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Ashley Solomon, Psy.D is a psychologist who specializes in the treatment of eating disorders, body image, trauma, and serious mental illness.

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Category: Ideas to Consider

10 Feb

How Our Current Approach to “Health” is Failing Our Children

Ideas to Consider No Comments by Ashley @ Nourishing the Soul

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In a paper published this fall in the journal Pediatrics, Drs.

Leslie Sim, Jocelyn Lebow, and Marcie Billings from the Mayo Clinic share two harrowing stories of teenagers who initially met criteria for through various attempts at weight loss developed eating disorders.

And lest you think these were case studies highlighted for their uniqueness, they were not. In fact, the authors point out that over 45% of the adolescent patients that present to their clinic have a history of obesity. The fact that eating disorders can flourish in the context of obesity — and perhaps, obesity intervention — is nothing new, particularly to those of who treat these young people.

Take “Kristin,” the 18-year-old who presented to the study authors’ clinic with an eating disorder. She had been told she was obese at 12-years-old and provided what is all too common for youth of higher body weights — a prescription by her doctor to focus on healthy eating and exercise. Kristin’s weight continued to climb, however, until age 14, at which point she reduced her caloric intake and began running many miles per day. Her weight began to fall, and with it Kristin stopped menstruating, became dizzy, and had difficulties with blood pressure while standing.

When she returned to her doctor, she was simply given birth control pills to address the loss of her period and told to drink more water. Over the next few years, Kristin continued to present with serious issues and lose more weight, all of which was by and large ignored by her various providers, who included her PCP, a sports medicine physician, and even a nutritionist. When her mother expressed to her doctor that she feared Kristin may have an eating disorder, the doctor pointed to her “normal BMI” and dismissed the concern.

We are failing our children.

The current emphasis – obsession – with BMI and weight reduction has locked our culture into a vicious paradigm in which losing weight is the holy grail and the health consequences are simply the price we pay.

It’s not just physicians who are to blame — not hardly: it’s public health advocates who get on soapboxes demonizing fat; it’s state legislators who push for penalizing people for being at what is often their genetically predetermined weight range; it’s school districts who put BMI on report cards; it’s states who think that campaigns like this one could possible be effective. But it’s not all just “them” either. It’s the little things the we do as well — the fat talking we do, the beauty privilege (and thin privilege) some enjoy, the media we support with our hard-earned money.

So how do support our youth in developing health and wellness without sending them spiraling into self-doubt, shame, and disordered eating?

Kathy Kater, LCSW has been working on this issue for several decades. She says, “Children who are anxious about weight begin to view their bodies from the outside-in—objectifying and judging themselves harshly according to external standards.” She’s figured out that the answer is not in addressing BMI or setting up systems of “punishment” for kids.

Instead, it’s about creating healthy kids and communities by teaching kids to connect with their bodies in new ways, challenge weight stigma, embrace healthy approaches to food and activity, and develop positive role models. Her Healthy Bodies curriculum has helped countless kids develop a more grounded perspective on their health. And it’s not just for overweight or obese kids — it’s for all kids.

It might not feel satisfying to some who are still in “panic mode” and arming up for the “war” on obesity. It doesn’t call for weight control or hyper-vigilance about Hershey Kisses. What is does is promote a balanced state of health, one that can be sustainable and non-stigmatizing.

To learn more about Kathy Kater’s work, the Healthy Bodies Curriculum, and how you can help be an agent of change towards health in your family or community, join me as I co-moderate a fun AED TweetChat with Kathy on Friday, February 14th at 1:00pm EST: Connecting Bodies with Hearts: Teaching Kids To Care, Not Compare.

What are you seeing in your community or personal experience? How is the approach to weight and health impacting the kids you know? 

03 Feb

Trigger Warning: Are These Warnings Really Helpful?

Ideas to Consider 3 Comments by Ashley @ Nourishing the Soul

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{image credit :: World Bank Photo Collection}

Amanda Marcotte, a writer over at Slate, recently 2013 the “Year of the Trigger Warning.” She points out that trigger warnings have proliferated across the blogosphere in the past year, expanding their reach in the type of sites on which they appear and content from which they attempt to protect readers. Marcotte highlights the outrage that was met by Shonda Rhimes when the show she created, Scandal, failed to provide a warning to viewers of a rape that was depicted on the show. Rhimes eventually acknowledged the purported mistake and tweeted, “I agree that a trigger warning would have been a very good and responsible thing.”

So what’s a trigger warning? While they’ve been used widely in the feminist blogosphere, trigger warnings aren’t particularly common in more mainstream media. They refer to the act of alerting a reader or viewer of material that could be potentially evocative and create distress. They often appear briefly but boldly at the start of a post or other media and list the specific content that might be disturbing to some individuals. Example: [Trigger Warning: Suicide, Rape]

Some suggest that trigger warnings are more common among feminist writers and artists because there is an increased attunement in these communities to the pervasive effects of trauma. The idea, it seems, is that these warnings allow individuals to make more informed and conscious decisions about what they are prepared to ingest. If someone has recently gotten clean from drugs, for instance, they may choose not to read an article with detailed descriptions of substance abuse.

Trigger warnings are all too common in the eating disorder community as well, at least in the community that is recovery-focused. There seems to be an expectation of curtesy among individuals with eating disorders and those who write about them to alert readers if the content could be disturbing or “triggering” to others.

But there remain a couple fundamental issues when it comes to trigger warnings that, to me, feel unresolved.

First, what does the term “trigger” even mean? Is it a noun or verb or both? It strikes me as an interesting word choice that has evolved to have so much meaning. The first definition listed by Merriam Webster for the word “trigger” refers to the lever that one finds on a gun to fire it. I think there’s a bit of irony there in using a word that refers to force and violence when talking about something evoking difficult or unwanted feelings.

The second definition reads, “something that causes something else to happen.” And this is where I struggle with the concept of triggers. From my vantage point, I see the idea of “triggers” referring to things that evoke strong emotions in the “triggered” person. Perhaps other uncomfortable experiences like re-enactments or flashbacks could occur to.

But I often hear the idea of triggers being used to refer to something that, like the definition says, “caused something else to happen.” But the truth is, it takes a multitude of factors for any given behavior or event to happen. Specifically, something that “triggers” one person to engage in self-harm may have no impact on someone else.

The chain events is more complicated than the idea of “triggers” allows. Take eating disorders, for examples. We sometimes use the analogy of eating disorders being like a gun. Genetics shape and mold the gun, the environment loads the gun, and certain events (e.g. bullying, dieting) pull the trigger. But if there was no gun to start with, or if it hadn’t been loaded, pulling the trigger would be impossible or non-eventful.

I personally feel that there may be an over-reliance on this concept. I think it over-simplifies the situation and externalizes the root of the feelings (e.g. “Seeing her eat that pizza triggered me to binge,” rather than considering what you were feeling prior to seeing her eat that, how hungry you were, the availability of binge food, etc.).

Back on the issue of trigger warnings in media, the other issue that is yet unresolved is the very basic question of whether these warnings are actually helpful or effective. For one, I think many people who may be most vulnerable to content (and who could potentially benefit from avoiding reading the post) are often the same people who will read it. This is part because there’s the fact that we are all a little rebellious (who doesn’t at least want to press that button that says not to press it…).

This is also because these are individuals who are emotionally struggling and often in need of support and relating. Personally, whenever I’ve struggled with something difficult, I’ve found myself seeking out stories of others going through the same thing. It made me feel less alone. Misery loves company, after all… So when they come across an article about something they personally have experienced (e.g. death of a friend, physical abuse, miscarriage), they may be more inclined to read it, even if they may be too emotionally vulnerable to do so.

Spending so much time recently turning this idea over and over in my head, I did a review of the research. I figured that that would help me better assess the utility of trigger warning. But it turns out that there’s really nothing out there that I could find addressing this issue. Basically, we don’t know if and how trigger warnings impact readers or viewers. I’d actually love to start doing some research on this, as it’s fascinating to me.

So we are left to rely on our own intuition. It could be that trigger warnings become a slippery slope of individualized censorship, or they could be protective of individuals who are too vulnerable in the moment for exposure to certain things.

I don’t have a firm answer, as I think this issue isn’t black and white and I like to consider what the data tells us before being more decisive on an issue (and there’s none! at least not that I’ve found — if you can, please let me know!).

I will say that I fear trigger warnings might be an example of falsely satisfying our own sense of altruism but not actually helping people. One writer had some interesting questions that he asked about trigger warnings, but summed up that he supposed they couldn’t harm anyone. I think it’s possible that they could (even while helping others). Perhaps perpetuating the idea of “triggers” could be harmful in and of itself, as it takes away from the complexity of given issues. Perhaps it gives us a false sense of security, or even keeps people in a pattern of avoiding things that would ultimately be helpful to have exposure to and work through (with a trained therapist, in many cases, of course).

But what do you think? Should writers include trigger warnings? Have they been helpful for you? 

06 Jan

Is it okay to not love your body?

Ideas to Consider 6 Comments by Ashley @ Nourishing the Soul

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{image credit: identity photogr@phy

I keep a digital post-it on my desk-top with interesting articles I come across and topics that I want to be sure to blog about when I have the time.

This post caught my attention way back in March, a couple days after my son was born, and since then the URL has been staring back at me each time I open my laptop. While the delay is certainly due to not being able to remember what it was about in my post-partum haze, it’s also due to the fact that the piece left me feeling conflicted.

First, I’ll tell you that on the whole, I love the post. Be warned that the author, Elyse Anders, is passionate about this topic and expresses that through the liberal use of expletives to show you just how much she believes what she’s saying. She’s a talented writer and got me thinking (for nine months apparently), so my hat goes off to her. But back to the post itself…

Elyse suggests that people should get off her freaking back about loving her body so much and mind their own damn business(es). She tells us she doesn’t like her body…

I don’t love my body. My body is awful. I will never love my body. I never have. And I’m 35 and maybe you think that’s too old to have real hang ups about my body. But I do. And I always will. And maybe you think that because I’ve lost a bunch of weight I should feel great about my body. But I don’t. And I won’t.

…and makes a fairly compelling case for why that should be A-OK to do so, pointing out the double-standards inherent in this instance on women embracing their bodies:

The problem is someone else telling me how to feel. The problem is being told that there is a standard of beauty, and I should ignore it. I should ignore it despite the fact that everyone is still holding me to it. I should ignore it and create my own. As long as it makes me feel pseudo-good, and makes other people feel okay with how I pretend to feel about me.

Really, just to read the post. I can’t copy and paste the whole thing for you. I’m not you’re assistant over here!

Okay, so you read it now, right?

So here’s the thing, I agree with Elyse on most of her points. We live in a world where women (and men) face impossible demands at every turn. Run six miles before dropping your kid off at school in your four-inch heels  with your perfectly blown out hair and don’t forget the holiday pot-luck at work! You did make that Pinterest recipe, didn’t you? So the idea that not only are we supposed to appear perfect, but we’re also supposed to appear as though we don’t care? It simply saddles us with more potentially impossible demands.

We don’t all love our bodies, and I get downright tired of hearing people say that we all should. In fact, some of us have been engaged in decades-long battles with our physical selves, for which there are all sorts of reasons. We’ve internalized the critical messages of our family. We’ve been the victim of sexual abuse. Our bodies have let us down when we needed them the most. To offer a blanket directive to love and adore our bodies doesn’t seem to adequately acknowledge the complexity of these relationships.

It can feel a little Pollyanna-ish, to be honest. And perhaps most importantly, I don’t know that it’s totally necessary. Hear me out…

If my goal in working with people was to change their feelings about their bodies from hatred to love, I could be stuck in my chair for a lifetime, and meanwhile, they’d be miserable. It would be like me trying to get my friend Lisa to like peanut butter when the stuff repulses her.

Instead, my goal is to help someone develop a sense of body neutrality. That doesn’t mean that they don’t have any feelings about their bodies — that’s just unrealistic. Rather, it means they have whatever feelings they are going to have about their bodies and they can still choose to make decisions about their bodies in a values-directed and educated way. For example, they can hate their belly with a vengeance but choose not to punish themselves with a ridiculous diet because they a.) know that it won’t work and b.) have more important things to do with their time and energy.

So I agree with Elyse that loving one’s body isn’t necessary, and it’s not helpful to others to put that expectation upon us. Where I start to bite my lip is here:

Stop telling women that we should find ourselves beautiful and that we should love ourselves when you are standing right there, judging us on how our knees look in short skirts and how prominent our boobs are in a sweater and how much makeup we are or are not wearing.

While we’re all part of the machine of culture, I find myself thinking of the many “body-love advocates” out there who are so often proclaiming to others to embrace their imperfections. These aren’t, on the whole, brazen hypocrites. They are people who who have found a true and deep appreciation for their own bodies and know that love is possible. I wonder if it can feel to some like that annoying friend who just got married and keeps telling you that true love is waiting for you! You just have to get out off your couch. But Prince Charming is out there!

It can be hard to swallow. And you may want to punch her in the face. But that doesn’t mean she’s judging your singledom, at least not intentionally.

The other thing I found myself thinking about is the fact that there’s a difference, to me, between love and gratitude. It may be a subtle distinction, but I think it’s important. I don’t have to love every line, every sag, every bulge, every soft spot. But I can still appreciate my body on the whole. I can wish to the heavens that my legs were more svelte while also feeling grateful that they allow me to dance until 2 a.m. with my girlfriends. If we don’t have a sense of our bodies playing a role in helping us to do the things we love and be the people we want to be, we won’t be motivated to take care of them.

I don’t think it’s a particularly helpful goal to set out to love your body (if you do, that’s great!), but I do think it’s worth aiming for neutrality and gratitude.

So what about you? Do you think we should try to love our bodies? And what place (or responsibility) do we have in the body-love of others?

 

01 Jan

What if this is the year?

Ideas to Consider 1 Comment by Ashley @ Nourishing the Soul

What if this is the year?

What if this is the year that you decide that the tug-of-war you’ve been engaged in with your body will never, can never, be won?

What if this is the year that you decide that even if it could be won, the toll is too high? That you’re battered and exhausted and your arms are tired?

What if this is the year that you realize that if you keep tugging, you can’t do anything else? That those are arms have been tied up for years in this war?

What if this is the year that you decide you want more than an endless tug-of-war?

What if this is the year that you decide that everyone else not in this tug-of-war seems to be having a good time?

What if this is the year that you decide you’ve had enough with diet gimmicks and all those false promises that make you feel like you’ve got more ammo, but really just leave you depleted?

What if this is the year that you realize your self-hatred isn’t changing your body or your mind any faster?

What if this is the year that you decide to drop the rope?

What then?

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