Disciplining the feminine: The reproduction of gender contradictions in the mental health care of women with eating disorders

This paper provides insights into the way gendered assumptions operate within health care interventions for women with eating disorders. A multidisciplinary sample of Australian health care workers were interviewed about their approaches to treatment, and discourse analysis was used to uncover the discursive dynamics and power relations characterising their accounts of intervention. The paper demonstrates a contradictory positioning of anorexic patients in relation to autonomy and control within the two common psychiatric interventions of bed rest intervention and psychotherapy. The paper argues that this is based on gendered assumptions about selfhood and femininity in eating disorders that are reproduced in the therapeutic relationship through the operation of a gendered parent-child dynamic, with the health care worker as father or mother, and the anorexic patient as daughter. One of the main effects of this is to re-inscribe rather than challenge the discursive 'double bind' of femininity that has been widely implicated by post-structural feminists in producing eating disorders in the first place. The paper also considers the widely acknowledged problem of resistance to treatment in anorexia as a function of controlling treatments, and discusses psychiatrists' perspectives on addressing this dilemma. Finally, the paper examines the potential of feminist-informed understandings of eating disorders for overcoming the gendered dilemmas inherent within the dominant psycho-medical treatment paradigm. (c) 2005 Elsevier Ltd. All rights reserved.