The recent killings of Rayshard Brooks, George Floyd, Breonna Taylor, and legacies of objectification and violence against countless named and unnamed other Black people have ignited responses across communities, in the midst of the COVID pandemic. We are witnessing a coming together in solidarity, rising calls for accountability, cautious optimism, critical questioning, commitments to do better, and a host of other emotions such as guilt and fear. Like many, I have been grieving the deaths and injustices hurting our Black and marginalized communities, while navigating this changing climate of interest in discussing racism through eating disorders and mental health. There is a heightened level of energy around these discussions: activism, urgency, hesitation about being further marginalized or called out, feeling shame for doing too little or too much. We’re in a period of emotional discomfort, vulnerability, and struggling with avoiding and pursuing discussions about racism. In my corner, this climate has sparked inquiries into my actions and commitments, interracial relationships, identities, and positions of privilege and marginalization in the U.S.

I offer my experiences and an invitation to slow down for a moment. I have been reflecting and learning a lot about how we grieve as communities of color, the lost lives who haven’t been grieved, who have the privilege to publicly grieve. How are we? What legacies of strength, resilience, guilt and pain are we holding? How are we connecting with supports and addressing our needs? My voice is not intended to be exhaustive or representative of all with similar identities, rather an offering of perspective. I approach this article grounded in my commitment to collaboration through building trust, vulnerability and nurturing our collective voice where all are welcome. As we continue this conversation, I invite openness and dialogue about our respective spaces, positions, and needs as individuals and within our communities to nurture authentic interactions.

Advocacy and community activism are central for many of us as we process and address the impact of injustices hurting our Black and marginalized communities. The questions of “what do we do?”, “what are we doing about this?”, and “how do we do this together as a collective voice?” are frequent. Actions speak louder than words. Silence, for fear of saying the wrong thing, may send the wrong message. We must do something.

Holistic Healing requires acknowledging and addressing the negative effects of racism across all racial groups, which we began discussing in our last blog, and it also requires a collective challenge to institutional, interpersonal, and internalized racism that hurt our communities. These are the same communities that nurture, shape, and surround people of color struggling with eating disorders and of which they are part.

To promote holistic healing, we must tend to the historical contexts and maintaining factors of racism as they impact the present wounds across mental health and healthcare. Camara Jones (2000) uses a gardener’s tale to illustrate how history informs the present. She stresses the importance of addressing the historical and present separation and unacknowledged differences in access and opportunities due to racism. Furthermore, we must deconstruct racism at the institutional and interpersonal levels. Black, Indigenous, and People of Color were subjected to dehumanizing medical treatments and experimentation throughout history due to bio-racist framing (e.g. Roberts, 1996). In the present, they experience differential racial treatment, including frequent misdiagnosis by (mostly white) mental health professionals. Such legacies further complicate and aggregate the power imbalances between healthcare providers and patients of color, as their relationship is also racialized (Feagin and Bennefield, 2014). With these legacies and current practices, it is unsurprising that Black, Indigenous, and People of Color have a mistrust of the healthcare system.

As healers, we can influence the healing of these wounds in our interactions with clients. It is not enough to recognize the institutional history of racism, we must also examine the internalized effects of racism. Internalized racism is private, layered in shame and rarely a presenting problem though embedded in issues of self-esteem, self-confidence, depression and anxiety (Watts-Jones, 2002). It is characterized as an experience of self-degradation, self-alienation and one that promotes an assumed position of inferiority (Watts-Jones, 2002). The impact and experiences of internalized racism on Black, Indigenous, and People of Color vary (e.g. Trieu, 2019). Internalized racism is also associated with depressive symptoms and serious psychological distress among Blacks in the US (Mouzon and McClean, 2017).

Challenging racism will require a coordinated response aimed at multiple levels through collaboration (Smedley, 2019). Two ways eating disorder specialists can use their roles are identified below, with additional suggestions during our upcoming webinar on this topic and addressing racism as a field. First, eating disorder specialists can conduct a thorough analysis of how institutional racism is replicated in our field and barriers to sustained changes. How do we respond to these? How do we cultivate actions that demonstrate a commitment to racial diversity among professionals, clients, and research participants we serve? Secondly, we can expand our perspectives by learning from studies of racism from the fields of sociology, public health, medicine, and others. In what ways are our struggles consistent, potentially indicative of a larger systemic bias at play? What are the barriers we may need to address in mental health globally?

There is much more to discuss and learn about the impact of racism on mental health, specifically on eating disorders. Healing across the institutional, interpersonal, and internalized levels will require our community to have difficult and intense conversations, openness, vulnerability and actions that align with our statements. I remain hopeful that we and our clients can learn from the past, create socially just changes in the present and embrace the opportunity to nurture trust, build relationships, and increase collective agency. Anti-racism practices can build a bridge at the interpersonal and institutional levels, connecting those who are targeted by racism and allies and building coalitions, transforming institutions, and changing population health outcomes (Came and Griffith, 2018).

References

Came, H., & Griffith, D. (2018). Tackling racism as a “wicked” public health problem: Enabling allies in anti-racism praxis. Social Science & Medicine, 199, 181–188. https://doi.org/10.1016/j.socscimed.2017.03.028

Feagin, J., & Bennefield, Z. (2014). Systemic racism and U.S. health care. Social Science & Medicine, 103, 7–14. https://doi.org/10.1016/j.socscimed.2013.09.006

Mouzon, D. M., & McLean, J. S. (2017). Internalized racism and mental health among African-Americans, US-born Caribbean Blacks, and foreign-born Caribbean Blacks. Ethnicity & Health, 22(1), 36–48. https://doi.org/10.1080/13557858.2016.1196652

Roberts, D. (1996). Reconstructing the patient: starting with women of color. In S. M. Wolf (Ed.), Feminism and bioethics: Beyond reproduction (pp. 124). New York: Oxford University Press.

Smedley, B. D. (2019). Multilevel interventions to undo the health consequences of racism: The need for comprehensive approaches. Cultural Diversity and Ethnic Minority Psychology, 25(1), 123–125. https://doi.org/10.1037/cdp0000263

Trieu, M. M. (2019). Understanding the use of “twinkie,” “banana,” and “FOB”: Identifying the origin, role, and consequences of internalized racism within Asian America. Sociology Compass, 13(5), e12679. https://doi.org/10.1111/soc4.12679

Watts‐Jones, D. (2002). Healing Internalized Racism: The Role of a Within-Group Sanctuary Among People of African Descent. Family Process, 41(4), 591–601. https://doi.org/10.1111/j.1545-5300.2002.00591.x

Author Bio:

Ashley Acle, LMFT is 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: ashley.acle@gmail.com

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