By Rachel Porter, PsyD

This year’s Binge Eating Disorder Association (BEDA) conference is dedicated to lifting voices of marginalized communities. As co-chair of the conference planning committee, I have been repeatedly awed by the organization and the committee’s stringent adherence to principles of inclusivity as we plan BEDA 2016.

BEDA 2016—inclusivity & community

As we discuss conference programming for BEDA 2016, we repeatedly come back to the same questions: Does this represent our theme? Is this person we want to invite going to represent a marginalized community? Is this person someone who doesn’t have the privilege of a platform readily available to them? It’s an honor and a privilege to work with such a group of people.

Civil rights takes a giant step back

And yet, simultaneous to this experience, I continually see state law after state law restricting the rights and the voices of these very same communities. I live and work in North Carolina, home of the now infamous HB2, commonly referred to as “the bathroom bill.” This bill is, of course, about far more than bathroom use by transgender people. But naturally that is what it has been reduced to in the popular media and rhetoric. Regardless of how it’s labeled, HB2 absolutely takes the progress of the civil rights movements in North Carolina backwards and supports harmful narrative that transgender individuals are dangerous members of society, when statistics show that people in the trans community are far more likely to be beaten, raped, and killed than cisgender individuals.

Earlier this week, I read about a new law working its way through the state government in Tennessee. HB 1840/SB 1556 allows therapists and counselors in Tennessee to deny mental health services to people whose lifestyles violate their own “deeply held religious beliefs.” This bill currently awaits Governor Bill Haslam’s determination as to whether it will become state law. It has passed through both state Senate and House procedures. The option remains for Governor Haslam to veto this.

Many counselors and therapists in Tennessee, as well as the American Counseling Association, have voiced strong disagreement with the bill. And yet, if North Carolina and many other states are any indication, there is a reasonably high likelihood that this bill will be signed into law. As with all laws such as this, it targets individuals in the LGBTQIA community and singles them out as people who live in opposition to the religious beliefs of others.

HB 1840/SB 1556—cruel & discriminatory

As a practicing psychologist, I had a number of reactions when I read about this bill. The first was feeling appalled that any mental health professional would use this law to deny care to individuals who need it. The next, coming very quickly, was the firm realization that this bill exists entirely to be cruel and discriminatory.

One of the things I was taught in graduate school was to not offer treatment to people outside the scope of my knowledge and ability. While I understand this to primarily mean things such as, “if you have not been trained in the treatment of mental disorder X, don’t try to treat mental disorder X, “My professors also talked to us about knowing what our “edges” were. That is, the areas that we would not be able to provide safe, effective, non-judgmental care. And there is truth in that. If you cannot be a safe counselor for someone, then the ethical thing to do is refer to someone who can.

Of the many problems with this bill, one is that it denies even this most basic right to individuals. The people who want this law in place aren’t just saying, “I can’t.” They are saying, “You don’t deserve this care.” Referring out is also not always possible- there are many facility-based professionals (and this facility could be school, a community mental health center, a hospital, etc.) that can’t or won’t refer away for a variety of reasons. And there are many areas of the country where there is no one to refer to. In these cases, the ethical thing to do is study, seek supervision, and do every single thing you can to provide appropriate care for the person seeking treatment.

The single most useful course I had in graduate school made us role play situations about which we felt uncomfortable. I chose to role play a homophobic parent with a gay son, and, while it was painfully uncomfortable to be inside that person’s skin, it is a lesson that has stuck with me for more than a decade of practice. While I strongly disagreed with the non-acceptance this parent was espousing, I got to understand that the parent was a person–a whole person with emotions and needs, and it was going to be my ethical responsibility to provide appropriate care.

This is the kind of practice I would suggest counselors who want this bill to engage in.

People in marginalized communities often already struggle to seek care. Kids just starting to figure out their identities are already bullied into silence by other kids and grown-ups alike. Individuals who don’t identify as cis/straight are already at much higher risk in our society. And seeking mental health counseling is often a difficult thing to do no matter who you are and what your identity is. There is plenty of stigma associated with this.

As Representative Ray Clemmons (D) stated while arguing against Tennessee’s bill, “Seeking help is hard enough.” Laws like this only make it more difficult, and make it more likely that we will lose more individuals to mental illness related deaths.

So what does all that have to do with BEDA & BEDA 2016?

When we look even more specifically, finding quality eating disorder treatment is exceptionally difficult in many areas of the country. While more treatment is certainly becoming available, training for professionals remains very limited.

We know that eating disorders are the deadliest of mental illnesses. And we also know that more people have binge eating disorder (BED) than any other eating disorder.

Treatment & training for BED

Despite this, BED treatment is perhaps the most difficult to find. As a new diagnosis in the DSM-V, research and training is still very limited. I have been contacted by people hours away trying to determine if it would be worth it to drive back and forth weekly to see me for BED treatment, as there is nobody closer to them.

Additionally, within the eating disorder treatment community, LGBTQIA individuals are underrepresented and underserved.

Limited access to care

What we have, then, is two underserved and marginalized communities intersecting—and a bill that makes it far more difficult than it already is to seek care.  LGBTQIA people who live in Tennessee have effectively been told by their state government (and by any counselor who chooses to live by this, should it become law) that they don’t matter and that they don’t deserve care.

If those people also happen to have BED, the risk of getting care has likely just become much greater than the risk of staying silent and sick. While friends of mine have noted that a silver lining to this bill is that it will serve as a “self-weeding” process for people seeking treatment, it’s also true that sometimes only weeds can be found—and sometimes there is only one weed in town.

And that’s why BEDA 2016 matters

It matters that an organization says, “You’re important. We hear you, we see you, and we care. We want to know your stories. You’re safe here.” As BEDA 2016 co-chair, I can definitively state: everyone’s invited, and your safety is of utmost importance to us. We are so ready to hear your voices.

Learn more about BEDA 2016

More about Rachel Porter

Dr. Rachel Porter is an eating disorder clinician living and working in North Carolina. Dr. Porter has dedicated her career to the treatment of individuals struggling with eating disorders. She has worked constantly in higher levels of care, focusing primarily on partial hospital and residential care. She also owns and operates a small private practice. Dr. Porter is a new member of the BEDA board of directors, has been involved in Weight Stigma Awareness Week for several years, and is a staunch advocate for eating disorder awareness. Dr. Porter uses the Health at Every Size™ paradigm with her clients. She often provides training presentations to other eating disorder professionals on BED, HAES™, and weight stigma. Dr. Porter is also a member of the International Association of Eating Disorder Professionals (iaedp™) and is involved with her local North Carolina iaedp™ chapter as the social media chair. She is co-chair for the BEDA 2016 Conference Planning Committee.

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