Recently I've read seveal memoirs about being anorexic, or books by doctors about eating disorders, that emphasize the metaphoric context of anorexia and bulimia. They talk about anorexics craving emptiness and hunger, the politics of appetite, the power trip of self-starvation.
I can see that for those who suffer from anorexia for a long time--more than a year? more than two?--the natural human tendency to assign meaning and metaphor to biological reality kicks in. When you live with something for a long time, it becomes part of your self-image, a key element in how you see yourself.
Such writers tend to make an important and to my mind unsupported leap, though. They generalize backward from their own situation, years down the line with anorexia, and conclude that the metaphor is what causes girls and boys to become anorexicv. This is the classic pitfall in anorexia treatment, the conventional wisdom espoused by doctors and therapists. And it's wrong.
It's important for parents and therapists and doctors to not get sucked in to the persuasive world of the anorexia metaphor. To remember that the vast majority of anorecxics become sick accidentally, from a diet that takes on a life of its own, an illness, a natural propensity for losing weight that gets pushed too far in some way and takes over a child's physial and psychological life.
To buy in to the notion of anorexia as metaphor is, frankly, to fall under its sway. I think this is one reason why, as Daniel Le Grange told me, even doctors and therapists sometimes make bad decisions about anorexia. "It's as if the anorexia affects the thinking processes of those around the sufferer," he told me.
I think the mechanism he was talking about is metaphor. And that's why I think it's absolutely vital that we de-metaphorize anorexia. We can best help our children--and other people's children--by taking anorexia's power away, both literally and metaphorically. By remembering that anorexia is a biological disease and that its symptoms and consequences are larely the result of starvation. And that the first line of treatment for it is not psychological but physiological: food.
There is time later, after a child is weight restored and mentally restored, to discuss the metaphors of eating disorders, if they apply. But it's a dangerous trap to fall into that conversation right away.