8. ISSUES OF MARGINALISATION At Eating Disorders Queensland (EDQ) we use a person-centred approach to tailor our services to ensure we meet the individual’s needs and to reduce marginalisation.
We are committed to intentional health promotion to reach those experiencing marginalisation. We acknowledge the structural and cultural forms of marginalisation present in our society and actively work towards a more equitable social system. The first guidelines here are general ones for approaching issues of marginalisation and valuing the intersectional nature of our life experiences. The following guidelines stem from the seven major forms of marginalisation that EDQ has identified and work with. 52. Become aware of relevant social / cultural / political beliefs in society that create marginalisation and the intersectional nature of their impacts. Intersectionality is a concept first developed by Kimberle Crenshaw91 to describe the ways in which privilege and disadvantage interrelate to create multiple forms of oppression through race, gender, disability, sexuality, class and other social categories92.
The construct of intersectionality is rooted in the scholarship of Black feminists and critical race theorists who recognised that multiple social identities operate both independently and interactively to determine risk of discrimination, disadvantage, and disparity93. While it is true that eating disorders occur in both males and females, in children, adolescents, adults and older adults; across all socio-economic groups; and from all cultural backgrounds94 the reality is more complex than this. Access to services, finances, as well as a range of other forms of marginalisation, all impact to make both the eating disorder and the access to treatment more complex. Recent research suggests that there are definite advantages in adopting an intersectional approach to eating disorders and that it appears that the risk of developing an eating disorder is greater with the compounding effect of different identities co-existing95. Workers need to be aware of the many social and structural processes that create marginalisation as we work with clients from a person-centred approach. Workers should be encouraged to undertake training with other specialist services in a range of issues of marginalisation and to develop an awareness of the
social issues that impact on client’s lives. It is inevitable that all workers will carry some biases and at times will find themselves making judgements. A reflective approach to practice should be employed and these issues actively processed with supervisors. As workers, we can all learn a great deal from listening to the stories and experiences of our clients and advocating for their rights. 53. Each client is unique and is the expert of their own life and experiences. Many clients with an eating disorder have been affected by multiple issues and infringements of their social and human rights and this understanding is crucial to the provision of quality service delivery. Workers must consider all factors that impact on a person’s life and their experience of their eating disorder. This means acknowledging that each person is the expert over their own lives and we as practitioners, cannot possibly know, or be aware of, the many life experiences that have formed who they are as a person96. Workers require a degree of humility in deferring ‘to the client about the client’. Only the client can know what is best for them and we as workers bring a kind and compassionate curiosity to these interactions. As workers it is our role to develop a collaborative understanding of the meaning and impact of life events on the client’s sense of self and to use this understanding to inform our approach to practice. While workers acknowledge the different intersections that clients identify as central to their experience, we also carry hope that they will regain a sense of agency and freedom of choice in their lives.
Crenshaw, K. W. (1989) ‘Demarginalizing the Intersection of Race and Sex: A Black Feminist Critique of Antidiscrimination Doctrine, Feminist Theory, and Antiracist Politics’, University of Chicago Legal Forum, 139–67. 92 Rice, C. et al. (2020) ‘Bodies at the Intersections: Refiguring intersectionality through queer women’s complex embodiments’, Signs, 46:1, 177-200. 93 Cole, 2009 cited in Burke, 2020:1605. 94 National Eating Disorders Collaboration (NEDC) (2012) An Integrated Response to Complexity: National Eating Disorders Framework, Report to the Australian Government Department of Health and Ageing, March, pp. 2. 95 Beccia, A. L. (2019) ‘Risk of disordered eating at the intersection of gender and racial / ethnic identity among U.S. high school students’, Eating Behaviours, 34, 1-7; Burke, N. L. et al. (2020) ‘Where identities converge: The importance of intersectionality in eating disorder research’, International Journal of Eating Disorders, 53:10, 1605-1609. 96 Brown, L.S. (2018) Feminist Therapy, 2nd edition, APA: Washington. 91
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