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The Cwetwork-Boundness" of Anorexia Nervosa: a Study of Scientific Knowledge Production and the Negotiating Implications of an Actor-Network Approach

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The Cwetwork-Boundness The cWetwork-Boundness" of Anorexia Nervosa: A Study of Scientific Knowledge Production and the Negotiating Implications of an Actor-Network Approach Hege Bakken A thesis submitted to the Faculty of Graduate Studies and Research in partiai fdfilment of the requirements for the degree of Masters of Arts Department of Sociology and Anthropology Carleton Univeniq Ottawa, Ontario July 16,1998 OCopyright 1998, Hege Bakken National Library Bibliothèque nationale Ifm of Canada du Canada Acquisitions and Acquisitions et Bibliographie Services sewices bibliographiques 395 Wellington Street 395. nie Wellington OttawaON K1AON4 Ottawa ON KI A ON4 Canada Canada Yaur fik Votre rëfërence Our tüe Notre rtifdrence The author has granted a non- L'auteur a accordé une licence non exclusive licence dlowing the exclusive permettant à la National Library of Canada tu Bibliothèque nationale du Canada de reproduce, loan, distribute or sell reproduire, prêter, distribuer ou copies of this thesis in microform, vendre des copies de cette thèse sous paper or electronic formats. la forme de microfiche/nlm, de reproduction sur papier ou sur format électronique. The author retains ownership of the L'auteur conserve la propriété du copyright in this thesis. Neither the droit d'auteur qui protège cette thèse. thesis nor substantial extracts from it Ni la thèse ni des extraits substantiels may be printed or othenvise de celle-ci ne doivent être imprimés reproduced without the author's ou autrement reproduits sans son permission. autorisation. Abstract This thesis explores the recent genealogical developrnents in the production of scientific knowledge of anorexia nervosa Applying an actor-network approach to the understanding of how certain knowledge claims about the syndrome have become stmng and encompassing "black-boxes", with particdar emphasis on the diagnostic concepts of "fat phobia" and "body image disturbance," the thesis argues that the debate about anorexia nervosa cm be used to illustrate how recent contributions to the Sociology of Scientific Knowledge (SSK), and actor-network theory in padcular, can contribute as a negotiating device between scientific realism, postmodem nominaiism, and reflexivistic social constmctivism. It is suggested that the anorexic debate has formed a large and pervasive actor-network where 'buth? about the syndrome, or what 1cal1 "standardization packages", are constmcted through a senes of "translation" and "nego tiation" practices, enrolling a range of different social worlds. As such, it is argued, anorexia nervosa can be seen as a "network-bound" syndrome, a conceptualization which may open up ways of understanding the syndrome that direct attention to the heterogeneous, dynamic and inclusive p ossibilities of the network rather than to hxed extemal truths or a set of apriori macroscopic socia! forces. 1hope that the network of people enrolled in this project in various ways will reaiize how much 1have appreciated their support, encouragements, criticism and knowledge. First of d,my supeMsor, Bruce Curtis, deserves a special honour and many th&. His theoretical insight and inspiration made it particulariy interesthg and worked as a driving force to explore the questions outlined for my project. 1 also want to thank Dominique Marshall for enlightening comments and encouragements. There is a long list of fellow students and fnends at Carleton Universiq who brought their greatly valuable support into this project and made me realize the beauty of academic work and cooperation. 1am indebted to Emma Whelan who guided me to some of the rnost crucial authors of my thesis. It helped me to hamrner out the basic framework of this project. 1also want to thank al1 the exceptional members of my thesis group who contributed with much needed criticism, support and motivation. You made me realize the prospects of fïnally concluding this work. niank you Annette Rogers, Kalapi Roy, KUn Elliott, Laura Gemmell, Lindsey McKay, Lucy Sharratt, Mythili Rajiva, Nindi Brar and Sharan Sarnagh. A special thank goes to Mythili Rajiva, Mireille Fong, Kalapi Roy and Angela Brommit who read through parts of my fmal draft. 1want especially to thank Peder Lykke who has lived through ali the happy and not so happy phases of my work. Besides your endless kindness and emotional support 1must also thank you for showing mie interest in my project and for your willingness to participate in our long and rough discussions about these issues that have preoccupied me for over a year. My family and fkiends in Nonvay also deserve special thanks. You have al1 showed how action at a distance is possible. Table of Contents Abstract Acknowledgements Table of Contents Introduction Chapter 1: The question of culture-boundness in anorexia nervosa 1.1. The idea of science and actor-network theory 1.1.1. Textuality 1.1.2. Nontextuai devices 1.1.3. Actor-network theory as a bridging device between scientific realisrn, postmodemism and social constructivism 1-2. Culture-boundness and anorexia nervosa 1.3. The "emergence" and "discovery" of anorexia nervosa and its culture-boundness 1.3.1. Great divide 1: The "emergence" of anorexia nervosa 1.3.2. Great divide II: The c'discovery" of anorexia nervosa 1.3.3. A realist-constructivist approach to the "emergence'7'discovery" question of anorexia nervosa 1.4. The "network- boundness" of anorexia nervosa Chapter 2: Crafting the initial "facts" of "prirnary anorexia ne~osa" 2.1. Interlude: From endocrine testing ground to psychodynamic confession practices 2.2. Scientific and clinical definitions of an increasing social problem 2.3. Constmcting ccprimary"anorexia nervosa with "fat phobiay'and "body image disturbance" Chapter 3 : Making the diagnostic package of anorexia nervosa cLuser-EendIy": Processes of standardization and popularization 105 3.1. The disease ofthe decade 107 3.2. The classification of mental illness, the neo-Kraepelinian movement and the DSM system 114 3.3. The search for body image disturbance 130 3 4 The popularization of anorexia nervosa 139 Chapter 4: Anorexia nervosa: Psychopathology or caricature of the ills of our culture? Actor-network theory, translation work and marginalized empowerment 155 4.1. Anorexia nervosa as a psychopathology? 157 4.2. Anorexia nervosa as a cultural-political constnict 169 4.3. Purification, translation and the marginalized selves: Implications of approaching anorexia nervosa with actor-network theory 177 Conclusion 188 Appendix 192 References 197 Introduction Through the beaded curtain enters the eagle, eager to do his bidding. Slowly eroding at self, beak and talons siphon. Nail it shut. So where is justice? ("voung anorexie" quoted in Lester, 1997:488). (. .) Thus, the two constitutional guarantees of the modems - the universal laws of things, and the inalienable rights of subjects - can no longer be recognized either on the side of Nature or on the side of the Social. The destiny of the starving multitudes and the fate of our poor planet are connected by the same Gordian knot that no Alexander will ever again manage to sever &atour. l993:5O). We need to ask questions (. .) that focus, for example, on what scientists produce, who they produce it for, how they produce it, and with what social, political, economic, and environmental consequences (Croissant & Restivo, 1995:86). Some of the most important questions raised in the sociology of scientific knowledge (SSK) in recent years are concemed with the dominance of scientific knowledge construction, how certain claims to truth become more powemil and iduential than others, how such tmth claims develop into instinitionalized building blocks and make it possible to "act at a distance" (Callon et al.! 1986) - to "raise the world" (Latour, 1987), how these scientific knowledges and practices have impact on and are related to the social world, and what an alternative epistemological position should consist of. According to Latour (1993), it is the failure of the "Modem Constitution?'to realize the sirnultaneousness and inseparable ontoiogical relationship between the naturd and cultural (or what he calls "hybrids," or ccquasi-objects"and ccquasi-subjects"),on the one hanci, and what he calls "purification work" and "translation work" on the other, which has led to the present cccrisis"of traditional 2 modemist epistemology. While the modemists' have tried to overemphasize their work as processes of purification between nature and culture, hurnans and nonhumans, their acruaI and simulianeous involvernent in processes of ûanslation between these dualities - processes which have been subjected to continuous attempts of denial and silencing - has contributed to a vast proliferation of hybnds, which, Latour argues, points to the urgent need to rethink the whole Constitution - to retie the Gordian Knot, and to realize that, in fact, we have never been truly modem (Latour, 1993). I argue that a genealogical examination of the recent scientific debate about anorexia nervosa' cmbe seen as capturing this epistemological debate, and that recent contributions to the SSK literature, with particular emphasis on actor-network theory, can be used as a way of negotiating a path between scientific realism, postmodern nominalisrn, and reflexivistic social constructivism (Latour, 1993; Ward, 1996). This change of perspective on scientific pracrice will in tum make it possible to raise clairns about the relation between epistemology and social order - the responsibility of science in its production of "monsters" (Leigh Star, 1992). Questions of
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