Fat Pain is Not Your Profundity

Rachel Fox explores how doctor-writer narratives often depict fat people in dehumanising and hurtful ways, and argues they need to be reframed with empathy.

During my six years as a student in the medical humanities, I’ve become quite familiar with the “doctor reflecting on a memorable patient encounter” genre of publication. These stories often follow a similar structure: anecdotal introduction, explanation of patient/case/doctor’s own training, dramatic or otherwise significant event, then conclusion with a broader lesson and/or resolution for the author. Stories that take this form are compelling and familiar; readers get to vicariously experience the stakes of medicine with the security of closure awaiting them at the end, while the doctor-writer gets a cohort of witnesses for their perspective on some significant part of their practice. At their best, these stories “humanize” the experience of medicine, giving a personal voice to the intimacies within a seemingly indifferent system. But I have yet to see a story of this genre that humanizes fat people.

In fact, all the doctor-writer essays about fat patients I have encountered do the opposite: they dehumanize fat people. It is incredibly painful, as someone who believes in the power of these stories to change medical practice, to read such a piece, hoping that is empathetic and insightful, only to find that it’s about how unhuman fat people (like me) are.

Doctor-writer personal essays hide violent anti-fatness under the veneer of humanistic story telling. Consider these examples:

Years ago, a woman who was morbidly obese passed out in the lobby of the clinic where I worked. She must have slid off her extra-large wheelchair because by the time I raced down the stairs she was lying on her back like a tipped-over refrigerator…It took eight strong men, sweating and red-faced, to hoist her into the ambulance. I never saw her face, never knew her name. In my memory, she is simply obesity incarnate (Reisman 2017, 661).

Donald is large. Very large. At more than 600 pounds, he is a mountain of flesh with a small opening at the top through which he speaks…Facing him, I feel momentarily put off. I’m not sure just where to start the examination, and when I begin, my hands look small and insignificant against the panorama of skin they’re kneading. It’s hard to tell, exactly, but I think his pain is coming from somewhere around his stomach (Thompson 2013).

For the last year and a half, Mr C had been my patient. Four years before I met him, before his two years in prison, he had injected heroin regularly and weighed almost half as much as he weighed now. As he walked resolutely out of his jail cell, reinvented at the age of 50, he swore off all heroin. Over the next six months, he replaced needles with bacon double-cheeseburgers and gained more than 40 pounds. He lumbered into my office, his belly as large as a duffle bag (Kapur 2010, 711).

Each of these passages comes from the first few paragraphs of a doctor-writer’s personal essay. Three essays, three different doctors, three sets of dehumanizing metaphors. A fat woman in crisis becomes a refrigerator. A fat man seeking out emergency care is a mountain. The torso of a fat man receiving primary care is luggage, not a body part.

Photo by AllGo – An App For Plus Size People on Unsplash

Three different stories, yet all set the reader up to see from the doctor’s point of view: the doctor-writer is the humanized self, and the fat patient is the dehumanized other. The remaining content of the stories matters less than the establishment of this narrative: it locks fat people out of the realm of full consideration and turns us into fodder for the writer’s agenda. These stories read as if the authors never considered that a fat patient might encounter them (which is especially ironic, given that Thompson’s essay was reprinted for a general audience in the Washington Post). It seems as if the authors had no recognition, gave no forethought to what it might be like to read their story and see yourself in the refrigerator, the mountain, the duffle bag.

This lack of consideration is familiar to me, a fat person who both lives and studies the receiving end of medicine’s derision. At every moment, I feel the ambient harm of existing in an anti-fat world. I’m used to it. The narrative injustice of a few essays would not ordinarily be my battle; I would usually leave such a fight to fat activist Ragen Chastain, blog moderator Hallelujah_Hippo, or Narrative Medicine professor Sayantani DasGupta.

But the ends of the stories are intolerable. I cannot stand the closure, the resolution; the doctor-writers’ attempts at extracting profundity from the discarded humanity of their fat patients:

More recently, when I met another patient, also morbidly obese, I asked him to stand and take a few steps as part of my evaluation. He heaved his huge body up with grunting difficulty and leaned ponderously on his walker. Deliberately, excruciatingly, he lifted each enormous leg, huffing and puffing…And then something changed. He sat, and caught his breath, and we chatted for a while about some news tidbit, something unimportant, something that had nothing to do with his weight. At that moment, I forgot about my patient’s hugeness. He was not an embodiment of obesity. He was simply himself  (Reisman 2017, 661, emphasis mine).

[Donald is] trapped in his own body like a prisoner in an enormous, fleshy castle; encircled by a moat of fat, he shouts from the parapets to anyone who might give him succor…Later on in my shift, still feeling the eldritch traces of Donald’s presence, I sit and stare at my 700-calorie dinner, all appetite gone, wondering where empathy ends and compassion begins. I know why my colleagues and I are so glad to have Donald out of the ER and stowed away upstairs: he’s an oversize mirror, reminding us of our own excesses. It’s easier to look away and joke at his expense than it is to peer into his eyes and see our own appetites staring back (Thompson 2013, emphasis mine).

“Don’t worry about me, Doc. I’ll lose this weight. Just you wait and see.” He laughed, loudly, unabashedly, his huge belly shaking, his voice echoing in the uncarpeted, sterile examination room. I smiled crookedly and shook my head. As he ambled down the hallway, his frame obscuring the petite medical assistants who scurried past him,I wondered about Mr C, my alter-ego, my doppelgänger. I wasn’t sure if he would lose his extra weight, but for that brief moment, his enthusiasm was infectious, and he filled me with hope. We would both not become two other casualties in the obesity epidemic. Through sheer determination and companionship, we would beat the odds (Kapur 2010, 712, emphasis mine).[1]

I know, via the conventions of the genre, that these endings are supposed to make the reader feel satisfied. But reading these as a fat person, against the narrative grain, these stories are not tales of empathy or compassion. They are flattened, stereotypical portrayals of fat people through the pathologizing lens of “obesity.” The patients are diseases first and humans second. Each story discloses the patient’s weight, each doctor-writer mentions food or calories in their piece. Every tale uncritically highlights the ways that medical practice oppresses fat people; the fat patients are cast as burdensome (needing extra people to be lifted into an ambulance, being difficult or unfamiliar to touch, needing a different medication dosage, being “difficult” to image with diagnostic equipment) or noncompliant (refusing bariatric surgery, gaining weight instead of losing).

These stories do not end with a lesson about how doctors should change their practices or advocate for better care and resources for their fat patients. They do not end with the doctor-writer developing empathy for the fat patients they are treating. They do not end with the fat patients being considered as people. Instead, they end with what the “obese” character did for the author: Reisman learned to see past “hugeness,” Thompson considered his “own excesses,” Kapur was “filled with hope.”

These final paragraphs neatly seal the narrative, ensuring the doctor-writer’s view remains dominant. They remind the reader who matters: not the fat person/people being written about, but the doctor-writer. Not the people in the story, but the storyteller. In fact, the doctor-writer’s perspective – how they feel about the story, why they have chosen to retell it – is the only priority. The stories must end with a redemptive gesture towards the profound. Otherwise, they would end with a fat patient in pain (Reisman), a fat patient found dead (Thompson), and yet another fat patient set out on an almost-sure-to-fail weight loss diet (Kapur).

Decenter the doctor-writer and you’re left with the mundane cruelty of what it’s like to be fat and need medical care, to be fat and trapped in a fatphobic world, to be fat and know the person who is supposed to care for you cannot grant you as much humanity as they grant themselves.

Empathy, as my recent research (2021) has shown, comes from taking significant time and care to get to know fat people as people. People who are complex, live interesting lives, face hardships, and feel joy. In short, the exact opposite of how fat patients are presented in these doctor-writer stories.

Empathy, in its most humanizing form, opposes resolution. Truly empathizing with fat people means feeling our pain on our terms. An empathetic story would not extract profundity from fat patients’ pain. An empathetic story would build momentum for change, call for reworking systems of care, and implore readers to seek out additional fat voices rather than assuming they know them all. Put simply, doctors who empathize with their fat patients don’t write self-congratulatory essays about it.

I can’t stop doctors from writing these pieces, but I want them to stop pretending they’re helping anyone but themselves with these stories. I want them to know that their desire for narrative closure comes at the expense of fat people’s humanity. And I want them to know that we – the refrigerators, the mountains, the duffle bags – have our own stories to tell. They (and the venues that publish them) should try listening to us instead.

About the Author

Rachel Fox is a doctoral candidate in Communication, Science Studies, and Critical Gender Studies at UC San Diego in the US. She has previously published work in the field of fat studies, and her dissertation in progress examines the history of pediatric weight loss efforts in the 20th century US.

Twitter handle: @rachel_e_fox

References

Fox, Rachel, Kelly Park, Rowan Hildebrand-Chupp, and Anne T. Vo. 2021. “Working toward Eradicating Weight Stigma by Combating Pathologization: A Qualitative Pilot Study Using Direct Contact and Narrative Medicine.” Journal of Applied Social Psychology, March. https://doi.org/10.1111/jasp.12717.

Kapur, Nitin Agrawal. 2010. “Doppelgänger.” JAMA 303 (8): 711–12. https://doi.org/10.1001/jama.2010.173.

Reisman, Anna. 2017. “Commentary on I Can’t Help the Way I Feel.” Academic Medicine 92 (5): 661. https://doi.org/10.1097/01.ACM.0000516446.05612.50.

Thompson, Edward. 2013. “Supersize Me.” Pulse: Voices from the Heart of Medicine (blog). November 22, 2013. https://pulsevoices.org/index.php/stories/supersize-me.

[1]. This story is written by a doctor who self-identifies as fat. Fat people can still perpetuate anti-fatness.

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