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  • Writer's pictureConnor O'Donoghue

In treatment

I felt like a high schooler going to prom. This was what I'd been waiting for for years. Finally, my turn had come. Three years and four months after first being referred by my GP, I'd reached the top of the waiting list and my NHS cognitive behavioural therapy (CBT) for my eating disorder was starting.

In those three years, I'd been diagnosed with bulimia twice, and you can read more about that here.

I'd briefly been treated by an eating disorder specialist before, when I was twenty-one and getting treated for depression, I was sent for two sessions with a woman who hated me. She made it clear to me that she thought bingeing and overeating weren't problematic behaviours and she openly compared me to her anorexic patients, who were the ones she thought had "real problems" and she gave me three pieces of advice - one was to avoid Pringles, because she said that they were the one food that made everyone feel guilty and crazy around food, second was to schedule weekly binges and stuff myself until I felt sick, and third was to go back to WeightWatchers if I wanted to lose weight.

I didn't avoid Pringles for very long, but she was right that I have never eaten them and not felt guilty. I tried scheduled binges a few times and while they did make bingeing a lot less fun they didn't make me stop my unplanned binges. And I did go back to WeightWatchers, a few times. Once I spent a whole year going to meetings and lost a lot of weight. I remember one of my colleagues saying that I was the only person in the staff room who she had never once seen eat one of the biscuits or sweets from the middle of the table. I was fanatical about tracking my points and I was a WeightWatchers success story. They talked to me about being in their magazine because I'd lost over six stone and I could inspire others. I continued going to WeightWatchers meetings when I stopped losing weight, stepping on the scales week after week as the pounds came back on, not understanding how the magic that had worked for so long had just stopped working, telling myself that the shame of another bad weigh-in would surely spur me into action. No one was asking me to be in their magazine now.

I had also attempted to psychologise my eating when I'd joined Overeaters Anonymous when I was thirty-two. I hated that. It was a small room with uncomfortable plastic chairs and it smelled strongly of church. We'd start by reading from the Alcoholics Anonymous book, their bible. Sometimes they would replace the word "drink" with "food" but sometimes they didn't. Sobriety for them meant eating a very limited amount of food in three small, flavourless meals a day for the rest of your life, going to four or five meetings a week, reading about the experiences of alcoholics in 1930s America and discussing how flawed we were, how diseased we were and how we had to hand over to God. It really was reminiscent of the religious group I'd grown up in and I hated it.

I'd had a lot of other experiences of counsellors since that disastrous eating disorder specialist. Some of them were truly terrible. I stopped going to one of them when he refused to believe that a gay man would have receptive anal sex for reasons of pleasure and it became clear that he thought that bottoms didn't exist and gay men just bottomed for each other as a favour. Another counsellor couldn't process her disbelief that I was gaining weight after having had weightloss surgery. She didn't think that was possible and wasn't afraid to tell me so. Another counsellor told me I was probably single because I needed to lower my standards and stop going for men who were better looking than me.

But I also had therapists who I loved, all of whom I paid for private sessions with on Zoom, all of whom I eventually stopped seeing because I ran out of money to pay them. They were usually gentle straight men, who would let me tell them my stories and then tell me to stop and feel my feelings when I got to the emotional parts of whatever story I was telling. I fell in love with two of these men, a safe, Zoom-based love, with non-threatening men who cared about my feelings and wanted to hear my stories. The counselling certainly didn't do me any harm, but I'm not sure it brought me any closer to a healthy relationship with food, eating and my body.

But in spite of all of my previous experience, I was exuberantly confident about the life changing potential of specialist eating disorder therapy on the NHS. This was a cure that the government were willing to invest in! It had to be great.

I met my assigned therapist and excitedly described my problems to her. At this stage, after a range of assessments and counsellors (and after a one-man show about my life story that I have now performed in four different cities) (and after ten or so years of blogging about my life), I can trot out my history with food and weight in a coherent and entertaining way for a new therapist. I like to think that a therapist's first session with Connor is enjoyable for all involved.

She was a small woman. Part of me suspects that anyone who decides to be an eating disorder therapist must have had an eating disorder and so I should know better than to focus on her body size, but I couldn't help envying her tiny body and feeling elephantine in the room with her, even though I knew that was exactly the opposite of what I should have been doing in this scenario. I was here to learn to be less judgemental about my body but it quickly became the time in my week when I was most conscious of my massive body. She would sit in her chair shrouded in a huge coat, always cold, with plenty of chair between her and the arms of the chair, while I would bounce in with my sleeves rolled up, sweating and panting in the heat, my bulging flesh rolling off my seat, the arms of the chair digging into me. As someone who constantly compares my body to others, I found her body deeply triggering. And I guess that's what's unfair about an eating disorder. An innocent bystander's body can induce feelings of self-hatred in me and it's not the fault of the person in that body but it doesn't mean that I don't feel what I feel.

She told me that the first sessions would focus on behaviour and then we'd start looking at the thoughts and feelings behind the behaviour. As she went into details about what we'd be doing for the first four weeks, my heart sank. It didn't sound like anything very new, like anything I hadn't tried before, but after having wanted specialist eating disorder treatment for about twenty years and having been on a waiting list for over three, I was determined to make this work as well as it could.

So the initial phase of my treatment for binge eating and bulimia was essentially like going back to WeightWatchers. The main tool we were using was a food diary. It wasn't exactly like WeightWatchers. I wasn't to track calories or points or anything like that, but I still had to track everything I ate and I was still expected to record my feelings (both emotional and physical) after eating. Of course, this made me moralise like crazy about food - it made me feel weak and naughty and sinful. Even trying to categorise what I had eaten as "breakfast", "lunch", "dinner" or "snack" made no sense to me. I needed to train myself to eat meals. The only thing I ate that could be described as a meal was lunch, and that was really only on work days. I didn't eat anything else while sitting down, or at a set time, or with a clear start or end point. The idea that I could point to something I had eaten and say definitively that it was my dinner was really difficult for me.

My counsellor tried not to make moral judgements about the food I was eating but she couldn't help it. She'd point out opportunities for vegetables or fruit. The whole process felt so reminiscent of the 4 years or so of my life that I spent going to WeightWatchers meetings. It didn't feel like a cure for anything. And even worse, each session included a weigh in. She made me guess whether I'd gained or lost weight and then I'd weigh myself in front of her to confirm this.

I was told that if, at the end of four weeks, I hadn't started managing my eating behaviours effectively, I'd be kicked off the programme and I'd lose out on the other six weeks.

Nothing that was happening seemed relevant to my issues. The whole process seemed geared towards helping anorexics to eat more and to gain weight. A lot of the materials she used were clearly aimed at much younger people - often taking for granted that I was living at home with my parents and still going to school or college. When the body sizes in question are so diverse, a one-size-fits-all approach seems misguided.

She had clearly never worked with someone who had had weightloss surgery before. My stomach is still changing since my gastric sleeve surgery over four years ago. I have a general idea of what will make me feel sick, of which foods induce chest pains from trapped wind and of which foods will make me vomit, but this can change. One week she produced a printout for me, listing what to eat after gastric sleeve surgery. I nearly ripped it up when she handed it to me, as it was the kind of guidance I'd received (and followed) in the weeks after my surgery. It really was difficult to make it relevant to my body now. Of course, I'm a well-brought up boy, so I thanked her for the advice.

My first session was the week before Christmas. This meant that my first food diary that she got to analyse was from Christmas at home in Ireland with my family. Everyone I know gets an eating disorder at Christmastime. No one would want someone examining a food diary that they kept on Christmas week. And I was completely honest in my food diary.

The side effect of this that I didn't predict was that it meant I was accidentally successful. She entered all my results weekly into a spreadsheet that then produced a graph to show the patient's progress. Week One was Christmas - so many binges, so much vomit. Every week thereafter, it looked like I was basically cured because I didn't binge or purge anything as much as I had at Christmas. The graph didn't lie. Statistically, mathematically, a cure had been worked. Week after week she would tell me how much better I was doing. I tried to rebut her politely and she told me that that was just my inner critic, and while I believe my inner critic is way too noisy, I still think it's utter madness that my records show remarkable improvement because the benchmark was Christmas week.

As the weeks went on, she began to hint that she didn't think cognitive behavioural therapy was right for me. She sneakily suggested books I could read about other approaches. And that's probably the most helpful thing she did for me, because very little that we did in the sessions themselves was very helpful. She really was very sincere though and she tried so hard, so I always wanted to give her the impression that it was all working. I am a people pleaser, so I started leaving some binges out of my food diaries so she could see even more progress. She was nice and she deserved it.

I only came close to anger three times.

Once was the week after I performed my one-man show in London for a week. She was really impressed by my food diary that week. I hadn't binged once at daytime that week. I'd always waited until after my performance. She thought there must be a key there. I don't know. I was starving myself in the daytime and bingeing as soon as the show was over. My eating was a lot more controlled, but I'm not sure it was any less disordered that week. But that wasn't what made me angry. What made me angry was when she told me that she was inspired by me writing and performing and she'd decided to write an article herself for a travel journal. Of course, my ego was delighted that I had inspired her. But I just felt this injustice welling up inside me. I was fine with inspiring literally every other person in the world, but her job was to inspire me. This was the wrong way round. It felt so unfair. I felt like she'd taken something from me.

The second time I got angry was worse. We were working on body image. She told me that a colleague of hers had done a survey and the results might surprise me. I was very open to hearing about the results of research but then she started telling me and I couldn't believe what I was hearing. Apparently, this colleague had gone out onto the street and asked three or four passers-by about their opinions about other people's weight. She "revealed" the "results" of the study with glee. It turned out none of them said they judged other people depending on how fat they are. They all said that your weight isn't the most important thing about you. I couldn't process that she was trying to tell me that because four people had once said they don't care if people are fat that no one cares that people are fat. I went on a rant. I have so many examples I could share with her of people calling me names, both strangers and friends. I told her about the time a friend of mine congratulated me for losing weight, telling me that he had no respect for fat people. I told her about the time a group of teenage girls had laughed at my "six pack" when I unbuttoned my shirt in the park on a boiling hot summer's day. Every other man had their shirts off - all I'd done was unbutton mine but keep it on, but apparently I was too fat even for that. I told her about the teenage boys who would cycle past me calling me a "fat fuck". I went on and on. I told her about the way the world is designed for thin people. About how difficult it is to find clothes that fit me. I don't have a jacket or coat that will zip up. About how chairs and beds have broken under me. About how people avoid sitting next to me on the Tube. I couldn't believe that she was trying to wheel out the testimony of a few randomers who claimed that they liked fat people to counter my lifelong experience. People don't value fat people as much as thin people. They just don't. It's illegal for a fat person to sit in the emergency exit row of an aeroplane. They might impede the exit of thin passengers in an emergency. I'm not making that up. Flight attendants have asked me to move in the past for this reason. My life is not as valuable as a thin person's life. It doesn't matter what people say when they're asked in a "survey".

She was apologetic and she said that the solution was probably a political one - to read up on and become involved in fat activism. I don't think there's a better answer than that.

The final time I got angry, I hid it much better. It was our last session. She showed me a YouTube video. As someone who has struggled with bingeing for years, I've spent hours watching videos on YouTube looking for answers. I'd watched the video she showed me at least twice. My last session wasn't going to have a secret answer. There wasn't going to be a magical revelation. There was no new advice.

I felt so forlorn once my NHS-mandated ten sessions were finished. I'd learnt some bits and pieces. But I wasn't anything like cured.

I'd taken the magic pill of weightloss surgery. And I'd been ecstatic while it worked and my life had changed completely and then it failed and as I gained weight I was so ashamed. I didn't want to be seen. I avoided friends and family. I had made an extreme decision and got myself into thousands of pounds of debt and changed my anatomy forever, and all for nothing. And now the therapy that I'd waited for for three years had failed. I felt like the medical system had chewed me up and spat me out and then stamped on me for good measure.

I felt like I'd taken what surgery had to offer and I'd taken what psychology had to offer and I'd realised they were both a sham. I felt like there was nothing left. Like there was no hope. Maybe life couldn't be better? Maybe I'm supposed to be locked in a non-stop struggle with my appetites and my body forever.

I finished my therapy in June.

I don't feel like that now. I keep on looking at the options out there for me. I think that some kind of mixture between compassion-based therapy and mindfulness and intuitive eating holds some kind of promise for me. The will to live is too strong in me. There's something unkillably optimistic in me. I'm not ground down yet!


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