BEDA promotes cultural acceptance of, and respect for, the natural diversity of sizes, as well as promoting a goal of improved health, which may or may not include weight change. The views expressed by our featured bloggers are their own.
Dr. Wendy Oliver-Pyatt is the Founder, Executive Director, Psychiatrist, Oliver-Pyatt Centers, South Miami, FL.
Dr. Oliver-Pyatt received her specialty training at New York University-Bellevue Hospital in New York City, where she served as Chief Resident. She has held faculty positions at New York University, Albert Einstein School of Medicine and University of Nevada School of Medicine. Prior to founding Oliver-Pyatt Centers, she founded Center for Hope of the Sierras and Eating Recovery and Wellness Center of Nevada. She served as the Medical Director for the State of Nevada Division of Mental Health and Disability Services, Medical Director and Chief of Staff of Northern Nevada Adult Mental Health and has received Senatorial Recognition for her commitment to the mental health community. READ MORE HERE…
Delivering Weight Shame or Delivering Proper Care?
John Bradshaw said in his powerful book Healing the Shame That Binds You, “Shame is often cited as the buried emotion in all forms of eating disorders, compulsive eating and substance abuse”. I could not agree more! This about sums it up! So that is why it is so exciting that we have Weight Stigma Awareness Week 2014, and that is why I am so happy to write on the subject of weight stigma and healthcare.
We, BEDA, created tool kits for patients to talk to physicians and for physicians to talk with patients. And I hope the tools are useful. I think this year, it is time for us to think further about the origins of shame, and what makes interventions useful or not, and to think more about commonalities among all humans beings that lead us from what Bradshaw calls “Healthy Shame” to internalized, “Unhealthy Shame”—shame which is more difficult to escape.
Healthy shame is a temporary state in response to specific actions we may have taken (and maybe should not have). Healthy shame contains us, reminds us that we are not perfect, and mitigates us away from self-centeredness and grandiosity. It may not feel good, but it keeps us in check. I think of the kids who play basketball with our school team; there are those who may tend to shoot and shoot and shoot in the game and tend to not look to pass the ball to their open teammate. My husband, “the coach”, with one disturbingly stern and upset look, is able to induce a temporary moment of shame in the overly zealous shooter, which hopefully will allow better choices in the upcoming moments of the game….and there you have it, healthy shame.
But what about unhealthy shame? Unhealthy shame is a state of existence that intrudes into our identity, sense of self worth, and ability to feel connected to others. And this is what we really want to avoid, because this non-stop state of shame is what drives eating disorders, compulsive eating and addiction.
I was giving a talk at a University on Friday, and to drive home the point that we all do experience shame, (and the difference between healthy and unhealthy shame), I asked all of the participants to write on a piece of paper something they are ashamed about, crumble it up, and put it into a box so that I could (anonymously) share this with the group. Here are some of the responses:
“I have herpes”
“I spend to much time tweezing my chin hair”
“ I feel shame about my disorganization and procrastination”
And then, as I was un-crumpling the paper, I stumbled onto this one:
“I sometimes still feel like the poor, unclean, fat, insignificant, person I felt like as a child”.
When I did this exercise during this presentation, we noticed as a whole, how much more quiet the room got, and how we all sort of felt closer when hearing these accounts of shame, we were humans among humans, all recognizing our collective perfect imperfections. In the first four accounts of shame that were read, it was clear that the shame was not a permanent state, it was an aspect of the participant’s life or themselves, that bothered them. It did not completely define them. The participant did not write: “I am herpes”. The participant wrote, “I have herpes”. The crumbled up paper did not say, “I am disorganization and procrastination” it said “I feel shame about my disorganization and procrastination”.
If we want to make the delivery of healthcare, something that is actually helpful and healthful, we have to be mindful of what we are delivering. Are we delivering a message that what you are is wrong, bad, and inadequate? Are we delivering shame? For those who are vulnerable, who have heard the message “eat less, and exercise more, weight loss is good at any cost, fat is bad”, throughout all of their life in a healthcare setting, this non-stop messaging can easily create a state of internalized unhealthy shame.
It is sad that the person in the last quote still sometimes feels like an unclean insignificant person. However, it is good news that the person said, “I sometimes still feel this way” rather than “I AM an unclean insignificant person”. There was probably a lot of suffering and therapeutic work behind the person going from the more permanent state of shame he/she described to “still sometimes feeling” this way.
We really must live by the rule of first doing no harm. Einstein said, “We cannot solve problems by using the same kind of thinking we used when we created them”.
Healthcare practitioners must be mindful of the impact of unhealthy shame in every interaction with their patients. And patients must be aware of the impact of what I call “unhelpful help”–when well-intentioned but uninformed healthcare providers use words and actions that are prone to inducing unnecessary and unhealthy shame.
It is okay, and it is even advised, to let out a gentle but powerful roar, and not allow the words or actions of others cause harm to ourselves or others.