Lillian struggles to fit herself into the chair. “Can’t even have a big enough chair” she grumbles. “You only have skinny patients? Don’t care about us big people.”
I remain silent.
“I binged every goddamn night this week,” she declares.
Lillian has thrown down one gauntlet after another. Although this is only Lillian’s third session, I already know that almost every statement she makes is meant as a challenge directed towards me.
“Are you saying that you want me to change that?” I ask.
“Well that’s why I’m here, aren’t I?”
“I don’t know,” I reply. “Do you want to stop binging?”
Lillian snorts. “Would I be paying you all that money if I was just playing around?”
“Again, Lillian, I don’t know. Part of you might want to stop binging, but you seemed pleased to tell me you binged every night.”
“You don’t know much, do you?”
I’m under attack. I don’t like the feeling and am becoming increasingly angry. I say, “You seem to enjoy attacking me, maligning me.”
“Oh, so now you’re using big words. Think you can intimidate me? Go ahead and try.”
“Lillian, am I the enemy?”
There’s a brief hesitation before Lillian comes back with her rejoinder. “That’s a stupid question.”
“Okay. So let’s say I am the enemy. Why? Why might I be the enemy? Self-protection? Fear of change? Fear of getting too close?”
Again, a second’s hesitation, and then, “Think you’re so smart, huh? Look at me. Know anyone who’d want to get near me?”
Despite Lillian’s unrelenting attacks, my anger has dissipated. In its place is sadness, sadness for Lillian’s aloneness, for her pain. Her weight and her anger defend against what must be tremendous feelings of emptiness and despair. I’m sure she will not give up her defenses easily.
“Let’s go back to the beginning of the hour, when you struggled to get into the chair and asked if I didn’t care about big people. I’m sure you feel that a lot. The shame of being too big, of not fitting in, of having people avoid you.” Then I add, “Try not to give some snide answer to what I just said, Lillian. Try to think about it, to feel about it.”
“What, you think you have me figured out?”
I smile. “I think that counts as a snide answer. And maybe my response does too. I wonder if we can stop sparring, Lillian. I’d like to be of help to you. At this point I know almost nothing about you, but I would guess that your weight defends you against some very painful feelings. And, no, I don’t think I’m going to wave a magic wand and make your anger or your fear or your sadness go away…”
“How about my weight?” Lillian says, interrupting me. “Can you wave a magic wand and make that go away?”
“You know, that’s an interesting question. Not that I have a magic wand, but I wonder how you’d feel if one day you woke up thin. What do you think?”
“I’d think it was great.”
I remain silent.
“I don’t remember being thin since I was a kid, a little kid. It is kind of difficult even trying to imagine what it would feel like.”
“I’m sure that’s true, Lillian. Being heavy is a part of how you’ve defined yourself for a long time. It’s hard to imagine suddenly having a different picture of yourself.”
“Well, we don’t have to worry about that, since it’s obviously not happening anyway.”
“What about your sadness, Lillian. What do you do with all your sadness?”
“Why? You think all fat people have to be sad?”
“What I think is that both your weight and your anger helps you stay away from difficult feelings.”
“You think I can’t just be angry?”
“I suspect that you’re not just angry, although I’m sure you are angry.”
“So what’s my anger about?”
“I think that’s something you’re going to have to tell me.”
“How about my uncle and his friends raped me, my mother didn’t believe me, and my brother laughed in my face.”
“I’m sorry, Lillian. Yes, I’d say that’s more than enough reason to be angry, to not trust people. and to not want to let anyone get close to you.”
“Give the lady a gold star! You got that about right.”
I can feel myself bristle. Lillian rejects even the smallest kindness, partially out of anger, partially out of fear and, partially, I suspect, because of her need to goad people into abusing her, just as she’s been abused in the past. This is going to be a long, hard treatment.