Body Language: ECHO Listens

In the basement of Quincy House F-Entry, next to the rumblings of the washers and dryers of the laundry room, is a door coated in chipped white paint and labeled "Store Room." But taped over the letters is a piece of yellow paper with a handwritten message--"echo."

ECHO's image is a balancing act--though the organization maintains a low profile so as not to intimidate students, it strives to be noticed by people looking for help with eating concerns.

Behind the closed door sit two of the 18 staffers for Eating Concerns Hotline and Outreach (ECHO), a group dedicated to raising campus awareness of eating disorders and body image problems. While outreach is an important part of ECHO's image, the office is also a place for people to stop by from 8 to 11 p.m., Sunday through Wednesday. After hours, the hotline forwards the calls to one counselor's personal telephone line.

The staff of ECHO is there for people with eating disorders, for friends of people with eating disorders or people who just need to talk about their food concerns.

"I do feel that it's something that touches us all, not only the people who have a diagnosed eating disorder. It's a spectrum," says one of ECHO's co-directors.

But it takes more than comfy couches and a quiet room to draw visitors to the ECHO office. To make students feel comfortable using the service, ECHO maintains a strict policy of confidentiality. In addition, students who use the service remain anonymous. In order to preserve this anonymity, the ECHO staff asked that their real names not be revealed in this article.

The Harvard Profile

In a college environment characterized by constant stress, eating disorders and body issues can become quite serious, ECHO members say. Harvard students' high expectations for themselves and their achievements often lead them to eating problems, and then ECHO's door.

"It's Harvard. There's a lot of stress here. People are striving to be perfect," one of the co-directors says. Harvard's emphasis on dress-up occasions--formals and cocktail parties abound--also puts on the pressure.

"You have so many opportunities to be judged on how you look. That can cause stress for someone who is not sure of their relationship with their body," she says.

Dr. Sheila M. Reindl, one of ECHO's two supervisors in the Bureau of Study Counsel, says statistical proof substantiates these hypotheses about Harvard's environment.

"People with eating disorders tend to be very driven, perfectionists, competitive and other-oriented," Reindl says. "Harvard tends to select for people who are going to be all of those. It's a very stressful environment. People turn to eating disorders to cope...It exacerbates any previous tendency to an eating disorder."

Reindl's conclusions come from both her interactions with students and a survey conducted by a member of the psychology department in 1991. The research showed that 24 percent of women and 4 percent of men said they had used starvation or fasting as a method of weight control sometime during college.

Binge eating is also a concern, with 25 percent of women acknowledging binge behavior.

But Harvard has food and weight problems beyond common forms of anorexia and bulimia.

One of ECHO's greatest concerns is compulsive exercise, which is a common form of bulimia among Harvard students. Instead of purging to get rid of food in their systems, compulsive exercisers turn to intensive workouts.

According to the survey, 13 percent of women and 5 percent of men defined themselves as compulsive exercisers and 25 percent of women said the main reason for their exercise is weight control.

"It can get extreme and dangerous," an ECHO counselor says. "I had a friend who was a compulsive exerciser, and she would just go running all of the time. It becomes all consuming."

The second co-director cautions that while it is wonderful for people to want to exercise, when the thought of missing a day is inconceivable, something is wrong.

"When it becomes an extra burden rather than a joy, that's not a healthy restriction," she says.

The tension that surrounds food and exercise is an important topic to ECHO counselors, even though it may not fall under the traditional definitions of eating disorders.

"People can call us for a huge variety of issues," she says. "People don't think they can call if they want to talk about their friend, or gaining weight instead of losing weight."

Reacting to the Individual

Whatever students' concerns may be when they call, ECHO has a wide range of methods to help.

"We might run through a role-play with them. Some people talk to us for two hours," one of the counselors says. "If you wanted to talk to your roommate about it, try it out on me."

ECHO staff members say they let the callers and visitors explain their situation and then tailor advice to the individual.

Conversations often focus on finding professional help. If students need more than their peers, ECHO has referral numbers and can give callers medical information on various disorders.

ECHO staffers say their counseling is supportive but it is just a first step in getting more help.

"Our rule as a hot line is to be for anyone who needs someone to talk to. On the other side of a hot line you can't change anybody, but you can help them identify a feeling they've had but haven't put a name on," a co-director says. ECHO can help students make decisions, but can't make those decisions for them, she adds.

"It depends on what they're looking for. For some people, you just listen. You don't say much except to assure them that it's okay," the other co-director says. "If someone's looking for help we coach people through. It isn't formula."

The most challenging aspect of counseling is figuring out what individual students need--especially when that call comes in the middle of the night.

"Crisis time can be at three. You have to snap out of sleep and talk to somebody," one of the co-directors says.

Reindl says the late night availability is one of ECHO's greatest assets.

"People experience a great deal of distress in the middle of the night when they feel alone," she says. "It's a difficult time for people with eating disorders who are overwhelmed with emotions. ECHO gives them another choice in that moment."

The solitude possible in a college environment can be one of the most difficult factors for students struggling with eating disorders to overcome, she adds.

On One End

New counselors join the ECHO staff at the start of each semester. After an interview process that includes role-play situations, new staff members go through extensive training with nutritionists, psychiatrists and other experts.

People often have personal reasons for joining ECHO. Members acknowledge that several staff members have a history of eating disorders.

"For some they've had an experience. Often people want to share what they've learned. It can be a wonderful asset when talking to somebody or helping somebody," a co-director says.

Reindl agrees that ECHO staffers with a more intimate knowledge of the concerns can bring their expertise to the counseling process.

"A number of them have now recovered, and it's a way to take some additional steps in their own healing," she says. "That's powerful that they can make a real contribution."

But even though not all counselors have had eating disorders, they all have experiences from their daily lives that make them aware of the threat.

"People on staff have, people on staff haven't. We all have pretty strong reasons for attaching ourselves to this peer group over another one," a co-director says.

Resonating in the Community

In recent years, ECHO has reinvigorated the group's outreach program. Staff members say eating disorders need a higher profile on campus.

"We're visible to people who are interested already. But those who don't know about it, those are the people we're trying to reach," a co-director says.

Besides hotline duty, staff members describe outreaches to first-year proctor groups as their most vital function.

The format follows a simple plan. First, they explain the nitty gritty of ECHO and then they pass out notecards for people to write questions on. They then read the cards, hoping a conversation will develop.

"The goal is to encourage discussion, jumping off points," a co-director says.

Introducing students to ECHO early in their college careers is crucial because of the traumas certain to hit in the first months of Yard life.

"Everybody has to go to Annenberg. That can be overwhelming, unlimited choices, all-you-can-eat," a co-director says. So ECHO steps in to explain that anxiety about eating is a normal feeling. "So much can throw you in freshman year. It's good to know what's going on."

The number of outreaches per year is dependent on the whims of first-year proctors. ECHO averages one outreach a month, a co-director says, adding that she wishes they could do more.

"We're there for 45 minutes. That's it," a counselor says. Such outreach programs from some peer counseling groups were once mandatory, but that policy ended three years ago.

One of ECHO's biggest projects is Eating Disorders Awareness week, which gives the group an opportunity to raise the issue for public discourse through panels, posters and table tents.

This year, ECHO tried out interactive displays in the Science Center, which received an enthusiastic response.

One day they hung up the outline of a body and asked passersby to stick construction paper hearts on the parts of the body they were not happy with and pledge to appreciate it for the day.

The ongoing poster campaign is integral to ECHO's effort to spread the word about eating problems.

Last year, one poster in a woman's bathroom stall prompted one woman to write a message on the paper. Others replied, starting a written conversation. This is the dialogue ECHO is striving for, a co-director says.

"I think the more the stigma can be removed, the more beneficial that will be to discussion and awareness," she adds.

The End Result

As with any counseling method, ECHO staff members say they regret the conclusions of some conversations with callers and visitors.

"Sometimes I feel frustrated, wish I could make it better," one counselor says.

But Reindl has seen the successful results of ECHO's endeavors first-hand. Many of the students who come to see her at the Bureau of Study Counsel were directed to her by the ECHO staff.

"That may not seem like a big deal, but people follow up on their referrals. That says a lot about [the service]," Reindl says.

Reindl says ECHO is an important part of the entire therapy process. Making the move to an anonymous student hotline is not as emotionally difficult as setting up an appointment at the Bureau of Study Counsel.

"For many people they are a point of entry. People can talk, and then talk to someone about a referral. It's the right sized step for someone to make," she adds.