules out no matter what -- like illegal conduct of any kind and sexual acting out. There isn't a way to make either in the best interests of the patient, not really. So those issues go behind a wall that cannot be breached. And the rest of the rules? Well, it falls to the therapist and the patient to deal with them together, talk about them, wrestle with them, become conscious of underlying issues. In other words, make them a part of the therapy.

Actor's Dreams

It's always nice to see some way that the insights of Jung are finding new applications. This week the NY Times reported that actors are turning to Jungian dream work methods to help them develop characters --

"In the last decade, dream work, as it is known, has spread into actors studios and classrooms across the country, taking its place among the ever expanding techniques of actor training and in the long-running debate over what leads to the most authentic performances.

Dream work grew largely out of Method acting, and it is now being taught at the New York home of the Method, the Actors Studio, and by several teachers in Los Angeles and elsewhere.

Teachers say that at least 1,000 actors have been trained so far and that interest is growing in the technique, which is inspired by the theories of Carl Jung, who believed that dreams are the expression of the unconscious, and the images and symbols in them communicate crucial information to the conscious mind."


In Treatment

There won't be any new episodes of In Treatment  next week, as HBO will be showing its miniseries on Alzheimers. New episodes resume on May 17.

It's not so bad

Behind the Couch had an interesting post the other day about shame and the psychotherapist. Interesting because it seems no one thinks much about some of the issues that being a therapist raises. A couple of them jumped out at me --

I stopped saying much about what I do when I am out and about socially because not much brings silence to a group than saying, "I am a psychotherapist." People seem to think that it means I am always "on", always watching others as I do my patients. I developed a flippant habit of saying, when someone would remark that I must think they are all crazy, "Don't worry, I only work when I get paid." Which may ease the tension but never feels right in the saying and comes off sounding kind of cold. When I am out with friends or at a social gathering, I just want to be able to be there as myself, who happens to work as a psychotherapist but who also frets about my garden, knits, likes to cook, read novels, and complain about my kids from time to time.

I am not put off at all by the way therapists are portrayed in movies and the like. In Treatment stands out for me because it is pretty good at showing how things are. But the others? I don't worry about them. I hope to teach a course at the Senior College here sometime called Shrinks on Film and look at some of the ways therapy has been shown in movies. I think I will start with What About Bob?


We are a motley lot, we psychotherapists are. We all do something similar but we come from a number of different professional directions -- medicine, psychology, social work, nursing, education. And we have varying degrees of identification with our basic professional group. I suppose this diversity of backgrounds is a strength of sorts but I believe that more it is a hindrance. Because we do not speak in a unified voice for ourselves and what we do. We engage in meaningless turf battles which has resulted in control of much of the field now resting with insurance companies and managed care rather than with those of us in practice.

A lot of psychotherapists have become kind of demoralized in the last 10 or 15 years as third parties have come more and more to determine what they could do. As therapy per se becomes less and less valued by these third party payers, incomes have dropped and some community clinics no longer even offer therapy at all. I suspect this will continue to be the case for those who practice in clinic settings or are dependent on insurance payments. A practice model which doesn't work all that well for physical medicine when applied to mental health and therapy becomes ludicrous, a mess of evidence-based treatments that aren't resting on good evidence, on outcome research that is only done with one modality. And on it goes.

And this is mostly our own fault -- or at least the fault of the folks who reman inside that system and who cling so stubbornly to turf that is shrinking by the day.

Still and all, for me, it is a privilege to be able to do the work I do. It's a minor thing to deal with the way people react when they know I am a therapist, extremely minor when compared to the intense satisfaction of being able to be a small part of the journey of the people I work with.



© Cheryl Fuller, 2007. All  rights reserved.