In ‘Half ton son’, a delicately titled television program shown on Channel 4 last Sunday night, 19-year-old Billy Robbins from Texas can’t move from his room because he weighs 60 stone. The programme follows him as he struggles into the ambulance that takes him to hospital, as the surgeons remove from him five stone of abdominal fat and then band his stomach, and then as he is eventually separated from his mother in recognition he is unlikely to continue to recover in her presence. How could such a thing happen?
In the film Billy and his mother are clearly ‘enmeshed’. Enmeshed families have members’ whose relationships are unusually tight and at their most extreme they are described as being able to read each other’s minds. Billy’s mother describes herself as Billy’s best friend, and she calls him her ‘baby’. Billy really still is her baby; his weight causes him so much disability that she not only feeds him (8000 calories a day), but also wipes his bottom. We don’t have to be psychoanalysts to see the roots of this; Billy’s older brother died before he was born, and in response she wishes to give Billy everything he needs, and that which she can no longer give her first born, whilst Billy – in his gluttony – seeks in vain to replace his dead brother.
Hand in hand with this enmeshment, the ‘boundaries’ between Billy and his mother are a mess. These boundaries are theoretical constructs that separate an individual from his or her surroundings. Our society is full of them and large part of growing up is learning where they lie. An example would be the inappropriateness, around here at any rate, of French kissing your mother-in-law. Boundaries within a family are of great interest to structural family therapists especially and can be thought of as rigid (leading to disagreement), clear (leading to autonomy) or permeable (a.k.a. fluid or undifferentiated) preventing family members from becoming autonomous.
Billy weight is clearly difficult problem to fix. And fascinating was the reaction of the healthcare professionals. Instead of tackling the root of the problem, the relationship between Billy and his mother, they preferred to tinker around the edge with a technological fix, an extremely risky stomach banding operation. And it’s of note that medical teams are involved at all; here then a demonstration of two cultural forces described by Ivan Illich in his book Medical Nemesis: social and cultural iatrogenesis. Social iatrogenesis is the medicalisation of life, and cultural iatrogenesis, the erosion of traditional ways of dealing with what have now come to be defined as medical problems*.
But, I was thinking on my cycle home today, what of this? What must it be like to be the ‘world’s heaviest teenager’ every day slowly eating yourself to death? Or his mother complicit in her son’s condition, driven by psychological impulses she only partially understands?
*Note that I described Billy’s weight as a problem to ‘fix’ as if he were a machine – these idioms are so ingrained that they are hard to avoid.