Papers (Eating Disorders) by Emma Louise Pudge
Despite intensive research efforts, anorexia nervosa (AN) remains poorly understood. The clinical... more Despite intensive research efforts, anorexia nervosa (AN) remains poorly understood. The clinical picture of AN consists of practices of food restriction and/or increased physical activity leading to physical degradation, co-occurring with significant psychological distress focusing on eating and embodiment. Several studies have analyzed binge eating as physiologically and psychologically functional responses to hunger and negative affect within larger cycles of body weight regulation and emotional mediation.However, eating in AN does not occur exclusively in the context of binge eating. Eating, in its myriad yet typically restrictive and idiosyncratic forms, is necessary to maintain the modes of embodiment and selfhood produced with and through AN. In turn, life itself is sustained, albeit ambivalently, precariously and paradoxically. Hence, eating, as well as not-eating, is constitutive of and integral to AN. By engaging with the multiplicity of embodied practices and sensations that shape the lives and experiences of individuals with AN, this paper asks what it means to ‘live’ with, within, through, or even for, AN.
The term orthorexia nervosa (ON), introduced by Bratman (1997), describes individuals with a clin... more The term orthorexia nervosa (ON), introduced by Bratman (1997), describes individuals with a clinically impaired fixation on "healthy" eating, as defined by a dietary theory or self-imposed dietary rules believed by the individual to promote optimum health (Dunn & Bratman, 2016). Compulsive behavior, mental preoccupation, emotional distress, social impairment and malnutrition distinguish ON from the alternative dietary practices and increasing focus on nutrition that form a part of everyday life within a health-valuing culture (Bratman, 2017; c.f. Crawford, 1980). Presently, ON is not recognized as a formal psychiatric diagnosis. Similarities and symptom overlap has been widely observed between ON and eating disorders such as anorexia nervosa (AN) (ibid.), avoidant/restrictive food intake disorder (AFRID) (Kreipe & Palomaki, 2012), obsessive compulsive and psychotic spectrum disorders (Koven & Wabry, 2015) and autistic spectrum disorders (Dell'Osso et al., 2016). This has contributed to a lack of consensus as to whether ON constitutes a distinct construct, an expression of a currently recognized disorder, or a societal trend that does not warrant medicalization (Gramaglia et al., 2017; Vandereycken, 2011). In this paper, I seek to enhance our understanding of the relationship between AN and ON by tracing the interplay of materialities, metaphors and meanings of 'fat'. This marks an important methodological and analytic departure from existing research that demonstrates a quantitative focus on prevalence, validity of diagnostic tools, and treatment outcomes (e.g. Dunn & Bratman, 2016). Instead, I take as my entry point the taken-for-granted distinction made between experiences of food restriction in AN and ON.
The aim of this paper is threefold and I seek to make contributions of both empirical and theoret... more The aim of this paper is threefold and I seek to make contributions of both empirical and theoretical significance, whilst refusing a hygienic separation of ontology and epistemology: (1) I examine the claim that AN is a "biologically based, serious mental [illness] (BBMI)" (Klump et al., 2009, p. 97) and re-assemble the onto-epistemological landscape to show how this formulation is held in place and co-produced by a number of social, political and institutional interests. (2) I propose metatheoretically, and demonstrate through writing this paper, a form of critical engagement with neuroscience and genetics research on AN that does not insist on the 'reductive' effects of neuro/genocentric inquiry, but rather seeks to elaborate its inherent complexity. (3) I invoke entanglement in order to reconceptualise AN as biopsychosocial phenomena according to Barad's technical description of phenomena as the ongoing flow of agency between ontologically indeterminate entities in their differential becoming (2003, p. 818). Furthermore, I suggest empirical support for this reconceptualization can be found within the neuroscience and genetics literature itself.
Individuals with anorexia nervosa often describe 'hearing' an 'anorexic voice'. Preliminary resea... more Individuals with anorexia nervosa often describe 'hearing' an 'anorexic voice'. Preliminary research suggests over 90% of diagnosed individuals experience a self-critical inner voice that can be distinguished from self-critical cognitions (Nooredenbos, Aliakbari & Campbell, 2014). As the illness progresses, egosyntonic thoughts are replaced by the experience of hearing a critical egodystonic voice which exerts a powerful influence of the individual's perceptions and behaviours (Williams & Reid, 2012). This phenomenon has emerged as an important phenomenological aspect of the condition in qualitative studies (Highbed & Fox, 2010; Tierney & Fox, 2010) and is the target of a number of influential treatment approaches such as narrative therapy (Maisel, Epston & Borden, 2004; c.f. Vituousek, 2005). The metaphor of the 'anorexic voice' provides a parsimonious formulation for many of the challenges faced in the treatment of anorexia, however the validity of the construct continues to be debated on both empirical and theoretical grounds (Pugh, 2016; Vitousek, 2005). Approached within a poststructuralist framework, metaphorical concepts do not unproblematically describe some underlying reality; rather, they are understood to constitute and transform that reality in particular context-specific ways (Foucault, 1972; Leary, 1990). This paper raises concerns over uncritical use of the metaphor of the 'anorexic voice' in eating disorders literature and treatment. In particular, it focuses on how this metaphor contributes to a particular construction of 'the eating disordered patient' as an entirely pathologized subjectivity (Malson et al., 2004, p. 482) in conflict with the emphasis narrative therapy places on separating the 'person' from the 'problem' (Lock et al., 2005).
Eating disorders (EDs) such as anorexia nervosa (AN) and bulimia nervosa (BN) stand apart from ot... more Eating disorders (EDs) such as anorexia nervosa (AN) and bulimia nervosa (BN) stand apart from other psychiatric disorders by the degree to which culture is recognised as a salient part of their aetiology. However, the notion of 'culture' in relation to EDs remains ambiguous and undertheorized, used sweepingly to describe anything not strictly biological or psychological . EDs are often framed as Western culturebound syndromes, largely owing to their preponderance in postindustrial Western societies. When EDs are
Papers (Health/medical humanities) by Emma Louise Pudge
Katie Green’s graphic memoir Lighter Than My Shadow explores the relationship between anorexia n... more Katie Green’s graphic memoir Lighter Than My Shadow explores the relationship between anorexia nervosa (AN) and personhood through the visual language and “expressive anatomy” (Ventakeen & Saji, 226) of the graphic form. The tension between representational codes – linguistic, discursive, visual, and corporeal – that finds absolute expression in the abstract black cloud of the illness resists a singular interpretation of anorexic embodiment and subjectivity. Hatfield suggests: “such verbal-visual tension opens up a space of opportunity, one in which pictorial metaphors can multiply promiscuously, offering a surreal or wildly subjective vision to counterbalance the truth claims that certify the text as autobiographical” (128). Through a close-reading of pages 148-153, the clinical encounter in which Katie is diagnosed with AN, I hope to demonstrate how Green’s representation of AN is entangled with cultural and clinical framings of the illness, yet also ruptures dominant paradigms via the graphic form.
Papers (English Literature) by Emma Louise Pudge
Shakespeare presents revenge as being unattainable for Hamlet, who neither has the moral convicti... more Shakespeare presents revenge as being unattainable for Hamlet, who neither has the moral conviction or fundamental desire to revenge his father"s death by killing the new King, Claudius. Middleton"s Revenger"s Tragedy features the archetypal revenge hero of Vindice who lusts and pursues revenge. By contrast, Shakespeare confronts the accepted Elizabethan hero by introducing a new type of antihero; a protagonist who will become the new model of man valued in Renaissance drama.
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Papers (Eating Disorders) by Emma Louise Pudge
Papers (Health/medical humanities) by Emma Louise Pudge
Papers (English Literature) by Emma Louise Pudge