It is only metaphor

I love me a good metaphor, I really do. Metaphors are a writer and a reader's nourishment and delight. Yet all good tools take judgment, and we can't lose sight of the fact that externalizing the illness is only metaphor.

Externalizing the illness, used in the Family-Based Maudsley Treatment, Narrative Therapy, and most notably by Jenni Schaefer to improve the lives of countless people is best employed to enhance but not replace our understanding of the illness itself. The best explorations of the benefits - and risks - has long been Vitousek's Alienating patients from the "Anorexic Self". We need this tool in the toolbox, used wisely!


  1. Thank you for this information (I will read it more thoroughly in the morning). Up 'till now I have been unsure about the merits of externalizing this problem; but understanding that it is a temporary step may make it easier to accept (or at least perhaps I might feel more comfortable in trying it).
    I often wonder if because I am older than the 'usual' patients my gp sees, that she assumes I understand things that I just don't. After all, I hadn't even heard the term 'restricting' until about 5 months ago.
    So I appreciate that you don't just assume everyone already knows, and that you took the time to post this information - it is very helpful.

  2. Thank you, Laura. I especially found the last Paper most enlightening and helpful. This is what I love about your blog. Constantly learning. Oh, and I am reading the book about Henrietta Lacks, Excellent!

  3. It took me a long time to understand metaphors as I was growing up; I was always very literal... However...

    In terms of externalising AN, and separating it from the primary self, I think this is really complex and not always good.

    If we are to separate the ED from the primary/core self we assume that first, the individual with the ED was 'normal' (whatever that means...) and 'healthy' in mind before they developed an ED - and second, that a primary/core self actually exists.

    Some individuals with EDs have co-existing neurodevelopmental disorders and have experienced a rather different path of development to most other people. For example, they might have had childhood OCPD and/or ASD traits. It has been hypothesised that AN is a manifestation of OCPD or ASD (ore OCD) in some people, and so it is not entirely separate.

    In terms of externalising EDs, then we are suggesting that the person with an ED has two or more selves: perhaps multiple personalities - but that a true, healthy, core self exists as one such personality. The problem is that many people with EDs fear being recovered because they don't know who they will be without their ED. So does that mean that they have no core identity/self? Some people argue that they hadn't a clue who they were before they developed AN.


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