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Our guest, Annie Goldsmith, is a registered dietician who works with trauma, and she explains how dissociation and digestion are connected. She explains why building safety and going very slowly is so important in bringing healing to both. She explains disordered eating and intentional eating. We discuss eating in the context of food scarcity and the pandemic. Trigger warning for discussion of disordered eating, eating disorders, weight stigma, and food-related traumas (with one example given).
Diagnosed with Dissociative Identity Disorder at age 36, Emma and her system share what they learn along the way about DID, dissociation, trauma, and mental health. Educational, supportive, inclusive, and inspiring, System Speak documents her healing journey through the best and worst of life in recovery through insights, conversations, and collaborations.
Over:
Speaker 2:Welcome to the System Speak Podcast, a podcast about Dissociative Identity Disorder. If you are new to the podcast, we recommend starting at the beginning episodes and listen in order to hear our story and what we have learned through this endeavor. Current episodes may be more applicable to long time listeners and are likely to contain more advanced topics, emotional or other triggering content, and or reference earlier episodes that provide more context to what
Speaker 3:we are currently learning and experiencing. As always, please care
Speaker 2:for yourself during and after listening to the podcast. Thank you. Annie Goldsmith holds an undergraduate degree from the University of Rochester in brain and cognitive sciences and attended Winthrop University for her graduate coursework in human nutrition. She has worked in eating disorder treatment at the partial hospitalization program, intensive outpatient program, and outpatient levels of care. She founded her group practice, second breakfast nutrition, in 02/2015.
Speaker 2:Her practice is rooted in the health at every size and intuitive eating philosophies. She is presented on weight inclusive care at the NCAND regional meeting and at the annual AHEC diabetes symposium in Charlotte, North Carolina. Annie became interested in somatically oriented and trauma informed approaches to nutrition therapy and eating disorder treatment in 2018, when she began training with embodied recovery institute. She realized that an understanding of how nervous system state impacts eating is missing from many traditional approaches to eating disorder treatment. She is passionate about bringing the body into conversation and providing education to colleagues about trauma informed approaches to nutrition therapy.
Speaker 2:Her website and Instagram links are available on the blog. Please note, this episode contains a trigger warning for discussion of eating disorders, disordered eating, weight stigma, diet culture, and food related traumas. As always, please care for yourselves during and after the podcast. Thank you.
Speaker 1:Hello? Hi. Hello, Emma. It's so good to talk to you.
Speaker 2:I can't believe we're really doing this. This is so funny. This is good.
Speaker 1:It's this is like it's like surreal for me. I I have been listening to your voice for a long time on your podcast.
Speaker 2:That's so funny. And I love that I then connected with you through the same people that you found the podcast.
Speaker 1:Yes. Well, you know, Rachel Rachel Lewis Marlowe is my supervisor, and she is, like, just incredible. So it's all of this is just feels super cool. I'm I'm really honored.
Speaker 2:I am so grateful. I really loved her interview, and I loved talking to her and the things that came out of it. And this whole, oh, I didn't even realize I live in my body body thing. It was so powerful.
Speaker 1:Yeah. Well, that's how I felt when I, you know, and I I was like, I've been a dietitian for how many years, and I didn't even understand the role of the body. You know? It's kind of wild.
Speaker 2:I'm already jumping into things and I haven't even let you introduce yourself.
Speaker 1:Well, my name is Annie Goldsmith. I am a registered dietitian, in private practice in, Charlotte, North Carolina. I have been a dietitian for about seven years now, but I opened up my private practice in 2015, mostly specializing in eating disorders. And I have become really, really interested in learning more about trauma and dissociation because as I have gone along in my work, I have just come to understand how eating disorders and trauma and dissociation are so intertwined with one another. And in order to do my work well, I've I've really wanted to learn more so that I can serve my clients better.
Speaker 1:And that is how I came to join the ISSTD because I wanted to learn from people who are doing this work, and that's how we found one another.
Speaker 2:I love this so much because there's such a context that's so real to it. Let me explain just so that you know that I have a relationship with dietitians because of my daughter, actually. Because she has the g tube, and everything is about calories and oils and fats and what she needs literally to stay alive because she has all these medical problems. And I know that's not what we're talking about today, but because of that, I have the context of how food becomes work when you have to pay attention to those things, and it's not the same as paying attention to your body and what your body feels like. So it's fascinating to me because we got connected sort of through that interview when you found the podcast, and now I found you, and we didn't realize that we had been listening to each other.
Speaker 2:And I follow some of what you share on social media, and it's been so powerful. And the other reason I wanted to talk to you is I have had two friends, both with trauma histories, just in the last year come out to me that they have an eating disorder. And one of them, I was even at a restaurant when they told me, and I was like, I'm really sorry. We could have done a different activity. Because I didn't know at all how to respond.
Speaker 2:Right? And so there are so many things that we can learn from you, and just having a conversation about trauma and the body and dissociation and eating disorders, and I'm so, so excited that you were willing to come talk to us. Thank you.
Speaker 1:Oh, it's absolutely my pleasure. I'm I'm thrilled to be able to give a perspective from a dietitian, because I think we we bring a lens, you know, we bring the food lens to the conversation, and sometimes I think it just gives a different point of view to the experience of being in a body.
Speaker 2:How do you so so start with your journey. Tell me, how did you first learn about trauma or realize that that was a thing when you were already in this field a little bit?
Speaker 1:Yes. So I I was starting to understand a little bit that the body was important, which is kind of a funny statement to even make because it's kind of so obvious. But, I had become interested in, you know, doing yoga training and incorporating, those sorts of elements just knowing that there was more than just understanding what to eat. And a lot of the orientation that I had as a dietitian working with eating disorders already was something called intuitive eating, which is really about connecting with the body, getting in with hunger and fullness cues, understanding the interplay of emotions and eating, how guilt and shame play into eating. So it's already pretty well kind of diving into those topics.
Speaker 1:But I did a training, through the Embodied Recovery Institute, which is run by Rachel Lewis Marlowe, who you had on your podcast, and Paula Scataloni. And they are both somatic therapists who, have sort of developed a model of eating disorder treatment that really looks through the lens of the nervous system and somatic processes and somatic interventions to essentially use the body as part of what we interact with directly to facilitate healing. And through their just mentorship, I went to the first training and I said, I have no idea what I just listened to. I spent three days of everything going over my head, but something landed and I said, there is something really important here. And so I just went down the rabbit hole of like polyvagal theory.
Speaker 1:I just devoured everything that I could about the nervous system and the window of tolerance and understanding the role of trauma. And it's just helped understand my clients experiences in such a profoundly different way that I've just really continued to pursue this particular path because it really feels like the missing piece of what I didn't feel like I understood in my more classic, eating disorder training.
Speaker 2:This sounds like you said, it sounds almost like a silly question because it seems so obvious. But what have you learned about what dissociation has to do with the body?
Speaker 1:So well, maybe I'll speak just from the lens of the nervous system. Right? So my understanding of polyvagal theory and how when the body is so overwhelmed that it doesn't feel like it can defend itself, it will go into that dorsal kind of shutdown, which is the physiology that facilitates dissociation. And also in that state, the machinery or the physiology of digestion is essentially kind of goes offline. And so there's this really intimate connection between the ability to, you know, take in food and digest it and eliminate it and all of those digestive processes and our nervous system state.
Speaker 1:And so the clients who I work with who experience a lot of dissociation, sometimes they'll almost talk about like just such a express such disconnection from the body, right, that the ability to eat in a normalized way is completely inaccessible. And so in order for somebody to be able to take in food in a normative way, they have to have a felt sense of safety. They have to have that ventral vagal engagement. And in my understanding of that, sort of understanding how critically important it is to centralize safety in the nutrition work, because that is what is going to underlie the entire entire process of eating.
Speaker 2:I feel like there are so many survivors who talk about eating being hard, sometimes because of triggers, sometimes because of body issues, sometimes because control issues, and there's all these different reasons. How does someone know when there is disordered eating happening as opposed to something that's just hard?
Speaker 1:Well, and I don't know how I would even differentiate that. If eating is hard, if if there isn't enough embodiment to support eating, then we might call that disordered eating. I think there's a lot of stereotypes about eating disorders. I think there's just a stereotyped picture of what someone with an eating disorder looks like. You know, often it's someone who is very, very emaciated and young and, you know, often like white teenagers.
Speaker 1:When in reality, people who struggle with disordered eating come in all shapes and colors and sizes and gender identities. And I think those stereotypes have actually made diagnosis and treatment really difficult for people who don't fit into that mold because often eating disorders are not identified. And so people don't realize that they could benefit from treatment.
Speaker 2:I feel like you've just opened a whole world up to me and I don't understand yet what I'm seeing. Like, that broadens the entire of what disordered eating is.
Speaker 1:Yes. And and to kind of push that even further, you know, we live in a culture. This is often the what I'll say to my client is we there is a cultural eating disorder. We live in a culture that prioritizes thinness over nourishment. We live in a culture that prioritizes disconnection from the body through starvation, over connection through reaching for food and enjoying food.
Speaker 1:It's you know, diet culture is the the water in which we swim, so to speak. And so so much of what is disordered eating is incredibly normalized within our culture. You know, diets are disordered eating. Taking in less food than your body needs to maintain energy balance is disordered eating, but that is just not our definition. That is not the working definition, I think, for society at large.
Speaker 2:So that reinforces some of the confusion. And I can understand as a survivor when I feel like there's already so many different areas of life where you're trying to sort out what is real and what is not and what is true and what is not because of things that happened to you growing up or because of the kinds of interactions and experiences you had growing up and because of dissociation which separates you even from that, that society externally reinforcing these false messages about food or your body makes things even more complicated than they already were.
Speaker 1:Yes. Because it's so hard to trust your inner truth. Right? Like, if internally, you're getting signals that say, hey. I'm hungry.
Speaker 1:But then externally, everyone around you is saying, but honoring your hunger isn't acceptable because maybe your body isn't the right size or, you know, those aren't the appropriate foods for you to eat. Then there starts to be this disconnection between what you're hearing as truth from the inside and what you're being told as truth from the outside and often to resolve that conflict, you're going to, especially if you're really young and you sort of are relying on the people around you to take care of you, you're gonna kinda do what it takes to get acceptable and so you might start to not listen to that inner voice that tells you, hey, I'm hungry or hey, I want to eat this food. And so, you know, over time, trusting your inner voice that tells you about your hunger becomes very difficult and sometimes even unsafe, Right? Because it's like, well, that inner voice is telling me to do something that's gonna get me potentially rejected by people around me.
Speaker 2:There's an incongruence there then that doesn't feel safe.
Speaker 1:Exactly. Exactly.
Speaker 2:You are also the second person I've heard say that in, like, a week because we've just interviewed last week David Archer who spoke about racism and white supremacy and what that looks like in a therapeutic setting and how it shows up in ways we don't even understand. And his key point, his key takeaway that he really emphasized was that we have to learn how to love ourselves, and we can't connect well with others without that peace because we're not offering our whole self dissociation or not. And so of course that pertains to people with DID, but you're saying sort of the same thing about food and your body and recognizing once again that attunement issue of I just have needs because I exist as a person. And needing to have food or needing to eat does not make me a bad person.
Speaker 1:Exactly. Exactly. And it's very difficult when we learn otherwise. It's like we start to have competing survival needs. Well, one of the things that I feel really passionate about in the work that I do is practicing from a weight inclusive standpoint.
Speaker 1:So I consider myself a health at every size dietitian, meaning that I don't view weight as a problem. I don't I sort of believe that bodies exist at a diversity of sizes and don't use weight as measure of health. But when when someone grows up in a in a naturally larger body or a larger body, you know, for whatever reason, you know, there is this messaging that that's dangerous, right? It's dangerous to be in a larger body. You're, you know, you're not gonna be accepted in certain ways relationally, and then also that's gonna pose some sort of health risk for you.
Speaker 1:And so the only way to solve that, quote, unquote, problem is to undermine basic biological needs and not take in enough food, and it becomes an impossible conflict. Impossible conflict.
Speaker 2:This is really big what you're saying. And having an explanation from a safety standpoint feels like everything. Because when we are not safe or when we are not functioning or when we are functioning a certain way because we think it will keep us safe, that explains why we do some of the things that we do even though it has consequences.
Speaker 1:Exactly. Exactly. It's it's it is competing needs for safety. It's like, you know, I I need to stay safe in my, you know, biophysiological need for for fuel, and I also need to stay safe, you know, relationally. And it's like, essentially, it feels like one of those has to be sacrificed in service of the other.
Speaker 2:It's so fascinating. I'm trying to reflect, of course, on my own experience and thinking, and and I have some specific food triggers that are specific to certain, abuse incidents. But, also, I'm a large girl, but I'm not as big as the people in my family. And so to me, it felt just normal and average. But then when you're surrounded by a world where average is supposed to be tiny I'm not tiny.
Speaker 2:And no matter how much I eat or don't eat, I'm not going to be tiny. I'm just not built that way. But I I I can play with my children, and I go for a long walk every day and trying to eat in a way like what you talked about of nourishing, seeking that out. But it has been a struggle, and I went through a couple of years where food was difficult for me because I was just thirsty all the time. And I don't know how else to explain it.
Speaker 2:Not in, like, I had diabetes. I mean, in fact, I worried. Do I have diabetes? Because I'm so thirsty. And I talked to my doctor about that, we tracked that, and I did not have diabetes.
Speaker 2:But I could think about water and drinking water more than I could think about even of eating food. And it turned out that I had an autoimmune thing with Sjogren's. And they were like, no, your body needs water and your body needs liquids. And learning how to incorporate more liquid besides just water so that I could get more nutrients in a way that was naturally eating. But the more that I've done that, and now that's been about two years, and learning how to focus on ways to get nutrients into my body in ways that I could, the autoimmune problem is is resolving sort of on its own because of, like, what you're talking about and what Rachel's talking about.
Speaker 2:I'm just learning to care for my body and what it needs, and it's not having to work so hard to get my attention.
Speaker 1:Yes. And and it's so you know, you're you're sort of naming you're naming a couple things. One is that just so important that there are ways that you are finding to take care of your body really well that have nothing to do with changing your body. And that that that is completely possible, which which is, I think, sometimes even just a novel concept. And that your needs are unique and and need to be tailored specifically to your body and and what it needs and that its needs have changed over time and that attunement with those needs is gonna mean that you can you can sort of pivot and change, you know, how you take care of yourself as as your body changes.
Speaker 1:And that when the body is nourished and there's a congruency there that's driven from a bottom up place, right? Like you're you're naming, I I learned how to respond to what I was being told from the body, that there's healing in that. And I think that there is so much truth to that. And in the eating disorder kind of work that I do, so often the people that I'm working with have relational trauma. And I've really started to think about, you know, food is a way that people sort of express and engage in relationship with themself.
Speaker 1:And how we learned how to be in relationship might be reflected and how we learn how to be in relationship with ourselves as reflected by how we nourish ourselves. And sometimes as we name that, we can start to really understand some of the barriers that exist around why it might feel safe or not safe to meet certain needs.
Speaker 2:My husband has talked about that, actually. He meets with a nutritionist once a month because he has what culturally they would call, like, a sugar addiction. Right? But he tries really hard. He's very open about this.
Speaker 2:I'm not telling his secrets, but he tries to use different language for that. But that's how pop culture would reference it right now. And what he has discovered through his journey is that his parents, even though they were good parents, like, he did not grow up with the kind of abuse that I went through. He had good parents, but his parents did not necessarily have boundaries. And what that looked like was people who had beautiful hearts and were very generous and very giving, but they did not have the capacity necessarily to put limits around that that were healthy for their children or caring for themselves.
Speaker 2:And so when he would tell people, I'm not eating my emotions, what he's realized is that he was eating his attachment. And and it's been a powerful insight to watch him notice that and learn about that and the changes that he's made and how he cares for himself differently. Whereas for me, I saw the opposite thing of never having some sort of disordered eating diagnosis, but absolutely just putting everything on pause and withholding any attention to myself. Not even just food, but whether that's hygiene or whether that's going for a walk, which I talked about early, it does so much every day to keep me stable. I am happier like a puppy if I can get a walk every day.
Speaker 2:But all of those things, when those things are removed from me or when I do that to myself or I'm too hard myself in all kinds of physical ways, not just with food, that's what my childhood was like. It was too much. It was too hard. And I can totally see what you're saying about our relationship with food reflecting our relationship with ourselves. That makes so much sense to me.
Speaker 1:It's pretty it's it's pretty powerful. And and I think too that's that's where I think I I wish that sort of the way as a culture that we talked about food and understood eating was different than than I think that it is, you know, because so much of the conversation around eating is like, how do we eat less or how do we avoid certain things or how do we, you know, make our hunger go away or how do we not ex you know, how how you know, our experience of pleasure is dangerous with food. Right? Like, it's it's sinful. Right?
Speaker 1:I mean, there's all these sort of there's so much verbiage that we can notice, you know, like different brands that will use words like, you know, guiltless or, you know, indulgent, right? These words that sort of imply that we can't really be trusted to just make these choices for ourselves. And I think the way that food is conceptualized culturally undermines our ability to give ourselves permission to eat with attunement.
Speaker 2:How would you describe that? You talked earlier about intuitive eating. How would you explain that to someone?
Speaker 1:Yeah. So intuitive eating is a model, a sort of paradigm that was developed about twenty years ago or so by two dietitians named Evelyn Tribbley and Elise Resch. And it's sort of evolved over time. They just came out with their fourth edition of the book, which has definitely evolved from their from the first edition. And there's 10 principles.
Speaker 1:But in the research that's been done around intuitive eating, there's sort of three core kind of characteristics that they use to to define or understand intuitive eaters. And so they talk about kind of the first one being, you know, intuitive eater has attunement with the body, so able to hear and interpret interoceptive cues. So, you know, interoception is the sense of just being able to feel sensation from the bottom up. So cues coming from the body to the brain, which includes hunger and fullness and satisfaction. And that part of intuitive eating is really what is can be so difficult when someone is often in a state of dissociation because those cues become really inaccessible.
Speaker 1:And a lot of the work that I do with folks is sort of how do how do we safely get back in touch with the body to be able to feel those cues. So that's one kind of core characteristic. The second one is, you know, understanding the interplay between emotions and eating. And, you know, I always talk with clients about, because I think also emotional eating has become something that is considered a bad thing. And I'll often name, you know, all humans eat emotionally.
Speaker 1:That's how we are wired. Food and emotion are just inextricably linked, and they're supposed to be. And so, you know, using food as one of the many tools in our toolbox that we have to cope and to soothe is not a bad thing. You know, where it can become maybe disruptive or difficult is when it feels like the only tool we have, or if it's a tool that we use to dissociate and not actually deal with the things that need to be tended to. But that in and of itself, emotional eating isn't bad.
Speaker 1:But it is important to understand how emotions and eating sort of work together in a way that supports our overall well-being. The third kind of characteristic of an intuitive eater, and this is the one that kind of gets people often, is permission to eat all foods without guilt or shame. So this is where we're talking about, you know, all foods are good foods. You know, let's work on taking away the labels of good or bad, healthy or unhealthy. Not because, you know, I'm gonna be the dietitian who says eat chips and ice cream all day every day, but because I trust your body to know how to seek variety because that's really what's gonna support it.
Speaker 1:And that when we deprive ourselves, that is actually when you know, it's funny when you were talking about that concept of food addiction, that kind of in the context of your husband's experience, so often people feel like they are addicted to food because they have been restricted or deprived of it. And, you know, that scarcity is what actually drives the preoccupation. And that's pretty well documented in the literature. And so when, you know, if I'm ever working with someone who who kinda talks about, I feel like I'm addicted to this, sort of paradoxically or maybe counterintuitively, the solution is, hey. Let's make sure you have a lot of access to it so that your body knows it's not going anywhere and that you've really gotten enough.
Speaker 1:And when you get enough, then you can have some just when you want it, not all of the time because you're afraid that this is the last time you're ever gonna have it. And so so kind of taking those three things together, right, the attunement with body, understanding food and emotions, and permission to eat all foods, you know, those things when they come together in synergy, that's intuitive eating. And it's really about trusting that this is what we knew how to do when we were born and that this is something that we can come back to.
Speaker 2:So when we are born with our immune systems and our nervous systems and the polyvagal, all of that already in place, that's something that happens naturally. And so therefore, when it gets injured, it's something that can heal, you think?
Speaker 1:Oh, yes. Yes. And I can attest because I have seen so many people go from feeling like they could never trust themselves, I will never have xyz in the house because I will just eat all of it or it just doesn't feel safe, to being able to just navigate these food experiences from a place of attunement and trust, and it's totally possible to heal.
Speaker 2:I wanna I wanna go back to something that you said earlier about scarcity because I've gotten a lot of emails about that because of the pandemic this year and people losing their jobs. And across our country, anyway, one of the programs that have been put into place is the Farmers to Families and and where you can get a box of food. But at least in our area, it's very hard to get them. The lines for them are very long. They run out very quickly.
Speaker 2:And so when you get one of these boxes, usually it has, like, some potatoes, some apples, some cucumbers, or or maybe some weeks there might be some butter or some yogurt if it's a dairy week or something. One time it had chicken in it. And so, anyway, my question is because it's so hard to get them, and then when you do get one, and here we had to get one, it was still only a little bit. And so, for example, when we get two potatoes in a box, and we're a family of eight, that's not very much food. And my daughter and I went to Africa last year and worked with some schools we were helping start there, and it's an ongoing crisis for them.
Speaker 2:And I do a lot of work with refugees where food has been an ongoing issue as far as scarcity. But this year during the pandemic, even locally, it's been so hard, and it's been really scary trying to keep the family fed and all of this. And what you were talking about with scarcity and how people respond differently, I have seen with my husband and I because he will want to eat more because we finally have the food. And so that what you were talking about, a fear of it not being available or it being restricted, and I didn't realize until then that that was a trigger for him. It was also a trigger for some of my children who all of them are foster were foster children and have been adopted from foster care.
Speaker 2:And so some of them would want to sort of hoard it. And then because of my experience growing up, I would want to make sure they had enough. And so I wouldn't wanna eat it at all because I was so scared of them being hungry. And so all of us, all eight of us responded differently to scarcity.
Speaker 1:Yes. And I I think naming that our early experiences can really inform how we might react definitely definitely makes a lot of sense. And it is so difficult what's happening right now, and and it is so difficult, anytime that there is food scarcity. When I work with, for example, a family where the children are hoarding food, most of the time it's because there have been restrictive feeding practices, like, in the home. And so, hoarding and hiding food is a really natural response to the sense that there isn't gonna be enough.
Speaker 2:So one of my experiences very young was there was a period of time when my mother was very, very not well, and she would feed us every three days like the chickens. And that's what she said all the time, and she said that a lot. And so that's what is triggered in me when you talk about that. But it's so funny to even think about that and let that come up in me and let that like, to sit with that memory and that feeling. Because I have chickens now, and I don't feed them every three days.
Speaker 2:I probably feed them three times a day. But I can see that with with the pandemic and the scarcity of, I don't wanna eat right now because it's so hard to get this food. I might need it more later. Mhmm. And I can see acting that out without even realizing it.
Speaker 1:That makes so much sense. If there is one thing that I have just embraced and I didn't you know, I knew none of this when I, you know, went to to school to be a dietitian is that relationship with food is sometimes at the heart of some of the hardest things.
Speaker 2:How what does that look like when it's sort of the opposite of, like, my husband's story and what he's talking about and and and eating and someone who who isn't able to eat hardly at all ever? What is that about in the relationship that they're acting out with themselves?
Speaker 1:So you're saying, like, someone who might experience more what what might be described as binging versus someone who is is primarily very restrictive?
Speaker 2:Yes. Restrictive eating. What is that pattern playing out as far as your relationship with yourself?
Speaker 1:So I think that it's different for every single person. I mean, I think that's the first thing. And so often, whenever I meet somebody new, I really feel like I'm a detective sort of right along with them trying to understand the role of the restriction. And it's often a process of discovery that we do together with like a lot of curiosity. In terms of patterns that I have that I notice, I sort of have this I sort of have this analogy that I've started to use.
Speaker 1:You know, one of the things that restriction seems to support is real disconnection from the body, that there's a real often dissociative process at play. And I have noticed that the folks that I work with who have some of the really, really hard trauma histories often will be some of the folks who restrict the most. Again, that's a big generalization, but for these particular folks, I think that coming, being nourished and being in an energy surplus versus an energy deficit literally brings them in touch with the body and that, you know, what is there in the body is being held in terms of, you know, in the nervous system. It's so scary to be there. And so restricting sort of allows, I think for some people, allows for functioning in the world.
Speaker 1:You know, it it it provides enough of a disconnection to be able to go and and do the things of life. And I'll often talk to people about this sort of, like, tightrope that I notice them walking, and it's not like they're counting calories or doing anything intentionally. But I think sometimes what happens is, you know, someone might eat enough to be able to function, to stay out of the hospital, to not be in any sort of medical crisis. Just enough for that, and then also eating not enough, right, to take them fully into embodiment and so that they can kind of walk this tightrope of I'm here, but I'm not here, and that allows me to function.
Speaker 2:I feel like that is the very definition of dissociation, what you just said about being here but not here.
Speaker 1:Uh-huh. And for for, I think, a lot of people, food is, like, really part of that. And I think it's a bi directional process, I think, that the state of the nervous system supports not taking in food, and I think not taking in food supports the dissociation, which is what makes it so hard. And I think this is also, this lack of understanding, I think, is why so many people are called quote unquote, and I kind of hate this term, like treatment resistant when it comes to eating disorders, because what happens is people will have multiple admissions to treatment centers where they will just be, you know, refed, so to speak, and and have all of this food come in so quickly and sometimes because the treatment center setting is is relatively safe, that's something that, you know, they can tolerate doing. But then coming back out into the world, it's like, woah, right?
Speaker 1:Like here I am in my body and back into all of the old things that do not feel safe, and it's just immediate relapse. And so I think that, you know, sometimes that's life saving too. Like sometimes people just are in a place where they have to go to treatment because it's too dangerous. But if they can be in that sort of tightrope place where they're medically stable, I've just really started to recognize how long and slow the work needs to be and that that's okay because because there has to be enough safety to come into when, you know, when becoming renourished. And sometimes it's a really long path.
Speaker 2:What can a survivor do to increase embodiment or increase safety so embodiment is even possible?
Speaker 1:Well, I mean, I think so many of the things that your guests have talked about in terms of what good treatment looks like. You know, for me in my work, I always am working in collaboration with amazing trauma therapists who are helping on that side of things with the healing of the trauma in the nervous system, which is going to create more capacity for eating. In the work that I do with clients, I just try to make their experience with me as safe as possible. One of the things that Rachel said to me recently in consultation was she said, You dietitians are like one big breast, meaning like we are the place where the nourishment and the safety and the nurturing and the connection come together, right? Like just like a baby, right?
Speaker 1:Like nursing and seeking comfort in that way. And sometimes I think my role is just to represent a safe, nurturing person who says, Yes, eat. Right? It's safe to eat. You have permission to eat.
Speaker 1:It's going to be okay if you eat. And hey, let's eat together, right? Let's have a meal together and experience in your body being in safe connection with me while you are taking food in. And I think just that can be really powerful.
Speaker 2:That's such an image of I think what we've been trying to learn about and wrestling with this year on the podcast is having that kind of safe place and that kind of safety and how to dare to connect with people, really have the audacity to connect with people. And it is absolutely a terrifying thing. And it feels like there's so much space between recognition of what would actually help, even though it's so counter intuitive of connecting in some way. Between that and the actual work of the effort of doing so, and then again there's a delay between your attempt and receiving the response from other people and having having that space that happens, whether it's in the moment with another person, it still feels like years as it those feelings track through the nervous system and the experience that you have in your body trying to hold that. And it takes even longer when it's by text or even longer when it's by a phone call or you're trying to set that up or whatever in in the context of quarantine.
Speaker 2:And so when you also have that nervous system response happening with food as you're trying to literally feed your body with actual food and recognizing that there's connection involved with that, with connection with yourself, connection with others, connection with even the concept of nourishment. So much happens viscerally in that experience.
Speaker 1:Yes. Yes. Right? Like, is it even okay for me to get my needs met? Is it even okay to take in what I really want to take in?
Speaker 1:All of that can be so overwhelming. And I think what you just named was so important too, right? That we need connection, but also if, you know, depending on your history and past experiences, connection might also feel terrifying. That if if you look look you know, if I look right at somebody, it's too much, and they might they might dissociate because being it's too intense, and that's so tricky.
Speaker 2:I appreciate you sharing that, actually. And this is a little off topic, but just in the context of the podcast, I appreciate you sharing that because we've learned so much about relational trauma this year, and we have tried so hard in some concentrated efforts to hold on to friendships, which are such a challenging thing for us anyway. But to hold onto that through quarantine and the pandemic and to transition to what that looks like and believe that they are still even there and trust those connections, all of that has been so so difficult this year. And for you to express that in words and how critical that attunement experience is and how difficult it can be to sit with that internally, not just internally, like, in my thoughts or my feelings, but to to to work on accurate thinking and to work on honoring the affective experience. But then connecting all of that back to the body is is huge.
Speaker 2:It's it's it's so it's so much. I don't even have words for it. It's so much to try and do that.
Speaker 1:Sometimes it does feel like it's it's such a big it's it's such a big picture to hold. It's like, where do you start?
Speaker 2:So many pieces. What would you recommend for clinicians who are wanting to help these kinds of survivors who are struggling with embodiment or disordered eating?
Speaker 1:Well, it's interesting. Think I would say I think that it's there's like an eating disorder treatment community and then there's a trauma treatment community and they don't seem to overlap or communicate all that much. But I think that if you are working with eating disorders, you are working with trauma. If you are working with trauma, you are working with eating disorders. And I think the wisdom that each sort of specialty holds is so important for the other to learn.
Speaker 1:And so my hope is that, you know, we can all really start talking to one another and sharing the wisdom that we have. And I want to encourage people who work primarily with trauma not to be scared of eating disorders. Because I think sometimes eating disorders are put in this like little bubble camp where it's like, oh, I don't work with eating disorders, right? And so, or, and then the eating disorder, you know, people might say, well, you know, I'll treat the eating disorder, but not the trauma. And I just think just like so much of treatment that happens, right?
Speaker 1:Even in just, not just in the therapy world, but it's like, I go to the doctor to deal with my medical stuff and I go to the dietician to talk about my food and I go to the therapist to talk about my emotions as if these things are all siloed off from each other, which is just one more way that we facilitate dissociation. And so much of what I think I've understood just as a dietitian is how much the physical and the emotional and the mental are all just connected. And I hope that we can all start to sort of integrate these understandings. And I think all of our clients will be much better served.
Speaker 2:And what about clients or survivors who are listening and recognizing, hey. This may be going on with me, or I would like more information about this, or how to ask for help, or what can I do to care for myself, to feel safer, to work on embodiment? Where where would they even start, or what would you say to them?
Speaker 1:So I one of the things that I would encourage people to do is you can always see reach out to the Embodied Recovery Institute and see if there's a clinician in your area who has been trained in embodied recovery, because those are going to be folks who have, I think, some of this understanding. If you think that you are struggling with your relationship with food, and I always say if you haven't identified and unpacked the way that diet culture has impacted you, you probably are to some extent. You can search in your area for what is for a haze or health at every size, so H A E S, dietitian. These are the dietitians who do understand that diet culture is a form of trauma and starvation is a form of trauma and are likely to understand these things better be probably a really good support system. And if you're, you know and that is there's there's so much privilege in that, right, to even be able to get support in that way.
Speaker 1:And so looking into Health at Every Size resources, you know, on social media is is a there's a lot of really cool information out there. And also just reminding yourself that you deserve to eat. You deserve to be fully nourished, you know, no matter your size and no matter what happened to you. And you deserve support if that's something you're struggling to do.
Speaker 2:Thank you so much. Is there anything else that you wanted to share that we didn't get to cover?
Speaker 1:Oh gosh. I think I'm just so grateful for the conversation we've had today, so it feels really good.
Speaker 2:I am so grateful as well. Thank you for talking with me and for for sharing with us about disordered eating, about intuitive eating, and really essentially permission to exist as a human being, as a person, as a living creature, that eating is part of that and and and not a bad thing. That we have a right not just to eat, but a right to exist.
Speaker 1:I think that's what it comes down to at its root. Right? I'm I'm claiming my right to exist when I nourish myself fully.
Speaker 2:That's amazing. And I feel like that. The embodiment of what you said into the embodiment of me and who I am is where I need to go for the next year. When I think about closing out a year and opening a new year or or enduring through the pandemic as cases go up and quarantine continues or staying in therapy, all of these pieces that feel so overwhelming right now, I feel like you've given life, literally, something to hold on to and something to explore even though it feels so scary. And I appreciate you sharing truly.
Speaker 1:You are so welcome. And I hope I hope that your table has as much food as you need on it, and I hope that for everyone out there who is who is struggling right now.
Speaker 2:Thank you so much. Before I let you go, can I ask you your counsel on usually, an episode like this, I would add a trigger warning at the beginning? What would be the proper way to add a trigger warning for disordered eating?
Speaker 1:Oh my goodness. That's a great question. I would just say, you know, disordered eating, eating disorders, weight stigma, and diet culture maybe are discussed.
Speaker 2:Thank you. I just wanted to make sure that I included I wanted to be sensitive to that. And I really know so very little, which is why I wanted to talk to you, and I appreciate it very much.
Speaker 1:Absolutely. I hope I hope that this is helpful for your listeners.
Speaker 2:So fantastic. And I literally, I I opened with the story about my daughter because it's easier to talk about that than me. Right? And then I can I can move into talking about my husband and then about me and then about the past, like inch my way in like cold water? Right?
Speaker 2:But but I remember holding my daughter and learning about feeding tubes and all of this kind of stuff for my daughter and them focusing on here are the choices you have and here are the different feeding tube formulas and and and all of these different kinds of things and learning about that and and getting into that support. And they would talk about how fed is best. And and usually usually, they would that would be a reference to breastfeeding or bottle feeding. Right? But but she was saying, like, it it doesn't matter that it comes from a feeding tube.
Speaker 2:Like, we have to keep her alive. And I remember how it hit me that moment of, I, of course, want to feed her and keep her alive as I would any of my children. But it was literally the first time I ever heard anyone say that out loud to me that it mattered that a child ate. And it mattered that a child was kept alive and that eating was connected to staying alive. Like, I'm an intelligent person.
Speaker 2:I have a Ph. D. It's not that I wasn't aware of this, but it was literally the first time I ever heard someone give permission to that of part of being alive is eating, and part of caring for yourself, or part of part of showing that you are welcome here on this planet is caring for you and doing the things that keep you alive, which includes eating and moving and being able to breathe. All of these very basic things we've learned from my daughter not to take for granted. And so just coming full circle with that, realizing that those same principles apply to me as well, just as a person.
Speaker 2:It's it's I don't I don't have words for what it means to me. Thank you so much for sharing.
Speaker 1:Oh, you're so welcome. Yeah. Like, you don't have to be be in a medical crisis for food to be important. It's so foundational for all of us.
Speaker 2:Right. I am so grateful. I'm super excited. I follow you on social media. I'm learning so much, and I'm grateful to have you as a new friend as well.
Speaker 1:The feeling is so mutual, and thank you for everything that you're doing and for having me on today in this conversation. I'm just gonna just gonna relish it for the rest of the day.
Speaker 2:Well, I'm so excited about it, actually. I've already recorded all of the interviews for next year, actually, but I and so yours was technically scheduled for November of next year, but I wanna get it out next week because people need it right now. And so all of your content was wonderful. So you'll see it or I'll send you the link or something, but I'm hoping that I can get it edited and out next Thursday.
Speaker 1:Oh my goodness. Okay. Cool.
Speaker 2:Yes. I'm super excited, actually. Super excited. It's so, so, so, so important.
Speaker 1:Well, I I hope I hope that some of the just people in the trauma world really do get interested and seek more because that's my biggest wish is that there's just more availability for people with eating disorders to get really good care. And unfortunately there's a lot of bad care in the eating disorder world, not trauma informed care. So anyway, that's that's a whole other podcast and probably
Speaker 2:opinions I Exactly. Thank you so much.
Speaker 1:Have a good rest of your day, and this was lovely. Thank you so much.
Speaker 2:Thank you for listening. Your support of the podcast, the workbooks, and the community means so much to us as we try to create something together that's never been done before, not like this. Connection brings healing, and you can join us on the community at www.systemsspeak.com. We'll see you there.