Space, Body and Power: Young people, anorexia nervosa and treatment environments

Abstract

With an acknowledgement to both the cultural and medical influences in the literature this thesis analyses the experiences of young people receiving in-patient treatment for anorexia nervosa. Due to the physical complications associated with anorexia nervosa and the age of diagnosis most often being during adolescence it is one of the few medicalised mental health conditions where specific in-patient treatment centres operate. Patients are often admitted for relatively long periods of time in order for safe weight gain and a behavioural approach is the underlying philosophy for treatment. The medicalisation of the disorder and focus on treatment and restoration of weight has been widely criticised for not acknowledging the societal and cultural factors that led to admission. Despite much research in this area treatment is often unsuccessful with clinicians referring to a revolving door phenomenon where young people are discharged and then deteriorate and are readmitted weeks or months later. This is often attributed to the resistance of the young people to treatment or their tenacity and determination to lose weight. There has been no research in to the treatment environments themselves and how access to and use of space within them may contribute to patient outcomes. This thesis addresses this through an interpretative phenomenological account of the lived experience of young people receiving in-patient treatment for anorexia nervosa in the United Kingdom. This approach was used because it is appropriate for examining major life experiences and how people make sense of them. Participants created mixed media posters expressing their experience of the spaces within and outside the centres where they were receiving treatment. The posters were then used as prompts during follow up, in depth, interviews. The data were then analysed both by individual case and by theme. The overarching message from the young people’s experience was that although the treatment centres provided a structure and the facilities of a therapeutic environment, the approaches to access and use of the treatment spaces were restrictive and inhibited the young people’s ability to develop the resilience they required to live fulfilling lives. In particular, the lack of access to outdoor space and the rules and dominance of the treatment teams left the young people feeling deviant and removed from society. This suggests that a more culturally informed treatment environment that enabled the young people to develop resilience would be more therapeutic. This thesis found that the treatment environments did not require structural change in order to become therapeutic in nature but the practices within them do need to change. Moving away from a philosophy of treatment and restoration of weight towards an environment that is more positive and focussed on developing the resilience required to live a fulfilling life could enhance current practice.

Date of Award	May 2016
Original language	English
Awarding Institution	University of Brighton