The meaning-centred anorexic body: a human rights-based approach to involuntary treatment

Umezulike, Chisom Cynthia (2020) The meaning-centred anorexic body: a human rights-based approach to involuntary treatment. Doctoral thesis, Birkbeck, University of London.

Abstract

This is a meaning centred study of the anorexic body. Its objective is to establish that anorexia nervosa is not exclusively a psychiatric condition and present a new enforceable alternative approach to the current “doctor-knows-best” treatment method which predominantly reiterates labelling and stereotyping in mental health practice. Contextual clinical narratives pose strong critical arguments reiterating that anorexia nervosa is solely due to mental illness which results to diminished autonomy, therefore, unconsented clinical interventions are within the rights of medical practitioners and not a violation of the person’s rights. This research shows that the clinical preference of disengaging with the subjective meaning underlying selfstarvation reinforces paternalistic intervention of medical practitioners to the detriment of asserting rights. Thus, this work is concerned with how to reconceptualise anorexia by meaningfully engaging and managing the anorexic body without using involuntary, coercive and forceful methods, thereby preserving their autonomous rights, best interests and subjective will. Although the current traditional approach under mental health laws is shown to produce no long-term recovery benefits or outcome for the anorexic body, Section 2 of the 1983 Mental Health Act still preserves the one-dimensional strict approach to the care and management of the anorexic body as they are detained for the treatment of both their physical and mental disorder. Through critical research and empirical work conducted in Nigeria, this thesis sustains the deconstruction of anorexia nervosa as exclusively a psychiatric disorder and enables the development of a meaning-centred anorexic body highlighting the limitation of the traditional western medical model to acknowledge the significant cultural and social dimensions that overrule anorexia nervosa. This research showed that the meaning-centred anorexic body is acknowledged and valued as a self-determining agent outside the confined spaces of the Mental Health Act, adverse and resistant to the established stereotypical boundaries and impositions of psychology, law and psychiatry. In examining Articles 3, 5 and 8 of the European Convention on Human Rights (ECHR), this research underpins the meaning-centred approach within a human rights based framework. It therefore establishes that human dignity and autonomous choices are integral and indispensable in creating a balanced code of medical ethics. Through critical analysis and both legal and non-legal considerations, this research identifies the meaningful emergence of a modern anorexic body removed from strict confines of the mental health laws’ universal attraction and acknowledgement of the body as a docile object that needs to be institutionally regulated, disciplined, and subjected to punishment. The main contribution of this thesis is in bringing clarity to a very conflicting area by identifying a meaning centred approach to the understanding of anorexia nervosa. A conceptualised spectrum is introduced by distinguishing the meaning-centred anorexic body thereby enhancing the realisation of self determination. In this regard, this thesis establishes the values of autonomous choices as central to dignifying the anorexics experiences, morals and choices and therefore can possess the much-required capacity to regain and retain bodily control, bodily integrity and autonomy. It is based on this independent setting that a meaningful study of anorexia nervosa can emerge, highlighting the values of individual freedom and the necessity of a human rights-based approach existing outside the traditionally modelled benevolent paternalism.

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