Beyond the clinic? Eluding a medical diagnosis of anorexia through narrative

Abstract

The persistence and recurrence of anorexia nervosa poses a clinical challenge, and provides support for critiques of oppressive and injurious facets of society inscribed on women’s bodies. This essay illustrates how a phenomenological, linguistic anthropological approach fruitfully traverses clinical and cultural perspectives by directing attention beyond the embodied experience of patients diagnosed with anorexia nervosa to those who are not clinically diagnosed. Extending a model of illness and recovery as entailing sufferers’ emplotting of past, present, and imagined future selves, I argue that women’s accounts of their experiences do not simply reflect lived reality, but actually propel health-relevant states of being by enlivening and creating these realities in the process of their telling. In indexical interaction with public and clinical discourses, narratives’ grammar, lexicon, and plot structures modify subjects’ experiences and interpretations of the events and feelings recounted. This article builds on the insight that linear narratives of “full recovery” that adopt a clinical and feminist voice can help tellers stay recovered, whereas for those “struggling to recover,” a genre of contingent, uncertain, sideshadowing narratives alternatively renders recovery an elusive and ambivalently desired object. This essay then identifies a third narrative genre, eluding a diagnosis, which combines elements of the first two genres to paradoxically keep its teller simultaneously sheltered from, and invisible to the well-meaning clutches of medical care, leaving her suffering, yet free, to starve. This focus on narrative genres illustrates the utility of linguistic analyses for discerning and interpreting distress in subclinical populations.