Practices and Ethics of Care in Eating Disorder Treatment in Italy

The ethnographic research that I am carrying out as part of the ESRC postdoctoral fellowship aims to further examine two important aspects that emerged during my doctoral fieldwork in an eating disorder treatment centre in Italy: i) the ways in which treatment needs to increasingly adjust to patients who are younger and younger - often children who are 8-12 years old; and ii) whether, and in what ways, the ‘family work’ that is done during residential treatment and that is considered fundamental for a successful recovery 'travels back' to patients' homes once they are discharged from the facility.  

One finding that emerged from my research is that most treatment practices for eating disorders are based on the assumption that the patient who is being treated has a psychological, internal world that s/he is aware of, capable of discovering and communicating about with her therapists. It is also assumed that most treatment approaches have the aim of helping patients regain some sort of 'autonomy'. This aim is based on the idea that part of the reason why patients developed an eating disorder in the first place has to do with their parents being 'overinvolved' or 'enmeshed'. Treatment thus mostly addresses these issues: reaching 'autonomy' is a key aim. For this fellowship I am exploring how treatment practices for eating disorders find themselves having to adjust to the increasingly prevalent phenomenon of 'preadolescent anorexia'. I am examining what can be done - and what professionals currently do - when this treatment logic comes to an impasse with these younger patients. How can treatment work with these patients, who are deemed incapable of expressing their thoughts and feelings with the depth considered necessary for successful therapeutic work? How can health professionals and patients collaborate if children are seen as lacking a supposedly coherent internal world to be disclosed to professionals during psychological therapy? How does the aim of helping patients to regain their autonomy work with children, who by virtue of their age are not considered autonomous and cannot disentangle themselves from their families? What kind of treatment practices are effective for these younger patients, and what could be considered as realistic aims of therapy - aside from restoring a 'healthy weight'? These questions are explored through research in one of the very few residential facilities in Italy that admit patients under the age of 14, by observing the ways in which therapeutic activities are adapted to these younger patients, and by interviewing members of the treatment team who work closely with them.

A second important issue that emerged during doctoral fieldwork is that the treatment team agrees that it is very hard for patients to recover if their families are not involved in treatment and do not undergo some 'family work'. Since eating disorders are understood to develop, in part, as ways to deal with complex and 'unhealthy' family dynamics, it follows that for treatment to work the patient's family will need to undergo some important transformation too. The family carers of the patients who are admitted in residential treatment are therefore assigned a family counsellor that they are supposed to meet once every two weeks, and are supposed to attend weekly support meetings for families. Through these activities, patients' parents are asked to 'work on themselves' and learn how to best support their daughters' and sons’ recovery. Nevertheless, professionals point out that many families find it difficult to do this. Several patients thus suffer from severe relapses once discharged, and need to be admitted to residential treatment again after a few months. By interviewing the family carers of patients who have been discharged, I am examining the 'roadblocks' of this important node of treatment - and what can be done to address them.