Assemblages of care: why women with disordered eating are ambivalent to seek therapeutic care

This thesis critically examines why women with disordered eating are reluctant or resistant to seek professional health care. In exploring whether participants perceive their eating practices to be problematic, I analyse how health, illness and disorder are constantly negotiated processes understood through the multiple contexts of care and its intersections with postfeminism, neoliberalism and healthism. I argue that these political and cultural contexts represent a constellation of contemporary forces that together have created an environment where disordered eating practices can be culturally valued, allowing the women in this study to rationalise their practices as healthy lifestyle choices and embodied performances of self-care. Employing a mixed methods approach (including ethnographic interviewing and observation, diary writing and psychological evaluation) with 28 women in metropolitan Adelaide, South Australia, this research is one of the few national or international studies to engage with people who deny they have disordered eating and/or do not actively seek professional help. Extending Foucauldian theories of self-discipline and individual responsibility I argue that Bourdieu’s (1977) concept of habitus and Mol, Moser and Pols’ (2008, 2010) concept of care provide a broader theoretical framework to understand the ways in which people with disordered eating embody and practise care as a form of ‘healthism’. In this way their agency of choice enables them to engage in gendered bodywork and symbolic capital. Key to my argument is how desire works in practices of care, and I draw on Deleuze and Guattari (1987) and Probyn’s (1996, 2000) productive theories of desire to show that desire is not contained within individuals but is constantly articulated in social relations and spaces. It is through this Deleuzian approach to desire that I reveal the ambivalence of care, and the ways in which disordered eating provides a safe space for both caring and not caring. In so doing I demonstrate how and why people rarely follow a linear trajectory from (distinct categories of) illness to recovery, and are instead propelled constantly back and forth in movements that connect them to the perceived safety of caring spaces. Desire is thus positioned as a rhizomatic framework for tracing the everyday enactments and multiple assemblages of care which intersect in participants’ lives. Examining experiences of disordered eating through the theoretical lens of care, this thesis provides new knowledge about how the notion of care is rationalised, experienced and performed in participants’ lives. I argue that this understanding of care is at odds with assumed, clinical and therapeutic models of care, thus providing new insights into the low rates of help seeking amongst people with disordered eating and the high rates of relapse and therapeutic treatment failure. This work has significance to both social scientists and to health professionals working in the fields of disordered eating.Thesis (Ph.D.) (Research by Publication) -- University of Adelaide, School of Social Sciences, 2016

‘Healthy anorexia’: The complexity of care in disordered eating

Author version made available in accordance with the publisher's policy. An embargo period of 36 months from date of publication will apply. © 2015. This manuscript version is made available under the CC-BY-NC-ND 4.0 license http://creativecommons.org/licenses/by-nc-nd/4.0/Objective: To develop a psychotherapy rating scale to measure therapist adherence in the Strong Without Anorexia Nervosa (SWAN) study; a multi-centre randomised controlled trial comparing three different psychological treatments for adults with Anorexia Nervosa. The three treatments under investigation were Enhanced Cognitive Behavioural Therapy (CBT-E), the Maudsley Anorexia Nervosa Treatment for Adults (MANTRA) and Specialist Supportive Clinical Management (SSCM). Method: The SWAN Psychotherapy Rating Scale (SWAN-PRS) was developed, after consultation with the developers of the treatments, and refined. Using the SWAN-PRS, two independent raters initially rated 48 audiotapes of treatment sessions to yield inter-rater reliability data. One rater proceeded to rate a total of 98 audiotapes from 64 trial participants. Results: The SWAN-PRS demonstrated sound psychometric properties, and was considered a reliable measure of therapist adherence. The three treatments were highly distinguishable by independent raters, with therapists demonstrating significantly more behaviours consistent with the actual allocated treatment compared to the other two treatment modalities. There were no significant site differences in therapist adherence observed. Discussion: The findings provide support for the internal validity of the SWAN study. The SWAN-PRS was deemed suitable for use in other trials involving CBT-E, MANTRA or SSCM

The management of cognitive labour in same-gender couples.

ObjectiveThis study explored how cognitive labour as a form of unpaid, household labour is performed by people in same-gender couples.BackgroundExcessive performance of unpaid labour has been associated with several health impacts. Cognitive labour (anticipating needs, identifying options for meeting needs, making decisions and monitoring progress) is an underexamined dimension of unpaid labour which has centered on the experiences of heterosexual couples.MethodDyadic and individual interviews were carried out to explore how cognitive labour was performed in same-gender couples between March and October 2021 using an inductive methodology. Adults who were in a same-gender couple, had lived with their partner for at least six months, were not living with children were recruited largely via social media.ResultsExamining cognitive labour performance amongst same-gender couples revealed four key themes: 1) habitually fostered patterns of trust; 2) agency in redefining family; 3) barriers to cognitive harmony; and 4) facilitators to cognitive harmony. Findings regarding the relationships between themes are presented in a narrative model. Dyadic interviews allowed for deep, narratives relating to cognitive labour performance.ConclusionsThe narrative model provides new conceptual understanding of how cognitive labour is performed outside of the heteronormative sphere. Couple's adoption of a strengths-based frame to cognitive labour performance removed the opposition inherent in gender dichotomies. These findings support calls for research to incorporate social change to build and refine theory, including how queer and feminist movements have challenged gendered and heteronormative family and household roles

How do advisory groups contribute to healthy public policy research?

Objectives: This paper reflects on experiences of Australian public health researchers and members of research policy advisory groups (PAGs) in working with PAGs. It considers their benefits and challenges for building researcher and policy actor collaboration and ensuring policy relevance of research. Methods: Four research projects conducted between 2015 and 2020 were selected for analysis. 68 PAG members from Australian federal, state and local governments, NGOs and academics participated in providing feedback. Thematic analysis of participant feedback and researchers’ critical reflections on the effectiveness and capacity of PAGs to support research translation was undertaken. Results: PAGs benefit the research process and can facilitate knowledge translation. PAG membership changes, differing researcher and policy actor agendas, and researchers’ need to balance policy relevance and research independence are challenges when working with PAGs. Strategies to improve the function of health policy research PAGs are identified. Conclusions: The paper suggests a broader adapted approach for gaining the benefits and addressing the challenges of working with PAGs. It opens theoretical and practical discussion of PAGs’ role and how they can increase research translation into policy

Gender Equality and the Global Gender Gap in Life Expectancy: An Exploratory Analysis of 152 Countries

When looking at life expectancy (LE) by sex, women live longer than men in all countries. Biological factors alone do not explain gender differences in LE, and examining structural differences may help illuminate other explanatory factors. The aim of this research is to analyse the influence of gender inequality on the gender gap in LE globally. We have carried out a regression analysis between the gender gap in relativised LE and the UN Gender Inequality Index (GII), with a sensitivity analysis conducted for its three dimensions, stratified by the six World Health Organization (WHO) regions. We adjusted the model by taking into consideration gross national income (GNI), democratic status and rural population. The results indicated a positive association for the European region (ß=0.184) and the Americas (ß=0.136) in our adjusted model. Conversely, for the African region, the relations between gender equality and the LE gender gap were found to be negative (ß=-0.125). The findings suggest that in the WHO European region and the Americas, greater gender equality leads to a narrowing of the gender LE gap, while it has a contrary relationship in Africa. We suggest that this could be because only higher scores in the GII between men and women show health benefits.This work was supported by the UK Academy of Medical Sciences Global Challenges Research Fund Networking Grant under Grant ACP Ref No. 102292 ‘Punching above their weight: Building capacity for research on some countries have better life expectancies than predicted by national income.

Punching above their weight: A network to understand broader determinants of increasing life expectancy

Background: Life expectancy initially improves rapidly with economic development but then tails off. Yet, at any level of economic development, some countries do better, and some worse, than expected - they either punch above or below their weight. Why this is the case has been previously researched but no full explanation of the complexity of this phenomenon is available. New research network: In order to advance understanding, the newly formed Punching Above Their Weight Research Network has developed a model to frame future research. It provides for consideration of the following influences within a country: political and institutional context and history; economic and social policies; scope for democratic participation; extent of health promoting policies affecting socio-economic inequities; gender roles and power dynamics; the extent of civil society activity and disease burdens. Conclusion: Further research using this framework has considerable potential to advance effective policies to advance health and equity.Flinders University provided a capacity building grant to support the research reported in this paper

Punching above their weight: a network to understand broader determinants of increasing life expectancy

BACKGROUND: Life expectancy initially improves rapidly with economic development but then tails off. Yet, at any level of economic development, some countries do better, and some worse, than expected – they either punch above or below their weight. Why this is the case has been previously researched but no full explanation of the complexity of this phenomenon is available. NEW RESEARCH NETWORK: In order to advance understanding, the newly formed Punching Above Their Weight Research Network has developed a model to frame future research. It provides for consideration of the following INFLUENCES WITHIN A COUNTRY: political and institutional context and history; economic and social policies; scope for democratic participation; extent of health promoting policies affecting socio-economic inequities; gender roles and power dynamics; the extent of civil society activity and disease burdens. CONCLUSION: Further research using this framework has considerable potential to advance effective policies to advance health and equity

Liveability transitioning: Results of a pilot study of walking, accessibility, and social connection strengths weaknesses in established suburbs in Adelaide

10.1080/23748834.2022.2161978Cities & Health73433-46

Why are Indigenous Affairs Policies Framed in ways that Undermine Indigenous Health and Equity? : Examining Australia’s Northern Territory Emergency Response

The 2007 Australian Northern Territory Emergency Response policy was harmful to the health of Aboriginal and Torres Strait Islander people. We thematically analysed 72 speech acts and reports from the three prominent perspectives: a Northern Territory government inquiry report, the Federal government, and an Aboriginal civil society coalition to examine how framings during the policy agenda setting phase constrained or supported scope for equitable health outcomes. The report authors and the coalition emphasised colonisation and other social determinants of Indigenous health. The Federal government used a discourse of pathology and white sovereignty. Our findings highlighted the need for Indigenous voice in policy making, and the need to address colonial assumptions underpinning policy framings to achieve Indigenous health equity

Why are Indigenous Affairs Policies Framed in ways that Undermine Indigenous Health and Equity? Examining Australia’s Northern Territory Emergency Response

The 2007 Australian Northern Territory Emergency Response policy was harmful to the health of Aboriginal and Torres Strait Islander people. We thematically analysed 72 speech acts and reports from the three prominent perspectives: a Northern Territory government inquiry report, the Federal government, and an Aboriginal civil society coalition to examine how framings during the policy agenda setting phase constrained or supported scope for equitable health outcomes. The report authors and the coalition emphasised colonisation and other social determinants of Indigenous health. The Federal government used a discourse of pathology and white sovereignty. Our findings highlighted the need for Indigenous voice in policy making, and the need to address colonial assumptions underpinning policy framings to achieve Indigenous health equity