CHATTING WITH CLINICIANS: DIET CULTURE, SOCIAL MEDIA, AND SELF-LOVE
Written by Regina Colie
As I’m working towards becoming a mental health counselor, I’m interested in specializing in eating disorders and postpartum depression. I interviewed three NYC-based therapists who specialize in eating disorders to gain more insight into this critical subject. Each of the providers’ answers to my questions are provided below.
Ann Miller (MHC-LP) is a therapist practicing in New York City. She specializes in treating eating disorders and attachment trauma. When she’s not practicing therapy, you’ll find her visiting her partner in the Hudson Valley, experimenting in her garden, hiking, and playing with the neighbors’ dog.
Amie Roe (LCSW) is a Clinical Social Worker/Therapist in private practice based in New York City. She specializes in treating depression, eating disorders, spirituality, trauma and PTSD, and mood disorders.
Angela Miller (LMHC) is a New York state licensed therapist who works with adults navigating interpersonal relationships, career stress, self-esteem, and personal growth. She received her Master’s from Fordham University in Mental Health Counseling and completed clinical training at The Renfrew Center. She has experience working with eating disorders, substance abuse, and trauma, and has special interest in working with the unique struggles of creative and performing artists. www.angelamillerlmhc.com
Questions:
1 - What made you interested in specializing in eating disorders?
Amie: When I began my career 11 years ago, I was very interested in treating trauma. I began treating patients who had experienced physical, sexual, and emotional abuse, as well as neglect. As I gathered more experience, I began to notice how many of my patients developed symptoms related to food and body, and how, at first, these symptoms did not stand out to me as much as more traditional trauma-related symptoms such as flashbacks, panic attacks, or interpersonal problems.
I noticed that talk about dieting, exercising to lose weight, and the desire to change one’s body were so normalized in my own life experience that they didn’t stand out to me, at first, as areas that were clinically important. I was missing this entire, very important piece of my clients’ lives.
They were using their relationships to food and to their bodies to seek relief from intense inner pain, and in the process, actually creating even more suffering. I realized that I had to understand more about this important clinical area if I was really going to be of use to my trauma clients. So I sought out and completed a postgraduate training program in the treatment of eating disorders, and here we are!
Ann: Healing from an eating disorder is moving toward your fullest self and I experience this as deeply meaningful work. Eating disorders can be a powerful way that we disconnect from ourselves and from our needs—nourishment, joy, safety. I have found that eating disorder work can only be done from a liberation framework. Finding permission to meet our needs happens as we name the ways that white supremacy shapes and harms all of us, how thin privilege is connected with white privilege and the patriarchy, and how the origins of so much of our fatphobia is connected with anti-Blackness. It is one of my greatest pleasures as a clinician to join people as they access the courageous parts of themself that enable them to heal.
Angela: Initially, I wanted to work with women which, somewhat naively, led me to an eating disorder clinic. Working there very quickly challenged my binary and heteronormative thinking when it came to eating disorder presentations.
I learned how impossible, and harmful it can be, to try to categorically define what an eating disorder looks like, or who is the typical eating disorder patient. All genders, sizes, identities, sexualities struggle with their bodies and food.
Eating disorders are sneaky and the more alone or “othered” the person suffering can feel as a result of the eating disorder, the more the disorder will thrive. This means radical acceptance around having the disorder at all is key. Eating disorders are a powerful coping mechanism that “work” for a long time, and usually by the time someone comes into my office, that eating disorder stops working in some way as they inevitably will.
Through self-compassion, I encourage those with eating disorders to recognize what needs those ED behaviors were meeting for them, reduce the shame in talking about how the behaviors may have soothed in the short term, and then work together to find long term more adaptive solutions to these real, human needs.
2 - What are your thoughts on diet culture? Is it more harmful than good?
Amie: Diet culture promotes the idea that our bodies can – and should – be modified in order to better fit an external standard. This external focus takes our attention off of our inner worlds. As a result, we are thinking less about what we want and how we feel. We become less self-directed. This external focus can go on forever, because achieving that external standard is always eluding us. In the process, we become more alienated from our own wants, needs, and desires.
Ann: More harmful, for sure! There are some amazing researchers and authors who have really quantified how damaging diet culture is, but I especially love the Naomi Wolf quote “a culture fixated on female thinness is not an obsession about female beauty, but an obsession about female obedience. Dieting is the most potent political sedative in women’s history.…” In my own experience, diet culture is a culture of comparison and loneliness and deprivation where we are so focused on the size of our bodies (and often so dysregulated from not receiving sufficient nourishment) that we aren’t available to be our fullest selves much less live fulfilling, purposeful lives.
Angela: Diet culture is so out of touch it’s embarrassing. In the midst of NYFW and watching interviews from the recent Met Gala, I cringed with the few celebrities who mentioned dieting or restricting to fit into their dresses. Even they seemed embarrassed about it. I feel as though the energy is shifting from a harmful “I wish I had that ‘self-discipline’” to “I feel sorry for them that they have to wear uncomfortable clothes and can’t eat.” It’s an old, boring narrative that just doesn’t feel “cool” anymore.
I know there are more critical minds this year than the year before, which means even more next year than this year. If this pandemic clarified anything it’s that life goes on, or ends, whether we are thin or not. There’s been a necessary shift in priorities and those who are behind are becoming irrelevant. Retail stores who are not selling inclusive sizes will have to either shift or they’ll die out. Fashion shows without body and ability diversity will be so inaccessible people will stop caring. We’re moving slowly, but I do feel we’re moving away from diet culture—as long as we continue to challenge it when we see it.
3 - Do you feel social media plays a role in how women’s bodies are portrayed?
Ann: For sure. Social media can be great — finding accounts where people are empowered to be in their bodies, but it can also be a way to support unreasonable expectations around food and body.
Amie: Every scroll through social media is designed to affect our emotions, our thinking, and our behavior. The images that are most effective at this get the most attention. So, for influencers and advertisers to do well, they have to be successful at manipulating people’s’ emotions. One incredibly successful strategy is to play on our most tender desires to be liked, accepted, loved, safe, and to feel well.
Images of thin bodies, social gatherings, and affluence present us with an imagined solution to some of these basic insecurities. Pictures of thin, smiling bodies, surrounded by friends and a hot, attentive partner subconsciously plant the idea – here is a possible solution to those feelings of loneliness, unworthiness, and self-hatred that you’re sitting with. Attain what this person has — their body size, their money, etc. — and you too can feel this good.
Angela: There’s a really fine line lately between “body positivity” and fat shaming, which usually results in something along the lines of “I’m fat BUT I love my body ANYWAY, NO MATTER WHAT” or “EVEN skinny people have fat rolls, see?” (cue influencer in awkward forced sitting angle). It’s subtle, but that language suggests fatness is this “problem” we have to overcome and the only way is to unconditionally love it.
Loving your body is such an individual moment-by-moment opinion and assuming it should be so globally prescribed is unrealistic and truly unnecessary. Representation of a variety of bodies in general - on social media, TV, Broadway, online stores, in offices and academia – feels more important to me than social media posts sharing opinions about body shape and size—even if those opinions are “positive ones.”
It can leave the viewers with questions like “well what does it mean if I don’t have those positive thoughts about my rolls or curves? Something must be really wrong with me then.” Nothing’s wrong with you. Today you don’t love your body; you may even be mad at it. Practicing self-acceptance means you can have that opinion of your body AND nourish it and respect today.
4 - Why is intuitive eating so important? Do you feel this is an effective tool?
Ann: For me, intuitive eating is about trusting the wisdom of the body. So, not only is it a useful tool in Eating Disorder treatment, but it’s a great tool for therapy! Learning to trust our innate wisdom is one of the ways we heal. Knowing that our bodies will ask for what they need and tell us when they are satiated is a powerfully concrete way to practice this process of trusting.
Amie: Intuitive eating is feeding yourself according to your own needs, wants, and desires. It also takes into account limitations that might get in the way of fulfilling these desires and needs, and helps you to flexibly navigate these constraints to feed yourself in the most nourishing way possible. As a practice, intuitive eating helps us to get reacquainted with our inner worlds, and to make choices that are more aligned with our needs. Once we learn this skill in our relationship to food, I find that this practice can generalize to other areas of life as well, to our relationships, our careers, etc.
Intuitive eating can be a very effective tool for reorganizing our relationship to food and feeding. It can be helpful to start this work under the guidance of a therapist or nutritionist who is familiar with the model. This is particularly important for folks with a history of restriction and disordered eating. Oftentimes people with a history of restriction in particular might need one-on-one guidance to help reacquaint themselves with their body’s innate cues for hunger and fullness.
Angela: While intuitive eating is important and effective, it can feel like a big and vague concept. Eating intuitively “simply” means eating what you are hungry for when you are hungry and stopping when you’re full. This can be extremely overwhelming for folks who have lost trust in knowing if they even are hungry or full. Working with a nutritionist who specializes in eating disorders and/or intuitive eating may be a helpful way to have accountability in starting this journey. It can be helpful to talk out food labels or internalized messaging about how and when to eat certain foods with someone else so those rules can be appropriately challenged. Intuitive eating is a practice and may not come naturally at first. Over time that imperfect practice, eating the forbidden food at the forbidden time, will lead to freedom.
5 - How can individuals move away from weight stigma and towards body positivity?
Amie: Weight stigma and fat phobia are so ingrained in our culture, that many people take them as fact. We tend to hold these oppressive views with unwarranted certainty. The opposite of certainty is skepticism and doubt. So, an important first step in shifting these beliefs is to question the hell out of them. Where did these ideas come from? Where is the evidence in support of them? In my therapy practice, I invite people to go about this process on their own terms, while offering them support.
Ann: One of the best pieces of advice I’ve received and would share is to surround yourself with people (friends, social media accounts, activists, and a therapy team) who support you and who are body positive themselves. When you’re new to the idea of body positivity, it can feel like you’re the only one and that can be not only lonely, but also discouraging and exhausting. Finding friends or support systems who won’t be body checking you or your food choices and who genuinely enjoy being around you is such an important part of your support system!
Angela: I think a lot of this work lies for those with thin privilege through a social justice lens.
Weight stigma is real and a product of misogyny, racism, and capitalism.
In order to move away from weight stigma and move towards body acceptance, people (myself included) need to question and challenge the ways they support institutions that uphold the belief that thin, white, and heterosexual is not only beautiful but normal. Who are we following on Instagram, who are we shopping from, who are we hanging out with, what jokes do we let slide? The work starts there.
6 - What is one piece of advice you would want your patients to walk away with?
Amie: If there is one thing that I want all of my patients to walk about with, it’s curiosity — curiosity about themselves, others, and the world around them. More often than not, my eating disorder patients have become stuck in very rigid patterns and beliefs surrounding food, their bodies, and themselves. Many have been stuck in these patterns for years and may be feeling quite certain that change isn’t possible for them.
Active curiosity and openness is the balm for moving people out of these rigid, damaging patterns. I want my clients to be authentically curious and ask big questions. How did this problem come to be? Was it always this way? Why is it that I binged on that particular day at that particular time? What was I thinking and feeling that may have contributed to this? This active questioning is the foundation from which my patients can learn new ways of being in the world, and of being in relationship to food, their bodies, and themselves.
Ann: This process is about having permission -- permission to be in your body, permission to find joy and take ahold of it with both hands, permission to be a full human with quirks and passions and feelings. It’s hard and our culture wants you to stay small (literally) but the work of giving yourself permission is one of the most powerful things you can do, and it touches every area of your life.
Angela: Reduce the pressure to wake up and love your body every morning. Change the language from “I love my body” to “I respect my body.” Respecting your body still takes work, but when the goal goes from loving to respecting, you’ll get more options.
7 - Any pieces of work you would recommend for people to read either to learn more about eating disorders or are in recovery for an eating disorder?
Amie: I love the FoodPsych podcast. For folks who may have comorbid Borderline Personality Disorder (BPD), I highly recommend the Borderliner Notes channel on YouTube.
Ann: Anti-Diet (and Christy Harrison’s work in general), Sick Enough, Intuitive Eating, Fearing the Black Body, @nalgonapositivitypride, @nic.mcdermid, @decolonizing_fitness
Angela: For those working towards a healing relationship with food or their bodies, I recommend anything by Kristen Neff. She wrote the book (literally) on self compassionate thinking and behaving. Although her work is not eating disorder centered, practicing self compassion work is such a vital skill when repairing the relationship with one’s body. For those working on dismantling some of their internalized fatphobia, I would recommend Fearing The Black Body by Sabrina Strings.
If you have a moment, please be sure to donate to my fundraising campaign! All proceeds will go towards Project HEAL’s mission. The link to my campaign can be found here: https://www.classy.org/fundraiser/3329892
Regina Colie (she/her/hers) is a Project Heal Ambassador. She is also a graduate student, getting her Masters in Clinical Mental Health Counseling (and hopefully her Ph.D!). She is looking to become a mental health counselor, and help women who are struggling with either eating disorders or postpartum depression. She is a firm believer in mental health advocacy, as well as giving women the opportunity to speak their truth.