The term “treatment resistant” has a couple of different meanings, one of which is a major cause of compassion fatigue and social worker burnout. Every now and then, someone in a helping profession encounters a patient or client who is, for all intents and purposes, un-helpable. An example that is seen too often is the abused woman who can’t be persuaded to leave the abuser.
The condition of treatment resistance has been described as a determination not to get well. It amounts to a low-grade and sometimes decades-long case of Munchausen Syndrome. To those in more robust mental and emotional health, treatment resistance is incomprehensible. A fellow named William Tell wrote:
Practitioners will meet no end of frustration until they accept that such patients exist. No amount of time, energy or resources will bring about a change that the patient doesn’t want.
In fact, the same dynamic plays out anytime one person seeks to impose on another person goals that aren’t congruent with that person’s own. Free will wins out every time.
Free will conquers all, even when that will is utilized to a self-destructive end. But why, why, why, would anyone choose to spend their free will in this counterproductive way? Escaping morbid obesity is such a worthy goal, what competing ambitions could possibly override it? In the same way that social workers can’t understand why leaving a brutal spouse might not be the highest priority, doctors can’t understand why losing dangerous and potentially deadly weight is not at the top of a patient’s to-do list.
Because of her wide acquaintance with morbidly obese people, psychotherapist and relationship specialist Mary Jo Rapini has been consulted by many bariatric surgeons. She writes:
The genetic role helps explain the body type; the way food may be processed, stored, and proportioned. It cannot explain what keeps the person from changing the behavior that contributes to obesity… These patients have a story to tell, but we aren’t listening and we continue asking the wrong questions.
It is easy to categorize patients as living on the legendary Egyptian river, “de Nile,” but Rapini reminds health professionals that they too can slide into denial, and warns them against it. She emphasizes a point that Dr. Pretlow has made, time and again. Most people know exactly what a healthful diet consists of. It simply doesn’t work for them.
Rapini pilots 12-step groups that address food addiction, and as part of the “amends” step of the program, she asks, “How do you benefit from being obese?” If a comedian asked some version of that question in a club, half the audience would probably walk. In these groups, however, the members are committed to rigorous self-examination.
It turns out that a large proportion of morbidly obese patients were indecently interfered with in childhood, and have built around themselves fortresses of fat designed to discourage any repetition of that trauma. Some are in marriages that never were good, or that started out happy and went off the rails. They wouldn’t cheat with an actual human, but food can make a satisfactory replacement.
Other reasons are less intense. Morbid obesity provides people with an excuse to not do things they don’t want to do. The rest of the world may often be persuaded to abandon its expectations and lower the bar. And this is too big a subject to be contained in one post.
(To be continued…)
Your responses and feedback are welcome!
Source: “Treatment resistant,” The Homeless Blogger, 07/05/16
Source: “What is Being Morbidly Obese Protecting You From?,” Chron.com, 09/27/11
Image by Roundhouse