African-Americans and Eating Disorders

FARAI CHIDEYA, host:

This is NEWS & NOTES. I'm Farai Chideya. Black people don't starve themselves, throw up, or do any other things that constitute an eating disorder. That's what some people think, but that's wrong. Some studies show that African-Americans are just as likely as whites to struggle with eating disorders. But the professionals don't always catch the problem. We'll talk with two experts about the disorders in a moment. But first, Marna Clowney-Robinson is an eating disorder survivor. She is now an advocate for people of color who struggle with the problem and she's here now to tell us her story. Marna, thanks for coming on.

Ms. MARNA CLOWNEY-ROBINSON (Eating Disorder Survivor): You're welcome.

CHIDEYA: So let's start when you were a teenager. Describe who you were and your relationship with food and what food meant to you and how you chose to deal with it?

Ms. CLOWNEY-ROBINSON: Well, I guess as a teenager I really wasn't sure who I was or where I fit in. Being that I'm from a multi-ethnic African-American family, it was real hard for me to make friends and to feel included within my community, and I used food as a way of, I would say, trying to find a place for myself to fit in as well as disappear. And when I say disappear, for me it meant not having people see me, not having people be able to make fun of me, to pick on me, to see the flaws that I was seeing within myself.

CHIDEYA: So you, by the time you were 17, were five feet ten. How much did you weigh at your lowest point?

Ms. CLOWNEY-ROBINSON: My lowest point I was about 112 pounds.

CHIDEYA: That's extreme, and did - how did your family react? Did they just say, oh, you know, you've got to eat a little bit more? Or did they recognize this was a major problem?

Ms. CLOWNEY-ROBINSON: Within my family I don't think they actually saw it as a eating disorder, and myself didn't really see it as a eating disorder nor saw it as a huge problem until I got treatment. I am one out of six siblings and we all use food as a way of coping with stresses and stressful situations that came up in our lives at the time. What I was doing was pretty much normal with my siblings. So to us it was normal behavior. It's how we - I mean we used food to deal with stress.

CHIDEYA: Now...

Ms. CLOWNEY-ROBINSON: Go ahead.

CHIDEYA: Why do you think that is, and what I mean is, you know, there's a lot of people who have eating disorders. I mean it's, you know, as you know, it's not uncommon. But do you think there was, I mean was there a moment in time where there was a stress when you were a child that kind of brought this out or was it just sort of a family practice? Why do you think you got caught up in it?

Ms. CLOWNEY-ROBINSON: I think for myself, I took it really hard when my parents split and felt that my father leaving was my fault, and a lot of different circumstances that led up to him leaving was actually my fault. So around eight or nine years old is when I first started experimenting with controlling my food intake or getting rid of my food intake.

CHIDEYA: Now, Marna, I want to get into more details of your story, but we've also got a couple other folks with us. Becky Thompson is a professor of sociology at the Simmons College in Boston. She also wrote "A Hunger So Wide and So Deep: A Multiracial View of Women's Eating Problems." And Divya Kakaiya is a licensed psychologist in San Diego, California, and she's been treating eating disorders since 1985.

So welcome, guys. And Becky, let me go straight to you. When you are hearing Marna talk about this, what does it call up for you from your experience?

Professor BECKY THOMPSON (Simmons College, Boston): Well, first, thanks for having me on the show. I really appreciate Marna's courage and honesty. It still takes a lot of guts to talk openly about the reasons that girls and women turn to food or away from it in order to protect themselves from a range of different traumas. So she is breaking ground in two ways, and one is to talk about her specific story, but also to really counter the notion that African-American women don't get eating problems. So I just appreciate your courage.

Ms. CLOWNEY-ROBINSON: Thank you.

CHIDEYA: So when you think about what she was saying about feeling like somehow her family divorce was her fault, is that something, is it common for people who have eating disorders to take on the weight of situations that they didn't control and may not have even really had a hand in?

Prof. THOMPSON: Definitely. One of the things that I saw over and over again among the women that I interviewed for "A Hunger So Wide and So Deep" is that they didn't feel like they had much control over anything at all. And they often turn to food or away from it as a way of trying to take care of themselves. One of the women I interviewed, for example, remembers hearing her parents go at it and her father beating up her mother. And she would make little cookies with the Ritz Crackers and raisins (unintelligible) smiles; raisins and smiles for me and my sisters is what she would say when she was four years old.

She was also being sexually abused at the time by a family member and also by a babysitter, and she really thought that she was at fault for all of that. So as young as four years old and then by seven years old she had really seen food as her main companion in the world.

CHIDEYA: Divya, let's dig in a little bit into what it really means to have an eating disorder. There's different types - you know, the main ones are anorexia and bulimia. Explain what those are, first of all, and then I want to ask you a little bit more about the distinctions.

Ms. DIVYA KAKAIYA (Psychologist): Right, right. Thank you. Thank you for having me on the show. I appreciate it, and just as Becky said, I think that it just really is tremendously courageous on Marna's part to tell her story because I think this is how we dispel a lot of the myths that we have in our community. And you know, when we look at anorexia, you know, there is a - again, with anorexia there's a believe out there that a person who is anorexic is - has stopped eating completely, and that is not the case.

A drive for thinness and sort of like this obsessiveness about needing to be thinner and never feeling like a person gets thin enough, so there's that whole piece of perfectionism that you find with anorexia; and then with bulimia, what we find is that women that tend to be prone to bulimia are more normal weight or slightly overweight women. And as I was mentioning, that a lot of times with anorexia there's a drive for thinness and with bulimia it's much more so about the control piece.

And so, and of course with anorexia we have the same thing too. So the underlying issues are often, you know, pretty significant with eating disorders.

CHIDEYA: When you think about some more of the distinctions around these behaviors, is there, you know, just tell us what the risks are, what can you do to yourself if you pursue either thinness or vomiting as a way of controlling what you do or any of the other methods?

Ms. KAKAIYA: You know what, it's with all the years I've been treating eating disorders, the medical risks are huge and tremendous. I mean with anorexia, clearly, you know, when a woman stops having her period and her estrogen levels drop, there's a resultant decline in bone density. And eating disorders, particularly anorexia, have the highest mortality rate of all eating disorders.

And unfortunately, you know, the more assimilated young African woman - American woman is, in the mainstream dominant Caucasian culture, the more high risk she tends to be for developing anorexia or bulimia, because what she's doing then is she's internalizing the values of the dominant white culture around thinness. And so the medical pieces are what often don't get talked about in terms of the complications with eating disorders.

CHIDEYA: Well, I just want to bring folks into the conversation in case they are just tuning in. This is actually the part of our, the wrap-up of our series on mental health, and you're listening to NPR's NEWS & NOTES. I'm Farai Chideya. Our guests in talking about eating disorders are Marna Clowney-Robinson, who has survived an eating disorder herself; Divya Kakaiya, a licensed psychologist; and Becky Thompson, who wrote "A Hunger So Wide and So Deep: A Multiracial View of Women's Eating Problems."

Marna, did you seek help ultimately because of medical reasons?

Ms. CLOWNEY-ROBINSON: Yes, I did. When I first tried to get help, I went to my regular doctor, because I was having a lot of chest pains, esophageal problems, and it was really hard for me to get a professional to actually take me serious. And I ended up struggling for another couple years until I actually finally found someone who could help me.

CHIDEYA: Why do you think people, some of these professionals, didn't seem to see you as someone who needed help?

Ms. CLOWNEY-ROBINSON: What one doctor told me was that they didn't see or recognize eating disorders in minority cultures, so he was not going to go down that road. He would test for other things.

I had another doctor tell me eat like a boy, you'll be better, and another nurse pretty much told me that it was all in my head; I was making it up, because they didn't see a lot of minority patients with eating disorders.

CHIDEYA: Becky, your book is about multiracial issues within eating disorders. Is there a lack of treatment that still affects some girls and women, and we should add, men and boys?

Ms. THOMPSON: I think one of the most painful things about talking to the women who I interviewed was how many times they didn't feel as if they were seen or heard or recognized when they tried to seek different kinds of treatment, and the only silver lining there is they often created ingenious strategies on their own.

You know, many of the women talked about - came to understand that the basis of their eating problems were from a number of different traumas, from exposure to racism or sexual abuse or physical abuse or poverty or the stress of acculturation or homophobia, and so for many of them healing included some form of activism, working in a rape crisis hotline or at a battered women's shelter or being part of a support group or getting money to go to college so that they could finish their education.

And these were strategies that were outside of the medical model but they saw as means of empowerment, and I think what's encouraging about that is that it talks about - that healing is really a communal affair, that people can't do it on their own, and even if they are ignored by the medical establishment, there are other ways that people can get help, including Overeaters Anonymous, which became a big tool for a lot of the women.

CHIDEYA: Divya, how about men? How do men fit into this picture of eating disorders?

Ms. KAKAIYA: You know, I think about maybe 10 years ago, one out of every 10 persons coming to treatment facilities was a male, and in the last five years I would say it's one out of seven that come to us that's a male, and I truly believe that the reason why we see this increase is because men's magazines are doing something very similar to what's been done for women.

Women of color, men of color, it's the same. You know, I was looking at some magazines a couple days ago and just looking at the oppression that men are starting to feel that women have felt for the last three or four decades in terms of only one particular body size is acceptable size, and with men too now they're getting more and more messages that that six-pack has to be equated with sexual virility.

And so even in my clinic now I'm starting to see more and more young men and men that come forward to seek help because actually the word is getting out there that this is not just a woman's disease, and it's not only a white woman's disease; it's a disease that affects all, across all socio-cultural lines and across all ethnic lines.

So I think that because there's more out in the field now, that we're having it be less of a taboo, that more men are coming forward, and the issues for men clinically are the same identical issues as they are for women, which are issues around empowerment, not having a voice, there may be - it doesn't necessarily have to have trauma, but there may be some trauma in the history, a very strong history of teasing with most eating disorders.

So if somebody has a certain body size and they've been teased about that, particularly for men and boys, that's a very huge traumatic event.

CHIDEYA: Marna, Becky was saying that a lot of women of color have turned, you know, to really addressing the underlying issues and/or activism. You are someone who's now involved in helping other people. What do you do? What kind of outreach do you do?

Ms. CLOWNEY-ROBINSON: Well, what I've done is I began working with ANAD out of Chicago, and I help coordinate their online support network, trying to get those who struggle with eating disorders linked into the right resources for their particular geographic location, and I also have run a couple of online support forum boards so that women, men and teens can go on and be able to talk openly, honestly, and express their voice. Because I know for myself it wasn't until I found my voice that the healing process could not begin for me, because with an eating disorder it quiets your voice so much that when you get it back, it's so empowering.

So what I do is I try and help people who are - and I say people because it is - it's men, women and even family members help find their voice in either surviving an eating disorder or helping a loved one with an eating disorder.

CHIDEYA: Becky, very briefly, what are a couple of resources that people can turn to?

Ms. THOMPSON: One of the most exciting programs around is called The Body Positive in San Francisco. It's an empowerment program that includes producing videos and training adult and youth leaders to help combat body hatred and early-onset eating problems.

I also think that the National Black Women's Health Project has been on the case with this for really 20 years, and I want to just celebrate the work that they've been doing.

And then what Marna talked about as well, about finding voice. One of the women I interviewed said I didn't have any feelings about how I felt when I ate. I didn't know that there were any feelings there because for years they were stripped away from me.

So for me, a first step in that process is talking with people about how to develop an affectionate understanding for the way that they did cope, not from a place of blame, but from a place of self-love.

CHIDEYA: Well, Becky, Divya, Marna, thank you so much.

Ms. THOMPSON: Thank you for having us.

Ms. KAKAIYA: Thank you.

Ms. CLOWNEY-ROBINSON: Thank you.

CHIDEYA: Marna Clowney-Robinson is on the board of directors of the National Association of Anorexia and Associated Disorders. She joined us from WUOM in Ann Arbor, Michigan. Divya Kakaiya is a licensed psychologist in San Diego. And Becky Thompson is a professor of sociology who wrote "A Hunger So Wide and So Deep."

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