Mealtime practices in the treatment of restrictive eating disorders: an ethnographic study of Norwegian youth psychiatric units

Youths with restrictive eating disorders can be admitted to voluntary and involuntary treatment in acute psychiatric units for children and adolescents when their need for help is urgent or there is an emergency situation related to their vital functions. Providing sufficient nutrition for these patients is a key focus in treatment plans, making meal planning and calorie intake an essential part of the treatment. This article examines mealtime practices in the treatment of restrictive eating disorders at child and adolescent psychiatric acute hospitals in Norway. The analysis shows a complex interplay between treatment and coercion, where coercion underpins and ultimately ensures treatment compliance. The study contributes to the limited literature on coercion in inpatient child and adolescent psychiatry, and findings call for critical reflection to advance new ways of enforcing nutritional intake for patients with eating disorders admitted to involuntary treatment. The analysis is based on ethnographic fieldwork conducted across three acute units in Norway. Drawing on Goffman's perspectives on frame analysis and his dramaturgical approach to social interaction, we examine how the establishment of frames in eating situations produces different meanings for this treatment activity. In our analysis, we demonstrate how three different frames (a biomedical therapeutic frame, a coercion frame, and a mealtime frame) constitute and regulate interactional behaviour in eating situations, and how participants negotiate these frames. It is argued that treatment and coercion are entangled in the routine treatment activity of meals, which makes coercion omnipresent in the treatment of restrictive eating disorders. • A biomedical approach dominates the treatment focus within youth psychiatric institutions, which makes meals and calorie intake an essential part of the treatment • The analysis demonstrates how treatment and coercion are entangled in the routine treatment activity of meals • Our findings encourage critical reflections on the current meal practices in the involuntary treatment of eating disorders