Culture of recovery? Schizophrenia, the United States' mental health system, and the American ethos of the self-made man.

摘要

At the turn of the 21st century, the American Recovery Movement - a group of concerned "consumers" (or users of the mental health system), researchers, policymakers, and family members of people with psychiatric disabilities - demanded changes be made to the institutional culture and treatment processes of the United States mental health care system. The Recovery Movement fundamentally believed that the healing experiences of people diagnosed with severe psychiatric disabilities were profoundly shaped by the cultural context in which they lived. Many medical anthropologists similarly argued that people's experience of mental distress may be socially mitigated by the way the cultural context in which they live attempts to understand and treat that distress (Kleinman 1980; Kleinman 1999; Jenkins and Barrett 2004; Good, Hyde et al. 2008). The Recovery Movement thus sought to promote a "culture of healing" rather than a "culture of recovery" within the "traditional" mental health system by making it more "recovery-oriented.";As part of this culture shift, the American Recovery Movement aimed to guide Americans with schizophrenia away from their role as a "crazy" person with a "chronic" psychiatric disability and towards the role of a "healthy" citizen who demonstrated civic virtue to gain access to the rights and interconnectedness of valued citizens. To do so, recovery advocates detailed a process of self-cultivation for people with schizophrenia unwittingly based on the classic American "journey of the self-made man," which they called the "journey of recovery." This journey included: establishing and maintaining an acceptable level of self-control and rationality, exhibiting an ability to act in one's own self-interest, and working hard in some kind of meaningful occupation.;This dissertation examined attempts to enact such a journey for members of Horizons, a psychosocial rehabilitation organization in the United States that was attempting to become more "recovery-oriented" by changing its organizational policies and offering peer services (or consumer run services).;As I analyzed the ways the "journey of recovery" was easy or difficult for members and staff at Horizons, I came to realize that the journey of recovery articulated by the American Recovery Movement - as it was presented at Horizons --- was, in three specific ways, a cultural mismatch between an institutional prescription for "healthy citizenship" and the actual needs and capabilities of Horizons' members with schizophrenia. First, the Recovery Movement largely ignored the limitations of the intensely stressful everyday situation from which many people with schizophrenia were expected to commence their journeys of recovery. Second, recovery advocates glossed over the stress embedded in the expectations of self-control, autonomy, and hard work demanded by the journey of recovery. Finally, the Recovery Movement never overtly addressed the lack of "social capital" available to people with schizophrenia living in the United States. These oversights had repercussions for Horizons' members and staff as they worked to implement the ideas of the Recovery Movement in a real-world setting and will ultimately need to be addressed for "recovery-oriented services" to move forward.