Thank you again for allowing me to get back and get my document correctly printed.
I will say that my president took quite a bit of time to review the previous testimonies and certainly that impacted the way that we chose to prepare for today.
As we already heard from NEDIC, the actual face of an eating disorder is heterogeneous: mostly female, but also male; individuals who identify with their assigned sex and gender, and those who don't; racialized individuals; newcomers to Canada and established Canadians; individuals with physical disabilities; individuals with concurrent medical or psychological disorders, such as, diabetes, substance abuse, depression, PTSD, and so on. Individuals from all socio-economic walks of life have eating disorders.
From a feminist lens, we have long been concerned with the messages women and girls receive about body image, sexuality, and in particular, the sexualization of young girls in the media. Conversely, from a feminist-disability perspective, in the quest to present women as strong and capable, the larger movement does not always reflect the face of women and girls with disabilities. We look everywhere but do not see our faces, and often there is no place for us, no model to follow.
In the intervening time we also see the deadly and devastating impacts of Internet pornography and cyberbullying. Women and girls are being exposed to online sexual harassment and stalking. Sex is a commodity, and your stock rises and falls with your appearance.
No exploration of media and eating disorders would be complete without flagging the issues posed by online groups that are involved in trading ideas about how to binge and purge, further reinforcing deadly practices. Additional impacts also come in the media for our virtual invisibility and the way society views mental illness and invisible disabilities, refining our view to the context of disability.
People with mental disabilities tend to come at the bottom of the hierarchy of impairments, below those with physical and learning disabilities, because they are constructed as deviant and dangerous...as possessing a spoiled identity and lacking rationality....
I'm quoting from Beresford.
The media plays a fundamental role in this portrayal focusing on the strange or aggressive behaviour of people categorised as 'mentally ill'. This has real consequences for individuals living with such disabilities because politicians are affected by what is reported and shape policies around mental health accordingly.
Disabled women experience violence and have a unique risk as a result of this.
Many of us recount our experiences, as young children, of having to display our bodies to groups of male doctors in the guise of “medical treatment” without prior knowledge or consent. We may have been asked to strip, to walk back and forth in front of complete strangers so that they could get a better view of what the physical “problem” is, or to manually manipulate our limbs to determine flexibility and dexterity. Today, pictures or videos are taken of us and used as educational tools for future doctors, with little thought given to our needs to have control over what happens to our bodies or who sees us. While the medical profession attempts to maintain control over our bodies, some women with disabilities may attempt to regain control through dieting, bingeing or other methods of body mutilation. It is ableism at play when a doctor asks a woman with a disability to lose weight before she becomes too heavy for her caregivers to lift. And that ableism persists when a woman with a physical disability loses weight, and instead of asking how she did it, congratulates her on her “success.”
Though identified as a serious environmental risk factor for eating disorders, every psychiatrist who testified spoke about the active discrimination faced by women and girls with eating disorders. This discrimination is in clear contradiction to the spirit of the Convention on the Rights of Persons with Disabilities, insofar as the right to be assisted in the recovery from injuries posed by their abuse.
DAWN Canada supports the recommendations made by the medical professionals presenting here and those of NEDIC. We offer a discussion of our own.
Recommendation number one. Canada’s approach to eating disorders must be strategic and involve all levels of education, practice, and research. We need to ensure that the intersectional, gender, and disability lenses are also trained on the process of research, practice, education, public awareness, and disability inclusion. Public health measures aimed at prevention and early detection must include physician screening; public health nurse screening; school nurse, mental health, and addiction screening; as well as the intervention and recognition that violence against women and girls is a cause, effect, and risk factor for eating disorders. Women and girls need choice and a continuum of referral points.
Caution is also urged in the area of interventions such as neuro-stimulation and magnetic stimulation. There is promise, but have all the risks been taken into account?
Recommendation number two. There are many references to best practices and evidence-based care but there must be room for innovation, new ideas, and also creative care for women and girls with disabilities for whom current evidence-based interventions are not working.
Recommendation number three. We must ensure that women and girls with disabilities are included in discussions of eating disorders and body image. Our voices, perspectives, and indeed our images are necessary in order to move forward effectively.
Recommendation number four. Treatment programs must include women and girls with disabilities and take into account the intersection of gender, violence, and disability.
The services need to be competent in addressing eating disorders, trauma, addictions, and the medical effects of eating disorders and disabilities of women and girls who present for treatment rather than using intersecting disorders as a rationale for exclusion.
Facilities must be developed using the principles of universal access and information must be made available in alternate formats to ensure that all women have the information they need. Treatment must be holistic, multidisciplinary, and offer a range of choices along a continuum of peer support, community treatment, day programs, brief intervention, and long-term treatment. The interventions must take the developmental level of the woman or girl with a disability into account and be appropriately tailored for their needs.
There's a lot of discussion in the presentation about the concurrent addiction but not much discussion on the appropriateness of addiction treatment modalities in helping manage compulsive aspects of eating disorders. More research is needed to help see if addictions modalities could assist eating disorder treatment.
Remove barriers to mothers with disabilities and eating disorders who need to go to treatment. I give Alberta as an example where, under the Child, Youth and Family Enhancement Act, if a child is in care for 200 cumulative days, they move to make the child a permanent guardianship order. If a mother has no other place to care for her children than in temporary foster care, this is a discriminatory measure. We are not sure if this measure is similar in other provinces. In order to provide a structure and framework for therapy, access for determinant of health must be in place.
Justice also has a role to play with mental health diversion and the Elizabeth Fry Society, when people are arrested for stealing to finance binge cycles, as well as ensuring that adequate treatment opportunities exist for women and girls with disabilities.
Women and girls with disabilities must have positive media coverage. Women and girls with disabilities must have access to programming in which they can see their own lives and realities reflected in the Canadian discourse. The CRTC needs to be more active in promoting these measures.
Ever mindful of the slippery slope of assisted suicide—and I bring this forward because it's such an important issue in the Canadian discourse today and such an important issue to people with disabilities—we look at the risk for women with disabilities being valued less for scarce treatment resources because the younger person was perhaps seen as more viable. So she, as a 53-year-old woman, was left for nature to take its course. That's referring to Dr. Woodside's testimony of November 28, 2013.
In countries where euthanasia exists.... The case of Ann G, a 44-year-old woman with anorexia nervosa who died by euthanasia is one in a series of cases that have come out of Belgium, including recent cases, again, as a sidebar, that include the euthanizing of baby girls with spina bifida.
The human family in Canada simply must offer better to all of its citizens, including women and girls with disabilities.
I'm looking forward to preparing a written brief. We had less than a week's notice, so we were not able to prepare it for today, but I wanted to indicate that we would be recommending that the committee also hear from a young woman named Kaley Roosen, who's currently pursuing her Ph.D. at York University. Ms. Roosen's thesis and research is focused on eating disorders and women with physical disabilities. In addition, we will bring some important findings from her research in our written brief.
Thank you.