The underlying challenges of eating disorders are no different in Jewish patients than others. But The Renfrew Center’s liaison to the Jewish community, Sarah Bateman, LCSW, spoke to the AJT about the center’s Jewish programming and specific struggles and successes of Jewish patients.
“We don’t have numbers [on Jews with eating disorders] but we know it’s a problem,” she said. “I try to stay really focused on how it manifests differently.”
The Renfrew Center, which has several locations including one in Atlanta, aims to ensure that Jewish patients are comfortable and accommodated for all levels of observance while in the program, such as keeping Shabbat, celebrating holidays and eating kashrut.
“Since 2009 we’ve had special programming for Jewish women with eating disorders, which we are in the process of reworking right now,” Bateman said. “For the past two years we’ve been using a unified treatment model developed from David Barlow’s Unified Protocol. … One of the things we’re doing now is looking at Jewish values and seeing how they can help with this treatment process.”
Bateman explained that initially, Jewish patients who wish to can undergo an assessment in which they discuss levels of observance and necessary accommodations.
“We also assess how their beliefs and Judaism, more generally, affect them and may have affected the development of their eating disorder, and what accommodations we can make for them,” she said. “That can mean anywhere from kosher food to working through issues with specific groups.”
She noted that a values-based approach was a core part of the center’s unified treatment model, and using Jewish values with Jewish patients is especially important. For example, she said, “Life comes first in Judaism, and that’s something we repeat a lot. These behaviors are harmful, and there’s a higher mortality rate with anorexia than any other mental illness. It’s not just about wanting to look thin; this is a deadly mental illness.”
While often holidays can be difficult times for patients, Bateman explained that Jewish practices can also create those same difficulties.
“Obviously we have Shabbat, so while I have non-Jewish patients coming to me around the holidays asking, ‘How do I get through a holiday meal?’ Jewish patients deal with that every week,” she said.
Simply shifting the mindset around that can be a big step, Bateman said.
“Instead of looking at that as: I do this every single week, what am I supposed to do? We can look at it as an accomplishment: I do this every single week!” she said. “We can plan for this and make it a part of your meal plan and treatment plan.”
With the high holidays quickly approaching, Bateman also mentioned a few of the challenges for those recovering from eating disorders around holidays, especially those that are traditionally centered around food.
“It’s very challenging, and it’s the same thing with Jews and non-Jews. It’s really important to take the focus off the food and think more about the holiday. Why do they observe it? Is there a way for them to consciously put the focus on something other than the food?”
She added that even with holidays like Passover, where the traditions can seem so directly tied to a meal, there is more to it.
“Unfortunately, we put the focus on the meal a lot of the time. … Being able to enjoy the meal and get that feeling of fulfillment is an important part of treatment, but we don’t want the focus to be all on the food,” she said.
Fasting is another big question for Jewish patients and Bateman noted that there is no specific rule stopping those with eating disorders from fasting, but additional caution is warranted around Yom Kippur.
“There are guidelines that we work with a rabbi to enforce. Someone with a history of anorexia, who has been very restricted and has been triggered similarly in the past, should not fast at all,” she said. “It can be extremely challenging for someone with an eating disorder to not fast. There are concerns about being different from everyone else who is fasting that often come up.”
She recommended using the high holidays as a time for reflection.
“If we use this as an opportunity to think about what we want and what we believe in and set some positive, healthy goals, we can work on tolerating the emotions,” she said “We can ask: Are my behaviors matching my beliefs?”