By Danielle Grossman
March 28, 2021
This article first appeared on Medium. To view the original article, click here.
What if we talked about sleep like we talk about food and eating?
Let’s imagine we lived in a culture that constantly talked about the dangers of too much sleep or sleeping incorrectly. Imagine that we offered status and privilege to those who slept only certain amounts and in certain ‘better’ ways. We also judged and stigmatized those who slept ‘too much’ or in ‘worse’ ways.
What would happen?
We’d have many people trying to sleep less or sleep only in certain positions. We would have people continually worried about their sleep, waking up repeatedly to yell at themselves for sleeping too much or sleeping wrong.
We would have lots of people not getting enough restorative sleep.
We would also have all the people not getting enough restorative sleep because they work night shifts or double shifts or lack a safe space to sleep or have an illness or disability or medical issue that impairs sleep.
If we talked about sleep the way we talked about food and eating, what would we say when these sleep deprived and sleep disrupted people started thinking about sleep all the time?
We’d say they are sleep addicts. If they started falling asleep uncontrollably and sleeping for longer than normal, we’d say they are binge sleeping. We’d say that they are using sleep to cope. We’d say they are acting out their need for love with sleep. We’d say they are using sleep to stuff their emotions and numb out. They have a problem with sleep. They are disordered.
We’d do a whole bunch of research studies to make sense of these problematic sleep behaviors. Our starting point would be that people are out of control with sleep and our hypothesis would be ‘maybe sleeping is just too comfortable and easy these days? Maybe that’s why people are so fixated on sleep and sleeping uncontrollably.’ Then we’d study sleep deprived rats and sleep deprived people and observe how they are fixated on sleep and how much their brains love sleep and how much they oversleep especially when they are in a comfortable soft bed. This would prove to us that sleep is addictive and that overly comfortable beds are dangerous. There would be sleep movements that called for a return to sleeping on hard ground amidst predators, just like our ancient ancestors.
Let’s also say that some people’s brains and bodies, largely because of their genetics, responded to sleep deficit by having horrific nightmares and becoming phobic of sleeping. Maybe this is an evolutionary adaptation that allowed people to stay awake and migrate when there was danger or lack of resources in their environment. So, these people, if they missed out on sleep for any reason, would start avoiding sleep more and more. They would create elaborate rules and equations and rituals around sleep to try to avoid falling asleep and facing the nightmares.
If we talked about sleep the way we talk about food, we would say that these people are acting out their emotional issues like low self esteem or trauma by controlling their sleep. We’d say that are filled with self-hate and so they are punishing themselves by avoiding sleep. We’d say that they don’t feel worthy of sleep. We’d say they have issues with control and perfectionism and need to learn to let go. We would diagnose them as having a mental illness.
At some point most of these people with the horrific nightmares would be so sleep deprived that they would start thinking about sleep all time. They would start falling asleep and sleeping for extra long periods of time. But because of the nightmares they would wake up and desperately try to avoid sleep again. Now we’d say they are in a restrict-binge cycle with sleep. They have a problem with sleep. They have a disorder.
Does all of this seem bizarre to you? Why are we continuing to use stories about eating that would be utterly ridiculous if applied to any other survival need?
When we talk about behaviors with food as maladaptive coping strategies or forms of acting out that are rooted in emotional or psychological issues, we are pathologizing normal healthy responses around food. Eating, like sleep, is a basic survival need. When there is a disruption in getting enough of what we need or a sense of fear or distress around getting our need met, normal survival responses are activated.
When a person is fixating on food, avoiding food or binge eating, the problem isn’t the person’s ‘relationship with food’. The problem is that there’s not enough food and/or distress around eating that’s been created by our culture or activated by food deficit. It’s unethical victim blaming and gaslighting to name these food behaviors as originating in the person’s ‘issues’.
Some people may be more susceptible to getting into these distress patterns with their basic survival needs like food or sleep. Those vulnerability factors can be a mix of genetics, personality traits, marginalization, life experiences and trauma. These factors can also make some people have more difficulty in getting out of these patterns. And within the food distress pattern, it can feel like control or coping to eat or not eat. The pattern does become ‘just what I do’ and it can be the person’s way of feeling safe or cohesive or capable of coping with life.
But we must be clear that a person’s thoughts and behaviors with food are not the problem and not even ‘a’ problem. Instead, the core question of assessment needs to be ‘does this person have distress around eating?’. The core question of treatment needs to be ‘what helps this person to get out of the distress pattern with food?’.
With this frame, we stop making pathologizing assumptions about those who suffer around eating. We stop using a narrative that makes people in distress around food feel more fearful and vigilant around their eating. We stop imposing stories onto people about eating that were made up by eating disorder theorists decades ago with no grounding in science or cultural awareness.
This frame also allows us to make all of those who suffer around eating visible within the eating disorder treatment field, not just those who fit within certain stereotypes about eating disorders. We are able to focus on effective treatment, whether that is exposure and response prevention therapy, practicing distress tolerance to allow eating amidst ‘nightmares’, family based treatment, connection with social services to increase food access, referral to a doctor that can help assess and treat any medical conditions that are affecting absorption of energy from food, and/or resourcing with support groups that can increase safety for the person as they face threat from those who attempt to get them to conform to the culture’s expectations around food and body.
As we support people to shift out of distress with eating, they may also need effective trauma focused therapies and relationship counseling and help with anxiety or depression or substance use. It totally depends on the individual and it can all occur within a frame that does not pathologize the eating behaviors or patterns.
So the next time you think about your behaviors with eating as being about your unhealthy emotional issues, or the next time you hear a client talk about their problematic relationship with food, I invite you to take some time and space to reconsider these narratives. I know it’s hard to reimagine ideas that have been powerfully embedded into us as truth. I think it’s possible. What do you think?