Tinkering with Food and Family: Striving for Good Care in an Eating Disorder Treatment Centre in Italy

This thesis examines practices of care in an Italian public treatment centre for people diagnosed with anorexia and bulimia nervosa. Drawing on patient-focused anthropological accounts of eating disorders as ‘technologies of the self’, and on existing ethnographic works that have highlighted the failures of eating disorder treatment in other countries, the thesis makes a case for a study of treatment that goes beyond a binary conception of success or failure. By focusing on the professionals of a treatment team, and examining the difficult care work that they do as they encounter patients and their families, the chapters highlight the grey areas between failure and success – and suggest how, when difficulties arise and things seem to be failing, novel forms of care emerge as team members try other ways to make their interventions work. The thesis sits at the intersection between anthropologies of science and biomedicine, and anthropologies of ethics, care and kinship. It shows that what patients experience as a self-care project, professionals frame as a potentially deadly pathology that has ‘taken over’ the ‘self’ of the patient. By framing the eating disorder in this way, the treatment team makes sense of the seemingly coercive practices that come with treatment. Both the patients’ and the professionals’ constructions point to the fact that eating disorders are ‘not really about food’ – but about issues with relatedness that are seen to be expressed through food. The chapters show, first, how the structure, knowledges, and everyday practices of treatment aim to create ‘healthier bodies’ and ‘healthier minds’ in patients – by gradually substituting their self-care projects with a definition of health that is jointly constituted by psychotherapists, psychiatrists, nutritionists, endocrinologists and educators. Second, with professionals seeing eating disorders as markers of ‘things gone awry in family relations’, other chapters show that the work of transforming the patient is felt to succeed only if the patient’s family is transformed, too. In focusing on how professionals tinker with kinship care by trying to channel its ‘dysfunctional’ aspects into ‘functional’ aids towards recovery, the thesis goes beyond exploring the potentially ‘dark side’ of kinship to suggest that kinship here becomes a therapeutic tool – albeit a difficult one to use.I am grateful to the Boak Student Support Fund of Clare Hall; to the Ling Roth Fund, the Ridgeway-Venn Travel Fund and the Richards Fund of the Social Anthropology Department; to the William Wyse Fund of Trinity College; to the Cambridge Trust, and to the University Fieldwork Fund for supporting this research project