Paper short abstract:

The paper explores 'rule breaking' in an Italian eating disorders treatment centre. It suggests that patients’ everyday transgressions of rules, far from being simply acts of resistance to care that boycott treatment, end up generating more care, a kind of unruly care with double-edged consequences.

Paper long abstract:

Drawing on fourteen months of doctoral fieldwork, the paper explores practices of rule breaking in an Italian residential treatment centre for eating disorders. On admission, patients are required to sign a therapeutic contract, which contains essential information regarding the organisation of the residential facility and establishes patients' 'rights and responsibilities’ during treatment. These include respecting a long list of rules – e.g. compulsory participation to the weekly group activities; being collaborative with 'nutritional therapy’; avoiding purging and other ‘compensatory behaviours’; avoiding self-harming behaviours; avoiding alcohol, drugs, laxatives and diuretics. Sustained transgression of the rules over time typically results in the treatment team questioning the patient’s motivation for treatment, and into a week of ‘pause for reflection’ which can lead to discharge. This is done on the ground that the waiting list for this public service is long, and that if a patient is not ‘motivated enough’, her spot could be better employed for someone else.

By focusing on the cases of three patients, I suggest that patients’ persistent transgressions of rules, far from being simply acts of resistance to care that boycott treatment and result into treatment discharge, can also function as a demand for care and be generative of more care. At the same time, these acts require the treatment team to themselves 'break the rules’ of treatment for the sake of patients, often with double-edged consequences for both patients’ lives and professionals’ own wellbeing.