Power Players: Exploring How Systems of Power Impact Eating Disorder Recovery

This blog is part of a special 12-month series titled, “Inclusive Eating Disorder Recovery: How Yoga Therapy Can Help” written for Yoga for Eating Disorders. Through my blogs and related social media posts, I will explore how we can use the ethics of Yoga, personal practice, movement, breath, focused attention, and meditation to create recovery spaces that are inclusive and reflective of diverse lived experience. Join in the conversation on Instagram by following along @yogaforeatingdisorders and @holisticyogatherapist.

Power \ pau̇(-ə)r (noun): The ability to act or produce an effect, possession of control, authority, or influence over others, legal or official authority, capacity, or right, political control or influence. —Merriam Webster

In 2019, medical sociologists in the United Kingdom confirmed that there is a power hierarchy that has historically influenced which healthcare services are invested in and developed. This means that the opinions of some professionals, patients and members of the public were valued more, and had more influence on the sort of care that is delivered, and who has access to it. The finding suggests a bias towards, and investment of power in specific different forms and how those holders of knowledge are seen, talked to, and how what they share shapes systems and structures.

How does this assignment of power shape how we think about eating disorders in systemically excluded and often disempowered groups, and how we reproduce social inequality and systemic exclusion when it comes to recovery? In this blog post, we’ll explore how the experiences of systemic exclusion and the power imbalance in healthcare systems, impact how people seek help for eating disorders and how yoga therapy can support inclusive recovery. 

Power and Trauma

Additional research indicates that people from systemically excluded groups who are often disempowered face complex barriers to treatment and recovery and experience more nervous system dysregulation. This is because seeking support means engaging with existing power structures and can cause more trauma in addition to what they have already experienced. This includes the traumatic experience of wondering if their concerns will be heard and taken seriously due to intersectional identity markers, or if they will be excluded because those with power in healthcare and recovery cater to those with power within the system.

The recurring trauma impact can be explained by the polyvagal theory which posits that when the body detects or senses danger in any way, including experiencing exclusion and oppression, the nervous system shifts into a state of self-protection. The first stage is a shift into a sympathetic state, more commonly known as the “fight or flight” response. If the threat cannot be resolved, the body then moves into a dorsal vagal state where it becomes frozen by fear.

People who experience being systemically excluded can have frequently dysregulated nervous systems because of ongoing trauma. This means their nervous system gets stuck moving between the fight/flight state and the freeze, which can look like cycling between intense anxiety and depression despite being in a safe environment. This can often be experienced along with eating disorders since eating disorder behaviours can be ways to cope with the traumatic stress of being excluded. This is because they can create a real, but false sense of safety, comfort and embodiment. 

In order to create inclusive environments for systemically excluded people, researchers and care providers need to understand how systems of power and privilege shape how care is provided, and how accessing that care impacts a person’s nervous system. Offering safe spaces and relationships that reset the power balance is critical to healing.

How Yoga Therapy Can Help

How can yoga therapy support a more inclusive eating disorder recovery for people who live with an eating disorder and who may be seeking care in systems and structures with an obvious power imbalance?

The practice of yoga, particularly when it is a customised practice co-designed by your yoga therapist will help you reconnect with your capacity for truer perception, and cultivate your capacity for truthfulness to yourself and those in your community. It might also help you better appreciate the experiences of others, to be open to hearing the truth of their experience and to recognizing how you can influence change on oppressive systems and structures when the time is right so you can restore your relationship with food and community. 

We have already explored how the yamas (yuh-muhs) and niyamas (knee-yuh-muhs) can generally be helpful. In this post we are going to learn more about how we can apply the practices of ahimsa (ahh-him-sah), santosa (sun-toe-sh-ah) and tapas (tuh-pus) to address power imbalances that are causing both immediate and longer term harm to individuals and communities.

Ahimsa

While it is generally defined as non-violence, a truer realization of ahimsa includes personal reflection and understanding of how our personal access to power and our internalized bias shapes our relationships to people, and to the systems and structures we maintain. This deliberate self-study will help ensure that we do more than invite people to the table, but that we build it with them to limit future harm.

Santosa

The niyama of santosa is defined as contentment, acceptance, or optimism. In the practice of addressing power imbalances it might look like acknowledging what you are avoiding, and being honest with yourself about it. This honesty creates the space to explore the roots of that avoidance, and then to either remove them, or to graft new, supportive ideas on top of them to create contentment and empowered action.

That empowered action is one way to start to address the harm caused by the power imbalances in how builds, maintains and delivers healthcare through systems - harm that includes the traumatization of care seekers with intersectional identity markers, or the exclusion of those with less power and privilege. 

Tapas

Sustaining the action necessary to address implicit bias and create a more inclusive experience for ourselves and others requires the niyama of tapas. Classically defined as discipline or persistence, this practice provides the grounding for the daily rituals that (re)build neural pathways and (re)establish healthier relationships with your body, breath and mind as well as with the world around you. Regular, committed practice of the other niyamas will amplify the impacts of the work, and will create space for you to model them for others.

Call to Action

As a researcher you might use these practices to explore how you negotiate the power balance as you determine research questions, invite participants to the table, and frame your work. You might also examine your internal bias around whose opinion you give more weight to. Another area of exploration might be how you use your personal and institutional power to make room for community informants/those who hold ancestral/cultural knowledge of healing practices? 

You could also choose to deliberately use your power model inclusive practices for your colleagues - including ways to include more culturally appreciative and inclusive approaches to food, or by specifically adding an analysis of cultural foodways to your work. The practice of satya 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 to a more generous approach.

If you are a care provider, you might use these practices to develop a ritual practice to check in with yourself about how you hold power and privilege. You may also choose to examine how you use your power to address your internal biases and those embedded in the systems you work in and uphold. You could also explore ways to use your power to deconstruct institutional/systemic disempowerment and reduce the trauma careseekers might experience.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 might include exploring how you raise issues of power and privilege with your care providers. You might also examine how you find care providers with anti-oppressive healing practices.

You might work with your yoga therapist, or other care providers to explore ways to address traumatic experiences into your healing journey. Or you might name and appreciate the barriers you experience in learning more about how to navigate oppressive systems as they relate to eating disorder recovery to your care team and community so they can help work to address the systems that maintain and enforce those barriers. 

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 be truthful in your choice 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 these practices to deepen your self awareness and reconnect with aspects of your identity and cultural practices to support your recovery, 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

A Hierarchy of Power: The Place of Patient and Public Involvement in Healthcare Service Development

How Marginalization Impacts Eating Disorder Recovery and the Autonomic Nervous System

What Is Privilege's Role in Overcoming Mental Health Stigma?

White Privilege and Mental Illness