Pesach is just around the corner and while most are worried about cleaning and getting the house ready, Shira* is consumed with anxiety about surviving an eight-day holiday centered around heavy late-night meals – while being surrounded by a table full of guests. It will be hard for her to sneak off to the restroom and purge. She is fear stricken. The possibility of gaining any weight whatsoever and the idea of losing control sends her into a manic state and she refuses to leave her room.
Shira is not an isolated case. According to a study conducted of ultra-Orthodox and Syrian communities in Brooklyn, 1 out of 19 girls is diagnosed with an eating disorder, a rate about 50 percent higher than the general U.S. population. We assume that our tight-knit, insular circles are immune to disorders of any kind, but in reality, we are not. There are women in our communities struggling everyday with eating disorders, and as there are too few resources, too little knowledge, and not enough places to seek appropriate treatment, many suffer in silence at the expense of their health and the well-being of their families.
Sadly, only 1 in 10 seek help, and Mendi Baron, a therapist who runs treatment centers, believes that the others don’t because there is no place that offers a safe environment that adheres to their religious concerns.
Or at least, there wasn’t.
Women like Shira propelled Baron to seek out the counsel of Rabbinic leaders and then open Eden Treatment Center, so that Orthodox women who are struggling with mental health and eating issues can get proper attention by professionals who have been servicing the Jewish community for years. Currently, there are no other specialized treatment centers that can serve those of the Jewish community in a clinically strong and spiritually accommodating fashion.
The Slow Death that is Killing our Nation
Eating disorders are not taken as seriously as other disorders like drugs or alcohol addiction. There are many reasons for this, but one of them is, as Baron points out, it is seen a like “slow death” and society with its diet-crazed culture doesn’t recognize the dangers until it’s too late. The facts are shocking: eating disorders have the highest mortality rate of all mental illness after opioid use. In fact, the mortality rate associated with anorexia nervosa is 12 times higher than the death rate of all causes of death for females 15-24 years old.
“Eating disorders often thrive in secrecy, preventing other people from noticing odd behaviors and challenging them. Many eating disorders also fall into a category psychotherapists call ‘ego-syntonic’ which means that the disorder is either approved by society or the person themselves,” explains Baron.
We don’t look down at those with eating disorders like we do at a drug addict sprawled on the street, desperately in need of assistance. In fact, we might even admire and praise those with unhealthy eating habits and see them as just being body and health conscious. Yet, the constant manipulation of the body causes vital organs to fail and the body slowly stops functioning.
It’s not just about being visibly skinny, some of the warning signs are hard to spot. Baron says that symptoms can be emotional, behavioral, and physical in nature. Some include, and are not limited to:
1) Being preoccupied with weight and food.
2) Frequent dieting or only eating certain foods.
3) Eating away from public eye to protect oneself from others seeing.
4) Extreme mood swings.
5) Sleep problems.
6) Abnormal laboratory findings.
7) Feeling cold all the time.
8) Unusual behaviors around or after eating.
Healing and Halacha
Battling an eating disorder is hard enough without having to worry about keeping kosher and Shabbos in a facility that is run by people who are unfamiliar with the intricate and extensive laws of Judaism. Other treatment centers may also be co-ed creating issues of modesty.
So, where does a frum young woman go if she recognizes that she has a problem? There are very limited options, which is why Eden Treatment Center was created. To accommodate his clientele, Baron employs staff that is frum, has an on-site rabbi and rebbetzin as well as a frum chef, who understands kashrus and respects the specific halachic level that an individual is on. They also work closely with Chabad and their rabbinical team as to how to balance sensitive halachic and hashkafik needs. The staff has been handpicked because of their noted talented abilities within this field. “With this in mind for example, we can balance both creating a feel of Shabbos for those who wish, while still assuring they receive professional care from a high caliber team that specializes in eating disorder treatment. Eden is at the forefront of developing ways to treat these disorders while still maintaining respect for individual needs within the community.”
Baron recounts an inspirational case that really hit home for him. Gitty* was a religious woman struggling with an eating disorder that had so spiraled out of control she was admitted to a hospital for stabilization after she went into shock from lack of eating. The hospital could not get her to eat, and when she was literally on the verge of total collapse, Eden’s team was called in to offer support and guidance. They discovered that the “kosher” meat meals being supplied to her were covered in cheese. Because the cheese was also kosher, the hospital staff didn’t understood why Gitty wouldn’t touch it. “This was a woman who many wouldn’t have considered ‘overly frum,’ says Baron, and “despite the fact that for ‘life and death’ situations one is permitted to do halachically what is necessary to survive, this frum girl’s neshama spoke louder than anything else, even in the face of life threatening danger.” To not take into account the spiritual life and the impact of community and family is to ignore a basic tenement of their very lives.
Baron acknowledges “it is an honor, but also a serious role that we play in the evolving of future treatment care for our community and also for eating disorder treatment centers on a national and global level as we develop unique techniques to balance the personal halachic or hashkafik needs of our community alongside prioritization of treatment care.”
Additionally, the fact that Eden takes insurance makes their services further accessible to a larger demographic.
It’s Never Just About The Chips
Media mogul Oprah Winfrey has always been very open with her weight struggles. She has fluctuating between fit and fat all her life. She once admitted that she thought the reason she was overweight was because she “just likes to eat a lot of potato chips.” It was only after entering therapy that she discovered her unhealthy eating habits were rooted in childhood trauma. Many have this erroneous belief that an eating disorder is rooted in a love/hate relationship with food. In reality, it can go so much deeper, which is why a trained mental health professional needs to be involved.
“Eating disorders are complex in nature due to the combination of trauma and attachment issues, mental health concerns, at times chemical dependency, as well the physiological effect that an eating disorder can have on an individual. This creates a strong need for our clinicians to be able to assess not only the behavior of our clients, but also the oftentimes underlying themes that are taking place,” says Baron.
It Takes a Village
The diagnoses and treatment of eating disorders have evolved and will continue to do so. Treatment centers must adapt and stay current to social and cultural nuances if they stand any chance in rescuing those that need help. In today’s digitalized world, there is a silent partner in all this and that is social media, and oftentimes an individual’s toxic relationship to social media plays a big role in their recovery. You can thank Facebook, Instagram, and Twitter for exasperating the issue, as professionals in the field believe that western media alone amounts to the 15% increase in eating disorder behavior. Baron says that this affects Eden’s clients’ perspectives and the treatment plan they need to take with them.
These days, everyone understands that addressing an eating disorder is much more complex than just examining food issues. Any respectful center now incorporates psychological intervention as well. But this is a new phenomenon. After all, the DSM (Diagnostic and Statistical Manual of Mental Disorders – III) only added an eating disorder section including anorexia in the 1980’s.
With this in mind, any successful treatment relies on providing holistic, evidenced based treatments and assessments by keeping up with the leading edge of research-based techniques and conceptualizations of this type of clientele. It truly takes a village to heal a patient and in Eden they are offered treatments by a multi-disciplinary team of professionals. The disorder wreaks havoc on an individual’s body requiring a collaborative team approach to support a psychological and physical recovery. Eden’s village is made up of a psychiatrist, internist, physical therapist, therapist, dietitian, chef, equine therapist, a mind and body wellness guide, and clinical assistants. Baron explains that if a client, for example, is struggling with eating a certain food, this information is not only important for the dietitian to know. The therapist is relayed this information so he or she can collaboratively explore the underlying needs that the client is attempting to fill. The psychiatrist is relayed this information to make assessments as to whether certain medications are appropriate or not. The chef and dietitian are notified to provide nutritionally appropriate meals in the future. Clinical assistants are made aware of this to provide appropriate support during mealtimes. This is also why the entire team is updated and contacted in real-time throughout the day of anything that pertains to the client at hand.
A Day In The Garden That Is Eden
Eden’s programming takes a dynamic approach, while understanding the need to address co-occurring concerns, concurrently. Each day includes morning and evening time for self-reflection, process orientated groups, psychoeducational groups with varying therapeutic modalities incorporated, expressive groups that include art, music, poetry as ways to process one’s emotions, coping skills and experience, experiences in the community to help clients learn how to adapt with real-life scenarios, equine therapy, and mind and body wellness. In addition, Eden’s Edge, a customized coaching program, includes basic skills in life such as creating a resume and job applications, and meetings with leading professionals in their respective fields to share their wisdom and advice for developing a life outside of treatment in a dynamic way. Every client’s journey differs, so their assigned team takes a collaborative approach in developing a specialized treatment plan. This allows the individual to advocate for his or her own goals while staying focused on stabilization. The team and individual work together to establish an appropriate length of stay.
When Adam and Eve dwelled in the paradise that is the Garden of Eden, they were enveloped in a cocoon of safety with all their needs met under a watchful Eye. It wasn’t until they ate a forbidden food that they felt lost, defeated and were plunged into a state of despair. These days, those suffering from an eating disorder feel the same way. They have a toxic relationship with food that is intertwined with other issues and affects their overall physical and mental health.
Now, I am not comparing the staff of Eden Treatment Center to G-d, however, they have given new life to hundreds of frum women who otherwise would have been banished from ever leading a normal life or could have experienced an even worse fate.
For more information, contact Eden at 866-475-2327.
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Common misconception about eating disorders:
Eating disorders are an excuse for attention
Eating disorders are far more complex than one reason and can rarely be explained through a one-dimensional lens. They are often complex, centered around multi-generational trauma, attachment issues, upbringing, personality, our personal go-to coping skills, systemic influences, unprocessed relationships with foods and other mental disorders. “Our society often plays a bigger role than we recognize. We also must acknowledge that our personal experiences with our clients and their will and interest in healing contradicts this misconception as well,” says Baron.
If someone’s weight is stabilized then they don’t have an eating disorder
On a simple level, we may think that we can assess people based on this, explains Baron; however, eating disorders are a mental disorder, not a physical disorder. The recovery route often needs more than just nutritional education. In fact, the real work truly begins when someone is eating and working alongside a multi-disciplinary team at the same time. Having just a therapist or dietitian is not an adequate approach for such an evasive and complex disorder.