The function of family is a key role surrounding Dolores’s obesity. Family cohesion, family adaptability and family boundaries play vital roles in Dolores’s health problems. Dolores has difficulty taking responsibility with her own health, and refuses to see a doctor for a physical required for college entrance. It ultimately takes a forceful act of her mother with “a steak knife in one hand, the hacked off television plug in the other” who will only repair Dolores’s beloved television “when and if [you] have a physical” (121). Although Dolores insists that her mother must really hate her for demanding that she get a physical, she is unaware of her mother’s and grandmother’s function in the family as the once to encourage and provide medical services. The clash between needs of an individual versus the needs of the family also becomes evident during Dolores’s physical. While “Ma and Grandma played by the rule: never to mention [her] weight” (123), in fear of throwing off the emotionally fragile Dolores and the family dynamic, her mother and grandmother ignore the health threatening issue of obesity. Issues regarding family boundaries also play a role in Dolores’s health issues and Dolores’s mother serves as a boundary between Dolores and her grandmother. Her grandmother, because of this boundary, “said nothing about her weight” (Lamb, 121) and became “tolerating [of] overindulgence” (Lamb, 279). Since Dolores no longer dealt with her grandmother directly, she ultimately lost a family intervention figure regarding her eating habits and health behavior.
In terms of health behavior change, Dolores goes through a process similar to the six stages of Procheska’s Transtheoretical model. At first, Dolores shows no interest in altering her health and addressing her obesity problem. She enjoys “consoling [herself] with a stack of pecan sandies” (Lamb 121). However, the loss of her mother, her entrance into college, the tumultuous relationship with her roommate and the constant teasing of peers, drives Dolores to think about changing her ways and ultimately causes a mental breakdown. During her time at the Gracewood Institute, a private mental health facility, working with a psychiatrist, Dolores “starts from scratch because of all the inadvertent damage” (Lamb, 265) and attempts to change not only her physical health, but more importantly her mental health. Although Dolores experiences small relapses in her mental health, brought about by stressful relationships with men and emotional instability, she trudges through and in the end, finds herself physically and mentally healthy.
In the current public health arena, obesity and mental health have become two very important topics and there has been substantial policy proposal regarding both issues. However, at the time of Dolores’s obesity and mental health problems in the early 1970s both topics were hardly on the public health concern. While there are no direct implications of public health interventions, it is the lack of public health intervention at the time that proves to be an issue surrounding Dolores and her health status. Dolores’s depression and mental health illness followed sexual assault by a neighbor and ultimately causes her to nurture herself with food rather than her family’s support. Perhaps if obesity or mental illness had been important topics during this time, Dolores’s family would have felt more comfortable seeking medical advice regarding these areas instead of side-stepping them. Perhaps social marketing and education surrounding obesity would have caused Dolores and her to think twice about being “armed with cigarettes and a mug of Pepsi” (Lamb, 121) or at least cause her family intervene. This book could influence public health policy for obesity and mental illness, especially in relating both obesity and mental illness to behavior change and could possible spark more research on the links between obesity and mental health and how the public health system could intervene. Though it seems farfetched, the book could help encourage public policy on obesity such as providing educational programs and implementing nutritional public services to those suffering from obesity.
Perhaps what is most surprising about She’s Come Undone, a book written about a women struggling with obesity and mental health illness who has been raped, verbally abused and abandoned is the male author. However, Lamb portrays Dolores and her struggles in a way that one would never know this. In order to understand the social reality of Dolores and her struggles, Lamb places Dolores in a less-than-idyllic situation. Abandoned by her father at an early age, teased by her peers, living with her emotionally fragile mother and traditional grandmother, struggling with a health and socially debilitating problem, Dolores understands loss and discontentment. Dolores seems socially “real” to the reader because her life is so far from perfect, and she tends to suffer from specific health and social problems that the readers could identify with. When Dolores confides in her mother about her fears of being “too fat” and “too afraid” of normal people, her mother reassures her. “You’re normal,” (133) she says to Dolores. Lamb uses such techniques as a way of projecting the struggles of obesity and mental health illness Dolores has to overcome as normal problems. The voice of Dolores resonates throughout the book in the detailed accounts of personal feelings she has regarding her struggles.
Over the course of reading this book, I seemed to notice certain parallels between Dolores and myself. In the context of family, I was able to relate to Dolores, but on the complete other end of the spectrum. Suffering from bulimia, my family turned a blind eye to my detrimental health behavior, because they were afraid that it would offend me and offset the family dynamic, causing a clash between the needs of my family and my individual needs. In Dolores’s case, her mother and grandmother, aware of her obesity as a health threat physically and mentally, decided that addressing the problem could threaten their personal relationships with Dolores and further cause damage to an already unstable family dynamic. Like Dolores, behavior change has also played a vital role in improving my personal health conditions. While Dolores’s behavior change extends of a course of stages, it is ultimately a key event, a mental breakdown from the loss of her mother, the pressures of college and the questioning of her identity that motivates Dolores to change her behavior. Similarly, my reckless behavior during my adolescent years involving drugs and alcohol use went through several stages, but it was a particular event that motivated my change. These paralleling of worlds made the book extremely meaningful because I was able to relate to particular situations and the issues of behavior change in a personal context.
Lamb, Wally She’s Come Undone Washington Square Press 1992