Obesity and mental illness cause constant struggle in the life of Dolores Price, and social and behavioral aspects of family, social network, socioeconomic status and behavior change play vital roles in the health issues that she endure.
She’s Come Undone follows Dolores and her struggles with health and behavior problems from childhood, through adolescence and into adulthood.We first meet Dolores as a happy, care-free child, but when her father leaves Dolores and her mother unexpectedly her life becomes a downward spiral of anger and depression. Comforting herself with binge eating, television and smoking after being sexually abused by a neighbor, Dolores constantly rejects her mother and grandmother’s love and nurture and struggles with the social and behavioral hardships of obesity and mental health illness. When Dolores ultimately suffers from a mental breakdown, she slowly begins to change her behavior to become improve her physical and mental health status.
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 herweight” (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.