The article is a warm description of a therapeutic process in which a severely overweight person, through subpersonality work, learns to disidentify from his body and find his center. With a significant weight loss as a result.
By Naomi Remen, Translation Annabritt Jakielski
Source: Synthesis I
In the fall of 1972, I received a call from Dr. Y. He sounded impatient and irritated. He apologized and asked me if I would do him a favor and take a “problem patient” who had been referred to him by a private practitioner in Sebastopol. That’s how I met Harold.
I admit that I was in a bad mood when I agreed to take Harold in. When Dr. Y. outlined Harold’s story, my heart sank. Harold was 13½ years old and had been perfectly healthy until 1970, when he entered puberty.
He was first admitted to the hospital because of severe muscle pain. The doctors at the hospital had suspected some strange but fascinating disorder and had tested him with every test they had available – only to find with frustration and confusion that all the test results were normal. A psychiatrist was called in and, after evaluating both Harold and his family, was able to declare them all emotionally healthy. Harold was sent home to await further developments.
His muscle pain continued, and when he was readmitted in 1971, he had been bedridden for almost a year. During that time, he had gained 30 kg. He had been seen by several specialists in the Sebastopol area and had been put on various diets, but none of them had worked. He had been prescribed many painkillers, but all had no effect.
The evaluation conducted during Harold’s second hospitalization was more extensive than that conducted in 1970, but the results were the same. Again, a psychiatrist was called in.
This time the report was that Harold was withdrawn, silent, and hostile, and his mother was anxious and overprotective. However, the psychiatrist was unable to say whether this was a primary emotional process or whether the cause was to be sought in stressful circumstances. Again, Harold was sent home without a diagnosis to await further developments.
Over the following year, he gained another 20 kg. He was completely isolated from other teenagers and had become unwilling to communicate in anything but monosyllabic words.
This morning, his private physician, Dr. Y., called me in desperation. Harold’s weight had begun to affect his breathing, and the situation was getting worse.
As the story unfolded, I felt a growing reluctance. As one of only a few general practitioners at the hospital, I had become accustomed to having patients whose medical histories no one really cared about being handed over to me. This case seemed too much to me. But Dr. Y. was a well-respected doctor, and I could hardly refuse his request. I agreed to take Harold in and made an appointment to see him and his mother at the end of the week.
They arrived on a Friday—Harold in a wheelchair. Our scale, which was designed for weighing pediatric patients, couldn’t go high enough to measure Harold’s weight. Two nurses wheeled him down to the adult clinic, where he was found to weigh 230 pounds and was 5 feet 11 inches tall. This awkward process took 45 minutes, during which Harold didn’t say a word.
When he had been placed in an examination room with his mother, I went in to talk to them and take a medical history. I had asked that Harold not take his clothes off, and he was sitting in his wheelchair in front of the desk. His mother had sat in a chair in the corner of the room. My first impression of Harold was that he seemed barely human and barely alive. He was massive and lethargic, and had accepted being placed in the examination room without making the slightest effort to help the nurses or his mother; 230 pounds of dead weight. He sat staring down at his palm and did not look up during the entire period I spoke to his mother.
Her story was very similar to the one Dr. Y had told. Harold had had a normal childhood on a ranch his parents ran outside Sebastopol. He was notable only for his bookishness (he had always been number one in his class) and for his aptitude and interest in mechanical things—especially cars and motorcycles.
While I was talking to his mother, I watched Harold out of the corner of my eye. He didn’t move.
I was starting to feel uncomfortable with fashion and had fallen into an old pattern of power-hungry thinking – could I cure this boy? could I make him lose weight? would I succeed where a dozen of my colleagues had failed, and in doing so prove that I was the best? As these thoughts came to mind, I became increasingly concerned. This was, after all, a test of my abilities. would I succeed or fail? In a subtle way, I had taken center stage and was the star of the show.
After I got the information I needed from his mother, I turned to Harold, who hadn’t said anything or moved for a full 20 minutes, and said, “Why did you agree to be brought here?”
Harold looked up. His face, like the rest of his body, was expressionless and motionless. But his eyes flashed with anger.
The strength and power of his anger shocked me and made me realize that I was definitely not alone on stage. Here was another actor who was very much present.
I felt my old patterns of power slipping away. I had been participating in a humanistic medicine training program for many months, and I was coming into contact with some new patterns. I did not take Harold’s anger personally, even though it seemed to be directed at me. I knew from personal experience with chronic illness that anger can often be the will to live expressed in a negative way.
At the same time, the training program had given me new and unique experiences. Over the course of a weekend learning about massage techniques, I had seen the human body in a whole new way and had become aware of the life energy that both myself and others contained.
Another weekend, this time on Gestalt therapy, had demonstrated on a psychological level the strength of this life energy – that, while the patient had all the questions, he also had all the answers he was seeking.
As I looked into Harold’s shining eyes, I became aware of my respect for this tremendous energy—and of a sense of relief. I wasn’t supposed to “heal” or “cure” this boy. He didn’t need my energy—he needed me to help him get in touch with his own.
After Harold and I looked at each other for a minute, and I smiled back in recognition of his energy and strength, he said, “Can’t you see it?”
His voice was deep – a man’s voice. It was not the voice of the body, but the voice of the eyes.
I said, “Yes, I can see that.”
“I want you to make me lose weight.”
I could see that Harold was putting the responsibility for his weight loss on me – and that I had to enable him to take responsibility for his own choices.
For a moment I felt a sense of fear – how could I do that? Then I understood that just as I had disidentified myself and my self-esteem from Harold’s weight loss, Harold had to disidentify from his obesity before he would be able to understand the meaning of his obesity and choose to change it. I had begun to realize that there is often a message in an illness – and that Harold’s weight loss was his way of expressing something. Only he knew what this was about, even if he probably wasn’t aware of it yet. I decided to take a chance and try out a new technique I had learned. It is true that these were not things I had learned in medical school; it is true that I was nervous about really entering a patient’s psychological life in this new way. But it felt right, and it felt right to continue. A Gestalt therapy technique seemed to me to be the ideal way to help Harold disidentify from his obesity and begin to understand the message it contained.
I stood up and grabbed a straight-backed chair, which I placed in front of Harold.
“Put your fat on this chair.”
Harold looked at me in dismay – for the first time no longer angry.
“What?”
I prayed that he was still close enough to his childhood to be able to fantasize, and said, “Place your fatness on this chair.” I showed with my hands what I meant. “Can you see your fatness here?”
Harold laughed. “Yes.”
“Talk to it.”
Harold laughed again. “What can I say?”
“Tell it what you don’t like about it.”
After a short silence, he began to speak. The words poured out—one angry statement after another. His obesity prevented him from having friends—from going to school—it made him ugly—it made it hard for him to breathe and to live. After ten minutes of monologue, Harold fell silent.
“Now tell your fatness what you think about it.”
Harold was deeply shocked. “Like it?”
“Yes, I think so.”
This time the silence lasted longer. Finally, Harold said that his obesity exempted him from daily tasks.
“And,” I prompted.
“Mom serves me food in bed and waits for me to wake up.”
“And”
“I don’t have to do anything I don’t want to.”
“And”
“I don’t have to try, and if I tried, I might not be able to.”
“Harold,” I said, “who spoke?”
“But I have that.”
“Am I the one who has spoken, thick or thin?”
“I don’t know – no, wait – my fatness is over there (he pointed towards the chair across from him). The me who spoke was the thin one.”
“Okay,” I said, moving my chair until I was sitting next to Harold across from the empty chair where he had placed his obesity.
“Well,” I said, “what are your “Thin Me” and I going to do about this obesity?”
Harold laughed again. He was really amused. “Let’s make it go away.”
“Okay,” I said, and in a conspiratorial way we talked about choices and decisions. I told Harold that I thought he had come out of childhood so recently that he might not have had the opportunity to make an adult decision. To choose for himself rather than having an adult choose for him. Maybe losing weight would be Harold’s first adult decision.
He looked interested. I told him that adult decisions require careful thought. I felt that Harold should go home and start writing in a journal. That he should first write down all the advantages of being fat, and then all the disadvantages of being fat. Then he should write down all the advantages of being thin and all the disadvantages of being thin.
On the other pages of the notebook, I asked Harold to write down everything he ate so he knew how many calories he consumed each day.
In the two weeks leading up to his next appointment, I asked him to decide if he wanted to lose weight now. I asked him to tell me about his decision at our next appointment.
Harold stood up and shook my hand. Again I felt a tremendous respect for the Angry Man, which I could see in his eyes.
I sat alone in the examination room, finishing my notes. As I stood up to leave the room, my eyes fell on the empty wheelchair that had carried Harold here—and I realized that he had left it under his own power. I felt invigorated and excited.
Two weeks later Harold returned with his notebook and his resolution. Yes. He wanted to lose weight. I told him I would call a dietitian who could help him.
Using the information given to him by the dietician, Harold worked out a diet for himself which I approved of as wise. I then told his mother that I thought it important that she not comment or criticize Harold in any way regarding his food, but that she put her cooking and shopping experience at his disposal. She was hesitant, but agreed to try it. I did not find her attitude unreasonable, since this was Harold’s fourth diet, but hoped that she would become more enthusiastic as Harold became aware of his strength and his strength became more visible to her.
Harold asked me when he was going to come back. I asked him how often he felt it would be beneficial for him to come here.
“Once a week at the moment – and later every other week.”
“Absolutely fine,” I said, “tell them at reception when you’re coming and have them let me know.”
Harold went out to make his next appointment. He walked with great difficulty, but he walked.
Over the next few months, using subpersonality techniques, I kept Harold in touch with the dialogue between his Thick Self and his Thin Self by helping him to adopt an observer role. His Thick Self and Thin Self can be considered subpersonalities (read more about this at www.psychosynthesize.dk) – organized patterns of attitudes, beliefs, behaviors and feelings. Each subpersonality can be considered to have its own needs and goals. Often these needs and goals will conflict with each other and with Harold’s own needs and goals. I showed Harold how skillfully his Thick Self outmaneuvered his Thin Self, or how skillfully his Thin Self had sometimes been at family meals. I emphasized skill and strength – as these were some of Harold’s most prominent qualities. What he had chosen to do with his skill could just as easily have been negative – but skill is skill, after all.
Some weeks Harold lost weight – other weeks he didn’t. During all this time I didn’t count his calories for him, nor did we discuss weight at all. I didn’t comment on his muscle pain other than by taking him off all pain medication, since it wasn’t working anyway.
However, the work on the subpersonalities continued, and Harold became aware of the tricks his Fat Self was playing with his Thin Self, and the circumstances under which his Thin Self would allow his Fat Self to eat. He began to enjoy watching his process.
During the first six months, Harold’s visits resulted in the following results on his part:
1. He lost 25 kg
2. He became interested in nutrition and read a lot. As a result of his reading, he insisted on doing his own shopping (and thus leaving home for the first time). Eventually, he started cooking and we exchanged recipes.
3. He became interested in building models and made some beautiful clipper ships, among other things.
4. He began subscribing to and reading motorcycle and car magazines.
During this period, I also underwent a profound change in my perception of my identity as a doctor. Through my training at the Institute of Human Medicine and my experience with Harold, I began to see myself as a gardener. I could not create so much as a blade of grass. Blades of grass, like patients, had their own life force and energy. But I could plant. I could plant in the sun if I loved the sun, and in the shade if I did not love the sun. I could water and weed. I could spray against insects and spread snail poison. I no longer demanded of myself that I should “cure” or “heal” – but rather that I should nourish the patient’s own healing power.
And then Harold stopped losing weight.
Five weeks passed without any change. After the second week I pointed out to Harold that he had been gaining about a pound a week in the 24 months before we met. During the past five weeks he had not gained any weight at all, so he had still managed to reverse his previous trend. He had also grown two inches. There was a certain joy.
As the weeks went by, I became more and more concerned. Because of the situation, Harold became quiet and withdrawn, and I began to slip into my old pattern of success and failure. I began to feel guilty about not being successful in getting Harold to lose weight. Now I began to dread his visits, even though I had looked forward to them in the past.
I spoke with several members of the institute staff and received support and suggestions. But I felt increasingly fragile.
At 7:30 one morning in July 1973, a colleague called me, and during the conversation we started talking about obesity and fat children. She asked me if I had ever noticed how my limits always expanded when I got into the car, and how I knew my new limits; I could park within 10 cm, place the car in very little space, etc.
I was amused by this glorious image, but when I later started the car, I decided to consciously experience it. So I let my limits expand until I was the size and shape of a 1969 Valiant, and in this new form I drove down the street to work. I experienced a false sense of strength— big is strong —and confused my physical limits with my spiritual state. I imagined that this must be how a fat person experienced it. I also thought of a cartoon I had seen 20 years ago, in which a little greenhorn of a man gets into his car and becomes an aggressive, determined, and brutal driver; and how, when he gets out of the car, he turns back into a greenhorn. I wondered if this change occurred because this little man suddenly experienced an expansion of his physical limits. Do fat people experience it this way? Could this be what obesity had to offer?
As I drove in the car, I was aware of how my boundaries kept other people away because they were further out. It felt okay because I knew I could get out of the car whenever I wanted. But to the greenhorn, it might not have felt just okay, but damn convincing. All morning long, this image kept popping up in my mind, and I kept getting amused by it. Around 1 p.m., the nurses came in to tell me that Harold was here. I hadn’t expected him and was annoyed.
When I discovered that Harold had not only come without an appointment, but that he had not lost any weight, I was really annoyed. (These old habits of “healing” are quite tenacious; the guilt of not coming up with a “cure” can give rise to resentment towards the patient.)
The dietitian had already talked to Harold and suggested that he eat more because he was more active. Without realizing it, she had spoken directly to his Fat Self. I was really annoyed, but they had driven all the way from Sebastopol on the highway….
So I went in and, in my irritation, asked Harold why he hadn’t lost weight in five weeks. He said angrily, “I was hungry.” So I asked him to: (a) count the calories in his diary. He was still writing everything down, but had stopped counting; (b) reconsider whether he wanted to lose weight. I told him that I thought a decision not to lose weight right now would be less harmful to him than continuing to “try” to lose weight and not acknowledging that he no longer wanted to. These “tryings” could make him feel like he had no choice. Again, we talked about how his diet represented the first adult decision of his life.
By now I had disidentified myself from my feelings of frustration. I was no longer angry. Then I noticed that Harold was wearing a new pair of jeans. I noticed, and in a shaky voice Harold told me that he had bought them recently and that they were four sizes too small. Finally I understood. About five weeks ago, Harold’s weight loss had really started to show. And maybe size equaled strength for him.
Then I began to tell him about my phone conversation and my experience of allowing myself to expand my boundaries until I felt like I had the shape of a 1969 Valiant. I told him about the greenhorn and the illusion that size equals strength and gave him several similar cases where a person could mistake their physical condition for a spiritual condition (i.e., because you couldn’t get pregnant, you didn’t think you were capable of being a mother to a child). I said to him, “I wonder if there’s a driver in you who is used to driving a three-axle truck and therefore gets annoyed when the truck gets smaller and smaller. The truck gets smaller and smaller. Soon it’ll be the size of… (I hesitated, looking for a picture, and my intuition gave me a…) a motorcycle.” That was the verdict.
Harold suddenly turned inward and said emphatically, “Have you ever been driving on a major highway on a Sunday morning when all the big cars are bumper to bumper and nobody can move out of the way, and there’s a guy on a motorcycle who can do 60 km/h in the middle of the road, giving them all the finger? Isn’t that what it’s all about? Being strong doesn’t mean being big. That’s what it is – being strong is being able to move.”
I said, “and ….”
Harold said, “And being able to decide where you want to go and move there.”
Then he smiled.
I was deeply moved. We all need to grow. We just need to be reminded of that. Harold had seen what “strength” really was – not size, not weight – but the freedom to move, to choose – to will. The treatment had entered a crucial phase.
I asked Harold, “Who was it that said, ‘I’m hungry’?” He replied, “The driver of the Chrysler Imperial.” I asked, “Why?” He replied, “Because he didn’t understand about motorcycles.”
Using another technique I had learned, I suggested to Harold that he communicate directly with his body, that he talk to it and write to it. That he tell his body that he apologized for making it hungry right now and that he acknowledged its patience. That he made it hungry because he wanted to spare its bones and suffered for the pain it had known for the past few years.
He laughed and said he would do that.
Harold returned two weeks later, having lost five kilos. His opening words were, “Here – I brought a picture of myself to show you.”
On my desk he placed a picture of a discarded, rusty engine lying on its side in a field.
Next to it he posted another picture of an engine. This time it was placed on blocks. It was clearly in working order and had been painted a bright blue.
I looked at him in confusion – and he said, “There – this is what I really look like – I change things – and the change is me.” And we both laughed.
A few months later, Harold started school. We had never discussed it, but when the fall semester began, it seemed natural to him to start school. He drove there in a little go-cart he had made from the engine he had repaired and some parts from a bicycle.
Harold has now been at school for six months. He is still 22 pounds overweight, but it doesn’t seem to bother him. The pressure of schoolwork has made him decide to come to me only twice a year. On his last visit, he told me that he had spent a week making a film with some classmates for his photography class. He had written the script and was the director. He put the script in my hands – “We called it ‘The Sword and the Stone’,” he said. “It’s about King Arthur and the time he pulled the Excalibur sword out of the stone and everyone knew he was the king.”
“That’s one of my favorite stories,” I said. “How did you come up with that?”
“Oh,” he said, “I chose it because it was a very important thing – it was there that King Arthur found out who he really was.”
Harold proved that he was not a “problem patient,” but rather one of my most remarkable medical experiences. By finding out “who he really was,” he also taught me “who he really was,” and, coincidentally, who I really am.
Together.
How to move forward
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Also read the article Psychosynthesis an Integral Psychology and the biography of Roberto Assagioli
