Mind Over Matter: Exploring How Mental Health Stigma Impacts Eating Disorder RecoveryNov 11, 2022
This blog is part of a special 12-month series titled, “Inclusive Eating Disorder Recovery: How Yoga Therapy Can Help” written for Yoga for Eating Disorders. Through my blogs and related social media posts, I will explore how we can use the ethics of Yoga, personal practice, movement, breath, focused attention, and meditation to create recovery spaces that are inclusive and reflective of diverse lived experience. Join in the conversation on Instagram by following along @yogaforeatingdisorders and @holisticyogatherapist.
Mental Health (noun): the condition of being sound mentally and emotionally that is characterised by the absence of mental illness and by adequate adjustment especially as reflected in feeling comfortable about oneself, positive feelings about others, and the ability to meet the demands of daily life. —Merriam Webster
Current research suggests that people living with eating disorders may also experience another mental health concern, which complicates their experience. It also suggests that individuals from systemically excluded communities often experience the impact of doubled stigma and are less likely to seek mental healthcare than the majority population.
How does the experience of stigma shape how we think about eating disorders in systemically excluded individuals experiencing mental health challenges, and how we reproduce social inequality and systemic exclusion when it comes to recovery? In this blog post, we’ll explore how the experiences of stigma and silence around mental health concerns, including eating disorders, impact how people seek help and how yoga therapy can support inclusive recovery.
Silence and Stigma
Studies from Oxford University suggest that individuals from systemically excluded groups are less likely to use mental healthcare services for a few reasons including different cultural perceptions of mental illness, silence and stigma in the community, institutional and provider discrimination, and mistrust of oppressive systems.
For some systemically excluded groups, notably model minorities, mental health issues, including eating disorders are experiences to be overcome with the same characteristics that give them their model status - willpower and mental toughness. This may also prevent them from seeking treatment in an effort to maintain the positive stereotype. They may also have reservations about the benefits of mental healthcare, especially delivered by systemically exclusive institutions.
Sometimes individuals struggling with mental health concerns may be seen as weak-willed, or a danger to community members and their model minority status. Those who are struggling may be afraid of being judged, discriminated against and may have internalised negative views of people with mental illness. The stigma associated with mental health concerns may also prevent individuals from acknowledging symptoms and their severity to themselves, or their care community until they cause significant harm.
The silence may be due to learned oppression, including cultural learning to be quiet, accept things as they are and to stay silent because the systems and institutions that deliver care will not change to accommodate diverse careseekers. Further, language itself may be a barrier to care seeking, especially for new immigrants because they may not have the words to clearly communicate their experience to a care provider.
This inability to communicate may be complicated by internalised stigma and bias around mental illness that may also result in choosing not to seek care or discontinuing treatment if it is not culturally aware and responsive - which in the case of eating disorders would include an understanding of the role food has within the culture.
The lack of culturally aware care can result in community mistrust of mental healthcare services, and is worsened by experiences of oppression, including the categorization of cultural differences as aspects of mental illness. They may also be frustrated by structured ways of engaging, and diagnostics that do not provide language or space for their experience. This combined with provider discrimination around intersectional identity markers may further discourage people from seeking care.
This mistrust may also stem from a history of interactions with healthcare providers where careseekers feared they would be reported to the police, child protective services or other violent forms of systemic engagement if they expressed self-harming tendencies.
How Yoga Therapy Can Help
How can yoga therapy support a more inclusive eating disorder recovery for people who live with an eating disorder or other mental health challenge and who may be seeking care that includes addressing the impact of multiple systems of oppression on those with intersectional identity markers?
We have already explored how the yamas (yuh-muhs) can generally be helpful. In this post we are going to learn more about how we can apply the yama of satya (s-uh-t-y-uh) which is generally translated as truthfulness. But what does truthfulness mean in this context?
Satya or complete honesty with ourselves requires us to create a little bit of space, stillness or at least some slowing-down of the mind so we can better understand the experiences of others. When we react instantly to situations on a purely primitive and emotional level, we’re often not seeing the truth. Our reactivity comes either from fear, or from conditioning and internal bias. The practice of satya includes being honest with ourselves about what we think about ourselves when it comes to internalized stigma and bias, and about others.
Practicing satya also includes being truthful to ourselves about why we are doing what we are doing - including seeking or turning away from help and support. We often avoid questioning our actions because doing so may prompt us to change our behaviour to be more inclusive.
The practice of yoga, particularly when it is a customised practice co-designed by your yoga therapist will help you reconnect with your capacity for truer perception and cultivate your capacity for truthfulness to yourself and those in your community. It might also help you better appreciate the experiences of others, to be open to hearing the truth of their experience and to recognizing how you can influence change on oppressive systems and structures when the time is right so you can restore your relationship with food and community.
This is done with the eventual focus of achieving your goals. Since the practice of satya includes pausing, reflecting and habit change, your yoga therapist will help you (re)build this capacity by suggesting an accessible daily practice that includes self-reflection, observation and study. Your task is to tap into your capacity for truthfulness and compassion to motivate yourself to complete it.
This deliberate way of deepening your awareness and where you might struggle with it, as well as which techniques help you change over time is particularly helpful in recovery because it gives us the space, and the attention to observe where we might limit our success by responding from a place of stigma, silence, or avoidance due to mistrust. As our capacity to see the truth of ourselves and our communities grows, we are better able to practice new habits, and restore our relationship with food and community.
This approach is critical because as we deepen our awareness of the truth, we are better able to share this with others and to either support or facilitate research, education and care that understands the complexity of the experience and enables inclusive recovery for our communities.
Call to Action
As a researcher, you might use the practice of satya to make space to hear the experiences of those from systemically excluded communities, or ask research questions that account for and create a larger research base including communities where mental health concerns are silenced? You might choose to explore the truth in the statement “People from different backgrounds experience and describe symptoms of mental ill health in different ways, which do not always fit prevailing models of mental healthcare.”
Another area that might benefit from the practice of truthfulness is to deepen your awareness of how your internalized stigma either supports or challenges institutional racism. How does your research make space for how mental health problems are experienced, shared, and supported within diverse minority communities? How might you explore which cultural settings and hold people back from reaching out for assistance when shame and stigma about poor mental health are common across societies? The practice of satya when it comes to how you see the world might also help you decolonize your approach when working with systematically excluded colleagues or change how you work with communities to a more generous approach.
If you are a care provider, you might use a satya practice to explore how you support individuals presenting with eating disorders who may have other mental health concerns but will not disclose/discuss them due to community norms? You might also examine how you support individuals from communities who don’t recognize eating disorders as a mental health concern and so not worth seeking care for?
You might also choose to use the practice to examine your comfort in supporting careseekers who raise topics like intergenerational effects of systemic racism on mental health, and how you can increase your capacity for care. You might also encourage the institutions you interact with to focus on developing culturally responsive ways to support care seekers while investing in education, helping decrease cultural stigmas, developing a resource list as well as securing resources to develop a multilingual mental health workforce and ensuring equitable language access through interpreter services.
If you are seeking care for yourself, or someone else, your practice of satya might include finding ways to address the breadth and depth of your experience, including systemic oppression that contributes to eating disorders. You might work with your yoga therapist, or other care providers to explore ways to address traumatic experiences into your healing journey. Or you might name and appreciate the barriers you experience in learning more about how to navigate oppressive systems as they relate to eating disorder recovery to your care team and community so they can help work to address the systems that maintain and enforce those barriers.
If it feels comfortable you might also use the practice to inform research and to help change systems at a more fundamental level. You might be truthful in your choice to share which forms of care or support to address eating disorders within the context of multiple barriers, or ongoing exclusion were most helpful so that other community members, care providers and system builders are aware and can integrate that information into their decision making.
If you are already using the practice of satya to deepen your self-awareness and reconnect with aspects of your identity and cultural practices to support your recovery, we would love to learn more about what you are up to.
Please share how it is going so far, what has worked well, and what you might set aside. Tell us in the comments, or message us on Instagram at https://www.instagram.com/holisticyogatherapist and https://www.instagram.com/yogaforeatingdisorders.
Resources to Support Your Exploration
Why Mental Healthcare is Less Accessible to Marginalized Communities
Breaking the Cycle of Silence Around Black Mental Health
Mental Health Stigma of Racism, Sexism, Agism
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