Monday, October 8, 2012

Healthism, HAES, and Mental Health

It's been a month since the FAT-tastic NOLOSE conference, and I'm still processing the wealth of ideas and points of view. As a (mental) health provider, I found myself drawn to workshops that focused on health. In one workshop, we shared personal experiences about what happens when our self-help practices, especially those involving nutrition and exercise, get conflated with mainstream fads, and get people assuming that weight loss is our goal. Another workshop focused on ways to motivate ourselves to do everyday actions that might make us feel better and improve our health. Still another took a very different perspective by challenging the "healthist" assumptions that make self-care into a moral imperative, whether it's directed toward weight loss or not.

That last one really got me thinking about how, even with a Health at Every Size approach, it is really easy to slip back into the same kind of self-criticism, shame, and guilt we've learned from weight loss culture. In fact, I've often thought there is additional pressure on us, as size-accepting fat women, to work hard at keeping ourselves healthy. Our bodies become a battleground for the debate between Health at Every Size and the popular paradigm that equates weight loss with good health. The healthist assumption that stood out most for me was the idea that we have a great deal of control over our health. Healthism overlooks the environment, stress, genetic diversity, disability issues, and numerous other influences on the quality and quantity of our lives. One participant pointed out that behaviors we control represent only a tiny percentage of what affects our present and future health. One of the most useful messages I took from the workshop is that it's time to relax those moral judgments and fears about whether I'm doing all I can to take care of my body.

I've been thinking about the healthist assumptions in mental health, too. I work with clients every day on behaviors they can use to help reduce depression, anxiety, relationship problems … and the list goes on. But too much focus on those self-directed behaviors can lead to shame and a sense of failure when emotional distress comes back. I sometimes say to clients who are dealing with depression or anxiety attacks, for example, that even if we were all climbing the same hill (which we're not), they're having to carry an extra bag of rocks on their backs. It isn't fair and it isn't fun, and perfect symptom management is too much to expect of themselves.

On the other hand, I don't want to promote a message of disempowerment. There are usually SOME factors we can control. I think one of the keys for escaping the guilt vs. helplessness trap, might be to understand how fluid and varied all the factors really are. With depression, for example, the serotonin levels in the brain are affected by what we eat, drink, and, breathe; what we're born with (huge factor); and how we move our bodies. They can also be altered by what happens in our relationships and environment to bring us joy or deprive us of it. Mental and spiritual beliefs and assumptions affect mood, as well. All these influences are in motion every day, interacting with each other. Sometimes a positive or negative mood shift can seem (and may well be) totally random.

Bottom line (which I reserve the right to change as my life and my thoughts continue to evolve), I think the science of cause and effect is useful for giving us suggestions about how to influence the way we feel, physically and emotionally. But those suggestions stop being useful when feelings of empowerment and self-determination give way to guilt and shame. During those moments, what's needed is compassion. In other words, cut yourself some slack. And if that's hard to do, cut yourself some slack about that, too.

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