A weighted issue of being a “case”

unpublished manuscript
by Michele Battle-Fisher

Emotional Fugue in a Supermodel World: An Autoethnography in Very Free Verse (Battle-Fisher, 2009)
Infidelity and deceit.
Sucralose and high fructose.
Waistlines and bulge.
BMI and IOU’s.
I despise the agony
Though I resign myself.
I want to be healthy.
Emotional entropy.
Psychological centrifuge.
As I run helter-skelter,
My weary heart, once beating
In calm syncopation,
Jumps into arrthymia.
Oops, that’s not a good thing.
No more parasitic love/hate with my weight.
I used to be a string-bean…
Now I am to lust legumes.
Proper recipient of such affection
Is stupifying…elusive.
Hell, I am tired and haven’t been walkin’ long.
Need thirty good minutes.
Guess that I do not need rest.
Not that my waistline is
The circumference of Gibraltar.
I am still shop at Banana Republic,
That bastion of suburban moms
That eat less to gain more.
I try to forget, fake a fugue.
(Saw it done in a movie once.)
To no avail, I merely exist.
Now I live ascetically.
Oh, that’s a psychosis.
Only 10 office visits allowed.
Hope that my DSM obliges.
No more desires.
(Reprinted with permission)

I have struggled with weight for far too long. It has never been a clinically severe obese case, just enough for me to despise the double chin as a foreboding of what could come if I did not change my sinful ways. So I wrote this autoethnography with a feminist and complexity lens in mind (see Vaughn, 2005; Naples & Sachs, 2000). Naples and Sachs (2006) positions a “standpoint” epistemology calls for self-reflection. It is my intention that the employing of autoethnography to give meaning to a social construction of “weight” in light of three (maybe four if you are overzealous with labels) distinct methodological paradigms: the positivist, interpretive and feminist/postcolonial.

As a former size of women’s 4/6 (a post-positivist label), any compounding of that measurement has brought much of the torture. It has been a system that has both physically and emotionally been disordered. This weight system has certainly become ordered since the outcomes have become most predictable. BMI up, weight up, emotions down. Of course, weight management is not that simple physiologically. If you recall the work of Booth-Sweeney, the bathtub analogy was perfect while people (even us so-called educated ones) continue to be highly and predictably imperfect in the ability to understand the stock and flows of even the most simple of systems. In terms of the fractal structure of nested networks (I argue that all social interaction is nested in some fashion), I made choices: to eat, to ignore advice, to remain autonomous. But this autonomy comes with a price, both on me as well as public health. I am a numerator “case” in a case study that I would rather not join. I add to the burden on society as well. What I attempted to do in the poem is to uncover the possible parameters in this emergent system of an expanding waistline. The worse outcomes of a system occur when the emergence die from failing to control the “entropy” or the system becomes frozen in a system of being “stuck” in this unhealthy health pattern.

I was not healthy at size 4/6 however at that weight society left me alone. As a practitioner of health, I fail to have the strength of Atlas to handle the guilt of the extra adipose that I carry now. I know the science. I practice my Vinyasa with honest intention. I dance to “Starmaker”, pretending to rival my idol of childhood, Irene Cara of Fame. The weight is coming off albeit it is still an outward sign of struggles and failures. But what is “knowing”? Health must inherently deal in part with the world outside of the science. We are embodied. But reconciling the “truth” with the “”voice” has not been without its pains (see Strauss & Corbin, 1997). The point of better health is to alleviate somatic pain. What residual that is often left behind is the collateral damage of the self with the diseased body. As my stanzas attempts to convey, there is often a grappling of meaning in trying reconciling the “known truth” of the etiology of weight with the oft overwhelming social pressures of conformity (see Peshken, 1988). Statistics have shown that I am not alone. What could be reviewed is what implications our public health initiatives have on the “whole” of society, employing a more constructionist lens. A rubric of treating disease that is purely positivist is woefully insufficient. But public health deviates from clinical medicine in the sense that now public health is in your home, in your mind with the hopes of paternally people to leading more healthful lifestyles. I find that my own struggle with self-image and weight could serve as an exemplar of how imperfect a patient can be (see Peshkin, 1988, Belensky et al., 1986).

Does it take a paradigm for that to happen? No, a paradigm is only as worthwhile as its popularity and its use by its converts (see Pegues, 2007). If a label of feminist is requested to validate the reassertion of female soma, so be it. If a public health practitioner is seen as having a critical lens, that promoter working with at-risk blacks for HIV see a burden and unmet need. It could be argued whether a label of epistemology were necessary at all. Labels are inherent to a post-positivist lens. Syphilis would not have a mode of treatment if it were not for a scientifically replicated definition of its reality (see Weaver and Olsen, 2006; Lather, 1991). But as Hardy points out (1993), demystifying science without regard for gender or race prolongs the misguiding tradition in science that race is a dispensable variable not worthy of investigation. A discussion of conformity to a Western ideal of health may preclude optimal transmission of health information if the cultural community is left unaccounted for (see Cohen, 1985). But this label does not guarantee a value-added treatment of care.

In the poem, the objectifying of body into a purely somatic entity allows the requirements of pure diagnostics. If it were not for Body Mass Index as mentioned in the authoethnography, there would not be a rubric of “measure more” to ensure that the proper charted course can be taken for my weight management (see Crotty, 1998; Crossley, 1996). But this “takes away” the intricacies of the self that is grappling with the health issue. There would no place in positivism for the ambiguity of self.

This would be counter-intuitive. But my feelings have no structured reasoning. I purport that this blog does not seek to demonize the clinical observation. Patients seek care and “cure” from their health professionals. The doctor must use objective senses to help diagnose (“objects and events”). But in this explanation of care, the body becomes a separate vessel, a possession of a disease that needs to be regained through a reaffirmation of selfhood. But often in this dialectic of doctor-patient, the patient may feel stripped of ability to compromise or perhaps “merge” ideas with the doctor to personalize health. The poem highlights this struggle of “borrowed identity” as patient that goes home to a mirror to be fully reminded of her struggle. The writer is caught in a hermeneutic that is all real by physical reminders and emotional dissonance (Crotty, 1998). Nor do the written words of the poem fully account for my personal rendering of weight and health. As an example of lack of parity in health, Syphilis is not created equal. Ask (if it were possible) the Tuskegee patient who lacked proper antibiotics and died of arsenic poisoning as a treatment of syphilis. His voice would speak a world apart from the accolades placed on The Tuskegee Project by some (see Cose, 1997). But as the positivists would highlight, a part of knowing is in the nomenclature (Crotty, 1998). Being critical may help in leading a researcher in a way of unraveling an issue, but the investment is overall that lives must be positively changed. But often the complex human is the hardest element which with to come to terms. I should have been satisfied with ion channels. They make sense.

When it comes to the issue of the research as predictability through hypothesis testing, a scholar must choose wisely where to stand. If ontology wasn’t the essence of being, then the arguments of truth versus mistruth would be fruitless (see Sipe and Constable, 1996). The doctor “problem solves” the illness. This leaves the social determinants of health to be left often for the patient to make meaning of. For the study of public health, scholars must grapple with balancing a “truth” in occurrence of disease with the unpredictability of the individual; again reliance on a purely quantified positivist isolation of problem will be woefully insufficient. This would require that medicine acknowledge the necessity of a “translation process” to infuse humanity into care. In addition, the “possession of the body” must not lie with the medical community; it must be reclaimed, evidenced by “embracing real life” and “giving (myself) a voice”.

Now the task of finding allegiance in numbers and staking claim to truth appears to be the vogue of scientific inquiry today. From the tangent of post-modernists that propose that truth is based on context to the propositions of knowing as concreteness of the positivist, the fact that the very dialectic of process production still, in my opinion, seeks verification of some linking of theory to a chosen reality. This was not created in a vacuum. My reality is the weight. My lens changes with the wind. But the reality of the event remains. I am not my weight but it still counts.

Battle-Fisher, M. (May 10, 2009). Emotional fugue in a supermodel world-autoethnography in
very free verse. [Electronic version]. The Yale Journal of Humanities in Medicine.
Retrieved from http://yjhm.yale.edu/poetry/mbattle-fisher20090510.htm.

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About Michele Battle-Fisher

This is an archive of the Orgcomplexity Blog. Please follow me at the following sites: mbattlefisher.wix.com/orgcomplexity Michele Battle-Fisher (Facebook author page) www.linkedin.com/in/mbattlefisher mbattlefisher (Twitter) michele.battle.fisher (Skype) Author Website http://amazon.com/author/michelebattlefisher

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