Culturally Sensitive Treatment Approaches: Addressing the Unique Needs of Muslim Individuals with Eating Disorders
I felt superior because I could tell everyone at the eating disorder treatment center that I was vegetarian. Vegetarians are supposed to be healthier and thinner, right? That’s what I assumed.
I wasn’t actually vegetarian, though. It’s just that my treatment center had no halal meat options for a Muslim like myself. Halal meat is meat that has been cut a certain way with a prayer. It's important to note that not all Muslims follow the same halal meat rules as me, but a large percentage do. So, the treatment center told me I would “have to eat vegetarian meals.” It was ironic actually. There were people there whose eating disorders had caused them to become vegetarian or vegan, so the treatment center had made them go back to eating meat, dairy, etc. But I was the opposite. It gave me some twisted sense of superiority. I was able to do what their eating disorders told them to do, but they couldn’t.
That was until I actually tasted the food itself. I come from a family that only eats Pakistani food. Meat-filled Pakistani food. I mean, whenever we go out to eat, we go to a Pakistani restaurant. Whenever food is cooked at home, it's Pakistani. Whenever we go to a party or someone else’s house, they serve Pakistani dishes. Of course, I’d eaten things like pizza and burgers before, as well as the occasional Mediterranean cuisine, but that was the extent of my experience with different foods. Imagine my delight when grilled tofu and black bean burgers made up the majority of my meals for the three months I was at the treatment center (insert sarcasm here).
Recovery is hard, and something as simple as finding halal meat in Houston (which is not difficult at all, considering the massive Muslim population) could have made it a little bit easier.
Even when I felt better about my body image and was okay with eating, the taste of the food and meat replacements made eating a struggle. Learning to enjoy your food is an important part of eating disorder recovery, but that was something I was never able to learn because the food was rarely ever to my taste. And when I voiced that complaint, I was accused of making excuses, and that my eating disorder was making me say those things.
I got through treatment by forcing myself to eat and trying to enjoy the foods that were there, but the consequences of this experience were inevitable. I got home and my food options were back to the ones I was used to. All good, right? Except my treatment center worked on an exchange system and my meal plan didn’t tell me how many exchanges were in my mom’s chicken curry or lentils. I knew the exchanges in a grilled chicken breast or a slice of pizza, but not this. My mind spiraled; I couldn’t eat these things if I didn’t know whether they fit into my meal plan. What if I ate more than my meal plan?
I vividly remember screaming when my grandma brought a plate into my room with some nihari (a beef curry) and naan on it. Not because I didn’t like it, but because there was oil floating on top of it. How many fat exchanges were in that oil? We only got little containers of butter as our fat exchanges at the treatment center. Also, was that beef? How many protein exchanges were in that? I only knew about chicken because that was on the paper they gave me, and I never ate beef at the center.
I’ve come out of all this knowing that I’m not the only one who has struggled like this. I’ve seen treatment centers provide kosher options (which is amazing and I’m not saying they shouldn’t) but not halal options. I powered through my experience at my treatment center, but there are many Muslims who may be discouraged from seeking treatment after hearing that they will be forced to go vegetarian. Others may fall into even more restrictive eating because being vegetarian limits your food options. They may try to convince themselves they can recover at home, even if it is not possible for them. And there are others that may go into treatment, and come out of it unable to eat their cultural foods due to rigid meal plans.
Of course, culturally sensitive treatment is not just needed at the residential or partial hospitalization program (PHP) level, but also at the outpatient level. Muslim eating disorder therapists cannot always be found, so many individuals will have to go to non-Muslim ones. There is often a misconception among Muslims that struggling with mental health is an indication that one is ungrateful to God. This leads to feelings of guilt for individuals in eating disorder treatment. I distinctly remember one of the imams (prayer leaders) at the mosque I go to telling me that my depression could be fixed easily with more gratitude to God and I don’t need antidepressants.
When I told my therapist about this, rather than simply telling me that he’s wrong and that depression is a chemical imbalance and has nothing to do with God, she asked me why I care about my religion and my relationship with God. What makes it so important? She tried to learn more about my religion and my thoughts about the divine so she could understand how she could help me. How she could help me realize that I was not ungrateful. She even helped me find religious coping skills (TW: oversimplification of physical health determinents) I could use when I felt disordered thoughts coming to plague me. This is something that you don’t have to be Muslim (or any religion that is the religion of your client) to do, but rather you have to be open-minded and ready to learn about someone else. Only then can one go beyond using the cookie-cutter skills they have been taught because those may not work for everyone.
Every individual is unique and has unique needs when it comes to eating disorder treatment. From my experiences and the experience of other Muslims I know, halal and cultural food accommodations and the understanding of one’s unique relationship with their religion and God can help make the difference between an effective or ineffective treatment experience.
