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European Eating Disorders Review

Eur. Eat. Disorders Rev. 15, 243–252 (2007)

Eating One’s Words, Part II:
The Embodied Mind
and Reflective Function in
Anorexia Nervosa—Theory
Finn Skårderud1,2*
1
Faculty of Health and Social Studies, Lillehammer University College, Norway
2
Centre for Child and Adolescent Mental Health, Eastern and Southern
Norway, Oslo, Norway

Anorexia nervosa as a psychiatric disorder presents itself through
the concreteness of symptoms. Emotions are experienced as a
corporeality here-and-now. In a companion article, Part I, different
‘body metaphors’ are described and categorised. The human body
functions as metaphor, and in anorexia nervosa there is a striking
closeness between emotions and different bodily experiences. This
is interpreted as impaired ‘reflective function’, referring to the
capacity to make mental representations, and is proposed as a
central psychopathological feature. The psychodynamic concepts
‘concretised metaphors’ and ‘psychic equivalence’ are discussed as
useful tools to better understand such compromised symbolic
capacity. Psychotherapy in anorexia nervosa can be described as
a relational process where concretised metaphors will be developed
into genuine linguistic ones. Part III in this series of articles
presents an outline for psychotherapy for anorexia nervosa.
Copyright # 2007 John Wiley & Sons, Ltd and Eating Disorders
Association.

Keywords: anorexia nervosa; embodiment; metaphor; mentalisation; psychoanalysis

INTRODUCTION logical processes underlying the capacity to make
mental representations, and has been described
This text is the second of three companion articles both in the psychoanalytic (Fonagy, 1989) and
aiming to further the understanding of the specific cognitive (e.g. Morton & Frith, 1995) psychology
psychopathology in anorexia nervosa. Despite literatures.
research efforts anorexia nervosa still qualifies for The empirical Part I (Skårderud, 2007a) was an
the designation as an enigma. The topic in this interview study with adult patients. A key concept
second part is ‘reflective function’ in anorexia is ‘metaphor’. Part I describes, based on categoris-
nervosa. Reflective function refers to the psycho- ation of the patients’ statements about food and
their own bodies, how bodily sensations and
attributes also function as a source area for
* Correspondence to: Professor Finn Skårderud, Institute for
metaphor production, giving form and expression
Eating Disorders, Kirkeveien 64 B, 0364 Oslo, Norway.
Tel: þ47 918 19 990. to emotions and cognitions. Physical qualities and
E-mail: finns@online.no sensations give form and content to non-physical

Copyright # 2007 John Wiley & Sons, Ltd and Eating Disorders Association.
Published online 23 January 2007 in Wiley InterScience (www.interscience.wiley.com) DOI: 10.1002/erv.778

findings. It is an experientially grounded mapping. In Part I the rather than thought and action. the bodily characteristic of language alone. is the patients’ reports of the closeness. a matter of words concretised feelings here-and-now. 2002). The metaphor is pervasive for systematic search for relevant literature. In this Part II of the presentation the main Johnson (1987) states: ‘Metaphor is not only a emphasis is on theoretical models describing linguistic mode of expression. on the contrary. Eat. The philosophers Mark Johnson The body as a source for metaphors is a general and George Lakoff have been the leading figures human phenomenon. alization and categorization’ (Lakoff & Johnson. as separated from perception and phenomenon. anorexia nervosa (Skårderud. They strongly argue against the THE THEORY OF METAPHOR tradition in Western philosophy that considers The essence of the metaphor is to understand and cognition and rationality as separated from our experience one phenomenon through another bodily existence. most concept ‘concretised metaphors’ is introduced to people think they can get along perfectly well describe such phenomena. without metaphor. Hence. metaphorical processes. This induced a based on perception. is fundamentally metaphorical in Many persons with anorexia nervosa experience the nature’ (p. and shape are physical entities that represent also p. Skårderud phenomena. The purpose of this article is to develop a theoretical metaphor is basic. However. 390) all linguistic signification is ultimately non-physical phenomena. that metaphor is pervasive in everyday life. is more than a mechanical object responding to Copyright # 2007 John Wiley & Sons. the model for the general function of mind.244 F. as the result of a conscious multi-stage process of The results presented in Part I demonstrate such interpretation. This applies to a number of professional bodily perception and sensorimotor experiences. a important trait in the psychopathology of anorexia rhetoric or artistic figure of speech. fantasy and reason. 15. philosophy and the philosophy of science. Ltd and Eating Disorders Association. The metaphor ‘What is important is that the peculiar nature of our has been extensively applied within cognitive bodies shapes our very possibilities for conceptu- science. think and act. ordered experiences that we can psychodynamic models of the body’s role in reason about and makes sense of’ (p. 2002). xi). more specifically tions. Mind is always and inevitably based on metaphor. metaphorical. We have found. and relating this chief cognitive structures by which we are able to to anorexia nervosa. 243–252 (2007) DOI: 10. The human body (Enckell. The main human understanding. immediate conceptual mapping via neural connec- ment of reflective function. frame to explain and comprehend the empirical metaphors are part of the cognitive unconscious. Consequently this does not point to The Bodily Mind linguistic metaphors about the body as such. Lakoff & Johnson. both on embodiment is the body philosophy of the in terms of psychodynamic theory and practice phenomenologist Merleau-Ponty. the overall finding in terms of changing interpretations of metaphor in the interview study. Special importance is placed on have coherent. it is rather a matter of concreteness. to becoming a nervosa. A major reference in their philosophical work interest in metaphor in psychoanalytic circles. Since the early 1980s there has been significant 1999). Their work is a rejection of the Cartesian dualism between body and soul. 2007b). 1999). but description in verbal language about how bodily According to the French phenomenologist philoso- sensations and qualities like hunger. reduced metaphorical capacity. A comprehensive defi. They state that there is no Cartesian dualistic person. Rather. 3). in terms of which we anorexia nervosa is the concreteness of symptoms. size. 1987. it is one of the compromised reflective function. here-and-now of their bodies as a ruthless reality Johnson and Lakoff do not consider the metaphor difficult to escape from.1002/erv . For this reason. According more or less immediate connection between to them (1980): ‘Metaphor is typically viewed as physical and psychological realities. One essential concept is the embodied growing interest for developing theories about mind. and proposed as an from being purely a phenomenon in language. Disorders Rev. Part III in this series of The common effort of Johnson and Lakoff is articles presents an outline for psychotherapy for ‘putting the body back into the mind’ (Johnson. Our feature—and a main limitation to therapy—in ordinary conceptual system. weight pher Maurice Merleau-Ponty (1907–1961) (1964. In the last decades there has been a movement. traditions outside literary science. and this is interpreted as an impair. not This again refers to how one striking clinical just in language but in thought and action. but often not conscious. rather. nition of this concept will follow (Enckell. Eur.

Johnson. conceptualisation of one of the two unknowables The authors make a distinction between ‘primary confronting human understanding—external rea- metaphors’ and ‘complex metaphors’. Some primary metaphors will never clear distinction between the ‘metaphoric process’ develop into words in language. namic theory is basically an instrument to be Narayanan. direction. Psychodynamic theory and practice deal with are not equivalent to ‘specific metaphors’ and the task of understanding the other—internal ‘compound metaphors’.Eating One’s Words 245 stimuli. Prices are high. colour. parts of our conceptual apparatus and of how we 1962). taste. 1999). 1997). Part I. Ltd and Eating Disorders Association. She states the necessity of making a with control. Their main. but as a relation. Rizzuto (2001) has written a state-of-the-art-article ences are to a great extent universal. an popular conceptions. 1980. and the function of the mind is to create the basis for primary metaphors (Fauconnier produce and elaborate representations. 1997). In their model of the function of mind language and human action are organised meta- there are three premises: (1) The mind is inherently phorically around interactional experiences embodied. 2001). Turner. Psychodynamic Theory and Practice They describe how the sensorimotor structuring of subjective experiences in man is based on a process The works referred above have made a significant of categorisation where the metaphor is absolutely contribution to the demonstration that cognition. think and feel. and this on contemporary psychodynamic models of ‘bodily explains the similarity across the world of such mind’ and metaphoric functioning. We may be ignorant about them. cally and unconsciously through what they term but also a model describing general psychic neural learning. 1999). intentionally Many such complex metaphors are stable—in the seeking meaning through movement and activity sense of conventions. Disorders Rev. essential. structure. Statements about quantity. 1987. body is always both object and subject. and form body as a primary experience through descriptions the basis for new metaphorical combinations. I am feeling up to it demands originating both in the internal and the today. hearing. Eat. To be alive presupposes categorisation. which organises our lives in an up–down axis. To understand internal reality means to to categorise body metaphors in anorexia nervosa in understand a human being who not only knows. In her review of primary metaphors. space. They constitute important (Duesund & Skårderud. 1989. structure. like concepts about 1995). 2003. process is all-encompassing. a To be burdened. and clinical issues. developed by the author reality. not as a ‘thing’. experienced and experiencing unity. control. 243–252 (2007) DOI: 10. function of mind. And according to the authors Lakoff and Johnson further this understanding of (Lakoff. rituals or art. Eur. 2002). social position have their basis in the Many psychoanalytic authors have used the sensorimotor domain of vertical orientation. mood. but they are experienced as ‘real’. The mental experiential world is a representational movement. they may be further recent findings in neuroscientific research and developed in language. Grady. (These terms lity. and cover different areas. However. For contemporary psychoanalytic Such primary metaphors are acquired automati. Or how knowledge and unifying trait is their psychodynamic understand- understanding are based on our visual senses: ‘I see ing of the metaphor. with its representations. Their writings move in different encing problems and the bodily sense of heaviness: directions. Bodily experi. belief systems and science. A concrete example is gravita. Thence. The metaphoric expressed as gestures.) They demonstrate how bodily experiences of but who also feels that knowledge (Rizzuto. in order to handle ‘More is up’. Merleau-Ponty. into linguistic conventions theories of metaphor she leans heavily on Johnson we may be conscious about and use deliberately and and Lakoff. The have been woven together with cultural models. forming of basic concepts. Psychody- & Turner. theory of metaphor to investigate both theoretical Another example is the connection between experi. 1997. in art of the role of perceptual and motoric systems in the and in everyday life (Lakoff & Turner. authors the metaphor is not only a linguistic device. and is essential to Copyright # 2007 John Wiley & Sons.1002/erv . focus of attention is their (Lakoff & Johnson. processes (Enckell. one feels on top. (2) Thought is mostly unconscious and between our bodies and the world. smell. space. external. etc. they structure our dreams. closeness and distance. It is heavy. The body is in continuous interaction with In complex metaphors the primary metaphors the world. (3) Abstract concepts are largely metaphorical though not exclusive. 15. used for understanding how the mind works tion. but may be and actual linguistic metaphors. structuring of events and basic emotions. 1994. as an expression of the what you mean’ (Lakoff & Johnson. similarity.

with reference to and teacher of English literature. and the Greek metaphor of representing. The problem is to distinguish metaphorical speech springs’. 2002. (Caruth & Ekstein. as a pioneer in her anorexia nervosa. and it becomes an immediate concrete experience. the analysand’s damaged ability to metaphorise There is a general agreement among many past and present. and writes that psycho. By using interpretations. with a view to this concept. The process by which verbal and non-verbal metaphors. analytic therapy goes in the opposite direction: In the corporeality of concretised metaphors there is ‘Our search when we listen to patients must be for the sense that this is the way things ‘really’ are. Enckell. 1998. 1997. and also of psychotherapy as an psychotic man complained about his sleeplessness. He refers to how it is In the wake of Sharp’s pioneering work. interaction where the understanding of metapho. Enckell (2002) propose that concretised metaphors Enckell (2002) mentions dreams and transference can be viewed as restitutional efforts. rical processes can guide the therapeutic activity. 1940). For the adult the between the metaphor and the object or phenom- bodily origin of thought is often forgotten. ands or buts. 2002. Disorders Rev. 1966) may form their experiences 1979. Rizzuto refers to Sharpe (1940).246 F. The translation into elaborate or later ones. These concretised states that ‘metaphor fuses sense experience and metaphors do not function mainly as representations thought in language’. Early perceptions organise more (Über-tragung/meta-phoros). Eat. 15. Sharpe. Ltd and Eating Disorders Association. She lisation. 1997. Rizzuto. but as psychological development goes from the ‘physical’ presentations experienced as concrete facts here- to the ‘metaphysical’. were identical. The ‘as if’ of the analyst can move ‘backwards’ to the long forgotten metaphor is turned into an ‘is’. the accumulated representations are the building blocks for the construction of both external and internal reality. Skårderud human life and culture. A ‘revitalisation’ of meta. It turned out that the thought of the the present in terms of the past and the past in terms girlfriend kept the patient awake. According to Rizzuto. a psychoanalyst Of particular interest in this paper. The ‘as-if’ quality of psychophysical matrix embedded in the manifest the more abstract meaning of the metaphor is lost metaphoric expressions. Übertragung. Melnick. 243–252 (2007) DOI: 10. with the physical basis and experience from which few ifs. Campbell and the past. The mind can be seen as CONCRETISED METAPHORS metaphorising the realities through the body. She useful as a superior concept. This can be of the present. Symptoms are seen as functioning metaphors. the authors that such phenomena.1002/erv . both consciously and unconsciously. One finds concretised metaphors dynamic understanding of psychic experience. He could not fall asleep due to a continuing light. And he also reminds us of the etymological states that body configurations are the basic closeness between Freud’s original German concept condition for the development of different levels of transference. represent a regression of processes that have been interrupted in their flow representational functioning and/or an insufficient from the past to the present and from the present to development of symbolic capacity. in metaphors which are subjectively not acknowl- Ogden. psychoanalysis sees sunshine’. They have contributed edged as such. This man had called his former girlfriend ‘my According to Borbely (1998). It therefore relates past and present described as a collapse of the capacity to use metaphorically to each other. are the metaphoric functions of conceptualisation of metaphor as essential for the the human body. Borbely. A metaphorising. and during development English might blur the fact that originally the words much representational material is accumulated. here named con- analyst helps the analysand to restore metaphorical cretised metaphors. Eur. Unconscious metaphors for external reality are constructed— configurations are transferred to different media understanding and experiencing one thing in terms where they find representations and hence actua- of another—applies to internal reality as well. With refer- as two examples illustrating a view according to ence to two cases of violent men. and-now and which are difficult to negotiate with. a number generally acknowledged that psychotic persons of authors have followed in her footsteps and even and patients suffering from borderline conditions moved beyond the linguistic metaphor (Arlow. phoric expressions might thus lead to an original Enckell (2002) reviews psychoanalytic literature sensual experience (Enckell. A vignette described by Kitayama with descriptions of both the mind as generally (1987) may be illustrative of this phenomenon. But the enon which is metaphorised. She starts from the idea that capable of containing an experience. they discuss such which the mind works through the medium of concrete presentation as a reaction to a threat of Copyright # 2007 John Wiley & Sons. 2001).

albeit a concrete one. Buhl (2002) does not use the concept of con- Concretised Metaphors in Eating Disorders cretised metaphors. but ‘concretism’ when describ- The phenomena here described are widely ing more or less identical phenomena. of maintaining the cohesion and stability of a very tenuous sense of self. p. 243–252 (2007) DOI: 10. Eur. His ability to expel something Copyright # 2007 John Wiley & Sons. Ltd and Eating Disorders Association. Part I. sensorimotor symbols’ specific body metaphors. More than inadequately developed ability to distinguish and that. subcategories. Eat. and an attempt to maintain a variety of bodily experiences. Goodsitt. where the patient’s use of food/ makes clear the equivalent relation between body metaphors. a ‘deficit functioning. 1989) characterised by an also a part of the anorectic experience. She refers to accepted as a corollary of psychotic or borderline this concretism as a developmental fault. that is the sense of control (p. being thin and a feeling of purity. there are few references to discussions they so directly refer to one domain of physical about this phenomenon with regard to the theory of experience relating to an emotional and cognitive metaphor and metaphorisation as a general func- experience. In this text I propose that they are pathology’ (Killingmo. like the sense of the integrity of the self. Disorders Rev. Geist. presents the The ‘concrete attitude’ is a pervasive trait in empirical results from interviews and therapy patients with anorexia nervosa. a reduced capacity for abstract thinking. 1989. Ritvo (1984) describes a behaviour. 1973. Within the psychoanalytic tradition of self. and that persons with anorexia nervosa are basically regard concretised metaphors as signs of essential suffering from a disorder of the self. 1985). and similar to specific meta- restoring a sense of the real. That article gives numerous And there are numerous references to these examples of such concretised body metaphors. The precursor of this text. patients’ tendencies to a notable deficiency in their They are categorised by the author in two main ability to think abstractly about psychological categories. tion of mind. Compound body metaphors are more ‘global’ psychology. the concept of concretised metaphors is a understand emotional states and needs. psychology. But what is sense of reality. nervosa [REF]. cohesive mental configuration. experiences of lack of control in different trying to strengthen the experience of being realms of life and low self-esteem inducing the grounded in their own bodies. with the tendency to sessions with 10-adult patients with anorexia focus concretely on food and weight (Miller. Although this concretism is adequately des- Specific body metaphors are named so because cribed. 1989. For patients faced with a threatening loss of can refer to an empty stomach.1002/erv . several authors (Barth. spatiality and solidity. 1991). a firm and solid integrity of the self and the concomitant loss of the body. 1997) argue create a distance to unpleasant experiences. 1962. and that the distancing defences (Alexandrowicz. 492). Caruth concretistic symptoms essentially serve the function & Ekstein. Shaly (1987) refers to the treatment of simplicity and certainty in living. and being singularly devoid of psychological metaphors’. The compound body concretisation as ‘the encapsulation of structures metaphors can be based on a combination of more of experience by concrete. Other authors claim that concretised metaphors 1984/85. Chessick. Different forms of stress may threaten to as central in anorexia nervosa. describes serious eating disorders as manifestations pathology of anorexia and also in understanding of disorders in the development of personality. with limitations and difficulties in therapy. 85). is the immediate relation between emotion/ attitude is then a means of maintaining one’s sense cognition and sensorimotor experience/behaviour. Goodsitt. 1985. 15. They define feeling of not deserving. 1985. both in actual living and in emotion/cognition and sensorimotor experience/ language. were extensive. Clinging to the concrete phors. 1966). of reality. ‘concretisation may serve to considered as the main finding in this main category ameliorate a disorienting sense of unreality by of body metaphors. ‘specific metaphors’ and ‘compound issues. and through concretisation vulnerability and a threatened and overburdened these persons attempt to bolster their sense of self by self. Both these categories have more insight (Bruch. and referring to ‘concretisation’ in persons with a vulnerable self. emotional and cognitive experiences often referred organisation. again based in a control his feelings. Atwood and Stolorow (1984) discuss than the specific ‘local’ ones. like pure food equalising purity.Eating One’s Words 247 inner fragmentation. These metaphors refer to a rich diversity case of an eating disordered man using laxatives to of meanings of self-starvation. Buhl particularly relevant tool in describing the psycho. Geist. This specificity a bulimic patient. 1988. of possessing an ordered and orderly Within the psychoanalytical tradition of self existence’ (Josephs. for example purity.

interpersonal mental and experiences in the body. since the projection of fantasy systematic presentation of different body meta. self-monitoring and the experience verbal accompaniment. A major theoretical concept There is psychic equivalence between the experi- in their work is ‘mentalization’. can In the literature one has not hitherto found any cause intense distress. This may become critical in adolescence. equation of the internal with the external. Bateman and Fonagy (2004) those whose psychological self-representation is and Fonagy. She refers to how there what exists out there must invariably also exist in is a ‘clinical restriction of language’ in many the mind. In combination. This is defined as ‘psychic equivalence’. Copyright # 2007 John Wiley & Sons. and Target (2002) write developmentally more advanced. when changes in Psychic Equivalence body shape and function signify a far greater Different conceptual tools may cover more or less change in identity for these individuals than for the same phenotypes. 243–252 (2007) DOI: 10. Those ‘from provide the child with a capacity to distinguish below’ are more likely to come from sensorimotor inner from outer reality. these sources and are more easily analysed.1002/erv . eating disturbances are rooted in persisting experi. above’ may also be present. ‘Psychic equivalence. grated. Hence. they become flexibly able to Lewin (1971) who applied Freud’s practical classi. 15. children make people’s behaviour evacuated his bowels.248 F. as a mode of experiencing the internal world. the body takes on an excessively central role for the continuity of the sense of self. It is tempting to compromised mentalising capacity. Skårderud unpleasant made life sufficiently tolerable. to ‘reflective function’. identify and express emotions. dividing verbally sets that are best suited to respond to particular expressed metaphors into those ‘from above’ and interpersonal transactions. He refers to the psychoanalyst behaviour better. Some adolescents in the tradition of contemporary psychoanalysis (such as early-onset anorexics) experience existen- and revised attachment theory. adolescents and is a lack of a good-enough verbal language to adults as one possible mode. Ritvo also discusses the organise multiple sets of self-other representations. Ritvo argues emotional processes from interpersonal communi- that the body metaphors used by individuals with cations’ (p. activate the representation(s) from these multiple fication of dreams to metaphors. 4). underlies the capacities for affect regulation. The infant’s and the young child’s early aware- Rizzuto (2001) briefly refers to eating disorders in ness of mental states is characterised by the her interesting ‘state-of-the-art’ article of contem. On this basis. those ‘from below’. referring to different This theoretical construct can be considered as sensorimotor and physical experiences as sources another naming of more or less similar phenomena for metaphorical production of emotions and as described by concretised metaphors. Mentalisation is defined as the be thinner is felt to be superior and is therefore developed ability to ‘read’ other people’s minds. Ltd and Eating Disorders Association. with clinical experience. Fonagy and meanings. Eat. Eur. 405). readily intelligible and conventional an interpersonal component. What porary psychodynamic models on ‘bodily mind’ exists in the mind must exist out there. although metaphors ‘from isation of the self. By superior’ (p. metaphors used in verbal language by eating As they learn to understand other people’s disordered patients. Disorders Rev. a minimal use of metaphor Insecurity in attachment relationships is a signal in language. meaningful and predictable. Their early experiences enabling him to temporarily ignore the complex with other people enable them to build up and emotions left in him. following problems of identifying of limitation in mentalising skills. as an aspect of ence of body shape and its concrete parameters. They are very much of self-agency—the building blocks of the organ- metaphors ‘from below’. This ability. nervosa. but there are a few references to eating tions and categorisations presented in Part I are disorders. Metaphors ‘from above’ refer to ‘Mentalization involves both a self-reflective and obvious. according to the authors. and where these also are related to colleagues do not explicitly discuss anorexia impaired reflective function. to the outside world can be terrifying’ (p. and and metaphoric functioning. 9). After he doing this. he had a feeling of goodness. Jurist. with psychic interpret her as saying: The body speaks when there equivalence in older children. seeking to integrate tial anxieties in relation to puberty: as if they have scientific knowledge of psychological development ceased to exist—have become different people. bulimics and anorexics. ences of the body and may have little figurative impulse control. phors in anorexia nervosa. the descrip. Different psy- common somatic reactions that accompany the chopathological phenomena are understood as experience of a variety of affects. Gergely. ‘When psychic reality is poorly inte- original.

having an empty stomach. Disorders Rev. the statements from the patients in Part states. induces a sense of logical self-insight into the anorexic behaviour as emotional purity. adopt an attitude comfort and protection (Serpell. unfortunately little conscious awareness of the The symptoms can basically be regarded as ‘a Copyright # 2007 John Wiley & Sons. 1999. no more different domains of physical life. The body To sum up. Treasure. is the patient’s adolescence’ (p. experience of being beautiful. as obsessional. Typically. patient is ‘used by’ rather than using them critically logical meaning’ (p. psychotherapy and in treatment in general. and felt. they guide us in bodily domain. this concretised. equivalence contributes to specific physical states It is the statement of this study that concretised acquiring exaggerated significance in relation to the metaphors. smell and temperature. impressions. the different sensorimotor experiences. Emotions are one’s experience. like feelings. We are able to reflect and clarity and/or that the illness represents upon it to a certain degree. sensorimotor palpable than the air we breathe. a direct definite form. metaphor’ is very well-known from clinical practice: Another probable limitation in therapeutic pro- The person with anorexia experiences how control. and so on. The anorectic’s problem is not that outside. the anorexic patient has and symptomatic behaviour as attempted solutions. 243–252 (2007) DOI: 10. Skårderud. It may be an The human body is unavoidably metaphorical. Persons with and-now for emotional. sense of self-worth. Once the ineffable and intangible aspects LIMITATIONS IN PSYCHOTHERAPY of experience. In anorexia and experiences are felt as actual solutions here- nervosa this process is unfree. tension Summing up. based on and thoughts are fleeting and ephemeral. are experienced as real in having concretised metaphors there is a closeness. ‘Physical attributes such as weight grasping some basic limitations and difficulties in come to reflect states such as internal well-being. that the is experienced as a physical being without psycho. ideas. The persistence of psychic in his/her thinking and acting. especially at the the normal tendency for this to happen in beginning of the treatment process. metaphors by the anorectic patients. Concretisation in this sense struc- tures experience by making it thing-like in its nature. Irrespective of the aetiology. Bodily qualities should control us in our everyday life. lack of insight into their own illness. can be controlled. symptoms and the underlying emotions and organisation need to find a sense of the self from sense of self. In these objectivated body. On this basis. towards it and not in the least consider how much it & Sullvian. In contrast. solidity. cognitive and relational anorexia nervosa themselves often experience their problems. manipulated and managed as It is striking how such statements point to a basic and though they were objects in the material world. ‘through treating themselves as objects. but rather as concrete reality. Emotional non-objective aspects of experience like emotions experiences are organised. Mental states. sensations. anorexia can be understood preoccupation with food. analogy and primary relation. and psychic equation. 405). Another example. control. far beyond One such limitation in therapy is. Eur. are reified. abstractions. Teasdale. thinking is metaphorical but rather that she/he is literally rather than metaphorically. a ‘compound pathological behaviour. cesses is the fact that many persons with anorexia ling food and appetite gives the feeling of more nervosa have an experience of receiving something general control in one’s life.Eating One’s Words 249 Not having a clear sense of themselves from metaphoric connections between her/his concrete within. yet equally vital to experiences and bodily attributes. a more or less ‘immediate translation’. I demonstrated the very concrete and direct character relationships. weight and size as an expression of a psychological defect or flaw. attitudes and so on. of being unique. weight. as descriptive self. One example of a ‘simple metaphor’ is de-symbolisation represents a defect in the very about purity. because the self possessed by these concretised metaphors. between emotions and taste. come to be represented in the anorexia nervosa. a patient describes how the act of not mode of experiencing. a feeling of predictability beyond the purely physical. these persons with impaired self. and thus a lack of psycho- eating. of We all ascribe a symbolical meaning to it that goes having a feeling of control. Eat. texture. the concept of psychic equivalence functions metaphorically. 15.1002/erv . but this symbolic com- further develops and enriches the language about munication via the body is not experienced as the ‘anorectic deficit’. 2000). substance. and in the case of anorexia nervosa the body. positive from their condition. they of many of the body metaphors in anorexia nervosa. Among other. close relationship between emotion and physical Objects. 406). unable to achieve representation concepts that contribute to better understandings of as ideas or feelings. Ltd and Eating Disorders Association. calories. moods.

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