From Maintenance to “Recovery”: Mental Health Care and “Necessity” in the Age of Assessment
Bibliographic record
Abstract
Community mental health in the US is apparently marked by perpetual revolutions. Case management, evidence-based medicine, neuroscience and more have all been identified as transformative forces that promise to change institutional logics, practices, and outcomes in major ways as they are deployed. The latest to emerge in this context is Recovery. This dissertation critically explores how a mental health program in Chicago called “Hemsworth” has attempted to implement the new treatment philosophy of Recovery. While numerous scholars, policy-makers, and consumers still recognize Recovery as a system-transforming force, I argue that Recovery itself has become a method to advance the knowledge, practices, and priorities of biopsychiatry and audit culture. To highlight this creative repurposing (and domestication) of Recovery I use Jacques Lacan’s discourse theory as a critical lens to ethnographically investigate program life. I begin by examining what is changing in the name of Recovery at Hemsworth, and discover that many of the services created in the name of recovery-oriented care advance a pedagogical-parental relationship that renders madness a problem of knowledge that is to be better accounted for by the consumer-qua-self-manager. I then closely consider other initiatives within public mental health that intersect with Recovery, namely medical necessity and audit-based practices. I demonstrate how these initiatives creatively appropriate the discursive resources of Recovery in order to further advance both neoliberal and biopsychiatric norms, values, and priorities – thus, ensuring that substantive changes to organizational culture do not occur. Perhaps the biggest revolution that Recovery is said to inaugurate is a subjective revolution, an imagining of a new human outfitted with previously unseen forms of agency and insight. At Hemsworth, however, I found a familiar subject that was guided to relate to oneself and others in rather predictable neoliberal and biomedical ways. I conclude with a discussion of anthropology’s interest in finding alternatives to hegemonic biopsychiatric care in the US, and go on to explore a novel mental health treatment program in Canada based on psychoanalytical theory.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.005 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".