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Eating Disorders in Women of Colour

eatingdisorders

When it comes to psychological studies and research of men and women, it can be very generalised. When looking at body dissatisfaction, it becomes even more uncompromising – particularly for women of colour.

Until very recently, women of colour have had very few physical role models that they could look up to, and young women of colour therefore had to compare themselves to the body images portrayed in the media who looked nothing like them – both in shape as well as colour. When I was thirteen, I used to compare myself to Britney Spears and then at fourteen I’d compare my thighs to my school friends’ and wonder why mine were so much bigger than theirs.

Only until recently, research has been dedicated to eating disorders specifically amongst these group of women (women of colour), who have being ignored, purely because it was believed that it didn’t exist (Arriaza & Mann, 2001; George & Franko, 2010; Smart, 2010b), however new research suggests that adolescents, are either like or at a higher risk than European women. I was at the height of my bulimia and over-exercising when between the ages of fourteen and eighteen.

When it comes to eating disorders amongst women of colour, we have unfortunately been let down; there is unfortunately very little research and this is because the Black African body shape can be attributed to all African and Caribbean women as the norm within that culture, therefore Western Clinicians dismiss that we might actually have any psychological body issues. However, a study by Taylor et al. (2007) found prevalence rates for anorexia among their African American sample and Caribbean Blacks sample, age of onset for anorexia (14.89).

What research has also found is that sufferers of eating disorders battle between two cultures: a dominant one and a home one – which one is the dominant one when you are person or colour and you look nothing like the women perpetuating the thin-ideal image on the billboards? And the TV? And the movies? And the magazines? And on the Underground/ Subway ads? So then you feel guilty and disgust and self-hatred that you’re rejecting your own culture, and so you punish yourself.

Pumariega et al. (1994) surveyed the Essence magazine African American female readership regarding their disordered eating attitudes and behaviors and their African American cultural identity. Results from their study suggested that the risk for developing eating disorders for African American women was the same as for their European American counterparts.

“Some researchers contend that African American women may use binge eating as a maladaptive coping strategy to manage negative affect (D. J. Harris & Kuba, 1997; Root, 1990, 2001; Smolak & Striegel-Moore, 2001; Talleyrand, 2006). Binge eating has also been linked to obesity, which may be used to explain the high levels of excess weight or obesity in African American women” (Striegel-Moore et al., 2000; Talleyrand, 2006), if they are using these habits as a method of dealing with psychological issues as they battle with societal pressures from their own culture and a foreign culture.

In conclusion, my research found that strong cultural identity protected African American women against some anorexia- and bulimia-related risk factors. Wood and Petrie (2010) also tested a sociocultural model of eating disorders on a sample (N = 322) of African American college women and found that women who internalized societal messages about beauty, reported engaging in eating disorder symptoms. In addition, the higher their level of ethnic identity, the less they internalised societal messages about beauty. This could mean that they were surrounded by healthy role models, or were brought up encouraged in appreciating Black Beauty for its true magnificence.

Therefore, this study believes that high levels of ethnic identity indirectly protected African American women from engaging in eating disorder symptoms. feelings of powerlessness and a lack of control driving women of colour to use food (e.g., either restricting food or bingeing) to cope with their feelings of internalised racism or to reject societal standards of beauty (Kempa & Thomas, 2000; Thompson, 1994, 1997). I have to agree.

Thus, it is imperative that researchers assess levels of oppression and stress and coping behaviours when studying eating disorders in women of color. One manner of assessing how an individual internalises racial oppression is the use of racial identity theory, which to be honest a lot of clinicians do not understand.

More research needs to be done, as it is evident that not only white, middle class women suffer from eating disorders and body dissatisfaction.

However, I believe that we have come a long way in educating our young men and women of colour in coming to terms with their own biology, so that they are not turning to whitewashed mainstream media for that education instead.

But please stop forgetting about us.

XOXO

 

References

Talleyrand R.M. (2011)  Disordered Eating in Women of Color: Some Counseling Considerations in Journal of Counseling & Development. Retrieved from: http://eds.b.ebscohost.com.liverpool.idm.oclc.org/eds/pdfviewer/pdfviewer?vid=2&sid=80b55bdb-be00-421d-9254-9980a58e970b%40sessionmgr101  

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Epilepsy: Self – Disgust

Last weekend my partner and I went to Windsor and Wiltshire, where we visited Stonehenge. While the museum was a fake (I’ll leave that for another post!), the stones were incredible. Absolutely beautiful.

Since coming home, I feel energised both physically and mentally. More aware of myself. I also haven’t had any seizures for over a week now, which is great.

Yesterday, I took part in a follow up psychological questionnaire about my feelings towards my epilepsy, and I realised that although I’d taken part in the initial questionnaire during my breakdown in the summer, admitting to feelings of disgust towards my condition, I’d very much avoided the notion of feeling disgusting. I’ve come a long way from Wiltshire (I was actually born there), and being back there with my partner was an incredibly proud moment, because I was able to go back to my birth town and I’d remembered the street name through my own efforts – without the help of anybody. I’m utilising this time away from employment to retrain my brain, particularly my memory, therefore being able to remember something from thirty years ago was definitely an achievement.

You Got It Dude

Yesterday, it was incredible to be able to speak to a Clinical Psychologist who also understood Epilepsy – something I’ve never experienced before: somebody who can sympathise with the feelings of dread before a seizure, the desperation to want to be alone afterwards (including the desire to want to separate yourself from your own body, even though you’ve just “left” it and returned, the constant feeling of betrayal you feel towards your body for being so weak and for failing you. I feign confidence because in my mind I realise that I’m becoming more confident as I become more “aware”, however within my body, I feel disconnected because it’s not my own.

I find my body disgusting. I wake up each morning not knowing what state I’m going to find it in and that disgusts me.

Unfortunately this Psychologist practices in Leicester, however she recognised that patients with Epilepsy are in desperate need of Psychotherapy, particularly because of the way we perceive ourselves through the eyes our condition.

She’s going to send me her data once she completes her write up, which will be interesting to read.

I used to blame myself for seizures, which I don’t do anymore, however up until as recently as a few weeks ago I was blaming myself, because if I wasn’t disgusting then I wouldn’t be a failure, and if I wasn’t a failure then I would be like everybody else. And if I was like everybody else, then I would be happy.

However, now I am happy and beautiful. I just have Epilepsy.

I came across this quote yesterday and felt that it was so apt to how I’ve been thinking about… thinking haha:

“We are shaped by our thoughts; we become what we think. When the mind is pure, joy follows like a shadow that never leaves.” – Gautama Buddha

XOXO

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The Social and Cultural Construction of Psychology: The Relationship Between Mind, Society and Culture

Representation Matters

(Image source)

All persons are embedded in and form part of their own culture. The students in this class reside in different regions of the world, but also form part of different social groups and have different sexual preferences. Some live in urban areas whilst others are rural dwellers. Some are deeply religious, and others are secular.

Yet, most psychologists have received their education and have conducted their research and professional practice in a largely male, White, Western, mostly urban middle-class context. Further, the vast majority of research has been conducted in what some humorously call WEIRD (Western, Educated, Industrialised, Rich and Democratic) cultures, doubtfully representative of humans as a whole.

Throughout the history of psychology, theories that were postulated and researched in Europe and North America have been imported and taught directly in other culturally different areas of the world without substantial modifications and local adaptation.

As Wendy Stainton Rogers remarks, psychology tends to operate:

‘almost exclusively in a strange monocultural world of people-like-us, where anything different is seen as alien and exotic’. It is built upon a profound misunderstanding: that experiments conducted by people from a particular worldview on people who share the same worldview can somehow tell us anything about universal human qualities’.

This is an overgeneralisation, as in the past decades a growing number of psychologists are adhering to society’s general critical perspective..

Social constructionists argue that each one of us has to be understood within our specific culture, context and language. The particular qualities of the social practices, beliefs and institutions of our time and place, they suggest, give rise to different ways of thinking and behaving. Language plays a critical role in social constructionism: it shapes what we know, selectively filtering our attention and determining what we can say.

Through different mechanisms of social influence, prevalent cultural views and values highlight certain features of objects, situations and relationships, and promote them to a meaningful quality, whilst others are ignored or undervalued. Applied to our discipline, this implies that the prevalent views in psychology determine which dimensions, aspects, etc., can be extracted from reality and become the object of psychological investigation – and also which dimensions, aspects, etc., will remain invisible.

One of the most commonly criticised aspects of prevalent or mainstream psychology is its individualistic orientation – arguably the result of a conception of psychology as the study of individuals, as opposed to disciplines such as sociology or anthropology. Whilst it is true that interactions and the social context are present in many theories and research – particularly in social psychology – many argue that it is still an individualistic approach. The discipline still largely sees the behaviour of abstract individuals as the response to a given environment, rather than apprehending the subjectivity of concrete human beings living in historically determined societal conditions.

The individualistic orientation in psychology is hardly surprising in a field dominated by the Western ideals of autonomy, independence and self-fulfillment through individual achievement and material acquisition (Cushman, 1995). In a world characterised by the privateness of individuals isolated from one another, societal relations may appear in the form of natural relations amongst things.

This has a deep impact on many aspects of our work. For instance, already in 1971 William Ryan criticised the ‘blame-the-victim‘ politics which, by blaming individuals for their widely shared problems and legitimising only individual solutions, makes people less likely to advocate social change.

Further, these ideals are not ‘exportable‘ to many communitarian social groups around the world, and to cultures whose values prioritise interdependence, family solidarity and mutuality.

But individualism is not the only Western-White-middle class-male value explicitly or implicitly supported by mainstream psychology. Social class is, for most theories and research, invisible or inconsistently conceptualised and reported. Research areas considered as ‘feminine’, like educational psychology, are often assigned lower status. Ethnic minorities are often equated with lower socioeconomic status, and class-based analyses, when conducted, tend to neglect gender inequalities.

Gender

(Image source)

References

Cushman, P. (1995). Constructing the self, constructing America: A cultural history of psychotherapy. Reading, MA: Addison-Wesley.

Ryan, W. (1971). Blaming the victim. New York: Pantheon Books.   

Copyright—Laureate Online Education © All rights reserved, 2000-2016. The Module, in all its parts—syllabus, guidelines, technical notes, images and any additional material—is copyrighted by Laureate Online Education B. V. Last update: 10 November 2016
Posted in Blog

The Social and Cultural Construction of Psychology: The Cultural Definition of Normality

 

Some specific aspects of politics and economy play an important role in the shaping of psychology – as in any other aspect of our life – and sometimes pose ethical challenges for practitioners. That is the case of the so-called managed care, of growing importance in the last decades in countries like the United States. The name refers to a set of techniques intended to reduce the cost and improve the quality of health benefits – which in practice promotes short, routinised and cheap mental health treatments. Treatment goals are often limited to superficial improvements, and drugs are used as a quick solution instead of in-depth longer-term therapy.

Managed care sometimes brings ethical dilemmas to psychologists participating in the system, such as breaches of confidentiality or ‘gag’ rules that limit what therapists are permitted to say to their clients about treatment options.

Pills

This issue is not too different from the growing intrusion of drug companies in the field of mental health. Expensive effort to market their products lead people to hold falsely optimistic expectations, encouraging them to take medication for minor difficulties, promoting the idea that most psychological problems are caused by brain or bodily malfunctions, and fostering a medicalised view of mental health that may discourage people from investing effort and time in psychotherapy.

The Diagnostic and Statistical Manual (DSM) and the American Psychiatric Association (APA) is the object of a strong controversy in this regard. The DSM is the most commonly used compendium of diagnostic categories for mental problems. By categorising and naming psychological difficulties, the DSM has considerable benefits for clinical practice and research: it permits the accumulation and synthesis of knowledge and experience, and provides professionals with a common language. As Mary Wylie indicated in 1995, the DSM is the official lingua franca of the mental health establishment. It not only influences diagnostic and treatment decisions, but it has also important legal, educational, institutional and monetary implications.

But many argue that the DSM not only reflects the social prejudices of the predominantly White, male, etc., persons responsible for its writing and update, but also strong economic pressures – mostly from the pharmaceutic industry. Its critics argue that this is evident in the manual’s growing emphasis on possible biological and heritable aspects, in the fact that psychiatric conditions are defined by a list of symptoms that mimic the style of biomedical diagnostic categories, and even in the terms utilised (disease, symptom, patient, syndrome, relapse). With huge fortunes at the stake, some wonder whether this is not part of a movement to definitely medicalise mental health.

It is obvious that psychologists’ ideas of normality of abnormality – as reflected in the DSM and other diagnostic criteria – do influence their diagnosis, the goals that they set for their clients and the options of treatment. But there are enormous social, cultural and historical variations in what is considered as normal or abnormal. Cultural differences can easily mislead interpretations of behaviour, resulting in over- or under– diagnosis.

If you tell your practitioner that you hear a recently dead relative speaking to you, and that you also speak to that person, you are a serious candidate to be diagnosed with some mental illness. Unless, of course, you belong to one of the several cultures where deceased members of the family are expected to communicate with their living relatives shortly after they pass away – as a sort of late goodbye in their departure from this world. Hearing dead people speaking is no cause of alarm for them.

Does it mean that the Western concept of normality does not apply to other cultures? You should be able to answer this question by now.

The growing number of diagnostic categories in the successive editions of the DSM also reflects a worrisome reality – that more and more behaviours formerly regarded as eccentricities, sins, crimes or ordinary life worries are being regarded as diseases or ‘conditions’. Restless children like Elvis Presley, John Lennon or John Fitzgerald Kennedy would today be diagnosed with attention deficit hyperactivity disorder – just to mention an example.

Crying Patient

The proliferation of diagnoses also contributes to what has been called ‘the diffusion of deficit’, or tendency to label everyday obstacles, shortcomings and disappointments as pathological – and diminishes our control on our own personal life, putting it under increasing scrutiny and regulation by socially sanctioned experts.

In some instances, the new diagnostic categories may be more related to social issues than to actual mental disorders. In 1993, Leslie Camhi published an interesting article where she argued that the diagnosis of kleptomania originated in parallel with the invention of large department stores. Shoppers of all social class stole – particularly women – but the authorities tended to consider lower- class women who stole as thieves, whereas upper-class women’s theft was rather explained as a mental illness – thus preserving their moral superiority.

Perhaps even more revealing is the proposal in 1851 by the American physician Samuel Cartwright, of the diagnostic category of drapetomania.

He argued that this was a mental illness in Black slaves that provoked an irresistible urge to run away from captivity. The treatment of slaves as equals by their masters was presented as the cause of this presumed illness, which could be cured with ‘proper medical advice’ and removing both big toes to make physical running impossible. But of course, drapetomania could be prevented if, following Dr. Cartwright’s advice, the devil was whipped out of the slave at the first sign of dissatisfaction.

Another well-known instance of socially tinted diagnosis proved that Sigmund Freud’s ideas were also the product of his era and social context. Dora was a teenager from Vienna who presented persistent cough and frequent headaches, and who complained of the sexual advances that a respectable adult friend of his father, Herr K., made on her. Analysing the case from his patriarchal perspective, Freud assumed that any girl would appreciate the attentions of a man in the position of Herr K. and concluded that Dora’s cough and headaches were hysterical symptoms of her disguised sexual desires for him. Dora then decided to quit therapy, which drove Freud to enrich his diagnosis with the additional labels of disagreeable, untruthful and vengeful. But shocking as the case is, we must not be surprised that mental health conceptions reflect not just the knowledge, but also the values of each era. As Jeanne Marecek and Rachel Hare-Mustin highlight, at the end of the 19th century many women were considered as afflicted by a mental disorder then called neurasthenia, a condition that combined aspects of what today might be labelled chronic fatigue syndrome, premenstrual syndrome and depression. One acclaimed treatment involved compulsory bed rest, the forced deprivation of mental stimulation, isolation from adult company and constant heavy feeding, leading to weight gains of 25 kilograms or more.

References

Camhi, L. (1993). Stealing Femininity: Department Store Kleptomania as Sexual Disorder. Differences 5(1), 26-50.
Cartwright, S. A. (1851). Report on the Diseases and Physical Peculiarities of the Negro Race. The New Orleans Medical and Surgical Journal, May, 691-715. Retrieved from Google Books: https://books.qooqle.co.uk/books?id=ofMcAAAAIAAJ&redir esc=v
Marecek, J., & Hare-Mustin, R. T. (2009). Clinical psychology: The politics of madness. In D. Fox, I. Prilleltensky, & S. Austin (Eds.), Critical psychology: An introduction (2nd ed., pp. 75-92). London: Sage.
Wylie, M. S. (1995). The power of DSM-IV: Diagnosing for dollars. Family Therapy Networker, 19(3), 22-32.

 

Copyright—Laureate Online Education © All rights reserved, 2000-2016. The Module, in all its parts—syllabus, guidelines, technical notes, images and any additional material—is copyrighted by Laureate Online Education B. V. Last update: 20 December 2016

 

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Conceptual and Historical Paradigms in Psychology: A Critical Analysis

Cognitive Psychology

Cognitive psychology is concerned with a variety of internal processes such as attention, perception, memory, learning, problem solving, language, thinking and reasoning. Obviously, these processes are not directly observable. Cognitive psychologists aim to understand them by observing the performance of people in various tasks – by observing their behaviour.

The most common analogy to describe early cognitive psychologists’ views was the comparison of the human mind with a computer. Both have a hardware – a series of permanent structures where information is processed or transformed – and a software, or the instructions that guide the functioning of the hardware. Basically, when a stimulus is presented to the system, it causes certain internal cognitive processes to occur, until the system produces the desired response or output. This view, known as the information processing approach, was very popular in the 1970s.

It was argued that the process was fundamentally affected by the stimulus input in what is often described as bottom-up processing, and that only one process could occur at any given moment in time – this is known as serial processing. But soon it was evident that task processing often involves top-down processing: the way our mind operates in the presence of a stimulus is strongly influenced by our knowledge and expectations. Read what it says on the screen: you will have no difficulty to identify the word, even when some ‘E’s have been replaced by 3s. Also, it soon became evident that, at least in some circumstances like when we perform a highly practiced task, our internal processes do not operate serially or one at a time, but in parallel. If you have a driving license, you may remember how at the beginning you had to think carefully one step after the other, whereas after a time you find yourself pressing the clutch, changing the gear and observing the mirror at the same time.

The accumulation of theories and research findings, but also the enormous technological and medical advances in past decades, have had an impact on cognitive psychology. Nowadays, we can differentiate at least four main approaches to human cognition:

  •       Cognitive psychology can now be defined in a more restrictive manner as the scientific approach to the understanding of human cognition by the use of behavioural science.
  •       Cognitive neuroscience involves using evidence from behaviour, but also of the human brain, to understand our cognition.
  •       Cognitive neuropsychology involves studying brain-damaged patients to gain an understanding of normal human cognition.
  • Computational cognitive science focuses on the development of computational models of our behaviour and mental functioning to improve our understanding of human cognition.

But just like psychoanalytic therapy derived from psychoanalysis, and behaviourist principles were applied to behavioural therapy, cognitive therapies are the therapeutic correlates of cognitive psychology – although rather loosely.

Cognitive therapy is an active approach where the therapist adopts a very directive role through a small number of strongly structured sessions.

Cognitive therapies focus on cognition – beliefs, attributions, expectancies – and on the mediating role that cognitions play between the events in our life and our reactions to them. Their therapeutic approach is based on the principle that, as erroneous or inadequate cognitions are at the base of psychological distress, behavioural change can be achieved by modifying the underlying cognitions.

There are several different cognitive therapies, however two of the most popular approaches are: Albert Ellis’ rational emotive behavior therapy, and Beck’s cognitive behavioural therapy.

Albert Ellis developed rational emotive behavior therapy (REBT) in 1955.

Albert Ellis

REBT is based on the premise that our reactions to the events taking place in our lives are mediated by the beliefs that we hold. To illustrate this, Ellis replaced the behaviourist SR (stimulus-response) format by an ABC format in which:

A. Something happens.

B. You have a belief about the situation.

C. You have an emotional reaction to the belief.

For example:

A. Your discussion question does not receive any follow-on post from your classmates

B. You believe they don’t reply because ‘I am not good at expressing things, and that is not going to change’.

C. You feel depressed.

The goal of REBT is to help people change their irrational beliefs into rational beliefs. This is achieved by the therapist challenging the client’s irrational beliefs with questions such as:

Do you think you are the only one who is not good at expressing things?

Is not having follow-on posts such a terrible thing?

Just because you want something, why must you have it?

Where with different beliefs, your emotional response might be different:

A.  Your discussion question does not receive any follow-on post from your classmates.

B.  You believe they don’t reply because the topic of your post was ‘not interesting’.

C.   You feel motivated to do better next time.

Also, on the premise that emotionally healthy human beings develop an acceptance of reality, even when reality is highly unpleasant, REBT therapists help their clients develop unconditional self-acceptance, other- acceptance and life-acceptance.

The third big name in cognitive therapy, Aaron Beck presented his approach to the treatment of depression in 1967, and in the following decades he and his followers extended their approach to other emotional disorders.

Beck’s cognitive therapy also argues that sustained erroneous thoughts are at the root of many psychological disorders, but he proposes a different methodological approach to these erroneous thought and to their change.

According to Beck, we all possess a variety of beliefs about the world, others and ourselves, often learned through interactions with the world and with others during our childhood. Those beliefs may be central (such as ‘I am less intelligent than the others‘) or intermediate, in the form of attitudes and assumptions (such as ‘being less intelligent than the others is terrible‘).

People tend to selectively focus on the information that confirms their beliefs, rejecting or not considering information that contradicts them. Beliefs are therefore maintained even when they are inexact and dysfunctional. They can be activated by different life events in the form of automatic irrational thoughts, which affect the person’s emotions and behaviour.

Depressed Man

Beck summarises irrational thoughts in a number of categories or inferences, including amongst others:

  • Dichotomous or ‘all or nothing’ thought: ‘Either I am perfect or I am horrendous’.
  • Magnification of the negative and minimisation of the positive:

‘I didn’t get the mark that I expected, therefore I will never be able to succeed in this subject’ or ‘I got a distinction, but only because the assignment was very easy’.

  • Overgeneralisations: I didn’t feel comfortable in the meeting, which means that I am not good at making friends’.
  • Personalisation, or tendency to think that everything others say or think is related to you: The teacher didn’t smile to me this morning, I must have done something wrong’.
  • Mind reading, or believing that you know what the others are thinking: ‘He is thinking that I cannot complete the task’.

The first step in Beck’s cognitive therapy is to identify the client’s automatic beliefs and to dispute them with questions such as:

What is the evidence for and against this idea?

What is the worst scenario here?

Could you resist it?

What is the most probable and realistic outcome?

Once the client is conscious that their thoughts are irrational, they are invited to replace them with alternative rational thoughts, through guided exercises complemented with behavioural experiments and other cognitive and behavioural techniques. These may include training in social skills, problem-solving, relaxation, systematic desensitisation, psychodrama or role playing, amongst others.

 

Copyright—Laureate Online Education © All rights reserved, 2000-2016. The Module, in all its parts—syllabus, guidelines, technical notes, images and any additional material—is copyrighted by Laureate Online Education B. V. Last update: 20 December 2016
Image: ‘Noam Chomsky’ by John Soares, uploaded to Commons by Stevertigo, then modified by Verdy p. (This version was initially uploaded by Stevertigo.) [Copyrighted free use], via Wikimedia Commons
Image: ‘Albert Ellis’ Permission granted by the Albert Ellis Institute