20 Ways to Uplift Marginalized Communities and Foster Allyship in Recovery
There is a long-overdue shift beginning to manifest in the eating disorders field. Thanks to the Affordable Care Act, more people from low-income communities are now able to afford previously inaccessible treatment and care and clinicians are starting to see more diverse patients and clients. The Anna Westin Act (which will clarify existing mental health parity language regarding insurance coverage for residential treatment, use existing grant monies for better training for healthcare professionals and the public, and recommend a study be conducted as to whether photoshopped images are harmful) is gaining bipartisan support in the House of Representatives and the Senate, which is critical not only to save lives but as a signal to the public that eating disorders are political and necessitate a swift politicized response. In that vein, there are more groups than ever working to create more accessible resources for and undermine stigma around eating disorders; grassroots organizations like T-FFED: Trans Folx Fighting Eating Disorders, Nalgona Positivity Pride, IED Action, Adios Barbie, It Gets Fatter, The Body Is Not an Apology, the spoken word duo Darkmatter, and others are challenging the status quo and insisting upon the re-framing of eating disorders as intersectional social justice issues.
For too long, stereotypes surrounding someone struggling with an eating disorder have espoused and reproduced aspects of privilege, perpetuating marginalization both within the field and society at large (with especially few thanks to the media, which continues to portray and sensationalize eating disorders as a corollary to white celebrity vanity). While increased support and evidence for FBT (family-based therapy) and support groups are putting recovery back in communities, eating disorders have long been the purview of clinics and boutique residential treatment centers, most of which do not or cannot accept public insurance, leaving low-income communities (often people of color, disabled folx, im/migrant, and LGBTQI communities) with few recovery options, especially when medical concerns or complications necessitate higher levels of care. Fortunately, there is an increasing understanding of the importance of addressing the multiple social justice issues at play in the development and treatment (including access to care) of eating disorders. We must continue to push for progress in this arena; working to undermine stigmas and dispel myths surrounding populations affected by EDs and examining how we might uplift marginalized communities in struggle and recovery. Here are twenty ways clinicians and advocates working in the field can foster allyship and demonstrate solidarity with their clients, patients, and service populations.
- Interrogate your own privilege. Allyship is only possible when parties occupying the role with more social power/privilege (white people, cisgender people, able-bodied people, heterosexual folks, neurotypical people, documented folks, etc.) are actively interrogating and deconstructing that privilege, including researching and working to undermine how that privilege has historically and currently perpetuated oppression, erasure, and violence. It is not enough for a cisgender (non-transgender or gender non-conforming) therapist to ask for pronouns; they must also understand why a trans client may be especially wary of seeking professional help, as trans communities have historically been pathologized, violated, and objectified by the medical industrial complex and ‘gender identity disorder’ was only recently removed from the DSM. It is not enough to offer materials in Spanish if you do not also understand the complex relationships many Spanish-speakers have with indigeneity, colonization and Latinidades.
- Continue to educate yourself and include making the intersections and connections not taught in schools or credential programs. How do food justice and eating disorders intersect, and what is that connection to an ‘obesity epidemic’ that perpetuates fatphobia and reproduces racist stereotypes about low-income parents of color? How do you affirm disabled bodies without reifying ableist tropes that tie worth to production?
- Support (or start) employment and representation initiatives that move more marginalized folx into positions of power. It is essential that we move from emphasizing cultural competencies held by white people towards real diversity and representation that doesn’t exist to bolster existing power structures or tokenize identities. For clients and patients, seeing someone on staff or in leadership who looks like us or comes from our communities is an instant affirmation that our identities and experiences matter and that at least someone will really understand us. Real staff/leadership diversity empowers marginalized communities, undermines white supremacy and other oppressions, and brings together people who can use their different experiences and subject positions to help the team progress and better serve diverse clientele/patient populations. Homogenous teams ‘don’t know what they don’t know.’ This lack of awareness and experience can be detrimental to progress and decision-making, can put off (if not offend and hurt) potential clients/patients, and unintentionally perpetuate stereotypes about eating disorders only affecting young, cis, white, able-bodied, middle to upper-class women.
- Understand EDs as coping mechanisms for marginalized communities. People of color experience oppression in daily messaging, from subtle images to micro-aggressions to overt violence, all of which amounts to white supremacist body terror . It is crucial that POC (People of Color) in recovery do not have to educate therapeutic teams and that health professionals recognize the ways medical and psychological communities have engendered a deep-seated mistrust of professional help; how POC’s bodies have been violated and their experiences with eating disorders erased, unacknowledged, and underfunded. Moreover, it is imperative for health professionals to understand how eating disorder genetic vulnerability has been created in communities of color by the violent processes of enslavement, colonization, imperialism and war, incarceration and police brutality, poverty, (forced) assimilation, and other structures that have created epigenetic trauma. Eating disorders professionals have long understood that personal trauma (such as abuse) can play into the development of an eating disorder, but to fully understand the experiences of clients/patients of color, it is important that we expand that understanding to include this type of historical, intergenerational trauma that changes genetic expression and can increase genetic vulnerability to mental illnesses, suicide, and addiction.
5. Help make transportation accessible. Offering bus tokens, metro cards, or helping to coordinate carpools can go a long way towards making your practice/facility accessible to low-income communities. Additionally, if you are looking for a physical space, consider an office or treatment center location that is central for multiple communities (it is imperative that ED clinics are not only located in wealthy areas!) and close to public transportation.
- Offer childcare, or partner with someone/a group who can. Offering childcare makes attending IOP/PH/a support group, or private therapy far more feasible for adults with children and helps to undermine the stereotype that eating disorders only affect young people.
- Make sure your practice/facility is relevant to and reflective of area demographics. If your facility or practice is located in a metropolitan area, you can show up for marginalized communities by ensuring your services, staff members, print and digital materials truly represent and serve local communities. This includes hiring staff that represent these communities, making materials available in different languages, and creating culturally relevant programming. Here are two examples of hospitals holding space for Native/Indigenous healing practices and better serving local Native communities: 1.)http://mtpr.org/post/helena-hospital-opens-smudging-room-native-americans
- Foster collaborations/partnerships with local organizations that serve and represent marginalized communities. Relationships with communities of color, LGBTQIA communities, disabled folks, etc., can’t just be comprised of clients and a few staff members – good relationships benefit everyone; they increase awareness of and access to services, keep organizations and teams accountable, work against misinformation and insulation, and increase opportunities for collaboration and intersectional discussions/work.
- Ask what identities someone holds and what each means to them in terms of their eating disorder development and manifestation.
- Act in solidarity with disabled folks. Provide sign language interpretation if needed. Learn how to hold space for and adapt yours to those with sensory processing disorders. Ensure your physical space is ADA compliant. Add descriptive text to your images for low-sight folks who use screen readers. And, work with medical professionals who understand chronic pain and illnesses.
- Don’t appropriate other cultures in implementing non-Western treatment and healing methods; try to have someone from the culture that developed a particular process/system leading or teaching it (such as yoga).
- Offer free support groups to community/families, especially low-income families who might not have access to prohibitively expensive higher levels of care, or to all the professional oversight components of FBT. These groups and families need support in understanding and implementing re-feeding and support structures at home. Be intentional about interrogating and de-constructing who makes up a family or support system, and hold space for non-traditional families. Reach out to im/migrant communities to better assess translation needs and consult on developing culturally sensitive programming. Additionally, offering groups/therapeutic sessions on weekends can help folks access your services if they cannot take off time from work during the week.
- Optimize the utilization of physical space; can extra rooms be used for community groups when not in use for therapeutic programming? Work with grassroots groups and other recovery-oriented groups; there is always a need for free space and recovery happens in a multitude of different spaces.
- Interrogate the trend of ‘inclusion.’ http://www.virgietovar.com/blog/3-reasons-to-rethink-inclusion-in-body-politics
- Establish accountability processes for working with marginalized communities. Solidarity is never perfect – it is a process rather than a product, and mistakes will happen. Have established processes for restoring dignity, trust and communication in a therapeutic or collegial relationship, including a small mediation team that can address and work through conflict.
- Provide scholarships for treatment or offer sliding-scale fees.
- Offer compensation for study participants from marginalized communities. Marginalized folks are usually overworked, underpaid, and constantly asked for or already volunteer free labor. Moreover, marginalized communities have a difficult history with the medical industrial complex and don’t need to be giving free labor to propel someone’s post-graduate work. Offering even a small amount of money demonstrates that your team or organization truly cares about populations or communities and sees folks as more than study subjects or an ‘edgy’ path to professional accolades.
- Ensure conferences are accessible and held in non-problematic spaces. While beachfront hotels are beautiful, they are not often close to public transportation. Make sure your conference planning committee or decision-making bodies have consulted with or have adequate representation from marginalized communities familiar with safe, affirming, geographically accessible locations. You can make conferences more accessible by offering scholarships, ensuring disability accessibility, being thoughtful and intentional about whom you select as your keynote speakers and workshop presenters, and by providing closed spaces for affinity groups (like a space for POC to heal in community and away from the overwhelmingly white attendee populations at ED conferences). Work to ensure that topics of intersectional marginalization are emphasized throughout your programming, as opposed to one or two workshop sessions that try to squeeze in every possible aspect of marginalization and tend to be too vague to have real impact.
- Ensure your required documents (such as intake forms) are gender-neutral and leave blank spaces, rather than boxes, to allow for self-description. (T-FFED: Trans Folx Fighting Eating Disorders is happy to consult with you or members of your practice/facility on best practices towards affirming trans and gender-diverse communities! www.TransFolxFightingEDs.org). Establish gender-neutral bathrooms and normalize asking for pronouns before assuming. Become familiar with language around gender identity, trans communities and the transition process. Work to understand how gender dysphoria and body dysmorphia can intersect with and influence each other in eating disorder manifestation, as well as the high degree of traumas, rejection, discrimination and violence enacted upon trans communities, especially when folks hold multiple marginalized identities. Work with gender-affirming endocrinologists or other knowledgeable health professionals to offer/support hormone therapy when a trans or gender non-conforming client wants to pursue a medical transition.
- Uplift, publicize, collaborate with, and donate to grassroots organizations, collectives, and individuals transforming the eating disorder field and helping to heal their communities.
Allyship and solidarity are processes, not a product or an identity. These processes require a good deal of introspection and interrogation, challenging beliefs and stereotypes, and are becoming more personally and professionally politicized. Moreover, these processes require understanding intersectionality; it is impossible to disentangle privileges and oppressions in areas of gender, race, class, age, ability, sexual orientation, documentation status, HIV status, nationality, sex work status, experience in foster care or in the adoption process, weight stigma, ethnicity, Indigeneity, etc. All of these identities and social positions inform how we relate to and receive messages about our bodies, food, exercise, professional treatment, and psychology/psychiatry. However, with a commitment to self-education and actively challenging the status quo of the ED field to be more accessible and representative, you can make an important, possible life-altering difference for marginalized communities in recovery.
About the author –
Dagan VanDemark is the Founder of T-FFED: Trans Folx Fighting Eating Disorders, an organization based in Los Angeles but quickly gaining national reach. Dagan, a genderqueer trans boi, battled bulimia/EDNOS for fifteen years. They have a B.A. in Women’s, Gender and Sexuality Studies, a deep love for building community interdependence and grassroots power, and three neurotic dogs. They are staunchly committed to an active, dynamic and nuanced practice of intersectional/transnational feminism, body and sex positivity, prison abolition, anti-capitalism & anti-racism. T-FFED works to make visible, interrupt and undermine the disproportionately high incidence of eating disorders in trans and gender-diverse communities through radical community healing and recovery institution reform.
 Sonya Renee Taylor of The Body is Not An Apology
2 Pember, Mary Annette. ‘Suicide and Trauma May Be Woven in DNA for Native Americans.’ 6 June, 2015. http://www.huffingtonpost.com/mary-annette-pember/suicide-native-americans_b_7520490.html
Additionally- Shulevitz, Judith. ‘The Science of Suffering.’ Nov. 16, 2014. https://newrepublic.com/article/120144/trauma-genetic-scientists-say-parents-are-passing-ptsd-kids
Lastly- Kellerman, Nathan P.F. ‘Epigenetic Transmission of Holocaust Trauma: Can Nightmares Be Inherited?’ Isr J Psychiatry Relat Sci – Vol. 50 – No 1 (2013).
3 Gloria Lucas, Nalgona Positivity Pride. Workshop, ‘From Margin to Center: Beyond Cultural Competencies.’ www.NalgonaPositivityPride.com