Viva logo

Fat Betty

Gaslighting in Therapy

By Sarah SparksPublished 7 years ago 3 min read
In 1989, psychotherapist Irvin Yalom published the candid autobiography called Love's Executioner and Other Tales of Psychotherapy which was a journey into Yalom's own mind and the encounters he had with patients over the course of his career. One of the patient's stories presented in the book, muddled with Yalom's own self-analysis, was the story of "Fat Betty".

Following are excerpts from the book:

“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 Irvin Yalom, Love's Executioner Basic Books (1989) pp.94-95

Over the course of the therapy, Betty lost 100 pounds and at the end of the excerpt 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.

Yalom has been lauded in several circles of his candid writing about the prejudices that can accompany what is supposed to be a neutral zone- the therapist's office. Therapists are trained to leave all judgments at the door, but the truth is that therapists, psychoanalysts, psychiatrists, doctors, and all those other mental health and medical professionals are people, too, who are just as prone to perpetuate social moralizing, stigmas and judgment as the rest of us. After all, they did not grow up in a vacuum outside of human society. While what Yalom writes is brave, it is also exploitative and does not examine the sexist and sizeist social constructs that lead to this type of hate thinking.

Why does he hate fat women so much? What patriarchal and controlling social structures are in place to make someone hate a fat person (and more specifically a fat woman, women being the main focus of his writing here) on first sight? Why do women have to bear the brunt of this body hate? Why have so much hate for someone who has no barring on your own existence? What societal mechanisms operate to give him the right to make these judgments about female bodies? How are female bodies controlled, how are fat bodies controlled and how is he reenacting those controls in the therapy space? Over the course of the therapy, Betty lost 100 pounds but statistics tell us that up to 97% of dieters gain the weight back within the first year. Yalom felt his therapy was a success because Betty lost weight but Betty herself confronts him to show that he was not truly successful because all though she lost weight, her own therapist will not touch or look at her so she is still living with the guilt and self-hate that she came into his office with that was never addressed in the therapeutic setting.

In an article entitled "The Effects of Obesity on the Clinical Judgement of Mental Health Professionals", Young and Powell (1985) conducted an experiment where mental health professionals were broken into three groups and given a patient history. Each group was given the same patient accompanied with a photo of the patient, the only difference for each group was the photo was doctored to show the same woman as thin, slightly overweight or obese.

The following excerpts show their findings:

"...doctors expressed a preference not to advise and/or treat the extremely overweight patient in part because the physicians viewed obesity as an indicator of several undesirable qualities, including lack of control (1985, p. 234)."
" long as the woman remains within an acceptable range from best weight... mental health workers will not view her as psychologically deviant. Only when she exceeds the latitude of acceptable weight is her weight viewed as causing problems (1985, p. 241)."
"These negative evaluations [of the obese client]... are less a function of objective clinical judgement based in theory and research than a function of societally stereotypical images of the obese woman (1985, p. 242)."

This is all important because it tells us something very profound, doctors and therapists are not the neutral, Bastions of hard science that we are taught to think they are. Both science and medicine can be sites of social control and social deviance. We have to remember that when we are hit with facts about the "obesity epidemic". Scientists, doctors, and therapists are not infallible knowledge gods but can hold some very deep prejudices and stereotypes that can affect the care they are giving their patients and the type of 'facts' they accept as real and truthful. Scientific 'fact' can be manipulated, regulated and controlled as much as any other part of society. All science is at the whim of funding which can have a huge impact on what is researched and why and what the outcome of that research might be. If a fat woman walks into a therapist's office to get help for the emotions caused by a lifetime of stereotyping, prejudice and fat hate only to find that repeated in therapy setting than the damages on her are only being multiplied.

Body stigma is not the only prejudice permeating the therapist's office. Sexism, racism, classism, and myriad of others-isms can affect the professional space of mental health and medical professionals. I think it's time for each individual in this society to closely examine what prejudices, stereotypes and hates we pack around with us and ask ourselves why? Why do we have them? What good are they serving? How is my hate helping to keep society normative and structured to keep some people at the top and everybody else hating themselves and each other to the detriment of our own well-being? Who is benefiting from all this hate? It's time to think very, very hard and start making changes within ourselves and our professional environments.


About the Creator

Sarah Sparks

Witchcraft poet, neurotic sex symbol, over-educated sadist, and generally only dangerous to herself and a few unfortunate bedmates. Found haunting the halls of academia, frequenting shady establishments and eating candy at home in bed.

Reader insights

Be the first to share your insights about this piece.

How does it work?

Add your insights


There are no comments for this story

Be the first to respond and start the conversation.

Sign in to comment

    Find us on social media

    Miscellaneous links

    • Explore
    • Contact
    • Privacy Policy
    • Terms of Use
    • Support

    © 2024 Creatd, Inc. All Rights Reserved.