Evidence of meeting #12 for Status of Women in the 41st Parliament, 2nd Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was disorders.
A recording is available from Parliament.
5:10 p.m.
NDP
Niki Ashton NDP Churchill, MB
Thank you so much.
Quickly, Dr. Jericho, as a follow-up, you work with, I'm sure, people from the LGBT community, as well as indigenous people. I'm wondering how you approached the work with diverse women.
5:10 p.m.
Psychiatrist and Medical Director, Calgary Eating Disorder Program, Alberta Health Services
It's a good question and you're absolutely right, we work with individuals from those communities. I have to say that we don't feel, or I certainly can speak for myself and say I don't feel like I approach those women in a vastly different way. I meet with every individual as an individual.
As was said earlier, there's no one-size-fits-all treatment. We take every single individual as an individual who has had their unique set of experiences and their unique experience of their body in this world.
I would say that I don't necessarily treat those individuals differently, but I am perhaps more sensitive to inquiry around the particular struggles they may face.
5:10 p.m.
Conservative
Joan Crockatt Conservative Calgary Centre, AB
Thank you very much.
Dr. Jericho, if I could just pick up where the discussion has sort of been going.... Maybe I'm taking a little bit of a different direction.
If I could just get you to explore for a minute what your thoughts are on whether or not getting someone to eat, to move away from seeing weight as bad, is the solution we're looking for, like getting an alcoholic not to drink. Or is the lack of eating a symptom of an underlying problem that you need to work to get at?
5:10 p.m.
Psychiatrist and Medical Director, Calgary Eating Disorder Program, Alberta Health Services
Would you like me to answer that?
5:15 p.m.
Psychiatrist and Medical Director, Calgary Eating Disorder Program, Alberta Health Services
Thank you. Sorry. I didn't want to step on toes.
I think the underlying problem is the cognitive and emotional issues that compel a person to stop eating. Thereafter it becomes a reciprocal process because the more a person engages in restricted eating, the more cognitively impaired they become. The more cognitively impaired they become, the more rigid their thinking becomes, the more preoccupied with issues related to body, food, shape, and weight they become. Then the cycle continues. It's kind of a snowball effect.
It's this combination and reciprocity that's difficult to actually halt. But when we talk about using food as treatment, what I'm speaking to there specifically is that in many cases it's about desensitizing someone to something that they need as a life-sustaining treatment. You're desensitizing somebody to something they actually need to survive and that's where the food comes in, almost a behavioural type of approach when folks are truly unable to recover in any other way and perhaps a more autonomous way.
It's a desensitization for those who are gravely ill. We really need to work hard with folks who have been quite sick and who have been eating in these distorted restrictive ways to get back into a normalized pattern, because the whole body adjusts to malnutrition. They no longer feel hunger cues. They don't have the relationship with food that you or I might take for granted. We really have to retrain folks.
5:15 p.m.
Conservative
Joan Crockatt Conservative Calgary Centre, AB
Does that solve the problem? I mean, we know now that the rates of recovery are much, much better with treatment. That's part of what we've been doing here, finding out how to get people to that point, but I'm still interested in knowing whether or not it solves the problem if we can get them to start eating.
So you've essentially desensitized them to thinking about food as being bad. You want them to think of food as being necessary to survive. But do they then move to cutting or some other behaviour?
5:15 p.m.
Psychiatrist and Medical Director, Calgary Eating Disorder Program, Alberta Health Services
I think you've really hit the nail on the head there.
I think we have to be really careful about looking at these illnesses as being about food. The restriction of food is a symptom of some underlying, more complex, as I said, kind of cognitive or emotional problem or dilemma. Now we get into really grey areas, where we start talking about the individual and what is the core, the root, of the conflict that has led to them needing to manifest that conflict or that struggle in these ways.
That's where the richness comes in—the social and cultural influences, the genetics, the biology, the early role-modelling. All of these factors will feed into some sort of need or conflict that will be played out or experienced as an eating disorder.
But you're quite right that if we just focus on food, if we cut off that branch of the tree without looking at the deeper issues and without helping a person to understand themselves, their narrative, their emotional experiences, or how to regulate them, then the problem will invariably resurface as abuse of alcohol or drugs, or cutting, or...in a quieter way, let's put it that way.
5:15 p.m.
Conservative
Joan Crockatt Conservative Calgary Centre, AB
I want to jump in with another question here, if I can, because I'm still hoping to get a question in to Dr. Rice.
We've asked a little bit about banning images and about whether we think society should start to move down a path of saying that we don't want certain images to be accessible to our kids in their formative ages, because they might be triggers. Having come from the media world myself, I know that we're somewhat genetically programmed to be highly attracted to certain body images. I'm not sure if we can train society away from that, even if we wanted to completely ban certain types of images.
I'm just wondering what your thoughts are on that.
5:15 p.m.
Psychiatrist and Medical Director, Calgary Eating Disorder Program, Alberta Health Services
I'm certainly not an expert in this, and I'm not an expert in the research in this field, but I think when we overemphasize the role of media, we miss the bigger picture.
Obviously I'm in support of not progressing towards increasingly severe emaciation and the other things we talked about in terms of the representation of women. But I think it's really important that we train our children, our youth, early care providers, and our parents to help support children in understanding these images; to provide them with resilience, both emotionally and cognitively, to understand these images; to see themselves as unique and distinct and capable of making choices.
You can't live in a bubble. I think we need to also look at that big picture of what breeds resilience in children. I think the same things that breed resilience in children around eating disorders are the same things that breed resilience around addictions, other mental health concerns, and so on.
I'm talking about early childhood stuff here.
5:15 p.m.
Conservative
Joan Crockatt Conservative Calgary Centre, AB
Thank you for that lovely answer. I wish I could hear more.
Dr. Rice, can I just ask you a question here? If you feel compelled to answer what I've already asked Dr. Jericho, feel free, but I'm also interested in knowing whether or not you've seen any countries that have models that we should be using in Canada, or taking more cues from.
You can choose what you wish to speak about.
5:15 p.m.
Canada Research Chair in Care, Gender and Relationships, Department of Family Relations & Applied Nutrition, University of Guelph
Wow, that is such a great question in terms of both prevention and treatment.
I can't give you a good answer to that question right now. I don't know that there is. I really don't know that there is.
To come back to this question about banning certain kinds of images, such as banning emaciated models from walking on the runway, which I think was attempted in 2006 in Spain, there was an attempt to—
5:20 p.m.
Canada Research Chair in Care, Gender and Relationships, Department of Family Relations & Applied Nutrition, University of Guelph
Okay. Sorry.
I'm not certain that's a good solution, because it just continues to put the female body as sort of the object of our surveillance and of our regulation. We need to be thinking at a very basic level about how we socialize girls to have another relationship with their bodies.
5:20 p.m.
Conservative
5:20 p.m.
Liberal
Kirsty Duncan Liberal Etobicoke North, ON
Thank you, Madam Chair.
I'd like to thank you all for your testimony today and thank you for the work you do.
Dr. Jericho, I believe you said that resources must match the scale of the problem. If you could make very specific recommendations that you would like to see in this committee's report, what would you want the resources for?
5:20 p.m.
Psychiatrist and Medical Director, Calgary Eating Disorder Program, Alberta Health Services
There's a variety of different things that come to mind as soon as you say that, and of course, because I'm a clinician I think immediately of the clinical context. I think about the fact that we have anywhere up to 10 individuals at any given time who are severely ill and at risk not being able to access appropriate hospital beds. That's the first thing I think about, because folks with eating disorders don't fit into the traditional psychiatric paradigm, and they don't fit into the traditional medical paradigm, so there's this gap. That's an acute need, and I think it's a need that is pervasive across the country.
But when I think about the application of resources in other ways, I do feel it would be nice to have some resources devoted to developing mechanisms where there can be more collaboration between programs, a better networking and greater understanding of what each of us is doing. I feel that within pockets we're all doing good things, right? In our program, say, we provide a consultation service to providers in the community. They can call us, they can ask us questions. I know many providers do teleconferencing and therapy that way for folks in the rural communities. But we need to talk to each other and have that facilitated.
5:20 p.m.
Liberal
Kirsty Duncan Liberal Etobicoke North, ON
So if you could take those two ideas and make them a recommendation.... You've talked about closing the gap between the traditional paradigm and the mental health paradigm. Would that be a recommendation?
5:20 p.m.
Psychiatrist and Medical Director, Calgary Eating Disorder Program, Alberta Health Services
Yes.
5:20 p.m.
Liberal
Kirsty Duncan Liberal Etobicoke North, ON
And you've gotten to one of the major issues, which is the range of treatment, the continuum of treatment, particularly for those who are gravely ill. So...closing the gap, real treatment for those who are gravely ill.
Do you want to specify more?
5:20 p.m.
Psychiatrist and Medical Director, Calgary Eating Disorder Program, Alberta Health Services
Yes. By real treatment I mean hospital-based capacity, designated beds.
5:20 p.m.
Liberal
Kirsty Duncan Liberal Etobicoke North, ON
That's what I was looking for, thanks.
Then on collaboration, are you looking for funding and sharing of best practices based on evidence-based medicine?
5:20 p.m.
Psychiatrist and Medical Director, Calgary Eating Disorder Program, Alberta Health Services
What I'm looking for here...and I'm really pleased, Dr. Rice, that you spoke the way you did, because I agree with you wholeheartedly that we don't have a lock on how to treat these conditions.
When I say evidence-based what I'm talking about is applying a standard that we can all discuss, and starting from that standard to build on and innovate from there. If we're all collaborating, then we can share in our discoveries around these innovations and move the field forward. But right now things are so compartmentalized that we just don't have enough to really build strong research. We end up doing great things in pockets, but we don't always know what each other is doing. Then we are stuck with evidence that comes only from randomized controlled trials.
