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A piece of my mind. Filling the void.

Filling the Void WHEN I FIRST MET PAULA, SHE WEIGHED MORE than 325 pounds, was shy and withdrawn, and spoke with a muted tone of heavy sadness. She was referred to me by her mother, who was seeking help with her daughter’s obesity. Both had resigned themselves to the apparent intractability of her obesity, but still desperately hoped that something could be done. A lengthy consultation included review of her history (I learned that an uncle had fondled and molested her when she was a teenager), examined her, and got the necessary laboratory tests. I then discussed her potential treatment options. These included bariatric surgery, but she felt that wasn’t something she wanted. She said she might consider medications in the future, but for now she wanted to make some changes herself and take control of her weight. With the help of a food journal, she stopped consuming all regular soft drinks, abandoned her afternoon and evening snacks, and reduced her meal portion sizes. But despite my strong advice and pleading, she would not talk with a psychologist. We worked together for more than six months, building a relationship of respect and trust, during which time she lost about 90 pounds. With this success, I again asked her to explain to me why she had become overweight. It was at the end of one of her many visits that I again asked her, “Paula, how and why did you come to be so heavy?” When I had asked this in the past, she usually offered a timid and evasive answer about eating too much fried food and not exercising enough. But this time, I was surprised when she said, “You know my having gained so much weight was not about being hungry or wanting certain foods. It wasn’t really about eating, although you and I both know that my bad eating habits didn’t help. It was about escaping and numbing my feelings. For my hunger, I could take care of it by eating. But for my unhappiness, there was no amount of food or eating that could take away those feelings. There was just too big of a hole in me to fill. No matter how much I would eat, I could never fill up that hole. I told you what happened with my uncle; he would come in to my bedroom, get into my bed, and touch me and do sexual things to me. I need to talk with you about it, but I can’t right now. Is that okay?” “Sure,” I said, surprised by her frankness and the openness of her feelings. “I understand. Let’s talk about what happened and your feelings when you’re ready. But would you now be willing to talk with a psychologist?” I asked. “No,” she replied, “not now.” We continued to work on her diet, even though she was reluctant to share any more of her feelings and emotional experiences. After another four or five months passed, Paula’s mother unexpectedly called the office and asked to see me but said she wanted to make sure our conversation would remain confidential. She told me how Paula had been abused by her uncle for more than four years. But during this time, Paula had never been able to tell her mother about what was happening. Even years after Paula had confided in her mother about her molestation, neither of them was able to confront the uncle about what had happened. She remarked, “Looking back on the whole thing now makes me realize that Paula has always been surrounded by sorrow and sadness. She has always been distant from people; she has no real friends. I knew something was wrong, but I couldn’t reach her. It was like she was always slipping past me, sinking into a dark pit, and I didn’t know how to help her. “I feel there is a wall of shame that surrounds her, like an insurmountable barrier, a deep void separating her from others. This void will always be with her; it will never be filled. I think the reason she’s so fat is because she’s tried to fill the void so many times by eating. She would eat throughout the day and night, always trying to find some relief from her painful memories. But she will never be able to fill that void, I’m sure of that. No amount of food will ever be able to make up for what her uncle did to her for all those years. “When Paula was about 22, she told me that she had wanted to talk with her uncle about what had happened. She knew it was important for her to clear up the past, repair what she could, and make peace with herself. And she tried, but he wouldn’t give her a chance, never allowing her to talk with him in private, avoiding and never returning her calls. So she continued using food as a way to numb her feelings. But then gradually over the years, she seemed resigned to make peace with herself and her uncle. She learned to move on with her life, but unfortunately not with her weight. Neither of us will ever be able to forget—me with my guilt for not doing anything about what happened, and Paula, with her obesity. Sad, isn’t it?” She sighed. I tried to soften the sadness of our meeting and lessen the mother’s grief by telling her of reports that found that for