Systems and Strawberries: A Post for World Eating Disorders Action Day 2017

Today is World Eating Disorders Action Day. Last year I was much more involved—check out my blog posts from last year here and here—but this year I’ve been much more low key about the day. This doesn’t mean I don’t care, or that I don’t think the day is important—I think it is an amazing example of bringing together people across the world to fight for better eating disorders treatment and research. My absence from the group has had more to do with practicing what I preach, in a way. It’s had a lot to do with learning how to say yes and when to say no in ways that fit for me. So this year I’m just saying yes in the form of writing a little about what I’ve been pondering lately, when it comes to eating disorders.

I’m a bit of a broken record or squeaky wheel or some other kind of cliché about repetitiousness when it comes to my fixation on the need to think about the broader systemic context when we think about eating disorders. Let’s leave aside, for a moment, the question of what role this system plays in the genesis of eating disorders (a complex question, and today isn’t the day for a debate) and consider instead what the system is doing to those seeking treatment and recovery from eating disorders.

At least a few times a month, I am asked for resources for people suffering from eating disorders—people themselves, supporters, acquaintances, and coworkers of people with eating disorders approach me, knowing my area of interest, and ask me if I know of any good services available for people with eating disorders. They usually ask if I know of anything in the Canadian context, but sometimes they’re requesting supports in the States, the UK, or elsewhere. Are there eating disorder treatment programs in these places? Of course (well, maybe not “of course,” if you think about the fact that the Canadian territories and several provinces lack significant supports…). Can I guarantee that the person will have a positive experience when they attend that treatment? No, I can’t.

I want to be crystal clear that this is not an indictment of individual clinicians who treat eating disorders. Particularly in Canada, I know many well-trained, compassionate, and hard-working eating disorder healthcare professionals. However, the systems we have in place to treat eating disorders are not meeting the needs of people seeking treatment. What gets in the way? Here’s an incomplete list:

  • Overwork and burnout amongst healthcare providers, working long hours in a field that is stigmatized (see this post I wrote a while back for more)
  • Treatment approaches that are rooted in white supremacist cultural norms (such as perfectionism, sense of urgency, a focus on quantity instead of quality—see this brilliant page for more)
  • Colonized treatment settings (see this post for more!) and other culturally inappropriate treatments that demand that patients perform a kind of White Western recovery built on stereotypes about eating disorders
  • Long wait lists, which have the dual problem of: a) making people who could really use support immediately stay stuck on a wait list, which may also contribute to feelings of “not being sick enough” to deserve treatment and b) meaning that there is a very low threshold for people being kicked out of programs, as there’s always someone else waiting on the wait list
  • Lack of funding for patient-centered and community based treatment, meaning that people often have to leave their whole lives behind in order to pursue treatment—something that is not possible or accessible to all
  • Missing or insufficient transitional services for people leaving or kicked out of treatment, meaning that people often return to toxic environments that perpetuated distress
  • Weight stigma that pervades treatment settings in insidious ways; again, this doesn’t have to look like an individual healthcare provider being fatphobic. It can look like weight thresholds for treatment, eating disorder treatment programs that also market weight loss programs, and the promise that “we won’t let you get fat”

This looks fairly bleak, doesn’t it? This might surprise those who know me as a highly critical individual, but it always feels uncomfortable, to me, to focus on the negative. But we have to. If we actually want action, we need to delineate what needs to be acted upon. We can’t simply tell people to love their bodies in a world that tell them their bodies are wrong—not only because of thinness norms but also because of racism, classism, sexism, ableism, heterosexism, transphobia, etc. We also can’t just tell people to “go get help” when the help is neither available nor appropriate. My list above is but a snapshot of the myriad places for action.

What can we do? How can we act? I’m no longer satisfied with only critiquing, and yet I’m often hesitant to propose concrete recommendations—because of the spaces of privilege I occupy (my whiteness, my thinness, my age, my heterosexuality, my cis-genderness, my passing-as-able body) there are weak spots I likely cannot see, and preferred ways of action I likely do not know. Because of this, my number one recommendation for action is to listen. To deeply listen to those who aren’t usually able to talk about this. How do you listen to those who can’t speak up for fear of negative consequences? That’s a tricky one. My best guess is to open spaces up—to acknowledge and recognize when and how our systems are shot through with power dynamics and gilded with privilege. And when people speak and their stories and experiences are not as expected; when people speak about how mainstream systems aren’t working for them, don’t tell them they’re wrong. Listen, acknowledge, and act.

[I also made a heart shaped strawberry-rhubarb galette, picture above... but that feels somehow less important.]