Therapists, [Emmeline] Clein writes, insist that the eating disorder is âa second self ⌠capable of mind control.â [...] Doctors would say, ââthis is the eating disorder talking,â when you try to describe desires or moods,â one patient recalls. âShe was praised when she was able to parse an âED thoughtâ from a supposedly genuine thought,â Clein writes, âand applauded when she narrated her illness in external terms, casting it as a bad friend or an abusive lover.â Anorexiaâs treatment thus reinscribes the diseaseâs own logic: the anorexic self is separate from the âtrueâ self, who must be recovered; threats to the true self must be identified, quarantined and locked awayâexorcised, evenârather than, as Clein puts it, âenduredâ and integrated. Clein, then, calls for a mode of treatment that teaches the patient to recognize the ways in which her agency has been scaffolded by and complicit in her disease. But she avoids any real confrontation with the problems that beset such a suggestion. The autonomy-deficit model has its attractions. In particular, it seeds an easy justification for why we must sometimes treat anorexics against their will. If anorexics are autonomous, shouldnât they be left to get on with their diets?
[...] I donât know whether Alyssa should have been prescribed the MAID [Medical Assistance in Dying] drugs. But I am sure that she wasnât lacking in autonomy. There was no demon lodged in Alyssa, wagging her tongue. Her voice is quite her own. The unhappy truth is that sometimes people with no agential defects will choose things that harm them. We can try to escape the hard choice between complicity on the one hand and paternalistic interference on the other by âfindingâ agential flaws where there are none. To read the anorexic as autonomous, then, need not mean that we stop trying to get her to eat. The anorexic governs and authors herself more fully than her peers. That doesnât show that we should admire her discipline. It shows that we should be warier of self-governance as an ideal.