The Jigsaw

I am overweight. Round, wiggly, jiggly and ashamed. I shouldn’t feel ashamed, my weight gain is not a moral failing. It does not come from some criminal act. It does not come from a lack of ability in self-control. My appearance of a round apple is not because I have rejected healthy food, moderation, or even movement. I look different than the social ideal. Each part of my body deviates from a surface ideal of rail-thin women with China-doll delicacy. I am thick, sturdy, a Venus Willendorf rather than a Venus de Milo, pendulous boobs and a stomach plump enough that when I give myself injections they don’t hurt.

My weight gain is a direct outcome of my illness—the combined effect of medication side effects, the inability to move coupled with enormous dietary restrictions due to Coumadin. I’ve lived with its fluctuations now for twenty years and at forty-two I am starting to accommodate to the companionship of this weight. Yet, despite these well-known factors I enter several of my doctors’ offices with dread as they decide to remind me that I’m obese. They tell me this with a serious, almost stern, expression as if I have no idea that my body has exploded outward.

When they make me stand on the scale I feel a well of shame. That I have failed in some significant way to live up to the social expectations of what a “good” person should be. Even though my rational mind knows full well there is no linkage between a person’s integrity and worth and their number on the scale, my self-perception born and raised in a culture that values thin women—or more accurately women who look and act closer to porn stars or the emaciated image of the waif-models who bear striking resemblances to women whose lives have been battered by heroin addiction—cannot make the distinction. In the Mirror I am a failure. A feeling that is often reinforced as I am lectured by physicians.

Physicians are not trained in multicultural counseling or multicultural perspectives that modern Psychology has espoused and currently teaches its students. Physicians are trained in parts. A body broken down into sections like a jigsaw puzzle. When illness strikes, the puzzle shatters into a million pieces and the physician has to figure out how to put it together again. But rather than having your unique image to go by, they work off the template of what is the social norm—how your body should be normal and how it should look. This creates a problem, a disconnect between them and me. They are attempting to trim my jigsaw pieces to fit an image I no longer even approximate.

Now not all my doctors do this, some have enormous understanding about how my body has fallen to pieces and what it might look like put back together: an image that incorporates my brokenness rather than seeks to deny it. These doctors see my weight as something that causes me emotional pain and is one more aspect of my life my illness has wreaked havoc. They do not see my weight as something shameful, something that cannot be hidden because no clothing designer makes vertical stripes for women. They quietly ignore the scale and focus on what is working well for me right now and look practically at what aspect of my illness needs further treatment. They know that the illness is the problem, not the weight, not some shameful behavior or lack of control. Weight is just another piece of the puzzle.

The doctors who highlight it typically don’t understand the extraordinary pain that I deal with on a day-by-day basis. Pain is another of those nebulous jigsaw pieces that is treated with suspicion and assumption of some moral failing. I often feel compelled to inform doctors that I don’t rely on pain medication in order to separate myself from their social image of someone with opiate addiction. This too is a jigsaw piece often emerging not out of moral failing but out of deep psychological pain and/or physical pain. These doctors lack empathy and an understanding that to eradicate symptoms, one must dive into the depths of disease—a murky landscape of often times incurable problems. A place where doctors confront the limits of their knowledge, the limits of their science.

I often come down to wondering if what informs our social ideals that cause so many problems for those who deviate doesn’t come down to a very naked truth of our powerlessness—that life is out of our control and the jigsaw puzzle that makes us all up is often hard to piece together because we are ultimately putting it together with the wrong pictures.