Because Being Fat Is Worse Than Being Insane. Apparently.

Amanda passed this infuriating article on to me. It tells the story of 17-year-old Nia, hospitalized with schizophrenia, and the psychiatrist who treats her — a psychiatrist who found it so alarming that she was gaining weight from the medication that finally and completely dealt with her symptoms that he took her off the medication.

It also tells another story about the authors of the piece, the deputy editor of the magazine and a psychiatrist — namely, that they don’t seem to find anything wrong with the treating shrink’s decision to compromise his patient’s treatment to save her willowy looks, but they sure can’t understand why she’s not bothered by the weight gain — unless she’s still mentally ill.

Here’s what Nia’s psychosis was doing to her:

Then, as she turned 17, Nia’s teenage behaviour began to become something else. She started crying out, shouting at invisible persecutors who came into her room. Her parents didn’t know what to do. They were a close family and at first avoided the thought of doctors. They tried to love her more. It wasn’t until Nia stopped going to school altogether that they broached the subject with their GP. He immediately referred her to a psychiatrist.

Nia had revealed little to her parents of what was really going on inside her head. But the soft-spoken psychiatrist at the local adolescent mental health centre won her confidence and she began to tell him about the trains. A railway line ran a few hundred yards past the bottom of their garden, far enough away for the family to ignore it. Nevertheless, Nia said she could hear people talking about her inside the painted steel carriages. In the clank of heavy rolling stock she could pick out snatches of conversations about her—derogatory insinuations that crept into her room through the plastic veneer of the double-glazing. She also told him that she had seen things on television. The newsreaders had begun looking at her. In the corners of their eyes she began to read signs. They were sending her messages; messages that linked up with the voices on the trains.

Got that? Auditory hallucinations. So severe that they’re impairing her ability to function. I don’t know if you’ve ever known anyone who suffers from hallucinations, but it’s pretty scary to watch them. I once worked with a woman who fell asleep a lot at work. When she was talked to about it, she said she didn’t sleep at night because her apartment was filled with demons that wouldn’t let her onto her own bed. She was fine at work except for the falling-asleep bit, because the demons stayed in the apartment. But one day, some of them hitched a ride in her hair, and we found her screaming among the files, beating at her head with her hands.

Nia told the psychiatrist all the things that she had kept secret from her parents. But by the end of the session she began to doubt the wisdom of doing so. She glanced at him with suspicion. He too was insinuating something. There were meanings to be found everywhere in her world. The psychiatrist gave Nia a prescription, which her parents collected from the chemist. She refused to touch it.

On the day before her admission to hospital, Nia had stood at her parents’ front door, unmoving, for five hours. They could get no explanation out of her. There seemed to be no explanation for any of this. Nia was dishevelled, and had stopped paying attention to her appearance, but that still couldn’t disguise her beauty. At their wits’ end, her parents agreed to her being forced to accept treatment.

Five hours. She stood stock-still at the front door for FIVE HOURS. And the authors, one a psychiatrist, are concerned about her appearance? But it’s okay, because she’s still beautiful.

Sitting in one of the interview rooms opposite the new arrival, the junior psychiatrist was struck by the patient’s beauty: shoulder-length brown hair, slender in hipster jeans and a fitted T-shirt. Apart from her distracted eyes she didn’t look unwell. He felt himself giving her more time than usual, fascinated by the experiences she related. Third-person auditory hallucinations, delusions of reference, ambitendency—it was as if this teenager had read a psychiatry textbook.

After a period of observation (apparently to make sure that her psychosis was not cannabis-related), she started getting worse and the doctors started considering treatment:

In fact she got worse. She wouldn’t talk to the staff and her meals were brought to her room. For hours on end she lay with her head under the pillow, the radio quietly on. The clinical team was now faced with the difficult decision of which medication to prescribe…. It is known that antipsychotics can block D2, one of the five dopamine receptors in the brain, and that this has an effect. Very often, the main effect is beneficial. Equally often, the side-effects are troubling.

The consultant favoured Olanzapine for Nia; he had found the drug to work well in her age group despite concerns about weight gain and diabetes. Other modern choices include Quetiapine, though many clinicians think it a weaker drug, and Risperidone, which can also cause weight gain and stiffness. The older drugs like Chlorpromazine and Haloperidol were felt to be “dirtier” and to have worse side effects, including the irreversible lip-smacking and protruding tongue movements of tardive dyskinesia. Seasoned sceptics argue that not much, fundamentally, has changed since the 1950s, apart from refining the choice of side-effects. The young psychiatrist wrote Nia up for Olanzapine—10mg, the regular dose. The drug being a sedative, Nia took it at night. She began to sleep.

The treatment proved successful and the young shrink patted himself on the back:

Not much changed for five days. Then, one morning, Nia was transformed. She left her bedroom, came to meals, had normal conversations with staff. Her face filled out with ordinary human expressions. A day later she was even laughing. A young woman, an intelligent teenager, had reappeared; the psychosis seemed to have left her. To see a patient respond to a drug in this way made the young psychiatrist feel like a real doctor. Almost ashamed of himself for feeling this, he noticed that he felt grateful towards Nia—for getting better.

Then, the side effects:

What the staff didn’t pick up immediately was Nia’s hunger. The nurses were so encouraged by her regular appearance in the dining room that they didn’t question the heap of beans and potatoes. But soon it became apparent that insanity had been replaced by appetite. Within three weeks she put on three stone.

Three stone is 42 pounds, which indeed is a hell of a lot of weight to put on in three weeks. And remember, one of the potential side effects of the drug prescribed is diabetes. But are the doctors concerned about her health? They are not. It’s all about her looks.

Now, for the first time, Nia’s features were being corrupted. She started to take on the shape of many of the chronically mentally ill. Her jawline collapsed below puffed-out cheeks. Her stomach sagged above her jeans. Even the consultant found the contrast alarming. “Get a dietician to see her; tell the staff to watch what she eats; change her to Quetiapine.”

I don’t really have a problem with the decision to switch her meds, per se. After all, she did gain an alarming amount of weight in a very short period of time and I have no idea if the effect of the original meds subside over time, or if the patient will continue to gain at this rate. But this whole focus on her looks rather than her health as the reason to switch is, I think, appalling. In any event, the next medication didn’t work so well and Nia was back to square one:

The Olanzapine leached out of the tissue of Nia’s central nervous system and made way for the new compound, Quetiapine. But now the illness began to resurface. She was eating less, but the paranoia had returned. “Put up the dose,” said the consultant. “Quetiapine hardly ever works below 750mg.”

Despite a month-long trial on the highest dose, the relapse of Nia’s psychosis was untouched. She became so vulnerable that one-to-one nursing became necessary. Isolated in her room, the voices tormented her.

So they decided to go back to the original medication, the one that worked. Pay attention, however, to what the shrink was concerned about:

The young psychiatrist’s early optimism collapsed under the grinding reality of Nia’s dilemma. The first drug had worked. But the change in her appearance seemed intolerable—and potentially devastating for the self-esteem of a 17-year-old girl. The second drug hadn’t made her fat, but nor had it treated her illness. The consultant felt there was no option but to put her back on the Olanzapine. Again, it worked. The terrors of persecution vanished, the voices quietened down. Even her parents said that this was the old Nia. They cried over her.

Got that? Here’s a young woman who’s been hearing voices in her head, who hasn’t been able to leave her bed for months, who was so tormented by her illness that she could no longer function — and the shrink is worried about the blow to her self-esteem if she walks out of the hospital free of the voices but fat? The authors certainly seem to buy into this as well — note how they set up the equivalence between psychosis and weight gain.

Oh, but here’s where it gets really good and the fatphobic attitudes of the psychiatrist and the authors come out:

The desire to experiment further with her medication left the consultant and the young psychiatrist. It was likely that the weight gain associated with Olanzapine would be very difficult to treat and that Nia would be fat, if not obese. But more disconcerting to the young psychiatrist was Nia’s apparent indifference to her predicament. While those around her worried about the beauty she had lost, she seemed unconcerned. Was she really as well as her family suggested? Had she really rejoined the image-conscious world of her peers? The dieticians came and went to little effect.

For a while the young psychiatrist worried about the consequences of the choices they had made in treating her. They had removed a stigma of the mind and replaced it with a stigma of the body. It struck him as strange that the patient had been the only one not to worry about a loss that the team around her found so tragic. Perhaps it didn’t matter. Perhaps, in fact, this was a merciful side-effect of medication, or even of the disorder itself; one that liberated Nia from the need to live up to the standards of an image-obsessed world.

The young psychiatrist wasn’t sure. The treatment had reversed a Faustian pact in which Nia had been beautiful and mad, and replaced it with another—in which she was fat and sane. But was it really a blessing that Nia seemed to have no conception of what she had lost?

She couldn’t possibly be sane, because if she were, she’d be bothered by the weight gain! Doesn’t she know she’s supposed to feel ashamed of being fat, instead of maybe thinking that being fat and sane is preferable to being thin and tormented by voices?

Cripes. None of these people seem to be able to comprehend that they’re putting their own issues on her, that while they’re mourning the loss of something pretty to look at, Nia’s got her freakin’ sanity back. She’s probably well aware of what she’s lost, but maybe, just maybe, she considers what she’s gained to be of more importance.


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65 Responses to Because Being Fat Is Worse Than Being Insane. Apparently.

  1. piny says:

    And dontcha just love the headline:

    Psychiatric drugs restored Nia’s sanity and destroyed her beauty, and she doesn’t mind

  2. piny says:

    For a while the young psychiatrist worried about the consequences of the choices they had made in treating her. They had removed a stigma of the mind and replaced it with a stigma of the body. It struck him as strange that the patient had been the only one not to worry about a loss that the team around her found so tragic. Perhaps it didn’t matter. Perhaps, in fact, this was a merciful side-effect of medication, or even of the disorder itself; one that liberated Nia from the need to live up to the standards of an image-obsessed world.

    The young psychiatrist wasn’t sure. The treatment had reversed a Faustian pact in which Nia had been beautiful and mad, and replaced it with another—in which she was fat and sane. But was it really a blessing that Nia seemed to have no conception of what she had lost?

    Oh, my God! Okay, so if she doesn’t care about gaining a lot of weight, it’s very likely a side-effect of the anti-psychotic drugs she’s taking? And the authors come right out and say that being fat is just as bad as being schizophrenic?

  3. Amber says:

    This makes me so mad I can’t see straight. Too bad there’s not a pill to cure my fat-and-ok-with-it body. Since apparently it’s just as serious a mental illness as schizophrenia.

  4. luna says:

    Typical, for the psychiatrist to assume that Nia “had no conception of what she had lost.” When I was on olanzapine, I gained a bunch of weight quickly. Yes, I noticed it. (The olanzapine did what it was supposed to do and reconnected me with reality. So yeah, I noticed that I’d gained 30 pounds in two months, particularly after my pants no longer buttoned.)

    I wasn’t thrilled, initially, to gain that much weight that fast. I got used to it, though. Furthermore, I didn’t really care about the weight gain because I was no longer disabled by psychosis and delusions. I felt fine and attractive once I got used to my new body.

    Maybe Nia felt fine and attractive at her heavier weight. Maybe it’s easier to feel fine and attractive when one isn’t consumed by psychosis. Maybe she understood she’d gained weight and just didn’t give a damn. I’m just sayin’.

  5. LL says:

    “But was it really a blessing that Nia seemed to have no conception of what she had lost?”

    Well, let’s see – she lost the hallucinations, the paranoia, the crippling fear, the insomnia….yeah doc, I think she’s got a good idea of what she’s lost. Schmuck.

  6. olivetti says:

    “Nia’s features were being corrupted. She started to take on the shape of many of the chronically mentally ill. Her jawline collapsed below puffed-out cheeks. Her stomach sagged above her jeans.”

    wow. first of all, this equates being overweight with being insane: “the shape of many of the chronically mentally ill.” second, it completely ignores the effect schizophrenia itself had on her appearance. “Apart from her distracted eyes she didn’t look unwell. ” And when she started taking the medication, “Nia was transformed…Her face filled out with ordinary human expressions. ”

    can there be any doubt that this “psychiatrist,” who is supposed to care for people’s brains, for god’s sake, doesn’t value Nia’s mind at all? Sure, when she was exhibiting schizophrenic symptoms she was thinner, but she looked EXPRESSIONLESS and VACANT. (Not to mention the fact that she was miserable!)

    if that’s this guy’s idea of beauty, dude should get himself an inflatable doll and leave living women alone.

  7. Erin M says:

    Had she really rejoined the image-conscious world of her peers?

    Because that would be a sign of wellness? Good grief!

  8. Clare says:

    ” Nia was dishevelled, and had stopped paying attention to her appearance, but that still couldn’t disguise her beauty”
    There’s a lot that pisses me off about this article, but this has really struck a chord.
    There is such a myth surrounding mental illness, this sort of vivien leigh syndrome. Schizophrenics are often portrayed as beautiful, you know what mean? ‘So beautiful, so crazy’… It’s not quite as strong as the tortured genius, granted, but it’s there. I was talking to a man a while ago for research for a uni essay (philosophy or morality of suicide, can’t recall title) and the guy was talking about a neighbour. He seemed at first to be talking about a crush, then he warned about the side effects of medication. “They make you fat, you know.” I’m not really sure about schizophrenia, but other disorders like, say, manic depression. Some of the meds are terrible, horrific side effects. And, in the case of someone I knew, she was warned forst about weight gain. Never mind that she might feel increased suicidal tendencies, disassociation etc. Weight gain.
    This is the other side of what you’re saying, I guess, but it’s still the same theme!

  9. sara says:

    I dunno.

    I mean, I see all of your points, and I don’t necessarily disagree. But for an emotionally unstable teenager, gaining that much weight seems like a death sentence.

    By curing one thing they were causing another. Yeah, maybe the article dwelled a lot on her beauty. But, as a teacher of adolescents, I can understand their concern.

    This coming from a very heavy woman, FYI.

  10. Nick Kiddle says:

    Erin: Apparently it is. My li’l bro’ has Asperger Syndrome, and one of the symptoms (according to his official psych report) is his complete indifference to the fads that swept his school. One part of the definition of “sane” is being bothered by the same things that bother one’s peers.

    So Nia’s not completely sane. I still think she’s probably happy to be rid of the voices.

  11. LL says:

    Just want to add –

    “Then Nia was herself, but not herself. She blended in, lumpenly.”

    I can’t put my finger on why, but that quote angers me the most.

  12. piny says:

    I mean, I see all of your points, and I don’t necessarily disagree. But for an emotionally unstable teenager, gaining that much weight seems like a death sentence.

    How so? She seemed to be adjusting to it better than any of her caretakers. I experienced weight gain due to medication–for something completely unrelated to Nia’s problem–and it was demoralizing, but it wasn’t on the level of a “death sentence.”

  13. piny says:

    I can’t put my finger on why, but that quote angers me the most.

    It’s like an all-you-can-eat outrage buffet!

    And Nick–It sounds like she never left the hospital where she was admitted prior to being medicated. So I dunno if her blithe body-acceptance is a sign that she’s not quite in touch with reality. Her reactions might well change if and when she’s exposed to her peer group again. It seems like now she’s just happy to be stable.

  14. zuzu says:

    I think it’s also telling that her parents didn’t seem to have any issue with her weight, at least from reading between the lines here. They were probably just thrilled to have her be responsive again.

    I didn’t quote it here, but the shrinks were also concerned about her boyfriend’s reaction to her. Without considering that any boyfriend she may have had while she was mentally ill might not be someone she’d want to keep around now that she’s healthy.

  15. LL says:

    sara – As the mother of an adolescent, I can *totally* see what you’re saying. At least 3 times a week, I hear “I’m faaaat” from my totally healthy, gorgeous 14yo daughter. So yes, I can see the point of worrying about taking away one problem and adding another. I’m not going to speak for anybody else, but I can say that what annoyed me is that her physical attractiveness was stressed and stressed and stressed. It almost sounds like her looks work against her at one point – like they can’t believe somebody so pretty could have a real problem. Also, the way it’s written, it sounds as if the doctor can’t BELIEVE that a teenaged girl could POSSIBLY be OK with being heavy. It’s this sort of shocked “but she was so pretty! HOW could she give that up??” tone that I have a problem with. As if, because she’s a teenager, she MUST be hung up on her appearance, and as if her weight will cause equal problems to having untreated schizophrenia. It’s the comparison of fat and insane that I take issue with.

    And, I can see another side, that maybe the doctors and nurses wanted to see Nia walk out of there, exactly the way she walked in just, y’know – sane. Good for them – laudable effort. However, when it didn’t work out that way, the dramatic “does she know what she’s giving up???” crap just, well…BLEH

  16. BeckAtsila says:

    I am an American woman with schizoaffective disorder. This attitude is unfortunately not uncommon. They took me off Remeron because my mother kept complaining about weight gain (20 pounds), which, rather predictably, caused me to have severe withdrawal symptoms and caused all my psych symptoms to return. Also, there are some meds the treatment team won’t even consider because I might gain weight.

    This is OT, but relevant–they’re determined to rehabilitate me for the workforce. However, their aspirations are what we in the States call “a dead-end job” or “wage slave”. I’m university educated, so my standards are a little higher. I already have a job as a freelancer, but the income isn’t regular so they’re pressuring me to leave it and go do something like wash dishes in a restaurant. They know that would make my condition worse, but I’d have the appearance of functioning normally…

    Hopefully she can find a better doc, one who doesn’t subscribe to this appearance bullshit, and get her life back.

  17. flyinfur says:

    I’ve worked for 15 years in the mental health field, 10 of those years researching new drugs.

    We had one med that turned out to have a side effect of gradually lengthening QT waves — upshot, if you got that side effect, and it was not treated, you were likely to just drop dead (we did not have any patients die, BTW).

    That drug worked for people with schizophrenia for whom nothing else had worked. It stopped the audio and visual hallucinations, the delusions, the paranoia, the social withdrawal. The drug had to be withdrawn due to the QT effect (FDA would never have approved it nor would we have been comfortable giving it once we knew); but every patient for whom it worked was ready to take his/her chances with dying; to quote one patient: “I’d much rather die sane than live insane, because that’s not really living.”

    Fat is nothing if the drug works. Instead of going to pieces over this woman’s “lost beauty”, they should have called in a dietician and an exercise bike.

    Plus I had this thought as well: a lot of times, people with psychoses want to be left alone. They do not want attention. If there’s this much emphasis on her beauty all the time, maybe she doesn’t regret any diminution of it.

  18. piny says:

    Or that seeing her, y’know, sane and happy wouldn’t make him happy, too.

    And from the article again:

    The young psychiatrist’s early optimism collapsed under the grinding reality of Nia’s dilemma. The first drug had worked. But the change in her appearance seemed intolerable—and potentially devastating for the self-esteem of a 17-year-old girl. The second drug hadn’t made her fat, but nor had it treated her illness. The consultant felt there was no option but to put her back on the Olanzapine.

    I love how this is presented as some kind of heartbreaking choice.

    Can’t you just imagine the made-for-TV movie (Finding Nia) where the handsome, committed doctor (Noah Wyle) contemplates the experimental treatment that might save the sanity of his patient (Amber Tamblyn) and return her to her parents (Felicity Huffman and Bill Pullman) but which will also ruin her life and mutilate her forever by causing her to gain fifty pounds!

    There could be this climactic scene where he’s sitting in his office late at night agonizing over the decision. “Chubby…crazy…chubby…crazy…chubby…crazy…what to do? What to do?” He looks at her charts, then at the labeling insert for the drug, then at the charts again, then at a picture of happy Nia, then at a picture of overweight Nia, then at a screen mounted above his desk showing Nia crouched in the corner of her padded cell. And then he takes a deep breath and picks up the phone.

    Then in the last scene, he’s standing with Nia’s parents in front of a big picture window facing their backyard. They’re watching Nia, who’s outside, sitting quietly because fat people don’t move. She’s wearing a fat suit on loan from Gwyneth Paltrow, and eating a large tub of ice cream because fat people eat constantly. She’s smiling and happy. The camera switches back to the adults, and Felicity Huffman, voice breaking and tears streaming from her eyes, says, “I have to believe it was the right choice, Doctor.” Pan out over the backyard and up into the sky as the opening bars of “Better than Chocolate” take us into the credits.

  19. zuzu says:

    Piny: Bwah!

    Don’t forget the single-note piano in the background. Because fat people don’t deserve chords.

    I found it very strange that the staff didn’t “pick up” on her increased appetite. In order for her to put on 42 pounds in three weeks, she’d have to be eating at several multiples of what she would normally require. They put her on a drug that was known to cause weight gain, and they didn’t “pick up” on how much she was eating?

  20. sara says:

    piny:

    How so? She seemed to be adjusting to it better than any of her caretakers. I experienced weight gain due to medication–for something completely unrelated to Nia’s problem–and it was demoralizing, but it wasn’t on the level of a “death sentence.”

    Being a fat, emotionally unstable teenager is a tough walk. Believe me. I look back on my behavior 12 years ago now (I’m 28) and shudder. Kids can be cruel, cruel, cruel.
    I’m not saying that taking her OFF the medication is a good choice. I can just understand the doctors’ trepidation, especially if they were used to working with teenagers.

    Fat is nothing if the drug works. Instead of going to pieces over this woman’s “lost beauty”, they should have called in a dietician and an exercise bike.

    flyinfur:

    It’s not always that easy. I have a dear friend, a beautiful Korean woman with major kidney problems. She’s been able to fight off most problems with very little meds for years but recently had to up the dose. She was maybe 5’5″, 110 and now weighs 150 just a few months later. No matter what she does – she has always been a very healthy eater and exercises daily – the weight will NOT come off.

  21. LL says:

    Piny? I think I love you.

    But you forgot – we’d have to hear for 6 months prior to the film release that Amber Tamblyn had really gained ALL THAT WEIGHT and all about her heroic struggle to take it off,and how she could really identify with Nia, and in her Oscar acceptance speech, she’d thank all those brave people who made the choice between living with schizophrenia and being fat, because they’re totally the same thing.

    I repeat – bleh.

  22. Lauren says:

    Don’t forget the single-note piano in the background. Because fat people don’t deserve chords.

    Ha!

  23. manxome says:

    “I have no idea if the effect of the original meds subside over time, or if the patient will continue to gain at this rate.”

    Nope. It’s a short-term side effect that wears off in a few months. Studies said this years ago. Skimming hundreds of anecdotal accounts of experiences with Zyprexa indicated it long before. It completely screws with your appetite. Your brain says eat carbs, even if nothing else does, and you don’t even realize how strange it is that you ate a whole cake in 15 minutes and have no indigestion. (me: 50 lbs in 3 months)

    Funny, you’d think that since she was in a controlled environment, they could have found a way to not allow her access to the ward’s all-you-can-eat buffet.

    The whole thing stinks of “I must keep her around to drool over.” To release her fat and with proper meds meant no more eye candy for him. Thin and sick, ooh babe.

    Fuckwit.

  24. Nick Kiddle says:

    So I dunno if her blithe body-acceptance is a sign that she’s not quite in touch with reality.

    I guess my comment didn’t make it clear, but I don’t think setting your own standards rather than going with the crowds means being out of touch with reality. I think a lot of shrinks think it is, but from someone who is proud to claim the label of “insane”, if that’s sane you can keep it.

  25. piny says:

    Don’t forget the single-note piano in the background. Because fat people don’t deserve chords.

    *Snort*

  26. sam says:

    The other thing that I notice is that they mention several times that Nia hadn’t been eating because of her delusions, and once she was medicated, she regained her appetite. So…

    Perhaps at least part of the rapid “weight gain” was merely her body becoming less starved and/or dehydrated. I mean, I got sick a few weeks ago, and couldn’t eat anything. Lost 14 pounds in a matter of days, due largely to dehydration. Once I got medication and got better, I immediately gained the weight back. I’m not saying the entire 42 pound weight gain was from this effect, but if her “starting point” as far as weight measurement was the highly emaciated, refused to eat anything for an extended period of time, then isn’t the “devastating” weight gain somewhat false? at least in part?

  27. Kristie says:

    Dont some people go to the doctor to stop having such in issue with being overweight? Specifically, people on meds that make them that way? So she’s a step ahead of the bunch if she doesnt mind being heavier set now. I sure as hell would take that over a completely non-functional life due to the voices in my head. What a jackass doctor.

  28. Thomas says:

    Anyone see a Helleresque irony? “If we make her sane, but she doesn’t mind being overweight, she must be crazy, and the drugs aren’t working. If the drugs were working and she was sane, she’d be appalled by her weight gain, so we’d take her off it, because the weight gain is a threat to her mental health.”

    Maybe they’ll combine the antipsychotics with fen-phen, so she can live fast, die young and leave a good looking corpse.

    I just don’t know where to start with this! It’s bad enough that we’re so caught up in thinness that we enable overweight women to hate their bodies and feel unattractive and asexual. Now, when a woman goes on meds to save her sanity, and shows no apparent discomfort with her body, we take her refusal to buy into the insane patriarchal standard as insanity!

    Is there an international medical society that can try to persuade doctors like this to stop fiendishly enforcing beauty norms at the expense of psychological health?

  29. Winnie says:

    Frankly I’m dissapointed with “The American Prospect” for printing this with the assumption “Better crazy than fat,” ethos here. For god’s sakes what’s wrong with these people?!?

  30. Jeanne says:

    flyinfur-nailed it.

    I am 50 pounds heavier than I was before lithium. Boo-fucking-hoo. I’m now the person I used to be: I enjoy my life fully and get excited about so many things. Oh yeah, and I can function in society.

    50 pounds ago, I spent each day trying to get enough energy to follow through on my suicide plan.

    I’ll take me sane and obese over thin and crazy.

  31. piny says:

    Zuzu, late though it may be: do you think Amp might let you submit this to the Big Fat Carnival?

  32. Pingback: Can’t we just sedate her and put her in a glass coffin? at Pandagon

  33. Scorpio says:

    Actually the weight made her doctor insane. Really.

  34. zuzu says:

    Frankly I’m dissapointed with “The American Prospect” for printing this with the assumption “Better crazy than fat,” ethos here. For god’s sakes what’s wrong with these people?!?

    It’s actually a British magazine, so The American Prospect is off the hook for now.

    Piny: Dunno. Is he still accepting submissions?

  35. flyinfur says:

    It’s not always that easy. I have a dear friend, a beautiful Korean woman with major kidney problems. She’s been able to fight off most problems with very little meds for years but recently had to up the dose. She was maybe 5′5″, 110 and now weighs 150 just a few months later. No matter what she does – she has always been a very healthy eater and exercises daily – the weight will NOT come off.

    zuzu, you’re right of course. It doesn’t always work. But they didn’t even try. Since the olanzapine worked, they should have tried treating the side effects before trying another drug. When someone is taking a drug known to cause weight gain, health care workers really should call in the health care worker who knows best how to educate the patient about it — the dietician, who is, after all, on staff and available. Exercise won’t hurt, might not help the weight gain but will keep the heart healthy.

  36. Rebecca E says:

    Unfortunately, I’ve seen my older sister go through the a similar thing, admittedly on a smaller scale. She was anorexic and is still recovering; she was at the worst point of it when I was very little, so most of what I know about her experience with her disorder is secondhand. Both she and I have had problems with anxiety, and were prescribed Paxil. Some time later, when she complained of being upset, I asked if the Paxil was helping.

    “Oh, I stopped taking it. I was gaining weight.”
    “…But now you’re sick with worry. Is your weight more important than your sanity?”

    Okay, there were more words than that, but that was the gist of it. I also gained weight on Paxil – although I started college at around the same time, so some of that may have been the “freshman 15”, and some of it was also the fact that I got so nervous before I started the medication that I would have no appetite, or be unable to keep food down. I would not trade that horrible, rotten feeling for a slender body, and that’s not half of what this poor girl went through.

    For my sister’s part, I am not sure whether or not she’s currently on medication, but she’s gained some weight, and she looks better and healthier than I’ve ever seen her. She worries about the imperfections that are underneath her clothing, but I’ve tried to say to her that no one sees or cares about that. She can’t believe me when I tell her I still weigh more than she does.

  37. Elayne Riggs says:

    Aside from just the shock and horror of reading what these fatphobic “professionals” were doing to this poor girl, what kept niggling at me was the idea of equating fat with ugly – as in, once she got fat she wasn’t beautiful any more. I see so many beautiful fat women all over the place, it’s so sad that people still think fat is ugly!!

  38. W. Kiernan says:

    it was as if this teenager had read a psychiatry textbook…

    No no no you concrete-headed bastard, she didn’t read a book, she’s the ding an sich. That book of yours, Doc, is about the incomprehensible thing she endured, which it took the efforts of generations of doctors to pry into that alien misery so they could but dimly outline it in your book.

    So here’s the story: poor girl was sick with hearing and seeing things. Maybe you don’t know, as I remember, how the God damn voices won’t shut up, won’t shut up, won’t shut up. Whatever, that was then, and this is the modern world, thank Heaven, so her psychiatrist and pharmacist “got her done” and fixed it. YAY! good science plan, take your bows now, you good old Saviour Men, you’ve won the game for sure.

    But then they were so smitten, these sex-mad jackasses, these psycho-the-rapists, with her teen-age-girl beauty, they yanked away her zines just because they temporarily impaired her glamour?!? Worse yet, they just up and admit this, type it up and submit it to a magazine, with no affect, like it’s nothing wrong! For nothing more than a voyeur’s thrill of gazing they shove her right back into the pit with the voices! So they could drool over her ass. Those vicious bastards took her zines!

    It’s like reading that “BTK” guy’s confession! That’s the most sadistic fucking story I ever read.

  39. suzanne says:

    I don’t know. I really don’t know. The doctor was trying to respond to what he’d be taught.

    At 15, I gained 50 pounds in about a month, too, from a medicine that controlled my bipolar disorder. For that month, I was a functioning human being. That’s the only time in my life that my mind has been whole and felt ok working. But the health effects started crashing back on me. Knees failing. Hips keeping me awake at night. Not being able to breathe as I walked to class. My body was saying “Too much, Suzanne. I can’t support this weight. It’s making me sick so sick. Please. You can’t keep gaining. Please. You’re 15; too young to blow out your knees and hips just walking around campus.” I had to go off that med; and almost six years later, I wish I was still on it.

    But that weight took 4 years to work off. My body is still suffering from that time.

    To some degree, I can understand what the doctor would be worried about. Framing the article in terms of Nia’s beauty is just sick. I hope…would like to think…that the doctor was at least somewhat worried about the physical aspects, too.

    And I understand the self-esteem thing. Maybe Nia was above it. Maybe Nia didn’t catch it. That makes Nia the exception and not the rule. Too many other young women have been crushed and have stopped their meds of their own volition and lied to parents, doctors, and teachers because the weight gain was too much.

    Walking with a mentally ill mind is hard enough. Not every mentally ill teen girl can be counted on to have the self-esteem to manage to accept and embrace the weight gain.

    I speak from my own pain and experience.

  40. Mnemosyne says:

    Plus I had this thought as well: a lot of times, people with psychoses want to be left alone. They do not want attention. If there’s this much emphasis on her beauty all the time, maybe she doesn’t regret any diminution of it.

    That was one of the first things that sprang to my mind: if we believe the doctor, this girl is extraordinarily beautiful. Stop-traffic-walking-down-the-street beautiful. Gorgeous beyond compare.

    Which means she’s probably been getting attention for that beauty for most of her life. She’s probably been getting pawed and propositioned by men since at least adolescence. Hell, one of the patients in the same hospital broke into her room and assaulted her (that charming little story of the “crush”).

    I can see that some weight gain would be welcome, especially since her delusions took the form of hearing people constantly talk about her/look at her. At a minimum, the weight gain would filter out some of the extraordinary attention she was getting and make it easier for her to distinguish between delusion and reality.

  41. zuzu says:

    Suzanne, maybe the psychiatrist did think about her health, and like I said, I would be completely sympathetic if their primary concern was her health and not her appearance, given that she gained so much weight so fast.

    And maybe the article proceeded from a certain angle, which I understand, having been a journalist.

    But.

    One of the authors of the story was a psychiatrist, someone who went to medical school and should have at the very least given lip service to the idea of what rapid weight gain might do to her cardiovascular system, or whether she might have developed diabetes. But it was all about her beauty (and may I say, as Elayne did, that the idea that only thin = beautiful is pretty awful).

    You’d think responsible psychiatrists would have done more to prepare her for what they feared might happen, but it seemed that they didn’t even bother asking her what she was feeling or why she might be okay with being fat if the voices stopped.

  42. Nobody’s saying that a weight gain of 42 pounds in three weeks is trivial. There are good metabolic, psychological, and social reasons to minimize that side effect if at all possible.

    Certainly, if the patient feels that the side effects are intolerable, she deserves to be taken seriously. It’s her body and her life.

    However, if the patient accepts the weight gain, her attitude should probably be praised evidence maturity, insight, and strong coping skills–not dismissed as sign of insanity or intoxication.

    Telling the story of Nia’s weight as an existential travesty is extremely self-indulgent on the doctor’s part. He saved her life. She gained some weight. She’s dealing, he’s freaking out.

  43. abd_chick says:

    I’ve read this article three time now, and every time it makes me angrier and angrier. I was on Stelazine for 3 out of 4 years of high school, along with Norpramin and some sort of anti-TD med to counter the side effects of the Stelazine. I gained over 100 pounds and was incessantly teased when I was actually in school, but (as others have commented) the meds did their job. (For the record, the diagnosis was ‘major depression with psychotic features’ – apparently, you can become so depressed you hallucinate. Personally, I had no idea this could happen, until it started happening to me.) I was just so happy to be ‘normal’ again it didn’t matter what I weighed, or how I looked. It was just nice waking up in the morning and not immediately wanting to die.

    From what I have witnessed, hospitals tend to rely heavily on starchy foods – it keeps costs down. Food actually tastes good again when you’re not depressed. As someone mentioned earlier, some of these antipsychotics are very good at messing with your appetite and food cravings. (Now, again, my experience with hospitalization and antipsychotics was anywhere from 12-15 years ago, so this could have improved. I honestly don’t know – are hospitals providing more fruit and veggies? Do they provide for activities designed to get their patients moving, instead of sitting?) When I was on one unit, we were allowed to write in whatever we wanted to eat, and you could ask for a double portion. If that doctor was so concerned about his patients’ health, he should have asked the hospital to provide some healthier alternatives, instead of lamenting her lost beauty. WhatEVER. Why wasn’t he concerned about the diabetes? Oh yeah….you don’t have to look at diabetes. (GRR)

    I got my shit together (thanks to some great therapists and a lot of work), went off the meds my senior year of high school without telling a soul until I was med-free for a month and still felt okay (and knowing full well that if things were NOT okay, it was time to start taking the damn pills again), and lost that 100 pounds….not because I want to fit some sort of standard of beauty, but because I wanted to. I am glad I don’t have to take those meds any more, but I owe my LIFE to them. Life trumps fat any day of the week (and Jeanne, your “I’ll take me sane and obese over thin and crazy” comment was perfect).

    If I ever met this doctor, I don’t think I would have good enough impulse control to avoid smacking that image-obsessed bastard right upside the head. Is that theraputic?

    Sorry to foist my rant on you – *ducks and returns to mostly lurking*

  44. R. Mildred says:

    She gained some weight. She’s dealing, he’s freaking out.

    Well of course he’s freaking out – so would john derbyshire if an object of his affection suddenly gained 42 pounds and subsequently grew those icky icky woman humps!

  45. Herbert Browne says:

    manxome: touche! ^..^

  46. zuzu says:

    Sorry to foist my rant on you – *ducks and returns to mostly lurking*

    Oh, don’t do that! It’s been great having so many people share their stories. Please stick around and keep contributing.

  47. jami says:

    “While those around her worried about the beauty she had lost, she seemed unconcerned.”

    Man, I needs me some o’ this Olanzepine. Give some to her “normal” looks-obsessed 17-year-old peers, too.

  48. Tanooki Joe says:

    Telling the story of Nia’s weight as an existential travesty is extremely self-indulgent on the doctor’s part.

    Did the writing style of the piece weird anyone else out? It was like medical writing mixed with Greek tragedy with a dash of masturbatory fantasy. Creepy.

  49. Tanooki, yes. It was like JAMA’s “literary” column + “Dear Penthouse” + inverse feeder slash.

  50. kate says:

    Alright, my take is a little different. As someone who has struggled with the mental health system here in the US, i’m pissed that they don’t seem to give a rats ass that a patient has to live with being seriously obese just in order to get better.

    I do believe that if it weren’t for the fact that most of those who use mental health medications are on medicaid or medicare there would be more incentive to find drugs that didn’t also have such side effects.

    If the author wanted to highlight this, using a young girl suffering from severe pschyzophrenia (sp?) is a crappy example Obviously, any intelligent person would say she’s better off, if a little heavier.

    But why bother to think about the millions of adult women and men who suffer from mania or depression and find their lives and opportunities, much less their self image and health, totally and often irrevocably changed by taking meds?

    Especially adult women. Who cares? Instead the writers exploit the most extreme example of mental illness and play on the male fascination with young girls. She gained weight, they deem her worthless and then lament that she doesn’t pine her loss as they do?

    What this article lacks is what is most pathetic. She won’t be locked up forever. How will she be accepted in society as a ‘fat girl’? What about her peers? How will that effect her coping skills?

    Does she have value beyond her appearance? What does this society do to females who aren’t the body ideal?

    This article runs like the ejaculate of a pubescent boy; all intention and fantasy with no focus and in the end absolutely no purpose other than purient release.

  51. KnifeGhost says:

    This article is a stark and frustrating reminder of one of the reasons why I got the fuck out of psychology after a year as an undergrad: it consistently conflate “normal” with “healthy”. Fuck you, psychology.

  52. Ledasmom says:

    Pity the doctor can’t be made to live inside her – premedication – mind, for about, oh, one week per sentence in that piece.

  53. Halfmad says:

    Jeeeeeezuz. As someone with a friend who became schizophrenic and ended up hanging himself, I think we all would have been happy to put up with some weight gain, him included. And he was gorgeous, incidentally. Of course, his gorgeousness isn’t what anyone misses.

    That article makes me want to run screaming down my own hall.

  54. Starla says:

    The part that pissed me off the most was at the end:

    The treatment had reversed a Faustian pact in which Nia had been beautiful and mad, and replaced it with another—in which she was fat and sane.

    Basically, all that’s saying is that because she was fat she was no longer beautiful or attractive or anything positive.

    So remember folks, if you are fat you are unattractive.

  55. everstar says:

    Oh god, how much am I grossed out by this doctor? A lot. The creepy details about how he gives her more time, and he’s struck by her beauty and… ew. It’s like he reads her file while wanking off.

    Forty-two pounds is a lot of weight to gain in three weeks, but if the poor girl finally has an appetite and can function again, who cares? And note nowhere in the article does it say how tall she is or what her original weight was, let alone her overall cardiovascular health or body fat percentage. We have only the outside assessments of people obsessed with her original appearance with which to judge her relative weight gain.

    I say, Go Nia. Rock on with your curvy, non-crazy self and enjoy the life you should always have had. And stay far away from that doctor. I think he’s got some problems.

  56. Norah says:

    The other thing that I notice is that they mention several times that Nia hadn’t been eating because of her delusions, and once she was medicated, she regained her appetite.

    I noticed that too. If she was way underweight to begin, a 42 lb. weight gain might not be so bad. Like an 80 lb. anoriexic gaining 42 lbs. to tip the scales at 122!

  57. Sina says:

    Yeah, but she was so *sexy* in her hipster jeans. I wonder if these doctors could tell from anorexic, or at least dangerously thin. Evidently, if you’re so sick you stop eating, well, what’s really the problem? As long as you’ve got hipster jeans. I mean, we can live with the crazy eyes so long as you’re thin and hot.

    And here is where I plug (yet another) article from Bitch magazine: there’s a great article in the current issue about media representations of hot, cool, crazy white chicks, and how these representations of mental illness (along with other factors, certainly) have harmed the ability of women of color to recognize and treat their own mentall illness. Because unless you’re gorgeous and slender in your hipster jeans, and white, maybe we’re not so interested in your brand of crazy.

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  62. Lynn says:

    Yeesh. To me the tradeoff between sane and fat vs insane and thin is a no-brainer. I got the impression the girl was enjoying being “with it” so much she didn’t care about the weight gain.

    It also scares me that a male shrink was so obsessed with this girl’s appearance rather than her weight gain for health reasons (IMHO a much more valid reason to be concerned).

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  64. Joel Sax says:

    zuzu, it is obvious that you don’t understand the issue here: being overweight due to excess fat isn’t healthy. It doesn’t help the mood when you are feeling additional aches and pains, feeling pressure on your heart, and wheezing because you have more mass to carry around.

    I know because I am bipolar and I gained 60 pounds. I have not stopped taking my meds, but I know that it hard and I resent writers who are dismissive across the board about my and other bipolars’ concerns. We don’t like the weight gain either. Guess why? No, it’s not for looks. It’s because when you gain weight suddenly, it’s bad on your body and you need to buy all new clothes. It is expensive.

    Gaining 42 pounds in 6 weeks is a bad thing, zuzu. Your rhetoric does an extreme disservice to your readers. (The doctor, incidentally, was an oaf but there is a point that deserves respect nonetheless. Dr. Maria handled it ably.) Pain does a number on your mood. All of us will rush to the pharmacies to grab a psychotropic which does not make us gain weight as long as it does the other job. Are you going to call us shallow and “beauty-conscious” because we want to slough off our cellulite?

    Men and women who suffer from my disorder say the same thing: we want to be thinner than we’ve become, not anorexic. We take stable over thin for the time being.

    I’ve caught it before from fat right activists spinning an alternative version of reality, but I will say it again: too much cellulite(read FAT) is a bad thing. Fat is not a feminist issue: it’s reason to be concerned for the patient’s health.

    What good is an anti-psychotic if the patient is in poor health or dead? Tell us that.

  65. zuzu says:

    zuzu, it is obvious that you don’t understand the issue here: being overweight due to excess fat isn’t healthy. It doesn’t help the mood when you are feeling additional aches and pains, feeling pressure on your heart, and wheezing because you have more mass to carry around.

    I guess you missed the part where I said I was overweight. So thanks, but I already know what it feels like.

    Gaining 42 pounds in 6 weeks is a bad thing, zuzu.

    Did you even read the post? It was three weeks, not 6, and I specifically addressed that:

    Three stone is 42 pounds, which indeed is a hell of a lot of weight to put on in three weeks. And remember, one of the potential side effects of the drug prescribed is diabetes. But are the doctors concerned about her health? They are not. It’s all about her looks.

    Like I said, if these doctors — the one treating her and the co-author of the article — gave even lip service to concerns about her health, I’d be able to buy that they were concerned about it. And the idea that the staff didn’t notice her eating enough to gain two pounds a day is pretty sketchy. This is a known side effect of the medication. She’s in a hospital, not at home. They had means at their disposal to help control the weight gain.

    But no, all they talked about was the corruption of her features.

    Men and women who suffer from my disorder say the same thing: we want to be thinner than we’ve become, not anorexic. We take stable over thin for the time being.

    And it’s pretty clear that Nia felt fine with that tradeoff; it was her doctors who couldn’t deal with it.

    What good is an anti-psychotic if the patient is in poor health or dead? Tell us that.

    No, you tell me what good is thinness and beauty if you can’t even get out of bed.

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