Title: Practices and Ethics of Care in Eating Disorder Treatment in Italy
Funder: Economic and Social Research Council

Abstract: If successful in obtaining ESRC funding, I plan to spend the 12 months of the fellowship to achieve the following objectives: 1) Conduct further research related to the PhD. Research will consist of three months of fieldwork and analysis of data in the same residential facility for eating disorders in Italy where I conducted doctoral fieldwork. This residential facility is one of the very few in Italy that admit preadolescent patients (patients younger than 14). The aim will be twofold: a) explore how eating disorder treatment is being adapted to the increasing number of preadolescent patients, and what this could reveal about taken-for-granted notions of 'dependence' and 'autonomy' (this part of the research will be based on participant observation in the treatment facility and on interviews with members of staff who work closely with preadolescent patients); b) examine whether, and in what forms, the family work that occurs during treatment travels back to patients' homes, with what kind of short- or long-term effects (this part of the research will be based on interviews with the family carers of patients who have been discharged from the residential facility). This research will also contribute to turning my thesis into a published monograph (see below). 2) Produce publications. I plan to produce two journal articles building on my PhD research, plus one chapter in an edited book (I am already working on the chapter and on the first article). I will also be working on turning the thesis into a book with the aim of submitting it to publishers - as highly recommended by my examiners during the viva voce examination. This work will mostly consist of adding more details on the Italian context and of drawing more attention to how the specificities of Italian kinship (see, for example, Bonaccorso 2008; Rusconi 2004; Saraceno 2015) play into the centre's treatment approach and 'outcomes'. 3) Engage with different audiences to communicate research findings. I plan to present one paper at the annual European Association of Social Anthropology (EASA) conference, and one at the Italian Association for Applied Anthropology (SIAA) annual conference. 4) Develop impact opportunities. In terms of research impact, I plan to teach a module in the specialisation course 'Good Treatment Practices for Eating Disorders' that is offered annually by the treatment centre where I conducted PhD fieldwork to members of treatment teams working in the field of eating disorders across the country. In addition, I intend to build networks with the following research institutes: - The Eating Disorder Research Group, Kings' College London (one of its Coordinators is internationally renowned as one of the world leading experts on family therapy for eating disorders); - The CNR Interdepartmental Centre for Research Ethics and Integrity, Institute of Bioethics, in Rome (Italy), which hosts multidisciplinary research on health, food and medicine. 5) Develop a funding proposal for a longer-term postdoctoral research project. Against the background of recent shifts of focus on 'prevention' programmes for eating disorders in Italy, what about the many who are already, and chronically, ill? My longer-term postdoctoral research project would explore the forms that care can take, within and outside clinics, for the many chronic patients who end up living with the condition for the rest of their lives, and for whom clinics sometimes become homes. The research proposal would be sent, among others, to the Wellcome Trust, the Marie Curie fellowship, and the British Academy fellowship. 6) Teaching. I will contribute to the teaching of the Social Anthropology Department by supervising one undergraduate dissertation (I have already been assigned the student) and by giving one lecture on the anthropology of eating disorders as part of the paper SAN13 Gender, Kinship and Care, of which my proposed mentor is Coordinator.

Lay abstract: The research that will be carried out as part of the fellowship will aim to address two important aspects that emerged during my doctoral research in an eating disorder treatment centre in Itay: 1) the ways in which treatment needs to increasingly adjust to patients who are younger and younger - often children of 8-12 years old; and 2) whether, and in what ways, the family work that is done during residential treatment and that is considered fundamental for a successful recovery 'travels back' to patients' homes once they are discharged from the facility. One finding that emerged from my research is that most treatment practices for eating disorders are based on the assumption that the patient who is being treated has a psychological, internal world that s/he is aware of, capable of discovering and communicating about with her therapists. It is also assumed that most treatment approaches have the aim of helping patients regain some sort of 'autonomy'. This aim is based on the idea that part of the reason why patients developed an eating disorder in the first place has to do with their parents being 'overinvolved' or 'enmeshed'. Treatment thus mostly addresses these issues: reaching 'autonomy' is a key aim. For this fellowship I want to explore how treatment practices for eating disorders find themselves having to adjust to the increasingly prevalent phenomenon of 'preadolescent anorexia'. I will investigate what can be done - and what professionals currently do - when this treatment logic comes to an impasse with these younger patients. How can treatment work with these patients, who are deemed incapable of expressing their thoughts and feelings with the depth considered necessary for successful therapeutic work? How can health professionals and patients collaborate if children are seen as lacking a supposedly coherent internal world to be disclosed to professionals during psychological therapy? How does the aim of helping patients to regain their autonomy work with children, who by virtue of their age are not considered autonomous and cannot disentangle themselves from their families? What kind of treatment practices are effective for these younger patients, and what could be considered as realistic aims of therapy - aside from restoring a 'healthy weight'? These questions will be explored through research in one of the very few residential facilities in Italy that admit patients under the age of 14, by observing the ways in which therapeutic activities are adapted to these younger patients, and by interviewing members of the treatment team who work closely with them. A second important issue that emerged during my doctoral fieldwork is that the treatment team agrees that it is very hard for patients to recover if their families are not involved in treatment and do not undergo some 'family work'. Since eating disorders are understood to develop, in part, as ways to deal with complex and 'unhealthy' family dynamics, it follows that for treatment to work the patient's family will need to undergo some important transformation too. The family carers of the patients who are admitted in residential treatment are therefore assigned a family counsellor that they are supposed to meet once every two weeks, and are supposed to attend weekly support meetings for families. Through these activities, patients' parents are asked to 'work on themselves' and learn how to best support their daughters' recovery. Nevertheless, professionals point out that many families find it difficult to do this. As a consequence, several patients suffer from severe relapses once discharged, and need to be admitted to residential treatment again after a few months. My aim, therefore, is to interview the family carers of patients who have been discharged, and examine the 'roadblocks' of this important node of treatment - and what can be done to address them.

Research activity codes: 5.6 PSYCHOLOGICAL AND BEHAVIOURAL;7.1 INDIVIDUAL CARE NEEDS
Health categories: MENTAL HEALTH