Mary Stugar - The Language of Food

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- So without further ado it gives me great pleasure to introduce Mary Stugar.

Mary: Hello! Well now, that's the formal part. You know, I'm really just giving my time and my experience to just see how I can help you in the room. Now obviously what I've done is I've put together some structure because I think that just helps. The structure I've put together is about language of food...this may work or may not (referring to visual aid)

But, just before I get into that, one thing I would like to say on a personal note is that I've been working in private practice for 14 years and what I really have a passion about is supporting people through change. When I first trained, I trained specifically in nutrition and what I was faced with when I actually went out and started working with people is an awful lot of people saying 'you should do this and you should do that' and not really a great understanding of people's emotional interaction with food or their social triggers. There are people walking into your consulting room and they might have very serious problem. Obviously if someone is anorexic it becomes fairly clear just by looking at them, but there is much more going on, on the emotional side. Certainly when you start looking at the process of change, you've got to look at your use of language and how you build rapport with people. How do you listen and interact on a practical level with somebody's life so that you can actually help them? Because if you don't, in my opinion, it's a waste of time.

As I show you some of the figures about just how bad this country is on issues of dieting or how difficult it is for anorexics to get better, I think you will start to see why I've taken the various avenues that I have. Because it has been purely based on the fact that I want to help people in a more effective way.

What I wanted to start with is to show you broadly what I thought that we could cover. You have to set goals if you are going to change. It's like if you are going to start a business, you can't do it without a plan. But there are very specific ways that I think make people more successful when they goal set. Let's really do an audit of people's emotional needs. If they are using food, alcohol or drugs of any kind instead of actually properly addressing different avenues for their emotions, the thing is that you can't just say, "Don't use food or alcohol to deal with your emotions." You actually have to show them in a sense of perspective and a different way of thinking about how they can redirect their emotions in a more healthy way.

I am doing a Masters in Human Givens Psychotherapy, which in context with food is 'short therapy'. So I'm not going into enormous depths of psychological change but I am showing people a positive psychology and a way of looking forward. Often I will work with a clinical psychologist alongside me, particularly with serious anorexia, abuse and different things.

I want to look at the process of change. And I think a lot more research needs to be done on this and as we go through you will see. Then, I want to throw the floor open to see what affects your food choices. So we will have a bit of a chat. Emotional triggers – looking at the resources that you bring to the table. Everybody has different resources. Finally, we will look at the balance that works for you, because this business of "you should do this and you should do that", if that does not fit in within the context of your life, then, again, I think that's ridiculous.

As a therapist I am not working to tell anybody what to do. What I am there for is to be, in a sense, a guide, a help and a support, often at quite critical times to show people where they could get more balance and how they could actually achieve that. That is a very supportive process rather than trying to find out your compliance rate. I almost cringe when people say, "What is your compliance rate" because it feels very controlling rather than supportive. I think that is a big difference.

When I'm looking at goal setting, I am looking at it being positive. In the context of food I would never say to somebody "You must give up that, you must give up this." I will not say, "You can't have cappuccino". I would say we'd be looking at a positive "What can you add in?"

When we are looking at the practical side of change, it's got to be achievable. But that's a discussion; it's not telling somebody what to do, rather it is a respectful discussion. I love this sort of needs orientated – and that's emotional needs - because there are some changes, and most changes, if you think about them, you can do them in a way that will actually fulfil an emotional need. I'm going to go through a sort of cut down hierarchy of needs so that you can see what I mean.

Just to give you a little aside on this, I was talking to a professional golfer who is also a sports scientist and lecturer. It was quite amusing. He actually came to me originally as a client. Then I said to him, "As a sports scientist and as a professional sportsman, you're the leaders in the world about setting goals and visualization for change and all of this". Then I said, "By the way, this is the criteria that I use", and he'd never come across the idea that you would actually, in training or any goals that you'd set, try to have an emotional need fulfilled. So I gave him information and he ran off excited. Again, that may be very obvious to people here who are psychologists.

The set of emotional needs that I use - and this is very much to get perspective - because if you're under-eating or over-eating and it's actually causing a serious health problem or various addictions, what we need is a different landscape to fulfil emotional needs. Otherwise you are dealing with a dried desert and again it's negative. You are telling people to "stop, don't do that, don't have emotional needs enmeshed with your eating". I don't think that is very helpful; it's got to be more positive.

One of the things I do is an emotional needs audit. I'm saying to people, "Let's go through and see where in your life you have a sense of autonomy. Are you giving and receiving attention? Emotional connections in terms of friendship. Connection to the wider community?" But obviously when people are very depressed and anxious, which often goes with the territory of illness, over-eating and under-eating, you'll often be dealing with a situation where you have to get people focusing outwards. So, again, get them to have a look at these emotional needs in terms of any goals that are being set.

People need a balance with privacy, a sense of status, a sense of competence, and also meaning and purpose in their lives. That's the landscape that I'm looking at. I just want to show you quickly that that comes from Human Givens and there has been a pilot scheme that is looking at a practice research network. For everybody here we should all be looking at what the outcome is. Are we actually being successful in helping people through the process of change? This was done in a primary care setting, GP practice. It was helping people with depression and also with anxiety. This idea of helping people go through change, but in the process fulfilling emotional needs, is something that is really working.

Time: 10:00

Now, how many people have seen this quote by Albert Einstein? I'll read it out:

"The significant problems that we created can't be solved at the same level of thinking we were at when we created them."

Wherever you were in your life, for the people who've come here for personal reasons today, something, or a set of events or a cascade of events has taken you into that place where perhaps you are over-eating, under-eating, drinking or whatever. You were doing what you thought was the best for your life, and I think that when you are working with people it's really important to respect that. Some of what I would call cascades of events that I've seen, I look at in terms of my own life and I think how would I actually have coped with that and would I have been able to cope with that? It's tough. A lot of things that happen in life and you've got very serious abuse and things, often.

Now, just as structure thinking, how many people have seen this idea of a process of change? Have quite a lot of you seen this? I think there are some people in the room who haven't, so I'm just going to quickly go through it. A lot of people, when they've had a cascade of events, and are doing whatever they're doing and coping emotionally in their lives, they may well be in a state of denial; in a sense, pre-contemplation. If you're in a state of pre-contemplation, you don't even acknowledge in your conscious mind that there is any problem.

If somebody is very severely losing weight, at some point an external person will say to them that they've got a problem. They may be forced, even though they might not think they have a problem, to go and see a doctor. At that point they may well get to a sort of contemplation side. But if people think that they are coping, they may not be coping in a healthy way but in their terms they're coping, how on earth do you move them realistically from contemplation to preparation?

You can do a variety of things but one of things, particularly with anorexia, is to make sure they are really clear about what the dangers are. So you can use very positive, very supportive language and try to take stress and load out of their lives. Try to redirect them to a different emotional territory. But, you really have to make sure they have a realistic idea of what's going on.

Have you all seen this book? If not, I really recommend you get it and have a good read, particularly psychologists who perhaps have not come across it. It's called "Changing for Good" by James Procasta. What a group of scientist did is that they took a lot of self-change methods from different schools of psychology, bolted it together and then did a lot of research. It's been taken up by the big cancer institutes and it shows very interesting things. I think one of the most interesting things is, if you're working as a therapist or are in the process of change yourself, it's looking at different ways or methods depending on where you are in the process of change.

For example, I was saying that I want to keep people out of denial particularly when it is life-threatening. Bear in mind that 10% of anorexics die; it's the highest death rate within diagnosed psychiatric illness. Raising consciousness and making sure they understand what the situation is with their bones, their long-term fertility and their hormones - I always get a consultant gynaecologist to look at exactly what is going on - then they have it in black and white in front of them showing how dangerous the situation actually is for them.

In many ways it is the same with obesity or with drinking. You have liver problems, potential high blood pressure and heart problems. You may not get them immediately - there are a lot of functional anorexics out there as well – but they really need to know where they are.

There is also the process of just looking at different behaviours and then moving people from contemplation to preparation. One of the things is emotional arousal, for example. If you are going to engage with somebody's emotions you've really got to understand where they are emotionally. Some of the tools that I actually use - again you are just trying to reach them and I like things which are visual - for example, when I'm working with people's resources, I say you have to have imagination and we are going to go through this and I actually hand them something. For example, here I have the observing self, which happens to be a globe. And I've got emotions, which happens to be a truck, because literally, when people are highly emotional, it almost runs over everything and they can't think straight. (There are) also rapport-building and socialization. You can use different tools but it must be real to people. Somehow, when you touch and feel things and you build rapport with people, you actually get people to begin to think forward.

Particularly when we're looking at dieting and things like that, I don't know how many of you are aware quite how bad we are at dieting but I just want to show you this. I was involved with quite a big report from about 10,000 British adults, and then there was another report that questioned 700 General Practitioners.

Look at this. 70% of British adults have dieted to lose weight but 92% said that their diets were a failure. Well, that did not work out very well. Next, only 32% of British adults increase exercise when trying to lose weight. Well everybody knows that there are various things you need to do if you are going to lose weight, exercise being one. And yet look how low that percentage is, relatively.

When I was thinking about the title, the idea about the language of food... you know we all have an internal language of food. For example, when people were asked they said that hunger, boredom, misery and disappointment were the words that came to mind when they were thinking of dieting.

Now I think this is a good moment to ask what any of you would say is your internal language of food and what that is made up from. For example, how were you brought up? I don't know if anybody would like to join in. When you were growing up how did your parents cook? What kind of foods were you given and what was the emotion associated with food within your family?

I don't know if anyone would like to jump in. Is anybody brave enough?

I can tell you my own, just to try and start off. I grew up on the Scottish border. My father had been evacuated during the Second World War. He thought it was a good place to bring us up. He was evacuated from London. At four years old there we were and you couldn't even buy vegetable. I'm a little bit older, possibly, than you think. So what we used to do was grow a lot of our vegetables and the family would always sit together at meal times. In a sense my language of food has always been fresh food. I know what fresh food straight out of the garden tastes like and it's so much nicer. There was always a lot of conversation and socialization around the table. But, as I've worked with people I've become incredibly aware that a lot of people don't have that.

Time: 20:00

So, is anybody brave enough to give a short synopsis of how they were brought up with food?

Audience member 1: I was brought up in the 50s and 60s. Rationing was still there in my parents mind for sugars, cheese etc. So it seemed very privileged. It was not sitting in a normal place. My memory is that food was a chore. It was not celebrated. It was not like France. Cost was always an issue. I remember that my father always had more meat than the rest of us.

Mary: How many kids were there?

Audience member 1: There were three. Convenience did not really exist. Apart from a few tins of pudding and things like that and taste was pretty bland. I can remember when I was 17 or 18 I had garlic for the first time. Likes and dislikes were largely ignored. You just had to just finish the plate.

Mary: Isn't it different today? Have I got someone in the room, a young person who perhaps has had the convenience food and would like to speak out about their language of food? Can I encourage you two? Only because I think that you are a bit younger and you might have quite a different view because you weren't subjected to rationing or the aftermath of rationing.

Audience member 2: I can say about growing up. I got to a point when I was a teenager that convenience food and takeaways became a big part of my life. I think it was more around A-levels and university that I put on of a lot of weight because of the Chinese food, McDonalds, kebabs and that sort of thing. It was there really and not that expensive, especially when you are studying and things.

Mary: So it was easy and convenient?

Audience member 2: That was it. That was dinner sorted.

Mary: How do you feel about that? You may not want to say, but when you look at that and you look at perhaps the options of fresh food and perhaps options of different levels of education about how would your body best run and what kind of food would your body best run on, do you have an insight that...?

Audience member 2: Well I know that my body functions better and I feel better within myself if I eat things that are healthier, that's got colour basically. I noticed that fast foods all have the same colour; it's all grey. Food like salads, vegetables and meats – it has a lot of colour to it. Now, I don't eat fast foods. That's pretty much cut out of my diet. I do eat more the healthier options.

Mary: So you're beginning to be much more aware about the changes. How did you find beginning to change? Was it something that you just decided: "I'm just going to change?" What sort of method did you use to start to change to fresh food?

Audience member 2: I never thought that had a problem. I used to be about three stones heavier than what I am now.

Mary: Right. Isn't that interesting. You didn't think that you had a problem. So when I showed the pre-contemplation or the denial, would you say that you were very must sitting within that?

Audience member 2: Yes that's right. I sort of accepted that this is who I am and I am this size. That's it! It was my parents who were saying that there's something wrong and you need to do something. I was very much pushed, even in primary school, to eat healthily. And I still remember at school lunches when everyone had their packets of crisps and I had my rice cakes.

Mary: Yes, that is sad in some ways.

Audience member 2: Yes, I got pushed to do something about it and to try a diet but it was probably a fad diet, one of those extreme diets...

Mary: Well, it's interesting isn't it - the whole idea of fad diets? When the research was done here, it showed that four out of five British adults believe that fad diets work. But, they clearly don't. If you look at the trajectory for what is going to happen. Does everybody know who Foresight are?

Foresight is a government body that is looking at major risk to the population; not minor risk but major risk. Quite a lot of consultants have being talking in the newspapers recently about the strain and the level of problems that are going to hit the NHS with the obesity epidemic. (Referring to chart) I think that when you first look at this it looks really confusing but if you look at it and I will just try to explain it. What we've got is.... Do people know what the body mass index is? So a normal body mass index is between about 20 and 25. It is a broad range. When you get to 25 to 30 that is pre-obese and then 30 to 40 you are talking about beginning to have major levels of obesity.

This chart starts from '93 and it goes right the way through basically to 2050. What we've got is a complete change. So, people who are at the 30 to 40 level of obesity and which will cause them serious health problems and the country a vast amount of money potentially... Instead of being at 14% in '93 we are looking at it going up to a huge 60%. The people that you see here who are of healthy weight. In '93 it was 40% of the population and it is projected to go down to a very small 5% of the population. Now already at the moment the British people have got the highest level of overweight. That is the 25-30BMI. What is projected to happen if you look at the figures is that those numbers will swap over. We are looking at this vast new level.

Does everyone know about the Department of Environment, Food and Rural Affairs? Anyway, they monitor us, which I always find interesting.

Here we go: The DEFRA Report. It really is quite bad reading. If you look at the level of fruit and vegetables it has gone down and food prices have significantly gone up in terms of fresh food. Obviously we are being hit by the worst recession that we have seen for a very long time, certainly in my lifetime. I don't know if you could all read those things. Fruit and vegetables - this is the amount that is actually bought but if you look at the wastage with fresh food it is 2.6 portions per person per day. That is really what is going on at the moment within the population. Your 'brown food', as you call it, is what is really taking over and these levels of obesity are going up.

Everybody knows about advertising but the thing is the advertising works. I've taken part in debates which have been put on, say by the Economist, and there was quite a move at one point to put a big tax on foods that were not healthy and in a sense that just hasn't happened. Within the Economist debate, they had the head of the food industry, the head of advertising for the food industry and quite an interesting selection on their panel. But the bottom line is that these things have been discussed and nothing has actually changed. It really is a complicated situation.

Time: 30:00

And, if you look at this idea of emotional needs ... if you look at something like Haagen-Dazs ice cream – we have to cut that, we don't want to get sued – well Haagen-Dazs sounds like hug and kiss. I don't know if any of you have noticed that, but it's subliminal. You've also got all the images of hugging and kissing. So, because our right brain pattern matches, that is how it works. Advertisers have known about this for a very long time. When you question people and ask them "Are you affected by advertising?" then everybody says "No. I'm not a stupid person". The problem is that if you go into their kitchens and open their cupboards and then you say, "Why did you buy this?" and "Why did you buy that?" and they are all branded products.

They'll say " know." Then they realize that actually "Yes. Of course I'm affected by it."

Through the year the hundred or so takeaway leaflets that you receive at your door...How did you find the take away outlets that you used to use?

Audience member 3: Unintelligible.

Mary: Yes. You are my favourite customer or one of my favourite customers. Absolutely.

Audience member 3: One of them I have not been to in the past two years. I have completely left it. I believe 'everything should be in moderation. It's nice to have these foods but is not a way of eating healthy.

Mary: That's right. Perhaps once a week will be a good guideline. That is the kind of thing where a lot of people, if they have had a very severe cascade of emotional events, the problem is they will go to a nutritionist or a dietician and they'll go to a psychologist but in a sense the two don't meet. That was why I went on the journey that I've gone on, because at some level those two really do need to meet. There are many psychologists that I work with who really don't care about the functioning of the body. And within very serious eating disorders, they will say: "Oh, you must not fear foods. Eat what you want; eat as much sugar and white wheat." Normally they are pretty good with not having caffeine but if you're looking at a body that really needs to become healthy, you've got to look at what is a healthy foundation and then get it into perspective, rather than one extreme and the other extreme. I actually do think it is a major problem that we have not got people trained in a combination, considering the obesity epidemic that we've got, in both nutrition and psychotherapy, at least to a basic level.

Personally, in terms of a book to read with good backed up information... Does everybody know what epidemiology is? Well there are a few who do not know in the audience. Epidemiology is where you look at countries and look at their habits – what are they eating, and what diseases they do and do not get. Obviously you've got potentially different genetic pools and there are variances within that, but you get some fantastic information. For example, the Eskimos and Omega-3. There was a question asked about the Eskimos; they are eating a very high-fat diet but they do not have heart disease at all. So what is going on? One of the bases of heart disease is information and Omega-3 actually helps your anti-inflammatory pathways work. Omega-3 research that has been done by Dr. Alex Richardson at Oxford University is showing wonderful results in terms of brain function.

Now let me just show you this book. This book is called "Eat, Drink and Be Healthy". It is the Harvard Medical School guide to healthy eating and it's really well referenced, and it has this food pyramid. Now people will be quite interested that if you look at this food pyramid, which is really based on epidemiology and very good nutrition, and then you look at the published American food pyramid, you will see that there are some big differences. This is a really good example of vested interest getting in the way of what actually is good nutrition.

The problem is that we have this vast food industry. I think that most people in the room will know that the more you process food and the more sugars that you put in the food the cheaper it is. If you put flavours and colours in, great. Actually do not even bother putting colours in it; they obviously do with some, but they certainly do put colours within the packaging. One of the things that I think that you need to start to ask yourself is: "What will build a good foundation of health for my body? Where am I actually being conned? And, "I am simply being a tool to make money for the food industry." I think that when you start to separate that and start to separate some of what I call the emotional manipulation that is within the advertising, instead of saying that I'm not affected by it; just look at it. You can begin to really get a sort of healthy basis for your life. I think this is a great way to go. It's very good basic information.

Now I just want to go back to the spiral of change. I just want to say that when you're looking at preparation, I will go into great practical detail with people about the preparation because it's got to be practical and they have to be able to afford it. How are you going to properly support your body? You cannot just hand people a leaflet, which is often what happens at a doctor's surgery in a hospital. Here you are, this is what you should be doing. Most people just will not make any change based on that. They actually need to look at things like "are they going to prepare soups, are they prepared to do that sort of thing and where are they going to buy fresh food from?" In other words, if you're a practitioner working in this area I really believe that you need to go into quite a lot of detail and have conversations about food.

Also, if part of the reasons are emotional and avoidance... How many of you when you were growing up had really good social interaction and you associate good humour and good conversation with food as you were growing up. How many would you say had that and how many people really didn't? They had quite a difficult upbringing in terms of how food was.

Would you be prepared to say anything about what you felt was wrong when you were growing up? Did you not speak? I'm looking at you, beautiful lady.

Audience member 4: I never really thought about my upbringing with food. My father loved expensive foods while my mother was into rationing. You know that it is the mother who prepares the food. We didn't eat together as a family. There were a lot of arguments and emotions flying all over the place. We actually ate together on weekends. That was because my father would come home very late from work. There was no timing of meals and my mother would give me supper in the bathtub while bathing.

Mary: Really, that is quite radical.

Audience member 4: Yes!

Mary: Do I take it that you are in some form of recovery at the moment?

Audience member 4: Yes, I am. I have been struggling with it.

Mary: Have you really done what I would call an audit of what happened when you grew up; the pros and cons of change; getting education about good food; and, how you are dealing with the rest of your emotional life etc? Would you say that you've done that?
Audience member 4: I'm undergoing therapy at the moment, which is very helpful, and I have seen nutritionist as well. I like what you said about combining those together because I don't have enough support around food really, but now I am aware of what is healthy and what is not.

Time: 40:00

Mary: It is actually perhaps doing a food diary or perhaps making a food plan - that step more formal - that might help you. Even if you were to see a nutritionist, say just once a month, you might be able to nail that a little bit better. So that might be something for you to look at.

One of the things that I do within that change is to come up with this thing called a 'decisional balance". What we know from the research, and I think this is common sense but it is backed up, is that if you don't have at least double the number of pros, reasons to change, versus things in the cold light of day that you really see as obstacles, you will not change. You get this sabotaging, albeit subconscious, that goes on.

(Referring to chart) So this is something that actually one of my clients filled in, and I ask people to do this. She took on board that she needed double and you can see that she actually has. The thing about nutrition is that it's not as though I can do nice manipulation on you like an osteopath or something. I can give you some support and guidance but you actually need to go and do it. You need to take responsibility. She has written some quite interesting things. She has become very aware of the long-term health benefits.

I say to people that one of my doctor friends says: "I've got every respect for people who don't deal with their weight and don't look at it, because actually they are likely to have high blood pressure, complications with heart disease and potential problems with adult onset diabetes. We have a lot of children now with what was called adult onset diabetes. There is also cancer risk involved etc." So this is something that if you can possibly begin to make change and manage your emotions, it is a really good idea for your long-term health. If people were to see their own pros against the cons... How many of you who are in the process of change or recovery honestly think they've got double the number of pros that they really want to change versus what I would call challenges and obstacles which are there? How many of you think you have double the number of really good reasons to change versus cons? Or is it the other way around?

Audience member 5: I think I'm getting close to it.

Mary: Brilliant, It is an interesting thing to look at, isn't?

Audience member 5: What was interesting is that I did hit it. I did change for a couple of years and lost three stones. Then I think the balance must have shifted again. So I put it back on when more emotional stuff happened. I was under a lot of pressure.

Mary: Do you think if you'd got support on both the nutritional side and the emotional, psychological side at that point in time as you began to put on weight again, that you could have perhaps stem the tide?

Audience member 5: Yes!

Mary: It is interesting that joint support is not really out there at the moment.

Audience member 6: I do not see it that way because sometimes the encouragement might outweigh the cons that you have.

Mary: I could not agree with you more. I think absolutely it's weighted and highly subjective. When you look at not necessarily just the numbers but you look at the weight of them, it's got to be double, in a sense, in importance and weighting. You know what research is like; they have to come up with something but you are right. That is why practice-based research and really listening to people are what is actually important.

What I also get people to do is just straight off: look at the emotional triggers, what's going around - exactly what you were saying - if there have been very complicated, almost emotional or sort of strange habits going on as you were a child or actually that you carried on as an adult. A lot of people can put on a lot weight and eat lots of bad food and they don't really feel anything. I almost feel very sorry for them because it's almost like you've got a long-term time bomb, whereas if your body reacts, it's almost better because it will force you if you're in that much pain.

Now she is a very proactive, very social person and I love her to bits. She's one of my clients that I absolutely adore. Slowly, slowly she had some very big emotional issues that came up in a life. Even though that was the difference, slowly she started to slip again. That was probably at 50:50 rather than a 100% percent focus. So that spiral of change.... lots of people, because life gets in the way and because we are human and are emotional and things happen... She had gone back to a sort of contemplation. She knew that she had to change but there were too many challenges in her life at that moment in time, or so she thought.

She had to almost go back to the same level of pain before she would be prepared to do it again. She's gone back to it completely. She's laughing because she knows that this is the balance she needs and that is the right balance for her.

This is the big point that I want to make. Some people are more private; some are more social. It's not my place as a therapist to tell you how to lead your life, but if I can just help you find your balance that you're comfortable with and that basically supports your body, that's what we're really looking for.

Often, even though I might start the process jointly and there will always be an understanding of that sort of joint side, when people need more specialized help I start working with other people and that really works. Often with the nutritional and the supportive side, what you've got to do, particularly with somebody with anorexia, is you've really got to hold them. It's almost like a mother nurturing role. If there's been, let's say a rape or serious abuse in the background, which very sadly I see more often the not, a serious cascades of events, then you've got somebody working with the nitty-gritty of some of those things. If I was to work with very high levels of anger, rape and disassociation I would not be able to hold them on the nutritional side. So that is when we split apart and we go back together again and we work together.

For any therapists in the room, you've really got to look at where your boundaries and your barriers are and what is best for the client you are working with at all times. Certainly within the nutritional field, I've seen a lot of attitudes like "they are my patient" and there is not a proper level of handing on, which has concerned me with some people I've worked with.

What I think I'd really like to do is just open it up to you to ask me questions or give me your view or whatever you like to.

Audience member 7: I was going to talk about the beginning. The gentleman in front of me had a very similar upbringing. I grew up in the Highlands of Scotland and I was born in 1946. My mother never had sugar in her tea because there wasn't any sugar. There was rationing and I grew up in poverty. I never understood but when I was five I decided I was a vegetarian. Whether I was just trying to be a rebel I do not know but it actually made me physically sick. I attended boarding schools and they would cane me to get me to eat roasted beef and stuff. It would all come up again. So as far as I know for my mother and father there was emotional trauma. I had my first banana when I was 11 and sat the 11-plus. I grew up with all the stuff about policies. She used to make Oxo cubes with barley because we were poor. Then my father came back and he had money and loved dining and all the stuff.

Time: 50:00

So it has to do with the emotional trauma for me basically, but I still don't want to eat. My mother would say to me, and I still remember - she died about 30 years ago - she said that I had eaten disorder. It manifested into alcoholism in my case but I have not done anything like that for a long time now. It's hard facing up to all these emotional ramifications that you were talking about. 

Mary: What my suggestion would be is that you have the perspective of good nutrition. Just look at the education and what you are doing, now, at first it may be that there's so much emotional enmeshment in that, it is almost as though it is like a regime. This is what you do. You getting up in the morning, you have a shower, brush your teeth and put your clothes on. That is how you eat and you may not even feel the emotions. And I often find people who've got trauma or an emotional disturbance along with food actually don't taste. It is like they are not hungry and don't taste it. The point is to know if that is emotional disturbance or if that actually is zinc deficiencies.

Audience member 7: Did you say zinc?

Mary: Yes, zinc. By the way zinc has to have a bit of copper in it so that it does not cause problems, so don't everybody go out to buy zinc if you do not taste your food.

What I suggest if you ever do go that route is that you do have minerals that are balanced. You have to be careful because they do compete with each other. There are physiological reasons why people do not taste. Personally, I think everybody who has problems with eating should just be checked for essential fats and zinc. There are a few others but you've got a very fine line about what support is there and could that thing go into the addictive process. You certainly do not want people taking 20 zinc tablets; that really would not be helpful. What I would just suggest, going back to the main question, is you can have a food diary or food plan. Then you look at how your emotions can be fulfilled, even though you are sort of unravelling things from the past and you might be doing trauma work.

What I really suggest is that you make an audit of your time, every hour or so for a week – no longer or that would be obsessive compulsive. You have the emotional needs there and you look at what activities am I doing, how am I spending my time and where am I actually getting some level of emotional fulfilment? It shows some interesting things. Just by making some changes and putting in some goals, it is like suddenly building beautiful 3-D sculptures in different areas of your life that you never thought really accessible. It is quite amazing, and people's level of happiness just goes up. Then slowly those two start connecting in a more healthy way. I do not know if that makes sense to you but if you get in touch with Lifeworks I can make sure you get that list of emotional needs and you might do a little of an audit; do a bit of decisional balance and see what you come up with.

Great, is there anybody else that would like to make a comment?

Audience member 8: I like what you said about the relationship with food and high blood pressure.

Mary: The relationship with food and high blood pressure? Yes, what you have there is obviously a certain level of obesity and what I call biochemically individuality. It will affect us in different ways. If you eat very large portions of vegetables and very large portions of essential fatty acids, so good fats and lots and lots of nuts and seeds, it may be you can be overweight as it is considered beautiful in India because it is associated with wealth but actually not have high blood pressure. Equally, you could be in this country eating saturated fat, leading to inflammation, and not be that overweight and still have high blood pressure. There should be a balance.

Have you heard of free radicals? Free radicals are the bad guys. We make a lot of free radicals every time that we breathe and then we have antioxidants. There are lots of different balances in the body. But it is the combination that affects us and that is why everything goes back to balance.

What I always suggest to people is to try to stay within a reasonably healthy BMI and do exercise but equally look at what your food intake is in terms of saturated fat. The other thing is that you may have a genetic predisposition to high blood pressure and high cholesterol. Homocysteine levels may not be right ...some of the markers that we really do associate with high blood pressure and heart disease. The point is that in a way, rather like my lady who had arthritis, you have to work much harder. But I always think that you should get those markers done. You should get a cardiovascular profile done if that is present within your family – you know, high blood pressure. You should get that done by your GP. Then start to work on what you can do to prevent it. Does that make sense?

Audience member 9: unintelligible

Mary: I think what you are saying is something that is very interesting. It's one of the things that I've noticed with nutritionists. It is this whole idea: "For goodness sake, I trained at the Institute for Optimum Nutrition". It is almost as though they are not looking at the emotional side. It's a bit like: "Here is my safety blanket. If I hold on to perfectionism, control," which we all know are very inter-related with eating disorders. "If I hold onto that, everything will be fine". The problem is that there's got to be a loosening and a confidence about your own emotions and your own emotional fulfilment within your life. There's probably just a gentle loosening that needs to go on there in the sense of building confidence, because it would not necessarily be a good idea to suddenly go and just have a lot of food.

But I think that if you and I were working together I would say if we had at first one day a week when you were a little bit looser and felt that you could literally let your hair down, what would that be for you? Because the point is that this is your life and not my life? There are no you shoulds in this; there's just a loosening.

In terms of your emotional fulfilment how could we add to that? How can we build, like I said before, those three dimensional sculptures in other areas where food is functional? Yes, I enjoy it. I like to go out and eat at nice restaurants but equally, quite often at home, to balance that I will eat in a healthy, regimented way. I don't think about it, it's just that I know that that's the basic balance that works for me.

I think it sounds like you're ready for a little loosening.

Audience member 9: In that situation I'm not referring to you personally. I'm looking at the entire central issue as what is going on.
Mary: Absolutely, that is exactly what I was looking at in terms of what I was saying about the "safety blanket" when you hold onto something. I think that is the perfect thing that you can do if you're working with a psychologist and look at some of those underlying patterns. Often fear, anger and unresolved problems are present. I do not know if you've got any further suggestions about that.

Audience member 9: Make it personal?

Mary: No, and I understand.

Audience member 9: If somebody sorted out the diet, then the diet itself has become the method of control and you want to start looking at what the need is to hold onto whatever it is that they are holding onto. It is more psychotherapeutic I suppose.

Time: 60:00

Mary: I would agree. I think, and this is my experience, some people are ready to go to deeper levels and others are not. I think you can be functioning if you can be fulfilling a lot of your emotional needs. This is just an example. If you look at a lot of the soldiers who fought in Vietnam, nearly all of them, or a huge percentage, were heroin addicts. I do not know if that is well known in the population.

The American government was absolutely terrified about all of these men coming back with very serious addiction problems. What in fact happened was that they came back, but into a family setting and a normalized society. In a sense, a lot of their emotional needs were met and there wasn't the drug problem that people thought was going to happen. That sort of happened naturally.

It is the difference between "Can you help people function in their lives?" and then it is almost another step to go to the deeper levels. I do think it is equally important but it's just where people are prepared to go, and do they have the money? Some people happy reading books but others are not prepared to go there. It is all a balance.

Audience member 10: Can I just say this? I've lived with victims of abuse for 15 years now. It seems that whatever addictions at some point have relation to food. It was absolutely a shock to me at the beginning to see the number of adult survivors of childhood abuse that I've counselled that were abused by food as well. The food was locked away. I remember one little girl saying that she was not allowed any crisps. Her father used to lock them under the bed and now she's addicted to crisps. If she gets crisps now she has to eat the whole six packets, or 12. I think is amazing what you said there.

Mary: I see a very clear link a sense you could say locking crisps under the bed is not ... I'm sure there was a lot more going on because .... You've got a kind of locked in trauma there. Often I would do something called visual kinaesthetic rewind. At least that would take the worst of that trauma out and then I work with a trauma psychologist who used to run a military trauma hospital so he knows a few things about how to work with trauma.

Audience member 10: I heard her speaking about it. Part of the abuse that was going on was that.

Mary: That's right. Then one of the things that you have to do, if they are eating to such an extent that their health really is at risk, is to take apart that enmeshment.

Audience member 10: She's gone from anorexia to obesity.

Mary: Yes which often happens.

Audience member 10: It's all the time. Her balance is changing.

Mary: Yes absolutely. She is somebody that needs a lot of support just on her basic nutrition. I would say that she needs some sort of trauma work, which is perhaps what you are doing with her, as well as some of the therapeutic. But she is still swinging, is she?

Audience member 10: Absolutely.

Mary: Does she actually work...?

Audience member 10: I don't see her anymore. We're not even in the same country.

Mary: This one of my examples. Look, I do not know but I very much doubt that she was held by somebody on the nutritional side...

Audience member 10: No she was not.

Mary: well as the psychology at the same time. If we are going to really solve a lot of the eating disorder problems we really need that. We need people to use language of change. Medical NLP was set up by Richard Bandier and Garner Thomson who teaches consultant anaesthetists "What is the language of healing?" They have done an audit in Birmingham with a consultant anaesthetist, because anaesthetists do pain management so they are quite an interesting group of doctors.

They are looking at an 80% lowering of medication when the doctors actually use positive normalizations. To give you an example, President Obama used a lot of positive words - peace, change, and all these sort of words. But what exactly does that mean? You have to kind of break it down.

I think we're going to have to stop in a second. I can see muttering over there.

Any practitioner who is here... and I was speaking today to a lovely consultant doctor I work with. She was saying, "You know, all I have to do is get them onto this medication and do this." But she said, "You know, it doesn't really work." And I was saying, "Why don't you go off and train in medical NLP?" It's just an awareness of language but if you don't start using some of that language, I don't think... A lot of people do it naturally to a certain extent but they don't do it systematically. I think it's an amazing tool. I think if you Google the Society for Medical NLP... it's a course and they have an initial six day course and it can be very, very useful.

Any other questions? But I think we may need to stop.{/slider}



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