Constructing 'control' over anorexia nervosa

David Tait
University College London
Anorexia nervosa is often chronic, with one of the highest death rates for psychological conditions. Law can compel treatment, but is rarely invoked, at least formally (though the strategic possibilities of orders confers internal authority within the clinical setting). Instead, 'control' (or management) is exercised diffusely, through disciplinary practices embedded in everyday clinic life, such as daily routines of eating and washing, behavioural 'contracts', regular surveillance and measuring, interactions with staff, visits and activities. The regulatory regime not only touches on such 'practices' but also targets 'identities' (including self-image, and attitudes to the body) and what Goffman called the 'moral career' of the patient (eg learning to play the 'patient role', to 'be' an 'anorexic'). We argue that it is not the clumsiness of the law, or the success of less restrictive options which explains why law is so infrequently engaged. Rather, based on an interpretation of Foucault, we concluded that the regulatory regimes that shape treatment of anorexia nervosa, is 'the law', in a sense. The regime of governmentality within the clinic is shaped by practices which operationalise 'duty of care', or translate medical expertise into medical authority, or show how interactions between 'experts', 'carers' and patients are mediated through conventions and rules, or which conscript 'empowerment' as control. The patient learns to provide consent 'freely', to make the 'correct' choices, to accept the 'empowerment' regime that is made even more convincing by the threat of legal intervention. In time the constraints learned in this way become part of the new role, that of the 'recovering' patient. The 'fiction' of acting 'responsibly', employed so hesitantly at first, becomes part of the new identity. The patient has become an active participant in the governance of self.
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