Experiences of 'Control' in Anorexia Nervosa Treatment: Delayed Coercion, Shadow of Law, or Disseminated Power & Control?

ANOREXIA NERVOSA AND BULIMIA NERVOSA: NEW RESEARCH, P. Swain, ed., pp. 41-61, Nova Science, 2006

Sydney Law School Research Paper No. 08/07

24 Pages Posted: 3 Jan 2008  

Terry Carney

The University of Sydney Law School

Miriam Ingvarson

Mental Health Legal Centre

David Tait

University of Canberra

Abstract

Anorexia nervosa is often chronic, with one of the highest death rates for psychological conditions. Law can compel treatment, but is rarely invoked, at least formally (though the strategic possibilities of orders confers internal authority within the clinical setting). Instead, "control" (or management) is exercised diffusely, through disciplinary practices embedded in everyday clinic life, such as daily routines of eating and washing, behavioural "contracts", regular surveillance and measuring, interactions with staff, visits and activities. The regulatory regime not only touches on such "practices" but also targets "identities" (including self-image, and attitudes to the body) and what Goffman called the "moral career" of the patient (eg learning to play the "patient role", to "be" an "anorexic"). We argue that it is not the clumsiness of the law, or the success of less restrictive options which explains why law is so infrequently engaged. Rather, based on an interpretation of Foucault, we concluded that the regulatory regimes that shape treatment of anorexia nervosa, is "the law", in a sense. The regime of governmentality within the clinic is shaped by practices which operationalise "duty of care", or translate medical expertise into medical authority, or show how interactions between "experts", "carers" and patients are mediated through conventions and rules, or which conscript "empowerment" as control. The patient learns to provide consent "freely", to make the "correct" choices, to accept the "empowerment" regime that is made even more convincing by the threat of legal intervention. In time the constraints learned in this way become part of the new role, that of the "recovering" patient. The "fiction" of acting "responsibly", employed so hesitantly at first, becomes part of the new identity. The patient has become an active participant in the governance of self.

Keywords: Anorexia Nervosa, Shadow of law, Socio-legal, Strategic use of law

JEL Classification: K10, K32, I18

Suggested Citation

Carney, Terry and Ingvarson, Miriam and Tait, David, Experiences of 'Control' in Anorexia Nervosa Treatment: Delayed Coercion, Shadow of Law, or Disseminated Power & Control?. ANOREXIA NERVOSA AND BULIMIA NERVOSA: NEW RESEARCH, P. Swain, ed., pp. 41-61, Nova Science, 2006; Sydney Law School Research Paper No. 08/07. Available at SSRN: https://ssrn.com/abstract=1080084

Terry Carney (Contact Author)

The University of Sydney Law School ( email )

New Law Building, F10
The University of Sydney
Sydney, NSW 2006
Australia

Miriam Ingvarson

Mental Health Legal Centre ( email )

Victoria
Australia

David Tait

University of Canberra ( email )

Law Faculty
Canberra, ACT 2601
Australia

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