Eating and emotion
Food is the currency of relationships. It brings people together and induces feelings of relaxation and companionship. The primary relationship between mother and infant does not only provide food but also provides warmth, comfort, safety, protection and love. So from the earliest times of our lives nourishment and nurturing are intimately associated. Lovers often feed each other like infants. Going out to dinner is often the precursor of greater intimacy. The family meal is of critical importance in consolidating family ties. Couples invite other couples around for meals to establish a sense of shared experience and empathy.
It is perhaps not too far fetched to say that people who feel contented and satisfied eat well. Digestion requires a relaxed attitude. If we are tense or we try to eat to quickly, then we can get pain and feel sick. Emotional tension increases the activity in the sympathetic nervous system which impairs digestion by drying up secretions, inhibiting peristalsis, causing parts of the gut to go into spasm and making the gut so sensitive that it develops aversive reactions to food.
A revolt in the gut
Several of; my patients are so severely afflicted by 'a revolt in the gut' to food of any sort that eating is a very difficult and laborious business.
Sally cannot eat with the rest of the family. If she tries, she has difficulty in swallowing, her mouth goes dry and the food seems to get stuck half way down and if it gets as far as the stomach, she gets such severe cramping and nausea that her food often comes straight back. The only way Sally can take enough food in is to eat in the early hours of the morning when everybody else is asleep. Even then she has to eat very slow/y and concentrate on something neutral that is completely disconnected with food.
Geraldine has a similar experience. Even thinking about food brings on severe IBS. So she eats very slowly and carefully, while trying to calm herself with music and take her mind off eating by reading a book. For both Sally and Geraldine, the idea of food causes so much emotional tension, that the gut can almost size up. Other patients have a more ambivalent relationship with food which reflects their relationship with people.
Tanya is tall with raven black hair, laughing eyes and a ready smile. She teaches drama at a further education college and seems to be a young woman who Iikes to enjoy life. Appearances can be deceptive. Tanya was referred to me with a strange constellation of symptoms; burning stomach, sore throat, sore eyes, hot head, hands and feet. They reminded her of the feelings she would have if she had drunk too much. She has, what she describes as a double relationship with food. She enjoys eating, but it can give bring on her symptoms. 'I like food but it doesn't like me.'
An exotic, exciting new experience with food is always associated with symptoms. She therefore avoids the food she likes because this would tend to leave her feeling anxious, guilty and out of control, and she tries to control her symptoms and calm her anxiety by eating sensible foods, such as scrambled eggs, soup, custard, milk, toast, baby foods and salads. These food are not only used to control her symptoms, but also seem to calm her down. When she was a teenager living at home, Tanya felt that she had to be the peacemaker, mediating between her extrovert father and her mother who was 'silent and deadly'.
As she grew up and left home both polarities were represented in her own personality. She likes to enjoy herself, go out clubbing, eat good food, drink too much, have fun, but if she ever gives free rein to this aspect of her personality, she pays for it afterwards by feeling awful. She then stays at home for weeks, avoids contact with people, eats sensible foods and watches television. So she oscillates between hedonism and isolation.
Tanya has never really been able to establish a long term relationship with a partner and feels depressed that she has missed out. So it seems that the way a person is with food can represent how she or he feels and how they are with other people. People who are careful about what they eat are careful people.Those who suffer from eating food can find relationships and other aspects of life difficult.
What can trigger food intolerance?
Some people have been intolerant of food for as long as they can remember. In others, food intolerance can be triggered by a specific event that may be associated with food. IBS can be provoked by an attack of food poisoning, but not everybody who has food poisoning develops long term symptoms of IBS. Most patients recover without any long term effects, but in about 30% of people the symptoms of food poisoning can go on for months or even years after the original infection has cleared up. This is much more likely to occur if the original attack of food poisoning is associated with emotional upset. In them the experience of food intolerance can set up psychological associations that can prove very resistant to treatment.
Amanda was so in love with Rick that she chose to ignore how late he was coming home and the increasing number of nights he had to spend out of town. Times were tough for both of them and she knew that Rick was taking on extra jobs so that they could get married and start a family.
So when Rick suggested that they go out for a meal because there was something he had to say to her, she felt thrilled and excited. The venue was perfect; a little fish restaurant in a village a few miles away. She thought she would wear the little black dress that Rick liked and and just for good luck she put a dab of that expensive, perfume he had bought her that first amazing Christmas together on the side of her neck just below her ears.
Rick was attentive as usual but seemed somehow tense and sad. They chose the 'supreme of salmon with prawns and Hollandaise sauce', and a lovely bottle of Semillon Chardonnay. There was something not quite right with the sauce but Amanda felt so relaxed and happy that she ignored it. She had just finished hers when he told her that had been having an affair with Margaret, who worked in the office. It had been going on for some time. He still loved her but he loved Margaret too, and well somehow she had got pregnant. Amanda listened with mounting horror and dread. How could this be happening? Suddenly she couldn't be there any more. She rushed through the restaurant to the 'ladies' where she was seized with the most violent spasms of retching.
She didn't stop vomiting for three days. Every time she even thought of food she would be sick.
That was three years ago. Rick married Margaret, but she lost the baby. Amanda took a job in another town. She has been out a few times with other men but always feels sick and often makes excuses not to go out. Subsequent to the attack of gastroenteritis on that fateful evening, she has developed an 'allergy' to fish. Even the smell of fish makes her violently ill. Other foods seem to upset her as well. She has lost a lot of weight. Her family are worried.
Amanda's gut reaction combined with Rick's catastrophic news had been so dramatic that anything that reminded her of that evening made her feel sick. If she had been able to talk about what happened, the emotion would have been worn away, and any food intolerance would have dissipated with it, but she was too ashamed that she couldn't tell anybody, not even her family.
So the emotional reaction established a memory loop, which could be activated by any association with that fateful meal. The same sort of mind gut connection has been conditioned in animals who were made allergic to milk protein. Whenever the milk protein was injected into the gut, a bell was sounded and the rats all developed diarrhoea. After a few trials, just ringing the bell alone was enough to induce the diarrhoea. The animals had associated ringing the bell with a gut reaction and reacted to the bell alone.
Other experiments carried out in the 1950s showed patients with severe milk intolerance only developed symptoms if they were told that milk was injected into the stomach irrespective of whether that was true or not. In other words, it was the idea that reproduced the symptoms and not the food itself.
In other patients the connection between emotion, food and gut symptoms may have been established early in childhood. Suzanne's long-standing aversion of milk is associated with conflicts over early feeding experiences and the relationship with her mother.
"Mum had told me that I did not feed very well when I was a baby and she would be upset about it, she would cry. She put me onto a bottle but apparently I used to scream whenever it was produced. Ever since I can remember I have never been able to tolerate the smell of milk and milky foods always seems to make my mouth sore and cause the most awful griping pains. And there was such a battle when I was being potty trained. I would have to stay in front of the fire on my potty for hours until there was this red rim around my bottom. Mum always worried about me. Mealtimes were a nightmare. I was a poor eater and I had to sit staring at my plate until I had finished....sometimes for hours. I am 25 now but I still get awful tummy ache and constipation when I go and visit mum."
"In childhood things were always so much more extreme and difficult to talk about. Many parents will recognise how their child's aversions to particular foods may have occurred as a result of battles over feeding. Meals became a battle ground and food came to represent the resistance to parental control."
"I just can't take any fibre foods. Muesli, All-bran, wholemeal bread they all upset me. Mum always used to shovel all of this stuff down me when I was a kid. I hated it then. I used to scream at her that it was just woodchip and sawdust but it didn't do any good then and it doesn't now."
"In fact I am sure it makes me worse. I get the most awful wind and pains and as far as my constipation is concerned it just makes that worse. If I take fibre, I don't go for a week. The only thing that makes me go to the loo is fried food and chocolate. Now this doesn't help my weight, but quite honestly I don't care."
Disease at the level of the Idea
Children can seem to go off certain foods with such regularity that it can try patience of even the most tolerant parent. If, however, we try to make our little monster eat his lovely carrots, he may get so upset that he is sick and never eats carrots again. In other words, an aversive association is set up between the food, the emotion and the symptom, that is activated whenever the same food is presented.
I remember that my brother asserted that he would not eat baked apples, and it was only when our mother hit on the idea of calling them 'Simon' apples that he began to view them as a good thing and eat his pudding up without getting tummy ache. So it can be the idea, associated with the food that can cause the problem. Often a specific intolerance bears a closer association with what that food represents for the patient, rather than a specific traumatic memory.
Tracey, a plump, seemingly jolly woman in her late twenties, seemed to exist almost entirely on chocolate. She would cook a meal for the family, but when she tried to sit down with them and eat it, she immediately vomited. The only food she could eat was chocolate and she ate very little else. She would not let her son have any chocolate because that was 'mummy's food'. Once a month, Tracey went out on the town with her girl friends and then she could even eat a hot curry without any problem at all.
Chocolate is a treat, a reward for good behaviour. Tracey was frustrated by her limited horizon of family and work in the local mill, and a husband who had no ambition apart from that for the local football team. She needed more out of life, more love, more excitement. She seemed to spend all her time caring for others but nobody cared for her. It seemed that the vomiting of the meals she had cooked for the family represented her rejection of the domestic role, while her chocolate consumption represented her desire to have a good time for herself.
The conviction that food is the cause of the symptoms is more likely to become consolidated when the emotional connection is difficult, painful and cannot be talked about. Bringing the emotional link to mind through the medium of psychotherapy can give the patient the opportunity to get rid of the symptoms by exploring the hidden emotional issues, but the she or he may not always be pleased about this.
'For years, I was so careful about what I ate because I was convinced that my disease was caused by an allergy to food. At Christmas when I went home, I ate everything and didn't get any problems with my tummy at all. Now I've come back to the stress and problems of my life here, all the symptoms come back again and I'm watching what I eat. I guess it must be due to stress."
''But you're disappointed.'
'Yes, because I have no control over the stress.'
Further Reading
For a totally enjoyable description of the emotional consequences of food, read Laura Esquivel's Like Water for Chocolate 1989 Black Swan London And for the science read David Pearson's papers. Pearson DJ (1988 Pseudofood Allergy British Medical Journal 292: 221-222.
