Society's sin eaters

What is the difference between being life-threateningly overweight and life-threateningly underweight? It seems increasingly the answer to this is societal concepts of personal choice. In essence, a person with a weight fixation that causes them to deliberately starve is afflicted by a severe mental health issue that deserves time, medical resources and, crucially, the sympathy of a wider public. Someone who over eats to the point of putting their life at risk is just plain fat and lazy. No sympathy there then just tough love to get them off the couch and into the gym.

This stark difference came to the fore for me recently whilst flicking through the many niche television channels - reason enough to get myself off the sofa - when I alighted on a programme with the stated intention of getting fat people to be thin. I am no great fan of all things reality television but I must admit to moments of compulsive viewing syndrome. The point of the programme appeared to be to take a group of severely and debilitatingly overweight people and, through extreme diet and gym work, drive their weight down to some apparently random target.

I think what made me hang around with this assault on my better judgement was the frankly unbelievable use of humiliation by the team leaders to achieve the results they sought. I found myself staring at something I could not believe was happening, least of all as a television event. With growing hindsight that seems a poor excuse for perpetuating this type of toxic television by adding my viewing to their figures. However, something quite powerful hit me as the visual car crash progressed.

What say we swap our overweight participants for their reverse, people bedevilled by Anorexia for example. How would humiliation wash with the viewing public if the individuals being shouted at were required to eat more or being labelled loser, of not caring for their children and family by putting their lives at risk and, ultimately, getting all they deserve. That would be entirely unacceptable and to date I have not seen any channel attempt it.

So why in some quarters is it acceptable to shout at and humiliate people with severe obesity. The answer, I think, lies within the societal issues and not some clever evaluation of what works to normalise the balance between calories in and calories out. Our eating habits are increasingly portrayed as exemplifying the greed that dogs us by a media fragmented and frequently bereft of the resources to uncover real stories. From fat cat bankers to greedy professional footballers over consumption is the topic of the day every day.

One way to deal with this, a way that does not require us to face our own over consumption, is to castigate the people that appear to embody that excess. As we beat them verbally in cheap television programme after cheap television programme we collectively agree that they will be our whipping boys, (and girls), who will take the punishment we subconsciously feel should be ours. They are our sin eaters. Shout the loudest, humiliate the most vehemently and we show how much we hate greed.

The problem with this is two fold. We do nothing to address our deep seated concerns about a society that has lost control over its drive to acquire and consume material possessions. Critically though, we offer no real help to people with food eating disorders. The Psychotherapist, even a student one like me, then meets a client not only dealing with behaviour symptomatic of other deep seated issues but a client damaged by a society that requires they be punished for the ills of a wider public.

Stats, studies and individuals

We love studies. Statistics that, when collected together, create universal truths rammed home by the sheer weight of their collective number. It helps us smooth out idiosyncrasies, to ignore or deny the possibility of differences that can annoy the smooth running of our lives. So, collate all those numbers together, make the individual a part of a group and the mean result can then be extrapolated out to interpret all future occurrences of similar events and people.

I started thinking about this when I read an article in Daily Rx about a study into the best treatments for depression. The piece is an interesting one, and I am not here attempting to question the robust nature of what is being said. However, and it is a big however, somewhere within the article I lost sight of the person, the individual. After all, depression is a very personal thing and it struck me that would make it quite resistant to the application of norms or averages.

To summarise, the study found that a combination of antidepressants and psychotherapy delivered the best results in reducing depression. That's good. I am a student Psychotherapist so it is encouraging to learn that our discipline can play an important role in such a crushing human experience. Putting aside that relief that we are not going to be written out of the process of helping depressed clients I was left wondering what value this news was to me, or indeed to a sufferer. The implication is that on meeting a client expressing evidence of depression I can run my finger down the diagnosis and treatment page and advise a series of sessions with me and a trip along to their GP. I am over simplifying but it makes the points I think.

The problem, and it might just be a problem for me, is that I appear to have come a long way with this client and not actually listened much. Certainly I have failed to engage in any meaningful way. If this was going to be so simple perhaps I should just start selling self-help books with a wealth of instant diagnoses. There's a thought.

My point, (and apologies if you were beginning to suspect I lacked one), is that as a Psychotherapist I am focused on the client. My attention is focused on my client; who they are and what they need. Sure, by the law of averages I now know that there is a good chance that Psychotherapy and medication will help them but that is just numbers at best and at worst a red herring that will lead me away from what they need.

So what does the client need. I would suggest a meeting first, an exploration together of the person sat with me. Whilst I might cast an eye back to the value of robust research my focus is here, in a room, listening to an individual not a number.