Assemblages of care: why women with disordered eating are ambivalent to seek therapeutic care

Abstract

This thesis critically examines why women with disordered eating are reluctant or resistant to seek professional health care. In exploring whether participants perceive their eating practices to be problematic, I analyse how health, illness and disorder are constantly negotiated processes understood through the multiple contexts of care and its intersections with postfeminism, neoliberalism and healthism. I argue that these political and cultural contexts represent a constellation of contemporary forces that together have created an environment where disordered eating practices can be culturally valued, allowing the women in this study to rationalise their practices as healthy lifestyle choices and embodied performances of self-care. Employing a mixed methods approach (including ethnographic interviewing and observation, diary writing and psychological evaluation) with 28 women in metropolitan Adelaide, South Australia, this research is one of the few national or international studies to engage with people who deny they have disordered eating and/or do not actively seek professional help. Extending Foucauldian theories of self-discipline and individual responsibility I argue that Bourdieu’s (1977) concept of habitus and Mol, Moser and Pols’ (2008, 2010) concept of care provide a broader theoretical framework to understand the ways in which people with disordered eating embody and practise care as a form of ‘healthism’. In this way their agency of choice enables them to engage in gendered bodywork and symbolic capital. Key to my argument is how desire works in practices of care, and I draw on Deleuze and Guattari (1987) and Probyn’s (1996, 2000) productive theories of desire to show that desire is not contained within individuals but is constantly articulated in social relations and spaces. It is through this Deleuzian approach to desire that I reveal the ambivalence of care, and the ways in which disordered eating provides a safe space for both caring and not caring. In so doing I demonstrate how and why people rarely follow a linear trajectory from (distinct categories of) illness to recovery, and are instead propelled constantly back and forth in movements that connect them to the perceived safety of caring spaces. Desire is thus positioned as a rhizomatic framework for tracing the everyday enactments and multiple assemblages of care which intersect in participants’ lives. Examining experiences of disordered eating through the theoretical lens of care, this thesis provides new knowledge about how the notion of care is rationalised, experienced and performed in participants’ lives. I argue that this understanding of care is at odds with assumed, clinical and therapeutic models of care, thus providing new insights into the low rates of help seeking amongst people with disordered eating and the high rates of relapse and therapeutic treatment failure. This work has significance to both social scientists and to health professionals working in the fields of disordered eating.