My Body and Other Stories: Anorexia Nervosa and the Legal Politics of Embodiment
| DOI | 10.1177/096466390000900402 |
| Published date | 01 December 2000 |
| Author | Kirsty Keywood |
| Date | 01 December 2000 |
| Subject Matter | Articles |
MY BODY AND OTHER
STORIES: ANOREXIA NERVOSA
AND THE LEGAL POLITICS OF
EMBODIMENT
KIRSTY KEYWOOD
University of Liverpool, UK
ABSTRACT
In a series of cases in the 1990s, English law confirmed the legality of tube feeding,
detention and restraint of anorexic women. In declaring such practices lawful, English
law has provided a space in which anorexic identity is constituted by reference to
dominant discursive regimes of medical positivism and dualistic conceptions of the
mind and body. This article examines critically law’s engagement with the anorexic
body. It also considers possible modes of resistance, in particular the potential of post-
structuralism, to make space for the resignifying of anorexic bodies in law.
INTRODUCTION
THE ANOREXICbody has become the site of struggle over meaning,
as both clinical and cultural theory and practice seek to make sense of
the enigmatic spectacle of anorexia nervosa. English law’s engagement
with anorexia nervosa in a series of cases reported in the 1990s means that
law has formulated its own story of the condition. This article explores law’s
story of anorexia nervosa and examines the potential of that story to speak
of female embodiment more generally.
The anorexia cases are worthy of legal analysis for a number of reasons.
First, this series of cases makes possible a range of different legal processes
through which the anorexic may be compelled. She may be subject to the com-
pulsory treatment and detention provisions of the Mental Health Act 1983;
she may be detained and treated without her consent but on the basis that she
lacks mental capacity to make decisions concerning her eating, treatment and
detention;1 if she is a minor, she may be detained and treated without her
SOCIAL & LEGAL STUDIES 0964 6639 (200012) 9:4 Copyright © 2000
SAGE Publications, London, Thousand Oaks, CA and New Delhi,
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consent, irrespective of her mental capacity. Second, while the notion of
patient autonomy is identified as a crucial component of health care decision
making, it is in reality undermined as the anorexic patient is consistently
denied the opportunity to make key decisions about her health care. Third,
the courts’ construction of anorexia as being grounded on a medical model of
disease and disorder, thus allied with the scientific positivist tradition,
obscures a range of alternative, contesting meanings of anorexia which may
provide rather different possibilities for dealing with anorexics in the English
legal system. Finally, all cases to come before the courts have concerned female
anorexics. This is perhaps not surprising, given that approximately 90 percent
of those physically diminished by the condition are women (Bowers and
Andersen, 1994: 193). An examination of the role that gender plays in the
courts’ constitution of the anorexic subject will tell us something about law’s
engagement with female embodiment more generally, for the legal disciplin-
ing of the anorexic female body forms part of a broader deployment of prac-
tices which constitute and discipline the female body in law. While the courts
are not explicit on the role that gender plays in their decisions, the anorexia
case law highlights uneasy parallels with dominant medical and philosophical
discourses, both of which have operated in various contexts to render female
corporeality in need of clinical regulation and moral management.
This article examines the deployment of two related discursive regimes –
the authority of medicine to determine the aetiology, diagnosis and treatment
of anorexia nervosa and the medicolegal construction of patient autonomy –
to produce anorexic identities in law. It also admits an analysis of competing
narratives, the ‘other’ stories to be told about anorexia and female embodi-
ment that do not find willing listeners in the courtroom.
THE AUTHORITY OF MEDICINE
Anorexia nervosa became the object of medical and psychiatric knowledge in
the 1870s, when Professor Charles Lasègue published a paper on ‘hysterical
anorexia’; this was followed a year later by a paper published by Sir William
Gull entitled ‘Anorexia Nervosa’ (Lasègue, 1873: 265–6; Gull, 1874: 22–8). In
both discussion papers, all patients presented were women. These accounts
of the conditions allied female hysteria to gastric disorders to produce a dis-
crete illness with its own specific causes and effects. The dominant reading of
the scientific ‘discovery’ of anorexia nervosa during the Victorian era is of an
inexorable advancement in medical diagnosis and treatment, suggesting an
unproblematic, linear development and refinement of clinical expertise to
uncover an always/already existing underlying (female) pathology. Such a
reading is facilitated by ahistorical analyses of anorexia, which use modern,
clinical diagnostic skills to identify cases of anorexia dating back to the
medieval period.2 Today, anorexia nervosa is classified as a mental illness by
the World Health Organization. The condition has been summarized as ‘a
relentless pursuit of thinness, a significant weight loss, a distorted perception
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of body size in which the individual sees herself as fat despite her emaciation,
a refusal to maintain normal weight, and an absence of any other disorder
responsible for the weight loss’ (Dresser, 1984: 298). The dominant meaning
ascribed to anorexia is one rooted firmly in the scientific positivist tradition
(see e.g. Tiller et al., 1993: 679), based on a model of physical disease and
psychological disorder (Hill and Hill, 1997: 296), despite a lack of positive
scientific evidence as to the cause(s) of anorexia, the success of medical/
psychotherapeutic intervention and likely prognosis (Bowers and Andersen,
1994: 193). The dominant medical discourses on anorexia purport to speak
the truth about anorexia, defining it as a pathological condition with its own
discrete aetiology, diagnostic indicators and recognized treatments, though
an extensive range of clinical literature gives at least some acknowledgement
to the cultural context in which the anorexic condition is located. The domi-
nance of biomedical/psychopathological explanations of anorexia present the
condition as an indisputable, scientific given, uncovered against a particular
historical and cultural backdrop, with little acknowledgement that social,
clinical and cultural processes are playing a role in the production of the
anorexic condition.
The privileging of medical discourses on the human body not only ensure
that a biomedical understanding of the human body prevails over competing
narratives (including those from within the medical profession), but also
create and convey relations of power. The prominence of particular medical
knowledges to explain the human condition and the consequent obfuscation
of other accounts of human development has invested the human body with
cultural meanings of sexual difference and embodiment. This is not to
suggest, of course, that medical accounts of human development are always
in agreement, or that resistance to the dominant biomedical model of human
development can only come from outside medical discourse. Rather, the
complex and fragmented array of medical knowledges on the human body
are represented/imagined as monolithic, universal and incontestable. The
plurality of medical voices on women’s physical and mental illness yield to a
dominant medical discourse on female corporeality that serves to conceal the
fragmentary, partial nature of medical knowledge. Those medical discourses
that gained dominance in social and cultural life have constructed the female
body as labile, potentially explosive and ‘too much’ (Bordo, 1992: 90). They
have cast a particular gaze upon the female body, viewing female biology as
producing sexual, and consequently social, difference, with medical accounts
of female health and reproduction justifying social, emotional and physical
confinement for the Victorian ‘nervous’ woman (Showalter, 1985), psycho-
therapeutic intervention for women whose ‘essence’ renders them unable to
resolve the conflicts of psychological development (Gilligan, 1982/1996) and
surgical intervention (in the form of cliterodectomy) for women unable to
control their sexualities (Ussher, 1991: 72). Female otherness is frequently
construed in opposition to the autonomous man, self-directed and free-
thinking and an active moral agent in the doctor–patient alliance (Diprose,
1994).3 Deviations from culturally inscribed behaviours produce distinct
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modes of disciplining for men and women: for Ussher ‘. . . men . . . are likely
to be positioned as bad. They are likely to manifest their discontent or
deviancy as criminals. Whilst women are positioned within the psychiatric
discourse, men are positioned within the criminal discourse’ (1991: 10). As
medical discourses produce a plurality of gendered identities (through inter-
action with race, ethnicity and class) – from the Victorian hysteric to the
Infanticidal Mother – the gendered and medicalized nature of anorexia
nervosa finds a ready echo in legal discourse.
PRIVILEGING THE MEDICAL
In July 1992, the Court of Appeal confirmed that the High Court’s inherent
jurisdiction could be exercised to override an anorexic minor’s competent
refusal of medical treatment and her...
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