Ask Aunt Fattie: Can I make my friend go to the doctor?

Dear Aunt Fattie,

I have a friend who is heavier than I am, and insists that there’s no point for HER to go to a doctor, because a doctor won’t help her, and she’ll just be wasting the copays to consult with them. She says that it makes sense for ME to go to doctors and take care of myself, because I’m less than 100 pounds overweight, and didn’t damage myself horribly while a child or adolescent.

However she was a horseback-rider as a teen, and has broken more bones than I can count. She seems to think this means she needs a doctor less than I do, because her case is already hopeless. At this point, she can’t sleep, because her arms fall asleep when she lays down, and she is having crippling back pain, and still says there’s no such thing as a doctor who can help her.

Screaming in Worried Frustration

Aunt Fattie does not envy your position, Screaming. Your friend has dug in her heels, and short of a dead-of-night kidnapping scheme there is no guaranteed way to get her to a doctor’s office. Nothing Aunt Fattie can suggest will be foolproof.

It sounds as though your friend is suffering from a touch of what some people, often talking about their mothers, refer to as a “martyr complex.” She is convinced that her suffering is somehow important, that it is necessary, and that it must not be endangered. In fact, her physical pain may have become an important aspect of her identity. Aunt Fattie mentions this in order to help you understand what you are asking her to give up, and why she is resisting. If her self-concept and security are wrapped up in her suffering, seeking treatment is a radical act.

So, your friend will not, or cannot, do this kind thing for herself, and you can’t do it for her. Or can you? If your friend were convinced she couldn’t have a desperately-needed new washing machine, you might take up collection to get one for her birthday, and the same approach could work in this case. Offering to cover her copays has no guarantee of working, because it’s likely that money is just a red herring here. But it does take away one of her excuses, and framed correctly — “I can’t stand to see you in so much pain, and if money is an obstacle, I want to make that go away; I know you think this is futile, but please consider taking care of yourself as a gift to me” — it is also disarming. Seeing that her pain is causing you distress and that you’re actively looking for solutions — even if the solutions are relatively symbolic, like fronting her the $25 for the copay — might melt her a little, maybe even enough to make an appointment. Putting in some research (RateMDs.com, Fat-Friendly Health Professionals, asking around, and maybe even doing some legwork to interview doctors) will help remove another excuse and make her feel more secure in taking that first step.

There is, of course, always a point at which one must step back and allow our friends to make decisions we think are harmful — our only choice is whether they make them with or without our support. But Aunt Fattie understands why you are not yet ready to give up on your friend, and wishes you luck.

If you’ve got your own questions on fat, fatshion, fatiquette, self-esteem, or body image, send them to auntfattie@gmail.com.

Update from Kate: It’s clear from the comments that Aunt Fattie should have broadened this response to include the possibility that our letter writer’s friend is hesitant to see doctors because of a history of being treated badly by them with regard to weight and/or chronic pain issues.

The thing is, Fillyjonk and I co-edit an entire blog about doctors’ mistreatment of fat people, and we’ve all talked both there and here about the dismissal of chronic pain as “all in your head” and/or something that will go away if you “just lose weight.” Our positions on those things–to wit, that they’re egregious failures of the medical profession to help people in need–have not changed. But this letter suggested something else, something we haven’t covered before: the fact that some people do indeed put off medical treatment because the suffering has become part of their identity. So that’s the angle Aunt Fattie took, in response to the particular letter in hand, rather than the general concept of fat people avoiding medical treatment; the omission of other possible angles was not meant to downplay the very real suffering of people with chronic pain or the very understandable fear many fat people have of going to the doctor.

We’re really sorry it came off that way. Please see the comments for some excellent exploration of those other possibilities, and what a friend can do to help.

47 thoughts on “Ask Aunt Fattie: Can I make my friend go to the doctor?

  1. I asked a friend once what was the worst thing she imagined happening if she went to see a doctor. When she told me what it was, I said, “Well, you are telling yourself that everyday and everytime you feel pain. How is it worse if a doctor tells it to you too? And what if there actually IS something a doctor can do for you? The way it is now, you are already doing the worst thing a doctor can do and not finding out what the best thing might be.”

  2. First time I’ve ever not fully agreed with Aunt Fattie. It’s likely that her experience of not being helped by doctors is grounded in reality and true life experience. I would resent the characterization that she feels that her pain is so important and that she has a “martyr complex”, perhaps her physical pain is easier to deal with than the pain and humiliation one more doctor shaming her about being fat and blaming all of her problems on her weight.

  3. liz, I love that!

    amgriffin, you could be right… that’s not what I got from the letter (specifically the insistence on “you go, I’ll just stay here and be in pain”), but of course everything we get is through the lens of the writer. Liz’s line would work admirably in that case (and all others, I think — it’s quite brilliant).

  4. I would bet she got this way from some bad doctor’s visits – you know, the doctors who blame fat people for being fat, assume all aches and pains are due to the fatness, and generally shame people into thinking they are not worthy of medical care until they lose weight. Some doctors will tell fat patients that there is nothing that can be done for them because they are fat, and once you hear that from a physician, it is very hard to believe that another one might disagree.

    If it were my friend and I really loved her, I would find out if that were the case, and if it was, I would find her a fat friendly doctor who will treat her like a human being. I would also probably offer to go with her, as backup.

  5. Conversely, if the writer did find a HAES-friendly doctor, with whom she had a good experience, she could also talk up how awesome that experience had been (perhaps mentioning that she saw people bigger than she in the waiting room as well, in case the friend is all “well, you had that experience because you’re smaller than me”). This could work in conjunction with Liz’s suggestion too: i.e. “I had this really great experience, and even if yours isn’t the same, the worst thing that the doctor can tell you is XYZ, and you’re telling yourself that every day anyway, so really, it’s not so scary. Just give it a try as a gift to me.”

  6. Depending on the kind of pain that your friend is experiencing, it might be worthwhile to suggest that she see a chiropractor or an accupuncturist. She may be more open to a non-traditional practitioner than one that is completely western medicine.

    MDs often suggest pills for pain, and this was something that I didn’t want, so I sought out help and am now relatively pain free. This friend needs to be reminded that there are lots of solutions to pain.

  7. I wonder if the friend’s problem isn’t just disliking going to the doctor or a martyr complex, but a belief that she deserves the pain for being heavy. (It wasn’t clear whether the friend is practicing HAES, but I was getting a vibe of ‘doctors are for you, because you are lighter and thus deserving of help, but not for me.’) Subtly reminding her that people of all shapes and sizes and athletic histories get severe back pain might help.

  8. Wow, how well this fits with me this week. I broke down in my allergist’s office last week complaining about a multitude of health badness that has onset in the last 6 months, and immediately got a lecture on gaining weight (I lost a lot as a side effect of going on some medication, and then gained it back once I was off it). Multiple lectures, in fact, during the course of the conversation. But the thing is that he did agree to do bloodwork and see if there was anything else wrong, and I did have a new blood pressure problem that has never been an issue with me before, so I’m waiting to see if there’s something else at the bottom of this.

    I guess my point is that even though it sucks rotten eggs to come up against a fat-nasty doctor, or a somewhat clueless doctor, even if you do, there still might be something they can do for you, and you can ignore the other stuff they’re telling you. I’ve gotten a really thick shell on this now – if a doctor tells me something that I know to be stupid, I might challenge them on it, or I might just smile and nod depending on my mood, but I ignore it. It goes along with liz’s advice – what’s the worst they can say? If it’s “it’s all because you’re fat” you just translate that as “it’s blah-blah-blah-blah” and push for other tests to be done just to be sure. If it’s that there is a problem, they can help.

    I also like the going with the friend idea, maybe making dual appointments with the writer going first to calm the friend down as to what will happen. Some people are truly doctor-phobic, and that might play a role in this as well.

  9. As someone with chronic pain and fatigue problems, I agree that the martyr complex assumption is not entirely helpful. I do know people who are like that, but even thin people with chronic pain often give up on trying to get help, as if a doctor can’t find a ‘medical reason’ they end up assuming you are either imagining things or at least exaggerating. I do agree that it is worth trying to encourage her to find a doctor who WILL at the very least try to find a way to help her.

  10. I’m echoing Anwen – it’s galling to see what essentially boils down to “but you just DON’T WANT to get better! You ENJOY being ill somehow, it must BENEFIT YOU or you’d DO SOMETHING about it!” here, where I’ve always been comfortable and felt that the normal things people judge me for – my size, my body, how it works or doesn’t work, and what I do about it – are not going to be questioned. Much more likely than a martyr complex (it exists, but really is way less common in people with chronic pain than is popularly believed) is that the friend has been refused help repeatedly on the grounds that if she lost weight it would All Go Away, and is sick of having to do battle every time she goes for help. Also, as Anwen said: if a doctor can’t figure out what the problem is, very often the patient will be deemed a hypochondriac at best (if s/he is thin) and – sadly more often, if s/he is fat – a lazy unmotivated lying overeater who refuses to take control of his/her health.
    I agree that if the friend will allow it, accompanying her to doctors as moral support would be really helpful; you could speak for her if she gets overwhelmed, or you could make sensible HAES points if she is unable, as you wouldn’t be the direct target of the fat-hatred. Be prepared to go to several doctors, though. It’s important to keep trying new doctors until one is found who treats all patients as deserving of the best possible care regardless of weight, and as we know, these are rare.

  11. I agree that the friend should accompany her to a doctor, and that perhaps the one in constant pain should have a letter stating the pain is not caused by her weight but by the broken bones due to her physical activity and not to reccommend dieting & strenuous exercise to help relieve the pain (if she is avoiding the doctor due to being afraid of weight lectures). I also agree she should seek one out that is not so focused on Western medicine; I assume it’s those that might be the most obsessed with weight loss as a cure for the ailments of the majority of fat people.

  12. Just another comment to echo Shira’s echoing of me – after eg the takedowns of that Dan bloke with the ‘dude, you would be totally within your rights to cheat on your formerly-thin wife’ nonsense, it is pretty depressing to see this here, and ironic that it’s in the agony aunt format…

  13. Wow. . .I see I’m agreeing with other commenters.

    I’ve got chronic health issues. I’ve gone through a multitude of doctors. They do the standard blood tests and are convinced I’m full of shit and should just lose weight. Never mind the crap started when I gained 20 pounds in 3 weeks and suddenly nothing fit. Somehow losing weight doesn’t work because in that time I’ve also had to deal with a nutrionist to get my anorexic eating habits under control (but you know it wasn’t actually anorexia because I didn’t lose any weight *rolls eyes*). And odd I’ve tried doctors off the Fat Friendly Health Professionals list and gotten the same crap. I personally have decided to give it a break on the regular doctors because it’s stressful to have to switch after you get an a*hole and to get bashed my medical professionals who are supposed to have your health as a whole person in mind. So now, I’m just worried about one thing at a time and that thing is getting a gyn who can get that issue under control. After that if they are respectful and do have all of my health in mind, I may ask the gyn for a PCP referral and baby steps from there.

    I think the tone of this response is sort of “well friend did it to themselves by not going to doctors” without realizing that everyone has a breaking point and perhaps the friend has reached that.

  14. My husband and I are approximately the same weight (~350 pounds), but he hasn’t bought into the whole FA thing yet (though I’ve sent him a few links and dropped some random facts here and there). He’s not dieting or making comments about my weight, but he does come out with the occasional grumble about his needing to exercise more, and having to buy new pants because his old ones were getting tight. And he is someone who actively avoids going to the doctor because he doesn’t want his problems to be dismissed as needing to lose weight. While our currently doctor makes the occasional comment but doesn’t pressure you or harp on it, he’s had the horrible kind before.

    This past winter he was exhausted and sleeping all of the time, and I kept bugging him to go to the doctor because I was genuinely worried. He refused on the assumption that she would just tell him to exercise more. And then I came down with the flu and was exhausted all of the time, went to the doctor, and found out that I had mono (no doubt caught from him).

  15. Since we don’t know the real cause, another suggestion might be to talk about how ridiculous her feelings are about it.

    I recently went to the doctor for a number of reasons, but mentioned that I had been itching underneath one of the fat rolls really badly and just wanted a recommendation of what I could put on it to help. I had been itching for *over a year* and it had gotten so bad the skin was raw and starting to break open. She took one look at it and told me it was a yeast infection…that I had for over a damn year! But I never said anything because even though I accept my fat, I still felt that I had no reason to complain because itchy, sweaty fat rolls are just one of those things fat people have to deal with. It was completely and entirely illogical and I finally realized that the moment she told me what it actually was.

    So if she feels this is somehow a punishment, just something she has to deal with because she’s a bad fatty or whatever, show her how stupid it is to think that way. Nobody should ever be forced to be in that much pain, and she’s just forcing herself by not going to a doctor.

  16. Oh good lord. Tip: don’t tell your friend she is being stupid. It will not make her listen. Also, guess what? There may actually be very little that can be done about her pain.

    I would suggest finding some good info on chronic pain/illness, such as the forums on butyoudontlooksick.com

  17. Since we don’t know the real cause, another suggestion might be to talk about how ridiculous her feelings are about it.

    “I don’t understand what your problem is so instead of trying to get some insight or learn something, I’m just going to tell you you’re being ridiculous!”

  18. Please attack me more based on a literal translation of what I said instead of viewing the base of the suggestion. Did everyone put on their bitchy pants today?

  19. Yeah, Shira, I’d say that was out of line. I understand how Casaana’s comment can be read the way you seem to have taken it, but I don’t think she’s calling anyone stupid or ridiculous. She used a very personal example to illustrate how we all have times when our fears get blown way out of proportion, to the point where we really do need reality checks about how irrational we’re being. That certainly resonates with me.

    In other news, I’ve updated the post to address the concerns that have come up here. I hope that helps people understand where we’re coming from.

  20. Um, how about viewing our actual points which are a) even if you were just being linguistically clumsy it is ultimately NOT HELPFUL to approach this friend with the idea that she is being ridiculous, I’m not sure how a figurative interpretation of that would be any better and b) perhaps you should consider that actually, she may not be being all that ridiculous, given that we do in fact live in a world where many doctors are both fat-phobic and inclined to believe that any chronic illness is actually just malingering/martyr complex/etc, and that actually even if you can convince a doctor that you are genuinely in real physical pain, there may just not be that much a doctor can do about it?

  21. And of course I understand that basically it was a sound point that she may be blowing things out of proportion but really, martyr complex, ridiculous, these are pretty sensitive points for Shira and myself, and a lot of other people with chronic illness.

  22. I’ve had horrible doctors and great ones.

    Some things that have helped me navigate through the bullshit:

    1. “I understand that my size is likely contributing to x, but since it’s not going to go away overnight, can you recommend treatment that will help me now?”

    2. “I’m not here to discuss my weight. That’s a matter between me and my endocrinologist (nutritionist, etc.) I’m here to talk to you about x.” (Alternatively: “I have an eating and activity plan with Dr. X. I’d like to talk to you about my ear infection/ingrown toenail/dizziness.)

    3. “I’ve been within 10 lbs. of this weight for the past 10 years. This problem has never happened before, so I seriously doubt it’s weight related.”

    I’ve also told some doctors that it’s not helpful to just tell me to lose weight. That’s a dereliction of their duty, which is to be my partner in improving my health. I want concrete, immediately applicable recommendations for specific activities and practices to improve my health. Telling me to “lose weight”? Not going to help. Telling me to walk 10 minutes a day and make sure I get plenty of protein? I can do that. Whether such things help me lose weight or not is irrelevant.

    Additionally: For people who are very large, I highly recommend calling in advance if you have any procedures scheduled at a new facility and making sure they have the equipment to handle your size. Narrow exam tables in the gyn’s office? Ugh.

  23. Thanks for the update, Kate, but I imagine that if a lot of my friends (or Shira’s) wrote a letter about us, it might come across pretty similar. It’s certainly possible that Screaming’s friend is just completely embracing the sick role and refusing the help that might be around the corner. But I’d guess it’s at least as likely (probably a lot more so) that she’s had the same kind of crappy experiences as those on First, Do No Harm and is bloody sick of wasting time and hope on doctors who will belittle her one way or another.

    Like I said, I’m really disappointed to see this here.

  24. Anwen, I just updated again to specifically encourage people to read the comments, because you and others have addressed the other side of things so well. In my head, it’s a given that everyone reads comments (which is one reason why I sign off on posts that don’t cover every possible angle of a topic). But of course, not everyone does, and on this one, they should.

  25. Yeah, Shira, I’d say that was out of line. I understand how Casaana’s comment can be read the way you seem to have taken it, but I don’t think she’s calling anyone stupid or ridiculous. She used a very personal example to illustrate how we all have times when our fears get blown way out of proportion, to the point where we really do need reality checks about how irrational we’re being. That certainly resonates with me.

    Well, I see your point, but as I’ve tried to make clear above, this is very personal for both Shira and myself (particularly Shira – I’ve never had my health problems dismissed solely due to weight, it was always ‘well, you DO have mental health problems…’ or ‘well, it’s puberty’ etc) and I think we’ve taken it all more personally than one “should” on the internet, but sometimes things hit very hard, you know?

  26. Oh, and just to be clear, I am sorry for jumping on anyone and everyone I may have jumped on. It’s just a very sore place for me, esp as I am currently the illest I can remember having been since school and am finding it extremely hard to have to choose between going to shul in the morning and going to a seder in the evening. And still being exhausted after the one I did choose. But I didn’t mean to be a meanie, I am lovely really!

  27. Caasana, I’ll concede that I read your tone wrong and I apologise for jumping on you. I am, as you can probably tell, very very touchy about people who don’t suffer with pain every single day of their lives trying to make out that they know better than the people who do live with constant pain, and until Kate pointed out what you were trying to get across, I am afraid I couldn’t get past my initial reaction which was something like “oh god, not another one”. I do have a tendency to take things literally, which can lead to problems on occasion.
    Kate, I see the point that Caasana was making now that you’ve explained it that way, and I also appreciate what you’ve said in your edit, but I still don’t feel that I can emphasise strongly enough to anyone who hasn’t lived with pain all day every day exactly why it’s so upsetting to see words like “martyr complex” and “out of proportion” and “ridiculous” thrown about. It’s all we ever hear, even from family and friends, and that’s on top of the fat hatred that you do know about and understand. I am extra-defensive about all this and I am sorry that my defensiveness has led to me causing offence.

  28. This is also a very touchy subject for me… Fortunately, I don’t have chronic pain. However, I am one of the people who are terrified of health professionals of any kind. I guess compared to other people my fear is still manageable – while I have made plenty bad experiences, they were not comparable to some of the things on “First, Do No Harm” and when I am doing really bad I go and see doctor. But the fear is still very strong – and I do skip regular checkups. I often get the advice that I should either ignore or confront doctors who don’t take me serious or who blame everything on my fat. That is easier said than done – although I have confronted some doctors in the past I always went home afterwards feeling like crap, berating myself that I am “stupid” etc. And the feeling sometimes lingered for days. Of course this is not a rational reaction. But it is not something I can easily stop – and yes, that means that the possible positive effects of a doctor’s appointment are often outweighed by the negative effects I experience whenever the appointment doesn’t go well.

  29. Erm. I’m with Arwen and Shira.

    Yeah, there are folks who do define themselves in terms of their pain and illness, and refuse help even when it’s readily available. But, in my observation and experience, it’s far more common for those with chronic illness and pain to give up out of a history of crappy care and fatigue. Hell, I’ve by and large had pretty good care, and I still got so damned tired with pain and meds that make me sick or stupid and just the limits of medicine to do anything really substantive about what ails me, there was a time I tossed in the towel. It took an emergency room visit to make me rethink that, too, I was that reluctant to hop back on the medical treadmill.

  30. LW may want to institute a personal policy that I use with my friends. “If you have a problem and refuse to attempt to solve it then I do not want to hear about it.”

    It’s not that I take away my friendship, it is that I remove my support for “venting” about problems that have an obvious solution. I make sure they know that I am available to them to help solve their problem, financially, with a ride, moral support, whatever. I also continue to stay in contact with them, but any conversation that comes back to venting about their bad situation they refuse to fix is redirected.

    Why should I waste my time talking to them about a problem that is so minor they refuse to attempt to fix it? And why should we continue to have the same conversation repeatedly?

    Now before everyone jumps on me, there ARE situations where nothing can be done and the best thing is venting. That’s not what I”m talking about. I am talking about the refusal to try for a solution for whatever reason. Refusing to even go to A doctor is definetly refusing to try.

    It sounds like she may have some issues that could be taken care of with some physical therapy to me, especially if she has pain that may be the result of old injuries. She may want to look into seeing a Doctor of Osteopathy, instead of an MD, it is essentially the same thing, but I think DOs get more training in wholistic methods.

  31. I have chronic pain issues (diagnosed with fibromyalgia in early 2007, to be more specific), like many of the other posters here. I don’t doubt that there are people in pain who do embrace the martyr role, but many of us do not. It isn’t particularly productive to make that assumption, and can lead to greater alienation on the part of the person with pain (ie: “You WANT to be sick!” which is something I’ve been told multiple times). Some of us *are* looking for help and do a lot to take care of ourselves, but may not have the right kind of support. Support from friends is ESPECIALLY important in times of total frustration with doctors–which, as other Shapelings have pointed out, is very common among people with pain.

    I would suggest that Screaming try to open the lines of communication with her friend–even saying something so simple as, “Hey, I’ve noticed that you seem to be in a lot more pain. Is there anything going on?” can help quite a bit. At the very least, it will help her friend realize that she has someone behind her during what seems to be a difficult period.

  32. I think that these are all valuable concerns, and I sincerely hope that SIWF, the letter writer, is reading this comment thread. There are so many reasons why a person may not go to a doctor, some of them based on experience and some of them based on anticipation. Aunt Fattie answered assuming that the friend won’t go because of anticipation, not experience, because that is how SIWF framed her question. It’s possible that SIWF is wrong, and that her friend is basing her decision on experience and has no need for SIWF to step in. SIWF, if you’re reading, I hope you’ve considered this possibility.

    A reason no one’s brought up yet that might also be in play is fear — not necessarily fear of doctors, but fear of what they might diagnose. I saw this happen with my mom a few years ago; she started having trouble with her memory and word recall, but she kept denying what was happening and refusing to go to a doctor. In fact, she refused for over a year, I think out of fear of what she would be told, and she only agreed to go after she fainted and got hurt in the fall. By this time, her cognitive impairments had increased tremendously. She saw a doctor eventually and was diagnosed with a non-fatal condition and got treatment, but they told us that if she had come in sooner her prognosis might have been much better. I suppose I’m telling this story as an example of how difficult a situation it can be for all involved when a loved one won’t see a doctor about a condition that significantly impacts their daily life. In some cases, the would-be patient has as much or more information as the doctor would, and of course has more knowledge of what it’s like to live in her own body and what impairment that causes. In other cases, the would-be patient refuses the possibility of getting more information out of fear of what the medical experience will entail, and the loved ones end up agonizing over every moment that that person spends in what *might* be needless pain.

    Whatever the psychology behind the situaton — whether the suffering person is sick of verbal abuse or condescension from doctors, scared of what she might find out, or understands pain as part of her identity — it’s crucial for both parties to acknowledge that they cannot walk in each other’s shoes or make decisions for each other. SIWF can’t force her friend to go to the doctor, but she can offer assistance and reasonable advice that her friend can choose to take or decline. By the same token, the friend can’t force SIWF to ignore the fact that she’s in pain, but she can acknowledge SIWF’s concerns, consider the offers of assistance, and tell SIWF if her actions or words are intrusive or hurtful.

    Like all advice columnists, Aunt Fattie is not an expert on every subject, but rather a (set of) person(s) willing to listen and offer an opinion. SIWF wrote because she didn’t know what to do; I hope reading this post and this thread give her a sense of some options and what might be at stake for her friend.

  33. SiWF, I suggest asking your friend to accompany you to YOUR doctor visits, as a second pair of ears and an advocate. If her avoidance of doctors is due to fear of what will happen to her as a patient—based on real past experiences or not—then experiencing a doctor in a role that isn’t “patient,” and seeing what a few doctor visits really are like, might help with the fear.

    (I’m not down with the “She has a martyr identity complex” theory. It seems too complicated for what’s being described.)

    Also, SiWF, if your friend’s pain and/or her complaining about her pain and/or her unwillingness to do what you want her to are causing you intense frustration, it might be worthwhile to ask yourself why, and whether you can make any behavior or expectation changes to reduce your frustration level. No one likes to see people suffer, but maybe you are feeling too much responsibility for what is the rightful decision of a competent adult with her own will.

  34. I sound a lot like Screaming’s friend. I’m terrified of doctors and haven’t been to one for anything in over a decade. There are things I’d like to ask one (like why my arms also go numb when I try to sleep) but am too afraid of what the response might be. Last fall I was injured (nothing major) and sought emergency care but they refused to treat me. It was a private clinic, so they had the right, but it doesn’t make the next attempt any easier. (And I never did get treatment for the injury; at that point, a few weeks of pain and discomfort were acceptable, though it left me with a small amount of permanent damage.)

  35. … or understands pain as part of her identity ….

    I’m not too happy with this rephrasing. I mean, I can’t speak for everyone. But me, I’m in some pain all of the time. I have been for roughly twenty years, and in all likelihood I will be for the rest of my life. So, yeah, I don’t think my understanding of pain is the same as that of the well and able-bodied, and yeah, pain has become an integral part of how I perceive myself. But this doesn’t mean that I suffer from some, what, ‘martyr complex’ or the like. It’s just an ordinary adjustment to my differing circumstances.

  36. Eucritta, I hear what you’re saying, and I didn’t mean for that phrase to read as a recap of the original martyr complex idea. I’m sorry it came across that way.

    I think this post is bringing out how much personal experience — with both medical history and friendship history! — informs how one reads the tone of the original letter.

  37. I can relate to the arms-falling-asleep-when-lying-down thing. I was around 300 pounds when my carpal tunnel syndrome got so bad that I couldn’t sleep at night. My doctor sent me to an orthopedic surgeon. Post-surgery, my hands hardly ever fall asleep.

    Throughout the whole process, everyone was really nice to me and never complained about my size. In fact, the surgical intern and I were flirting at one point!

    Yeah, I have complaints about my doctors’ office (about which you can read on my blog), but over all, they don’t stress the weightloss issue. I suppose I’m lucky like that.

  38. Stef, I really like your idea that SIWF ask her friend to accompany her on appointments as a favor. I would consider this a tremendous compliment, and it would validate my decades of experience as a patient as worth something to someone.

    Also, I am a private person, probably in good part due to the fact that I was not given the luxury of medical privacy for any of my childhood. I would not be immediately open to a friend accompanying me to a doctor appointment for that reason – I would be terrified that some humiliating detail about myself would come out. However, if a friend were willing to open up that part of her life to me first…. this has never happened to me, but I think I would feel like we could be allies in this, rather than my thinking “here’s another person who thinks she can live my life better than I do.”

    I also hope that SIWF considers that she probably does not know her friend’s full medical history, nor quite understands the complexities of whatever condition is being discussed. Some of my medical history is too personal to tell my own husband.

    Oh, and Eucritta – absolutely, on being in pain (or in my case, being chronically ill) IS part of your identity. I am the person I am because I grew up ill in an unforgiving medical environment, just like someone else is the person she is because she grew up fat. I wish it weren’t so, but it is so, and one makes the best of it.

    Aunt Fattie hit the mark with her final bit of advice. As difficult as it may be, SIWF will need to let her friend make the final decision about her own health. I just hope she can support her, even if she strenuously disagrees with her actions.

  39. Thirding Cariad. Pain does become part of who you are, and that acceptance does change the way you see things.

    Also, I would like to add that having your crippling mental and physical disorders diagnosed as ‘pyschosomatic’, ie., all in your head, isn’t as bad as it sounds. You get to sit on a comfy chair and someone gets to tell you, ‘I think it’s all in your head’, and you smile at them and find someone else. It actually matters very little in the scheme of things. There are reasons for everything, and no one person has all the answers to everything ever; look for someone else.

    Look into alternative medicines, look for someone else who knows their stuff. It’s possible that their friend is just too tired to vet doctors and treatment themselves, so they may require help to do it — I know I did. It’s also possible that their friend is depressed. There’s certainly also the possiblity, if her arms are falling asleep at night, it could be something as simple as the prospect of having to fill out or sign a form that could be tripping her up — I have rhuematoid arthritis in my hands, and it was bad enough that I couldn’t hold a pen, and that simple inability to hold a pen was enough to stop me from doing a damn thing about it because I might have to fill out a form when I couldn’t, and the thought of that broke my heart. It could be any number of things.

    The point is, SIWF needs to talk to her friend. Not pressuring her to go to a doctor, or telling her that she’ll eventually end up crippled if she doesn’t go, or trying to bribe her, but sitting down and flat-out talking to her. Get an understanding of what is going on, and an idea of the friend’s mental state, WITHOUT judging her or immediately going on the offensive/putting her on the defensive, which is hard to do, yes, but worthwhile. Don’t talk about the pain directly, unless she brings it up — talk about how she feels.

    I really can’t stress enough how important it is for SIWF to listen without jumping in to correct her friend. How her friend sees it is how her friend sees it, period, and telling her that it’s wrong or unfounded isn’t going to go anywhere — that’s like telling me that sounds at a hundred decibels hurt your ears; it’s useless and achieves nothing, because that makes it about you, not me. It makes it about SIWF, not her friend. Work with the assumption that your friend is right, right, right dead right about how everything she feels, and the emotional/mental impact that it will/does have on her. Even if you don’t think she is, think of it as she is anyway, and you will minimise her pain less, and solutions that will help both of you will come easier.

    If she describes it as a crushing weight, don’t tell her that the rock is really just a crumb and she should damn well stand up straight; tell her that she can make a yoke to balance the load. Given her history of broken bones, a cure is not likely, and something along the lines of a yoke is probably all you’re going to get.

    Further, treat her current condition, and her pain, as though it’s something that needs balancing between her ability to cope and her need to do this or that, rather than as something that needs to Magically Go Away. It really is a case of, ‘something somewhere is off-balance and is straining you beyond what you can cope with. We need to find a way to redistribute it until it balances again’. Part of that rebalancing may involve a Western-style doctor. It might not. However it’s dealt with, it’s important to put it in the proper context so as to avoid screaming with frustration when your current mode of thinking isn’t working. ;)

    That’s all I’ve got, really — a bit of reframing, to put things in a context that I find most people in SIWF’s position handle better. SIWF’s burden is just an invisible as her friend’s, but it’s no less a burden for it. Being a friend in her position is very, very emotionally taxing, and I applaud her bravery in asking this. Hopefully Shapelings as a community can come up with something that works for this particular situation.

  40. Not to take anything away from anyone who has commented previously on legitimate and profound reasons for avoiding doctors, but I did want to speak up in favor of Aunt Fattie’s response.

    Not that it is necessarily a valid description of anyone in a similar situation, but my mother (who has always been thin, and isn’t to my knowledge in chronic pain) REFUSES to go to the doctor at all. For anything. Ever. And will give the most ridiculous reasons ($10 co-pay too much, no time, et c., but hey are those new shoes? And how was that trip/seminar/event that you just did for 4 days?)
    And the ‘martyr complex-choosing-to-suffer-as-identity’, is a thoroughly accurate assesment of her behavior in many aspects of her life; not just healthcare.
    Did I mention she’s a psychologist?
    ~headdesk~

  41. Wow, there’s a lot of good discussion here. I think the only thing I can add is to be wary of practitioners of alternative modalities as well. And I say this as a shiatsu therapist with knowledge of the benefits of complementary medicine. In fact, it is because of my training that I would like to point out that there is such an emphasis on lifestyle and prevention in most modalities that the practitioners can be overly zealous. I have had acupuncturists tell me to lose weight so that I can rid myself of asthma (which I have had since I was a skinny kid), and have had chiropractors attempt to place me on strict gluten and dairy-free vegetarian diets (to flush out all of the toxins that are stored in my unhealthy adipose, and restore thriving intestinal flora and fauna, curing all manner of ills caused by unhealthy modern lifestyle). While I have had fewer issues with fat prejudice in alternative medicine versus standard medicine overall, I have had to actively work to find service providers that take me as I am without laying on the guilt about how the absence of sickness isn’t true health, that true health takes work and constant vigilance, and a particular lifestyle, which may or may not directly contradict the advice of practitioners of different modalities. If you do decide to recommend alternative medicine, please remember that it’s not a magic bullet to topple the evils of Western Medicine. Make sure to get a conscientious practitioner who understands the value of taking people as they are, and knows that “health” is not a moral ideal.

    *steps off soapbox and quietly retreats*

  42. FWIW, I do think there ARE some people with martyr complexes who refuse to see doctors at least partially for that reason. My late MIL was one of them. She was having obvious symptoms of cardiorespiratory trouble and just could not bring herself to go to the doctor because she’d be taking time away from her job where they needed her so much, her sick husband who needed her so much, etc. In retrospect, I think she really was hoping she would “go” before her husband did, because she couldn’t bear the idea of living alone, and so she helped make that a reality.

    But you know, the doctors themselves aren’t helping either. Too many of them really are giant flaming assbuckets and can’t see anything but fat or (and this goes for alt-pracs too) blame people of all sizes, Louise Hay-style, for having a “bad attitude” that caused them to be sick. That reputation certainly gets into the air. I don’t blame people for feeling like they don’t want to subject themselves to any kind of abuse, that they’ve suffered enough as it is.

    Now, since I have the MIL story to work with, if I was in the LW’s position, I could tell my friend, “Look, this is what happened to my MIL, and it would absolutely kill me if something like that happened to you. Please, I will do whatever it takes to find you a good practitioner and go to the appointment and advocate for you, I’ll even pay the co-pay. But please, please don’t just let this go, please don’t give up. I really want you to have this. You have no idea what this means to me.” A little heavy-duty? Maybe. But sometimes a little shock therapy is necessary in a situation like that.

  43. In fact, her physical pain may have become an important aspect of her identity.

    Her physical pain may well have become part of her identity – much the same way that being fat has become part of my identity. I have lived being fat since I was 5. I don’t think my remaining fat (and choosing not to diet) has to do with not wanting to lose something on which my identity is based. It does have a lot to do with accepting the inevitability of my fatness (and learning to like it).

    Similarly, I think it is possible to have chronic pain as part of one’s identity but still want an end to the pain. It sounds like nothing has worked for her in the past and so she may also have accepted the inevitability of pain. That doesn’t necessarily equate to martyrdom.

    Having said that, however, I do understand what you are getting at here, and Kate has addressed the intent of the post as well.

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