It may not come as a surprise that the mental health industry is riddled with unethical practices. What may leave your mouth ill-tasting however are the untouched, systemically prevalent layers of discrimination in the treatment of eating disorders.

Prior to my professional work as a clinician specializing in eating disorder (ED) treatment, I had gained personal experience with unscrupulous practices and practitioners serving high-risk populations. Yet it’s entirely different to see maltreatment at the hands of colleagues, management, and treatment centers entrusted with the care of fragile lives.

As the group therapist for both day programs of the ED treatment facility, my role provided a unique perspective of all of the clients who came through the doors of the partial hospital and outpatient center. Each client was there by choice, there to place their health and their lives in our hands while facing their arduous journey toward a recovered life. In these years as a pre-licensed clinician, I extended a “benefit of the doubt” approach when workplace procedures differed from my own judgment. After all, I thought, these clinicians were using the best possible practices to help people within a diagnosis-driven business.It wasn’t until months after the last time I switched off the lights in the office within the marble-walled building, known for charging thousands of dollars a day for services, that I came to see the micro-aggressive behaviors for what they truly were.

Let me make it clear that I don’t purport conscious malice or believe there is gain in pointing fingers but it is our excused blindness that holds this field and all clients in dangerously isolated disparities. My intention in writing this article is to create exposure. By giving a voice and space to the words that reveal our misdeeds we may begin the process of collective recovery and restoration of our souls.

There was inequality painted all over the neutral-colored walls of the ED treatment corporation. On one hand, socio-economics barricaded admission to all levels of care. Less obviously, trauma-based work washeld at arm’s length. Worksheets and transfers were often dished out to satisfy the big T trauma buried deep in the consciousness of those who restrict, purge, binge, self-harm. Overstretched clinicians juggling handfuls of client cases recoiled at the presentation of unresolved and newly revealed trauma histories.Trauma aside, there was gender inequity so pervasive that I recall one non-female-identifying client during the years I facilitated therapy at a site claiming to treat all genders. Like trauma, gender flew under the radar of clinical levels of concern, excused away with a “we treat the client’s we get” mentality. Hard to argue with the bottom line of a national corporation operating within a broken system.

Yet It wasn’t the financial restrictions, the lacking trauma care, or the obvious gender disproportions that emplored the writing of this article but the deeply-rooted, industry-wide racism that permeated the clinical practices in the treatment of eating disorders.

From retrospect’s 20/20 perspective, the white-washed complacency endemic in ED diagnosis and treatment became undeniable. Upon reflecting on my time at this facility I recognized the disparity of care provided; clients of color were discussed at greater arms-length in clinical reviews, given less time in their once-weekly individual sessions, left unresponded to when knocking on the office door for support, asked fewer personal, familial, and cultural history questions at intake. POC who arrived hungry for connection were sooner satiated with non-medical discharge. Of course, the historically non-cultural diagnostic

considerations of the DSM played a part as well. Overall, the few clients of color who were admitted to the day program did not receive the same clinical care as the other members of their milieu.

Such pervasive discrimination didn’t stop at the clients, it was also directed at me, the only brown, ethnic clinician or staff member in both the residential and outpatient programs. I hadn’t identified the monster when I was swimming in its muddy wake but in my final days as the lead group therapist, the inhuman scales were becoming more clear. When directed at me I could brush ill-treatment away with excuses,“it’s because I’m new, because I only work 4 days a week, because the group therapist spends more time with clients than with staff, because I’m the only art therapist, because this manager is new, because this director is new…”. These excuses sufficed my own ego enough to redirect my focus back to the care of the clients but the unchecked projections that trickled down from high-level managers could only be temporarily palated, not digested.

My employment experience as the brown, POC clinician gave me a tiny taste of the treatment that thePOC clients received.

After our weekly clinical staff meeting one Tuesday I was pulled aside by my group co-leader. She looked concerned as she led me into the spill-over office where we often spent after-hours completing clinical notes on the available floor space. She was checking in on me, voicing her discontent over the revilement our clinical director had just showered me with. Though the context hardly mattered, the director had been told a lie by her POC client who was still heavily in her eating disorder. False facts were common during early ED treatment- eating disorders thrive in secrecy- but this was the first time any member of staff had been targeted with audible blame instead of the typical procedure to ‘check the facts’. Post-meeting processing with my colleague made it clear that leadership was strained by their inability to build vital rapport with struggling POC clients.

A couple of weeks after this meeting the ugliness resurfaced twice more. I arrived to work one early afternoon to find all of the client artwork that gave life to the colorless walls had been ripped down, thrown away, or stuffed into file cabinet drawers with complete abandon. Clay forms sculpted through conquered pain, resistance, and self-rejection lay shattered on the floor of the group room. Vision “manifesting”boards collaged with the dreams of a recovered future were crumpled and buried in garbage bins right in front of their once-proud display wall. Beautifully painted silk hoops and coping boxes filled with client affirmations were stuffed into my file cabinet drawer with complete disregard. I spent several group sessions thwarting client distress over the mysterious vandalism to their creations. Clients were hurt.Trust was damaged. Nothing could have warranted such a level of disrespect extended to the tangible expressions of self-discovery so proudly displayed by their makers. In the next staff meeting, I sought to understand the intent of this malicious act, a way to explain what had happened to the clients. Though the damage was visible on the walls, awareness was denied by all.

That night the recovery coach and I cleaned up the remains and reorganized the supplies in the art closet(domain of the sole art therapist). When I arrived for my next shift I was disheartened to find the art supply closet in worse disrepair than before. Again, I brought this issue to the staff meeting. Again, every member of clinical and non-clinical staff denied involvement. The fault was assigned to the triggered behaviors of our one client of color in the PHP program. I was astonished to find that this incident was offered the same paltry disregard extended to the desecrated artworks.

These are merely a few examples aimed to cast light on our industry’s insufficient approaches to equitable treatment. My shared stories hardly cover the full extent of the harm inflicted by discriminatory decision-makers. While I have been able to move on, POC are being denied, minimized, or polarized from their right to receive equal care for disordered illnesses.

Accepting my own part in the silent perpetuation of this story has required a breaking down of ego and an uncomfortable look in the mirror, tasks that each of us must endure to truly and collectively tell the story of inclusivity in mental health care. We are all responsible to elucidate and eradicate the narratives of discrimination that lay dormant within our psyches. Our willingness to dismantle the scaffolds that uphold these broken foundations will be what defines the future of mental health and the eating disorder treatment industry.

Actions of unconscious discrimination or marginalization perpetuated by social culture and promulgated through the unchecked behaviors of care providers send riptides of suffering through the underbelly of our subconscious lives. In the world of mental health and ED treatment, our work is in harm reduction, yet these conversations about race and color go unspoken and unseen. As clinicians, our few CE requirements in power and privilege are clearly insufficient. How can we reconstruct our practices in a system dictating negligence? Our learned reactions and internalized schemas need to be brought to the surface in order to be neurochemically and physiologically rescripted.

Eating disorders occur across all social classes and races. Our current practices, in both society and in treatment centers, operate under the assumption that most eating disorders exist among Caucasian, young upper-middle class females. This is not only untrue, it leaves minority and marginalized peoples without proper care.

What I have Seen in regards to discrimination and marginalization in treatment has brought me to where I am now and illuminated my path ahead to Be the change in how I provide mental health services. Over the last two years I have built a private practice that provides holistic arts-based therapy for people of color and ethnic minorities who are struggling with eating disorders. As we continue to have conversations around inclusivity I aim to offer a space of belonging and care to all who have been underrepresented, through the universal languages of the arts. I encourage everyone to join me in building communities and accessible opportunities that empower equitable care for all people seeking recovery.

As we know, recovery, though nonlinear, is possible together.

Lenna Salbashian