Recovery's Edge

Reviewed by: Recovery's Edge: An Ethnography of Mental Health Care and Moral Agency by Neely Laurenzo Myers Ippolytos Kalofonos 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 the United States since the turn of the millennium. A treatment philosophy that emerged from the disaster of deinstitutionalization and the disappointment of the psychopharmaceutical revolution, it draws on sources eclectic as antipsychiatry, the 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 the hopelessness of biological reductionism, nor dependent on social services. The central precepts of recovery 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 recovery movement's ostensibly radical "core concepts of empowerment, self-determination, and freedom of choice" (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 recovery by neoliberal reformers as a move to withdraw care and services from the chronically mentally ill by declaring them "recovered" and substituting care with choice (Braslow 2013, Myers 2015:8). This is the point of departure of Neely Myers's powerful book, in which she ethnographically documents how one community mental health [End Page 299] agency in the urban US, called Horizons, navigated the shift from "traditional" mental health services to recovery-oriented care through the creation of a peer-led treatment program. Myers documents her own intimate journey as she developed relationships with the staff and clients, or "members," of the agency. She provides a contextualized account of the stark realities of living with severe, chronic mental illness and poverty in the urban US, revealing the promises, pitfalls, complexities, and contradictions of contemporary mental health reform and the 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 the "oft-overlooked driver of recovery" (13). Mental health crisis results in an initial loss of moral agency. This loss is perpetuated by the 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 the context with an account of the history of deinstitutionalization and the never-delivered promise of community-based care. A major theme introduced here is the 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 the "institutional circuit," including hospitals, jails, prisons, shelters, nursing homes, outpatient day programs, and the streets. Their lives revolved around the relationships, rules, and tasks of everyday life at the agency. Given this near total marginalization from mainstream society, members of the center created their "own local moral world" (49) that served as a sanctuary of sorts. This proved to be another double bind, as members were expected to recover, "graduate" from care, and leave those connections behind. [End Page 300] When operationalized in a context of commonsense American individualism and processed through contemporary neoliberal logics

Agency (philosophy) · Empowerment · Health care · Mental health · Mental illness · Political science · Politics · Presidential system · Psychotherapist · Social science · Sociology · Historical Psychiatry and Medical Practices · Law · Mental Health and Patient Involvement · Mental Health and Psychiatry · Psychology

• Rethinking social recovery in schizophrenia

  Open Access•K Hopper•Social Science & Medicine•2007

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