As the Jewish community approaches another pandemic- era Passover, staff at the Renfrew Center, a national network of eating disorder treatment facilities, are working to support Jewish women and girls whose experiences with eating disorders become more challenging during the holiday.
“Doing a lot of inspection of food and cleaning around the home can bring up a lot of the rigidity that we sometimes see with anorexic patients and, of course, some of the large amounts of food that can be prepared and potentially consumed can be really triggering for those with a bulimia or binge-eating diagnosis,” said Jillian Hartman, licensed mental health counselor and site director at the Renfrew Center of New York.
She said eating disorders are a form of emotional dysregulation — patients are unable to manage their emotional responses in healthy ways. The strong feelings of excitement and anxiety, not to mention the emphasis on physical appearance, that large family gatherings generate, can be difficult to process.
Sarah Bateman, licensed clinical social worker and Renfrew Center Jewish community liaison, said the sadness of being unable to gather with family or the frustration of spending too much time with people in their immediate households due to the pandemic adds to patients’ stress this year.
She said Renfrew Center staff teach patients how to slow down and process these emotions. However, women who are expected to care for children, cook, clean and attend to guests may have difficulty making time to care for themselves and their treatment needs during the holiday.
Patients are also given a meal plan to help them get used to eating a healthy amount of food in regular intervals throughout the day, and dietary laws can create issues in that part of the process.
The prohibition of chametz on Passover disrupts eating routines and means that the pasta, bread and other carbohydrates patients are usually encouraged to eat are literally off the table. Eating large quantities of matzah can cause digestive problems that interfere with patients’ ability to feel hungry or full.
“For somebody with an eating disorder, this isn’t just physical. It becomes emotional, and mentally it becomes challenging to be able to continue feeding oneself properly,” Bateman said.
Bateman said she never blames Jewish rituals or traditions for causing or worsening eating disorders. But she believes it’s important for therapists to understand how they shape people’s relationship with food in order to provide culturally sensitive and sustainable treatment — having kosher food available at treatment centers and understanding holiday rules, for example.
“We want to make sure that they’re able to stick to the rules as much as possible while also participating in treatment,” she said. “And for somebody in outpatient treatment, we want to make sure that their individualized treatment plan works with their lifestyle and their needs.”
If Passover restrictions threaten to disrupt treatment, the Renfrew Center will work with patients’ rabbis to create more flexibility. For observant Ashkenazi patients, rabbis often give permission to eat rice, beans and other forms of kitniyot that would otherwise be forbidden.
“A lot of times with an eating disorder, or with mental illness in general, we see a lot of black-and-white thinking where everything is kind of all or nothing,” Bateman said. “What we do in a generalized way would be to try and increase that flexibility and consider other options.”
Some restrictions of the pandemic have actually led to more flexibility, especially regarding using technology to connect with loved ones on holidays. Many of her patients’ rabbis have made statements permitting those who struggle with their mental health to use phones and computers to connect with support on Passover, even offering to leave their own phones on so they are accessible to congregants.
She said the toll of isolation and loneliness on eating disorder patients can’t be underestimated, and she was pleased that communities have responded with urgency.
“This was just a really profound acknowledgment of the need for connection at this time of isolation,” she said.
Hartman said patients’ experiences of being treated for eating disorders has parallels with the Passover story of escaping slavery.
“It can feel like you’re under this kind of dictatorship,” she said. “And then there is an ability to seek treatment, to get support and engage in recovery, and recovery will look different for everyone and it’s a very personal journey, but it can also be a journey in which they look to gain their freedom back.”
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