Shaping bulimia: an ethnographic analysis

This study seeks to investigate the shaping and conceptualisation of the contemporary bulimic subject. It aims to answer the question: Who and what do we designate in the depiction, treatment, and portrayal of bulimia nervosa? Who is the bulimic, and how is her behaviour conceptualised, framed, and explained?
The importance of these questions lies in the changing ways in which patient responsibility is taking shape today; new forms of treatment such as "shared decision-making" presuppose a responsible, "active" patient. Meanwhile, novel theoretical models are being developed in the field of bulimia specifically. New therapies, aetiologies and clinical explanations have a tremendous influence on the role the patient is expected to play, but also the experience of the illness. Moreover, changes in psychiatric treatment have consequences in- and outside the context of psychiatry only. How, where, and by whom those living under the description of a psychiatric diagnosis are treated is related to how we think about health, illness and its organisation in society. Critical, ethnographic research into this field is needed: as psychiatric practices are related to ideas about health and illness, personhood and subjectivity, but also responsibility and autonomy.
To analyse these questions, I propose an analysis of two leading UK research centres, that are both involved in the design and development of novel treatment models. Both these research units have developed contrasting models with regard to what it means to be bulimic, and what treatment is required. Analysing these models is vital, not only because it will provide us with insight into how bulimia is conceptualised, treated and depicted in the UK today, but because these models differ tremendously with regard to how the illness itself is defined, the patient's role in their recovery, and the responsibility they have in their treatment. I aim to gain insight into the underlying premises of what the "illness" bulimia consists of (is it a behavioural, neurological, social deficit). This means I will also analyse how progress and recovery are defined.
These are issues that do not only touch upon bulimia and its treatment, but also changes affecting the organisation and structure of psychiatric care in Western Europe. Novel forms of treatment and therapy necessarily impact the relation between the patient and their illness, but also changes the practice of medical expertise and organisation of psychiatric institutions

A part of this study consists of a discourse analysis of recovery blogs, which are written by women who practiced bulimia. In doing so, I aim to include the voices of those who had been living under the description of bulimia, and how they conceptualise the experience and treatment of the disease. This will also help me to gain insight into how (ex)patients relate to their illness, and how they picture and portray recovery, or the lack thereof.