Episode 5: “I’m Afraid I’ll Make It Worse”: Why We Need to Talk About Mental Health
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Sam: Hey, I’m Sam!
Ashley: Hi, I’m Ashley and you’re listening to All Bodies. All Foods. presented by The Renfrew Center for Eating Disorders. We want to create a space for all bodies to come together authentically and purposefully to discuss various areas that impact us on a cultural and relational level.
Sam: We believe that all bodies and all foods are welcome, we would love for you to join us on this journey. Let’s learn together.
Ashley: Hey Sam, how are you?
Sam: Hi Ashley. I’m well, how are you?
Ashley: I’m well, welcome to another talk.
Sam: Another talk. Welcome back.
Ashley: Yeah, welcome back everybody. Um, well, Sam, I was curious if we could talk about some things that we’re just seeing in our industry. Um, some news that we’re hearing. And I have a couple of articles with me that I’m curious if we could go over, how does that sound?
Sam: Let’s do it.
Ashley: Okay, I think also, I I’ll just say this, I think that this would be helpful for anybody listening, for our professionals, for our family, our supporters at home, for anyone in recovery. Like, I think this would be helpful for anybody, just to kind of address what we’re seeing in our society right now.
Sam: Absolutely. Yeah. So, I know we come across so many articles and we try to stay up to date what’s going on in the news. What stood out to you this week.
Ashley: Yeah. So, I was reading, and I found this article. I’m just going to read you the title and then I just want us to talk about it because I’m so excited. It says West Virginia House passes bill requiring schools to provide eating disorder and self-harm training.
Sam: Love it.
Ashley: Love it. That is the title. It caught me immediately and I just thought, well, I am very interested to see exactly what is going on here.
Sam: Yes, it’s so needed. I mean, the more eyes we have on the signs and symptoms.
Sam: Not only eating disorders, but depression.
Sam: The earlier we can catch things, the better. I always say, let’s catch early, treat early.
Ashley: Yeah, I think that’s so true. And I feel like, um, I don’t know, I’m just super excited to talk about this. I feel like people in multiple professions, whether that’s educators, whether that’s you know, clinical field, whatever. There are so many people that are coming in contact with others that may have something going on with them, they might have a mental health diagnosis, they might have self-harming ideology, they might have an eating disorder and it can go so unmissed. So, the idea that this House of West Virginia wants to make training mandatory for eating disorders and self-harm is just incredible to me.
Sam: It’s amazing.
Sam: Amazing. Yes, it is missed. It’s missed a lot. And to take it a step further. I think even when, you know, a teacher or even a parent notices the signs, they don’t know what to do. I get these questions all the time where it’s like, I think my loved one is struggling, but I don’t know what to say. I don’t know what to do. I don’t know how to bring it up. I don’t know where to go for help. And so it’s not only, I mean catching the signs as one piece of it, but then it’s also what do you do? How do you approach it in the most healing way possible?
Ashley: And my thought is if they, if the state of West Virginia is going to provide a training for their educators, how incredible. Because then not only will they know the signs and symptoms. I’m guessing they will be trained and here’s an outlet, right? And that’s just, that’s the piece that missing sometimes is, so what do we do with this information that we know.
Sam: Right? Like what’s the next step? How do we even approach the child about what we’re noticing and how do we do it without scaring them off or without shutting down or becoming, you know, even more distrustful. So, yeah, it’s complicated, but it’s really, it’s one of the questions I probably get the most from the public is how I approach someone who I think might be struggling.
Ashley: Yeah. Yeah. You know, Sam you’ve probably done this too, I love going into schools and kind of talking about, we talk a little bit about body image, we talk a little bit about some of these signs and symptoms, but then giving them the tools. And I just, this article makes me excited that this is actually something that the state is considering giving to their educators. So, I just wanted to read a little bit of it. Is that okay with you?
Sam: I’d love to hear it.
Ashley: Okay. So, it says the West Virginia House passed a bill that requires schools to provide eating disorder and self-harm training for their teachers and students. The bill passed the house 93 to 0. That’s amazing. That’s incredible.
Sam: Yeah. We don’t see that much agreement in government.
Ashley: And obviously this shows that that we are needing these resources so desperately. I mean, our educators, you know, my heart has been with them since everything Covid has been around. You know, they are seeing so much and having to manage so much, and you and I both know this and so does the public, the mental health, especially among adolescents has definitely spiked since Covid. So, I just feel like this passing of this bill 93 to 0 is evidence that like we are thirsty for this information in our systems.
Sam: It speaks volumes.
Sam: The pandemic has, it’s really been the perfect storm for the development of not only eating disorders, but mental health issues. The isolation alone, not, to mention the loss and the grief. And I’m not talking about, I’m not only talking about deaths from Covid, but I’m also talking about loss of a prom, a graduation ceremony, loss of being on a sports team. I mean, there has been so much loss for adolescents just across the board and we know eating disorders thrive in periods of isolation. Loss can trigger on an eating disorder. So, it’s really, it’s been so hard.
Ashley: Yeah, it has. And I think it’s so incredible that, you know, the powers that be if you will are seeing that from kind of that top down level for the state to kind of own and recognize what is needed for these adolescents regarding their mental health, I think is just incredible.
Sam: Yeah. I wonder who will be doing the training, who’s developing that?
Ashley: I know. So, let me read a little bit more. I’m not quite sure yet. But so, it says the bill would include instructions and information to better equip schools and their employees on how to recognize warning signs of self-harm behaviors and eating disorders that can lead to serious health issues and death. It would also support the healthy development of students by learning how to appropriately respond to or refer a student who exhibits warning signs of self-harm or eating disorders and provide consistent and standard protocols for responding to disclosures or discovery of self-harm or an eating disorder. Under the bill, public school employees will need to complete the required training every three years, which I love. And then it says students between grades 5 through 12 would receive information regarding self-harm and eating disorder, signs, prevention, and treatment at least once per academic year. The training and teaching to the students would begin September 1, 2022, if passed into law. So that’s the information I have. I don’t know who is providing the training. I don’t know where they’re going to get their material from but man, is this encouraging to see?
Sam: It really is. I really like the idea that the students will be part of the education so that they can notice and really give words to what might be happening in their life or also, if they know a friend is going through something that they might be able to spot it.
Ashley: Yeah, I absolutely love that they’re taking both the educators and the students into account with this. That’s, I mean, that’s just incredible.
Sam: Yeah, I think a lot of times, well, because so many disordered behaviors are so normalized in our culture. I think there’s so many people, especially adolescents who might not even realize what they’re doing is dangerous and might be damaging their relationship with food or with their body and to give them the words and the tools to recognize, oh, this is disordered eating. This is a sign of an eating disorder. That’s important.
Ashley: When you’ve spoken at schools before, I’m assuming you’ve spoken at schools before. What are some of the questions or what are, what is maybe the takeaway or the feedback that you’re hearing that is helpful for the students or the educators?
Sam: Oh, that’s such a good question. Just to go back to what I was saying earlier, I think many times the question is how do I approach someone who I think might be struggling? You know, what do I say? Like almost wanting just concrete directions, I think the instinct for so many people and by the way, I don’t think anyone means any harm. I think, you know, most people want to help, and they want to be that supportive person. And I think the instinct sometimes is to say, to comment immediately about weight and how the person looks, it’s like you look too thin or you look like your weight is changing, like what’s going on. I think also the instinct is to talk about this stuff during meals because that’s when they’re noticing it and it’s sort of counterintuitive in that way, because a lot of the education that I do is about trying to have these conversations, not during a meal, that’s already a super stressful time for someone who might be struggling, and to also shift the focus from weight and appearance to more, how is this person, how are they being, how is this, how are the symptoms impairing their social life, their emotional world. You know, do they seem less happy lately? Are they isolated? Do they just not seem like themselves and to start there with what they’re noticing in their relationships with their mood and to stay away from weight and food as the focus of the conversation.
Ashley: Yeah, I think that’s great. I remember specifically I was giving a talk, also I just want to give a shout out to those educators out there, I do not know how they stand in front of those classrooms and speak all day long. I did this one-day in a health class and just kind of gave a talk on body image every single class period and by the end of the day I did not even have a voice.
Sam: Oh my gosh.
Ashley: Completely horse, it was gone. But you know, I was talking about body image and just kind of again what we see in schools, what we see in our culture, um kind of, you know how we are expected to look or be or act a certain way and that is really the conversation that I was talking about. Well afterwards I had a student come up to me and she waited for everybody else to leave, which I thought was interesting or maybe she was just waiting her turn. But she specifically shared with me that she was having suicidal ideation and what I found so fascinating in that instance in that moment is that I wasn’t, I think that the students viewed me as a helper. Yes, but I was in there talking about body image and this student was very needing of a helper type figure or somebody that maybe she interpreted knew what they were doing, you know, to come and talk to me about that. And so, I just think when we as a society and as the ones that are providing for our young people um and giving, you know, being the example, we’re kind of coaching them and teaching them if we can be proactive about how to take care of ourselves and also be proactive about what non-health looks like, right? Like what are these media messages that we’re seeing that are so unhelpful for us, you know? Um I just think that that can do so much for our younger generation.
Sam: Oh, I agree, I am so glad that you’re bringing this up because I think even just having these trainings and these conversations creates a safe space. It opens a safe space to talk about more than just eating disorder, self-harm, and body image. It sort of it creates the space where it’s ok to talk about mental health and that there are helpers that understand and can listen and that I can go to talk to. I mean, another thing with adolescents, I think they’re not always sure who they can talk to about this stuff. They don’t want to upset their parents; they don’t really know who the counselor is in school all the time. They don’t know, you know which teacher it would be safe to go to. They feel uncomfortable. But if we have these trainings, it just it gives permission for kids to talk openly about what they might be experiencing. And it’s interesting that you brought up suicidality because I think often times, you know, we of course we want to prevent suicide, of course, like, you know, we’re all on board with that, but I think that what we’re doing most of the time is we’re screening for depression, we’re screening for specific signs of, you know, suicidality, maybe things people are saying. But actually, eating disorders are associated with suicidality. So, if we want to prevent death by suicide,
Sam: Screening for eating disorders is part of it.
Ashely: Yes, it is absolutely
Sam: Needs to be part of it.
Ashley: It very much needs to be part of it. I don’t I don’t know that the general public understands how closely related eating disorders and death by suicide is.
Sam: No, I don’t. I think you’re right, but the risk is elevated, not only for folks with eating disorders, but even for folks with disordered eating, there is elevated risk. And then the risk is even further elevated if you are an oppressed minority, if you are dealing with intersectionality, where it’s not only do you have an eating disorder, but you have, you’re dealing with racism or you’re dealing with homophobia, or you’re dealing with food scarcity. All of these things interact, and it increases your risk even more. So, if we’re going to talk about suicide prevention, how can we not talk about eating disorders as well?
Sam: We have to.
Ashley: We do. And, yeah, I just want to say, well done to the state of west Virginia. Like this is incredible. I would love to see this kind of be mandated, you know, across the country, like train our providers, train our educators, help them understand what the signs and symptoms are. And also, well, what that does, what that training does is that empowers them as the adult or as the helper to feel comfortable because of course, you know, as an adult, you might feel uncomfortable if a teenager brings up the idea of suicidal ideation or their eating disorder, you might not have any idea what to do with it, but if you had training every three years, you would know what to do, right?
Sam: Yeah, you would have the tools.
Ashley: And you would be empowered to support them, you’d be empowered to simply listen to them. I love working with teenagers. I think that they’re very misunderstood population, but really, I think that they’re very tuned in with themselves at that age and really kind of seeking healthy lifestyles and how to be the best they can be, and so why not be able to support them in that, right, listening to them, they just want to talk about stuff. And you know, they might feel uncomfortable going to mom and dad of course and if you, if we, don’t as the adult have the answer, what are the tools then, who do we go to? You know, I mean, this, this bill says that they would give them tools or places to tell the students to go to. They would have the tools to empower the students.
Ashley: Yeah, they would have the resources. I don’t know, I just, I think that this is great, and I am thankful that this is kind of having its voice.
Sam: Yes, I love hearing this and at the same time, there is this little part of me or maybe not so little, that’s thinking to myself, please let there not be weight stigma embedded in this training.
Ashley: Can you explain a little bit more about that?
Sam: Yes, I can tell you exactly where my mind is going. And I’m like, I want to be hopeful, I want to celebrate with you, and you know hooray, this is great, I’m so happy. And at the same time, I’m thinking, oh my gosh, I hope that this training is a good one and done by the professionals who understand the detrimental and harmful effects of weight stigma and how it can interfere with the diagnosis of eating disorders. So just to give you an example, I think that there are unfortunately people, adolescents included, who are restricting their intake. They have a very poor body image. They want to lose weight. They are essentially starving themselves and they’re getting praised because they’re in a higher weight body and their doctors are saying you are doing all the right things. You’re losing weight. This is great. Or maybe they’re not being praised, but it’s minimized. Like it’s not that big of a deal because you’re not emaciated. And I really, I want to use this opportunity right now to debunk that there was a study I came across and there are other studies, but one study that stood out to me, they looked at an adolescent eating disorder unit where there was a group who had anorexia and then the other group had atypical anorexia, which in my opinion is just a fat phobic label for the same exact disorder, same symptoms, same presentation. It’s just one person is in a smaller body. So, they compared the groups and they found no significant difference between medical conditions like bradycardia or the stasis, suicidality, co-morbid, so co-occurring conditions, no difference. And actually, the atypical group was more severe in certain cases.
Ashley: Yes, and I’m wondering if it’s because maybe you were going to touch on this, if it’s because their presentation got missed for so long because their weight, I’m air quoting here is not low enough to be classified as anorexia.
Sam: Right, but those behaviors are equally as dangerous. No matter what body you’re in. Most people are so surprised to learn that malnutrition can occur at any size, weight, shape, and the physical and psychological ramifications are the same.
Sam: And people, they don’t seem to understand that because there’s this misconception that if someone is quote unquote overweight that somehow, they are immune to the psychological and physical complications of self-starvation or binging and purging or whatever it may be. And my hope is that in this training there isn’t information about how we need to be at a healthy weight and that you need to diet or you, I don’t know, I really hope not.
Ashley: Well, if anyone from the West Virginia House is listening to our podcast, give us a call.
Sam: I’d be happy to do the training.
Ashley: We will help you with this.
Sam: I’ll clear my schedule or, you know, another thing that comes up for me, you know, the signs and symptoms. I’m hoping that when they’re talking about eating disorders like anorexia, they’re not talking about someone who is thin, you cannot possibly tell the kind of eating disorders someone has by looking at them and you can’t really even tell how severe an eating disorder is by looking at someone.
Ashley: Yeah, absolutely not. And that that’s so helpful to debunk for everyone that is listening. The visual presentation of a body does not give us anything.
Sam: No. Thank you for saying that. Yes, it gives us nothing. Nothing. And even, you know, folks who are depressed, we can’t always tell.
Sam: The signs can be so subtle. And I think many folks put on a happy face.
Sam: Especially if they have a trauma background and their people pleasers and they have learned to sort of suppress all their emotions and go along to get along that fawn response where it’s like, let me just be, let me just not have any needs and emotions so I can keep everyone around me happy and I can feel safe. We can’t always tell if someone is struggling. Certainly not with an eating disorder or really any other mental health issues. But there are some signs, I think that we can pick up on, but they’re not always so obvious.
Ashley: Like what are those signs?
Sam: For example, someone with an eating disorder, you might, they might just be spending a lot of time alone and they might be blaming it on, well, it’s the pandemic, I don’t want to go out, which could be true. I mean, I understand that, but isolation is a sign of anything disorder. Someone who maybe always seem to have an excuse why they don’t need to eat, oh, I just ate, oh, I’m not hungry, oh, I’m not feeling good. And on the surface, you might want to believe them because I think it’s easier to believe someone rather than, you know, the scary reality that they might have a potentially fatal disorder.
Sam: So, the signs just aren’t always so obvious. I mean, even folks who, I mean, adolescents who I’ve worked with in the past with restrictive eating disorders and weight loss, they’ll wear clothes to hide what’s happening with their body and so you’re not going to really be able to see weight fluctuations that maybe might clue you in. Not that weight, I mean, weight, can’t tell us everything about an eating disorder, but sometimes weight fluctuation and weight loss can be can be a sign that something might be going on, but it’s not always obvious and I think some parents think that like their kid is being healthy, oh my kids going to the gym, my kids eating healthy foods now and it gets mixed up in diet culture and that just confuses everything.
Ashley: Yeah, and I noticed too that I’ve even used healthy, I’ve said that word twice I think in this podcast and I’m so curious even if that has triggered that response from the diet culture, you know, if like healthy, what does that even look like, right? I mean, and that we could have an entire podcast about that too. But truly, I think you’re right, I think that there are so many signs that do go unmissed because it just kind of what you’re saying, you know, it’s easier to go about your day and go about life as it traditionally is than to approach this potentially fatal disorder.
Sam: It’s scary and at the same time we need to understand, and I hope this West Virginia training includes this piece is that talking directly about this stuff is not going to make it worse. Talking directly about suicide is not going to increase the chances of someone dying by suicide, you know, talking openly, asking questions. What’s your relationship with food? Like how have you been feeling around food, asking these direct questions are not harmful. It’s okay to talk about this stuff.
Ashley: And just a quick tip with asking these direct questions, ask them mindfully. So, at Renfrew mindfulness for us, we view it as present focused nonjudgmental awareness. So, when we are asking these questions, it is imperative that we do not ask these questions with judgment. It is imperative that we simply bring up the direct questions, what we what we are seeking. These students want to talk about it. They actually really want to talk about it and when they can feel safe and non-judged in the presence of a helper or a support person, whoever that may be, they will talk about what it is that they need to discuss. So just wanted to add that quick little tip there.
Sam: Agree, we need to create more of those safe spaces. Well, thank you, Ashley, this was wonderful.
Ashley: Sam, this was so great. And to all of you listening, thank you so much again. Our podcast is All Bodies. All Foods. We really believe that we really stand by that and thank you all for listening with us.
Sam: See you next time.
Ashley: Thank you for listening with us today on All Bodies. All Foods. presented by The Renfrew Center for Eating Disorders.
Sam: We’re looking forward to you joining us next time as we continue these conversations.
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