87. Disordered Eating in Dance with Josh Spell, LICSW, and Guest Co-Host Jennifer Milner

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Linda Bluestein, MD (00:01.874)

Welcome back, Every Bendy Body. This is the Bendy Bodies podcast, and I'm your host and founder, Dr. Linda Bluestein the hypermobility MD. This is going to be a great episode, so be sure to stick around until the very end, and then you won't miss any of our special hypermobility hacks. As always, this information is for educational purposes only, and is not a substitute for personalized medical advice.

Linda Bluestein, MD (00:30.746)

Today we are so excited to have Josh Spell, social worker, therapist, dancer, plant enthusiast, and lover of the arts with us. But before I welcome Josh, let me introduce my friend and yours, Jennifer Milner, former professional ballet and Broadway dancer who trains hypermobile artists to work to their fullest potential. She knows a thing or two about being a bendy body. We are so fortunate to have Jen here today co-hosting this episode.

Hey, Jen, it's so great to see you again and to have you here.

Jennifer Milner (01:03.15)

Hi, thanks for having me back. Always happy to jump in and be part of the conversation.

Linda Bluestein, MD (01:08.03)

Yay, I'm so excited. And Josh has been working in the mental health field for nearly a decade. He has experience working with clients facing depression, anxiety, PTSD, bipolar disorder, grief, suicidality, anorexia, bulimia, and more. Josh is currently the consulting mental health therapist with the Pacific Northwest Ballet and the owner of flexible mind consulting offering one on one counseling and workshops worldwide.

Josh, hello and welcome to Bendy Bodies.

Josh Spell (he/him) (01:39.301)

Hello, thank you so much for having me.

Linda Bluestein, MD (01:42.852)

Absolutely.

Jennifer Milner (01:44.27)

And Ash, we are really excited to have you today because we want to talk about eating disorders which, as you know, can come up a lot in the dance population and can also come up in the hypermobile population because there's a lot of overlay. We know that people with hypermobile disorders are seven to eight times more likely to struggle with anxiety, with depression, with OCD, eating disorders. So we already know that this community is at risk.

And then we know that dancers are at even greater risk and that there is a higher percentage of hypermobile people in the dance population than there is in the general population. So that's what we want to explore today, that eating disorder and how they kind of overlap there. In your practice, and I know this can come across as a silly question, but in your practice, how commonplace is it for you to encounter someone with disordered eating or an eating disorder?

Josh Spell (he/him) (02:39.757)

Yeah, you know, I would say probably about 50% and that's in my practice that is non-dancer and dancer related. If I'm thinking about my specific work with dancers, I would still say about 50%, but it may go up a little bit. It might be a little bit higher just because of the nature of the aesthetic sport and just kind of relationship with body.

Jennifer Milner (02:50.722)

Mmm.

Jennifer Milner (03:09.226)

Yeah, that's a fair number. Do you think that number is so high because these are the people who are seeking you out for help already and know that they're struggling with something or do you think that might, how do you think that number translates to the population that we're talking about?

Josh Spell (he/him) (03:27.297)

Well, I think just in general, diet culture is so pervasive, non-dancer, dancer. So it's everywhere that we see advertisements about how to lose weight or how to be healthy or things like that. And so we're already exposed to that. And then when we add the layer of dancer and how much time is spent in a studio, in leotards, in front of a mirror,

Jennifer Milner (03:35.83)

Mm-hmm.

Josh Spell (he/him) (03:54.601)

It just sort of exacerbates that and elevates, I think, the emphasis on body.

Linda Bluestein, MD (04:02.146)

Yeah, definitely. And and do you see very many people with either known or suspected hypermobility disorders or connective tissue disorders like one of the Ehlers Danlos syndromes?

Josh Spell (he/him) (04:13.577)

Yes, actually. So my non-dancers, I have not really seen hypermobility, but when working with dancers, yes, EHS is, sorry, EDS is definitely a diagnosis that I am familiar with. I am not sure of the others though, but the, yeah, EDS is something that I have acknowledged, I have helped.

of dancers and again like that overlap that you're saying with increased anxiety and other mental health concerns and then specifically eating disorders it makes sense to me just because there is this emphasis on why is my body giving out what can I do to sort of control or sort of reverse try to compensate for what's happening.

Jennifer Milner (05:00.819)

Mm-hmm.

Jennifer Milner (05:08.746)

Well, and you used an interesting word there that we're going to get to in a second about control because there are a lot of myths surrounding eating disorders, right? Like dancers are doing it just to be thin or you have to be thin in order to have an eating disorder. Like you should be able to look and see or if you're not dangerously underweight, then it doesn't really count as an eating disorder. And in reality, an eating disorder is a mental illness and you can't just see it.

by looking at someone. So can you help us understand a little bit more about eating disorders?

Josh Spell (he/him) (05:42.037)

Yes, so I talk about eating disorders as a psychological injury because dancers have experienced injury before. So it's a way of relating and it's not just about body. I think that's the main thing is it's often a coping mechanism. It's a coping strategy either to control, like you said with that word, or to avoid.

Avoid difficult emotions, avoid failure, avoid just chaos and being exposed to stress. So dancers often find this sense of control or also it can be a numbing sensation, right? Like when we get into overwhelm in our nervous system, we need to find some way of relief and just...

space from all of the mental chatter or from just the stressors of the dance world, perhaps. So sometimes eating disorders are kind of what emerges. And so another way to see this is kind of like this psychological or relational distress that could be coming up in a person's life. So like for example, with restriction.

You know, it could be, like if we think about the pandemic, right, there was a lot that was taken from us. It felt like we could not just have the freedom, the flexibility that we were used to before. And so sometimes individuals who restrict emotion or kind of keep this very...

a clear safe way of interacting with the world. So maybe restricting behavior, restricting social engagements. So we can often see this parallel with something like anorexia, nervosa. But that can also be the case with like binge eating, perhaps, and feeling really this out of control nature, or maybe there was exposure to really restrictive,

Josh Spell (he/him) (08:00.081)

not even like foods, but just time of meals, or maybe there was food scarcity, right? This inability to procure food. So now all of a sudden we have individuals that are, you know, in this kind of cycle of overeating, binging, and that's a way really, again, to make sense of those restrictive natures.

that have emerged in their life. Also like binge purge, that can be a way of wanting to rid the body of unhelpful stressors or difficult emotions, things like that. So again, I think it's so important to see, it is not just about wanting to be thin. It's really about how am I making sense of what's happening?

to me. So just like other coping responses that we have, like alcohol or shopping or other behaviors, eating disorders are sort of a response and they most of the time in the beginning make individuals feel better. But we all know eventually that sort of honeymoon phase subsides.

Jennifer Milner (09:21.502)

Yeah, and it's interesting to think about the two sides of that coin. On one side is the control and on one side is the avoidance. And I know dancers and other artists feel so helpless. And like, we, like, we don't have a lot of choices in our everyday life. We figure out what point shoes work best for us. And those are the points shoes we wear. We have a little bit of freedom to what we wear in the dance studio, but not a lot. We have no control over our schedules. We have no control over casting. Like there's so many things that we feel like we don't have control over.

And that mirror, I can see control being one way to deal with having to face the mirror, and I can see avoidance being another way to deal with having to face the mirror. So it's those two sides that are both us trying to find some way, as you said, to make sense of our lives and to be able to frame it in a way that we can cope with. I know that, I know that

As we talked about, people with hypermobility are so much more likely to have OCD, anxiety, depression, those sorts of things. In your practice, do you see connections between eating disorders and other mental health issues like anxiety, depression, and OCD?

Josh Spell (he/him) (10:35.013)

Definitely, there's a lot of intersection and there's a lot of co-occurring disorders that are happening simultaneously with eating disorders. And so, you know, anxiety, OCD, depression, all, I see all of that. And especially when working in more higher level of care, eating disorder works.

Often we see individuals who all of a sudden they're having a lot more space from their eating disorder, right? The eating disorder voice is sort of softer, but then all of a sudden we have the anxiety spike or the OCD spike, right? And so it kind of becomes this whack-a-mole situation where, yeah, like we have to address similar factors, but things like...

eating disorders and OCD, perfectionism is definitely a part of this as well, and uphold some of those behaviors. But we can definitely see the crossover, right? With just focusing on what the body looks like. And so maybe there's this obsessive body checking, and then when we don't check, then all of a sudden the anxiety spikes. Or if we say something we don't like, then we get very upset about

who we are, we get very down, our self-worth is challenged. So there's so much and so many directions to go, which is why I think eating disorders are so difficult because it's not just one singular behavior just in terms of, yeah, if you just eat, you'll be okay. There's a lot of reasons why individuals cannot or maybe are using food in a different way, not just the restrictive aspect.

Jennifer Milner (12:25.718)

And I think that that's one of the important things what you just said was it's not just about if you'll just eat, you'll be okay. And that's often the first line of attack with a family with a younger dancer or with a company with an older dancer saying, let's just get you eating again. And as you said, you're addressing what people see, but not the underlying issues, the moles that are popping up that need to get whacked, the anxiety, the depression, the need for control, the OCD that enjoys counting calories and organizing foods and that sort of thing.

And it is a much more complicated issue than a lot of people really understand. You mentioned the pandemic and sort of how things have changed and that it could have contributed to dancers in some ways. What do you see right now as far as dancers and their self-image? I'm wondering like with the social justice issues that have come up and dancers starting to find their own voices, have we seen a change for the better? Have we seen a change for the worse because of the uncertainty of the pandemic?

so many ballet companies stressing about funding? Like what have you noticed with dancers and self-image?

Josh Spell (he/him) (13:30.337)

You know, I think that we are in a very different place than ever, I guess, in the dance world in terms of acknowledging all of these concerns. And something like relationship with self is also influenced. And so I think that there's more space to explore what is coming up for individuals.

but also I think there's some fear in the overall structure that sometimes makes it difficult to challenge things like body image. So I still get this very perfectionistic, I don't wanna say obsession, but there's sort of this perfectionistic tendency, right? Where it's like dancers are still holding themselves to very, very high standards. So.

you know, that feeling of wanting to perfect the machine or right, kind of like our body as this like mechanism for our art, I think that dancers are always wanting to push that, which sometimes takes them out of kind of their own reality and listening to their bodies. And it's not always just in a pursuit of losing weight or manipulating a body.

It's not always about that, but I think that there is that desire still to be the best version of what a dancer can be. We're always working to improve. That's what class is about. That's what rehearsal is about. So there's constantly kind of pointing out maybe things that aren't working. And so I think sometimes dancers' sense of self becomes more obsessed with the things that they need to work on, versus like,

Linda Bluestein, MD (15:26.175)

Mm-hmm.

Josh Spell (he/him) (15:27.689)

actually are you bringing to the space? Like what is your unique body able to do with this, you know, lexicon of steps and this repertory? What can you do that is uniquely you versus the I need to just fit this very specific mold of the dancer ideal?

Linda Bluestein, MD (15:54.938)

Yeah, no, that makes a lot of sense. I really like that. And if in terms of trends that you've been noticing recently, have you been making any observations? Like for example, we, you know, obviously a lot of us are spending more time on various different video platforms or more spending more time on social media, perhaps. Have you been seeing any changes there with dancers and struggling with these kinds of problems?

Josh Spell (he/him) (16:19.973)

I think definitely for the younger generation, social media is a huge component of this because when I was dancing, I did not have access to someone's feed right away or YouTube even. I mean I watched videos on VHS tapes. You know.

Jennifer Milner (16:26.047)

Yeah.

Jennifer Milner (16:41.339)

Right?

Linda Bluestein, MD (16:42.322)

Yeah, we probably all did.

Josh Spell (he/him) (16:44.941)

Right, like I remember that Don Quixote of Cynthia Harvey and Mikhail Brishnikov, like, you know, but that's how I got the exposure. So now that we have just like all different styles, genres, dancers who are out there, I think there is a lot of comparison just on like, okay, I need to push myself to the extreme. Because if I see this person doing it, then

Jennifer Milner (16:50.495)

Oh of course, yes.

Linda Bluestein, MD (17:06.319)

Mm-hmm.

Josh Spell (he/him) (17:13.813)

why can't I do it? And there's that unrealistic just acknowledgement that I can control my body, I can push my body past sort of these just warning signs. But also Linda, you mentioned Zoom, and even right now, if we were talking in a room in person, I don't think we would be able to see our reflections. And so,

with zoom right like people do see themselves of course there's the option to hide the speaker view things like that but i think that we've never had to really consider you know seeing ourselves all of the time and then the other thing that i just i know i've said this before about diet culture but we can't ignore the influence that diet culture has that sort of just

Linda Bluestein, MD (17:43.312)

Mm.

Josh Spell (he/him) (18:13.001)

of smuggles this idea that you can change your body through discipline, through diet, through exercise. Now there's this whole conversation about weight loss drugs, which again is just signaling even more of the responsibility on to individuals versus being able to say like, hey, we all have

different. We want to work towards, you know, some of the similar things for dancers, right? We want our bodies and our instruments to be tuned to a highest level possible. However, we have to acknowledge, right, that it's not that easy. It's not a quick fix. It's not something that we can just, you know, snap our fingers and we have control all of a sudden.

Jennifer Milner (19:10.142)

Right. Well, and not only are the diet culture saying, you know, you can do this, but they're saying you should want to do this, right? And that's what makes you feel that little extra spark that makes you go, Oh, well, if I, if I'm satisfied, I must be missing something. Like if I'm content with myself.

Josh Spell (he/him) (19:28.781)

Exactly, exactly. And I think that shows up too, right, with that self-criticism piece. So there's that belief that you have to be hard on yourself in order to be a successful dancer. And I think part of being hard on yourself is almost sacrificing. Like I remember at School of American Ballet, everyone was on some sort of, I don't know if it was a diet, we didn't use that.

but there was some sort of sacrifice being made, right? Like I have to eat a certain way or I have to jump on the bandwagon, you know? And that just complicates things. And I don't think it has to be that way. And that is a lot of what I talk about is we don't just have to...

Josh Spell (he/him) (20:19.013)

freely accept that we have to struggle and we have to struggle with our bodies in order to be a good dancer.

Jennifer Milner (20:25.294)

Uh huh.

Jennifer Milner (20:28.93)

Well, and I tell my dancers, as a dancer, you will have to sacrifice in some ways. You may have to live in a cheaper apartment than you would like to. You may have to rent books from the library instead of buying books, right? Like there will be sacrifices that most people have to make to pursue a career in dance, but you should never have to suffer. And that's that pivot point to me is we sacrifice being able to go out at nights because our friends get to go out and do fun stuff and we don't because we have a show the next day or we're in a show that night.

So there are things that we do have to give up, but they should not feel like suffering, and they should not feel like I must go through this in order to be a real dancer. Would you agree with that?

Josh Spell (he/him) (21:10.762)

Exactly. I mean, I think that there's a difference, like you're saying, in the suffering and the sacrificing. Yes. That whole idea of like our dancer identity and, you know, being very focused on just this pursuit of becoming a dancer, I think can sometimes just bring up

Jennifer Milner (21:17.3)

Mm-hmm.

Josh Spell (he/him) (21:35.701)

some questions, some difficulties for other individuals who are like, wait a second, I don't want to sacrifice. But on a Friday night, you might not be able to go to homecoming because you do have a rehearsal or you are getting ready for Nutcracker or things like that. But I think the main thing is our self-worth is not contingent on how good of a dancer we are or how thin we are or...

just again, our ability as a dancer. We have to really make sure, and this is what I do with a lot of my clients, is how am I nurturing that sense of self that can then acknowledge these things like I can't go to a football game or hang out with other individuals. That's not a personal deficit. That's just the reality of, yeah, choosing this pursuit of wanting to be a dancer.

Jennifer Milner (22:32.05)

Yep. Well, and I think this generation especially, as you were mentioning with social media and everything, they're also on, they're also judged and have put have themselves put in front of themselves on a daily basis. So many of my students will do a class and a private lesson to work on a solo. And then it's filmed at the end and then they stand there and right away watch the video and the teacher picks apart and shows them everything that they did wrong. Like I think I was probably not nearly as good of a dancer as I thought I was.

but there's no video proof around for me to know because I didn't have to watch myself. So I'm safe with my fantasies in my head. But these dancers are confronted every day with videos of themselves, not just YouTube and social media to aspire to, but having to look at themselves and 10 year olds getting critiques in depth from multiple judges at every competition they go to. You need to do this, fix that, fix that. And at a very early age, they're being critiqued and judged.

Linda Bluestein, MD (23:07.442)

I'm sorry.

Jennifer Milner (23:28.802)

based on who they are as a dancer. So obviously that that's going to feed into eating disorders and the bigger picture also is the dance world, our studios and directors and companies sort of contributing to this sort of idea of a higher identity as a dancer and are they fostering that sense of you must be a dancer first you must sacrifice.

Are you noticing that or does it feel like it's starting to even out or what are you seeing?

Josh Spell (he/him) (24:00.261)

I still notice sort of that messaging. Maybe it's not as overt, but even like when a teacher gives an example of, when I was dancing, right, I do not have a partner, or I did not get to go to the movies, or whatever that is, to me that is sort of a kind of flavor of, you have to be all in here.

Jennifer Milner (24:14.136)

Right

Jennifer Milner (24:28.45)

Mm-hmm.

Josh Spell (he/him) (24:31.189)

So I do see that. I think again, we're having conversations now, not just with dancers, but also with administrators, also with teachers. And it's sort of just that kind of getting over the hump of wait a second, but that's not how it was when I was dancing, perhaps. So, you know, they're...

there are a lot more resources available for dancers now. And I think that a lot of the messaging is around, like having outside interest actually is bolstering who you are in the studio. It's actually needed in the studio. And I think we can still emphasize, right? Like that dedication piece and maybe for a lot of dancers, I know myself,

Jennifer Milner (25:14.925)

Mm-hmm.

Josh Spell (he/him) (25:26.637)

That was my favorite identity, but it doesn't mean that I can't explore other parts of myself. And I also don't think that, you know, it means that teachers put into question a dancer's dedication, maybe if they do choose to do something extracurricular. And I think that then kind of circles back to maybe some of that restrictive nature.

and feeling like my life is being restricted because of dance or because of another pursuit. And so I will find my freedom or I will find sort of my outlet for who I am through something like an eating disorder, for example.

Jennifer Milner (26:13.258)

Right, that avoidance, right. Well, let's assume that we're in an ideal world and let's assume that we're in a great company or a great studio where the teachers are all giving positive feedback and it's nurturing and encouraging the dancer to be more than just a dancer, right? And they're getting lots of positive feedback, their social media is curated, they're not diving too deep into it. All the things are lining up correctly.

and yet a teacher, a company member, a director is concerned about a dancer and concerned that they are developing an eating disorder. It's a really helpless feeling because your instinct is, my first instinct is to just go eat, right? Even though you know that that's wrong, but you're so worried about them. So what can that side of the table do? How can directors in schools and stuff help? What steps can they take?

If they're already doing everything right, what's next for them if they suspect a dancer has an eating disorder?

Josh Spell (he/him) (27:13.837)

Yeah, so I think this is gonna look different in a lot of settings, dance settings, because, well, we're going back to your ideal. So I'm gonna take it there. I think that there would be someone like a therapist or a dietician that a person can go to right away or a doctor that's in house, right? Someone that knows the work with dancers has,

Jennifer Milner (27:25.262)

Thank you.

Linda Bluestein, MD (27:26.467)

Huh.

Josh Spell (he/him) (27:43.485)

education around eating disorders has some sort of special interest, that would be the ideal scenario is the teacher, the director, maybe a colleague, a fellow dancer can just kind of bring it to that person who is a little bit more removed because we don't want a teacher or a peer, a colleague to sort of out someone in front of everyone.

Jennifer Milner (28:12.994)

Right.

Josh Spell (he/him) (28:13.357)

really does not help the eating disorder at all. That could be like, oh yes, I have been acknowledged and so it fuels the eating disorder in a way or it can't. So the main thing is really how do we bring awareness and interrupt some of what is already happening and then get some of the professional help, some of the support, but also if that is not

Linda Bluestein, MD (28:23.184)

Mm-hmm.

Josh Spell (he/him) (28:42.213)

readily available, I think we have to really be compassionate and look at the individual for who they are versus just the eating disorder, right? So we're kind of being able to acknowledge the full person, the whole person, and being able to just say like, I'm concerned, I care about you, I'm worried, things like that. I have a really great resource.

let's talk to a dietician. Because a lot of times, what I have seen with under-fueling is there's just a lack of knowledge or a lack of understanding. That's sort of how things may start. And then it sort of just snowballs. So being able to acknowledge it right away, research is saying that the sooner that we're able to catch an eating disorder, that

the treatment has the most benefit, right? That early intervention piece is so important. So a lot of times, you know, I think people are, oh, someone's probably dealing with that. Someone's probably helped that dancer. That dancer probably already knows. So let me not say anything to someone or try to find sort of a resource there. And again, eating disorders.

Jennifer Milner (29:45.421)

Mm-hmm.

Josh Spell (he/him) (30:09.569)

mental illness all thrive in secrecy. So we really want to be able to just say like, hey, I see you, here is a resource, here is a space of support. And again, we can't force someone into treatment, but I did have some feedback this summer from an administrator.

who heard specifically from a dancer about how an eating disorder or a suspected eating disorder was acknowledged in the space. So because PNB has a protocol, that sort of set up space for the dancers to then be able to trust the system and be able to trust that the person is getting some sort of help and they're not having to be so concerned.

Because first, it's acknowledged as this is not okay. We're not just going to accept that dancers can freely dance with eating disorders. So I think that's helpful. And then they don't feel like they have to step in because there already is a system in place.

Jennifer Milner (31:29.706)

Yeah, so if I'm hearing you correctly, it sounds like when we're talking about people in positions of authority, many times, most of the time, these people in positions of authority have no mental health training, right? They're not mental health professionals. They're wearing 18 different hats as janitors and costume makers and teachers and all that stuff, right? So one of the best things they can do is to have a plan in place before they need one so that there is a protocol that they can fall back on.

Linda Bluestein, MD (31:49.566)

Thank you.

Jennifer Milner (31:58.954)

Something else I think that you said was not confronting them in public, not making it public, and not having them confronted by a teacher or someone who works closely with them as a mentor, right? Like trying to find someone who's a little more distanced, and having that contact list, that Rolodex, again before it's needed so you can reach out and find a person who already is somewhat familiar with the school or the studio.

so that you're not scrambling and you're not going, I don't know what to do, because you can feel really helpless as a teacher. And I think even as a dancer, so if you suspect a loved one, parent, sibling, you're a 14 year old girl and you think your best friend has an eating disorder, what can you do? What can your next steps be?

Josh Spell (he/him) (32:47.009)

Yeah, I would reach out to an adult. I would see if there's someone that I feel comfortable talking to. I'm putting myself into the 14-year-old girl identity. I think that's what you're asking me. Okay, just wanted to clarify. Well, again, I will not hold this information for myself because the 14-year-old is not expected to know how to treat someone or what to do.

Jennifer Milner (33:01.238)

Yes.

Josh Spell (he/him) (33:17.049)

bringing someone else into the mix, whether that is your parent, whether that is a teacher at the school, whether that is the school principal. If you have a therapist in the school or if there is a dietician, if you have access to those resources, I would definitely, that would be my first step, is just again, I am concerned, I don't know what is going on.

Jennifer Milner (33:39.458)

Mm.

Josh Spell (he/him) (33:44.173)

We never want to be accusatory because we don't know what's happening for an individual, but bringing in that extra layer of support. So this is a team effort. Oftentimes individuals who have been diagnosed with an eating disorder have a full team of medical doctors, of a dietician, of a therapist. Maybe there is milieu support.

it's not ever really treated with one sole provider, because there are so many nuances that are present. So I think getting the ball rolling would really be the best first step. And again, like being able to just listen as a friend, right, you're allowed to check in and say, how are you doing? Right? Like I...

I care about you, is everything okay? I'm here if you need to talk, right? But if that individual then is like, yes, I'm struggling with an eating disorder, there could be that feeling, that urgency of like, oh no, what am I supposed to do? And like what you were saying, that's why we do have preventative measures in place, so it doesn't have to be so frantic. And so it can take some of that like nervousness off of my 14 year old self.

Jennifer Milner (35:12.99)

Well, and I know, I mean, from my personal experience, I know that 14 year old self feels that burden to help their friend, right? And is worried about them and may be scared to approach the parent or the dance teacher. And I have been approached many times by my dancers saying they are worried about another dancer. And the burden that you see lifted from their shoulders after they tell me, they're like, I know they need help. I don't know what to do. I have found a safe adult.

Now I don't have to stress about it anymore because they shouldn't have to stress about it and they shouldn't have to fix it. So I am glad that you encouraged them to go, find that safe adult that they can talk to because they shouldn't have to try to figure out how to fix their friend. Let's drill down one more step. And if you think that you are struggling with an eating disorder, then I imagine there's gonna be a fair amount of conflicting feelings.

Maybe denial, you don't want to acknowledge it, but maybe deep down, you know, there's something Maybe you don't want to talk to anybody about it because you feel shame that you can't control yourself or you are embarrassed that you didn't achieve whatever result you thought you needed to achieve or any of those really Isolating and lonely feelings. So if you suspect that you are struggling with an eating disorder, what can you do?

Josh Spell (he/him) (36:31.661)

Yes, so I first I want to just extend some compassion to that part of ourselves, right, the eating disorder part that feels very ashamed, that feels very guilty, that feels very isolated. Being able to just acknowledge that this is not your sort of soul identity, being able to just create a little bit of separation, right, from the eating disorder. I wanted to say that first. But

Now we have things like hotlines, we have text lines, we have the ability to be a little bit more anonymous so we can maybe take the first step because it is courageous to take a step towards healing, towards recovery, and also the eating disorder does not like that. And so it needs to have these incremental steps available. So...

Being able to text something like the crisis line, being able to call the eating disorder hotline. I know that there are a couple of eating disorder hotlines now available. That really would be my first step. And eventually that resource or that initial step forward can maybe open the door to getting resources like

therapist or a dietician or just other clinicians that may be able to support an individual. Also maybe having that initial conversation then does build some tolerance to be able to tell someone in your life, to be able to tell someone that you trust, to be able to tell someone that you know supports you unconditionally, but also recognizing that there's a reason

why the shame is present. There's a reason why that desire just to shut everyone out is present, because it's scary, it's not easy. So baby steps, right? Dipping the toe. So finding just these preliminary steps that then eventually can lead to maybe more assertive care.

Jennifer Milner (38:56.63)

I love that the first step is finding compassion for that part of yourself, because that's something that we struggle with. If that's something that we're, if we're dealing with an eating disorder, there's a reason. There's an emotional reason that we've got that. And finding up, trying to find some self-compassion for it. And how comforting I think it is to a lot of people, as you said, the anonymity of these hotlines. I know there's the 988 National Crisis Hotline, which is not just for people with suicidal thoughts.

but is for people in any sort of a crisis. So it's such an easy number to remember, 988. And if that person thinks that they need to point you in another direction, they will have a great conversation with you and help you find some other help you need. But I know there are a few other crisis hotlines. Do you know the names of them off the top of your head? Because I can't remember them.

Josh Spell (he/him) (39:44.417)

I don't have them off the top of my head, but...

Jennifer Milner (39:48.715)

I will find them and we'll put them in the notes for the show for sure so that people have those.

Josh Spell (he/him) (39:51.425)

Yeah, because it's almost sort of thinking about it as like triage, right? And so having someone in the medical field or having someone in the eating disorder field or just having knowledge, that removes a barrier to reaching out. Because I think, again, that's sort of one of the number one reasons that individuals don't reach out is because there are a lot of

Jennifer Milner (39:56.43)

Mm-hmm.

Josh Spell (he/him) (40:20.897)

which make it difficult. I am a therapist and it is difficult to find other therapists, right? And I know what I'm looking for. I understand super bills. I understand all of those insurance aspects and it's challenging for me. So I wanna normalize for everyone listening that yes, kind of feeling that initial, like I don't know what to do and I feel very stuck, you're not alone in that.

Linda Bluestein, MD (40:28.762)

Yeah.

Josh Spell (he/him) (40:50.517)

And that's why things like these hotlines open the door and they allow for more work and more networking to be possible.

Linda Bluestein, MD (41:05.026)

that's really helpful because I think for a lot of people, it's just really hard to know where to start. And even if they do acknowledge that they that they need the help, which of course is a huge first step, right?

Linda Bluestein, MD (41:20.893)

Oh. Did we miss any questions, or do you have any final thoughts before we ask about the hypermobility hacks?

Josh Spell (he/him) (41:29.517)

I mean, I have so many thoughts just in terms of this podcast and the specificity with hypermobility and just how all of these sort of intersect. But I guess I don't have one thread to follow right now. I feel inspired having this conversation, I have to say.

Linda Bluestein, MD (41:33.347)

Hahaha

Jennifer Milner (41:35.082)

right.

Jennifer Milner (41:54.23)

Well, we feel the same way for sure. And I feel like we pulled a fair amount of threads and you were very gracious in helping us chase them down and fill us in on them. So thank you for that information.

Josh Spell (he/him) (42:06.371)

My pleasure.

Linda Bluestein, MD (42:08.81)

Okay, so we always like to finish, of course, where people find you, but before we do that, your favorite hypermobility hacks. Or hack.

Josh Spell (he/him) (42:18.089)

Yeah, so if I'm thinking... Oh, I'm sorry, I interrupted you.

Linda Bluestein, MD (42:24.494)

No, no, that's okay. You didn't.

Josh Spell (he/him) (42:27.961)

Um, yeah, I'm thinking about eating disorders and kind of what I have learned along the way. And I think the biggest hack would be sort of giving your eating disorder a persona essentially, and being able to separate these multiple layers of who you are from just who you are.

Linda Bluestein, MD (42:32.292)

Mm-hmm.

Josh Spell (he/him) (42:56.453)

am Josh and I have an eating disorder. Right? It's like that feels really overwhelming and I mean it is overwhelming but if I can say like I am Josh and there is a part of me that struggles with an eating disorder I can get to know all of the stressors that maybe activate that eating disorder I can get to know maybe all of the emotional pain

that the eating disorder is trying to protect me from because most of the time we...

Josh Spell (he/him) (43:34.201)

develop some of these types of mental health disorders as a response to conditioning, to stressors like we talked about earlier. So really being able to create some space is so helpful because I think then even when we are ashamed of this part we don't have to be ashamed of who we are right just sort of

as a human being. And so therefore then it may be just a tiny bit more accessible to offer understanding, to offer self-compassion, right? To offer care and support to this part. And you know, in my treatment with individuals who struggle with eating disorders, a lot of times we go off on this journey of like,

What's the eating disorder's name? How do they talk? How do they walk? How do they dress? What do they want you to know? What would happen if they did soften back, right? And then all of a sudden it's like, oh, there would be chaos and I would have no sense of control and the ballet studio would be even more overwhelming if I didn't have it. And it's like, well, great. That is really helpful information. That is amazing noticing. So yeah, that's my biggest hack.

Jennifer Milner (45:01.806)

That's a great hack, I love that.

Linda Bluestein, MD (45:06.873)

I do too, that's really great. And where can people find you online?

Josh Spell (he/him) (45:12.833)

Yes, so you can go to my website, which is FlexibleMindCounseling.org. I also have an Instagram handle, Spellbound20. And then also LinkedIn. You can find me there.

Linda Bluestein, MD (45:30.902)

Okay, great. And we will make sure to have all of those links in the show notes as well. So thank you so much for that. All right. Well, Josh, this has been such a great conversation. And I want to remind everyone that you've been listening to the Bendy Bodies with a hypermobility MD podcast. And our guest today was Josh Spell, social worker, therapist, dancer, plant enthusiast and lover of the arts. I love how you had that in your bio, I had to just include all of that. Josh, thank you so much for coming on the Bendy Bodies podcast.

and sharing your incredible wisdom and knowledge with us.

Josh Spell (he/him) (46:05.217)

Thanks so much for having me. It was such a pleasure to talk and, yes, just explore these really important topics.

Jennifer Milner (46:13.878)

Yeah, thank you so much, Josh. I always love hearing what you have to say because you've got so much wisdom in this area. So thank you.