Holistic Healing during and after COVID-19
By Ashley Acle, LMFT
With increasing racism towards Asians and racial minorities in the US and around the world in the COVID-19 pandemic, it has been difficult to not feel heavy-hearted and carry the impact that these experiences are having on clients, loved ones, and communities. I find myself asking if people I care about have been assaulted, spat on, called names, and blamed for this pandemic. How many have witnessed these acts, internalized these messages, or participated from a place of their own fear? Addressing racism is especially important now: We have significant racial disparities in COVID-related illness and death harming communities of color. Xenophobia and race-based crimes increase concerns about safety, like whether to face the dangers of racial profiling by wearing a mask or do without and risk exposure to COVID. We are seeing a magnification of existing inequalities, scapegoating, division, and fear leading to worse outcomes for all (Devakumar et al, 2020), some of which we started exploring in our last blog. In the midst of this, we are physically distant and desperately in need of connection to tend to our collective wounds. Addressing racism, across all racial groups, is essential to building connections and relationships that can support healing during and after this pandemic.
Whether you’re a person who has been hurt by racism, benefited from it, or both, discussing racism is often uncomfortable and therefore avoided, despite its negative effects across all races. The detection and impact of racism is often perceived and felt differently by different groups, with different tones, variability in instances of racism (including racial discrimination and microaggression) and historical sociocultural contexts (Okazaki, 2009). Among communities of color, racism is associated with a host of negative effects across dimensions of both physical and psychological health, beyond inequitable access to resources. Racism-related negative psychological states include, but are not limited to, symptoms of depression and anxiety, lower well-being, lower self-regard and ill health (see Okazaki, 2009; Carter, 2007; Clark et al, 1999; Harrell et al, 2003; Sue et al, 2007) as well as impact on coping, psychological and physiological stress responses (Clark et al, 1999). In the US, much of the existing research has explored the effects of racism on Blacks, though more research is showing negative effects in other racial groups and ages (e.g. Asian/Cambodian American adolescents, see Sangalang & Gee, 2015). Whites are also impacted by racism, which can include negative effects on mental health, loss of authentic sense of self, relationships, ethical and spiritual integrity and opportunity to develop a full range of knowledge about self, others and the world (Goodman, 2017). Participation in anti-racism intervention has shown positive mental health effects (e.g. Kelaher et al, 2018).
Racism is also associated with negative effects specific to clinical and sub-clinical eating pathology in communities of color. Among African Americans, experiences of racism and discrimination are associated with higher odds of Binge Eating Disorder (BED), with a stronger effect on women than men (Assari, 2018). Emotional distress and stress related to racism are associated with binge eating among Native Americans/American Indians, with these two factors and lifetime experiences of racism as significant predictors of binge eating (Clark & Winterowd, 2012). Among Asian American women, experiences of racial and sexual objectification are related to trauma symptoms, body image concerns, and eating disorders (Cheng & Kim, 2018). Asian American women who report greater levels of racial/ethnic teasing or racial discrimination are more likely to adopt and internalize mainstream media portrayals of beauty ideals, which are connected with body shame and disordered eating (Cheng et al, 2017). Research on Pacific Islanders is needed to examine the impact of racism, eating pathology, and recommendations for treatment in this community.
It is especially important that providers use their roles as healers to address racism, given the negative mental health effects across all racial groups, the specific risk for eating disorders, and the positive mental health effects associated with participation in anti-racism interventions. Three ways clinicians can use their roles are identified below, with an invitation for additional thoughts and dialogue. First, clinicians can explore with curiosity the impact of racism, specifically how involvement and/or witnessed events have shaped views of the world and others. Clinicians should be cognizant of the compounding effects due to multiple instances of racism and how this may activate or exacerbate typical PTSD symptoms (Nadal, 2018). Secondly, clinicians can assess how racism impacts connection with self and the body, especially if these have been targets. This is particularly relevant for those working with eating disorders. Clinicians are encouraged to become educated about working with racial minorities, using culturally-sensitive interventions and attending to intersectional identities (e.g. ethnicity, documentation status, ableism, gender, etc). In honor of Asian/Pacific Heritage Month (APHM), I want to highlight the contributions of Yu et al (2019) and Cheng and Kim (2018) that include practical recommendations for working with Asian Americans with eating disorders, specifically attending to the assessment process, clinical factors (e.g. resistance, shame, stigma), treatment modalities, conceptualizations, family involvement, and racial and sexual objectification. Third, clinicians can contribute to dialogue and healing in our own communities. Reflection on these and related questions may be valuable: How can we create communities where the effects of racism are openly discussed, to encourage coming together to address this? How can we vulnerably, compassionately, and respectfully address the pain, fear and shame associated with racism? How can we increase our cultural competence and sensitivity in integrating discussions about racism in to treatment?
On a personal note, I am especially grateful to have a diverse community of supports who have inspired and encouraged me to embrace inclusivity, build community, honor our roots, and discuss profoundly difficult topics and experiences with vulnerability and respect. These relationships, cultural values, and my lived experiences have informed how I approach this conversation. I am grateful for the strengths of my communities that I’ve leaned on through these challenging times. I am also aware that there are many more intersectional identities to consider, beyond what has been highlighted. I invite others to join these conversations and look forward to being part of this process and creating a holistic experience of healing across groups and differences.
Ashley Acle, LMFT and currently the California Regional Compliance Manager for Alsana: An Eating Recovery Community. Her research and clinical interests include eating disorders, suicidality and emotional expression and the influence of contextual factors on these presentations. Ashley is passionate about integrating culture in mental health, specifically in the treatment of eating disorders among ethnic and racial minorities, and has brought this unique perspective in to her previous roles as Director of Clinical Services and Program Director. She has worked with diverse individuals, families and couples struggling with suicidality, acute psychosis, homicidality, eating disorders, mood disorders and co-occurring relational distress for the last 10 years. Ashley is committed to increasing access to quality mental health care for underserved populations using technology and increased community awareness.
Ashley completed her B.A. at Swarthmore College and her Master of Family Therapy at Drexel University. Ashley has presented at several conferences and in the community on mental health and eating disorders. She is a member of the Northern California Community for Emotionally Focused Therapy (NCCEFT) and California Association of Marriage and Family Therapists (CAMFT). Contact: firstname.lastname@example.org