Ethical, integrative, scientific practice
Many moons ago I decided to withdraw from midwifery training after a year. I had witnessed serious case reviews in my first year and experienced bullying from a mentor, who in hindsight really needed some support herself. I was blocked from having the kind of conversations I needed to have about critical midwifery because ‘this is the way it is’. The last straw for me was the pervasive weight stigma I witnessed in maternity care. It wasn’t all bad though; I loved being with mothers and families and I was good at it. I worked with two supportive mentors (you know who you are) who one day took me aside and said:
‘Why aren’t you working as a counsellor?’
I realised that midwifery was not a role where I could care for people in a way that felt aligned with my values. At 38 it was an immense decision to walk away and I had to do some serious soul searching about next steps. But, you’re not here to read about my story. Let’s move on.
Fast forward and I now hold an MSc Nutrition and Behaviour and I’m a registered nutritionist (AfN) working toward my RNutr. I was already a yoga therapist and PT with a psychology undergrad and counselling training under my belt, so I continued with Intuitive Eating counselling professional training (with Evelyn Tribole and Elyse Resch). I am now in my second year of a professional counselling psychology doctorate on placement in the NHS. I have a private practice aimed at people who want to develop a more compassionate relationship with their body and heal from disordered eating. It is not an accident that I am dual qualified. I engineered it that way. Why? Read on.
Being aware of what I might not know
Going into my masters as a mature student meant I had a backstory. I had lived experience of an eating disorder and the reality was that in order for me to recover from anorexia nervosa I had to get over fat phobia. I’d been working as a PT with amature athletes and bodybuilders so I had internalised the body image ideal of extreme athleticism and was immersed in the world of clean eating, back in the day when Lyle McDonald was losing his shit on his forum daily and T Nation was telling everyone to ditch everything but rice and chicken. Leigh Peele saved me. I am eternally grateful to that beautiful human for introducing me to metabolic science that made sense.
I had to gain weight and learn how to care for myself in a new and compassionate way that didn’t involve cultivating bodily safety by following rules and restriction. So,here I was attending Bournemouth uni, a nonbinary identifying person sensitive to the narratives of food and body, a science nerd interested in how the interacting mechanisms of physiology, genetics, environment, psychology and crucially relationships, influence our experience of being in the world. So basically, I was the most irritating mature student you can imagine. I took nothing for granted.
Nutrition is not the (only) answer
I saw the limitations of the nutrition discipline as being rooted in the certainties of positivist epistemology that sought binary solutions for complicated problems. In coming to a hypothesis with the assumption that fatness = problem, fails to acknowledge the complex structural and personal influences behind the fat body. There is a respect granted to quantitative research that is deserved: I look to well conducted scientific research as much as the next professional to guide my practice. However, I hold softly the utility of research that offers answers on only one determinant of an endpoint, when there may be thousands.
Psychology is also not the (only) answer
I saw the limitations of psychology as being obsessed with neurobiology. Again, this is rooted in the positivist paradigm that seeks to prove objective truths and condense knowledge to finite observable facts. Whilst fMRI is fascinating, it can only tell us so much about the activity in a brain area: useful for myriad purposes and an interest of mine particularly in understanding how a ketogenic diet can be used as an adjunct treatment in glioblastoma multiforme (a really nasty brain cancer). However, what neurobiology/psychology cannot tell us is how a person experiences something or how a person might have a ‘felt-sense’ of themselves and how this might affect their eating, physical activity and ability to care for themselves.
The missing link
…is counselling. Not any counselling though. It must be the kind of counselling that is properly inclusive, integrated and holds softly the ‘facts’ of nutrition and psychology whilst interrogating critically the ways that neoliberal narratives of body and health uphold power and make it unsafe for those in marginalised bodies to exist. This work is unapologetically political, for it to be of any use it must explore the structures that convey messages about the body to the very people we purport to be helping. It is not enough to peddle the thin, white body as the only acceptable body, any more than it is useful to call some foods ‘junk’ and other foods ‘healthy’. To repackage binary solutions to solve complex problems is tantamount to ‘iatrogenic harm’.
This properly pisses me off.
As a white, thin (ish) person I represent the very body that is the norm. My journey into nutrition science and psychology is the result of opportunities afforded to me not just because of my hard work, but because of matters of representation and structural opportunities. I don’t assume that I know what another person needs based on my experience or my education and training. I know that what I do ‘know’ or think I know is really the tip of a gargantuan iceberg and one that looks very different depending on your position. Take a look at the psychologists and nutritionists working very visibly – the overwhelming majority are white and cisgendered. Unless these professionals (including scientists) reflect on how they might be unconsciously contributing to the narrow ideals of body and health and fail to challenge power imbalances in either disciplines, then it’s just lazy practice in my opinion.
Without going off on a tangent about counselling modalities, I’d like to just try to convey the significance that relationships have on the cultivation of health. Harking back to Descartes, if we think that the body is just some kind of transport for the head then we’re missing vital cues. Likewise, if psychologists think we can all just ‘mindful’ the shit out of fatness and override basic physiological processes with concentration, then this is literally conveying a message that anyone with a history of anorexia knows – you can but not without a toll charge. What psychologists (not all of them granted, and certainly not counselling) but definitely nutritionists, might not realise is that some people have such deeply internalised levels of threat in their body, that concerns about nutrition or self care are really really really far down on the list of priorities. This might not be visible and in fact it might be manifest as extreme success or achievement. Anyone in a fat body will probably attest to the levels of threat experienced on an almost daily basis. The people sustaining the very bodies that represent the ideal, might secretly be really hungry, sad and on a relentless wheel of never ending problem solving in order to sustain that body. My point is, we don’t know what we don’t know and it is probably sensible and ethical to avoid writing an entire book unless you’re really sure you’re not going to have to back peddle at some point because you’ve realised, oops! There’s something you don’t know.
So, the take home? I’m not expecting everyone to run off and take up a new discipline to ratify these discrepancies. However, I am asking that when you choose your epistemological and disciplinary hills to die on, make sure you know what the limitations are and hold softly the idea that you know the answer. Your solution may be another person’s prison.