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Eating the Emotion. How we use food to change our mood.

Ayse Banbridge and Sonia Di Gennaro

Banbridge A., Di Gennaro S., Eating the Emotion. How we use food to change our mood in Cohen S. (2012) Toughts For Food (21st Century Dilemmas), UK: Honnao.

Introduction. Eating the emotion: How we use food to change our mood This chapter will cover the often complex relationship human beings have with food. In the last 30 years or so, we have seen a huge rise in food-related disorders, ranging from anorexia nervosa and bulimia to compulsive overeating. More insidious has been the rise of those who are not considered to be at the ‘disorder’ end of the spectrum but nonetheless spend an inordinate amount of time obsessed by the food they have consumed and the effect this may have on their bodies and more importantly, on their sense of self. Wherever a person may be on this spectrum, they will share to a lesser or greater extent, from a poor image of their body, low self-confidence and a way of punishingly controlling their bodies by over- or under-eating in an attempt to tolerate their emotions. Food is used as a freely available mood and image altering substance. Their sense of themselves and their place in the world is measured by how successful they have been at restricting the amount of food they have consumed, purging it or over-exercising away its effects. Unlike other substances, such as the over- consumption of alcohol or the misuse of drugs, the ridding or restricting of which enables the individual to lead a healthier life, food is as essential as oxygen and water. Cutting out this substance or replacing it with something else is just not an option. This is one relationship we have to get right. And of course it is not food per se that is the problem but the associations we make between our emotions and food that cause this balance to become disturbed. We will look at how this balance, so delicately tuned by nature, goes wrong, how this manifests itself in our lives, and what we can do to restore this balance so that we re-engage with food and use it not as a way of changing our mood or managing our feelings, nor indeed as a weapon with which we can beat ourselves, but as nature intended: a means of nourishing our bodies and delighting our senses. Many of our clients who compulsively overeat have lost the ability to attune with their natural appetite. Instead they often overeat because they are feeling bad, be it a challenging day at work, relationship issues, loneliness, boredom or indeed any other feeling they cannot manage. They are eating on what has come to be known as ‘mouth hunger’, bypassing the innate ability all animals, including human beings, are born with: the ability to eat when they are hungry and stop when they are full.

In the beginning... we are born hungry, hungry for love, hungry for food As babies we learn quickly that mostly when we cry, we are fed. We feel anxious, we cry and we are fed and soothed. This is our way of making contact with the world. We have limited ways of communicating and we learn to regulate ourselves via the early relationship with our primary caregiver, usually our mother, and food, love and survival become inextricably linked. Most parents love their children and want them to thrive, and a way of demonstrating this love is often via food. The messages that our parents received from their parents get passed on from generation to generation. One of the authors is a child of a parent who experienced rationing post World War ll and was often reminded of the scarcity of food via simple messages such as “...Finish your food. You are very lucky to have fresh eggs! When I was a girl we only had powdered eggs and no chocolate!” She quickly learned that in order to please mother she had to finish everything on her plate, even if she was full. Unchecked, she found herself unwittingly passing on to her own children the message ‘eat beyond the point of satiety or you risk appearing ungrateful’. Food is often used as a reward. Many of us will be familiar with ‘eat your vegetables and you can have some pudding’ or ‘if you finish your homework, I will give you a treat’. We are not suggesting that food can never be given as a treat or simply enjoyed just for pleasure. Food can be all of those things. The problem arises when: - we use food as a primary way of soothing ourselves and managing our emotions; - we lose the balance between our feelings and our bodily sensations; - we no longer recognise that food is something essential to be enjoyed; - we are no longer in touch with the signal that tells us we are full and that we can stop;

- we reach for food solely for the comfort, reward or for something else that is missing in our lives and then afterwards feel a sense of guilt or failure and we know that we are using food inappropriately. The ideas and the cases we present are a combination of our clinical work with hundreds of men and women with whom we have worked who have used food in this way. Below we use our work with ‘Clara’ and ‘Dan’, who are composites of some of our clients who present with food issues.

Clara Clara, an attractive, bright woman in her mid-thirties came to therapy because she was tired of struggling with her binge-eating and yo-yo dieting. Like most of our clients, Clara knew a great deal about food and diets - after all she had spent most of her adult life on some kind of food plan in an effort to control her weight and feel good about herself. She was not obviously overweight, just within an acceptable Body Mass Index for her, but she was increasingly concerned that her obsession with, and behaviour around food and weight were controlling her life. She was also concerned how her preoccupation with food, dieting and body image might affect her two young daughters. Food took up an inordinate amount of her mental energy; she was either shopping for it, preparing it or eating it. More often than not however, she was on yet another diet, feeling deprived because she wasn’t eating what she wanted to eat or what the rest of her family were eating or berating herself because yet again she had failed to stick to her diet. Clara’s story is not unlike many of the other stories we hear in our work. What touched us was her palpable distress that her eldest daughter was refusing to eat certain foods because they were ‘fattening’. Clara knew she was passing her relationship, her thoughts, feelings and behaviours around food, weight and body image on to her daughters, and more than anything she didn’t want this. Interestingly, most compulsive overeaters that we have worked with are more concerned with the feelings of others than for their own welfare. She was a much longed-for only child. Her mother was a tall, slender, attractive woman who was always busy. She was, Clara reported, very concerned with outward appearance; the house had to be perfect, she was always perfectly groomed and so was her young daughter. Clara received many messages around this, such as being OK, being attractive, meant being slim and this could only be achieved by eating the ‘healthy’ foods mother gave her. She longed to eat like other children. When she went to her friend’s house she noticed that they were sometimes allowed to eat biscuits and even chocolate cake for dessert. Clara on the other hand was always given half an orange or an apple after her meal. Not sticking to her mother’s carefully prescribed eating plan meant running the risk of mother’s disapproval. Clara did not inherit her mother’s body shape. She was more like her father’s rather larger frame. Her father was an amenable, somewhat passive man, often controlled by his ‘perfect’ wife. Like most parents, Clara’s mother wanted the best for her daughter; she therefore controlled the amount and type of food her daughter ate and meal times, Clara remembers, were often an anxious time for her. Some of Clara’s fondest memories are of her mother teaching her to bake. Although Clara’s mother was often distracted by social events and other community duties, these times with her mother were special. Her mother was patient, loving and contactful. She was in effect teaching her how to be an acceptable woman. In Clara’s mind the smell of baking became the smell of love, of intimacy and of contact. Clara often helped her mother prepare these biscuits and cakes, but was only allowed to eat one or two before they were packed away into beautifully presented boxes and whisked off to the school fete or some other such good cause. Her mother’s undivided attention disappeared with the boxes of delicious biscuits and cakes.

Dan Dan, a bright 26-year-old IT consultant, came to therapy because he was overweight and had never been in a relationship. Dan was a sensitive and gentle boy who loved reading and playing computer games with his brother. His mother, although kind and loving, suffered frequent bouts of depression and was often unavailable to her children. His father, a strict, controlling man, had fixed views on how boys should be. Dan, unlike his brother, didn’t fit with his father’s ideal of a son: he didn’t share his father’s passion for sports, he was shy, and at times he was teased by his father and sometimes even his brother. When Dan was about six years old, his parents started arguing. Even though he reported feeling terrified of his parents’ arguments and would often cry himself to sleep with a pillow over his head to block out their screaming, he still maintained for a long time that his childhood was happy and in some ways it was. Only after months of therapy did he allow his sadness and anger to emerge. His parents’ relationship deteriorated and Dan remembers objects being thrown and being fearful that his parents were hurting each other. His mother in an effort to protect her children from the growing violence would lock the boys in their rooms. Dan decided early on that being close, meant arguing, and arguing was not safe and led to violence. Dan spent long periods on his own at home and at school. He felt not like the other children, fearful of engaging with them, since being close was on some level dangerous. Dan longed for his family to be OK; when asked what OK meant to him as child he replied “...for mum and dad not to be arguing and dad not teasing me all the time...” The moments he remembered with fondness were the rare occasions when his mother prepared a meal and the family sat around the table enjoying their food in relative harmony. As the tension between his parents rose, they became less and less available to Dan and his brother. By the time Dan was twelve his parents had separated. Any money he got - money was not an issue as his parents were lavish with both gifts and money, perhaps as a way of overcompensating for their unavailability - he spent on bars of chocolate, sweets and crisps, and later on takeaway meals. Dan found that food consoled him, helped him feel better, entertained him and kept him company. By his late teens, he was significantly overweight. He had now become physically as well as psychologically not like the others, his peers or even his brother. The few friends he had were also disengaged and their conversations were mainly around their shared interest of computing. Dan threw himself into his work and soon became much in demand as an IT consultant, moving from company to company, never staying around long enough to build relationships with his co-workers, which suited him.

Using a framework to understand emotional eating Eric Berne, the father of Transactional Analysis, created a very accessible way of understanding our mind states, how we relate to ourselves internally, and how we make sense of our world and our place in it. He called this the ego-state model (Berne, 1961). The concept of ego-states can be a useful tool to help us understand the way we have come to think, feel and behave in certain situations. Ego-states are drawn as three stacked circles and they are called Parent, Adult and Child. Each human being at every age will be made up of a Parent, Adult and Child ego-state. We will use some of the models from Transactional Analysis as a framework for understanding emotional eating.

Fig. 1. First-order structural diagram: The ego-state model (Berne, 1961)

Parent ego-state

The Parent ego-state consists of a set of the thoughts, feelings and behaviours that we have learned and copied from our parents, our extended family and the expectations of the societies and cultures in which we live. It is as though these ways of being are ‘swallowed whole’ by the small child, who will make sense of them depending on the early attachment with the primary caregiver and the limited, unsophisticated reasoning available. For a child is entirely dependent upon the love and care of their parents and will go to great lengths to keep mummy, daddy and the world good in order to survive. Mostly our parents gave us these messages to keep us safe and well, to ensure that we are ‘acceptable’ within our family systems, with their own unique values and codes of conduct, and in society at large. Who hasn’t as a parent encouraged their children to ‘be polite’, ‘sit up straight at the dinner table’, ‘chew your food with your mouth closed’ or ‘take care when you are crossing the road’? Clara will unconsciously have taken in and processed the message that she had to ‘be perfect’, just like mum, to ‘please others’, just like mum, from her mother’s Parent ego-state, because just like us, our parents also have their own set of ego-states. She will have swallowed whole that in order to be acceptable this is how she must be. From her passive, accommodating father, she will have taken in the message ‘please others’. Likewise, from his often depressed and fearful mother, Dan will have received the implicit message that to be OK you must ‘hide yourself’. From his father the message was the more overt ‘be strong’ or, to use a more contemporary idiom, ‘man up’. Often when we find ourselves thinking that we should or ought to be a certain way, this is a result of the messages taken in our early life and our childhood responses to them. Our Parent ego-state is also where we store the message of how we should be that we have received and taken in from the cultures and subcultures in which we find ourselves. For example, some African cultures celebrate and desire the more well-rounded female body, while western cultures emphasise the beauty and desirability of a slim, ‘perfect’ body.

Adult ego-state The Adult ego-state is the thinking, feeling and behaving that we engage in when we respond to a situation in the here and now. It gathers and processes data and prepares predictions. It is also capable of intimacy and spontaneity. In the Adult ego-state are located not only the strategies for reality-testing and problem- solving that are available to us in the here and now but also our ‘real time’ evaluations of what is in our Child and Parent, mediating between both ego-states. Although reality-testing and problem-solving seem more thinking and behaving, the feeling responses of this ego-state are very helpful too. Imagine, for example, if you came face to face with a wild animal, the feeling response for most people might be terror. The thinkingwould be that you are in a dangerous situation and your behaviour would be to run away. Perhaps you are feeling sadness or grief at the loss of a loved one or the end of an important relationship. This is an appropriate response to a here and now feeling and, in the case of loss, is part of the healing process (Stewart and Joines, 1987). Clara is aware that her responses to and behaviour around food is damaging her and her daughters and it is from this ego-state that she is looking for long-term solutions to her problem. Dan is also aware that he has an issue with food and that in some way it is prohibiting him from being in a relationship.

Child ego-state The Child ego-state is a set of thoughts, feelings and behaviours which we use to respond to various situations. When a person is in this ego-state as an adult, he or she will think, feel and behave as they did when they were a child. For example, one of the authors found herself becoming very anxious because she was late for a meeting. Her heart was racing, her hands sweating as she navigated her way through unexpected road works. She felt unable to think clearly and felt full of shame at the thought of arriving late and incurring the wrath of the person she was meeting. In her family timekeeping was a serious business. Being late meant being disrespectful of the other. Mealtimes were strictly observed. Anyone not keeping to the tightly-run schedule was punished or shamed in some way. She remembers with horror her mother shaming her in front of guests because she arrived a few minutes late for dinner or literally dragging her away from her play-date because the allotted time was up. In this situation she was replaying in the here and now her child responses to being late. This is a particularly strong response as time-keeping was introduced in infancy. Her mother talks with genuine pride of her ‘well-behaved children’ who were certainly not fed on demand and were sleeping through the night at six weeks.

Human beings are hard-wired to be in relationship. As infants and young children we need the love and care of our parents in order to survive. Our need for survival means we cannot lose their love and a way of not losing this love and surviving is by adapting to their rules. And so with the limited reasoning available to us as children, we learned and observed the rules our parents gave us because if we did not then the love and care might go away. We found scary or even ‘magical thinking’ ways to obey them in order to secure our survival. The messages given by her mother around food, weight, acceptance and beauty may well have been perceived by the young Clara as ‘don’t be you’ ‘you are not good as you are’; ‘don’t think’ – ‘you cannot be trusted to know when you are full and what to eat’. Unconsciously, from her child place, she made a decision to obey these rules even if it meant pushing down her own needs and her sense of self. The battle was on between her natural instincts, to eat what was good and stop when she was full, and the commands of her mother. Not only do we obey ‘these contrary to our instincts’ rules but we love and depend upon the people that issued them. Just as we need our parents to love us, we need to love our parents and hold them as good, ergo if they are good, then with the polarised thinking of a small child, we must be bad. No one wants to stay bad, to have unmanageable feelings, to feel not OK. From our child-reasoning place we conclude that the only way to gain conditional OK-ness is to be ‘perfect’, or to ‘try hard’ and that means observing the rules; to look, act and feel in the prescribed way. With his child reasoning, Dan experienced his parents arguing as somehow his fault; if he was good enough, worthy of love, his parents wouldn’t be fighting. Like most children, whatever happened he needed to hold his parents as ‘good’ in order to survive and if they were ‘good’ then it must be him that was bad. Being close meant arguing and arguing was dangerous and led to loss. Better to build a boundary around yourself, to make yourself not like others, to not engage than to run the risk of danger and loss. In his Child, Dan may have processed the messages from his parents as ‘don’t be you’ – he was not seen as OK by his father and his mother’s unavailability due to her depression, coupled with his early experiences of their violent arguments, may have prompted the ‘don’t be close’ message. In reality most parents are much less threatening than the fantasised versions created in a small child’s mind. The message ‘why can’t you be more like your brother? He is such as good boy’ delivered by an angry or exasperated parent might be interpreted by a small child as ‘I am not good and if I am not good mummy won’t love me and I am unlovable’. Those of us who have been around children will be familiar with the black and white reasoning of a child where things are either good or bad, something is ‘yummy or yucky’. In order to cope with perceived threats, and as a way of maintaining the love of the parents, the child develops a series of strategies for problem solving and getting their needs met. These strategies and decisions form part of the Child ego-state.

How do we decide to use food to soothe ourselves? Sometimes our Adult becomes contaminated by the contents of our Parent ego-state and we take on that thinking as though it were our own here and now reality. For example Clara firmly believes that the only way to be OK in the world is to be slim. Dan’s Adult is contaminated by his father’s message, which he holds in his Parent ego-state, that feelings are not OK and that boys shouldn’t cry. His Adult is also contaminated by his Child in which he stores the belief that relationships are dangerous. Both Clara and Dan hold in their Child ego-state that they are not OK as they are. Clara and Dan, indeed any of us, come into the world as small, fragile creatures, needing to be held, reassured, fed, stimulated and taken care of. We need to be loved. It is only via the love and attunement of a ‘good enough’ parent (Winnicott, 1965) that we can thrive. Love shapes our brains and the absence or availability of it in early childhood is a significant factor in determining how we might react to stress and anxiety as adults. As infants our only means of reaching out to the world was by crying when distressed, and our bodily sensations were the only reliable resources we had. If Clara felt uncomfortable, hungry, scared or in pain the only way to communicate it was by crying. She could not run

away, she could not feed herself, she could not soothe herself. Clara needed an adult to survive. Clara needed not only to identify with her mother, but also that her mother strongly identify with her, feeling her needs as an extension of her own. Babies cannot self-regulate and they rely entirely on the availability of a consistent person to show them they are loved, worthy and that the world is OK. The carer acts as a mirror (Kohut, 1971) reflecting love and acceptability and the baby takes this in, and it is this holding and containing that forms part of the infant’s, and later the adult’s, sense of self in the world. It is this ability to contain that allows him or her as an adult to manage anxious feelings. Simply put, if the infant has received this, he or she has the resources, the reserve to use it when times are stressful. A baby that has not had a good enough, well-managed experience, will not. A fully functioning internal framework for coping with the world and its demands will not be available to the individual as an adult. But as human beings we have an innate tendency for survival and if it is not available to us internally, we will soon find an external object that offers us relief from anxiety, even if this is in the illusory form of food or any other substance or compulsive activity that offers a way of not feeling what we feel. Compulsive overeaters use food as a way of silencing their critical, internalised Parent and ignoring their here-and-now Adult. They are left with a raging Child who will act out either by overeating as a way of temporality self-soothing, or over-adapt by sticking rigidly to a prescribed eating plan and feeling deprived. Because of the misattunement many of our clients had with their primary caregivers, often their sense of self is located externally. When our sense of who we are resides externally, be it in the media, peers or family, it is open to the vagaries of current trends and ways of being dictated by others. It is a paper-thin, permeable, precarious thing. As children, our Adult will use all the information at its disposal to decide how we will be in the world and what we can expect from our lives and will formulate the best solution under these conditions. The decision we make will become our script (Berne, 1961) and it comes from the conflict between our autonomous inclinations, the messages we received from our primary caregiver and how we processed and internalised these messages. Based on this decision, we will act out our script like a play. If our early decision was that the world is a frightening, unsafe place then we will as adults somehow make that come to pass. On the other hand if our attunement with our primary caregiver was good enough, we are able to develop a good sense of self and our script might be ‘people can be trusted and I am OK’. Because we received the tools we needed early on in our lives, as adults, they are able to use them to soothe ourselves when we are anxious. The age at which we make these decisions varies from person to person. During adolescence we can see how the script decisions around identity begin to manifest more overtly. For many this is when eating disorders begin to emerge. The raging hormones of adolescence coupled with the ever-increasing messages about body image and weight act as a perfect backdrop to this process. By the age of four years old the main script decisions are made. However, if there is serious misattunement, then this decision is made even earlier. Usually the earlier the injury, the more tendency there is towards a negative belief about self, and the more the ability to tolerate anxious feelings is impaired. Dan’s mother’s depression meant that she was not able to be present with her baby and it is in this environment, one in which the necessary attunement did not have the opportunity to become established, that he developed an internal model of himself as not able to contain his own feelings. He simply didn’t have the tools. Clara, like most children, wanted to enjoy treats like her peers, yet she also longed for her mother’s approval and attention. She decided very early on that in order to gain and keep mother’s love she must be a good girl, be the girl her mother wanted her to be. In that decision she had found a way of reducing the tension between her own inclinations, to eat like other children and the requests of her environment. But it could only offer her short-term satisfaction; she must be perfect to be OK and we all know how subjective and impossible a concept ‘perfect’ is. A script matrix (Steiner, 1974) is a way of representing the messages that we received from the ego-states of our primary caregivers. Figure 2 and 3 below show how the Script Matrix for Clara and Dan might look.

Fig. 2. Clara’s Script Matrix (adapted from Steiner, 1974).

Fig. 3. Dan’s Script Matrix (adapted from Steiner, 1974).

The ego-state model, the concept of script and the script matrix help us understand how and why we feel, think and behave in certain ways in certain situations. It also suggests that even if one person’s experience or situation is similar to another’s, each human being has a unique way of organising, categorising and deciding how they will act based on past childhood ways of adapting. Eric Berne tells the story of how a mother told her two young sons that they would end up in a mental institution; one became an in-patient while the other a psychiatrist. In our work as psychotherapists, our clients often ask us how their present behaviours and struggles are influenced by their early life and the out-of-awareness decisions they made as a small child. The question that we often hear is: ‘how is it possible that a decision I don’t even

remember can affect me now? I am an adult and on the whole I function well. If only I could get to my goal weight then I would be happy’. But we all know that the story doesn’t end like that. It is difficult to believe that as adults we still use the same coping mechanisms we employed as children to survive, to make sense of our world and ourselves in it. But that is exactly what we do. Unchecked, we continue with our strategies and the internal dynamics we co-created as a response to our early unmet needs. However, those early responses to the perceived traumatic situations we faced when young were rudimentary and made with the thinking and reasoning ability of a child. They are no longer appropriate or effective in dealing with the here and now situations that face us as adults. Our Adult on which we rely to reality-test our current situation has often been contaminated by the contents of our Parent and Child ego- states. Under the stress and pressure of being in a world that seemingly expects us to be a certain way, to be slim, to be attractive, to be successful and therefore loveable, we continue with the same feelings about ourselves and the same internal strategies for dealing with them. We have no other way, we know no other way, only that something is bad, something is hurting or missing and we need a way of soothing ourselves, and for the compulsive overeater what better way than to push down our unmanageable feelings, and soothe ourselves, than with food. After all, were we not soothed and loved by our mother with food?

Some common patterns One of the exercises we do is to ask our clients to brainstorm and list all the times they eat when they are not hungry. These are some of the responses we have received: - To protect myself from feeling things I don't think I can handle - I bury myself - I don’t want to feel what I am feeling - Something is wrong and I want it to go away - Because I'm scared of being too strong because if I am I will be alone To change my focus from what is hurting/upsetting/making me angry Give myself control over something when I feel out of control - It's easier - Because I don't know another way - Because life scares me - Because I'm lonely - Because I'm bored - To protect myself from dealing with uncomfortable situations - To protect myself from dealing with people - To give myself a reason why people don't want to be with me - To give myself a reason why men/women won’t find me attractive - To make sure men/women don't find me attractive - Give everyone something to reject me for - To give myself a reason for people rejecting me - Because I'm a bad person - Because I don't deserve to look good - Because I don't deserve to feel good - Because I can't say no to people - Because I don't want to smoke - It's a habit - I’m tired - It protects me - Because I don't feel safe going out - Because it doesn't let me down - Because food never rejects me.

The misery that compulsive overeating wreaks on the lives of the people with whom we work is often unseen; mostly they function well, hold down responsible jobs and care for their families. They are not addicts in the conventional sense yet they are addicted. They use food to alter their mood, to manage situations and feelings that seem uncontainable in any other way. More and more, however, we are presented with yet another client who lives with not only the physical manifestations of overeating but of the deep guilt and shame their compulsive behaviour has on their lives and, in some cases, on the lives of those around them. Often however it is a painful secret they do not want to share and by the time they

seek help they have tried innumerable eating plans, all of which afford only a transitory relief, leaving them hopeless and usually heavier then when they started. Julie, a pleasant, hardworking social worker, spends her time taking care of others in her professional and personal life. Overtaken by her compulsion to eat uncontrollably, she regularly hides herself in the toilet at work and eats until she feels sick. After these episodes she is left feeling ‘dirty, bad, useless, out of control and hopeless’. When asked how she feels when she is eating in this way Julie tells us: “’s as though nothing else exists, it doesn’t hurt anymore, and I feel soothed, spaced out, not in my life...” As we journey further into the lives of our clients, we often find that mother decided not only what they should eat but that certain food groups were either not allowed or given indiscriminately. “What is wrong with that? Is it not the mother who usually decides what is good for her family?” You might ask. And you would be right. However what seems to surface is that not only were these individuals not allowed to make choices around food, but choices in other areas of their lives were also taken away from them. As young children, they did not get the opportunity to decide what was good, what was not and also more importantly, what was enough. How many times have we seen an over-anxious, albeit well-meaning mother feeding her child when the child has clearly had enough? They did not get the opportunity to discover their ‘enough’ and, more importantly, that they could get it wrong and still be held as good enough. Using the examples of Clara, Dan and Julie we have seen how food in some way may be associated with love. It might represent for the child and later for the adult a way, without awareness, to regulate uncomfortable moods or feelings. Food often becomes an object connected with our caregiver, the one whose role of soothing and loving was so crucial. Because food is an important component of that early relationship, it might also represent not only the love and the soothing but also the anxiety felt when that relationship did not fulfil our needs. Whether it was good enough, not good enough, fulfilling, overwhelming or lacking, that relationship taught us how to be in the world, how to cope. It was introjected and as a result, we used it to model our relationship with ourselves, others and the way we deal with stressful situations. In this way, food may have become something that is never enough, extremely important or something that was overwhelming and must be denied. It might even represent both objects, being at first devoured and then expelled. Either way, food can be used as a means to control our anxiety in a world that is, at times, not so easy to live in. This pattern is so deep-rooted, such a core part of the person’s coping mechanism, it is all they know, that’s how they survived. Even if those affected can see cognitively - for many as we said, are intelligent, functioning individuals - how under-developed and ineffective their current strategies might be, compulsive overeating gives them a sense of apparent control over not feeling abused, used, deprived or destroyed. This behaviour becomes a fundamental part of their identity: being in control of food gives them a sense of self-cohesion. Pushing down our emotions with food is a temporary illusion of control and fullness and sooner or later it will be substituted by a sense of emptiness and worthlessness. This poor sense of self is expressed also in the compulsive overeater’s urge to constantly compare themselves to others. They will look at the achievements of those around them and discount any of their own successes. There is no achievement on a lower scale, for there is either success or failure. Their perfectionism allows them to feel happiness or pleasure in only a limited way. It is as though if they go beyond a certain point, anxiety starts to set in. ‘Feeling good’, is connected to being perfect so they cannot be happy because being perfect is impossible (Brunt, 2005). This black and white thinking is reflected also in the ‘if-then’ statements they present: ‘if I stop overeating, I will become a drug addict’, ‘if I give up dieting, I will become extremely fat”, ‘if I lose control, I will be destroyed’, ‘if I stop working so hard, I will be a failure’, ‘if I show anger, nobody will love me’. The rule cannot be avoided, the rule is the law and it must be respected rigidly. One slip in a diet and the result will be catastrophic. They are usually extremely sensitive to criticism and struggle to keep boundaries with others. The black and white dichotomy sets unrealistic standards where it is easy to fall and to call that fall ‘failure’. Thus, the third alternative, natural appetite, eating from stomach hunger and stopping when full, does not exist. It is all about control or lack of it (Riebel, 1985). Indeed, the emotional eater has lost track of the body signal of hunger and repletion. Their body image becomes distorted. Thinness is considered to be beauty, desirability and admiration. Being fat means not only being ugly but also being bad. This sense of badness is bound up with an

over-valuation of shape and weight, is associated with guilty feelings and represents their criterion of self-worth. They are fat, they are bad therefore they must suffer. The unconscious decision is reinforced. People who use food to regulate their emotions are more vulnerable and distressed when there is an emotional unavailability of a significant person. Because they are unable to regulate their own feelings, there is an over-reliance on significant others to do that for them.

What initiates and perpetuates emotional eating? There is a strong neurochemical link between food and mood. Many of our clients report that they crave sweet, sugary foods and it is these foods that often lead to bingeing. Different neurotransmitters in our brain stimulate and inhibit the drive to eat and they are also mixed up with and conditioned by psychological factors. If we are not thinking about food, then the chances are we won’t be acting out by using it. The pattern of thought-feeling-behaviour is very much in evidence in most human behaviours and can be easily tracked where there is compulsive behaviour. A recent advertisement on the television seductively describing a gooey chocolate pudding sent one of our clients into the biggest binge she can remember. A few minutes earlier she was not even thinking about food, simply enjoying her favourite programme. Within seconds, she was overtaken by the intense desire to eat everything sweet in her path. Being a serial dieter, she had nothing but low fat foods in her house. This triggered her feelings of emptiness and she acted on it by driving in her pyjamas to the nearest store and consuming countless bars of chocolate and of course the closest thing she could find to chocolate pudding. But it is not only the compulsive overeater who eats when they are not hungry. There are many of us who are driven to eat just because it is one o’clock and time to eat. The neurotransmitters are released not because we are hungry but simply by the clock. We often justify this behaviour either because it fits in with our life or, more often than not, because somehow we believe that even in this land of plenty, our food supply will run out. The various chemicals in our brain not only stimulate or inhibit our appetite but are also involved in the modulation of mood. Serotonin, for example, is fundamental in promoting satiety and relaxation, and in decreasing anxiety. Endorphin, a kind of natural morphine, makes us feel good and relieves discomfort. It is released after we exercise but also triggered and released after we eat sugary foods, and it plays a key role in regulating our eating behaviour. In addition, food is the fuel for our body and mind. During chronic dieting or starvation the metabolism slows down so it is more difficult to lose weight and easier to gain it once we go back to normal eating. And of course there are those of us who genetically have metabolisms that are more predisposed to gaining weight. There are many triggering factors as to why we eat when we are not hungry. There is a strong argument that we simply become addicted to sugar and, given the hidden amounts in our everyday foods, this is entirely plausible. While it is easy to see how we might become addicted to the highs sugary food induces, our work with clients who crave sugar suggests that there are almost always underlying issues. Sugar often becomes our drug of choice because it is readily available and mood-enhancing. This does not detract from our belief that if there were not an underlying anxiety, feelings we were not able to manage, flawed beliefs about ourselves and our place in the world, there would be no need to seek comfort by compulsively overeating. And while sugar may well trigger bingeing, there are, as we have seen, many factors such as personality, personal history and the environment that influence and contribute to the aetiology of emotional eating. Many of our clients present with a history of childhood physical, emotional and sexual abuse and a loss, or difficulty in an important relationship. As mentioned previously, adolescence is usually the most powerful triggering period. This stage represents a transitional crisis where there are major changes physically and emotionally. Sexuality develops and emotional eating might appear as a way of avoiding or annulling these changes. Media influence and culture represent a real challenge to natural appetite and body image. The myth of being slim is associated with being glamorous and sexy. Television, magazines and movies bombard us with messages describing the advantages of being slim. The impossibly thin, perfectly airbrushed models and the movie star, proudly showing off a skeletal body achieved by yet another fad diet, is all too common a part of the daily images that are fed to us. The exaggerated emphasis given to body size and shape becomes an issue which affects the relationship between body, and mind thus the foundation of our identity. The relentless importance given to how we should look generates, especially in

young adults, a negative body image in which the body is perceived not with an objective eye but with the mind’s eye that compares it to impossible standards and myths. In the smaller community of the emotional eater, the same friends and family members may stroke the loss of weight by congratulating them on achieving their new body shape. This reinforcement will boost the self-esteem and motivate the person in maintaining an obsessive control. The ‘if-then’ statements we mentioned before may be very influential reinforcing factors, which can also be translated into ‘as long as’ statements: ‘as long as I am in control (dieting/bingeing), I can protect myself’; ‘as long as I am dieting, I will be loved, liked’; ‘as long as I can do things perfectly, I am a worthwhile person’. A weight loss achieved by any means, whether healthy or not, may be reinforced by a sense of satisfaction and success, thus exhilaration that they have finally beaten their demons and have some measure of control in at least one area of their lives. When this is experienced, the emotional eater will switch from a not OK to a seemingly OK position and feel a sense of superiority at their self control, commiserating with people unable to lose weight.

Why diets alone don’t work Dieting is big business. One look at the glossies, television and the lifestyle sections of any bookshop and you will find a myriad of diets ranging from food combining and protein-only, to the more sensible Weight Watchers or Slimming World concepts, to the more glamorous Hollywood movie star miracle diets. Dieting is a very popular way to lose weight and at a first glance seems a good idea; if you consume fewer calories than you use up, you will lose weight. The compulsive overeater will try almost anything to lose a few pounds. Unfortunately, although dieting produces short-term results, people often end up putting on the weight they have lost and then some. Why? Any diet which involves a change in the way we eat requires a change in our long-established eating habits. This if approached in the right way, being mindful, for example, of the salt or the sugar we consume and portion size, can mean a healthier, longer life, which for any of us including the compulsive overeater can only be a good thing. However, another word for diet is ‘regime’ which has become synonymous with governments that impose oppressive conditions on their citizens, often provoking rebellion. Using the ego-state model, the regime might be seen as the strict Parent, and the rebellion, the put-upon Child’s response. Even the ‘easiest’ diet is hard to follow as our eating habits, unlike the diet, fit exactly with our established lifestyle and our relationships. Dieting thus provokes additional physical and emotional pressure in our already stressed lives. Apart from the fact that we have to adhere to it, we also have to plan and negotiate certain social situations such as going out to dinner or eating differently from our friends and family. Diets rely in our willpower, this magical, spiritual internal force, with limited resources, which will somehow, we believe, help us stay within the constraints of our chosen eating plan, even though we would really rather be eating something else, often anything else that is not on the plan. Again we are faced with the dichotomy of winning or losing, succeeding or failing. It can feel like a constant, internal conflict, which cannot be resolved; either way, we are not satisfied. If we lapse by filling our stomachs, we are left with feelings of guilt and failure. If we ‘win’ by fighting our hunger and feelings of deprivation, our cravings become bigger and bigger and sooner or later we slip. Each time we use our willpower in an effort to change our long standing habits we allow our powerful internalised Parent ego-state to tell to us: ‘you cannot be trusted, your hunger (for pleasure, food, love...) is bottomless’. This will often lead us to a hopeless place. This state of mind, in addition to the deprivation, shame, guilt and the fear that it provokes, is unlikely ever to lead us to a permanent change in our eating habits (Roth, 1998).

What is more likely to happen is that the impositions from our internal Parent will lead our Child to rebel by overeating, and again this lapse will lead us to experience feelings of inadequacy. Clara describes how she stands at the fridge and eats until she feels sick even though she vowed that this time it would be different because she was in a really determined place. This cycle of behaviour so dependent upon willpower and a strictly prescribed regime, which Clara went into with such good faith, lead her into a pattern of ‘yo-yo dieting’. For many of our clients this results in a metabolism that is severely out of balance, health problems because certain essential food groups are completely excluded or restricted or more worryingly, the development of serious eating disorders. Time and time again we see that the compulsive overeaters with whom we work are not eating on stomach hunger; often they never experience real hunger because they will not allow themselves to feel emptiness, physically or emotionally, unless of course they are on a diet and feeling bad because they are depriving themselves of the very thing that keeps them OK. And herein lies the problem. A diet represents the illusion that if they stick to it, they will achieve a sense of OK-ness, however transitory and conditional this may be. Not only do they not solve the problem, but most diets exacerbate it by causing extra stress and in some cases deep depressive states.

What is the alternative to dieting? Eating, as well as being an indispensable, physiological requirement, also forms part of our social and emotional life. Human beings need a degree of predictability in their lives and in their relationships. Our relationship with food is no different. We develop certain ways of being which fit with our world and our relationship with ourselves and with others. It follows that in order to change a long-established habit there might be something in our world, in our relatedness to ourselves and to others, that also needs our attention and understanding. As we said, when we eat, we do not always from physiological hunger. We use food to run away from our feelings. Often we are using the wrong weapons to fight our demons and failing. Willpower may be useful for a while but then it quickly gives way to feelings of worthlessness, despair and guilt. For as long as we continue with the cycle of dieting and binging we will never have control of our lives. Gaining weight and compulsive overeating are merely symptoms that cannot be addressed by dieting alone. Unless we attend to the underlying causes, the destructive cycle cannot be broken. It is like putting a plaster over a gaping wound; eventually it falls off and we are left with a wound and scarring that becomes harder and harder to heal. We use more ‘powerful’ weapons, we fight harder and longer and our scars become bigger and our advance is slow and arduous. We turn those weapons onto ourselves and call it failure, not being good enough, not being strong enough. Not being enough. And we continue with this sense of not enough, this lack of something, this cognitive dissonance, the feeling we get when we know that something is not right and there is something missing. Clara described this feeling as “...a big empty hole that needs filling. On the outside I have everything, healthy children, a kind husband, good friends and I still feel not good enough, I feel like a fraud. If people knew what I was really like, they would not like me ...” Big empty holes need filling and so Clara being the good adapted girl she is, reached not for drugs or alcohol as a way of pushing down these emotions, she reached for food. All the biscuits, cakes or ice-cream in the world, as anaesthetizing as they seemed in that moment, could not fill the big void she felt because it is not what the big hole was empty for. For a short while, she didn’t feel unlovable, bad, lonely or worthless. In that moment her drug of choice filled that hole. Clara describes how she shamefully, guiltily pushed down her emotions: “...It is as though [her feelings of badness] are like an erupting volcano that will burn and demolish everything in its path. I need to keep the lid down. If I could just to my goal weight and be OK with food everything else would be OK...” So how can we stop eating our emotions? We started the chapter by saying that our relationship with food is one relationship that we must get right. We discussed some of the reasons why a person might turn to food as a way of discounting and denying the part of themselves and their emotions that feels unbearable.

Here are some of the ways we can begin to get in touch with our natural appetite and restore balance between our minds and bodies:

  • Trust yourself: start trusting and being attuned to your body. Our bodies know what they need. This takes time and practice and can be one of the scariest things to do. It involves letting go of the very structures that have given us a sense of conditional OK-ness.

  • Eat when you are hungry: once we become more aware of our real physiological hunger then we absolutely need to eat and to eat what we are hungry for. Eating is about all our senses, our body and our mind. It is an experience that should be honoured with our awareness. Our body knows exactly what we need and when we are full. Stop when you just suspect you might be full. The signals of fullness take around twenty minutes to reach your consciousness. The food is always there if you feel hungry later on.

  • Be curious and explore your hunger: there are different hungers and if we really pay attention to our body, we can begin to recognise them. We just need to stop and think before starting to eat.

  • Pay attention: when you eat, sit down and focus on what you are eating. Be wholly present. If your mind wanders, as it invariably will, bring it back to your food. Open all your senses and allow the food to be a sensual experience, one of pleasure, and a self-nurturing act. Eating without all your senses is like hearing without listening or looking without seeing; it is much more satisfying when we allow ourselves to be fully present. And only when we are in this space can we begin the journey of attunement between body and mind. Eating mindfully is an experience of taste, smell, sight, touch, sound and heart and one to be savoured and enjoyed.

  • Rate your hunger: ask yourself am ‘I hungry? Is it food I want? When did I last eat and is it possible that I am hungry for food? How hungry are you on a scale from 1 to 10, where 1 is absolutely starving, 6 is full and 9 is so full you want to be sick? You should be aiming to eat when your stomach is around 3.

  • Eat slowly: chew your food at least three times slower than you normally would. Try using your non-dominant hand or chopsticks. That usually slows things down.

  • Put your knife, fork or spoon down between each mouthful: when you do this you really enjoy every mouthful. Take your time.

  • Always eat sitting down: if you are eating standing up, say while you are cooking or running around, even if your stomach is full your mind won’t recognise the signals and you will continue eating.

  • Avoid distractions while you eat: if you eat when you are driving, watching television or using the computer again, your attention is not on your food and it is very easy to eat mindlessly.

  • Don’t obsess about food or calories: eat what you need, what your body is asking for.

  • STOP when you are satisfied, even if there is still food in your plate or anyone else’s; you are not a dustbin for your children’s leftover food. Few of us like to waste food, especially when so much of the world is starving, but eating what you don’t need rather than putting in the dustbin where it belongs will not help anyone, least of all you.

  • Eat different food: experiment with your senses. You may be surprised at what you actually want when you tune into your body. Eating a varied diet that involves all food groups will help you in establishing and maintaining a healthy diet.

  • Hydrate your body: apart from the obvious benefits of drinking plenty of water throughout the day, we often confuse thirst with hunger. Drink a glass of water, wait a few minutes and eat if you are still hungry. You will soon learn to recognise the difference between stomach and mouth hunger.

  • Honour your body and honour yourself: instead of feeling fat, approach your body image with positivity, attunement and compassion. The compulsive overeater is, as we mentioned, good at taking care of others. Afford yourself the care and attention you freely extend to those around you.

  • Move your body: chose an exercise you enjoy. It may be walking, swimming or dancing. Even a little effort will bring you tremendous gains. Current government guidelines are that we should aim for at least 30 minutes of moderate-intensity- exercise, measured by making you slightly breathless or a little warm, five days a week. This sounds like a lot but you don’t have to do the whole lot in one go. Break it up into 10 minute bursts if you prefer. It’s the total that matters. The important thing is that you do it and enjoy what you are doing. The additional benefit is that exercise stimulates the release of endorphins which make us feel good. If you have any pre- existing medical conditions you should always consult your doctor first before starting a new exercise plan.

  • Rest your body: just as we need to move our bodies, we also need to rest them. Often we reach for sugary foods when we are tired.

  • Don’t weigh yourself more than once every few months.

  • When the hunger of your demons comes, listen to it and allow it to be rather than acting out by eating on this impulse. Though it may seem unmanageable, with time, practice and the appropriate help, we can learn to manage our emotions another way.

  • Write a food and mood diary and notice what your hunger is about. What feelings are triggering your thoughts, what thoughts are triggering your feelings? Let them talk to you. Keep writing, especially when you feel stuck, and recognise that you are in a familiar place, that place that might lead you to act out by binging. Use your here and now Adult ego-state to ask your Child what it needs. Listen out for the shoulds and oughts of your Parent ego-state. Ask each one what they are feeling, thinking and what they would like to do. Allow them time to answer and listen in a non-judgmental way. Be curious and present. A food and mood diary is a powerful way of connecting your thoughts, feelings and behaviour. The act of putting down on paper thoughts and feelings that have been taking up so much space in your head is often a cathartic, freeing experience that can lead to real change.

Seeking professional help We believe that no one knows us better than we know ourselves and we have within us the resources we need to change unwanted behaviours, thoughts and feelings. However, attempting to do this on one’s own is a daunting task. Most compulsive overeaters have tried and continue to try almost anything that might relieve their pain. Firstly, it is difficult to see why and how we may have got to this place because as compulsive overeaters, we have become masters in defending ourselves against our anxiety. As well as being a major contributing factor, the cycle of overeating, dieting and bingeing is what is keeping us from feeling the unbearable; we are hardly going to allow ourselves to unravel and reveal the very things that we are guarding against, on our own. Secondly, we have had years of training. We are so used to adapting to a belief about how we ‘should’ and ‘ought to’ be that we have to some extent lost our sense of autonomy. Our sense of self becomes fractured and is external. Counselling and the longer-term work that psychotherapy facilitates allows us the space and time we need to explore why and how we get stuck in these repetitive, destructive patterns of thinking, feeling and behaviour. Hypnotherapy is also a useful way of getting to the unconscious reasons and beliefs about ourselves. When we are relaxed the unconscious becomes more available. It can allow deeply buried childhood experiences to surface and these can be looked at using the reality-testing ability of the Adult ego-state. Having more access to the unconscious also means that while our experiences cannot be wiped from our minds, they can be overlaid with new, more appropriate messages and can often offer a different narrative to our Child via our Adult.

Conclusion We have seen how it is possible to develop unhealthy connections between food and love and how food is used at times as a comforter, a soother and as a substitute for something that is missing in our lives, often not consciously knowing what that ‘something’ is. We have also seen how we can allow the messages taken in with the under-developed thinking of a child to dictate our compulsive behaviour, how these dynamics were created and how they play out in our lives as adults. Many compulsive overeaters come to us because they want to lose weight. They hope that simply shedding the weight will somehow magically transform their lives. It is true that having what is deemed by you and others as an acceptable body image certainly creates a sense of immense satisfaction. But they are often still in the same place. The temporary euphoria experienced by achieving their goal weight soon gives way to feelings of inadequacy and emptiness. Gradually the weight so arduously lost starts creeping back. It is only when our clients begin to recognise this behaviour as something other than a cycle of loss and gain, being good or bad, a winner or a loser, that we can embark on the real work of healing; the plaster that was the diet is off and the wounds need time, commitment and patience to heal. What we are suggesting here is commitment to ourselves rather than willpower, fulfilment rather than emptiness, compassion for ourselves rather than opposition and self- condemnation. We suggest feeding our demons rather than fighting them (Allione, 2008) and mindfulness and awareness rather than the obedience to rigid rules. Each of us has the right to live the life we want, to be the best that we can be, to have freedom and options, and our relationship with food is an important part of that plan. In our body there is all the wisdom we need, we just need to learn to trust it! Over time and within the safe and confidential space that the therapeutic relationship provides, our clients tell their stories. There is no magic wand and sadly no quick fix. We cannot change our clients’ experience but we can help them in discovering why and how they may have developed the damaging and inappropriate strategies for coping. We work with them to find different ways of being in the world and with themselves. Ways that do not involve eating their emotions.

Citations Allione T (2008) Feeding Your Demons. Ancient Wisdom for Resolving Inner Conflict. London: Hay House. Berne E (1961) Transactional Analysis in Psychotherapy. New York: Grove Press. Brunt M (2005) The Use of Transactional Analysis in the Treatment of Eating Disorders 35 (3): 240-253. Kohut H (1971) The Analysis of the Self. New York: International Universities Press. Riebel L (1985) Eating Disorders and Personal Constructs. Transactional Analysis Journal 15 (1): 42-47. Roth G (1998) When You Eat at the Refrigerator, Pull up a Chair: 50 Ways to Feel Thin, Gorgeous and Happy (When You Feel Anything But). New York: Hyperon. Steiner C (1974) Scripts People Live: Transactional Analysis of Life Scripts. New York: Grove Press. Stewart I and Joines V (1987) T A Today. A New Introduction to Transactional Analysis. Nottingham: Lifespace Publishing. Winnicott DW (1965) The Maturational Process and the Facilitative Environment. New York: International Universities Press.

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