Mind the Overlap - Exploring How Systemic Exclusion Impacts Eating Disorder Recovery

Exclusion (noun): ˌĭk-skloo͞′zhən: The act or instance of preventing or restricting the entrance of, or barring from participation, consideration, or inclusion. —Merriam Webster

 Research continues to indicate that belonging is a human need. Being excluded causes emotional, mental and physical pain because the need is hardwired into our DNA. Neuroimaging studies go so far as to indicate the similarities between the pain experiences which support our understanding of the impact of exclusion. 

When individuals, or groups of people, are systemically prevented from participating, or restricted from accessing support, or their experiences are removed from consideration, this can cause harm on numerous levels. These systemic barriers may be put in place and maintained by formal regulations and policies, or may be influenced by cultural biases in the interpretation of those formal documents.

Examples of Systemic Exclusion

An example of systemic exclusion in a formal way is the institutional decision not to design or implement a policy that requires researchers to conduct an analysis of race, ethnicity, or socio-economic identity markers when conducting studies on eating disorders. 

Another example of formal systemic exclusion in a clinical setting may be the policy decision to limit services to those who can afford to pay for them at a certain price point which might exclude care-seekers from racialized or marginalised groups that experience increased rates of poverty due to a lack of accessible housing, transportation or food insecurity, or due to higher rates of incarceration. Often these forms of exclusion remain in place, despite the creation of inclusion or diversity policies and in many cases these policies exist and are applied side by side.

An example of systemic exclusion in a cultural way can be seen in the fact that the bulk of research subjects when it comes to studying eating disorders identify as white appearing and female bodied because these are the people who generally have the ability to access medical care for their conditions and researchers might choose not to go through the additional effort to recruit and deliberately include participants who do not meet those identity markers.

Another example of cultural systemic exclusion in a more clinical setting may be the choice a care provider makes in not asking questions about food insecurity on someone's experience with an eating disorder because they aren't aware of how the experiences relate, or are not aware of the fact that the care seeker may have both experiences simultaneously.

Explicit and Implicit Systemic Exclusion

Systemic exclusion is both subtle and pervasive, in part because the people who maintain systems do not realise how much of a role they have. Whether explicitly or implicitly, working within systems that are often founded on white supremacist, patriarchal and capitalist models of governance and thinking without seeking to change them increases how these systems leave out the lived experiences of those with intersectional identities. This impacts the experience of eating disorders and recovery. 

As we start to better understand systemic exclusion and our role in maintaining harmful systems and structures, we are challenged to explore how we can use our power and privilege to start to question why they are the way they are, and explore how we can work to change them to become more inclusive so people see themselves as represented in the research, and can access safe, appropriate help to support their recovery.

Why Yoga Therapy Can Help

How can yoga therapy support a more inclusive eating disorder recovery for people who live with an eating disorder and have been systemically excluded? In this blog series, we have already explored how the yamas (yuh-muhs) and niyamas (nee-yuh-muhs) can generally be helpful, and have considered how the niyama of svādhyāya (svahd-YAH-yah) can support our understanding of intersectionality. In this post we are going to learn about how we can apply the niyama of tapas (TAH-pahs) to make systems more inclusive.

Tapas

Tapas, which comes from the root word which means to heat, to give out warmth, to shine, or to burn, is often translated into ‘discipline’ or ‘burning enthusiasm’. Applying this niyama helps us better understand and build our capacity for self discipline, passion, and courage. While individual experiences of these capacities, and how we express them will be different depending on your identity, goals, and capacity, the core of the experience remains. To practice tapas is to tap into our inner drive that feeds our sense of inner purpose. 

The practice of yoga, particularly when it is a customised practice co-designed by your yoga therapist will help you reconnect with that drive, and that inner purpose. This is done with the eventual focus of achieving your goals. Since the practice of tapas is one of self discipline, your yoga therapist will help you (re)build this capacity by suggesting an accessible daily practice that includes self reflection, observation and study. Your task is to tap into the self discipline necessary to motivate yourself to complete it. 

This deliberate way of exploring self discipline and where you might struggle with it, as well as which techniques help you change over time is particularly helpful in recovery because it gives us the space, and the attention to observe where we might limit our success, or where additional supports might be useful as we re-learn how to commit to maintaining our wellbeing. As our capacity to reconnect to our purpose grows, we are better able to practise new habits, and build new neural pathways so we feel more fulfilled. 

In the long term, this practice of self-discipline and working with purpose brings us in closer contact with our true self. If we choose, we can also deepen our awareness of what drives us, what systems we are part of, and where they may be excluding people due to systemic bias. This deliberate understanding of how we are part of systems can help us shift our perspective, and by practising working from a place of courage and purpose, we can help address the places and ways of exclusion to build systems that are more inclusive.

Call to Action

If you are a researcher, you might use the practice of tapas to reconnect with the sense of purpose that drove you to your work. Over time, you might examine how the systems you work within exclude people and examine how you can use your privilege to shift the culture, or the policy. You could also choose to deliberately model inclusive practices for your colleagues - including ways to remove systemic barriers for research participants, or by specifically adding an analysis of intersectional identity markers to your work. 

You might also choose to help build the body of research and knowledge around the experience of systemic exclusion, to help fill the gaps in information about what it is like to be experience disordered eating along with multiple forms of discrimination and how that impacts access to care and support. The practice of self discipline, and purposefulness when it comes to how you see the world might also help you decolonize your approach when working with systematically excluded colleagues, or change how you work with communities.

 If you are a care provider, you might use a tapas practice to courageously make space for care seekers who are being excluded by the formal or informal aspects of the system you work within. You might also ask questions or policy and decision makers, and become more clear about what inclusion means in your organisation, and how you can remove barriers that exist as you support recovery. 

If you are seeking care for yourself, or someone else, your practice of tapas might help you better identify where you face systemic exclusion, and name the barriers as they relate to eating disorders to your care team and community so they can help work to address the systems that maintain and enforce them. 

If it feels comfortable, you might also use the practice to inform research and to help change systems at a more fundamental level. You might also choose to share which forms of care or support to address eating disorders within the context of multiple barriers, or ongoing exclusion were most helpful so that other community members, care providers and system builders are aware and can integrate that information into their decision making.

If you are already using the practice of tapas to deepen your self discipline and reconnect with your purpose, we would love to learn more about what you are up to. 

Please share how it is going so far, what has worked well, and what you might set aside. Tell us in the comments, or message us on instagram at https://www.instagram.com/holisticyogatherapist and https://www.instagram.com/yogaforeatingdisorders

Resources to Support Your Exploration

• Consistently Inconsistent 

• Full of yourself Intersectional approach to ED 

• Transcultural Feminist model