Like most people, I am often asked, "What do you do for a living?" As a therapist of color, I think about what it is like to walk into my office. The walls are covered with my photography and beautiful illustrations from former patients of anxiety, depression, and recovery. "Thank You" cards are strung up, and the bulletin-board shows messages of allyship. On closer inspection, you might notice a carefully curated bookcase with titles on trauma, body image, and culture. Everything in the office is done consciously and intentionally; my space is not only a reflection of me but an invitation to others: an invitation offering my office as a safe space to do the work necessary for recovery.
When people become aware that I work with eating disorders, the reply is "Clearly, I don't have an eating disorder," "I don't have a problem with food," or something similar. It has also been a shock to some that I, a Black woman, work with eating disorders.
The feeling of needing to be "Superwoman" can result in extreme amounts of stress that are hidden and highly internalized.
When people think of eating disorders, they envision a white, adolescent female, middle or upper class, but, eating disorders do not discriminate. According to the Academy for Eating Disorders, 9% of the US population (or 28.8 million Americans) will have an eating disorder in their lifetime. Despite this prevalence, many individuals do not seek treatment for an eating disorder, especially Black people.
Eating disorders are disorders of emotion and connection. When assessing, diagnosing, and treating Black women with eating disorders, it is vital to recognize all the ways emotions and connection are unique within the Black community.
The Role of Stress in Eating Disorders
The pressures that a Black woman feels to succeed are unlike those other women in our society experience. The success of a Black women is not only a personal victory but a victory for the community and the future legacy. This pressure also sends a message that Black women must be strong and capable of handling all challenges. Additionally, it cautions weakness or vulnerability. The feeling of needing to be "Superwoman" can result in extreme amounts of stress that are hidden and highly internalized. Keeping this hidden can lead Black women to be susceptible to eating disorders.
9% of the US population (or 28.8 million Americans) will have an eating disorder in their lifetime.
Look at Kamala Harris. Her Vice-Presidential nomination is historic. She is the first Black woman, the first Asian American woman, and the first graduate of a historically Black college or university to join a major party's presidential ticket. This is not only a personal victory but a victory that has the power to uplift entire communities and leave a legacy. Harris has already been the target of racially-motivated denigration. Nonetheless, Harris will have to work until election day, with hate and vitriol being flung at her, without being categorized as an "angry Black woman," keeping the stress and pressure she may feel hidden. This is unique to Black women.
Beauty Standards and Body Image Ideals, Another Stressor
"Beauty is skin deep!" I'm not sure how often you have heard this, but I recall hearing it frequently. Was this an attempt to help "ugly" or "fat" people to be more accepting of themselves or to not focus on size, shape, and weight? Did it work?
Standards of beauty are constantly shifting and are influenced by both cultural and social norms and ideals. For many Black women, beauty encompasses how one may feel in their body, skin color, and hair; Black women want to feel good, they want to look good. It is more than the traditional definition of body image. There are many cultural icons that serve as beauty standards for Black girls and women, so it may be inevitable for some to compare themselves to others which may reinforce attempts to obtain the "desired" look.
We all know someone who is constantly on a diet or engaged in disordered eating patterns. The extent that some Black women take to "look good" may include changing one's hair, skin color, or cosmetic surgical procedures to alter their body shape.
What Can a Provider Do?
Do not discount disorder eating behaviors
In assessing disordered eating behaviors, providers must explore historical patterns of eating within a family and culture and if there are deviations from those expected within one's culture. If eating disorder behavior does not line up with the predominant culture, it does not mean it is not disordered.
Examine the concept of beauty
In assessing body image concerns, it is important to explore if your client's concept of beauty is congruent with the predominant society or with ethno-culture of origin. Additionally, examine the level of acculturation which may influence your client's belief about their physical appearance.
Anyone working with a Black client must understand the client as a unique individual and within the context of being a member of an oppressed group.
Know your lens
Your lens is influenced by your prior experiences, what you have been taught, and what has been modeled to you. It is important to understand your assumptions, biases, and beliefs, and recognize your lens may be significantly different from your clients'.
Like most industries, the mental health profession lacks diversity. Minority populations are becoming the "new majority" but account for a significantly smaller portion of the mental health field. It is very likely a Black person seeking treatment will not work with a therapist who shares a similar cultural or ethnic background. Anyone working with a Black client must understand the client as a unique individual and within the context of being a member of an oppressed group. Therapists are reminded to do no harm and immerse oneself in opportunities to learn about their client's culture. They need to demonstrate cultural humility and be willing to ask the hard questions. Some examples may be:
What is important to you about your culture/ethnicity?
What influence has your race/ethnicity played in shaping your body image and beauty standards?
What is the role of food in your culture?
What is it like to be in places that were not explicitly designed for you?
Remember, be curious!
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Help! My Friend Is a No Show
Dear Armchair Psychologist,
I have a friend who doesn't reply to my messages about meeting for dinner, etc. Although, last week I ran into her at a local restaurant of mine, it has always been awkward to be friends with her. Should I continue our friendship or discontinue it? We've been friends for a total four years and nothing has changed. I don't feel as comfortable with her as my other close friends, and I don't think I'll ever be able to reach that comfort zone in pure friendship.
Dear Sadsies,I am sorry to hear you've been neglected by your friend. You may already have the answer to your question, since you're evaluating the non-existing bond between yourself and your friend. However, I'll gladly affirm to you that a friendship that isn't reciprocated is not a good friendship.
I have had a similar situation with a friend whom I'd grown up with but who was also consistently a very negative person, a true Debby Downer. One day, I just had enough of her criticism and vitriol. I stopped making excuses for her and dumped her. It was a great decision and I haven't looked back. With that in mind, it could be possible that something has changed in your friend's life, but it's insignificant if she isn't responding to you. It's time to dump her and spend your energy where it's appreciated. Don't dwell on this friend. History is not enough to create a lasting bond, it only means just that—you and your friend have history—so let her be history!
- The Armchair Psychologist