The Boundaries of a Good Anorexic: Exploring Pro-Anorexia on the Internet and in the Clinic
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1 The Boundaries of a Good Anorexic: Exploring Pro-Anorexia on the Internet and in the Clinic Anna Claire Lavis Thesis presented to Goldsmiths, University of London, for the degree of Doctor of Philosophy, July 2011. 2 I, Anna Claire Lavis, confirm that the work presented in this thesis is my own. Where information has been derived from other sources, I confirm that this has been indicated in the thesis. 3 Abstract This thesis explores pro-anorexia, a desire amongst some anorexics to maintain or enhance their existing illness. Through ethnographic fieldwork in an English eating disorders unit and with participants to pro-anorexia websites this anthropological research centrally explores relationships between personhood and illness as they are articulated and experienced by anorexic informants. Without assuming pro- anorexic desire to be either fully agential of just a product of the illness itself, the thesis traces the ebb and flow of informants‘ desires for anorexia and the selves, bodies and anorexia(s) that such processes enact. Moving across these two field sites reveals not only how each illuminates pro-anorexia in the other, but also that both tangibly impact on ways in which informants experience and desire anorexia in the other. This thesis therefore suggests that in both spaces relationships between anorexia and personhood, agency and desire, bodies and eating, are perhaps both ‗virtual‘ and ‗actual.‘ Importantly, an analytic emphasis on exploring experiences and subjectivities, rather than on corporeal emaciation, seeks to listen to informants‘ desires for anorexia whilst also recognising the realities of the illness. This reveals how desire and ambivalence are often conjoined as pro-anorexia signifies both a response to, and reconfiguration of, compromised conditions of possibility. By exploring ways in which seeming antitheses such as pro-anorexia and biomedicine or desire and ambivalence are not only related, but are mutually productive, in informants‘ accounts, this thesis not only addresses the largely unexplored topic of pro-anorexia; it also reflects on the practices of anthropology itself, its ethics, ways of looking – or perhaps listening – and its modes of representation. 4 Contents Acknowledgements 10 Chapter One Introduction 11 Part One Introducing the Field Sites 14 1: A Pro-Anorexia Websites 14 1: B The Eating Disorders Unit (EDU) 21 Part Two Theoretical Perspectives 28 2: A Anorexia as Terminology 28 2: B Anorexia in the Clinic 29 2: C Anorexia in The Humanities & Social Sciences Part One: Thinking 33 (Through) Thinness 2: D Gendered Preoccupations: Clinical & Cultural Entanglements 35 2: E Anorexia in the Humanities & Social Sciences Part Two: 38 ―Embodied Sentience‖ to Pro-Anorexic Desire 2: F ―Ethical Ambivalence:‖ ‗Brackets‘ & Juxtapositions 41 Part Three Methodologies & Ethics 44 3: A Multiple Sites, Coherent Ethics 44 3: B Participant Observation & Interviewing on the Internet 46 3: C Participant Observation & Interviewing in the EDU 52 3: D A Brief Note on the Text: From Field to Page 60 Part Four Thesis Outline 63 4: A Overview 63 4: B Chapter Synopses 64 5 Chapter Two Compromises, Other People & Ambivalence: 67 The Making and Unmaking of „Good Anorexics‟ 71 Part One Individual Practices: Starving, Discipline & Hunger 1: A Food as Dangerous, Contaminating and Fattening 71 1: B Engaging with Food: Self-Testing 74 1: C Looking at Hunger: Thinspirational Practices of Food Refusal 78 Conclusion to Part One 81 Part Two Negotiating Impossibility: How to Be a „Good 82 Anorexic‟? 2: A Death: Achievement and Failure 82 2: B ―Making Do‖ 86 2: B. 1 From Commandments to Tips: Getting Help from Memoirs 86 2: B. 2 Food Rules 87 2: B. 3 Relinquishing Responsibility 89 2: B. 4 Vomiting: A Compromising Compromise 91 Conclusion to Part Two 94 Part Three Thinness & Other People: Social (Un)Making of 95 „Good Anorexics‟ 3: A Making Oneself a ‗Good Anorexic‘ through Bodily Thinness 95 3: A. 1 Patrolling & (Re)Producing Bodily Perimeters 95 3: A. 2 ‗Motivating‘ Oneself by Turning One‘s Gaze on Others 98 3: B The Unmaking Gaze of Others 101 3: B. 1 Be(com)ing A ‗Bad Anorexic‘ in the Eyes of Others 101 3: B. 2 Reclaiming Agency from Another‘s Gaze 103 3: B. 3 Be(com)ing Unmade to Oneself 105 Conclusion to Part Three 109 6 Part Four The Emergence of Ambivalence 110 4: A Other People: Competition and Care 110 4: B Desire to be a ‗Good Anorexic,‘ but not an Anorexic 115 4: B. 1 Competing Desires 115 4: B. 2 When Desire Becomes Need 118 Conclusion 121 Chapter Three “That‟s the Anorexia Talking:” Exploring 122 Anorexia & Personhood in Multiple Uses of a Clinical Phrase Part One The Clinic‟s Uses of “That‟s the Anorexia 127 Talking” 1: A Dividing Anorexia from Self 127 1: A. 1 Holly & Treatment Refusal 127 1: A. 2 Motivational Therapies: Using Ambivalence to Construct 130 Authenticity 1: B From Food to Persons: Anorexia Takes Over personhood 136 1: B. 1 Eating Behaviour - Any Behaviour 136 1: B. 2 Friendships: ―Just the Anorexia Talking?‖ 140 Conclusion to Part One 143 Part Two Informants‟ Conceptualisations of “the Anorexia 144 Talking” 2: A Informants‘ Responses to being told, ―That‘s Your Anorexia 144 Talking‖ 2: A. 1 Revisiting the Discourses of Division and Authenticity 144 2: A. 2 Anorexia in Control? 147 7 2: A. 3 Ramifications of a Clinical Phrase 149 2: B Anorexic Informants‘ Uses of ―That‘s the Anorexia Talking‖ 154 2: B. 1 When Anorexia Does and Does Not Talk about Food and 154 Weight 2: B: 2 From Food to Voice: Using the Phrase as Reassurance 157 2: B. 3 Lying as ―The Anorexia Talking‖ 159 2: B. 4 Good Anorexics & The ―Internal Bully:‖ The ―Inside 161 Voice‖ of Anorexia Talking 2: B. 5 Anorexia Talking on the Internet: The Figure of Ana 165 2: B. 6 ―That‘s The Anorexia Acting:‖ A Final Troubling of 168 Discourses of Authenticity and Control Conclusion 171 Chapter Four “Anorexia Won‟t Trick you Like Food Does:” 172 Following the Many Threads of Pro- Anorexic Desire Part One Relationality: Holding Onto What One Is and Has 178 1: A Friendship: (Re-)Productions of Desire through Relationality 178 1: A. 1 ―My Friend Anorexia‖: Personhood, Shared Agency & 178 ―Help‖ 1: A. 2 Temporalities of Friendship: Desire in the Present & Past 184 1: B Friendship, Treatment & Ambivalence 187 1: B. 1 Resisting Recovery as Protecting One‘s Friend 187 1: B. 2 Mutual Productions of Intensity & Lack: Anorexia‘s Cycles 193 of Desire 1: B. 3 Complexities of Friendship: (Un)Desired Desires 197 Conclusion to Part One 201 8 Part Two Relationality Goes Wrong: Still Holding Onto What 203 One Is and Has 2: A Illness Progression & Desire: Intersections & Contradictions 203 2: A. 1 Reconfiguring Anorexia‘s Take-Over: From Entrapment 203 to ―Positive Withdrawal‖ 2: A. 2 Being Supplemented ‗Out of Oneself‘: Milla‘s Perimeters 209 & (More) Temporalities of Pro-Anorexia 2: B Making Alternative Anorexia(s) 212 2: B. 1 Using Food‘s Agency to Balance Anorexia & Personhood 212 2: B. 2 Discursive (Re-)Formations: Assembling Anorexia(s) 216 Conclusion 225 Chapter Five Dialectical Engagements: Complexity, 227 “Bad Examples” & Thinness as Pro- Anorexia Meets the Clinic Part One Tracings: Informants‟ Appropriations & 233 Reconfigurations of the Clinic 1: A Categories & Inhabited Spaces 233 1: A. 1 Relationships with Diagnosis 233 1: A. 2 ―Healthy Anorexia‖ 240 1: B Appropriations & Subversions of the Clinic 245 1: B. 1 Texts: Ambivalences & Oppositions 245 1: B. 2 Using the Clinic Against Itself 249 Conclusion to Part One 255 Part Two Mappings: Mimed & Emergent Anorexias 256 2: A The Clinic‘s Performances of Anorexia 256 2: A. 1 Food: Mimesis & Production 256 2: A. 2 Clinical Performances of Anorexia as About the Body 262 9 2: B Informants & the ‗Hyperreal‘ Anorexia 266 2: B. 1 Loopings & Emergences: Learning the Clinic‘s Anorexia 266 2: B. 2 Hardcore Bones: The Clinic‘s Performance as 272 Thinspiration? Conclusion 278 Chapter Six Conclusion 280 References 293 10 Acknowledgements Individuals‘ experiences of anorexia are intimate, often painful, and, even, sometimes concealed from friends or families. The first thank you therefore must go to the many informants across the field sites who contributed to this research; it is to their voices that this thesis owes its contents. In particular, I hope that this finished work does justice to the memories of the two informants who sadly died during my fieldwork. In the EDU, specifically, my gratitude goes to both staff and patients - those who did not actively participate in the research alongside those who did – for allowing me to ‗hang out‘ in their space for a year. Particular thanks go to Olivia Kyriacou and Sara Garaway for letting me share their office and to John Waine for all the lifts after late-shifts, which enabled me to experience the EDU at all hours. For making the research possible in the closed-access setting of the hospital, as well as for their continual support in the field, I also thank Lynn St Louis, Janet Treasure, Ulrike Schmidt and Geoffrey Wolff. This research went before the SLaM IoP ethics committee who awarded it CoRec Ethics Committee Number 06/Q0706/128. I am lucky to have had two brilliant supervisors in Dr Simon Cohn and Professor Catherine Alexander, whose intellectual insights have been rivalled only by their support in numerous other ways. This PhD has also benefitted from the intellectual stimulation and pastoral support of many members of the Anthropology Department at Goldsmiths, not least of Dr Victoria Goddard and Dr Frances Pine, who were my upgrade committee, and of Professor Sophie Day who led our writing up seminars.