The Fruitless Quest

But who, if it comes to that, has fully realized that history is not contained in thick books but lives in our very blood? So long as a woman lives the life of the past she can never come into conflict with history. But no sooner does she begin to deviate, however slightly, from a cultural trend that has dominated the past than she encounters the full weight of historical inertia, and this unexpected shock may injure her, perhaps fatally. C.G. Jung1

There is a lot that Jung wrote about women that we might disagree with —I know I do. But I think he hits something important here. Think about what has happened to women who deviated from the course of things and choose to run for President. All have encountered exactly what Jung says above: But no sooner does she begin to deviate, however slightly, from a cultural trend that has dominated the past than she encounters the full weight of historical inertia.

Deviating from the cultural norm gets one tagged as pathological. In the West it is no longer the case that a woman is expected to eschew ambition and stay at home raising children and caring for the home. Though a considerable portion of people in the US still subscribe to the notion that a woman’s place is in the house, but not the House, it cannot be denied that our horizons are wider than they once were, wider even than when I was a young woman. But it is still expected that a woman conform to the image of ideal femininity, that is be slender and visually appealing, mostly to men.

If Thine Eye Offend Thee

Few of us realize that we do not see unmodified images of people, especially of women, in magazines, film, or television.  The images of those we see as ideals, as possessing the looks we should aspire to are not real. We do not see those woman as we would see them were we to encounter them in the supermarket or on the street. 

…it is the photographic image— both the moving image on TV and film and the still photograph— that has created the new visual grammar. Its effects should not be underestimated. They are changing the way we relate to our bodies. John Berger’s prescient statement that (bourgeois) women watch themselves being looked at has been transmuted into women assuming the gaze of the observer, looking at themselves from the outside and finding that they continually fail to meet the expectations our pervasive and persuasive visual culture demands.2

We are bombarded with altered images, thousands per week — images that convey an idea of a body which does not exist in the real world.  Cosmetic surgery as a means to attain this non-existent ideal has flourished in this environment. Cosmetic surgery as a consumer option is becoming normalized. In some communities women casually discuss, even compete over the procedures they will have. To not get one’s eyelids “done” or have Botox injections to smooth wrinkles, to not alter themselves is taken as a sign of self-neglect.

The surgeon, both authoritative and solicitous, becomes the arbiter on female beauty. As he acknowledges the pain his patients feel, he demonstrates how he can change different aspects of their body for them, enabling them to reach the beauty standard he has himself set. In his engagement with them, he gives them the body they could never imagine they would have. He is confident and persuasive. He responds to their wish with gravity but also as though they were choosing their dream holiday.2

The beauty industry and the diet industry reap profits in the billions of dollars each year as women pursue the hopeless quest of achieving the perfection of the images placed in front of us thousands of time each week, of sleek flawless bodies which seem never to age. It is also worth noting that 90% of cosmetic surgeons, the “arbiter[s] on female beauty”, are male and 90% of patients seeking such surgery are female.

The Wrong Body 

What does it mean when a person says she is in the wrong body?  We hear this most in an indirect way when any of the legions of women unhappy with their weight go on diet after diet in a largely fruitless quest to release the thin woman they believe lives inside them, a thin woman trapped in the wrong body. What does that mean? The effort to find “the right body” leads to all manner of surgical solutions, ranging from the cosmetic procedures to removal of most of the stomach in order to lose weight. In other words, the quest for the right body easily leads to mutilation of the existing body. Though little noted, bariatric surgery has an unexpected consequence of significantly elevated risk of suicide post-operatively. Among patients who have undergone bariatric surgery, the suicide rate is 6-7 times higher for people who have had the surgery than those who did not.3 Suicide risk in this group, people desperate to obtain and inhabit “the right body”, suggests that in at least a significant percentage of them, the body itself is not the problem. But in a society that finds efforts to pursue perfection through surgery acceptable if not admirable, there is little critical examination of what taking that pursuit to such dramatic lengths means nor of the inherent danger of the entire notion of the perfect body.

…the very problems the style industries diagnose are the same ones the beauty industry purports to fix. They are handmaidens in the process of deconstructing and reconstructing our bodies. And the purported fixes are offered as solutions which we can’t help but wish to take advantage of. The solutions entice us. We do not see ourselves as victims of an industry bent on exploiting us. In fact we are excited to engage with and reframe the problem: there is something wrong with me that with effort exercise, cash and vigilance— I can repair. I can make my offending body part( s) right.1

1.Jung, C.G., (1964). ‘Woman in Europe’. CW10, p. 130

2. Orbach, Susie. Bodies (BIG IDEAS//small books)

3. Castaneda, D., Popov, V.B., Wander, P. et al. Risk of Suicide and Self-harm Is Increased After Bariatric Surgery—a Systematic Review and Meta-analysis. OBES SURG 29, 322–333 (2019).

 The image above is a reproduction of a sculpture found in an alcove in an underground temple on the Island of Malta, dating back approximately 6,000 years ago.

Fat: Guidelines for Therapists

A note on nomenclature: I deliberately use the term “fat” not “obese”. In groups of people who have been marginalised on the basis of race or sexual orientation, an important part of claiming agency is declaring the right to choose what members call themselves. Similarly it is the practice in the fat community to reclaim the term “fat” from the pool of epithets directed against us, as segments of the gay community have reclaimed “queer”. Therefore in what follows, I use “fat” rather than “obese” except when quoting or referring to research reports.

I have been able to locate three sets of guidelines for therapists when dealing with patients with size issues — one published in the American Psychological Association’s Monitor, one by NAAFA, and the last by Marion Woodman. So let’s look at the first two. 

From the APA Monitor:

From the APA Monitor, a brief set of guidelines for therapists interested in being “size friendly” — it’s a short piece and seems to have been little noticed, though it was published in January 2004.

Here are the guidelines:

  • Don’t make assumptions about overweight clients, such as about whether they have an eating disorder or are working toward acceptance of their weight.
  •  Display size-friendly artwork or magazines–such as BBW Magazine–in your office or lounge.
  • Have seating in your office that can accommodate larger people. An example is armless chairs.
  • Raise your colleagues’ and students’ awareness by addressing these issues in formal and informal ways, such as during clinical supervision or in workshops. 
  •  Ask larger clients about eating behaviors in the same way you would ask a thin or average-sized person.
  • Through self-questioning and introspection, become aware of your own level of prejudice toward overweight people.
  • Educate yourself on issues that affect overweight people, such as the genetic influences of size and the effects of dieting on physical and mental health.
  • Understand that an overweight person’s problems are not always a result of their weight and that therapy does not bring thinness. Be aware that resolving life issues also does not necessarily result in weight loss.

From NAAFA:

Next, NAAFA(National Association to Advance Fat Acceptance ) has updated its guidelines for therapists. Here is their list of common assumptions for you to consider:

GUIDELINES FOR THERAPISTS WHO TREAT FAT CLIENTS

There are several assumptions, based on myth and prejudice rather than fact, which many members of our culture–including psychotherapists–believe to be true about fat people. These assumptions affect how therapists view and work with fat people in their practices. It is imperative that therapists recognize and clear out misinformation and bias in order to be most supportive and effective with their clients. We recommend that psychotherapists practice weight neutrality – i.e., make no assumptions based on a person’s weight, and not tie goals of treatment to weight outcomes. The following stereotypes are common perceptions that should be challenged.

ASSUMPTION #1:

You can determine what people are doing about eating and exercise, just by looking at them. 

People naturally come in all sizes and shapes. Many fat people eat no more than thin people. some fat people are extremely active; some thin people are extremely inactive. Therapists must get to know each individual and his or her unique life.

ASSUMPTION #2:

Emotional issues cause “excess weight,” and once the issues are resolved, the person will lose weight. 

Humans come in a range of weights, just as they come in a range of heights. There is no evidence that emotional problems are more often the cause of higher weight. The idea that one has to explain why someone is at a higher weight is as nonsensical as trying to explain why someone is tall. There are fat people with emotional problems just as there are thin people with emotional problems, and the problems do not necessarily have anything to do with weight.

ASSUMPTION #2A:

Large body size indicates sexual abuse, or a defense against sexuality. 

Some people who have been sexually abused may be fat; however, we cannot draw any conclusions about a person’s psyche based on body size. Many fat people are comfortable with their sexuality and are sexually active.

(I am not certain where the notion came from but around 15-20 years ago, the same folks who were promoting MPD were also promoting the idea that some 90% of fat women had been sexually abused. I never saw any research to support this figure but it was widely held for some time — C.F.)

ASSUMPTION #2b:

Fat people must be binge eaters. 

A small minority of fat people meet the criteria for Binge eating Disorder (BeD), as do a minority of thin people. There are also fat people who are malnourished, restricting, purging, and below their “healthy” weight. People with eating disorders deserve effective treatment and are often able to recover; however, their weight may or may not change in that process. An arbitrarily chosen weight should not be a goal of treatment, since weight is not under direct control. The focus should be on a sustainable, high quality of life, and on helping the person to accept the resulting body size.

ASSUMPTION #3:

If a person is distressed and fat, weight loss is the solution. 

Being the target of weight prejudice can be cause for profound distress; however, the solution to prejudice is to address the prejudice, not the stigmatized characteristic. What would we do for a thin person in similar distress? The quality of support the person is able to give herself, and the quality of support available to her in the world, are key areas of focus. We do not have interventions that lead to lasting weight change, but we do have interventions that free people to be kinder to themselves and mobilize their energy to make their lives better.

ASSUMPTION #4:

Fat children must have been abused or neglected. 

Their problems can be fixed by restrictive dieting and rigorous exercise. fat children and their parents have been increasingly ostracized in a culture that equates a thin body size with personal value and appropriate parenting. children often gain extra weight before a growth spurt. enforcing weight- loss dieting and competitive exercise can lead to rebellion against both, as well as disordered eating. children need to be supported in using hunger and satiety cues to make decisions about eating, and in valuing their bodies and the variety of bodies in the world. 

ASSUMPTION #5:

I am not biased against fat people. 

Research consistently shows that most people, including most healthcare professionals and even those who work closely with fat people, hold negative beliefs about fat people. Please investigate your own associations with weight and bodies of different sizes, including your own body, as essential preparation for working with fat people. (2) Therapists should be able to let go of any agenda to eliminate fatness, and see the beauty in fat bodies and the strengths of fat people living under oppression.

If you are in therapy or have been in therapy, how does/did your therapist stack up against these guidelines? Are there others you think should be included?