We Need A Harm Reductionist Approach to Eating Disorders

People who don’t wish to ‘recover’ still deserve autonomy and care.

Photo by Louis Hansel on Unsplash

I just finished reading the book Saving Our Own Lives by Shira Hassan last week, and it stands out to me as the first book I’ve ever read that applies a harm reduction framework to eating disordered behaviors. The conversation with Gloria Lucas included in the book discusses this subject, and what it looks like in practice the most thoroughly, but since I’d never heard it discussed before, I was alight with excitement and curiosity the moment Hassan brought the topic up within the book’s first few pages.

Harm reduction, for those unfamiliar, is an approach to public health issues that prioritizes body autonomy over forcing a person to meet external standard of ‘healthiness’ or moral correctness. Harm reduction holds that society has a responsibility to care for all people, no matter their choices, behaviors, or desires. It views individuals as the sole authority on what happens to their own bodies — and it acknowledges that trying to force an outcome or behavior change on a person who doesn’t want it is not only destined to fail, it’s a violation of their consent and dignity.

Rather than judging people for their choices, or attempting to shape their behavior from the outside using manipulation, coercion, shaming, or punishment, a harm reductionist accepts people as they currently are, and aims to help them meet their needs, on their terms.

Rather than trying to “rescue” a person from engaging in survival sex work, for instance, a harm reductionist asks a sex worker directly what it is that she needs. Condoms? Regular STI tests? Free childcare while she works? Would stable access to food and housing allow her to be more choosy about her tricks? Or does she just want a quiet place to charge her phone for a few minutes and to be left the hell alone?

Most nonprofit health clinics and shelters see themselves as providing services to the “needy” without showing respect for them as full people. Care providers at such organizations often presume to know what is good for a sex worker better than she knows herself. Such organizations may even refuse to give a client the benefits she does desire unless she promises to stay…