Whose Body? Whose Business?

HOW I PRACTICE | The Therapist’s Appearance and Recovery: Perspectives on Treatment, Supervision, and Ethical Implications

BETH HARTMAN MCGILLEY, University of Kansas School of Medicine – Wichita, Wichita, Kansas, USA, Author

M. JOY JACOBS, Section Editor, STACEY NYE, Section Editor

While the AED listserve community focused their attention on the content of the initial post mentioned above, I focused on the rapid process by which our professional community reflexively interpreted the colleague’s weight loss as resulting from an eating disorder (vs. medically ill, or depressed), and it raised a number of questions in my mind. How much does the focus of our field of treatment narrow our field of vision? What if the supervisor had dealt with the situation, the effects or details of which were legitimately no one else’s business? Does an employee’s thinness carry more worrisome weight in the eating disorder work setting than weight cycling or obesity? In other words, from an employment standpoint, are the physical, psychiatric and cognitive effects of bingeing and/or purging associated with bulimia and binge eating disorder of equal cause for alarm as those associated with anorexia nervosa? Based on what objective data?

Each question begged another, and the sociopolitical implications loomed large. Who decides and when does an eating disorder therapist’s body and health legitimately become his/her colleagues business? More pointedly, what does our body or weight have to do with our professional competence?

My perspective is informed as a psychologist but I suspect all of the healing professions have similar ethical and legal guidelines. Psychologists are ethically required to intervene if we suspect a colleague is impaired in his/her ability to practice according to abiding standards of care (APA, 2002). It is critical, in this context, to not confuse impairment with an ethical violation—the former does not always imply the latter. Equally critical but perhaps more elusive, is the issue of defining and determining impairment when most of what we do as therapists occurs behind closed doors and under the protective cloak of confidentiality. To flesh out the inherent predicament most literally—a therapist’s weight (or weight loss as noted in the listserve post), should not be the focus of a confrontation from a strictly business, ethical, or legal standpoint. A therapist’s performance is rightfully a matter of objective review. In the absence of evidence of impairment in professional functioning, our colleague’s bodies are really not meant to be our business (Adamitis, 2000; Solovay, 2000). There are national organizations dedicated to protecting the rights of those facing weight discrimination (e.g., Council on Size and Weight Discrimination). Michigan is the only state to make it illegal, but with rare exception, outside of our tiny field of eating disorders, employees’ weights and eating habits do not figure into their performance reviews or their colleague’s consciousness—at least with regard to their professional functioning.

Returning, then, to the fundamental question: are our colleagues’ bodies our business simply because we’re in the business of bodies? Depending on the level of inquiry (personal, professional, ethical, legal), the answers I have definitively arrived at are yes, yes, maybe, and almost always, no! Yes and yes on the personal and professional levels, given the specific content and context of eating disorder work and especially for those of us with known personal history who are demonstrating observable signs of relapse. It is noteworthy, however, that I was unable to find a single published article addressing if, how and under what circumstances an eating disorder specialist’s weight or questionable symptom status should be confronted. Nor did anyone from eating disorder treatment facilities reply to my request on the listserve for copies of their policies on this matter. It appears this is addressed on a case by case basis, informed by little, if any, data directing the process. On the ethical front, the answer appears to be maybe and only in so far as weight changes are associated with an underlying condition which is impairing one’s capacity to effectively function (i.e. weight status is thus not the primary issue, but a potential symptom of a compromised mental or physical status). Finally, and most definitively, where legalities weigh in on the dilemma, it is almost uniformly discouraged if not disallowed to address an employee’s weight or appearance.

All things thus considered, confronting a clinician considered impaired related to an eating disorder is complicated at best, risky at worst. Where the personal and professional imperatives collide with the ethical and legal constraints, a critical juncture is exposed that we have not adequately addressed as a field. Decisions are likely influenced by one’s professional as well as body biases, empathic regard or collegial indifference, position of power or lack thereof, and avoidance of or comfort with conflict. Seeking supervision at such times seems prudent, if not essential to determining a proper course of action. The writer on the listserve is to be commended for bravely reaching out to her colleagues, and thanked for the provocative and illuminating discourse (including this article) which it inspired.