Recovery's Edge: An Ethnography of Mental Health Care and Moral Agency by Neely Laurenzo Myers

Abstract

Neely Laurenzo Myers, Recovery's Edge: An Ethnography of Mental Health Care and Moral Agency. Nashville: Vanderbilt University Press, 2015. 208 pp.Recovery has been a dominant paradigm shaping mental health policy in United States since turn of millennium. A treatment philosophy that emerged from disaster of deinstitutionalization and disappointment of psychopharmaceutical revolution, it draws on sources eclectic as antipsychiatry, psychiatric survivors and consumer rights movements, and psychosocial rehabilitation (Braslow 2013). Recovery advocates envision a new system of care that produces citizens no longer doomed by hopelessness of biological reductionism, nor dependent on social services. The central precepts of have been summarized as: renewing a sense of possibility, regaining competencies, reconnecting and finding a place in society, and repairing disruptions in self and career (Hopper 2007). The role of people with lived experience of mental illness, or peers is central to this approach at every level, from research, policy-making, and advocacy to frontline care provision. The movement's ostensibly radical core concepts of empowerment, self-determination, and freedom of (Myers 2015:7) were enshrined in George W. Bush's Presidential New Freedom Commission of 2003, an unfunded set of recommendations that many states have subsequently tried to implement. Critics see this embrace of by neoliberal reformers as a move to withdraw care and services from chronically mentally ill by declaring them recovered and substituting care with choice (Braslow 2013, Myers 2015:8).This is point of departure of Neely Myers's powerful book, in which she ethnographically documents how one community mental health agency in urban US, called Horizons, navigated shift from mental health services to recovery-oriented care through creation of a peer-led treatment program. Myers documents her own intimate journey as she developed relationships with staff and clients, or members, of agency. She provides a contextualized account of stark realities of living with severe, chronic mental illness and poverty in urban US, revealing promises, pitfalls, complexities, and contradictions of contemporary mental health reform and social abandonment members and staff worked against. Her detailed observations, poignant reflections, and incisive critique create a compelling account and an important contribution to medical anthropology and community psychiatry. Recovery's Edge is a story of relationships, therapeutic and traumatic, personal and professional, ruptured and repaired, lost and longed for, and often tragically unattainable.Myers's central thesis is that moral agency, the ability to be recognized as a 'good' person in a way that makes possible intimate connections with others, is oft-overlooked driver of recovery (13). Mental health crisis results in an initial loss of moral agency. This loss is perpetuated by ways people with mental illness are treated, both by society in general and by traditional mental health programs in particular. As a result, those with chronic, severe mental illness remain isolated and marginalized.Chapter 2, No Direction Home, establishes context with an account of history of deinstitutionalization and never-delivered promise of community-based care. A major theme introduced here is contradictions and double binds members faced as they sought to rebuild their lives despite recurring mental health crisis. One classic trap they faced was a dependence on Social Security insurance and Medicaid to pay for their high healthcare costs, yet full time, competitive employment would disqualify them of these benefits without providing a viable alternative. Members cycled through institutional circuit, including hospitals, jails, prisons, shelters, nursing homes, outpatient day programs, and streets. …