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Stefanie is a large woman with ashen blond curls that cascade down her back. She is a bundle of fast-talking energy. She is brilliant, a grad student in philosophy, who processes her experiences with a mental agility that is impressive. I wait patiently for my openings, and it has been this way for our 10 years in treatment. She chews on what I say in between sessions and brings up my words years later as a meaningful shared reference point.
A few months ago, after a lifetime of obesity, Stefanie chose to have gastric bypass surgery. She had been mulling over the decision for years, as she lost and gained back the same weight numerous times and hovered around 300 pounds. We were both fearful of the challenges the surgery would bring about. Would she be able to stick to the vitamin regimen and strict scheduling of mealtimes and limited foods after the procedure? If she failed, would she be able to live with her inability to follow through on this last-chance solution? If she was successful, what would happen to her relationships when she got more in touch with her bodily desires? And what about those health-at-any-size body positive beliefs that she had nurtured as a self-defining protest against her parents’—and the world’s—insistence on the value of being thin? What if she lost her connection to her community of fatness, where she felt she belonged, where she had experienced love and acceptance? And how would she deal with people looking at her all the while her body was changing? Would she be able to tolerate their gaze and worse yet their positive commentary?
Stefanie hates feeling exposed. I found myself in an impossible dilemma. If I didn’t see and in some way acknowledge the weight she immediately started losing, after the surgery, then how could I provide witnessing to her constantly changing body. But if I did look, how could I keep my gaze not about my reactions but still allow it to be about her.
This is the psychoanalytic terrain we were cautiously traversin