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How Fatphobia Manifests in Therapy

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How Fatphobia Manifests in Therapy “LET’S TALK ABOUT YOUR WEIGHT”: HOW FATPHOBIA MANIFESTS IN THERAPY SAMANTHA ABEL A DISSERTATION SUBMITTED TO THE FACULTY OF GRADUATE STUDIES IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF DOCTOR OF PHILOSOPHY GRADUATE PROGRAM IN COMMUNICATION AND CULTURE YORK UNIVERSITY TORONTO, ONTARIO June 2020 © Samantha Abel, 2020 ii ABSTRACT Fat people experience individual and structural oppression in a variety of cultural and relational arenas. Experiences of fatphobia are shaped by body discourses, neoliberal agendas, and the medical model. This dissertation uses semi-structured narrative interviews and visual data to explore fat clients’ body histories and how their experiences of fatphobia are reproduced within the therapeutic space. Therapy is another arena where fat bodies are disciplined, operating as a vehicle to transmit dominant expectations to citizens. Cultural, medical, and psychiatric understandings of “obesity” permeate therapeutic interactions, linking mental illness and physical embodiment. Therapists often entrench client/clinician power relations, reinscribe client deviance, and promote weight loss. When clients attempt to challenge or shift the narratives around their body, therapists become defensive. Mental health practitioners have an ethical obligation to treat clients with dignity and respect, regardless of body size. It is vital for therapists to engage in reflexive practices and to think critically about whether they are meeting client needs or acting as agents of social control. Fat Studies, fat activism, and anti-oppressive practice principles offer therapists lenses to contextualize fat clients’ experiences within broader structural and systemic power relations, rather than seeing fat bodies as individual examples of deviance. This dissertation outlines practice recommendations for therapists so that body work can be undertaken from an emancipatory lens. iii ACKNOWLEDGEMENTS I am indebted to my supervisor Dr. May Friedman, who has been my mentor for the past twelve years. She taught the first undergraduate social work course I took in night school, and my experiences in her course inspired me to switch careers. May made space for me to explore Fat Studies as I started to make connections between fat activism and social work practice, and she was the second reader for my Master’s research. She saw my path to this dissertation long before I did, and I am so grateful for her ongoing guidance and support. Deep thanks to my committee members Dr. Jacqui Gingras and Dr. Anne MacLennan who both believed in this research and provided invaluable guidance every step of the way. Thank you to Dr. Lisa Barnoff who has supported me throughout my undergraduate and graduate years. Heartfelt thanks to my community who rallied around me as I navigated this PhD. To my parents who provided ongoing and diverse forms of support. To my friends who stood by me as I weathered the peaks and valleys of the doctoral process. To Rosie, J.B., and Lucy for keeping me grounded. Special thanks to my friend and colleague Crystal Kotow, who was six weeks ahead of me in her dissertation writing process and fielded my constant panicked questions with grace and patience. I do not have enough words to thank my partner Trevor, who celebrated my triumphs and buoyed me when I was struggling. Trevor took on additional responsibilities so that I could focus on finishing. His contribution over the past six years cannot be overstated. Finally, I am extremely grateful to my participants, who thoughtfully and insightfully described their body-related experiences, even when it was painful. Thank you for trusting me with your stories. iv DEDICATION For the Village. v TABLE OF CONTENTS Abstract.........................................................................................................................ii Acknowledgments........................................................................................................iii Dedication....................................................................................................................iv Table of Contents..........................................................................................................v List of Figures..............................................................................................................ix Chapter One: Introduction............................................................................................1 Why This Research?.........................................................................................3 Researcher Positionality...................................................................................4 Professional Observations................................................................................6 Pushing Back in the Workplace.......................................................................9 Chapter Two: Theoretical Framework........................................................................11 The Discursive Framing of Bodies..................................................................11 Normative Neoliberal Bodies..........................................................................13 The Medical Model.........................................................................................16 The Body Mass Index.....................................................................................18 Fat Studies and Fat Activism..........................................................................19 The Therapeutic Relationship.........................................................................23 Power Relations in Therapy................................................................25 Social Work and the State...................................................................26 Oppression and Anti-oppressive Practice...........................................28 vi Politicizing Fat in Therapeutic Practice..............................................32 Conclusion......................................................................................................34 Chapter Three: Research Methods..............................................................................35 Recruitment.....................................................................................................41 Interviews........................................................................................................43 Analysis...........................................................................................................44 Demographics.................................................................................................49 Limitations......................................................................................................52 Chapter Four: Socializing the Fat Body.....................................................................53 Public Space...................................................................................................55 Work...............................................................................................................65 Clothes............................................................................................................68 Family.............................................................................................................73 Mothers...............................................................................................75 Fathers.................................................................................................76 Other Family Members.......................................................................78 Dating and Relationships................................................................................80 Policing the Self..............................................................................................87 Disembodiment as Coping..............................................................................91 Conclusion......................................................................................................94 Chapter Five: Fat Politics ..........................................................................................95 Describing the Body.......................................................................................95 Fat Community...............................................................................................99 vii Literature............................................................................................99 Fat Friends.........................................................................................101 Art and Performance.........................................................................103 Liberating Clothes.............................................................................107 Fat Activist Struggles....................................................................................113 Conclusion.....................................................................................................115 Chapter Six: Medicalizing the Fat Body...................................................................117 Weight Discrimination from Doctors............................................................119 Psychiatry and Psychiatric Drugs..................................................................134 Dieting and Disordered Eating......................................................................139 Chronic Illness and Disability.......................................................................142
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