In Depth with Worimi Woman Dr. Liz Dale
Liz Dale is a Worimi Woman and Doctor of Psychology whose work involves Aboriginal and Torres Strait Islander peoples’ lived experience of eating disorders and body image concerns, as well as Aboriginal approaches to wellness and care.
A holistic approach is becoming increasingly accepted as key to ongoing recovery. However, many of us steeped in Western European treatment models are still figuring out what a holistic approach might actually mean.
Dr. Dale believes that understanding and appreciating an Indigenous worldview can help. “Aboriginal ways of knowing, being and doing can enhance mainstream treatment,” she says.
To Aboriginal and Torres Strait Islander people, good health is more than merely the absence of disease, and social and emotional wellbeing is the foundation of both physical and mental health. A person’s whole life is involved: their physical, social, emotional, cultural, and spiritual well-being, as well as their connection to Country and community.
“Australia is a very individualistic society,” says Dr. Dale. “That’s a huge contrast to Aboriginal culture, which is entirely collectivist. Our sense of self is inseparable from and embedded within our family and the members of our community. It’s connected to the Country that we’re from, and within that Country, we have access to all the knowledge that we need to understand how to live.”
The problem is that, currently, Aboriginal and Torres Strait Islander people are up to three times more likely to experience mental health conditions and eating disorders than their non-Aboriginal peers.
Dr. Dale spent time with host Sam Ikin in this episode of Let’s Talk in Depth to review why this is true, as well as how culture and community can support any person at risk.
Read more about Aboriginal and Torres Strait Islander concepts of wellbeing
find out more about Dr. Liz Dale
Sam Ikin 00:10
This is Let’s Talk in Depth from Butterfly, your national voice for body image and eating disorders.
Liz Dale 00:17
Hi Sam. Barraba Yitirr Liz, Dhanbaan Worimi Golbaan. My name is Liz and I’m a proud Worimi woman. I’m a mother of two beautiful boys, a clinical psychology registrar, I’m a senior lecturer at the University of Wollongong and a person with a lived experience of anorexia.
Sam Ikin 00:32
You’ve heard us talk a lot about the holistic approach to recovery from eating disorders, which is becoming a widely accepted key to effective treatment. But what holistic means is difficult for many of us from a Western European background to get our heads around. Liz Dale, who works closely with Aboriginal and Torres Strait Islander people in this field, says a traditional worldview might be just what we need to enhance and improve mainstream treatment.
Liz Dale 00:58
I’m a really passionate advocate for the improvement of Aboriginal health and wellbeing via the recognition and integration of our ways of knowing, being and doing within the mainstream healthcare sector. But I think it wasn’t until my own lived experience journey with anorexia, that I realised that there’s a particular gap in the body image and eating disorders field for understanding how eating disorders are experienced and caused and by Aboriginal people, and what is necessary and appropriate for our health and recovery in that space. So at the moment, there’s very little research that that is informing our assessment, treatment and diagnosis, processes that have involved either Aboriginal people or Aboriginal knowledges.
Sam Ikin 01:51
That kind of leads me into the next question. We’re talking about Aboriginal concepts of health and wellbeing and the ways that they differ from the prevailing Western approaches. Can you tell us a little bit about that and how diagnosing and treating disease might be approached differently?
Liz Dale 02:08
Yeah, so the key differences between Western Aboriginal understandings is that Aboriginal people regard health and wellbeing from a collectivist perspective, and holistically according to seven interrelating whole of life elements. Whereas the western approach is typically individualistic and based on an absence of a disease biomedical model that focuses on symptom identification and resolution. It has been built on Aboriginal cultural ways of experiencing life experiencing each other, tradition, and protocols in terms of what we know makes us strong and healthy peoples, what we know has been really important for the continuation of our culture. And what we know is what contributes to our strength and resilience. So, the seven whole of life elements that have been packaged under what we now articulate as a social emotional wellbeing model, connection to body connection to mind and emotions, connection to family and kinship, connection to community connection to culture, to country to spirituality, and ancestors. And within that model, it also recognises that the social, cultural, political and historical context have a real concurrent and cumulative effect on the social emotional wellbeing of a community and therefore an individual.
Sam Ikin 03:31
And when it comes to the differences in perspective, following on from that, what about mental health, how is the way that you approach mental health different?
Liz Dale 03:40
So the social emotional wellbeing model is one way of conceptualising an individual’s mental health conditions or what they’re experiencing? It’s not specifically a mental health tool because within the model you can also understand why people might be physically unwell or relationally, unwell or spiritually unwell. But some of the differences within the mental health field is that the mainstream field tends to compartmentalise the human experience. And scientists, “scientistifise” people and problems. Not sure if that’s a word, but it’s a new word now. It seems to overlook the influence of culture and spirituality on a person’s health and wellbeing.
Sam Ikin 04:26
How would you describe that connection between mental health body image and eating disorders? Obviously, they’re all connected.
Liz Dale 04:33
As an Aboriginal person drawing from clinical lived experience and cultural knowledge, I see these issues as having interrelated causes and perpetuation of one another. So I understand these issues according to the supermodel. And just to explain a little bit about how they’re connected. I’m going to use a colleague of mines analogy, where if we can say the soup wheel as the soup model as a car wheel, at the centre of the hub, we will place the self. But remember, for Aboriginal people, it’s a collectivist perspective of self, which is defined and experienced in relation to our kin in our community systems. Then the wheel will be divided into the seven elements and what do we know happens is a car wheel is say pierced with a nail, for example? The whole wheel deflates, it’s not just the point of the puncture. So say for example, you know, utilising that analogy, a person stops going to the community events because they’re experiencing feelings of grief and loss, for example, you know, we we’re constantly unfortunately, experiencing a lot of grief and loss in our communities. It’s something that affects us on a day-to-day basis. So let’s just say for example, someone’s in sorry business. They’re grieving and they’re decreased community participation means that they don’t have emotional cultural support for these feelings. And that’s likely to lead to a depressed mood. And that’s likely to affect things like their sleeping and their eating patterns, which might look like under overeating or oversleeping. And then that could transpire into how a person sees and feels about the body. And then it’s just continuous perpetuation. And then the overeating might lead to a higher risk of chronic diseases. And that person becomes very unwell at multiple, multiple levels.
Sam Ikin 06:24
And I think you’ve started to answer this next question already is, what ways do the risk factors for Aboriginal and Torres Strait Islander people differ for those of us who were non-Indigenous?
Liz Dale 06:34
Yeah, so we know from some of the government reports and the research that’s been done that Aboriginal people are up to three times more likely to experience psychological issues than non-Aboriginal people. And you know, to put simply, it’s because we live in a colonised society, where white privilege dominates policymaking and clinical practices. And we’re living within a Eurocentric dominated society that devalues culture and cultural knowledge. And it’s overtly racist towards us through actions and inactions. So either the exclusion of Aboriginal people from media and advertising, or continually being negatively portrayed through the media and the portrayal of us through racial stereotypes. So that not only affects how Aboriginal people see each other, they how they see themselves. And it creates barriers for the integration of our ways of knowing being in doing into, like a mainstream healthcare sector that would ultimately be our source of strength and healing.
Sam Ikin 07:34
That’s staggering, though three times as much. That’s huge. You must be extremely busy as a clinical psychologist in your community.
Liz Dale 07:42
Yeah, well, yes, and no, you think so. But again, because when we consider Aboriginal health and wellbeing, we need to recognise that there are a range of access and engagement barriers for, for people to seek treatment. And the treatment that is being sought is is often inappropriate. Like it goes back to the fact that our ways of knowing being and doing have not been well enough researched or highlighted or articulated or valued enough to be embedded into the sector, or to be readily available to us.
Sam Ikin 08:17
Wow. So people are not feeling empowered enough to go and get help for something, even if they know they’ve got a problem?
Liz Dale 08:24
Not sure if it’s about necessarily not feeling empowered, I feel like it’s more that the system is not as accommodating or as in or as inviting, or as welcoming as it could be, you know, for a lot of us mob we carry the burden of intergenerational trauma. And, and within that there’s a mistrust for white services and for white service providers, which dominate the industry, particularly with eating disorders in the body image sector. But there’s also like, for rural or remote people a lack of access to appropriate care, or the care that they’re provided is, you know, that fly in fly out model where it’s a different service provider almost every time and so it’s this that inability to form a trusting relationship with someone and then be able to speak to that person about your deep issues and your personal concerns and then trust them enough to either provide you with a service or if you’re lucky enough, be able to access an Aboriginal worker who can provide you a culturally informed approach to your treatment and care. That may or may not involve some of the mainstream approaches. I’m a firm believer that there is a chance that Aboriginal ways of knowing being and doing can actually enhance the mainstream treatment sector right now. We’ve got just Yeah.
Sam Ikin 09:54
So tell us about that. What ways can Aboriginal concepts of health and wellbeing kind of protect against mental ill-health, including body image and eating disorders? Maybe that’s something that the Western part of our community could learn from as well and benefit from.
Liz Dale 10:12
I feel it could. I feel like particularly our holistic approach to addressing mental health concerns or to addressing a problem, a person’s health condition would be of great benefit. And as we know, coming through some of the eating disorder research that reconnecting people to their lives and helping people reestablish meaningful relationships is beneficial. And it actually helps people recover from eating disorders. And we know that part of the eating disorder treatment involves you know, socialised eating. And for Aboriginal people eating was culture was tradition was ceremony, there was, there was a lot around the preparation of food, the gathering of food, the acquisition of food, the types of food you ate, the times that you ate, the food, the people you ate the food with.
Sam Ikin 11:08
If you look at the way that we are treating our own community, in terms of, you know, the broader white community, maybe we can incorporate some of the things that you are learning, and it might have an amazing effect.
Liz Dale 11:22
I believe so. And I think I read recently that Australia was actually the second highest individualistic society in the world. And so already, that is a huge contrast to the Aboriginal culture, which is entirely collectivist, where we regard our sense of self, from the people that we’re connected to, and how we’re connected to those people. Our sense of self is inseparable from and embedded within our family and our members of our community and, and that’s connected to the country that we’re from. And within that country, we have access to the knowledges we need to understand how to leave and how to be healthy and to be strong. And that is like our source of resilience. That’s our protective factors.
Sam Ikin 12:15
What kind of things do mental health, mental health professionals need to know when they’re caring for Aboriginal and Torres Strait Islander people? Like what should they be doing differently?
Liz Dale 12:27
Well, I have some practical advice. But I also want to back up what you said in that I feel like people are doing their best and that, you know, as I said before, the western approach is very scientific and it’s based heavily on the research and the evidence, literature, which don’t get me wrong, I’m not discrediting that, and I think that that has effect and I have seen and utilise that myself as a clinician to the benefit of other people. But I feel like because you as you said, we’re still seeing very high rates of eating disorder and body image concerns. Sadly, a lot of death associated with people who have not made recovery possible that it is time to broaden our minds and our approaches and look at alternative, not alternative approaches, but other approaches out there, which I’m proposing would be the Aboriginal way of looking at life and recovery and healing and recovery. So my practical advice to any health professional who is caring for an Aboriginal Torres Strait Islander person, either with an eating disorder or with any kind of health issue would be just first of all, get to know your client as a person. We’re a relational community. So it’s really important that you establish a trusting relationship first. And then your job would be to listen to their story and then to ask questions. Don’t assume cultural homogeneity because we are a very diverse cultural group. Don’t assume cross cultural equivalence of symptom expression or experience. Practice critical reflection, so reflect on how your position of privilege might be coming across in that healing space and in that relationship. Treat our health matters holistically, i.e., you’re not just treating anorexia, but you’re treating the person’s connection to their culture, their community, their spirit, etc. And also be aware of the historical political and social determinants of a person’s health situation. And pushed back against systemic access engagement barriers, such as lack of transport or service cost, or even clinical settings that are very kind of clinical or harsh or don’t appear inviting, or comfortable, safe for Aboriginal people and, and it’s not just about putting dock paintings up, it’s about actually thinking about clinical rooms as spaces as healing places, a storytelling kind of spaces where people can tell story and share knowledge is about, about recovery and about health. And then champion be a champion in your workplace for the integration of Aboriginal knowledge is within the healthcare system and within your workplace.
Sam Ikin 15:24
I really liked this approach as well because we are all people, right? You your community, however, has tens of thousands of years more experience in being a community, whereas we’ve only got the last few 100 years like, I don’t know, is that too simplistic? Or am I onto something?
Liz Dale 15:42
No, I think you’ve certainly onto something. And the fact that our culture has survived through… it’s one of the oldest living cultures in the world shows how important that sense of community is and that belonging, and that, that belongingness to our community, and that community approach to whole of life living is.
Sam Ikin 16:05
I reckon it’s something really, we really should look into a little bit more and try and work together more. Wouldn’t it be nice?
Liz Dale 16:13
It would be nice, I think. So I think definitely there’s that need to, obviously treat people individually where they are. And obviously, at the end of the day, each person is different. So a communal approach may work for some or an individualistic approach might work better for another person. But rather than applying the biomedical symptom resolution model, where for a lot of eating disorder, people it might involve, you know, nutritional restoration and neural rewiring, look at that person in sent in terms of that community that they belong to, or the community that they used to belong to, but the eating disorder has taken from them, and reconnecting them back into a system where they’re more that they are supported and other aspects of their life can be strengthened, which would weaken hopefully, the need for the eating disorder to be there. Because we all know that eating disorders pop up in people’s lives for different reasons.
Sam Ikin 17:19
Like as somebody who has recovered from an eating disorder, who is Aboriginal, what kind of what advice do you have for people who could be Aboriginal and Torres Strait Islander or people who are non-Indigenous who are struggling with the same issues?
Liz Dale 17:34
The first thing I’m going to say is that recovery is damn hard. And there’s no sugarcoating the fact that you have to sit in many spaces of discomfort, and that it is emotionally, physically, spiritually relationally draining and exhausting. And it’s really important that amongst that you find your why. And that you find your champions, recovery is not possible on your own you because you’re susceptible to the eating disorder, involving itself in your recovery. And that’s exactly what we don’t want or need. So you really do need to acknowledge that it’s a difficult process, but that it’s the process, if you think about it from a different perspective, that you’re regaining life, and that you are reconnecting to a life from a more knowledgeable and wise place because the recovery journey can actually be quite empowering and enriching because you’re able to, you’re taught to reflect on yourself and to, to learn about yourself again. It always depends on each person’s own experience, of course, and how long they’ve lived with that, but but there is a way that you can reframe it in your mind as a positive and empowering process. And I would, and I would encourage people not to hesitate to reach out for help and support as early as possible.
Sam Ikin 19:20
Thank you so much for giving us a little bit of insight into a world that a lot of us have got no idea about. Thank you very much. Appreciate it.
Liz Dale 19:28
Very welcome. Appreciate you having the yarn with me today.
Sam Ikin 19:35
For more information and some great resources on improving the treatment of Aboriginal and Torres Strait Islander people go to butterfly.org.au and search for EveryBODY is Deadly. There’s a link in the show notes as well in case that helps. And if you need support now there are trained support officers ready to help at the Butterfly Helpline. The number to call is 1800 ED HOPE, or 1800 33 46 73. That’s 1800 33 46 73. Let’s Talk in Depth is an Ikin Media production for the Butterfly Foundation. And if you like what we’re doing here, please leave us a rating or review. We’d really appreciate that. I’m Sam Ikin. Thank you so much for your company.