To kick off the one month countdown to the 2015 BEDA Conference we share a post from Oliver-Pyatt Centers Founder and Executive Medical Director Wendy Oliver-Pyatt, MD, FAED, CEDS on delivering proper care and buffering from the harmful effects and many times unintentional weight shaming.
John Bradshaw said in his powerful book Healing the Shame That Binds You, “Shame is often cited as the buried emotion in all forms of eating disorders, compulsive eating and substance abuse.” I could not agree more! This about sums it up! That is why it is so exciting that we have Weight Stigma Awareness Week and why I am so happy to write on the subject of weight stigma and healthcare.
We, BEDA, created tool kits for patients to talk to physicians and for physicians to talk with patients. And I hope the tools are useful. I think this year, it is time for us to think further about the origins of shame, what makes interventions useful or not, and to think more about commonalities among all humans beings that lead us from what Bradshaw calls “Healthy Shame” to internalized, “Unhealthy Shame” – shame which is more difficult to escape.
Healthy shame is a temporary state in response to specific actions we may have taken (and maybe should not have). Healthy shame contains us, reminds us that we are not perfect, and mitigates us away from self-centeredness and grandiosity. It may not feel good, but it keeps us in check. I think of the kids who play basketball with our school team; there are those who may tend to shoot and shoot and shoot in the game and tend to not look to past the ball to their open teammate. My husband, “the coach,” with one disturbingly stern and upset look is able to induce a temporary moment of shame in the overly zealous shooter, which hopefully will allow better choices in the upcoming moments of the game – healthy shame.
But what about unhealthy shame? Unhealthy shame is a state of existence that intrudes into our identity, sense of self worth, and ability to feel connected to others. And this is what we really want to avoid, because this non-stop state of shame is what drives eating disorders, compulsive eating and addiction.
I was giving a talk at a university on Friday, and to drive home the point that we all experience shame, and the difference between healthy and unhealthy shame, I asked all participants to write on a piece of paper something they are ashamed about, crumble it up, and put it into a box so that I could (anonymously) share with the group. Here are some of the responses:
“I have herpes”
“I spend to much time tweezing my chin hair”
“I feel shame about my disorganization and procrastination”
And then, as I was un-crumpling the paper, I stumbled onto this one:
“I sometimes still feel like the poor, unclean, fat, insignificant, person I felt like as a child.”
When we completed this exercise, we noticed as a whole, how quiet the room became, and how we all felt closer when hearing these accounts of shame. We were humans among humans, all recognizing our collective perfect imperfections. In the first four accounts of shame that were read, it was clear that the shame was not a permanent state, it was an aspect of the participant’s life or themselves that bothered them. It did not completely define them. The participant did not write “I am herpes.” The participant wrote “I have herpes.” The crumbled up paper did not say, “I am disorganization and procrastination” it said “I feel shame about my disorganization and procrastination.”
If we want to make the delivery of healthcare something that is actually helpful and healthful, we have to be mindful of what we are delivering. Are we delivering a message that what you are is wrong, bad, and inadequate? Are we delivering shame? For those who are vulnerable, who have heard the message “eat less and exercise more, weight loss is good at any cost, fat is bad” throughout their lives in a healthcare setting, this non-stop messaging can easily create a state of internalized, unhealthy shame.
It is sad the person in the last quote still sometimes feels like an unclean, insignificant person. However, it is good news the person said, “I sometimes still feel this way” rather than “I am an unclean, insignificant person.” There was probably a lot of suffering and therapeutic work behind the person going from the more permanent state of shame he/she described to “still sometimes feeling” this way.
We really must live by the rule of first doing no harm. Einstein said, “We cannot solve problems by using the same kind of thinking we used when we created them.”
Healthcare practitioners must be mindful of the impact of unhealthy shame in every interaction with their patients. And patients must be aware of the impact of what I call “unhelpful help” – when well-intentioned, but uninformed healthcare providers use words and actions that are prone to inducing unnecessary and unhealthy shame.
It is okay, and it is even advised, to let out a gentle but powerful roar, and not allow the words or actions of others cause harm to ourselves or others.
This post was originally published on the BEDA website as an educational piece in support of Weight Stigma Awareness Week 2014 and the National BEDA Conference. To register for the 2015 BEDA Conference, please visit the registration page here.
Sydney Keller, Mental Health Worker at Monte Nido Eating Disorder Center of Boston, helps us wave goodbye to summer and welcomes us into the holiday season with a recovery focused post on vacations. While vacations, trips home, or experiences in new places can be fun and exciting they can also induce feelings of trepidation and unease. Sydney provides us her top six tips to support your recovery during times of travel.
Summer is the time for rest and relaxation, spending time outside, and going on vacation with family and friends. Wouldn’t it be nice for even one day, one week, one trip, to take a vacation from your eating disorder?
I recognize you might not be able to go on vacation because of the added stress that can interfere with recovery. However, for those who do, provided is a list of tips to utilize while you are away.
1. Be flexible. Just like your home life, vacation is not always on a set schedule. Planes can be delayed, weather is not always as we expect, and traveling can take longer than planned. Be prepared for these situations and have snacks that are both fulfilling and nourish your body. Remember not to let more than two hours go by without eating.
2. Journal. Journal to resist urges, create a dialogue with your healthy self and ED self, and to explore any feelings that may surface.
3. Do not be afraid to try new things and step out of your comfort zone. When traveling to a new environment, the foods you may typically have at home may not be available. That is okay! Stepping outside of your comfort zone is a part of life and so is trying new foods that you may not otherwise expose yourself to. Challenge yourself and try something new if you have the opportunity.
4. Don’t focus on your appearance in family photos, but rather the beauty of your surroundings and the incredible memories you are making as you partake in new experiences. To be in a new place can be both nerve racking and exciting, however, remember to take a moment and capture the beauty around you, rather than focusing and analyzing your figure in photos.
5. Reach out to others. Your family and friends are your main support systems. Lean on them in times of need, especially if you are struggling. It is vital to your recovery to reach out to your supports in order to gain a realistic perspective. This can be achieved in a variety of forms including talking, taking a walk together, or even simply, a hug. Use these supports and remember they will always be there for you.
6. Lastly, enjoy yourself and HAVE FUN! Vacations are a time to unwind, relax, and let go. While taking a vacation from your eating disorder during recovery is not possible, it does not mean you cannot enjoy this time with your loved ones.
For more posts from Sydney, please visit Eating Disorders Blogs where she has been featured as a guest contributor. To learn more about Monte Nido Eating Disorder & Affiliates eating disorder programs, please visit their website here.
Clinical Director of Intensive Outpatient and Transitional Living Programming at Oliver-Pyatt Centers Jamie Morris, MS, LMHC shares her dedication and speaks to the passion all of us at OPC have for eating disorder treatment, recovery and the ever-present need for increased support of those struggling with eating disorders and their families on the path to recovery.
I must admit when I was asked to write this post, I found myself questioning, “how do I inspire others in a few paragraphs to care about the #MarchAgainstED?” As I reflected on what motivates me to engage in various advocacy efforts, I thought of the quote by Saint Ignatius of Loyola, “Go set the world aflame.” Within my role as a clinician, I have the opportunity and responsibility to promote social justice and advocate for individuals and families impacted by eating disorders. This sense of responsibility, desire to make a difference, and belief that unifying voices foster change are what have inspired and motivated me to participate in the #MarchAgainstED and advocacy efforts at the federal level.
Both within and outside of the treatment center setting, individuals and families are facing the devastating news that insurance will not cover the clinically-recommended treatment they need. The impact of these determinations is vast. And for some, the result of these determinations has led to an outcome that we all hope we never have to experience — the death of a loved one or individual we have treated. Some sit complacently in response to learning about these stories of social injustice. Some become angry; some apathetic. And for some, it ignites interest and passion as well as a desire to change the present reality.
The #MarchAgainstED is one way that we, at the Oliver-Pyatt Centers eating disorder treatment program, believe we can honor our interest, passion, and desire to change the present reality. We recognize this march as an event that unifies voices, but also a call to advocate for social justice. #MarchAgainstED provides a platform for us to do extraordinary things in promoting the reduction of stigma, shame and discrimination associated with eating disorders.
At Oliver-Pyatt Centers, my colleagues and I recognize we have the honor and privilege of working with individuals and families who have been deeply impacted by these devastating illnesses. We consult on how we can do better and be better for the individuals we serve. We consider how we can support the community engaged in prevention and advocacy efforts, and support and encourage our team members’ participation in these various efforts. Participation in the #MarchAgainstED is one way we can do better and be better for those affected by eating disorders. We believe it is important to be at the table and have a voice when lawmakers are considering their role in improving access to treatment and prevention services.
We are excited about that the collaboration between Mothers Against Eating Disorders (MAED), The Alliance for Eating Disorders Awareness, the Eating Disorders Coalition (EDC) and treatment centers throughout the country and feel hopeful this collaboration will improve the climate in the eating disorder community. We believe full recovery from an eating disorder is possible when effective treatment is provided and strive to genuinely connect with each individual, to address the core issues driving the eating disorder, and to provide the tools needed to live a meaningful life.
For more information and to register for the upcoming #MarchAgainstED, visit here.