Category: Therapeutic Issue

The Tyranny of Slenderness

In the early eighties I wrote several books about eating disorders; one of them became a national best seller. In the first book: The Obsession, Reflections on the Tyranny of Slenderness, I researched the way our culture's fear of women was directed against women's bodies and, in particular, against a large woman's body. I felt that the cultural preference for very slender women revealed a wish to see women reduce themselves as women and relinquish their power.

Here’s how I reasoned back then: “The body holds meaning. A woman obsessed with the size of her body, wishing to make her breasts and thighs and hips and belly smaller and less apparent, may be expressing the fact that she feels uncomfortable being female in this culture. A woman obsessed with the size of her appetite, wishing to control her hungers and urges, may be expressing the fact that she has been taught to regard her emotional life, her passions and 'appetites,' as dangerous, requiring control and careful monitoring. “A woman obsessed with the reduction of her flesh may be revealing the fact that she is alienated from a natural source of female power and has not been allowed to develop a reverential feeling for her body.””

The second book, The Hungry Self: Women, Eating and Identity, studied the way a woman's hunger for self-development, creative expression and liberation might express itself if it was not recognized as a hunger for food. I was curious about the emotion and conflict and turbulence that might be disguised as a craving for food, and especially “forbidden” foods like carbohydrates and sweets. “In [this] book I extend [my] analysis to include the mother/daughter bond and the issue of failed female development….We cannot heal ourselves until we understand the hidden struggle for self-development that eating disorders bring to expression in a covert way. We cannot indeed even begin to think of self-healing until we stop using the words “eating disorders” to hide from ourselves the formidable struggle for a self in which every woman suffering in her relationship to food is secretly engaged.”

In the third book, Reinventing Eve: Modern Woman in Search of a Self, I issued a call to women to step up and re-invent ourselves, freeing ourselves from the pressures and constraints of a society that feared women. I saw Eve as a radical, the first woman who was forbidden to eat food and who broke the taboo. “Women speaking intimately about their lives are usually, whether they know it or name it, on the far side of outworn ideas…We [have had] to start with the assumption that we knew little, had been lied to a great deal, that secrets had been kept from us, we were setting out as pioneers together, groping to find a suitable language for our experience….”

The Tyranny of Obesity

Thirty years later these ideas are still meaningful to me but my vision of possibility has been checked. “Fat is Beautiful,” a movement I greatly admired, has now become, thirty years later, a group of aging, obese women with serious health problems. I used to refer women who wanted to lose weight to other clinicians; I explained that my work offered them a chance to make peace with their body, not to change it. I now look back and think that I was rather close-minded, as if I knew what should matter to every woman who came to me for help.

Over these thirty years I've counseled countless women, discussed these issues with them, found them open to these ideas, yet progressively we have realized that it was no easy task to overcome the predominant dislike for big, fat or obese women. This overcoming of cultural dictates is a task suitable for some of us, not for everyone, and why should it be? Many women would rather work towards the body our culture admires than analyze the reasons they dislike their body as it is.

When I began to speak these ideas publicly, women who had read my earlier books were shocked; they felt that I had abandoned them in their quest to accept their body and their appetites. This new orientation seemed a betrayal, a renunciation of my earlier thinking with its cultural and psychological understandings. But I myself had begun to feel that my earlier ideas were hardening into an absolute, as if what was right for some women had to be right for all women, another once-size-fits-all approach to women and food.

I’ve had to explain that these days more and more women have to lose weight for the sake of their health, and that my clients and I had found a way to transform dieting from a self-defeating, frustrating, futile exercise into a useful therapeutic tool. A diet is—or can be—a way of becoming conscious of why one eats or feels driven to eat. Paradoxically, limiting what we eat is often the most direct way to uncover the feelings that drive us into self-destructive eating. Earlier, I had been opposed to the very idea of dieting, now I was willing to offer women help if they chose to diet. I left the decision to them, offering them both possibilities of work—towards body acceptance, weight loss, or sometimes the two together.

But there is more. There are other changes during the last thirty years that I have come to take very seriously. Following Michael Pollan, I began to study the food we are given to eat, so much of which has been degraded. The additives in it actively cause weight gain, and it is offered up in mega portions we tend to accept because there they are on the plate in front of us. As Michael Pollan writes: "Researchers have found that people (and animals) presented with large portions will eat up to 30 percent more than they would otherwise." Some of the weight we unhappily carry around with us is not really ours, it isn't natural, we haven't chosen it. Much of it has come upon us in surreptitious ways, through mysteriously named presences in our food, like high fructose corn syrup and its near-relations—aspartamine, glucose, dextrose, maltodextrin, maltose—which most people do not recognize as sweeteners. Even when reading a label and consciously hoping to avoid sugar, we end up with sweetening agents we don't want.

The Tyranny of American Culture

Thirty years ago I was asked to help people suffering from anorexia, bulimia and compulsive eating; these days women are calling me because, over the years, they have gained so much weight their doctors are alarmed for them. It was short-sighted to send them to someone else when I was a person who had dieted on and off for most of my life, at times winning, at times losing, the battle against our culture’s standards. And wasn’t I now, just as then, responding to a cry for help from our culture? After all, three of every five Americans are overweight. Obesity is an epidemic.

And so too is a woman's unhappy preoccupation with the size and shape of her body, or some part of her body, or some new diet that promises to change her body. I know this, not only from my clients, but far more intimately from myself. “I am a feminist, I care about women's self-development and the cultural and psychological obstacles that inhibit it, yet I have struggled, since the age of seventeen, to be at home in a body that has never been overweight but still has not been acceptable to me.” In spite of my three books about women and food, and all the lectures I have given, and the deep conversations in which I've been engaged; even in spite of the fact that I never any longer eat compulsively, a preoccupation with food and body size is still hanging around in my life. As a result, I can no longer underestimate the power of this conflict, as I observe it listing towards a feminist understanding about a woman's right to make decisions about her body, free of cultural pressures, and then spinning off in the opposite direction towards the next miracle diet that comes along, promising a body that conforms to our culture's punishing ideals. Weight and body size present us with a problem for which we don’t have an adequate solution.

Taken together, these are good reasons to change one’s point of view. I have changed mine in an effort to supplement—not replace—my earlier work. I intend to help people find the right diet and support them while they are losing weight, an emotionally demanding task whatever the nature of the diet. But losing weight is only part of it; we have to learn to eat in a way that often contradicts everything we’ve been taught about healthy nutrition. Not three meals a day but a small meal every couple of hours; not avoiding water because it may produce weight gain but drinking quarts of it; eating at night, before bed, because the body even in sleep requires 500 calories to keep itself going. Eating fat because we feel nourished by it, learning what are desirable portions, eating local produce because the food contains more of what food should contain and will therefore nourish us in smaller amounts. There is no one diet that is suitable for everyone—creating the right diet has elements of a quest for identity, a coming to know and be able to choose what is good for one. If this isn’t meaningful therapeutic work I don’t know what is.

Catherine's Story

A client of many years returned to work with me. Her doctor had just told her she had to lose between 25 and 40 pounds because her medical condition was severe. She came full of despair, wondering how we could approach this assignment since we had always discussed body-acceptance and appreciation for big and voluptuous women, which she was. Beautiful, certainly; but perhaps not healthy?

I began to work with Catherine in 1995. She was 26 at the time, a graduate from an Ivy League school, a women’s studies major who sought me out because she had read my books. She came from a small town on the East Coast, from a family active in their Episcopal church. For her to leave home, move to the West Coast, live with a man to whom she was not married, give up all religious affiliation and develop an interest in feminism while her two sisters and one brother remained close to home, was daring. She had graduated with honors and gone out into the world eager to make the most of herself. But this promising development had stalled. She was working as a secretary at a job she hated, was preoccupied with compulsive eating and her body’s size, found life meaningless and disappointing, described herself as depressed and despairing and at times suicidal. I was then in training with Otto Will, who had trained with Harry Stack Sullivan, who had worked with Freda Fromm Reichman. I was following their interpersonal approach with a dose of object relations mixed in, supplemented by an analytic interest in childhood memories.

Catherine found it almost impossible to cook for herself, although she had no trouble cooking on the night assigned to her by her collective. She didn’t plan for her meals but grazed throughout the day, almost entirely on cookies, candies and anything sweet. She ate in secret, disliked herself for doing so, was afraid that I was judging her, and suffered from guilt and remorse. Together, we observed the nuances of our relationship as it developed over many years, curious about the fact that she always stopped for food before her session and immediately went out afterwards for a piece of cake. She suggested that she was filling herself up so as not to bring a ferocious desire to eat into the room with me, evidently afraid that she would gobble me up. The cake that came after the session was to restore the energy that she felt had been depleted in thinking about these issues. She discovered that she refused to cook for herself because she wanted her mother to cook for her and would rather not eat than have to provide food for herself. Although she had voluntarily left the family for a larger life, she missed the closeness and safety of the small town, their church and especially her mother’s devotion to feeding the family. She was brilliant and analytic and good at interpreting symptoms; her childhood memories grew richer and more plentiful over the years, as did her ability to piece together a plausible narrative of her childhood. “Catherine ate in secret, disliked herself for doing so, was afraid that I was judging her, and suffered from guilt and remorse.”

She was the youngest in her family, and by the time she arrived her mother was exhausted and depleted. She hadn’t wanted another child, her milk dried up when Catherine was a few weeks old, and the care of the infant was largely handed over to her elder sister. Nevertheless, on the surface they were a happy, close-knit family, admired in their church and appreciated for their good works. Mother spent the day cooking for them, trying out new menus and culinary ideas, seemingly satisfied with her life but with an undercurrent of bitterness only Catherine seemed to recognize. Although well fed by her mother as she was growing up, Catherine began to wonder if she’d ever been nourished. Even her desire to have mother cook for her now that she was an adult began to seem a poignant wish that mother’s care and even her cooking had contained more authentic nourishment. The family dinners, which she’d always remembered as happy occasions, began to reveal their seams of stress—her older sister resenting her for the care she’d given her, her brother, two years older, in fierce competition for attention, her father absent, the second sister gentle and meek, as if she’d early decided that life was not going to offer her much, mother tyrannical when it came to the family’s enjoyment of her cooking. Dinner table conversation was lively but largely restricted to comments and conversation about food.

Catherine’s life changed dramatically through our work. She left her job, started a not-for-profit organization that became very successful, developed a strong interest in psychology, got an M.A. in counseling, worked out an honest and passionate relationship with her boyfriend, bought a house with several friends and lived collectively. When she got pregnant she decided to stop her work with me, owing both to financial concerns and to a general feeling that we had accomplished much and that she wasn’t capable at that time of going further. She still ate compulsively, giving us both the impression there was a lot more to understand.

I present this story in order to muse about the fact that excellent psychological work can be done that nevertheless does not reach a troubling emotional core. This did not surprise me. In my decades of work with eating disorders I have found that the underlying reasons a person eats compulsively, or eats more than they want, or far less than they ought, are hard to experience as direct, unmediated emotional events. The symptoms of a troubled relationship to food are so powerful and so deeply ingrained in the way one soothes and rewards oneself, hides from loneliness, expresses outrage and sorrow and in general shuts off consciousness, that it is hard to get beneath symptom into the raw emotion that is giving rise to it. She sensed that there was more to her emotional life than we'd yet explored; nevertheless, that is where we left it until, six years later, she came to speak with me about her doctor’s insistence that she lose weight.

Catherine's Diary

I have permission to quote from the diary she kept during the first three weeks of the diet. My comments follow her diary entries. This is not a description of the way Catherine and I worked together but an account of her process of uncovering meaning in what earlier had been unconscious, compulsive acts.

Catherine: I have a strange sensation—I am not really that hungry, though I can feel an underlying pull in my stomach now that's it's been a few hours since my breakfast. I am sad and irritable. My mind brightly goes to "treat" several times an hour, for myself, and socially ("like, oh I should take the girls out for burritos for lunch!" "I want a latte and a scone!"). Then I am disappointed in some deep way when I remember, but it's not exactly about being hungry. Fascinating. What is it about?

I am interested in the fact that from the first day of dieting hunger is put under suspicion. It can’t be taken at face value. This is an insight Catherine has not had before.

Catherine: Today, the glutton, the sensualist in me rebels. I can feel a sense of victimization mounting. "I hate restriction, I don't want to do this."

Here, as we can see, the issue has now become one of dislike for restriction. Insight is developing: this is a character trait, not an eating behavior. Catherine has not previously named in herself this rebellion against limitation. Indeed, it would be hard to recognize when there is a lifetime pattern of instant self-gratification.

Catherine: “OK, this is bearable, I am OK. But the sense of comfort I am missing—I am working so hard, I am so tired and worn out from childcare. How will I replace food as comfort? How? How? So far there is no replacement and I’m not sure there ever could be one. I am working so hard.

An additional meaning has been attributed to food. It is now recognized not only as a comfort but also as a reward for having had a hard time. This is a steady growth in the capacity to think symbolically. Hunger is no longer simply hunger and food is no longer simply food.

Catherine: It’s not hunger that’s hard. What I have to know about myself is what’s hard. I’d rather not know.

The progression of self-awareness has moved on into the striking discovery that the struggle with food has been a drama about self-knowledge. Or rather, about refusing self-knowledge. This is a lot of insight to achieve in a week.

Catherine: Last night at the party someone said I seemed like a happy person and I felt so embarrassed I almost cried. "I am having a terrible time, I'm filled with jealousy and poison," I thought. "Why does she think I'm happy?

Catherine has always had the capacity to seem happy, well-adjusted and cheerful, traits that were required by her family. They’ve been a second skin and only now are being viewed as alien. Although these traits have served as a protective covering, they have also been misleading as to who she really is. As she comes to know herself authentically, a wish to be authentically known begins to emerge.

Catherine: The depressive, dark, roiling, murky, angry, resentful, revengeful part of me is so present now when I am alone and I never show it in public—Who is this? I can see why she’s been out of sight. I don’t want her. I feel suffocated by these feelings and their bare truth. I can't push this part of me away and "think positive." I must integrate, integrate, integrate. I wish I could cry, but I feel so bottled up. Maybe I will cry today. Would crying be more satisfying than a burrito?

I thought of this as an important breakthrough. A subterranean world of feeling, now present in her awareness, has brought in the crucial thought that an ability to feel, to cry, or even to want to feel might be more satisfying than eating.

Catherine: It's very hard for me. These feelings are hard for me. I didn’t know I was filled with so much poison. Feeling these feelings is what’s hard for me. I don’t like who I am. But I do like myself for knowing all this.

The capacity to know and name herself is making the emergence of difficult self-knowledge bearable. We know how crucial this particular exchange is in psychological work. Not liking who one is but liking oneself for the ability to know it. The supposed safety of not-knowing is falling away before the power of insight.

Catherine: Last night I dreamed I was trying to warn a school full of small children (preschool) and teachers that a huge tidal wave was coming. Everyone was very busy and distracted and could not focus. Then I was in a meeting where someone was presenting us with his new beautiful chocolate bar. I raised my hand and asked, "What was your aesthetic inspiration for making this chocolate?"

I often dream about tidal waves: massive, blind destruction. But I never thought they were about what I was feeling. Or not feeling.

I think they represent my dread and fear and the sense of overwhelm I have about things. And the chocolate is so funny! That’s what I’ve found in my life, a chocolate bar to keep me safe against a tidal wave.

This is a curious insight because in fact the chocolate bar and its sister-sweets have served to protect her from the tidal wave of feelings that she fears. They’ve worked; they’ve captured her consciousness and shut it off. That’s why chocolate and muffins and brownies have been so hard to give up. Nevertheless, they are now seen for what they are and have become ludicrous.

Catherine: Any choice about my size, about losing weight, is astonishing to me. It lifts a lifetime of discouragement. How do I comfort and reward myself if not with food? (I want to replace compulsive eating with compulsive writing!) My shoulders ache, my eyes are heavy with un-slept sleep. I want to lie down right now in this library and cry.

Wonderful, this wish to replace compulsive eating with compulsive writing. She is in fact a very good writer and will, in a few months, discover that when she sits down to write, the inner turbulence she feels will subside. Not every time, not completely, but often enough to make her aware she has a choice between chocolate and self-expression.

Catherine: It's getting somewhat easier for me. Still many fantasies of treats, but it is balanced out by feelings of excitement and accomplishment. After all, it wasn’t hunger that was the problem. But all this poison inside me. So, now that I know it’s here? Now what? Can I just live with it? I don’t think so. But that’s what I’ve been doing, isn’t it?

The sense that these feelings are unbearable has not gone away, but there is the simultaneous discovery that after all they have been borne. The unbearable has become bearable. If this happens once, it can happen again: “I can’t live with it, but paradoxically I’ve just discovered that I have been living with it.”

Catherine: Clothes that were a bit too tight feel good and are fitting. Joy. Joy. JOY. Having these intense, florid cravings a few times a day. They stop me in my tracks. Today it was my childhood birthday cakes—"bakery cakes" we called them—white cake and frosting with clusters of pink frosting roses, they were even better slightly stale. Everyone wanted a rose on their slice—a mouthful of pure frosting. I practically moaned aloud as I pictured this. Bizarre. I could eat a truckload of that soft, fragrant, sweet white cake and frosting. Yesterday had a craving about thick ice cream shakes full of candy. Amazing that this is there, so deeply. Much much more than a memory. I can right now taste that pink frosting. Like those frosting roses were going to make up for everything that wasn’t so great in our childhood?

I still find it extraordinary that this transformational journey is taking place simply because Catherine isn’t eating in the way she ordinarily would. Through this precise memory, this sensually present image of the pink frosting roses, she has understood the full power of the emotions that she is engaging.

Catherine: I am starkly alone with all these bad feelings. I am hungry and I want to eat. I am sad and I want a treat and a reward. The only thing I can think of is going to bed, not so much as a reward but as a way to live through this. I am going to live through this. I have to live through this.

I admire this knowledge, this clear seeing of these very difficult feelings and the search for something other than food to see her through. Above all I am taken with this resolution: “I am going to live through this. I have to live through this.” It has some of the quality of a hero’s, or more precisely, a heroine’s journey.

Catherine: It gets easier. I am living with medium to mild cravings and longings; not much hunger; and a mounting pleasure in what I have done. It has been so hard and it’s not about hunger. I have been wrestling with an angel and trying to find my meaning in it all. The feelings are so intense: jealousy, grief, rage, cruelty, indifference, helplessness, mad cravings and feeling crushed. It's like living through a hurricane at times. I’m thinking again this is the hardest thing I’ve ever done in my life. But somehow I’m doing it.

I take this testimony seriously; this probably is the hardest thing she’s ever done in her life, harder than giving birth or separating from her family. The newly discovered feelings write the emotional narrative that had been driven out of awareness but was always lurking, lurking, driving the compulsion to eat.

Catherine: I am at my desired weight. I am really pleased. It's amazing. On the feelings front, I am in lots of turmoil. My temper is short, I am touchy and sad. This is the perfect moment to "assault eat." And I will not. I want to be able to handle my feelings and not use food to soothe them, but will I be able to do that for the rest of my life? Maybe if I ever am told I have 3 months to live I promise myself I will eat only ice cream.

I love the way she can simply say, after a lifetime of struggle with eating: I will not. She has acquired choice where she previously experienced compulsion. This transformation of compulsion into choice may be the single most crucial accomplishment in anyone’s therapeutic work.

Catherine: I want support from you and from my man but I feel vulnerable and raw when I think about sharing all this. But maybe it will be better if I talk to him? Maybe I will feel more recognized for how hard this is for me? I am not sure.

Food has so many purposes, meanings and uses; no wonder it’s so hard to work them all out. You give up food as comfort then it shows up as reward; you recognize it as a consolation, then it appears as an interpersonal shield.

Catherine: I spoke to you on the phone about how I'm feeling today. I'm noticing this kind or foundational feeling (that's the word I keep finding)—as if I have more of a right to be here. I think it has to do with feeling proud of myself for doing the hardest thing I can do. Working on my relationship to food is the oldest, toughest, most entrenched part of me. As we said today—it's not likely for me to find something harder. With my clients, I feel a new sense of balance, of rootedness. If I can deal with this for myself, I can ask them to do the hard things they need to do for themselves too. I can support them to do those things. This makes me feel transparent, more authentic. Like I am not a fraud.

This is a beautiful piece of psychological work. Catherine has discovered that experiences and moods she took at face value are actually the expression of emotions and conflicts. I love to recall that resounding phase: “I will not.” She has been able to substitute choice for compulsion. She has gained a great deal of self-respect by succeeding at something she found really difficult. She feels more confident in the work she does with her clients. She understands the meaning of her dreams, she sees life-patterns emerging, she has achieved much more self-knowledge than she’s had before. I like to think of this as the deconstruction of eating in favor of meaning. To this day, after some thirty years of work with these issues, I’m still astonished that something as seemingly mundane, concrete and literal as eating and food can have this crucial importance. Maybe it’s not surprising if we remind ourselves that our first act after birth and taking our first breath is a reaching out for food.

The Journey Continues

Successfully losing weight is not the end of the story, far from it.

Weight-loss faces anyone who has accomplished it with a number of immediate dilemmas. The body has changed but intimacy is still frightening; being dressed in size 8 clothes doesn’t necessarily secure a job; if one was shy before very likely one is still shy. A lot more social attention may be directed towards a woman who has changed her body’s size but cat calls, whistles, crude remarks, are not necessarily the attention she desires. The magic that weight-loss was supposed to produce as it solved all of life’s problems gets tarnished very fast. And there we still are, the same self in a different body, unless the dieting has helped us to change that self.

There’s still a long, hard road ahead. Learning to eat properly, sticking to the new habits one has acquired, shifting from the food of immediate gratification to food that supports health, these are going to present an ongoing struggle.

Catherine’s is not a typical story. Most people who lose weight on any kind of diet do not make a transformational journey. Nevertheless, many do. My intention in writing this article is to suggest that, as clinicians, we are going to be faced increasingly with the problem of obesity and its effect on health. If we learn to use dieting as a therapeutic tool, as a way of uncovering unconscious impulses and compulsions, weight-loss may be easier to accomplish, and certainly will be more rewarding, as knowledge of the self is acquired at the same time.

In closing, I would like to point out that I am not just speaking about dieting here. Any close examination of one’s eating habits and behaviors can yield the same consciousness of deep feelings, memories and life-patterns. As clinicians, I have the impression that we tend to be overly interested in people’s sexual experience and fantasy, and far less concerned than we ought to be in what food and eating have meant to them. In that sense, there is no contradiction between my work of thirty years ago and my work now: whether an individual chooses to diet or to become conscious of the ways she eats, the shared goal can be self-knowledge. Eating behaviors, as I wrote many years ago, can be the royal road to the unconscious as much as, or maybe even more than dreams, Freud’s favorite candidates for that distinction.