How to promote health without being healthist

Have you ever felt suffocated by the pressure to be healthy? To eat “clean food,” run 5ks, go vegan, lose weight, tone up, eat paleo, buy agave nectar, do Crossfit, meditate, track your steps, count calories, eat organic, go paraben-free, switch to coconut oil, try acupuncture, use a Himalayan Salt Lamp, or quit sugar?

Do you ever feel like a bad person for failing to meet this standard of health so clearly articulated on sites like Pinterest?

health on pinterestWhen it’s your job to promote health, it’s also your responsibility to be aware of the barrage of health messaging out there and of the way it can make people feel: confused, overwhelmed, frustrated, insufficient, lazy, incapable, flawed, ugly, less-than, defeated, worthless, or even hopeless.

I’m going to throw out a radical thought experiment. What if I chose to be unhealthy? What if I simply opted out our contemporary culture of wellness? What if I decided that I didn’t care about longevity or preventing disease? What if I wasn’t interested in athletic pursuits? What if I was happy with my life without any of that stuff?

Would that make me a “bad” person? Would that make me less deserving of civil rights and legal protections? Healthcare? Federal or state assistance? Education? Would it make me less deserving of respect? Kindness? Compassion?

What if rejecting the active pursuit of health and wellness was a valid choice? 

Believe it or not, I do think it’s a valid choice. This may be surprising coming from a public health professional. But I think it is especially an important perspective for health professionals to have. My job is to promote health and wellness as well as to prevent and alleviate illness, violence, and suffering in the community I serve. Convincing people to care about their health and wellness is part of my job, but it’s something that has to be done carefully and thoughtfully so that I do not fall into the trap of perpetuating an oppressive culture of “healthism.”

What is Healthism?

The term “healthism” can be traced back to a 1980 article by political economist Robert Crawford, “Healthism and the medicalization of everyday life”:

Healthism represents a particular way of viewing the health problem, and is characteristic of the new health consciousness and movements. It can best be understood as a form of medicalization, meaning that it still retains key medical notions. Like medicine, healthism situates the problem of health and disease at the level of the individual. Solutions are formulated at that level as well. To the extent that healthism shapes popular beliefs, we will continue to have a non-political, and therefore, ultimately ineffective conception and strategy of health promotion. Further, by elevating health to a super value, a metaphor for all that is good in life, healthism reinforces the privatization of the struggle for generalized well-being. –  Inlt J Health Serv

Implicit in healthism is morality, a driving force behind public health since the Civil War. The sanitation movement of the 1860s and 70s was largely led by the social (and moral) reformers of the Women’s Christian Temperance Union, who fought unsanitary living conditions and prostitution in the same breath.

Sylvester Graham (of Graham Crackers) and later Dr. John Harvey Kellogg (of Kellogg’s Cornflakes) were practicing healthists in the 1880s. They believed in a connection between immorality and disease, and prescribed bland foods and abstinence (from masturbation especially) as part of a healthy lifestyle that would produce a “higher. purer, and nobler type.”

Petr Skrabanek, whose 1994 book The Death of Humane Medicine and the Rise of Coercive Healthism explored this issue, wrote that healthism begins when all human activities are judged according to their health impact, and deemed either “healthy” or “unhealthy”, “responsible” or “irresponsible”, “acceptable” and “not acceptable” based on this measure. Skrabanek goes further to claim that “healthism either leads to, or is a symptom of, incipient totalitarianism … Healthism justifies racism, segregation, and eugenic control; for the healthist, what is ‘healthy’ is moral, patriotic, and pure; while what is ‘unhealthy’ is foreign, polluted, and impure.”

In his review of Skrabanek’s book, Bryan Appleyard wrote:

Skrabanek has two arguments against healthism. First he insists that this kind of pressure and coercion amounts to a fascistic imposition on the lives and freedom of individuals.

And, secondly, he points out that most of the healthist assumptions are either not proven, wrong or highly biased. For example, he says that screening – a central doctrine of healthism – has been found to have no health benefits, but that this finding has been suppressed. And he regards the caring of the healthists as a hypocritical cover for crude authoritarianism.

‘As healthism is driven by power,’ he writes, ‘rather than by concern for the welfare of fellow men, it is devoid of any moral principles.’

, calls healthism “the new Puritanism“:

Healthism is an avenue for subliminal narcissism. There is something seductively deterministic and morally appealing about eating like a cheese-fearing vegan rabbit and looking better, living longer and getting 50 % of the insurance premium back thanks to Affordable Care Act’s Zen-sounding Wellness provisions.

In short, healthism is the new puritanism. The old puritans worked for God’s glory with a famed work ethic which, according to Max Weber, might have been the chiefly responsible for the success of capitalism.

The righteous, mirthless, po-faced, lycra-clad new puritans are forever punching numbers in to risk calculators and obsessing over arbitrary thresholds of LDL-cholesterol whilst watching the Dr. Oz show with the fastidiousness with which the old puritans internalized Leviticus, lest they miss another opportunity for a miniscule relative risk reduction.

Fall Ferguson, Assistant Professor of Health Education at John F. Kennedy University and current President of the Association for Size Diversity in Health says:

Healthism includes the idea that anyone who isn’t healthy just isn’t trying hard enough or has some moral failing or sin to account for … More subtly, healthism represents the widespread ethic of individual responsibility for health in our culture. In the debate over U.S. health care reform, we obsess over the health of individuals, whether it’s reshaping individual behavior to our liking or finding ways to pay for the expensive treatment protocols that we see as being needed because of people’s personal “failure” to care for their own health.

At best, “healthism” refers to a cultural preoccupation with health. At worst, it describes an ethical paradigm in which certain health behaviors are considered moral imperatives and a person’s value and character is judged based on their adherence to those behaviors. A person might also be denied services, benefits, and rights based on their adherence to those behaviors. This is highly problematic.

People engaged in the work of health education/promotion, public health, medicine, nutrition and fitness, etc., must be aware of the pitfalls of healthism, and try to avoid them whenever possible.

Why is healthism bad for INDIVIDUAL HEALTH?

Obsession is not healthy, even if it’s an obsession with health. Encouraging or condoning this kind of preoccupation or obsession in others can be seriously detrimental to their mental, emotional, and physical health. It’s what leads to disordered eating and exercise behaviors, as well as what some are calling “orthorexia nervosa” – a rigid fixation on food quality and purity. It teaches people to ignore their body’s signals – to “push through the pain” – resulting in injury. It robs people of time and resources that they otherwise could put towards fostering social connections, creative hobbies, community service, and other worthwhile pursuits that foster well-being and happiness.

Healthism also creates and encourages stigma, particularly fat stigma. By promoting this idea that “fat = always unhealthy” (which is just not true), fat people are singled out as failing to uphold their “personal responsibility” to maintain their health. As a result, they are labeled as “lazy,” “ignorant,” “lacking willpower,” “gluttonous,” “greedy,” etc.

Whoever came up with the idea of making dieting about health is simply brilliant. Now, society can be prejudiced, but it is ok because it’s about health. Now, you are not shallow if you focus all your attention on dieting, you are righteous. And, whoa be to you who do not diet – for thou art sinning! – Lonie McMichael in Talking Fat

If fat people are automatically “sinners” by virtue of being fat, then it becomes socially acceptable to insult them or shame them. In some cases it can even be seen as a moral imperative to insult and shame them, especially if one believes that will cause them to lose weight. But being fat does not necessarily mean someone is unhealthy. And not only is insulting and shaming people a generally shitty thing to do, it DOES. NOT. HELP. PROMOTE. WEIGHT. LOSS. In fact, it can result in weight gain. So, not only is it cruel, it’s detrimental.

laci green quoteWhy is healthism bad for PUBLIC HEALTH?

Another major problem with healthism is that it tends to focus the attention and resources of public health work on fostering individual behavior change, when we know that social determinants of health influence our health more than individual behaviors do. Public health professionals and health educators pay a lot of lip service to the socio-ecological model intended to address these social determinants.

S-E-ModelYet, due to the influence of healthism, health professionals tend to concentrate most of their efforts at the individual level. Fall Ferguson writes:

In my own field of health education/health promotion, there is a disturbing disconnect between the evidence about the social determinants of health and the profession’s focus on changing individual health behaviors. Even “ecological” approaches to health education, which are inspired by systems perspectives that highlight the interconnected web of health causes, tend to focus on the end result of changing individual behavior rather than collective solutions to health issues. A 2012 article in Health Education and Behavior reviewed 20 years of reported ecological health education interventions; the article acknowledged the field’s shortcomings in this arena, and noted that in addition to certain structural barriers, we may need to move past our own training: “health educators may not have the training or resources to successfully plan and implement institutional-, community-, or policy-level programs.”

Maybe it’s more than just our training that holds us back. Maybe we need to acknowledge our basic healthism instilled by our cultural milieu as well as our professional training. And maybe we need to unpack the privilege that has allowed us to focus so much attention on the role of individual behavior in health.

Why is healthism bad for SOCIETY?

Today we often speak about eating and exercise in terms of morality, often to the point of absurdity. Amy Schumer did a great job of calling out the way we self-flagellate for eating dessert in her sketch, “I’m so bad!”

But this is one symptom of a much bigger problem. Healthism is a social justice issue. To focus on wellness requires resources, namely money, access, and time. This is a matter of privilege. Who has access to organic foods in their neighborhood and who does not? Who can afford childcare in order to exercise and who cannot? Who has healthcare benefits and who does not? Who can devote time to their meditation practice and who cannot? Fall Ferguson writes:

It seems to me that healthism is reflective of deep privilege; it is (in my opinion) a classic “first-world” problem. Healthism can only thrive in a culture where the dominant groups do not have to worry about such things as famine, infectious disease, war, poverty, and hatred as factors that affect their health. It’s privilege that allows us to make health a “project” that we can judge others for not taking up.

Those with lower socioeconomic status do not always have the luxury to focus on their wellness, especially if they are struggling with the basics of Maslow’s Hierarchy of Needs, like safety, housing, and hunger. We cannot talk health behaviors as “necessary” or “essential” or “mandatory,” (as in, “eating GMO-free is basically mandatory”) when they are often beyond the reach of lots of people. We must not judge people for failing to prioritize wellness based on our assumptions about their lives and our paternalistic ideas about what is best for them.

We also must remain vigilant and push back against legislation and policies that discriminate against people based on their health. As Ragen Chastain, educator, activist, and fitness enthusiast, frequently reminds us: “the rights to life, liberty and the pursuit of happiness are inalienable and not size, health, or healthy habit dependent.

The good news? There are things we can do to help avoid the pitfalls of healthism.

Here are some tips for health professionals:

  • Do not focus your work solely on individual behavior change. Make sure that you’re spending equal, if not more, time and resources on addressing social determinants through policy and environmental approaches. If your wellness program is focused solely on individual behavior change and there is no additional support for addressing social determinants in place, you need to rethink your program.
  • When sharing health promotion knowledge/tips/techniques/advice, always start with a disclaimer. For example, “Nobody has any obligation to participate in exercise, however for those who would like to participate – or just learn about the benefits of physical activity- I’m going to share the following info and tips.” Remind people that their heath habits have no bearing on their worth, their moral “goodness,” or their human and civil rights.
  • Be reasonable with your goals and expectations. Not everyone has to have the body of an athlete. Not everyone has to eat like a “health nut.” When you share guidelines, make them reasonable for the average person. Remember that for some people, the absence of illness and suffering is healthy enough, and that’s their choice and it’s valid.
  • Do not impose your beliefs about health and morality on your patient/client/student by automatically assuming they want to lose weight or devote time and other resources to fitness, nutrition, wellness, or weight loss. Use motivational interviewing techniques to find out what their motivations are for seeking help and work from there. Find out what they believe and respect their goals and value system.
  • Understand that shame and guilt are NEVER good motivators. Under any circumstance. Not only do they NOT WORK, they have a negative impact on a person’s mental and emotional well-being and can actually discourage them from participating in healthy behaviors.
  • Help every person cultivate a positive body image. It will not “promote obesity,” I promise.

Have you encountered healthism in your life or work? Have any other tips for how to avoid these pitfalls? Please share your thought and experiences in the comments!

The Thing About Being a Fat Health Educator

I am a college health educator and I am fat. I suspect that people do a mental double-take when I introduce myself as a health educator. My educated guess is based on the fact that fat stigma exists. In 2009, Salon published an article asking if Dr. Regina Benjamin, a renowned MD and recipient of the MacArthur genius award, was “too fat” to be Surgeon General. If folks are asking that about her, it’s not much of a stretch to imagine they’re wondering about me too. But here’s the thing. I don’t think my weight has any bearing on my qualifications as a health educator, and here’s a whole list of reasons why.

  1. Nutrition, fitness, and weight management are only one small part of a college health educator’s job. Depending on a college’s size and organization, they may not be in the job description at all. For example, my job description instructs me to spend at least 60% of my time on alcohol and drug abuse prevention, with a secondary focus on running our peer health education program. My next prescribed priorities are stress management, sexual health education, tobacco cessation, and sexual assault prevention. In my copious spare time (sarcasm alert) I attempt to cover the rest, including cold and flu prevention, cancer prevention, eating disorder prevention, and education around sleep, nutrition, and fitness.
  2. Not every health educator became a health educator because they’re a nutrition and fitness enthusiast. In fact, a lot of college health educators get into this field because of the badass health topics we get to cover: sex, drugs, and rock n’ roll. My academic interest in sexual health politics (the HIV epidemic, Roe v. Wade, etc.) are what led me to this field; learning more about other wellness topics in the process has been a bonus.
  3. You can’t accurately judge my health status based on my weight. Health does not equal thin. Plenty of thin people engage in unhealthy behaviors, and plenty of fat people engage in healthy behaviors. It is folly to assume that you know anything about a person’s health based on their appearance.
  4. Sometimes being a fat health educator can actually come in handy. Students struggling with weight, body image, or eating disorders sometimes feel more comfortable speaking with someone who they believe can relate to their experiences. Just as they might judge fat health educators as being able to relate to those experiences, they may judge thin health educators as being unable to understand their struggles. Clearly, you cannot tell by looking at a person whether or not they have struggled with weight, body image, or eating disorders, but it’s not far from the mark to assume that a visibly fat person has probably experienced fat stigma and can relate to what that feels like. The desire to receive help and support from someone who shares your experience or perspective is not unique to this issue. For example, many people struggling with substance addiction seek help from other recovering addicts. We see this in the sponsorship model in Alcoholics Anonymous and Narcotics Anonymous. It’s also not surprising that at any given time, 37%-57% of addiction counselors are in recovery themselves. I do not intend to equate the experiences of being fat and addiction because they are two completely different things. But sometimes it really helps to talk to someone who’s been there, you know what I mean?
  5. As a fat health educator, I know first-hand that nutrition, fitness, and weight management are not easy or simple – despite what some people would have you believe. I also know first-hand the unintended consequences of talking about weight management as if it were easy, simple, or even attainable for the majority of people. Those unintended consequences can range from frustration to self-hatred, from “fat talk” to dangerous disordered eating and exercise behaviors. As a result of this knowledge and experience, I am incredibly careful in my messaging around nutrition, fitness, and weight management. I avoid using calorie counts because those numbers can be triggering for people struggling with eating disorders. I stress Health at Every Size – a philosophy that promotes healthy eating and exercise behaviors for their own sake, regardless of whether or not they result in weight loss. I do not promote dieting, but I do promote making healthy dietary choices. I teach nutrition, fitness, and positive body image within a framework that supports an understanding of wellness as multi-dimensional – and I trust students to decide for themselves which dimensions they will prioritize.

It has been suggested to me that I should lose weight in order to be “taken seriously” as a health educator. This is so, so, so problematic on so many levels.

First of all, this is essentially saying that in order to escape the consequences of fat stigma, I should stop being fat. That’s a bit like suggesting a black person change their race in order to avoid the consequences of racism in the workplace, or that gay people stop being gay in order to avoid the effects of homophobia. With social stigma, the morally correct response is to fight to end the stigma, not eliminate the group of people who are stigmatized.

To be sure, being fat is different from being black or gay. I do not mean to equate these different experiences of oppression. Instead, I am suggesting that it’s not really helpful to think of being fat as something a person can necessarily change.

People do not always have control over the circumstances of their lives, especially in regards to health and disability, access to medical care, and financial security. Sometimes people may have medical reasons why they cannot lose weight. For others, the time, money, and energy it would require to lose weight may be more than they have to give. To assume that every fat person could lose weight if they chose to is a hugely reductive perspective, based in stigma, that denies fat people the right to their own individual stories, situations, and experiences.

To get more personal, I guess I could be classified as a person who “could” lose weight if I chose to. The thing is, I have made that choice in the past and it didn’t go so well for me. You can read all about in “My Breakup with Exercise.”

From my past experience, I know that In order to be a thin health educator, I would have to sacrifice to a degree that would have an overall negative impact on my life and personal wellness, as well as my job performance. For me, maintaining a low body weight is a mentally exhausting and extremely time intensive endeavor. It requires devoting nearly all of my free time to exercise and meal planning, to the extent that I do not have enough time or brainpower leftover to hang with friends, see shows, or work on creative projects like quilt-making, comedy writing and improv, and this blog.

The “decision fatigue” from focusing so much attention on food choices would also take its toll at work, leaving little decision-making power for my actual work. Plus, have you ever tried to go a whole work day on yogurt and salad? It’s not easy to keep that upbeat smile going when you’re hungry and irritable, and it’s definitely inconvenient when a serious one-on-one with an at-risk student is continually interrupted by your stomach growling.

However, with moderation, I can maintain a decent level of health without making those kinds of sacrifices. I may not be thin, but I can live a full life and perform my best at work.

For me, wellness continues to be a journey.

A Softer World

Each year I adopt new behaviors to improve different dimensions of my health and wellness. My priorities may change, but I will be continuing this journey for the rest of my life. My weight may or may not fluctuate as a result of my choices, but I refuse to think any less of myself for doing health education – or any work, for that matter – in a fat body.

So the next time you judge a health professional for being fat, take a step back and check your prejudice. It is up to all of us to create a future where professionals are judged not by their appearance, weight, race, ethnicity, religion, gender, sexuality, or gender expression, but by the quality of their work.

WTF is “lifestyle change” supposed to mean anyway?

lifestyle changeIf you’re like me, you’ve heard the term “lifestyle change” thrown around quite a bit. For example, it was used plenty of times in the comments on my recent post, My Breakup with Exercise. People are always saying things like, “It’s not about dieting, it’s about making a lifestyle change.” But oftentimes one person’s “lifestyle change” is another person’s diet, and vice versa. So WTF does “lifestyle change” actually mean?

Growing up, I first heard my parents use the term to describe a family friend and the healthy changes she made many years ago. Even then I was confused because her story began with everyone’s favorite diet company, Weight Watchers. Even though she no longer follows the program, she continues to practice some of their tips and tricks to maintain her weight, like tracking what she eats, looking for foods high in fiber, etc. A relative told me about a coworker who “doesn’t diet” but just has “plus days” and “minus days”; if she had a “plus day,” she’d compensate by having a “minus day.” To me, this all still sounds like dieting because it involves monitoring your food intake, following food “rules” or restrictions, and placing value judgements on foods or eating habits as being “good” or “bad.” Of course, you might not agree, and that’s okay.

Although the intention is usually good, telling someone to make a “lifestyle change” is problematic because everyone’s understanding of what that means is different. For example, it could mean switching to sugar-free versions of your favorite foods, or it could mean never eating artificial sweeteners ever again. Those of us who struggle with weight and body image often understand the term to apply to eating and exercise behaviors, but for others it could refer to quitting smoking or taking up a meditation practice or switching to paraben-free bath products.

The beauty of the term, though, is that it can mean whatever you want it to mean — whatever makes sense to you.

At it’s most basic level, a “lifestyle change” means making changes to support one’s personal wellness. Did you know that there are actually seven different dimensions of wellness?

  • Physical wellness can include fitness, diet and nutrition, sexual behavior, substance use or abuse, medical care, and sleep.
  • Intellectual wellness can include the pursuit of knowledge, awareness of current events, and the expression or experience of creativity.
  • Emotional wellness can include stress management and relaxation, as well as self-awareness, self-acceptance, and mental health.
  • Social wellness can include interpersonal relationships, social justice, and community service.
  • Spiritual wellness can include your value or belief system (including but not limited to religion), and finding personal meaning, hope, and optimism.
  • Environmental wellness can include the protection and conservation of natural resources, as well as the health and safety of animals, humans, and our own bodies.
  • Occupational wellness can include job satisfaction, work/life balance, and financial security.

It’s helpful to consider of all of these dimensions because it reminds us that neither our worth nor our happiness nor our “wellness” is defined by our appearance, our fitness, or our diet. Part of figuring out what making a “lifestyle change” means to you is figuring out what dimensions of wellness you want to pay more attention to–recognizing that each are equally valid and important in your personal pursuit of health and happiness.

Last year I taught a course on leadership and we used a ranking activity to help students think deeper about their own values. (Mad props to Steve R. for the activity!) I modified it and I think this version could be helpful in terms of figuring out what “lifestyle change” you might be interested in. Below are 50 different things that could be part of making a healthy “lifestyle” change, in no particular order.

 Weight management

 Fitness/ Strength

 Smoking

 Religious belief & practice

 Community Service

 Finances/debt management

  Job satisfaction

 Inner Harmony

 Environmental conservation

 Social Justice activism

 Hope/Optimism

 Stress management

 Animal rights

Being active

  Nutrition

 Vegetarian diet/ vegan diet

 Mindfullness/ meditation

  Sleep

 Creativity/ Creative expression

 Sexual pleasure/sex life

 Family relationships

 Social life/ friendships

 Avoiding processed foods

 Career Advancement

 Romantic relationships

 Pursuit of knowledge

 Alcohol use/abuse

 Medical care

 Sexuality/ gender identity and expression

 Self-care/ Self-compassion

 Awareness of current events

 Political involvement

 Mental health

 Avoiding artificial sweeteners

 Body image

 Reducing intake of chemicals in bath/beauty/cleaning products, etc.

 Intuitive eating/mindful eating practice

 

 Self-acceptance

Avoiding artificial growth hormones in meat/dairy

 Drug use/abuse

 Community engagement

 

Experiencing new things/places

Eating less sugar/high fructose corn syrup

 JOY!

FUN!

 Eating whole grains

 Work/life balance

 Hobbies/skill development

 Gratitude

 Eating local/food sustainability

 

 Intimacy

Okay, here’s the hard part. Here’s the link to download and print it out: Defining your Wellness Values Chart

  1. Cross off the 10 that either a) you’re already satisfied with, or b) that are least important to you right now. (Remember that this doesn’t mean these things are unimportant, just that they are less important to you, right now, than the remaining 40.)
  2. Now cross off 10 more (30 remaining). Give yourself a time limit.
  3. Now cross off 7 (23 remaining). Take a quick break and then come back to it.
  4. Now cross off another 7 (16 remaining).
  5. Cross off 6 more (10 remaining). This is getting tough, huh?
  6. Cross off 5 more (5 remaining).
  7. Circle the most important wellness element to you at this point in time.

I just did this activity and it was really freaking hard, but I narrowed my top 5 wellness elements to: building fitness/strength, improving family relationships, self-acceptance, intuitive eating, and reducing my intake of chemicals, These are the areas I want to focus on to improve my overall “wellness.” So, for me, a “lifestyle change” means working out, accepting myself the way I am, finding more ways to make meaningful and positive connections with my family, listening to what my body wants, and staying away from processed foods and chemicalized bath and beauty products.

The thing about changing your lifestyle is that it has to be something you actually WANT to do. Wanting to lose weight because you struggle with body image is not the same thing as wanting to change the way you eat. For example, the person in that scenario might experience more success and actually feel better by choosing to focus on positive body image and building self-esteem.

Only you know what a “healthy lifestyle” means for you. And if you’re not sure yet, perhaps this activity will help.

Let me know how it goes! I am hoping to try this with my students next year, and your feedback will be super useful.

 

 

Bystander Education is Not a Silver Bullet

Bystander intervention education is great. I really believe in its power to make the world a better place, and to make college campuses safer and more welcoming for all. But I also believe that bystander education won’t do much to prevent sexual assault until we agree that sexual assault is a gendered issue, and that sexism is still a big, fat, effing problem.

Let me explain.

Bystander education teaches students how to step in and intervene when they see or hear something that’s not okay. When they witness someone in trouble. But it will never be effective at combating sexual violence or harassment if we can’t even agree on the basic premise that yelling at women on the street is not okay. Or that having sex with a really, really, blacked-out, drunk person is not okay. If that’s where students are stuck, then bystander education is a waste of everyone’s time. Those students don’t need bystander education. They need Sexism 101.

But do students get taught Sexism 101? Ever in their 12 years of grade school? Nope. Not one bit. Why not? Because we – the adults – can’t even agree that sexism still exists.

DESPITE THE FACT that most women experience street harassment on a daily basis. DESPITE THE FACT that most women would love to “Lean In,” except for that whole bit about how it so often backfires because nobody likes an assertive woman in the workplace. DESPITE THE FACT that most women have experienced being groped by a stranger at a dance club. DESPITE THE FACT that even the supposedly-feminist “girl’s” toys are pastel pink. DESPITE THE FACT that news about women is a separate category on news sites as if women were a special interest group instead of half the population. DESPITE THE FACT that intimate partner violence is a leading cause of death for pregnant women. DESPITE THE FACT that Game of Thrones Director Alex Graves thinks a textbook rape scene isn’t rape. DESPITE THE FACT that rape-threats and death-threats are “just another day at the office” for female bloggers. DESPITE the wage gap, slut shaming, “BLURRED LINES,” and multiple pro-rape Fraternities, we still can’t reach consensus that women are marginalized in America.

Hades angry gif

Despite all evidence to the contrary, respectable, educated people still argue that sexism isn’t a thing anymore. That we are living in a “post-sexist” America. (Just like we are living in a “post-racial” America, amirite?) But not only are they arguing that feminism succeeded and we’re fine now, they’re giving space in publications like the New Republic to voice the concerns of MRA’s who think that men are now the primary targets of gender discrimination, and who have been known to harass, stalk, and bully feminist writers and activists to further their cause.

really

Some college students respond really well to bystander intervention education. They recognize the problem and want to help. Other college students think that bystander education is unfair and “biased” because sometimes men are the aggressors or perpetrators in various scenarios.* Try telling them the truth – that even though most men do not rape, 99% of rapes are committed by men – and they argue back that that’s one-sided. Biased. Unfair. Demonizing. The only sexual assault prevention education they’re interested in is one in which men and women are “equal,” regardless of the reality.

Equal?

tumblr_madf8iTGSD1qcp1zx

*The scenarios I use feature men, women, and the gender-neutral “Jamie” as aggressors, yet that special minority of students will still accuse me of bias against men.

As an educator, you have two choices. You can pretend that men and women are “equal” when it comes to sexual assault, thereby validating this inverted thinking and perpetuating the fallacy that women are just as likely to rape men as men are to rape women. And you can rationalize it by telling yourself “Well, if that’s what I have to do to get them to come to the table and talk about this stuff then it’s worth it.” You could do that. But you’d be wrong.

Sexual harassment and sexual assault are not equal. They are not even. They are not fair. They are gendered issues. Who are most likely to be victims? Trans people and women. Who are most likely to be perpetrators? Men. Sorry. That’s the reality.

Am I suggesting that men are evil? That men are hardwired to be horrible, violent, abusers? No. Not even close. Men and women are shaped by the society they live in, and our society is one that tells young men that women are asking for it, that drunk women are “DTF,” that women lie about being raped because they regret having sex, and that real men want sex all the time no matter what. That a boy being raped by a woman at age 8 will help him grow up to be a “beast” at sex. That being offended by homophobic slurs makes you a “pussy.” That the worst thing you can ever be accused of is being feminine – or gay, because it’s basically the same thing.

And even so, men who grow up in that society, espousing those hideous, sexist beliefs, usually don’t rape people. Except for a small few. But those hideous, sexist beliefs of the majority allow the violent few to rape with impunity. Because who would ever believe that drunk slut anyway, right? 

All the bystander intervention skills and techniques in the world won’t make a damned bit of difference to a student who won’t accept the simple premise that rape is real, and it is gendered. That “false rape accusations” are not happening as frequently as actual rape. That sexual harassment is actually harassment, and not a compliment.

The White House recently created a Sexual Assault Task Force and handed down a bunch of new mandates for colleges under VAWA and the Campus SaVE Act and Title IX. One of those mandates is bystander education. And I think that’s good and right and important. But nowhere in that recent White House report did it say anything about addressing sexism. Nowhere is anti-sexism education mandated. Some colleges have Women’s Studies programs and Women’s Centers and those are amazing. But plenty of schools don’t. And at those schools, no one is standing up and acknowledging that sexism plays a major role in campus sexual assault. No one is mandating that first year students take an anti-sexism seminar.

What about primary and secondary education? Grade schools have taken up the anti-bullying flag, but still, no anti-sexism flag. It’s okay to talk about being an active bystander and standing up to bullies, but it’s not okay to talk about sexism because the grown-ups still can’t agree that it exists.

Until we start teaching anti-sexism, bystander education can only do so much. When it comes to primary prevention – actually preventing sexual assault from happening – bystander education is not our silver bullet.

Until our students understand what sexism is, what it looks like, and the role it plays in perpetuating sexual violence against women and other marginalized groups in our global community, bystander education will not be effective as a primary prevention strategy to combat rape. Unless our students can understand and identify situations of sexual harassment and assault, bystander education will remain a solution to a problem-they-don’t-believe-is-actually-a-problem.

As an educator charged with the task of bystander education, I am frustrated. I love doing bystander education because when students are ready for it, it is the most fulfilling and inspiring and uplifting part of my job. But lots of students aren’t ready for it because they have no understanding of sexism or gender discrimination or gender violence. And who takes responsibility for that? Where is the accountability for that?

Addressing the sleep deficit, NOT one person at a time

The more I learn about health and wellness, the more convinced I am that sleep is magic.

Not only does getting the recommended 7-9 hours help you feel awake and refreshed in the morning, it also helps regulate your metabolism and improves your memory, focus, judgment, problem solving, and athletic performance.

New and terrifying research links not-enough-sleep (the 5-6 hours most Americans currently get) with weight gain, increased risk of cold/flu, diabetes, cancer, and ADHD-like symptoms. Additionally, not getting enough sleep results in poorer cognitive abilities (lack of focus, concentration, ability to remember what you’ve learned), poor judgment, and impaired driving on par with drunk driving. It’s also correlated with depression, anxiety, and other mental illness.

wE9muBx

When I saw this New York Times post basically summing it all up (and providing links if you want to check out the research) I was ecstatic and all “That’s what I’ve been saying!” Then I read the comments.

“You assume it’s a choice, that people actively choose to get less sleep and, if they want to, can choose to get more. That may well be true of upper class people who can hire others to do their work for them – housework, tutoring, etc. As for me, a middle class shlub, well, I would LOVE to get more sleep. But I am a single mom. I have to get up at 5:30 am for my job. And I have to work or I will land in the street with my kids. ANd I have to stay up at least until 10:30 pm most nights to get this or that child hither and thither, help with homework, and son on. I cannot hire anyone to do any chore– lawnmowing, housecare, homework, driving, shopping, bill paying, college planning for kids, etc etc etc etc. Basically, I work from the moment I get up until the moment I sleep. I have no time to exercise either.”

And it hit me. The sleep deficit is a lot like the obesity epidemic; it is a systemic problem that cannot be solved by encouraging individuals to make healthier choices.

I work with college students who probably could get more sleep if they spent a couple fewer hours playing videogames.

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Shit college students say.

Of course, some of my students work more than the recommended 10 hours per week and can’t choose to sleep more. But in general, I feel okay about trying to encourage them to prioritize sleep over partying or more time on Reddit because they can usually make changes without too much trouble. For the general adult population, however, this really isn’t the case.

The comments on the New York Times post read like a laundry list of reasons why Americans are not sleeping. Parents are kept up by new babies. Physicians-in-training are working 28-hour shifts. People who travel constantly for work (flight crews, journalists, musicians, etc.) are forced to keep irregular schedules in different time zones. Single parents are working full time jobs in addition to the “second shift” just to make ends meet.

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But it isn’t just our jobs, families, and full schedules that are keeping us up. The world has changed. Energy drinks and caffeinated latte drinks are sold on every corner and and marketed either as health supplements or entertainment. We are constantly connected, if not tethered to, our phones, tablets, and the internet — whether it’s for work, entertainment, or connection. A recent study found that the light from backlit screens can disrupt sleep by suppressing melatonin, a hormone that helps regulate our circadian systems. But this is even bigger than a gadget issue.

Our circadian rhythm, which is how our body knows when to sleep and when to wake, is informed by both light and temperature. Darkness and cooler temperatures let our bodies know it’s nighttime, and therefore bedtime. So what happens to our circadian rhythm when we live in consistently temperature-controlled environments? And about that darkness thing? Yeah. We don’t really have that anymore. Just check out these NASA images of the world at night.

Captured in 1994

Captured in 1994

Light pollution projected growth

Light pollution projected growth in 2025

So basically our artificial environment is  really screwing with our circadian systems, and we wonder why no one can sleep? Some scientists are even concerned that light pollution is killing off wildlife.

Animals need sleep too.

Animals need sleep too.

It’s no wonder that the New York Times post, which encouraged readers to get more sleep and discuss the issue with their doctors, made some people angry. For so many of us, sleep is simply outside our realm of control. Before I’ve made the argument that our obesity problem should not be addressed through individual behavior change because it is a systemic problem that can really only be solved through systemic changes to our environments and our policies. When we try to treat obesity as if it were simply an individual problem, it manifests as shaming people for things beyond their control. When we consider that sleep and weight are inextricably linked, it’s not surprising that the same thing happens when we tell people they need more sleep.

And, just like weight shaming can cause people to develop eating disorders or depression/self-esteem issues that lead to further weight gain, warning people about the health risks of sleep deficit can actually make the problem worse:

“As a law school graduate studying for the New York Bar and planning an impending move to NYC–without yet a job, praying to find one in public interest law–I lie awake every night, worrying.  But at least now I know all of the harmful things that are happening to me.”

“Constantly counting the number of hours of sleep I got each night hasn’t been good for my mental health either. It’s like counting calories. It made me obsessed. So I stopped.”

“One thing that would help me sleep is not being constantly told how awful it is not to get it.”

The Health Belief Model of behavior change tells us that if you scare people about a health issue without providing a clear solution for how they can prevent or treat it, they are not going to respond well. Telling folks the dangers of not getting enough sleep without providing realistic solutions will cause them to feel like it’s hopeless and shut down. This issue cannot be solved by telling people to try to get more sleep.

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So how can we address the sleep deficit at the systematic level? In college health we have an advantage because we have a fair amount of control over the environment our students inhabit. We have the ability to provide a campus that encourages and supports healthy behavior. We can close down our libraries, gyms, labs, and campus centers at 10 pm. We can ban 8 am classes to let our students sleep in later. We can mandate quiet hours in our residence halls. We can ban Red Bull and 5 Hour Energy from promoting their goods on campus. It’s a little more complicated in the real world.

tumblr_inline_mmq91iJGyJ1qz4rgpWhat could some of those systemic changes look like? Is it even possible to regulate light pollution in urban areas? How would we accomplish that? We could tax the crap out of energy drinks like we tax cigarettes. We could create similar disincentives for 24-hour service availability. For example, in Spain, most businesses are closed during siesta in the afternoon. People simply have to run errands another time, and they make it work. We could also place stricter regulations around the “full time” (read: eligible for benefits) work week, reducing it from the standard 4o-45 hours to something closer to 35. (Again, a lot of Europeans do it this way.)

But beyond regulation, true systemic change requires a culture shift. We need to foster a culture that doesn’t reward employees for putting in extra hours, or make anyone feel like they need to put in extra hours to keep their job. In industries where it’s possible, like in most office jobs, we need to institutionalize flex time and let workers telecommute in order to snooze that extra hour it would take to commute. We need to change the norm from one where we lie in bed with our phones checking email to one where that kind of behavior is uncommon. We could stop creating reasons for people to stay up late, like scheduling evening events earlier and no longer airing popular TV shows after 10 pm.

But this kind of societal change takes decades and requires tireless efforts from public health folks and other advocates. Perhaps the first step of that work is recognizing that the sleep deficit is bigger than you and your insomnia, her and her new baby, or him and his ridiculous work schedule. For those who can make the choice to sleep more, doing so will definitely improve their health. But the focus of public health messaging and health journalism should not be to scare or shame people who, for whatever reason, can’t get enough sleep.

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TL;DR sleep zombie friends?

What I’m really trying to say is that the only way to really address the issue is to treat society’s sleep deficit as the gigantic, systemic, clusterfuck of a problem that it truly is.

Goodnight.

Goodnight.

What sucks about condom snorting

Sure it’s a little gross to watch someone snort a piece of latex up their nose and pull it out through their mouth. We can all agree that it’s one of those stupid things young people do, just like sticking cinnamint gum wrappers to your forehead until it burns, piercing your own ears with safety pins, or standing against a wall while a friend runs into your chest to make you pass out. In my opinion, these types of shenanigans are developmentally appropriate; for the most part, everyone survives and grows out of it and it’s no big deal. The problem with condom snorting is not that teenagers are snorting condoms, but that journalists are having a field day with this because they’re snorting condoms. Like, condoms for sex.

For example, Kat Stoeffel writes in New York Magazine’s The Cut (emphasis added):

Teenagers are snorting condoms up their noses and pulling them out of their mouths, on camera and on the Internet, according to a Huffington Post report that raises more questions than it answers. A YouTube search for “condom challenge” yields more than 200,000 results, most of them NSFW due to gross noises. Is this the “gateway sexual activity”? Or is this what happens when there’s no sex ed? Is it an elaborate ruse to buy and possess condoms? And is this better or worse than the condom’s intended purpose?

Seriously? Let me clear this up.

“Is this a gateway sexual activity?” No.

“Is this what happens when there’s no sex ed?” No. What happens is one out of two young people will get an STI by the age of 25 and most wont know they are infected.

“Is it an elaborate ruse to buy and possess condoms?” No. Teenagers have every right, if not every imperative, to buy and posses condoms. Just like teenagers should own helmets, wear sunscreen, and use seatbelts, they should possess and use condoms. If they want to snort a few up their nose, so be it.

“Is this better or worse than the condoms intended purpose?” ARE YOU KIDDING ME?  Teenagers have sex. Condoms should be used for sex. Teenagers should use condoms when they have sex. Snorting condoms is not going to keep teenagers from having sex. There’s nothing wrong with teenagers having protected sex. Condoms are used to have protected sex. It’s really awesome when teenagers use condoms to have protected sex. Do we need to go around one more time?

I’m not sure what the health risks are of condom snorting, but I imagine choking is a legitimate concern. Still, it’s a fairly innocuous pastime compared to the expansive list of dangerously stupid things teenagers have devised to occupy their time, like skateboarding off rooftops, playing with fireworks, giving themselves homemade tattoos, etc.

The media hand-wringing over condom snorting is reminiscent of that of the cinnamon challenge, but this time it will have the added bonus of panic since this time they’re snorting lubed latex that’s made for (hushed whisper) s-e-x. 

This is a case where kids will be kids, and adults need to grow up.

Connecting the dots: Nice Guys™, MRAs, mass shooters, and aggrieved entitlement

A few things happened in the last couple weeks that stood out to me because they felt connected. About a week ago someone showed me the hot new tumblr, Nice Guys of OKCupid.

Never before has Nice Guy Syndrome been so clearly illustrated.

Not long after that, I got a spike in hits recently from a not-so-feminist-friendly forum and as you might imagine, the comments coming in have been … unkind. One pointed me to a blog called “A Voice for Men.” Up for a good hate read, I clicked. This is what I saw on the site’s masthead.

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Yep. Clear as day, right next to the words “compassion for boys and men” is an ad promising revenge on bitches with the graphic image of a bloody knife. So much for compassion. (This is also an example of their fine work.)

Men’s Rights Activism (MRA) is not a legitimate movement advocating for boys and men, but a vehicle for misogyny, violence, and hate. Even the Good Men Project, which has recently come under fire for their icky rape apologism, agrees that Men’s Rights is bullshit. David Futrelle wrote: “the more I delved into the movement online, the more convinced I became that, for most of those involved in it, the movement isn’t really about the issues at all—rather, it’s an excuse to vent male rage and spew misogyny online. To borrow a phrase from computer programmers: misogyny isn’t a bug in the Men’s Rights Movement; it’s a feature.”

MRA Marmoset gets it

Instead of advocating or protesting or doing anything really to better the lives of boys and men, MRAs just like to bash women and feminists in particular. And when I use the term “bash” I mean it both figuratively (complaining about them on the internet) and literally (advocating for violence against women, often supposedly “in jest”). And handy for them, MRAs’ misogyny is supported and reinforced by dominant cultural beliefs about women being manipulative, back-stabbing sluts.

Like everyone else, I’ve also spent a lot of time this week reading and reflecting on the horrific tragedy at Newtown’s Sandy Hook elementary school. I came across a great Examiner piece by William Hamby on school shootings and white, male privilege that introduced me to the concept of “aggrieved entitlement.”

Aggrieved entitlement is a term used to explain the psychology behind mass shooters, which have all been white males. It is perhaps best defined by Rachel Kalish and Michael Kimmel (2010) in their article, Suicide by mass murder: Masculinity, aggrieved entitlement, and rampage school shootings:

These perpetrators were not just misguided ‘kids’, or ‘youth’ or ‘troubled teens’ – they’re boys. They are a group of boys, deeply aggrieved by a system that they may feel is cruel or demeaning. Feeling aggrieved, wronged by the world – these are typical adolescent feelings, common to many boys and girls. What transforms the aggrieved into mass murders is also a sense of entitlement, a sense of using violence against others, making others hurt as you, yourself, might hurt. Aggrieved entitlement inspires revenge against those who have wronged you; it is the compensation for humiliation. Humiliation is emasculation: humiliate someone and you take away his manhood. For many men, humiliation must be avenged, or you cease to be a man. Aggrieved entitlement is a gendered emotion, a fusion of that humiliating loss of manhood and the moral obligation and entitlement to get it back. And its gender is masculine.

Aggrieved entitlement is the thread connecting Nice Guys™, MRAs, and mass shooters. I spent a couple hours yesterday drawing webs, diagrams, and graphs trying to figure this all out. I wanted to see if I could diagram the different expressions and mutations of aggrieved entitlement in relation to variables like aggression, perceived threat of emasculation, introversion, extroversion, isolation, etc. I wasn’t able to come up with a model that made sense to represent this whole mess, but I did come up with a hypothesis.

MRAs and mass shooters probably started out as Nice Guys™. 

Now, I realize I can’t prove this hypothesis. I also don’t want to be misunderstood — I am not saying that all Nice Guys™ are future murderers or bigots. I just believe that they have the potential to be, depending on their circumstances and the influence of certain variables.

For example, an aggrieved and entitled Nice Guy™ who experiences rejection and the perceived threat of emasculation who is an extrovert may seek connection and community on the internet, and may one day become an MRA. An aggrieved and entitled Nice Guy™ who experiences rejection and the perceived threat of emasculation who is an introvert, on the other hand, may bottle up his anger and frustration. If you factor in aggression and the desire for revenge, that Nice Guy™ could be positioned to become an Adam Lanza or Seung-Hui Cho.

Of course, an aggrieved and entitled Nice Guy™ could become a lot of things. He could become an abusive partner, a rapist, the next radio host calling Sandra Fluke a “slut,” or the next right-wing Republican congressman trying to legislate birth control. But just as likely, an aggrieved and entitled Nice Guy™ could grow out of it. He could get educated and learn to understand the problems with this way of thinking and go on to become a perfectly healthy, well-adjusted, non-misogynist man and partner.

So, how do we make that happen? What can we do to help Nice Guys™ climb their way out of that aggrieved entitlement rabbit hole?

In a perfectly timed Cracked article, 6 Harsh Truths That Will Make You a Better Person, David Wong gives some straight talk advice to Nice Guys™:

“I read several dozen stories a year from miserable, lonely guys who insist that women won’t come near them despite the fact that they are just the nicest guys in the world.”

“I’m asking what do you offer? Are you smart? Funny? Interesting? Talented? Ambitious? Creative? OK, now what do you do to demonstrate those attributes to the world? Don’t say that you’re a nice guy — that’s the bare minimum. Pretty girls have guys being nice to them 36 times a day.”

“…don’t complain about how girls fall for jerks; they fall for those jerks because those jerks have other things they can offer. “But I’m a great listener!” Are you? Because you’re willing to sit quietly in exchange for the chance to be in the proximity of a pretty girl (and spend every second imagining how soft her skin must be)? Well guess what, there’s another guy in her life who also knows how to do that, and he can play the guitar.

It’s a good start, but we need to do more than explain that being nice isn’t enough to get girls.

We need to teach boys how to be friends with women. We need to teach them that friendship and kindness are standard elements of being a decent human being, not precious commodities to be rewarded or paid for in sex. We need to teach boys that rejection is a normal part of life, and to stop lashing out at All Women Ever when they feel hurt. We need to teach boys that violence doesn’t make them any more of a “man,” and that revenge is never the answer.

The past few weeks have been full of finger-pointing and solution-hunting. Gun control, mental health, and school security are all important things to talk about in light of what happened at Sandy Hook. However, the issue is larger than Sandy Hook and larger than mass shootings.

This issue at hand is the complex web of sexism, misogyny, and violence that spawns from aggrieved entitlement. In my opinion, the best place to start this deeply important work is consciousness raising with those young, marginalized, and misguided kids who identify themselves to us as “Nice Guys.”

While Nice Guys of OKCupid is a great tool to help explain Nice Guy Syndrome and raise awareness of the problem, it’s also a vehicle to further shame and humiliate kids who already feel marginalized and rejected. It’s not going to help them, and they need help. This is the real challenge. How do we reach out to them? How do we get through to them?

We need to start thinking of solutions; the potential cost of ignoring or further humiliating Nice Guys™ is far too scary to ignore.

My new identity as a college health educator

I returned from South America in late August, unemployed and not at all sure where I’d end up or how long it would take. I could not have imagined that in only three weeks, I’d have landed my dream job. I finally get to combine my personal interest in health with my training in health communication and my love of education as a bonafide health and wellness educator at a college in Boston, MA.

In my new role, I teach classes and workshops, coach students in individual sessions, design and run education campaigns and behavior change interventions, plan events and programming, collect and analyze student data, and advise a student group of peer health educators. My new world revolves around alcohol and drugs, sexual health, stress management, sleep, nutrition, fitness, eating disorders, mental health, and wellness.

I absolutely love, love, love my new job. And what’s more, it’s prompting me to think about a lot of new things and considerations. For example.

My role as role model

  • So, like, can I never mention drinking in a tweet ever again?
  • Must I now avoid bars where there might be undergrads?
  • If I choose to get drunk, does that make me a hypocrite?
  • Will people be watching my personal health/eating habits more closely?
  • Does it reflect poorly on my authority/credibility as a health educator/expert if I am overweight?

Serving a population that is 85% male and 15% female

  • How do I make sure to dedicate enough resources to women’s health topics when women are such a minority?
  • Opportunities for sexual assault prevention aimed at a male audience (bystander education)
  • Making sure that sex ed/sexual assault/body image/eating disorder programming reflects feminist perspective
  • What men’s health issues do I need to learn more about?

Education vs. social marketing

  • Social marketing has traditionally not been used at this college; in what cases is it worth pushing for change?
  • How much time/effort/money do I dedicate to educational initiatives when I believe behavior change interventions would be more effective?
  • How much time/effort/money do I dedicate to the complicated process of designing behavior change interventions?
  • When is it worth designing original materials vs. using materials already available?

Health vs. Wellness

  • What’s the difference?

Pretty great stuff, right?

I look forward to exploring the intricate details and delicate dilemmas involved in college health education with you at Talkin’ Reckless. In addition to my usual gender- and health-related ranting.