Tania's Journey

I was seeing a woman I’ll call Tania aged 40. She was a charismatic, intelligent woman who was very interested in all things psychological. Nonetheless she had severe health issues and was morbidly obese. We worked on some of her psychological problems until it was time for me to broach the ‘elephant in the room’ problem, so to speak. Tania had difficulty walking due to her heavy structure.

I learned later from her that at that time she weighed 140 kgs. At 40 years of age she had not had any diagnosis of ‘health problems’ and never brought any physical problem forward to me. We talked around the issue. She was training to be a somatic psychotherapist and a requirement of her course contract was to attend a certain number of psychotherapy sessions. So since her training course regarded the body (Greek word soma) as important we both had the understanding that the physical aspects of her work were just sitting there waiting to be broached.

Psychically and mentally Tania was challenging me to be the one to introduce the weight issue. I didn’t. I had my reasons. So a psychic war was declared by her and she was very clever in her attempts to make it clear that no such war existed. All along though, I knew that she knew that I knew that she knew about what was not being addressed. One day she was feeling very hot and asked me for a glass of water. I gave her the glass of water and asked her whether she had problems on the hot Summer days we were experiencing. She told me emphatically, "No, never." She said it was quite unusual for her to feel the heat. We both knew what I was getting at.

In her next session a week later I decided that because she had felt a little vulnerable in the previous session and had actually had to ask something of me I would ask her whether her weight contributed to overheating. I asked her. That was enough. She had been waiting for this moment and she rose to the occasion with great fury and indignation. She told me very firmly that her weight was none of my business, that it had nothing to do with any of her problems. She was furious for the rest of the session… and numbers of future sessions where I took the position that if she came to see me with the defensive denial of her physical problem she would have to leave her fat at the door. If we did not deal with the issue of what was causing her to be so overweight we would deal with nothing but her intellect and I was not interested in that style of therapy. On many occasions she threatened me with not ever coming back until I finally got her to see that her not coming back was no threat to me. It was purely a choice she was making.

From that point on Tania began to face her extreme problem. After a half hearted attempt at trying to persuade me ‘It was probably hormonal’ she began to own up to the fact that at the base of her morbid obesity was an addiction to food and eating, much of it whilst propped up on her couch watching videos. She never walked other than to and from her car and never did any form of exercise at all.

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We worked very deeply with the core issues that had made her unhappy all of her life. One was her claim to thinking she had been sexually abused by her father. I say ‘thinking’ because, as we explored the issue, I found out that she believed her symptoms, obesity for one, were all in line with what she had suspected … that her father must have come into her room and sexually abused her while she was asleep. This contentious issue had to be handled very delicately so we remained open to the possibility that her father sexually abused her. At the same time I made it very clear that unless her ‘suppressed memory’ became cleared and she experienced ‘actual’ memory and or any other evidence of her father having sexually abused her we would be moving into dangerous territory. To ‘assume’ something as horrific as that was not the way I would work with her. Tania was a little relieved as time went by, especially after discussing the fact that there had been a worldwide trend in therapy circles where women were being encouraged to lay the blame for all of their problems on the fact that they had been sexually abused when they had not. What we did work with however, was the fact that Tania had never felt worthy of her mother’s love and had never felt she mattered. At a certain point Tania agreed she would need to lose some weight. She was too ashamed and embarrassed to do anything physical in public so together we decided to find a suitable method to bring her back to some kind of physical health. Amazingly Tania had always visited her doctor regularly. He had agreed to support her on a programme his clinic recommended and she was initially keen to begin. I suggested that she walk a very short distance every day, straight out of her apartment door and along the pavement for as far as she felt comfortable. She did just that and quite enjoyed it but could never walk very far. Unfortunately she was having no success in following a restricted food intake. She felt she was being punished. We tried many different ideas including have her take long service leave from her job and immerse herself in a weight reduction programme of some kind. We could never find a programme. Tania was so addicted to her binge eating life style she could never succeed on her own. She became increasingly fatigued, I thought that may have been from the physical exercise. She had nothing to motivate her. She had a few followers with whom she would have ‘coffee meets’ and also one or two closer friends but essentially she was alone in her troubles. She was too proud and lacking in humility to talk about any of her own problems with her friends and followers. I always encouraged her to open up about it but she never wanted to.

One day Tania came to me angry and depressed. She said her therapy wasn't working. She was having a lot of difficulty with self discipline around eating and exercising. She was tired and felt her life was at an end. I had to wonder whether it was. It just happened to be a dark and gloomy day. I listened to her. I heard her. I felt her pain with her and she remained angry. She told me that she had been having thoughts about jumping off the balcony from the 16th floor room we were in. I knew that could not happen as I had strictly followed my policy of a securely locked balcony door. I looked across at the glass doors and noticed a stream of light shining through the dark clouds hitting the balcony floor. I got up out of my chair and moved over to the door, assuring her there was no possible way she could jump off the balcony but that I had something I wanted to show her. She heaved herself up off the chair and walked tentatively toward me I pointed to the beam of light which by this time fortuitously or miraculously had turned into the brightest ray of sun. Within a clear space above that there was also a tiny patch of blue sky visible. I put my arm over her enormous shoulder. I told her to look up at the shard of light. ‘Did she notice the blue sky.? ‘She answered ‘Yes’ reluctantly. I told her the blue sky was her mind and the dark clouds were the obscurations in the form of her dark mood. The clouds had come and it was difficult to see the blue sky. Her dark mood had come and it was difficult to remember she still had a nice light clear mind. The sky would clear as it always does. But even in the unlikely event that her dark mood never cleared she had to remember that her blue sky mind was there as large and beautiful as ever, along with the gloomy clouds. She had to sit down. She was so moved, so released from the pressure that had built up inside her. She laughed and cried. She apologised (For what? I asked). She thanked me and thanked me. Then she sat up straighter than I had ever seen her and asked quite seriously, ‘But what does the shard of light represent?’ I stared at her with my eyes popping. ‘What ever you want to make of it.’ I replied. There were a magical few moments of silence and then we both burst out laughing. It was a great, great moment.

After that session, Tania had learned that she could come out of her dark moods if she chose to. She often said that she had a new tool at her disposal. From the contrast of one moment wanting to jump off a balcony and end her life to then seeing the worthwhileness of her real self Tania gained great confidence in being able to make herself well. She did just that. She began to unravel her own part in her own demise and take some responsibility for her situation rather than looking for blame. She kept increasing her physical exercise and lost a small amount of weight. Unfortunately she could not face her attachment to her lifestyle with food. She eventually revealed the truth that she ate enormous amounts of food at night. She had to sedate herself and make herself feel ill and then she could go to sleep. She decided she would take time out from her work but I felt unless she could be in a live – in programme where she could get help with her eating problems she would be no better off, maybe it would be worse. Unfortunately we could not find a live-in rehabilitation programme. She did continue to make progress though with just a small amount of walking every day. Her doctor was very supportive of her and although he found her blood pressure to be a little elevated, it was not to a dangerous level. Also she was losing weight very little by very little.

One day out of the blue Tania called me to cancel her appointment. She was in hospital with severe ‘stomach’ pain and tests were being carried out. She agreed to get a friend to keep me posted as to what was happening. The bad news soon came. Tania, the doctors had found, had been living with a large tumour on one ovary. It had burst. The cancerous fluid had filled her abdomen and the oncologist specialists were experimenting with ways to drain off the fluid. From then on Tania was to become an ongoing experiment as doctors struggled to save her life. Her friend kept me up to date with her progress and nothing convinced me that she would live through this. Nonetheless, I sent all my love and prayed she would get well. Maybe this was turning out to be one of the turning points I had put to her as a catalyst that would motivate her… a dire health problem … a disease or some such thing. Nothing improved and I heard she was in intensive care. As a therapist, these situations prove to be very difficult. I felt very compelled to visit Tania to give her some encouragement and a chance to be honest about where she was up to and how she felt. Her friend was being more honest with her and she was responding but I felt I had to give her more of a chance. I arranged with hospital staff to see her privately and I went to her ward. She was very ill. She was heavily sedated but we managed to meet through her foggy mind and I my deep concern. I kept my head close to hers on the pillow and she whispered many things. I asked her if she felt she could come through and she said ‘Yes’. She knew I was going away for my annual break and I said she had better hurry herself along so that we could have a few sessions before I left. I asked her how her blue sky mind was and she said, ‘Still there.’ I squeezed her hand and we both cried a little. I told her to stay ‘here’ if she could and I would see her soon. She said ‘OK’ and we both knew that was not going to happen. She stared into my eyes, not desperate, not resigned. I squeezed her hand and kissed her on the forehead, told her I had a lot of love for her and to make sure to hang in there and I would see her again soon. She said she would. I told her there is only blue sky mind and she smiled a tiny smile. I left. Three days later I heard she had died.

I hope she remained with her blue sky mind when she died. I was very sad and very sorry she had to die.

With fondness and love and in sweet memory of Tania. I am sorry you had to suffer so much, Megan.

#cancer #blueskymind