P R O L O G U E
This book is an ethnographic study of a psy-
chiatric program in North America that spe-
cializes in the treatment of anorexia nervosa
(or anorexia) among adolescent girls. An-
orexia is a phenomenon of self-starvation,
often coupled with rigorous exercise, occur-
ring primarily among girls and young
women. It is notoriously di≈cult to cure.
This di≈culty is ordinarily attributed to pa-
tients’ ‘‘pathology’’ and tenacity, but in this
study, I shift the focus of concern to prob-
lems with therapeutic practices. In address-
ing the question of why treatments for an-
orexia are so fraught with conflict and
struggle, I argue that mainstream therapies
participate unwittingly in historically spe-
cific, dominant cultural discourses of gen-
der, individualism, physical fitness, and
family life that help constitute anorexia’s
conditions of possibility.
The site for this study is a small inpatient
unit called Walsh (a pseudonym, as are all
names used for participants in the treatment
program), located in a major teaching and
research hospital in the western part of the
United States. I spent time in the outpatient
clinic associated with the unit as well, but
the inpatient unit is the site for the fullest
elaboration of treatment protocols and is the
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