Paper short abstract:

Drawing on doctoral fieldwork in an Italian treatment centre for anorexia and bulimia nervosa, the paper explores how professionals (struggle to) cultivate responsibility for a biomedically defined 'health' in patients who experience their eating disordered practices as a way of 'mastering myself'.

Paper long abstract:

Drawing on doctoral fieldwork in an Italian treatment centre for anorexia and bulimia nervosa, the paper examines what kind of care is possible when the thinking patterns and bodily practices that are deemed pathological by professionals, are for patients a way of ‘mastering myself’. Without questioning the concrete risks and consequences of extreme food restriction, frequent purging, and physical exercise to exhaustion – but taking seriously the fact that patients experience these as self-care practices – we will see how treatment works by gradually substituting patients’ ways of ‘being well’ with a definition of health that is jointly constituted by psychotherapists, psychiatrists, nutritionists, endocrinologists and educators. In the process from residential to semi-residential and outpatient treatment, patients are thus required to gradually assume responsibility for a kind of wellbeing that is determined elsewhere than in their self. For this to happen, some coercion is considered necessary to first deconstruct patients’ ‘pathological’ self-control and self-medication; only then can they acquire the tools for a ‘self-transformation’ that will ‘enhance their health’. Throughout the paper, I trace how the structure, rules, knowledges, and everyday practices of treatment turn ‘resistant’ and ‘ambivalent’ patients into ‘aware’, ‘motivated’, and ‘responsible’ ones. This is a process in which, ethnographically, mind and body are two entities: professionals work on patients’ minds to create ‘healthier bodies’ for them, and in turn, with a healthier body, patients can acquire a ‘more autonomous mind’ – pointing to a biomedical definition of ‘being well’ that is endowed with culturally specific notions of dependence and autonomy.