Season 8, Episode 2, Emmerline Irving on Stigma & Obesity

As we continue the series on 'stigma', join Dr Lisa Cherry in conversation with Emmerline Irving as we talk candidly about obesity & stigma and why blame-based stories in the media and in healthcare block recovery, dignity and effective treatment. 

We explore obesity as a chronic, relapsing disease shaped by biology, trauma, poverty and an obesogenic environment, naming what trauma-informed support can look like in real services.

We explore: 

• Emmeline’s lived experience of obesity and her public health work across West Yorkshire
• Where GLP-1 medicines such as semaglutide come from and why press coverage becomes stigmatising
• Why terms like “fat jabs” do harm and why “metabolic drugs” is more accurate
• The bi-directional link between trauma and obesity and what we learn from lived experience
• Why weight management services can be re-traumatising and set people up to relapse
• “Food noise” and why clinicians often misread it as depression, anxiety or an eating disorder
• How GP interactions show how stigma gets embedded in pathways and referrals
• Obesity, poverty, double stigma and the commercial determinants of health
• Reframing obesity through both a trauma-informed lens and a clinical lens
• What personalised, essential care looks like before, during, and after treatment

You can learn more about Emm's work here. 

Transcript

Why Stigma Matters Here

SPEAKER_01 0:03

This is the Trauma Resonance Resilience Podcast. This is for you if you are interested in compassion, connection, and relationships and how we can all work together creating services that do not add to harm but rather seek to support recovery from it. I'm your host, Lisa Cherry, and this is your time to sit back and listen in on conversations that make a difference.

SPEAKER_02 0:30

So here we are, again looking in this new series at stigma. Remember, there are two other series to listen to if you haven't heard them already. There's the one around the dilution of trauma, and there is also a series on liminality, but today we are focused on stigma. And so I am joined by public health specialist Emmeline Irvin. Hello, Em. Hi, Lisa. It's so good to see you. And we're looking today specifically at stigma and obesity. It's an area that I know you're particularly passionate about. How did you arrive at a point where you had such an interest in obesity personally and professionally?

SPEAKER_00 1:23

So if I take the personal first, I've lived with obesity all my adult life and not really understood it until the last few years. It's had a massive impact on my life and the choices, decisions, the way I've lived my life, every aspect of my life. Professionally, as a public health specialist, I've always sort of done work around prevention and obesity, obviously, is one of those areas. Normally classed as weight management support, normally behaviour change, which reinforces stigma, which we can come back to at some point. But in the last three years, before I finished with the Integrated Care Board, I was the lead for the obesity programme across West Yorkshire for the last 18 months, co-lead for the colleagues. And obviously, obesity

Emmeline’s Personal And Professional Lens

SPEAKER_00 2:10

at the moment is the topic of everybody's conversation because of the new treatments that are available around obesity. So that really catapulted the programme of work in the ICB.

SPEAKER_02 2:22

So just for the listener, who might not necessarily know or understand where drugs like Azempic came from. Could you just give a little bit of clarity about that, please?

SPEAKER_00 2:36

Yeah, so I'm the the drugs, the the phenomena that you're seeing now around weight loss drugs was discovered through smaglotide, which was used for diabetes. And people realised that people that were taking that drug in a very in a much lower dose for smaglide, one of the indirect consequences was weight loss. And so obviously the pharmaceutical companies have explored that. And now we've got this plethora and a whole pipeline of bo of these drugs coming onto the scene. And they are life-changing. They're not a magic wand, but they are life-changing. And so they're really changing the landscape for obesity and people living with obesity.

SPEAKER_02 3:17

Because the the press has been very mixed about it because of side effects and who's been using it. And I mean, I I know several people who who are on those drugs.

SPEAKER_00 3:30

It's had mixed press, I think it would be fair to say. And and this is why we're doing a podcast on stigma, because ultimately that mixed mixed press is due to stigma and lack of understanding and ignorance. And you're absolutely right. And and some of the press has been incredibly damaging. I absolutely hate the term fat jabs. They're not fat jabs. You know, and like any medication and treatment anybody takes, you need to get the right clinical support, the right advice, and themselves on their own, they're not a magic wand. You you still have to look at your lifestyle, you still have to look at the conditions that are around you that add to um obesogenic lives. And you still have to take into account why you're living with obesity, understand the biology, understand the psychology and the trauma. And a huge element of that is stigma because people blame individuals for living with obesity. They think it's a choice. You're either not moving enough or you're too greedy, but ultimately it's your fault. And so when the drugs came online, the press got hold of that and labelled them fat jabs and all sorts of stigmatising language. And of course, the industry that the Hollywood stars, you know, the people that didn't necessarily live with obesity but found that they were very rewarding when it came to weight loss also didn't help that press. I mean, stigma and media is a whole different podcast, I think, Lisa. But certainly in relation to this, they really do need to start calling them metabolic drugs.

SPEAKER_02 5:10

So let's just go back to thinking around obesity and you raised trauma because lots of people don't understand that the adverse childhood experiences study that was completed between 95 and 97 actually started in um an obesity clinic, which is really interesting because that study is very old now and and has been very heavily critiqued and heavily enjoyed in equal measure because it doesn't tell you huge amounts about individuals because it's an epidemiological study. It's not a study on an individual's life. But what it did seek to do was make the link that you

How Semaglutide Changed The Conversation

SPEAKER_02 5:50

have just raised.

SPEAKER_00 5:52

Yeah, so I tell everybody that listens that that's the adverse child experiences study came from an obesity study. Not to promote the adverse child experience study, but to promote the fact that trauma has a bi-directional link with obesity. So I'm not saying that everybody that lives with obesity has suffered trauma. That's absolutely not the case. And obviously, we'd have to do a massive study to really understand that. But like any life-changing physiological or psychological condition, which obesity is, it is a chronic relapsing condition, it is a disease. If you look back to the root causes of why somebody might be living with that condition, you will absolutely find adversity and trauma in the majority of people. So we did the More Than Weight report in West Yorkshire to find to look at the human cost of obesity. And what came out of that was trauma. And people were saying things like, This body saved my life because I ate instead of self-harming. Now, if that's not a statement that doesn't give you goosebumps, it actually makes me cry a lot of the time when I say it, then there never is a statement that will, because what that person's saying is they were hurting to a point where they would have coped in a more harmful way, but they chose to overeat. And that happens to a lot of people. So well, I I say chose. They didn't choose, their coping mechanism was eating and eating dopamine-rich food, eating to make themselves feel good because ultimately they didn't, and and their body and their energy was telling them that they were missing something. So if we are looking at obesity, we have to look at the root causes. We can't just look at obesity as numbers on scales. That's absolutely not what it is. It's to do with hormones, it's to do with your genes, it's to do with the conditions that you live in and what's happened to you most importantly. But if you've then lived with obesity for a long time and you've tried to seek help, you will probably find, just like I have done over the last 35 years, that that help is re-traumatising, not helpful. And actually the help isn't there because our systems aren't programmed. They're programmed for people who may have a small amount of weight to lose and not living with obesity. And actually, if if you go to um an exercise on prescription class or get the vouchers that often are level one services provide, yeah, they might help for some people. But ultimately, if you're living with the condition of obesity and you stop doing those things, you are likely to relapse. That in itself is also re-traumatising. And then you've got the way people with obesity living with obesity are treated. People that live in larger bodies. And I want to make this really clear that you can be living with obesity in a smaller body. And until we really understand that, people won't start to understand obesity. You don't have to be living in a larger body for the changes biologically and physiologically to have happened to you, for you to be living and in a point where you could relapse and regain weight at any point. So if we don't start looking at the language and the way we treat people living with obesity, then we're just continuing to cause further harm. So it's a really complex condition that is absolutely underpinned by trauma but re-traumatising.

SPEAKER_02 9:22

So there's three things I'm kind of picking up here, uh, which really speak to how complex this is. So the first thing is you're talking about obesity in the way that I talk about addiction, which is that until we stop seeing it as a person's inability to manage their own desires, then we are going to have a very punitive approach to addiction rather than understanding that it's medication. It's self-medication, it's soothing, it's a

Trauma Links And The “More Than Weight” Stories

SPEAKER_02 9:55

way of dealing with really overwhelming feelings. The second thing I'm hearing from you is around the two ways that you've described that are traumatizing. One of those are the services themselves, which I want you to explore with me a bit further. And then the other is the stigma held in society about obesity and about people, which we're all aware of because we've all socialized in that environment, much the same way as we might think about racism, or we might think about homelessness, or we might think about crime, or all of the areas that we grow up with those continuous messages that we have to work on removing and shifting because they're loud. So, I mean, I don't really have a question about that. I suppose I was just wanting to relay back to you what I heard you say.

SPEAKER_00 11:04

Yeah, you're absolutely right. And and unfortunately evidence hasn't caught up yet. So if you look at the evidence around obesity and addiction, for example, the evidence base suggests it's not an addiction. But actually, food addiction, if you talk to people with lived experience, is huge. And the food noise, which again, there's very different people with different views on this based on the evidence. I think it's the evidence that's out of date, Lisa, not what people are saying, because a lot of people will suggest that food noise is something that's been said by somebody with lived experience who's on the GLP1 drugs, and then it's been jumped on by the press and the pharmaceutical companies as another way of trying to promote the effectiveness. I would completely disagree with that because I live with obesity and I've lived with food noise, and the food noise of obesity is horrific. And when we talk about food noise, I can only describe it, and everybody will have their own experience of this. I can only describe it as waking up in the morning and thinking about what you're gonna put in your mouth, having something to eat, and then five minutes later having that same feeling. What am I gonna put in my mouth? What am I gonna eat? Can I find something? Is there something in the cupboards, rushing around the cupboards? You're constantly thinking about food and where your next item of food is gonna come from. It's not your next meal, it's not your next, it's not a hunger thing, it's not, you know, that you've been starved of food. Actually, there's probably a plethora of food in my kitchen most days because my husband's a bit of a hoarder. But it's about the it's about eating, it's about the the comfort, it's about, it quietens the anxiety, it quietens those thoughts in your head. So I've often gone to the GP and said, I can't stop thinking about eating. I can't stop thinking about food. How do I stop doing that? Now, if that's not an addiction, if that's not my brain telling me something, then I don't know what is. But the the evidence hasn't caught up yet. So absolutely, I I do truly believe that. And one of the things that the GLP1 drugs did, and this isn't about me pushing GLP1 drugs because, like I say, they are not a magic wand, they do turn off that food noise.

SPEAKER_02 13:20

Which is so powerful. But I wanted to ask you when you say to the doctor, I can't stop thinking about food, help me, what happens then?

SPEAKER_00 13:30

Oh, Lisa, and honestly, we don't have enough time on this podcast for me to tell you the horrific stories I've had trying to get support for weight loss. And I never understood I was living with obesity. I could never say that word. I wouldn't say obesity in my and and describe myself because that was that that was a a dirty word. I wouldn't say it. Now I've claimed that word because actually I understand what living with obesity means, and that's really important. So whenever I went to the GP and I would say that, they would say I was depressed, they would say I was just anxious. They would not relate it to me having any kind of food addiction or anything.

SPEAKER_02 14:09

How bizarre to have you in front of them. And for them to say, I mean, well, is it bizarre or is it their way of thinking about trauma? You know, in a really clumsy sort of way. Okay, I might, I mean, I I might be you know I think you're being too kind. Well, you know, I am always thinking curiously about why people do what they do. So my curiosity would lend me to think, why have they gone to anxiety? That's interesting.

SPEAKER_00 14:44

Well, because as well, it depends how you present at the at the GP as well. So I've presented at health services and mental health services in many different ways. So I've presented, saying I've talked about my mood, and my mood is low, and when my mood's low, I eat, or you know, I'll I'll eat something, and then on occasions I've I've made myself sick and this, that, and the other. The only way they can think about that is in terms of the acuity that they see and that the evidence tells them. So to diagnose them with depression and anxiety is far easier. What I know since, and this is a whole other podcast, is that I never had depression, anxiety, I had undiagnosed combined ADHD, which is a whole nother added complexity to my situation. But at the same time, when I've gone previously, the minute I've said I made myself sick, they diagnosed me with bulimia. Because the only things they have are eating disorders and food addiction and binge eating, binge eating more so now, aren't eating disorders. Um, we've started human language like disordered eating,

Obesity Beyond The Scales

SPEAKER_00 15:55

which may allude to that a little bit more, but we're still not looking at the fact that actually food isn't the problem, food is the coping mechanism. But they're trying, they're still trying to diagnose you with an acute an acuity of an eating disorder, because they can treat that.

SPEAKER_02 16:11

Well, also they love the word, and I say they, but you know, it's very embedded in our culture that they love disorders. Yeah. There's a love of of anything that can be disordered. It's a disorder. As if there's a norm, as if there's a norm that we all circle around, you know. Yeah. Um, but if the doctor had said the right thing to you, what would they have said?

SPEAKER_00 16:37

I guess what I have to explain first is is how they said the wrong things. And tell you about one of my most recent experiences. So I've been seeking help for over 25 years, and I've been in and out of the mental health system for the best part of 20 years trying to get help for what I didn't even know was wrong or happened or um is who I am. I have some of those answers now, and that's been amazing. But I have those answers, Lisa's, because I fought for them. Now I'm a public health specialist that's had a career in the NHS and the local authority for over 30 years. I know the system, I know how it works. So I've been able to fight for them. I've had the privilege of knowing how to do that. There are so many people that don't and won't get the help. And the last time I went for help, I'd just had some routine blood tests done. And they told me that my HBA1C, which is the diabetes test, was in pre-diabetic, almost diabetic, it was like three points. Well, it was diabetic, it was three points into the diabetic range. But to be diagnosed with diabetes, you need a follow-up test three months later. I refused to have that follow-up test because I didn't want to be diagnosed with diabetes because that had a whole different stigma for me and a whole different outcome for other reasons in life. So, but and I knew the reason why my HBAC, HBA1C was that high. It was lifestyle, it was my weight. It was to do with living with obesity. So I asked for help. At this point, I wasn't, I was starting to learn more about obesity and obesity as a disease rather than than it just being a thing that I do to myself. I was I was starting to learn more about it. And I refused to go for the blood test. I asked for help instead. I asked to be referred to what we now, what we call at the minute tier three weight management services, which are services offered by a hospital. And they're before the next level, which is bariatric services, and they're supposed to help people really start to understand and and understand how they can sort out their weight. And it was just on the time that that Mongiaro, not Mongiaro, WeGovere, semaglutide was coming onto the market. I asked for help and I was told, oh no, no, you can't get that referral unless you go to Tier One. Well, I've been to Tier One services pretty much all my adult life and tier two services. They can see that on my records. I explained this to them. I said, just going to Slimming World isn't going to help me. I'm living with obesity. I need more than that. Oh no, you can't do that. No, but I can I can refer you to podiatry and retinopathy for your diabetes. I don't have diabetes. I don't want that referral. Don't, don't put that on my records. This went on for about 10 minutes to the point that actually I got nowhere and I ended up getting no help whatsoever and ending the call. Around six weeks later, I get a call from the GP practice saying you need to come for your blood tests. And I also got a letter through telling me I needed to go to the retinopathy clinic. And so I phoned my GP and I was really, really cross. And I said, First of all, I hope there is no coding on my record of me having diabetes because I've not been diagnosed with diabetes. I've not had the follow-up test, and therefore that's incorrect. And they did apologize for that and they did say they'd remove it. But then they

Food Noise And The Addiction Debate

SPEAKER_00 19:55

said, But you've got to come in for your blood tests. And I went, I'm not having my blood tested until somebody gives me some help and refers me to a service that's going to help me. I've got a BMI of 49. I have high blood pressure, and I'm potentially gonna, if I come for that blood test, be diagnosed with diabetes, I need some help. And this GP turned round to me and said, How do I know you've got a BMI of 49? Oh my goodness. So I what I said after that blowing my brain, I turned round to him and said, Look, the bottom line is I'm not coming in for a blood test. I will come in and be with and prove to you that that's where my BMI is, but I'm not having a blood test. I then mentioned to them that I had started accessing privately GLP1 drugs, and he berated me for accessing them privately and not getting them through a proper clinician. And what I said to him was, Well, you're not going to help me. I've asked and repeatedly, you've either accused me of lying or decided you don't want to help. And I have lots of people around me because of the job I do, I'm privileged that I can get support if I need it. I said, So, unless you want to weigh me and refer me to Tier 3 weight management services, I am not coming into the surgery. And 10 minutes after that call, Lisa, I was about to train a group of junior GPs on the trauma of obesity. And I was in floods of tears, and I had to ring a colleague, I had to debrief, and I had to say, What on earth am I going to do? And I did run the session. And what I ran that session about was if you want to support people living with obesity, you have to listen to them, you have to personalise the care and understand what's happened to them, and you have to be Prepared to remove the barriers, remove the tears, and you have to give that person the treatment and support that they need at the time that they need it. And you can only do that through a full trauma-informed personalised triage.

SPEAKER_02 22:17

I think it's wonderful that you went and did that training, even though that experience sounds awful. I just think the material that that gave you. I mean, you know, I deliver a lot of training. So when things happen to me, I'm like, boom, great, that's material. And for you to have something so fresh and the feelings that go with it to take into that room would have been so invaluable for those GPs. But what I want to ask you is, how has and where is the stigma that has found its way so into the heart of the services that are designed to help? What's your view on that?

SPEAKER_00 23:01

So obesity has always been the poor relation in public health. So if you look at the tobacco agenda and what's happened in tobacco is phenomenal. Yes. And the support that we've been able to give people. And probably if you go back 20, 25 years, people would say that people, it was quite blaming and shaming if you smoked. But it's not like that now. If you go to a clinician for help around smoking, you're not blamed. It's not seen necessarily as a choice. And certainly giving you treatment isn't something that they would resist doing. They would actively promote it. When you look at obesity, that language, that viewpoint hasn't changed because people still think it's about eating too much and not moving enough. So you are blamed. It's a choice. Apparently, I choose to live with obesity. I choose to be ridiculed. I choose to go on an aeroplane and the seatbelt not fit and feel humiliated. I choose to go to theme parks with my kids and not be able to fit on the rides. Apparently, that's a choice. If that was a choice, believe me, I would have chosen very differently. So until we start seeing obesity as a disease and a condition, and we start looking at what's the right treatment for that, and we stop seeing obesity as individual choice and lifestyle. There is life, don't get me wrong, lifestyle is a part of the treatment. Lifestyle is a part of staying in remission and not relapsing and putting weight back on. Because we all need the protective factors of good health. We all need to stay well, we all need to be physically active. Physical activity is one of the biggest gateways to good health and other protective health factors like good mental health, good sleep. We all need that. Everybody needs that. It's not something that's particularly lacking in people living with obesity. Because you can have, I swim five times a week. I've always had a very active life. But I live with obesity. It's because we blame people, and because actually, Lisa, there's so many people now living with obesity and undiagnosed obesity and living with the plethora of comorbidities that come alongside it, and quite acute comorbidities that actually we've got to a point where we can't afford it. We can't afford the treatment.

SPEAKER_02 25:35

And also there is a link with obesity and poverty. Such a huge rise in poverty in this rich country that we live in. So undoubtedly, all of the things that are linked to poverty are going to rise as well. And obesity will be one of those things. And then you've got, then you're into the double stigma, because of course, we have a history in this country of blaming poor people for being poor, you know, uh,

A GP Encounter That Shows System Failure

SPEAKER_02 26:10

and people were punished in workhouses for being poor so that they would stop being poor.

SPEAKER_00 26:17

And we blame people. We have records of this, so we have a history. And they and they're blamed for making their wrong choices. Well, then it's the same thing again. It's not a choice.

SPEAKER_02 26:29

Yeah, but it's the same thing again. Anything because of individualism, neoliberalism, anything that is about blaming the person is always going to be something that is stigmatized because ultimately you're just not trying hard enough, and that's on you. But what is really important, I think, which you've mentioned several times, is that it's not about removing the individual away from all of those structures. The individual is important, you know, what we bring into everything that we're doing is really important. And I want to ask a final question, really. So if we reframed obesity not in that way as a personal failing, but imagine if we thought about it as an adaptation or survival, or as having unmet relational needs, which is something I spend a lot of my time focused on. What then kind of opens up for how obesity is worked with?

SPEAKER_00 27:33

Yeah, absolutely. And there's two things in that. There's reframing obesity, and there are critiques of this. There's there's reframing obesity, not as just the the corporate mechanism and and and the ability to survive what's happening to you. But there's, and that would absolutely be our trauma-informed way of reframing it. But we do need a medical way of reframing it as well. It has to be reframed as a clinical condition, a chronic relapsing disease, because that's what it is. The fear that comes with that is that we medicalize the response. And we've had this conversation about trauma and medicalizing the response when not everything that happens to somebody that suffered trauma or living with a beastie can be dealt with in a medical, in fact, only a tiny amount of it can be dealt with in that medical model. We have to have a social response. So we do need to reframe it, we need to see it as a coping mechanism, we need to see it as a result of what's happening to somebody, but we also do need to see it as a disease because it that is what it is. But the way in which we can respond to it is by recognising that the individual has to be at the heart of it because you've got to understand what's happened to that individual, and you have to understand the personal care that that person that person's going to need, but you have to understand the obesogenic environment that that person is living in. So you mentioned poverty. Poverty leads to people not being able to bite the right nutritional food. But then also, if you look at the um commercial determinants of health and how fast food and and everything is advertised and that, as well, there's it's so complex.

SPEAKER_02 29:13

Oh, yeah, you don't get three for two strawberries, do you?

SPEAKER_00 29:16

No, exactly.

SPEAKER_02 29:17

You don't get one strawberry, get another strawberry-free. So like it's a very deliberate strategy.

SPEAKER_00 29:25

So we so we've got to look at the obesogenic environment, we've got to understand the biology, and even the clinicians out there have got to understand the biology because they they all don't, Lisa. And there are some phenomenal um medical people out there, like Giles Yeo and others, that that tell the biology in a really easily understood way. And and we need to understand the biology, we need to understand the psychology, that this isn't something that's just an acute eating disorder or or an addiction, that actually there is a whole spectrum, just like just like trauma and adversity, that stress spectrum, there is a whole spectrum of things that contribute to the psychology, and it's not necessarily going to need a mental health referral to support somebody. For example, I know there's a there's a PCN at a primary care network in Leeds that they're taking people that are coming into their obesity clinic bowling because they've seen social isolation as one of the reasons as to why they're struggling. So the the psychology has to be really understood. Then we need to understand obesogenic environment and the determinants of health. Then we need to build in the protective factors. And finally, the last element is the medical model, is the treatment. And that treatment may be GLP1 drugs, they're not going to work for everybody, they're not sit well with everybody. It may be bariatric surgery or it may be a mental health service, but that's when the treatment bit comes in. And one of the things that I want to do and continue to work on in my role now is that

A Trauma-Informed And Medical Reframe

SPEAKER_00 30:55

that five pillar framework of support that people need if we want to get the essential care. So they call it wrap around care, which again is very stigmatizing, Lisa, because why would you wrap around care, why would you wrap care around a drug? Because you're basically saying that the treatment and the drug isn't the most important thing, not the individual. So actually, it's the essential care and support that people need before they start any treatment, during any treatment, and after the treatment. But actually, we get that essential care right early doors, but they may never need treatment. So, you know, it's that's prevention again, aren't we? Absolutely. Yeah. And unfortunately, at the moment, we can only afford a to look at a cure. So that at the moment, a very small percentage of our population is being able to access the treatment necessary to help them. And there is a massive cohort of people like myself and and others in this middle land where we like to call them the waiting well, I call them the waiting to die, because without some form of intervention, they're just building up comorbidities. And we don't have the money in the system, it has to be from somewhere, but we don't have the money in the system at the moment to commission on such a scale that those people can get the treatment and support that they need. And let's let's be real, the drugs are expensive at the minute, they are, because they're new. But there are hundreds of them in the pipeline, and the price will come down. What's really expensive, Lisa, is training the knowledge, skills, and competences of our staff and our workforce not only to be able to support people living with obesity in the right way, so we're not re-stigmatizing, we're not re-traumatising people, but also so they themselves can get support because a lot of our workforce are living with obesity. And the moral injury of people working in services, supporting people living with obesity or weight loss services, that they either can't help them or they don't understand the problem, or they themselves are looking for that same help, is huge. So this isn't just an issue for people living with obesity, this is an issue for our workforce as well. If we want to have a healthy, thriving workforce, we have to make sure we care for them. And this is one of the things that we need to care for them with.

SPEAKER_02 33:25

It's been brilliant talking, Chief. Thank you so much. And I know that there are people who will be listening to this and they will be learning huge amounts about something that just isn't talked about in the way that you've talked about it in the

Final Reflections And Listener Ask

SPEAKER_02 33:40

public space. So thank you very much, and I'll see you soon. Thank you.

SPEAKER_01 33:47

You've been listening to the Trauma Resonance Resilience podcast with me, your host, Lisa Cherry. Brought to you straight from the heart of the knowledge that high quality relationships are the cornerstone of learning, healing, and growing. If you've enjoyed this episode, please consider sharing or reviewing. Until next time.