James Downs, prominent mental health campaigner and expert by experience in eating disorders, generously shares his thoughts and experience as our latest Orri Guest Blogger.
Life is supposed to be a journey from one happy event to the next, right? The glossy side of social media tells us the story that we are only living our “best lives” when we don’t have to contend with difficult emotions. The self-help section of any book shop will be full of titles telling us that the way to overcome our problems is to “think positive” – to manifest the life that we want through the sheer willpower of happiness.
When you step aside from that, you pretty soon realise that life is full of suffering. However much we want to look the other way, pain is one of the hallmarks of what it is to be a feeling human being. The great thinkers of human history (- or at least the men whose ideas are remembered) have time and again tried to articulate this fact and provide responses to it.
But when does pain and suffering become trauma? That’s a difficult question to unpack. I think that difficult, painful and traumatic times all have something to do with unmet needs, or the violation of our needs – and these are times when we can reach to other behaviours to try and prevent, avoid or soften some of this pain. Some painful experiences are short, acute. Others may be less obvious but persist over time to wear us thin.
“Emotions are called “feelings” for a reason – we feel them in our bodies, and the body experiences and keeps a record of our emotional pain in the same way it remembers physical pain, illness and injury.”
Literature from emotion-focused therapy models provides a really helpful way of understanding needs, and the core painful feelings that can arise when those needs are unmet. The need for safety is an existential one, and without it we feel insecurity, invasion, terror. The need for love and connection also provides us with security – we only survive in communities. Without this, we feel alone, isolated and unloved. When the need for validation and a sense of value and agency is lost, we can feel ashamed, worthless and rejected. None of us can sustain having our needs violated or unmet – either in key moments or over time – without it leaving its mark. The emotional pain we feel from this isn’t some abstract thing that is all in our heads. Emotions are called “feelings” for a reason – we feel them in our bodies, and the body experiences and keeps a record of our emotional pain in the same way it remembers physical pain, illness and injury.
“Yes, someone else will always have had worse experiences, but the only ones you have the responsibility to work through are your own.”
Each of us can think of times when our needs haven’t been met. We’ve all felt threats to our safety, periods of loneliness, pangs of being worthless. The triggers for these feelings and the ways in which we perceive and interpret our experiences are different for us all, and all trauma is equally valid. It is so easy to compare your own difficult experiences with someone who’s had it worse than you, and write off your own adversities as not being real or traumatic enough. But that only serves to undermine your need for validation even more, digging you further into emotional pain and trauma. Yes, someone else will always have had worse experiences, but the only ones you have the responsibility to work through are your own.
I understand my own unique “trauma map” as being made up many pieces of different sizes and shapes which slot together to reinforce feelings that I am not safe, loved or worth loving. I know this isn’t always true, but my body has been told this over many years in many subtle and unsubtle ways. As much as I can rationalise that I am as worthy as anyone else, I’m the product of my experiences as much as I am of my ability to think. I haven’t been able to think my way out of my mental health problems and eating disorder, despite the confidence of professionals that I would be able to with minimal or no support.
And that’s the thing about traumatic experiences and the ways we try and cope with them. They aren’t about faulty thinking or some deficiency in you, they are about needs. And the thing about needs is that we can’t do without them. Only we do. We make do. We do the best we can to paper over the damage, or to fill in the gaps left so painfully empty. This is where my experiences with eating disorders steps in.
I developed anorexia when I was in my mid-teens. Already in treatment for OCD and depression, I struggled to feel seen and understood and as though my experience of life was valid. This was across the board. My family and school teachers couldn’t see how devastatingly bored I was and left me to my own devices because I would get A*s. The psychiatrists didn’t see the distress that was driving my OCD and the feelings of being unsafe and unacceptable to others that pervaded my life – they only saw a clever person who would supposedly recover simply because they could grasp the ideas of CBT.
“However we may appear, whatever our backgrounds or life experiences or prospects, we all have needs.”
My need to be stimulated, to feel like I belonged, for someone to “get me” and see what I needed – all of these were overlooked, including by the people who were supposed to help me. This was deeply frightening – if the professionals couldn’t understand me and meet me in my suffering, then who would? Because I was bright, came from a respectable family and appeared confident, it seemed like nobody thought I needed very much. But however we may appear, whatever our backgrounds or life experiences or prospects, we all have have needs.
I am not proud of it, but I chose to lose weight. In no way am I suggesting that eating disorders are a straightforward choice, but for me, anorexia was the only option I had to keep myself safe in a world I found profoundly threatening. Anyone who tells you an eating disorder is a choice has no idea what it is like to be in a position where an eating disorder is the only thing that will keep you safe. Many people say eating disorders are all about “control”, but for me, that control was all about safety. Perhaps anorexia was also an unconscious way of asking for help and showing just how distressed I was when asking for help hadn’t worked in the way I’d hoped before. I don’t know, but I have to be compassionate to that young person who needed someone to understand their experiences.
But validation, emotional safety and connection weren’t easy to come by. Instead of focusing on the needs I was meeting through destructive eating behaviours, I was repeatedly told that what I really needed was to stop having an eating disorder. As though everything would be fine as soon as I gave up anorexia or bulimia, and by implication that I would have my needs met if only I wasn’t so badly behaved. Only the reality was that weight restoration, supervised eating and enforced cold-turkey from exercise didn’t make me feel better at all. I was sold a lie, and actually I felt worse after I gained weight. All the emotional pain I didn’t have to feel when engrossed in the eating disorder came back, and worse. More dysregulated, more intense for being squashed down so long, more frightening. All the security I gained from eating disorder behaviours, gone.
“Eating disorders don’t occur in a vacuum, they are rooted in the fabric of our lives and develop and evolve in relation to our interactions with others and the world around us.”
My years of experience living with eating disorders has taught me that they exist for a reason. They are malfunctional, but that’s still a kind of functional. They provide a false sense of security, which is better than no security at all. They provide something to connect to when you might feel unreached by the world around you. They are powerful tools for regulating emotions, even if you wished your emotions were not so dysregulated in the first place. I’ve learnt from treatment programmes that the level of support, skills, relationships and effort you need to come anywhere near to matching the automaticity and effectiveness of your eating disorder is really, really hard to come by. And I have realised that it is not my fault that I have the problems that I do, and have not received the help that I have needed when I needed it.
Eating disorders don’t occur in a vacuum, they are rooted in the fabric of our lives and develop and evolve in relation to our interactions with others and the world around us. In each given moment, I believe that we are all generally trying to do the best that we can. I wish that professionals could have seen that, for me, my eating problems were the best way I knew to meet my needs. For all the times I was told “you are going to kill yourself”, “you’re putting your health at risk”, and, “ you should “stop your anorexic behaviours”, I wish someone had said, “I see you are in pain”, “your experience is valid”, and, “well done for coping in the only way that you could – how resourceful you are to have survived”. I also craved for someone to see beyond my eating problems and behaviours and see a person that has so much more to offer and enjoy in life, but who can’t do it entirely on their own, however confident they seem.
“I was never going to get better when I was living in a destructive environment.”
We tell ourselves all different kinds of stories – about what we can or can’t do, about who we are, our identities, about what we deserve, our worth. Positive psychology will tell you that your narrative is something you can choose. Unhappy with where you are at? Tear up the old story about yourself and choose a new one. I would tell you that the stories we tell ourselves about our value are inextricable from our experiences of the world around us. If your interactions with others have shown you that you are worth less, or your relationship with the world tells you that your body, skin colour, sexuality or anything else makes you unacceptable as you are, then no wonder you start to buy into that story. For someone who has endured violation of their needs, it’s not as simple as picking a new story off the shelf and choosing to feel happy or to give up an eating disorder. The world may seem unsafe because you have experienced it as such, your experiences invalid because others have told you as much.
I’ve wanted to write a new story for myself, to take that book off the self-help shelf that tells me I can be whoever I want to be, to curate a new recovered life like a shiny new Instagram account. But without a context in which I can meet my needs in less destructive ways, this has often felt impossible. I was never going to get better when I was living in a destructive environment. I was never going to be able to give up binge eating and purging cycles when I was in a retraumatising relationship where I felt invalid in asking for basic human care. I was never going to do it alone, because as humans our social needs are as important as our biological needs.
“Maybe we can learn new ways to fill these gaps with the safety, love, connection and validation that we need.”
As deeply personal, intimate and unique anyone’s experience of an eating disorder may be, eating problems are based as much in our interactions with the world around us as they are in our “self”. If eating disorders emerge (at least in part) in response to the way we experience the world around us, then moving away from a place where your eating disorder is a vital, necessary survival tool might involve changing our situation in the world, as much as it involves changing ourselves.
And if we didn’t get into needing an eating disorder by ourselves, maybe we need to find and accept help to get out of it too. Maybe it will take a very long time for anything to meet the needs an eating disorder can so readily satisfy, even if it ultimately leaves you hungry. Maybe the gaps that are filled by eating, exercising, purging and obsessing will feel painful when we start to let go of the eating disorder. Maybe we can learn new ways to fill these gaps with the safety, love, connection and validation that we need, but it probably won’t happen overnight and it probably involves being prepared to feel unsafe, disconnected and unreal at times to recognise that the things we are really missing are nothing to do with food. Maybe we can’t simply take a nice neat story of eating disorder recovery off the shelf – but we can, together, choose to at least start the process of writing a new one.
James is a mental health campaigner and expert by experience in eating disorders. He holds various roles at the Royal College of Psychiatrists, NHS England and Mind aimed at improving support for those experiencing mental health problems and eating disorders and their carers. James also represents various charities including Samaritans, MQ Mental health and Beat, and is a yoga and barre teacher. He has written extensively about his own experiences with the hope that those who read his work find comfort, affirmation and hope.