Does Your Approach to Treating Eating Disorders Aim at Prison Abolition?

Lucy Aphramor
Image by Tom Blackout Unsplash. Used with permission.

Thought Prisons and Eating Disorders

Does your approach to eating disorder recovery aim at abolition? was their first question. Wow. That’s like … searching, definitely not something I get asked every day. In fact, ever before. Abolition means working towards a society where prisons are no longer needed. So the question links individual eating distress to social injustice via the prison-industrial complex. The prison-industrial complex is ‘a collection of social structures, systems, and policies — especially institutional racism, the war on drugs and mass incarceration… [that] imprison and dehumanize convicted individuals in the United States’. It’s the sort of scrutiny that pushes us to reconsider what we mean by accountability. And health.

And yes, it does. My approach to food and bodies, called Well Now, is a social action approach. A shaping assumption in Well Now is that health will emerge in a world where no-one is starved of food, dignity, connection or security, one that’s on the way to making prisons redundant. Getting rid of the need for prisons means dismantling the inter-related drivers of neoliberalism, racism, patriarchy and their many other cheerleaders. We’d have a decolonized, gender-equitable, compassionate society, where prisons are no longer relevant and where eating disorder prevalence is drastically reduced.

And what do you think of intuitive and mindful eating? was their next question. What I think of intuitive and mindful eating (IE/ME) is that these can be, often are, experienced as an incredible relief by some people struggling with eating. And that heaps of caring, experienced, thoughtful people are passionately behind them. Also that they’re really problematic because they don’t make a jot of difference to undoing the deep roots of oppression. In fact, they hide them.

The idea that IE and ME are seriously flawed is a pretty dramatic departure from other readings. I think it’s a stance that needs air time because IE and ME headline the show when it comes to critical approaches to eating disorder treatment. They also get an excellent press across food justice and health equity communities, plus some religious and spiritual groups too. We’re drawn to critical engagement because we want deep change and sure, there’s some voices grappling with inconsistencies and gaps in IE/ME theories -like how to account for poverty, medication, and values, for instance. But these critiques are presented as shortfalls in knowledge translation. They remain anchored to the assumption that while there’s outlying areas of real-life application that need more attention, the foundational premise of ME and IE is itself beyond question.

It’s this position I take issue with. I don’t think the problems with IE and ME will be resolved through accumulating more scholarship within their existing framework. For me, the fact that ME and IE exclude people, because of poverty and disability for example, is a symptom of a serious error in their core theoretical beliefs, or ontological position, if you’re that way inclined.

What are Mindful and Intuitive Eating?

Let’s take a look at these core beliefs. The Center for Mindful Eatingsays we’re practicing mindful eating (ME) when we pay attention to the process of eating, and don’t judge anything about it. The theory goes that eating like this works to “reconnect[ing] [us] with our innate inner wisdom about hunger and satiety”.

Mindful eating is often used synonymously with intuitive eating(IE) a term coined by Evelyn Tribole and Elyse Resch. Evelyn condensed the 10 principles of intuitive eating into 3 hallmarks that I’ve paraphrased as: ‘eat for physical rather than emotional reasons, rely on internal hunger and satiety cues and give yourself unconditional permission to eat what you fancy’.

ME and IE overlap where they encourage us to pay attention to interoception, or internal body awareness/perception of body state. They’re not the first theories to do this: before the terms were out there, Molly Groger was telling fat people that being sensitive to body signals in ‘eating awareness training’ (EAT) would help them (sic) lose weight. The drive to eradicate the fat body arises specifically from the diet mentality which is a particular manifestation of binary thinking rooted in fat hate. Its party line is that everybody can and should (want to be) be thin and it gives rise to thin supremacy and condemnation of fatness. Diet mentality thinking is a mainstay of the neoliberal delusions of lifestylism and healthism.

In ME and IE, we’re also asked to trust body signals — and in contrast to EAT, this is from a principle of non-judgement. Because as well as overlapping where they rely on interoception, ME and IE are both shaped by a commitment to size acceptance. (A principle which gets corrupted in their name, even by incredible teachers). The explicit commitment to non-judgement in IE and ME places them firmly within the non-diet paradigm called health at every size, or HAES. Unlike the diet mentality, the HAES model doesn’t make health and size a moral judgement. Instead non-diet proponents ‘reject both the use of weight, size, or BMI as proxies for health, and the myth that weight is a choice’ as explained by HAES trademark holders, the Association for Size and Diversity and Health, or ASDAH for short

Ok, so that gives a diet paradigm, seen here in EAT and also generally pervasive in Western health discourse, and the non-diet paradigm HAES used in IE and ME. And, for clarity, I use a third paradigm of health-justice, called Well Now. Well Now is body aware, relational and intentionally political, and teaches connected eating.

Like ME and IE, connected eating embraces non-judgement and uses interoception, and yet it is distinct, a paradigm apart from them. This is because Connected Eating has a very different take on knowledge-creation and the role, status and provenance of body signals than IE and ME. For instance, Connected Eating factors in neuroception as well as interception. Neuroception described the process in which body signals assess safety. An example that’s often given is how a baby will coo when looking at a caregiver but bawl when looking at a stranger. Connected Eating pays attention to neouroception because it presupposes the need to respond to trauma at its source, not as an addendum. I’ll explain.

The Problem with Privileging Privilege

For me, ME and IE remain problematic even after rejecting fat hate because the shared narrative they construct around ‘trust body signals’ centres privileged bodies. For yes, the body is a neglected variable in knowledge production. Yet the unqualified reification of body wisdom as a step in healing inadvertently imposes a false universality of experience: the story it tells is one that disappears trauma, violence, disability and privilege. An appeal to the unmediated wholesomeness of body guidance only works if we assume safe bodies living in a safe world. This of course is not our common lived reality. It is true for some people in the general population but not all of us. It is more likely to be untrue than true in people with experience of disordered eating. It works for some people and it leaves most of us behind.

The core presupposition that body signals to action are inherently favourable to an individual overlooks the fact that the strongest body signal we may experience at a given time can be the impulse to self-harm. Teaching people to ‘trust body signals’ in a model that does not integrate intellect and experience is trauma exclusionary. It may also be trauma inducing. ‘Your body’s intelligence is dependable as a stand-alone lead’ is a therapeutic standpoint that applies to particular bodies, minds and lives, not all, not mine. That makes it plain dangerous, personally and politically.

Yes, it can be indisputably helpful to highlight body signals in any blueprint for making peace with food. But when we do it in a way that doesn’t also flag up our inter-connectedness, and misses the fact that body signals are a social construct, then personal recovery remains off-limits for some and is always achieved at the expense of a coherent approach to collective liberation.

If it’s not radical, it’s racist.

If we do not help each other recognise how bodies shape and are shaped by the body politic then we’re adapting to the conditions of neoliberalism, capitalism and denial that cause suffering, not transforming them. I know first-hand the relief that flows from finally being free of eating disorder symptoms. What I’m saying is let’s support healing through a framework that acknowledges there is such a thing as society with its pedestals and trip-wires and triggers. Let’s acknowledge that society is literally incorporated. Let’s refuse to be part of any framework of knowledge creation that invites us to act as if society doesn’t exist orand can be extracted from our ongoing realities. Because when we deny this interdependence, we deny the inescapable corporal, material, psychic reality of power, we minimise its soul-crushing potential.

By Habila Mazawaje. Unsplash. Used with permission.

Peace with food and the peace of abolition have the same roots. These goals are mutually reinforced when we foster systems of thought that are clear about the role power occupies. These systems of thought will be healing-engaged, which means they will be trauma-informed, compassion-centred and justice enhancing (this is how I theorise Well Now). They are not linear and they are not limited by the narrowly permissible concerns of evidence-based medicine or department guidelines or group consensus. They do not start and end at reducing eating distress, though they’ll serve this function too. They are concerned with understanding how power links inequity, violence and eating disorders across time and space and language and what this means for knowledge. They recognise that we will be embattled for as long as we use a system of thought that acquiesces to the fantastical fiction of the absence of power.

The task is to rock the boat that lulls privilege to sleep because in its untroubled journey it is capsizing other boats.

Connected Eating: Letting Body, Mind, and Context Inform Our Eating

Connected Eating supports us to figure out food choices (discern) from a guiding confluence of body-cognition-context. Part of the work in Connected Eating lies in reconsidering the myth that visceral sensations are ‘naturally’ emergent. Because of course what we feel isn’t harnessed to a trajectory set in bones and nerves and chromosomes at birth, we start out with a particular make-up and that’s then moulded by our life circumstances. Realising this can be really significant in helping us make sense of our story. There’s a lot of data in neuroscience behind this assertion and there’s heaps of IE and ME advocates who draw on neuroscience, and the related concept of co-regulation, to shape their work. But in subscribing to IE and ME, they edit out this learning when it comes to eating.

There will be even more advocates who understand that we don’t form attitudes from an emotionally uncontaminated, neutral place but from an intimate social conditioning which predisposes us to feel and think in stereotypes, a theory called implicit bias. So there’s a stark disjuncture here, as if theory on body signals and the eating self can be compartmentalised off from the rest of our being-in-the-world. Ignoring the fault-line keeps the creed intact and serves the politics of orthodoxy, which is not the same as the the politics of liberation.

Doing Justice and the Need for a Constituted Self

Contrary to the intellectual and political commitments of IE and ME practitioners, the theories expunge the constituted self and overlook the fact that we are inextricably fashioned by, and forming, the culture we’re steeped in. In theorising for interoception but not neuroception, ME/IE entrench a false demarcation between the eating self and the socially embedded self.

This is a significant compass error because it diverts us away from doing the real work of eating disorder prevention, which is surely, to strategize for a decolonised future? If this is indeed what we want, let’s reflect on the role played by IE and ME. Have they fostered community awareness of trauma? How do they present the body politic? Whose voices have counted in their frameworks, whose have been side-stepped? Is it possible that they are not what you meant to sign up for after all?

What to do? I think we can become better aware of underlying incongruence, and counter it, by training ourselves to cross-reference between agenda, affect, actions and analysis. Or in shorthand, by using praxis.

Praxis involves linking theory and action and when we do this we find out how things map together. It helps us join the dots between community norms, the knowledge we craft, what happens in therapy, and abolition. Without a commitment to praxis it’s easy to get in the habit of leaping from one pleasing conjecture to the next, all the while flying by the seat of magical thinking, closed off to the possibility that nither our feelings of conviction, wholeheartedness, apparent consensus or lack of obvious alternatives are in themselves any guarantee of right thinking. Scrutinising methodology isn’t a prerequisite for an individual making peace with food but it is vital if we want to foster peace with food more inclusively and build knowledge that serves collective liberation.

Addressing racism in eating disorder services does not stop at ensuring culturally appropriate knowledge of foods and eating, and recognising how racism is interwoven in causes of eating disorders, and impacts healing. These are all vital, but if they happen within the existing frame without changing the nature of how we relate to the facts, then the old order can relax, safely reassured that nothing deep has been understood.

Praxis matters because figuring out why we do and say what we do and say about body signals in a racist society can be a life and death situation. White supremacist thinking constructs an affective, or sensory, body response in white people where we learn to experience Black people as menacing and dangerous. White police who murder Black children have used their bodies fear response as defence: as if their felt sense of threat justifies their violence. Systemic racism assures this learned emotional response gets sanctioned as a credible explanation and ‘I did it because of my body signals’ is normalised as legitimate reason for murder.

It’s not a given that a white person must feel afraid when looking at a Black person. Or that a Black person or person of colour will feel fear for that matter. No, not inherent, not inevitable but inculcated and sculpted from racist stereotypes and other structural violence. We learn to fear and hate and love, just as we learn our hungers and desires. The work of liberation requires us to identify and interrogate these intersections, not hide them under the rock of ‘inevitable’. The story told by ME and IE over the last three decades or so has served to submerge trauma and relationality, not reveal them. In a strategy for radical change we’ll highlight power structures, not whitewash them out. That’s why I teach Connected Eating.

Once we open the doors to fresh perspectives we notice other instances where culturally learned emotions kill and acquit, such as ‘homosexual panic’ as a get-out of jail clause for queer bashing. Those that couple Madness with danger. And those that link fat with disgust/shame/fear, which of course is the very anti-thesis of what IE and ME intend.

Alas, good intentions don’t make any of us, or our leaders and therapists and supervisors, infallible. Qualifications and community standing confer legitimacy, not to be confused with our intellectual integrity or moral inviolability. Our theories are situated in time and place and when we’re trained to applaud healthism and be immune to white supremacy it’s not surprising that power is extracted from the conceptual frameworks we inherit.

Health enhancement, which embraces a reduction in eating disorders and the conditions for recovery, needs peace, justice and a fair world. This means we need to envision abolition and make the links between eating disorders, coloniality, supremacy and other toxic manifestations of power a consistent line of questioning throughout our work. It follows from this that we need to consider what’s kept the rising stars of ME and IE in ascendance without challenge for so long, and how to change this.

And because our fallibility can bruise egos, shake faith in certainties and destabilise identities it’s useful for us to help each other remember that it doesn’t touch our dignity, which really is innate.

So, what I think of IE and ME is that they are unintentionally politically regressive, in part because they rely on deep principles that construct bodies as separable entities. Aligned with this, their theories assume the binary of human nature/culture that underpins Western thought and practices. This sucks, because binary thinking as an ontological device sustains coloniality through laying down a framing of rank and division in our minds that we subsequently live and teach from. In one column, there is Reason, White, Thin, Man and so on, and in the other column, a devalued list of Body, Black, Woman, Fat etc. That’s right, singular ‘truths’, oppositional hierarchies, and no room for queerness. Anti-racist works needs (eating) theories that banish this binary, not ones that cherish it.

What’s more, as we have seen, an IE/ME mindset creates the segregated self, rather than painting us in as situated, implicated selves. So, they don’t foster awareness of our social and physiological embeddedness across time and space in any meaningful way. In short, there is a gaping chasm between impact and intent as the atomistic, neoliberal self of their shared substrata is an organising principle that unwittingly transmits systemic violence by detaching bodies from the body politic.

If it’s not radical, it’s racist. In and beyond our work with food, the task lies in urgently restrategizing so we construct the emancipatory narratives needed to see in abolition.

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Aphramor’s Binary Construct Dismantler : Western thought is rooted in a hierarchical system of thinking that relies on binaries, epitomised in the nature-culture divide. We can help contribute to knowledge for justice by training ourselves think differently. This involves dismantling binaries. In order to do this we need to get in the habit of using words that imply plurality as well as words that indicate a binary where this occurs. Some words I use are ‘nither’ and ‘orand’. These replace the binaried terms of ‘either, neither’ and ‘and/or’ that they echo.

Acknowledgements: with thanks to Em Castle for asking the questions in the first place, and Em, Kimberly Dark and Nicole Maunsell for comments and conversation thta helped shaped this piece.

Lucy Aphramor

Written by

Lucy Aphramor is a poetitian — a radical dietitian and performance poet. They developed the health justice approach Well Now. www.lucyaphramor.com

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