An open letter

Sunday I met for the first time with another therapist who had contacted me some time ago because she found we shared an interest in Jung and in knitting. And because for me meeting another knitting Jungian therapist is something not to be missed, I agreed to meet with her. I knew a little about her history and she a little about mine, both through things we have written. So I knew she had a history of eating disorder and she knew I am fat. 

The meeting went pretty well in spite of the occasional difference of opinion and then she asked about my current interests. So I started talking about my writing and thinking about fat and the Jungian community and all that. And then things went south. She asserted that if only I would do what she had done by joining Food Addicts Anonymous and following their program, I would lose weight, keep it off and be healthy. As I often do in situations where I am angry and don't feel free to express my anger, I responded intellectually citing all the research which supports my position. When I asked if she believed that she should urge weight loss for any fat patient who came to see her, she said yes because she would want them to be "healthy". At that point I tried to politely back us out of the whole topic. We came to time to part and said our polite farewells.

On my way home I began to regret not having really told her how I experienced her "helpful" suggestion. And yesterday I wrote a letter to her. I thought when I wrote it I would mail it to her but then I asked myself what that would accomplish. So this morning I decided to post it as an open letter here, an open letter which is not just for her but for anyone who believes she knows better than I what I need. 

Dear Well-Intentioned One,

I am glad that you have found something important for you in FA. I understand it was your intention to be helpful when you said to me that you were certain that if I went to FA and got a food plan and a sponsor and followed the program I would lose weight. I thought of this today when a couple of Jehovah's Witnesses came to my door. I understand that proselytizing is an important part of their faith, but I do not feel obligated in any way to listen to them about faith because I did not invite them and am not looking for religious instruction. So I politely told them "No thank you" and closed the door. I understand that any of us can fall prey to evangelical zeal when we become convinced of the truth of something in our lives.

When you offered your well-meant recommendation, I believe you were not only offering something you believe to be helpful but that you were also exercising thin privilege. One way to understand privilege is that it is  bias with action, that privilege is the result of giving bias power and authority. Privilege is the benefit that accrues to the person or group that has to endure the least bias and/or prejudice. In this sense, privilege can be invisible. You have no idea about the state of my health, my history, how I feel about my body, the work I have done on the issues I experience from having and being this body. It is thin privilege and the assumptions you make that allow you to believe that an assertion such as the one you made is appropriate and actually almost imperative because you believe you have the interests of my health in mind just as the Jehovah's Witnesses believe they have the interests of my soul in mind when they knock on my door.

I responded to your suggestion intellectually. I wish now I had let you know at the time about my emotional response. Unsolicited advice is seldom welcomed by anyone. It is a sad fact that people feel free to offer advice to fat people because the belief is widespread that we are responsible for our weight and somehow it is a matter of ignorance that we have failed to take our ample selves in hand and disciplined mind and body so as to become "normal" weight. Such advice is as ill-advised and unlikely to be welcomed as any. I actually found your suggestion, even though I believe I understand your intent, to be intrusive and insulting. In the interest of being nice Sunday, I didn't say that. 

I am a big fan of Barbara Stevens Sullivan. She is one of the Jungian writers I most respect. In her most recent book, The Mystery of Analysis, she 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."(p.217)

Once I thought that no one would notice me when I entered a room until I spoke. I could imagine being Echo, the voice without a body. I could wrap myself in my invisibility cloak of charm and move through the world insulated from the judgments and scrutiny. It was simply too painful for me to consider the absurdity of that belief; had I done so, I wouldn't have gone anywhere. Having done the work I have, I now know that long before I say a word, when I walk into a room, people seeing me will have judgements, fantasies, beliefs about me based purely on my size. I might wish otherwise but I know that to be so. Samantha Murray, a fat studies scholar, describes what it is like to be subjected to the medical gaze (Foucault coined the term "medical gaze" to denote the dehumanizing medical separation of the patient's body from the patient's person):

"I stand before you now, and I can feel you all 'knowing' my body. You see my fatness, and co-extensive with it, you perceive its indisputable deviation from practices of health and care of the body. I am aware that here, in this space, in fact in most spaces, my body is a quintessential symbol of pathology. When you witness me now: seeing my dimpled thighs, my soft bulges and fatty rolls, you believe you know me. The visible marker of my fatness is laden with knowledges of who I am. Looking at me now, you must ask yourself what you know about my body, and, therefore, about me? The visible markers of my fatness, my wide hips, protruding belly, vast thighs, all signal a knowingness of pathology and disease. You read my fat as symptomatic of overeating, lack of exercise, poor nutrition. You see me as a high-risk candidate for diabetes, gall bladder disease, hypertension and heart attack. At a deeper level, you may see a lazy woman without willpower, a sedentary being, a woman out of control, a woman of unmanaged desires and gluttonous obsessions." Murray quoted in The Obesity Epidemic, p. 166

When you saw me, you believed you "knew" me because of what you saw.

Another book which has given me much to contemplate is Eating Problems: A Feminist Psychoanalytic Treatment Model by Carol Bloom, Andrea Gitter, Susan Gutwill, Laura Kogel, Lela Zaphiropoulos. Here are several important thoughts from that book:

"The therapist can feel concern about weight, but to be invested in weight loss as a goal is to be aligned with the cultural and internal saboteur." P. 70

"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 its concomitant bodily changes, outraged at and contemptuous of the imperfect out-of-control body and repulsed by immodest female appetites and hunger."p. 152

Clearly I have strong feelings about this. Of course I do as this is one of the great issues in my life, one that I have spent many hours in analysis, reading, struggling, writing, working with and through. I write to you today in hopes that what I have shared with you here might give you pause for a moment, might allow you to examine your privilege and perhaps lead you to be more open to the variety of sizes and shapes our wonderful human bodies come in and be able to listen to and deeply understand that it is important that we be able to be with our patients as they find their way to having the life they want and be able to allow that to be different from what we ourselves would or have chosen. I recognize that your evangelical zeal mirrors my own. I hope that my offering you these extended reflections does not offend you nor suggest that I take lightly your own journey.

I wish you well.

Cheryl Fuller