Read: Sick Enough by Dr. Jennifer L. Gaudiani MD, CEDS, FAED

It is highly unlikely that you will find any other medical text recommended on this platform. That is not, as one might assume, due to the unique and niche role that this text fills for the field of eating disorder work, but rather, because the ease with which it can be understood sets it apart from the vast majority of other texts of this caliber.  

Sick Enough, is of critical value to any practicing medical professional. Regardless of specialty, at some point, there will be an interaction with a patient that either counters weight bias and the varying stigmas that minimize and/or perpetuate eating disorders, or there will be a missed opportunity that quietly lays root to harm. If those stakes feel high for medical practitioners, they should.

Luckily, in addition to various medical interventions, the book is capped with a number of actions that can be taken by providers and loved ones alike so as not to be paralyzed in the face of concern. This book will leave every reader armed with knowledge and grace to feel capable in the critical role of support.

Dr. Gaudiani is as adept at capturing and distilling medical nuances as she is with broadly addressing a multitude of social issues that not only impact this population, but the vast entirety of our diverse and complex culture. Sadly, I find it as rare in the medical community as I do refreshing, how Dr. Gaudiani languages issues pertaining to the social oppressions that so many patients face. Her unique approach  to zoom out far beyond the physical human body and into the social realms and constructs impacting each individual, truly exemplifies whole person care.

Anyone who is a provider, despite efforts to be as non-hierarchical as we can, is in a position of power. Dr. Gaudiani tackles this truth with deep humility and powerful dedication towards her role as a pioneer in the medical field for truly doing no harm on a much more influential level.

This book is as critical for the education of providers and supports as it is for the validation of those living with eating disorders.  

https://www.amazon.com/Sick-Enough-Medical-Complications-Disorders/dp/0815382456/ref=sr_1_1?s=books&ie=UTF8&qid=1539097995&sr=1-1&keywords=sick+enough

Read: Why Therapists Should Talk Politics by Richard Brouillette

https://opinionator.blogs.nytimes.com/2016/03/15/why-therapists-should-talk-politics

As a social worker, I feel grateful to have a background that encouraged me to zoom out into broader circles of influence when looking at the roots of what a client is bringing to the table in therapy. Social workers are encouraged to look closely at culture and politics and economics and gender etc. The list is long when it comes to variables other than diagnostic criteria. The article even states that this wider angle lens is one that is historically associated with social work, but deeply translatable to the wide realm of therapeutic approaches.

Often a client will come into therapy with a problem that is felt to be internally located, “I am anxious, I am an addict, I have anger management issues…” and this perspective is one that can quickly lead to feelings of hopelessness and helplessness. Zooming out to locate broader threads behind the concern allows that person space to engage and grapple with the problem and not identify as the keeper and holder of the problem at all times. This article does a beautiful job of looking at the powerful impact of this therapeutic strategy.

“This is, in ways, an old quandary in psychotherapy. Should therapy strive to help a patient adjust, or to help prepare [one] to change the world around [oneself]? Is the patient’s internal world skewed? Or is it the so-called real world that has gone awry?”

In today’s world, there is a delicate balance for many providers between remaining impartial and removed from politics or other major events and naming where there may be injustice in certain structures for a client’s well-being. Last week, in my own practice, it would have been arguably harmful to ignore the sociocultural context of the hearings as it was actively impacting so many of my clients, especially my clients who have experienced sexual assault. The pain they were and are experiencing is amplified and echoed by these events in their cultural context. Without locating the context they are operating within, their pain becomes further isolating and silencing and the problem can again feel located in them. We are constantly asking our clients to use their words to speak to their experiences and story them. I love that this article makes the case that we as providers, might need to join with our clients in this dialogue with a little more frequency.

“You would be surprised how seldom it occurs to people that their problems are not their fault. By focusing on fairness and justice, a patient may have a chance to find what has so frequently been lost: an ability to care for and stand up for [oneself].”

*Quotes have been adjusted for more gender inclusive language.

Listen: This American Life, Episode #647 "Ladonna"

Privilege is a tricky thing to illuminate. This is because if you happen to be benefiting from privilege, it is more often than not, somewhat invisible to you. On the other side of the coin, if you are at the expense of someone else’s privilege, that can be either incredibly overt or deeply insidious and hard to even pinpoint. It is the insidiousness of the privilege/oppression cycle that I find myself drawn to illuminating most often.

This theme arises frequently in my practice with clients struggling with eating disorders and the size shaming, diet promoting dynamics that perpetuate oppression and privilege cycles amongst body types. It also arises in time spent with women who have been through sexual assault, who so quickly internalize feelings of fault and blame. It shows up in the day to day identity exploration with my LGBTQ+ clients in deep levels of being invisibilized by our heteronormative promoting culture. These are just a few frequent examples, the list is long.

As a social worker, a lot of my social justice work is slowly illuminating those dynamics of oppression and privilege. Without doing so, all too often people move through the world entangled in these webs without being able to see them, which makes them feel as though the problem must be located within.  

In this episode of my long-held favorite radio program, This American Life, a woman named Ladonna, walks us through her experiences of peeling back the curtain of her work environment to see the many layers of oppression at play to sustain privilege for some at the significant expense of others. Repeatedly throughout the story, as Ladonna makes progress moving up the ranks, the interviewer asks her, “did that make you feel powerful when…” to which Ladonna answers, “no it did not.” Ladonna answers the same way, every single time. The interviewer reflects on her surprise and her clear emphatic belief that it must somehow be getting better for her as she gains more authority in the system.

However, what Ladonna beautifully illuminates, are the massive invisible forces of racism and sexism, and the pain of noticing them and the ways in which institutions can uphold them, both unknowingly and then intentionally. The listener is left with accurate, if disheartening awareness, that something radical on a much larger level would have to shift in order for Ladonna to feel the way the interviewer so badly wishes for her to feel.  

The bittersweet realization that the problem is not just yours, but SO much larger than you, is powerful. It is both a relief and a daunting and exhausting call to action. As a provider, I repeatedly examine where I may unintentionally collude with invisible forces of oppression and where my privileges are sustained through it.

This is a listen for anyone who has ever felt unseen and powerless, but all the more so, for anyone who hasn’t.

https://www.thisamericanlife.org/647/ladonna

View: Nanette, by Hannah Gadsby

You likely have already heard of the buzz swirling around the new Netflix comedy special, “Nanette,” by Hannah Gadbsy. The special has caught fire due to Hannah’s deft skill at addressing the painful themes of gender-based violence, social constructs behind gender-based oppression and her raw telling of her own repeated assaults, all within the platform of a comedy special.

The first comedy special I remember creating a similar frenzy of excitement and confusion was Tig Notaro’s stand-up special at The Largo, the day after she was diagnosed with severe breast cancer. Both comedians wrestle aloud with their difficulty pursuing their craft while struggling to process their own personal painful life experiences. Both use the raw themes of their life within the set, but both also note the difficulty to really effectively sublimate the material all the way. Use of pain for the purpose of artistry is often a valuable way of re-storying. 

However, both artists come up against their limitations in doing so. Tig encounters this in real time with a palpably confused audience and Hannah names her own refusal to continue using her pain in this way, ultimately leading to statements that she may have to leave comedy entirely. If Tig’s special was about using humor to cope with extreme grief, Hannah’s special is about abandoning humor and taking action to prevent it.

“Nanette,” rings as particularly critical listening as it offers both visibility for hard-hit populations including the LGBTQ+ population as well as those who have experienced assault or other gender-based violence. These are not themes commonly explored in the standup world, in fact, they are populations often exploited in it. Hannah struggles with how to use this platform to bring light to them, while in full transparent awareness that humor and comedy will not do them the justice they deserve and so she abandons that goal openly. It is a portrayal of an artist on the brink of relinquishing her craft because her tools fail to convey the portrait she is moved to create.

As a therapist, my role is continually helping to foster the art of storying and then re-storying the experiences of my clients. What I found so parallel in this performance, was the space we often find ourselves in with silence. The space where tension is created because words fail or because silence and helplessness within massive overwhelming tension are the story. We as clinicians have to become comfortable with tension and to explore where that is unsettling for us. In “Nanette,” the audience is asked to do the same thing and to take it further. Where might tension lead to silence that we need to face, and how do we uphold the social constructs that are behind that silence, or fight against them?  “Nanette,” is a window for empathy and a battle cry for social justice.

https://www.theguardian.com/culture/2012/oct/19/tig-notaro-reveals-cancer-on-stage

https://www.youtube.com/watch?v=5aE29fiatQ0&feature=youtu.be