Monday, October 22, 2007

Obesity As A Metaphor

Olvlz's post below provoked an interesting discussion in the comments thread about how to view fatness or obesity and about the correlations between obesity and ill health in general. One commenter asked:

Seriously. What am I missing here? Why are people defending fatness?

It is a valid question, and worth thinking about. I didn't participate in that thread, but my own answer to the question would have been that I'm not defending fatness. Or thinness or any other particular body shape. But I believe what deserves further exploration is the connection between a particular body weight and the ideas of goodness or worthiness, the Puritan equation between sloth and weight or weakness of character and weight, and the mirror image of this equation in how we view very thin women as somehow having won over their greedy and weak sides, even when the level of thinness they have achieved is a medical emergency.

The tendency to draw moral parallels between ill health and human worth is an old one. Mentally ill people were once seen as carrying demons and the treatment was to exorcize the demons in ways which often caused intense pain to the mentally ill themselves. Susan Sontag's work on illness as metaphors bears repeating here:

"Susan Sontag's Illness as Metaphor was the first to point out the accusatory side of the metaphors of empowerment that seek to enlist the patient's will to resist disease. It is largely as a result of her work that the how-to health books avoid the blame-ridden term 'cancer personality' and speak more soothingly of 'disease-producing lifestyles.' . . . Sontag's new book AIDS and Its Metaphors extends her critique of cancer metaphors to the metaphors of dread surrounding the AIDS virus. Taken together, the two essays are an exemplary demonstration of the power of the intellect in the face of the lethal metaphors of fear." --Michael Ignatieff, The New Republic

Something similar is visible on many discussions about health issues. An illness is seen as "deserved" if the patient ever engaged in any activity which is now known to be correlated with that illness, and the illness itself is now viewed as punishment for evil deeds. Illness becomes a moral condition and the search for its epidemiology becomes a court case where the jury looks for that one decision where the patient went wrong, the one sin for which the current pain and suffering might be a just punishment.

In some ways we have stepped out of the framework where illnesses were caused by demons and into the scientifically medical one. But in other ways we have brought those demons with us, transformed into a different type of an ethical judgment or into a search of a different type of causal explanation, and that little hidden demon is what allows us now to judge other people without feeling any embarrassment over doing so. After all, if medical science tells us that some patients "caused" their own illnesses, then it is simply natural that we, too, point out that causal mechanism in all sorts of daily interactions.

We are not being nasty and intrusive when we worry about what that juice-looking drink in that pregnant woman's glass might be. Nope. We are waging a war on behalf of the fetus in her stomach. What if she is drinking wine, for example? Surely we should interfere, at least to make sure that it is juice.

And see that baby being fed from a bottle, over there? What if the milk in the bottle isn't from the mother's breasts? Does she know what untold harm she may be causing to her baby? Better that we go over and interrogate her.

Or how about that fat lady at the ice-cream bar! She is actually eating ice-cream, not low-fat yoghurt. Doesn't she know how bad obesity is for her health? Maybe we should say something.

Much of this may be just a search for a world where you get what you deserve, where horrible random events don't wipe out your life in one single accident, where eating all the right things and smoking none of the wrong things will keep you alive for a century at least. We want a word which works by rewarding good behavior, a word which is more predictable and less frightening, not so out-of-control, and by pointing out how others may have earned their illness we are really telling ourselves that we are going to stay healthy, because we have earned health.

This is understandable. But it does turn medical issues into moral issues, and moral issues for only the individuals. The kind of questioning I describe might be extended to a pregnant woman eating a tuna sandwich (doesn't she know about the mercury in the tuna? doesn't she care?), but not to the industries which allow tuna to be poisoned with mercury. Illness becomes an individual sentence and a moral judgment.

But not in all fields of life. I have read much about the effect of stress on ill health. Unemployment is very bad for your health, for example. Having a sadistic boss might be the reason for that heart attack the subordinate died from, after years of mental torture. A politician supporting a law which makes pollution in poor areas greater may in fact be responsible for much later illness and suffering, but we don't take him or her to task for it. The moral message we tell is always limited to the acts of the patients alone (except, of course, for pregnant women), not to the acts of others which may have caused the condition or which may make the management of the condition more difficult.

I see obesity as one of the metaphors which lets the rest of us (the slim ones, the tofu eating ones, the exercising one, the ones with better genes) off the hook. If obesity is what causes heart attacks or bad backs, then our hearts and backs will serve us well, and we deserve that good service, too. Not only that, but we don't really have to spend time and energy on trying to understand what it is that is making obesity more common in the society, because the obvious reason lies in the weak willpower and greediness of the fat people themselves. If only they shaped up, the way we have.