Society for Medical Anthropology
Oral Presentation Session
Public mental health care in Western Europe is being thoroughly reorganized: more patients are treated “at home”, and there is an increased focus on patient responsibility. New psychiatric techniques such as “shared decision-making” aim to activate an autonomous and responsible patient, who needs to transform herself into an accountable, empowered psychiatric agent. However, the patient still needs to be categorized as psychiatrically ill by a medical expert. This results in the paradoxical situation that, while unwell, she is required to “treat” herself, accompanied by a medical expert.
In this paper, I provide a critical ethnographic analysis of how these changes crystallize in the way bulimia nervosa is explained, treated, and portrayed in the UK today. This paper draws on a year of fieldwork in the United Kingdom in which I have interviewed “experts” in the field (psychiatrists, clinicians, researchers) and attended research meetings and conferences.
There is no agreement within the field of psychiatry about the causes of, and treatments for, bulimia: clinical explanations vary from hypotheses on emotional instability and impaired decision-making to neurological brain deficits, implying different conceptualizations (bulimia as an “addiction”, “bad habit”, emotional coping mechanism) and treatments.
I retrace the most prominent “styles of thought” currently operating in this context, and how these reshape the different manifestations of bulimia, their understanding and treatment, with a particular emphasis on how the changing relationship between the patient and her illness unfolds in this new dynamic between diagnosed patients and changing forms of medical expertise.