Conversations about weight in a NYC therapy office?
Listening to the recent episode “Tell Me I’m Fat” of the podcast This American Life, I began thinking about weight, appearance, and honesty in therapy. The episode, which aired on June 17, invited a series of guests including writers Lindy West and Roxane Gay to talk about their experiences being fat, maneuvering through the world as a fat person and accepting (or not accepting) their bodies.
In her segment, Lindy West calls out people who hide their biases behind “health concerns” and discusses her decision to “come out” as fat. At first, West’s “coming out” might seem like an atypical use of the term and also a bit redundant. If one is fat, then that tends to be self-apparent. However, what is lovely about West’s “coming out” as fat is the ways this opens up space for one’s body–a body that is right in front of us–to be spoken about in a way that acknowledges all the conflicted assumptions the world makes.
In other words, being fat in the world (and West and others insist we use the word fat) is a thing. It affects how one is seen in a world that has strong notions of attractiveness. It affects one’s ability to be hired and to be included. It affects the experience of going to dinner and buying clothes. There is a lived experience that fat people have that is a part of who they are.
When I was still fairly new to the practice of therapy, I worked with a woman who was particularly overweight. Roxane Gay would refer to her as not “Lane Bryant fat,” meaning too heavy to wear clothes from the plus-sized women’s clothing store. After some time, she came into a therapy group I led for a few years. She asked for help with an emotional issue and the group was hesitant to help her. They gave her canned answers that weren’t really up to what they were capable of offering.
I asked, “How come no one is talking about the fact that SoAndSo is fat?” Nearly everyone in the room looked at me with terror, but SoAndSO just laughed. “Finally!” she blurted out. “Can we just talk about it already?” The group hadn’t been honest and that meant there was no way she would be able to get help in her therapy.
Honesty is what therapy is all about for me. There are so many reasons we are dishonest with ourselves and with others. With weight–something that is literally embodied and in the room, the urge to be polite usually suggests not being honest.
At the risk of sounding bombastic, weight and appearance are places where mind-body dualism is particularly problematic. In Western culture, we talk about our minds and our emotions. “Who we are” means “who we are on the inside.” However, part of what gets negated in that formulation is that a vital part of who we are is our bodies. It is our bodies that people see in the world. And our bodies are loaded with cultural assumptions and rules–not just about weight, but conceptions of attractiveness, our perceived gender, race, and age. In trying to create a more enlightened world, we began to assert that these things “don’t matter.” But, of course, they matter.
As a therapist, when we suggest that our bodies “don’t matter,” we effectively locate them out of reach. In the therapy group, for example, we couldn’t help SoAndSo until we acknowledged her body. It was just too significant a part of who she was, what she was experiencing, and how we were experiencing her in the room.
In our practice, we talk about the importance, as therapists, of naming something. This means, quite literally, to state that a thing exists or has happened. This is a practice that can be almost habit-forming. When most therapists and our patients do this more and more, they realize just how many facts and how many experiences in our lives have gone ignored, even those that are the most obvious.
With my patients, I form a sort of contract or rule: In our office, we’re honest with each other. We name and acknowledge what is. Our bodies, race, sexuality, histories, experiences in childhood and adulthood, and weight matter and have mattered to us. At any given moment this may not be immediately relevant, but the practice of honesty establishes that these realities will not go ignored or unattended.