At the end of a patient’s journey, I will end our last visit by asking, “tell me something you want me to know as I continue to do this work?” That question started a conversation where a patient, who I had the pleasure of taking care of, took the time to describe why her treatment episode at this juncture in her life was so profoundly different than in the past.
She had been struggling with an eating disorder for her entire life. She was the youngest of seven children, the only girl, and an African American. She knew she had “strange” eating patterns, as did her entire family. She even resided with another family member during her undergraduate years who also had an eating disorder, and neither of them had any idea that something was officially wrong.
This beautiful human was in her mid-forties and, despite struggling with disordered eating her entire adult life, had not been identified as having one until after a conversation in graduate school with a friend who happened to be a medical student. Her friend, who was white, frankly shared her experience with the diagnosis amongst her own friends and family members and helped my patient connect the dots. This, in turn, guided her into treatment. She was grateful for this experience. The difference for her now, twenty years later, was how important it was for her to have treatment team members to talk to about her life that looked like her.
That information hit me hard. I had to let that that sit with me. I had to explore what that meant for her and me. What it means for my past and future patients. What roadblocks are ahead, and how can we continue to navigate this in a way that helps, not hinders, a patient’s experience. We are about the same age. A generation where one would naively hope that these things do not have to matter but we all know they do. Why does this happen?
I do not think it is a surprise that in America, there is a stereotype for a what a person with an eating disorder looks like: using my patient’s description, “it’s a white person problem, typically well off, and skinny”. However, as much as we know that stereotype exists, it clearly overshadows the existence of eating disorders and their prevalence in the BIPOC community. Notably, African American women are disenfranchised by all areas of the medical community with the detrimental strong Black woman stereotype. Unfortunately, within Psychiatry, diagnosis and treatment of eating disorders falls short.
There needs to be more of an effort for all of us to understand the history of eating disorders and their connection to diet culture, as well as the importance of the root of that diet culture differs for each culture. Without doing this, we are embracing the racism designed to keep a separation between those treated and those not treated. Finding ways to connect with our patients means that we may have to attempt to understand something utterly foreign to us.
This story is more about two people of BIPOC descent connecting. It informs us about how we may need to consider how we currently provide care. Are we attempting to attract members of the treatment team that reflect the community we serve? What is the culture of our organization? Do we lead with humility and honor when engaging members from these communities with a focus on building relationships? Have we discussed and explored how to lean into building empathy with our patients with cultural differences? Have we engaged with our professionals in a way that allows them to nurture self-awareness so that they can become aware of their attitudes, biases, prejudices, and resulting stereotypes? Lastly, what has been done to develop skills within our organization that promote engagement with representatives of these communities to facilitate trust and growth so that our message is that they are welcome?
What did that conversation with this patient tell me? That it is essential first to have knowledge and self-awareness of what institutional and cultural racism has in the context of identifying disorders and ensuring access to treatment for our patients. It means more than simply having people of color on the team. It involves inviting pieces of ourselves into the room. Something we are most often taught not to do.
To that, I will dedicate this discussion to all of my patients to ensure there will not be one more day where we assume that we know more about a patient than they know about themselves. Remaining open and curious about their experiences will be the best approach to saving lives.
Not one more assumption that we know more about a patient than they know about themselves.
Not one more day of allowing race to dictate proper diagnosis and treatment.
Not one more stereotype about what an eating disorder looks like.
Not one more roadblock to receiving treatment.
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Jessica Lee, CRNP, PMHNP-BC, CARN-AP, graduated from Drexel University with a Post Master’s Certificate as a Psychiatric Nurse Practitioner. Her clinical experience is in substance-related challenges and psychopharmacology for psychiatric disorders. She has worked with many individuals through issues related to anxiety, mood disorders, eating disorders, post-traumatic stress, obsessive and compulsive disorders, pregnancy, postpartum, menopausal transition, gender and multiethnic affirming care. Her personal philosophy is a commitment to a distinctively personal approach to your health and wellness. Jessica’s approach is based on warmth, genuineness, honesty and humor. For more information about Banyan Treatment Center, please visit: banyantreatmentcenter.com