Constructing the self in mental health practice: identity, individualism and the feminization of deficiency
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75 constructing the self
Nicole Moulding
abstract The discursive production of the ‘self’ in the context of mental health care has potential implications for how the subjects of intervention come to understand and experience themselves. Eating disorders provide an illustrative example of the ways in which conceptualizations of the self that structure mental health practices can be gendered, because they are mainly diagnosed in women and dominant explanations of their origins are feminized. This discourse analytic study examines the gendered nature of mental health workers’ constructions of the eating-disordered self through the psychological construct of ‘identity’, examining the dominant discourses implicated in the feminization of deficient identity, and addressing the implications of this construction for mental health practice.
keywords identity; eating disorders; discourse; gender; feminism
feminist review 75 2003 c 2003 Feminist Review. 0141-7789/03 $15 www.feminist-review.com (57–74)
57
introduction While psychological theories and associated interventions used to explain and treat ‘mental disorders’ make claims to gender-neutrality, mental health workers’ assumptions about mental health and illness in women and men are known to be profoundly gendered (Broverman et al., 1972). Eating disorders provide a useful illustration of particular ways in which assumptions about gender can structure explanations and practices in the mental health arena because, firstly, they are mainly diagnosed in women (American Psychiatric Association, 1994) and, secondly, dominant conceptualizations of their origins are feminized (Hepworth, 1999). For example, problematic female puberty is seen as central in anorexia nervosa, despite its diagnosis in males (Crisp, 1979). The extent to which assumptions about gender underpin theory and practice in relation to eating disorders has potential implications for the ways in which women come to understand and experience themselves.1 Various forms of individual psychological therapy represent the predominant method of intervention and, despite relatively poor outcomes (Hsu et al., 1992), there has been little attention to alternative approaches such as addressing the sociocultural factors widely implicated in causation (Moulding and Hepworth, 2001). Thus, the main forms of intervention are individually focused and intrinsically language-based, offering particular forms of subjectivity to women as the main subjects of intervention. Drawing on the writings of the French philosopher Michel Foucault language is ‘the place where actual and possible forms of social organization and their likely social and political consequences are defined and contestedyit is also the place where our sense of ourselves, our subjectivity, is constructed’ (Weedon, 1987: 21). Subjectivity is, therefore, produced in a range of discursive practices and the meanings of these can be understood as sites of struggle over power (Weedon, 1987). The discursive practices that constitute interventions for eating disord
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