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  • Rachel Benson Monroe

What do I know anyway

I struggled to even begin writing this because I feel the ED world is already oversaturated with white women with opinions on food and body. I also don’t think that what I think or feel is particularly unique or special but I also know that I’m gonna die someday and maybe someone will get something from something I offer to the world. I also had 1 glass of wine and some Nutella straight from the jar which is essentially my superhero concoction and makes me feel brave. So here it is.


I’m writing partially because I was inspired by a recent podcast episode from Food Psych, hosted by Christy Harrison. Christy (who is truly fabulous and I cannot recommend her podcast and new book enough!) hosted Shira Rosenbluth, a psychotherapist and advocate, to discuss her experience of being a clinician who also experiences an eating disorder and details the mistreatment she received at the hands of people who are supposed to know better. In the podcast episode, Christy and Shira discuss Shira’s treatment for an eating disorder and the myriad baffling ways treatment providers and centers have fucked up for her. I don’t need to go into it because you should just listen to the episode but basically its bad science + poor training + unethical treatment + fatphobia + ignorance + a corrupt and fucked up system = a person who is facing a severe illness without proper treatment that should be accessible and available to all. Honestly I wasn’t surprised, just mad. I kind of want Shira to name names of these treatment providers and centers that are doing this and I understand why she does not. And can I just say that the things that could have potentially made a difference to Shira and so may other patients are NOT DIFFICULT FOR TREATMENT PROVIDERS TO PROVIDE. Clearly I wasn’t there but in my understanding, there is NO PART OF EATING DISORDER TREATMENT THAT SHOULD INCLUDE RESTRICTION OF ANY KIND. Like- even with binge eating disorder and bulimia, having any restriction would just exacerbate the existing condition and fuel the ED further because like Christy mentions on the show, all EDs are essentially restrictive by nature. Okay.


So why is this hard? Why. Why? Why is it difficult to have eating disorder treatment that does not include body shaming or treating someone differently because of their body size? Why does no eating disorder treatment center (that I’m aware of) come out and say fully, totally, WE ARE HAES AND WE LOVE FAT PEOPLE AND WE WON’T TRY TO MAKE YOU THIN IN FACT YOUR BODY IS JUST A PIECE OF THIS WE ARE GOING TO HELP HEAL YOUR RELATIONSHIP WITH FOOD AND HELP YOU ACCEPT THE BODY THAT ACCOMPANIES THAT NEW BRAIN STRUCTURE? FAT? YOU’RE GREAT AND WORTHY OF TREATMENT. QUEER? YUP. BIPOC? HEY! LOVE YOU. SYSTEMS OF OPPRESSION GOT YOU DOWN? WE HAVE SPECIFIC GROUPS LED BY BIPOC/QUEER/FAT FOLKS WHERE YOU CAN FEEL SOMEWHAT SAFER TO SHARE YOUR LIVED EXPERIENCE. Oh dear I could keep going but my heart rate is rising so I’m gonna move on for now.


Is this already happening? WHAT AM I MISSING? Please, please, tell me. Is it that insurers won’t pay for treatment if that’s the case? And why? I know the medical field is still using BMI but like… even from a capitalistic standpoint if they did away with BMI restrictions MORE PEOPLE WOULD GO TO TREATMENT WHICH WOULD MEAN MORE MONEY FOR INSURANCE COMPANIES. Amirite? No? Please, let’s talk about this.


*I spent a year working at Veritas Collaborative and I am happy to say that in my experience as an employee (not a patient so this might differ) their treatment is weight neutral and patients are re-nourished properly regardless of body size. This is not a sponsored post just keeping it real.*


So, TLDR; Shira is very brave to speak on this and Christy is doing great work of using her platform to give voice to folks like Shira and we just simply have to do better. Have to. HAVE TO. And I don’t know exactly how but I’m not going to stop thinking about it.


Which brings me to another topic discussed in the podcast- being a clinician who also experiences an eating disorder. It is well known that may clinicians suffer/have suffered. The question that many have grappled with is- does that hinder or help patients who are themselves suffering? And of course the answer is NEVER BLACK AND WHITE. Nope. Just isn’t. Hello- DBT?


However, there are a few things that I personally believe are essential for a clinician working on their own recovery to have a clear understanding of and grasp of in their work. Again- JUST MY LOWLY OPINION and NO this is not backed up by research because while many excellent people have done research on recovering clinicians I don’t have that at my fingertips and I don’t think it’s necessarily connected to patient experience or treatment outcomes so. Someone do that research or tell me about it if it’s been done! Okay.

I believe a clinician treating humans with eating disorders NO MATTER WHAT but ESPECIALLY IF THEY HAVE HAD AN ED should:


*before I say anything else. IF. YOU. HAVE. NOT. HAD. TRAINING. IN. EATING. DISORDERS. YOU. CAN’T. SAY. YOU. TREAT. THESE. AMAZING. PEOPLE! You can learn! Yup! You can pay people to teach you! But you can’t just SAY YOU DO IT AND TAKE PEOPLE’S MONEY AND NOT ACTUALLY KNOW. You could be (and likely are) doing serious, serious harm if this is the case. Stop. It doesn’t matter if you did it yourself! The ED field is exploding with cool science and treatment modalities and you can be in that club of people who learn and there’s not one right away and “evidence based” isn’t EVERYTHING like we think it is and yet! There are people who know a lot and they can help you learn or you can send people to them! And if you are in a rural area and there’s no one else to help them you CAN you just need to get some support!* oh man that went long.


So again- if you’re gonna help humans who experience eating disorders I think it would behoove you to consider and do the following:


-have done a full inventory of your body beliefs. You could do the Body Trust questionnaire workbook by the inimitable Hilary Kinavey and Dana Sturtevant, creators of Be Nourished https://benourished.org/ That would be a good place to start.


-have asked yourself- what would I do/thing/say/believe if I gained 50 pounds RIGHT NOW. If your answer isn’t something nice and loving and interested and curious, hmm. (of course you may be perturbed because fatphobia and diet culture are real and suck and bigotry against fat people is horrifying but do you see how that’s different?)


-examine what your brain tells you when you look at fat people. If it's anything other than "yup what a cutie love that person their body is fine and great and they deserve proper seating and medical care if they need it and to eat what they want and not be judged and and to not be harassed and to just live in glorious peace in their fat bodies" then do some work on that! and ESPECIALLY if it's anything like "oh they are so brave for daring to like themselves, yay them" or "tsk tsk if they just ate more mindfully they could lose the weight!1!" or "i'm body positive but THEIR KNEES" then theres work. to. do. Do it.

-DO A FULL INVENTORY OF YOUR INTERNET PRESENCE. Yup. PATIENTS/CLIENTS AND THEIR FAMILIES ARE GOING TO LOOK YOU UP IMMEDIATELY AND BOY WILL THEY HAVE THOUGHTS AND JUDGMENTS ABOUT ANYTHING YOU HAVE EVER WRITTEN AND ANY PHOTO YOU HAVE EVER POSTED AND YUP YOU NEED TO HAVE DEALT WITH THAT.


-I’m serious. If you have disclosed an ED in any capacity or basically posted anything online YOUR CLIENTS WILL KNOW. AND THAT IS OKAY BUT YOU NEED TO BE PREPARED TO DISCUSS IT HONESTLY WITH THEM. Or have a few lines about why you don’t feel it’s appropriate to discuss or whatever but you gotta have something.


-be able to nourish themselves fully, properly, and eat generally without an overwhelming sense of shame, guilt, or anxiety. (Please note this is not about nutrients, I don't care if you eat a single green thing and maybe you have a dietary need if so THIS ISN'T ABOUT YOU but I mean- can you eat? Enough? Without freaking out?) How much real estate does food and body take up in your mind?


-Why? Well? I can't say I 100% actually know. Are patients going to know your innermost thoughts and eating habits? Maybe not. And. Honestly sometimes when I am with someone I can just FEEL if they have an ED. And when I am with someone who does not I can feel that too. No evidence for that. Just knowing I’m in the presence of someone who has done their own healing work and is taking care of themselves just brings a warmth and fuzziness and depth to my experience of people. Could I be making it up? Yup. BUT. I think it’s worth considering. Not to mention these disorders are TOUGH and if you aren't feeding yourself and resting you will likely not be properly equipped to do right by your client.


-be able to generally abstain from, as part of an existing ED starve, purge, binge, compulsively exercise. Listen- WE ALL HAVE OLD HABITS THAT DIE HARD LIKE JOHN MCLEAN. BUT WE MUST KNOW HOW TO SPOT THEM AND KNOW THE ROLE THEY PLAY IN OUR LIVES. AND NO ONE IS TOTALLY “NORMAL” WITH FOOD THERE IS NO SUCH THING!


-Listen! If you need a meal plan? COOL. Still look at exchanges? Neato. Practice intuitive eating? Wowza! Have gorgeous meals prepared with mindfulness and care sitting at a lovely table with no distractions wearing a nice robe or something? (WHO ARE YOU TEACH ME) Love you! Do none of the above? You’re a winner! It’s just a matter of KNOWING THYSELF and caring for yourself enough to manage and adapt on most days. Most. My life in recovery includes all the above and most recently has included a love affair with whole milk and Golden Grahams/Apple Jacks but I digress, that’s my journey.


-HAVE A GAME PLAN IN PLACE FOR IF URGES OCCUR AND BE WELL VERSED IN THEM. AND HAVE A BACK UP LIST AND A BACK UP LIST TO THAT BACK UP LIST.

-be able to move their bodies IN ANY WAY THEY MAY WISH (WHICH MIGHT NOT BE AT ALL) and accounts for differing abilities and neurodiversity! And to be aware of your own privilege! I could write a whole post on that but I believe others have already done it, and better, but also check out anything Anna Sweeney has ever done and also @decolonizingfitness and @withthisbody and @sonyareneetaylor and more more more


-be able to fully believe and know that your client’s DO.NOT.NEED.TO.LOSE.WEIGHT.OR.MAKE.THEIR.BODIES. SMALLER.OR.DIFFERENT.EVER. NOPE. NO MATTER WHAT THEIR DOCTOR SAYS NOPE NOPE NOPE.


-be able to not collude with their client’s eating disorder. Be able to spot it and know when it’s trying to stay there to protect the client. This takes practice and supervision.


-understand and know their “triggers” and a more nuanced way of saying it is- “what is the template by which you operate that may or may not allow you to care for yourself and embody your values in recovery?” For example- myself, as a recovered/ing clinician, have never really felt “triggered” by a client in the way many in our field would define it by. I have, though, become overwhelmed by the intense needs of my clients and spiraled into bad boundary habits and constant worrying for my clients and doing too much work for them and not letting them do things for themselves, which is my own unhelpful operating untemplate. Do you see what I mean? Listening to someone talk about how they hate their body doesn’t make me hate my body per se (also because I live with hella privilege in every different possible way so that’s a huge part of it) but it DOES potentially trigger me in other ways that may end up in me using ED behaviors to cope. This shit is complicated! Still with me?

I’m going to wrap this up because I’m starting to get anxious about what I have to DO with this little stream of consciousness, which may be nothing.


Moral of the story. YOU. No matter what you are dealing with. HAVE AN AMAZING CAPACITY TO HEAL YOURSELF AND OTHERS. IF YOU HAVE DEALT WITH AN EATING DISORDER YOU ARE IN NO WAY NO WAY NO WAY EXCLUDED FROM HELPING OTHERS WITH THESE ILLNESSES!

AND! I think it behooves providers to maybe do the things I said above before you do.

I am not sure if this was helpful. I would really appreciate any insight or feedback on this. I like to think I’m not the kind of fragile white lady who can’t handle being called out for being problematic and i'm perfectly happy with being put to that test. I’d like the chance to find out and be humble and learn and grow and support other providers as best as I can, speaking only from my own experience. Thank you again to Shira and Christy for providing the inspiration, as well as Nutella and Jam Jar wine. (not sponsored but could be hint hint). I'd also like to thank Beth Mayer amongst others for teaching me alot of the things I said above.

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