Refusal and coercion in the treatment of severe Anorexia Nervosa: The Antigone paradigm

Abstract

I examine dynamics of refusal and coercion in the reciprocal relationship between traumatised individuals suffering from severe forms of Anorexia Nervosa and fragmented systems of care engaged in the clinical endeavour of pressing food upon them. Inpatient services treating sufferers using various forms of force-feeding face the clinical challenge of refusal: refusal to eat – refusal to comply with treatment – ‘refusal to get better’. In this dynamic, the ‘irresistible force’ of compulsory treatment under the mental health act meets the ‘immovable object’ of the individual sufferer’s refusal to accept food and treatment on the terms offered. In writing this paper, I have worked alongside a small group of anonymous experts by experience. I take as my main ‘case material’ the story of Creon and Antigone, representing the societal ‘irresistible force’ and the individual ‘immovable object’. I explore some of the shared characteristics of present-day sufferers and I trace the history of the aesthetics of starvation in western culture back to the Antigone myth. I examine the paradigmatic collision between Antigone and Creon in different accounts of the story in order to develop hypotheses about the dynamics of negotiation, in pursuit of a radical reimagining of the terms of the encounter.