Going Global? Recovery Stories and Autobiographical Power in the 21st Century

In our third post responding to The Recovery Narrative: Politics and Possibilities of a Genre, Neely Myers affirms the value of recovery narratives and writes about the importance of autobiographical power to healing. 

“Do not be satisfied with the stories that come before you. Unfold your own myth.”—Jalal al-Din Rumi, Sufi poet, 13th century

“And as the crowd rose to its feet, she began to shout: Recovery! Get it, get over it, or get out!  Take this back to the programs and the services and the case managers! Take it and run with it!” – Vera, 2004, peer support leader1

What is Recovery, anyways?

I have been engaged in ethnographic research on mental health recovery for 15 years in the U.S. and six years in Tanzania. As an anthropologist, I focus on the ways that culture[i]  shapes the experience of “recovery” from what Woods, Hart and Spandler2 describe as “madness, distress and mental illness.”3  Through this research, I have found that a person is in “recovery” when they experience a return to what they consider to be a “good life,” however that is defined in the social context in which they aim to flourish.4 This return to a good life, I argue, is a culturally-informed, intersubjective healing process that often involves moral agency5, or the freedom to aspire to a “good life” in a way that makes possible intimate engagements with others. By analysing recovery stories from my work in the U.S., I identified three key capabilities that make moral agency possible for people seeking mental health recovery: autobiographical power, or the ability to at least be the editor of one’s own life story; the ability to be recognized[ii] by others as a “good” and valued person (the social bases of self‐respect); and “peopled opportunities” to engage in meaningful relationships with others (e.g., close friendships, marriage, employment, volunteer roles).4 Autobiographical power, or being able to at least be the editor of own’s own life, is crucial to replenishing moral agency in the aftermath of a psychiatric crisis, at least in local moral worlds that value the narrative self.[iii]

From Quixotic to Generic: Autobiographical Power and the American Recovery Movement

Autobiographical power is not a freedom afforded to everyone who has experienced a mental health crisis; it must be made culturally available. Since the 1970s, at least, many advocates in the patchwork American Recovery Movement – acting with the verve suggested in Vera’s quote above – have aspired to their own, culturally-informed version of a “good life” in part through the reclaiming of autobiographical power.6 This has, in part, led to the creation and sharing of recovery stories.7–9

When I first started asking about recovery stories in 2004 as I engaged in my first invited ethnographic project, which is now a book1, getting a person to tell me any recovery story was challenging. It was definitely not a genre. Many of the long-term mental health service users I was trying to interview were confused when I asked about recovery. They had been told they had a chronic mental illness and would never live a normal life. “We have no idea what recovery is,” one service user protested at an administrator-led meeting about promoting recovery at the state capitol for the service organization. When so few people knew what recovery was, it was easy for it to be co-opted and misappropriated and used by institutions for neoliberal means as Woods, Handler and Spade warned. Chronic and persistent mental illness was the main paradigm and recovery and people in recovery leading peer support services quixotic to many of the mental health service administrators and providers that I met. And while many folks still think this way in the U.S., things are changing here thanks to the bravery of activists who shared their recovery stories with others and so created the genre.

Whose Story?

In 2012, I engaged in a second invited ethnographic project at a peer service organization in an impoverished, African American urban neighbourhood. I was again struck by how often people told me they had never even been asked to tell their stories.10 Our interlocutors shared stories of challenging life circumstances (high neighbourhood violence and high police presence and violence, a culture of high drug use) that contributed to adolescent confusion and some very mental health-threatening circumstances, such as being overmedicated, experiencing multiple incarcerations without mental health support, and being placed in solitary confinement (which can be psychotogenic), for example.11  These stories included numerous mis/missed-understandings[iv] at the hands of medical and law enforcement professionals. When asked, many indicated that no one had ever asked them to tell their life story before—and many were grateful for our listening.

In this social context, the loss of autobiographical power for our interlocutors was a form of social defeat12 that had a negative effect on people’s mental health recovery. How can you even begin to tell your own story if no one asks, and instead, people tell stories about you that put you down?  What happens if your autobiographical details are erased by institutions assigned with your “care” so that you become another statistic justifying the need for that institution? This project inspired me to help more people have the opportunity to tell their own stories in their own ways.  We need ethical storytelling, but we still need stories.

Recovery Stories as Moral Laboratories

Recovery stories are more than a genre; they help people heal.  In my research, sharing stories can help a person reorient themselves in their local moral worlds13 in the aftermath of a crisis. They invite mutual recognition and moral resonance between the teller and the audience. They can reconnect a person who previously felt disconnected, unrecognized, and unloved for whatever reason. They help people feel understood and help loved ones understand.

In my most recent research in the U.S., my research team engaged 37 young people who had experienced a recent initial psychotic break and followed up with them ethnographically over the next six months.14 This time, I had the opportunity to watch many recovery stories emerge over time between young people and their self-identified “key supporters.” While many of our participants avoided mental health “care” during the six months after their initial hospitalization, they still sought to make sense of their past, present and future. Many young people used autobiographical power in collaboration with their key supporters during this time to heal.

For example, one of my interlocutors, Ariana, stopped taking medications, quit her job where people were gossiping viciously about her previous behaviours during her psychotic break, and dropped out of mental health treatment.15  Most institutional “recovery stories” would not go this direction, but Ariana’s efforts helped restore her to being a “good” person in her local moral world as her key supporters helped her re-envision herself as a good daughter, a good wife, and a good aunt rather than someone who had been to the “crazy house.” Anthropologist Cheryl Mattingly claims that spaces of everyday life can be “moral laboratories,” or spaces of creative “narrative re‐envisioning” where, with the help of others, one can potentially come “to see one’s self in a new way…becoming a kind of person capable of formulating and acting upon commitments that one deems ethical.”16  As long as one has autobiographical power, recovery stories can be moral laboratories that make space for interpersonal healing.15 And I have never met a person who has recovered alone.

Where There are No Recovery Stories

But I have come across people who have become so alone they cannot experience recovery. Social abandonment of people with serious mental illness is a real issue that is being documented in various ways in various cultural contexts around the world, including the U.S.17,18 [v] This happens more easily, I think, where no one has heard a recovery story.

In 2015, I gave an invited lecture at a major medical training facility in Tanzania on recovery from schizophrenia in the U.S.  During the Q & A and further conversations that day, I realized that many people did not believe that recovery from a psychotic disorder was possible. In Tanzania, there is little to no support for mental health care. There is a lack of funding, hospital beds, medications, social welfare programs, mental health professionals—the list goes on.19 “This recovery is just not something we see here,” a professor told me later that day.

In a more rural area later that summer, I tried to explain to a well-educated pastor that his sister who very likely had postpartum psychosis could get better with moral support and the right medication at a minimum dose over a short period of time (as I had been advised by an American psychiatrist by phone the day before). He had been trying to help her in every way possible for the past six months but the family was running out of money and hope and his sister’s mental well-being remained precarious.

He looked at me with an expression I have come to know from working in this incredibly low-resource setting with a long history of white people making promises they can’t keep—a wrenching expression of pain, sorrow, distrust, confusion…hope?

“This getting better is something we have never seen,” he said quietly. “If a person here runs mad, they are lost.” So please, could I bring a person in recovery with me next time and introduce them to others so they could see for themselves that recovery was possible? Even better if they were from a nearby village so people know it is true. “We need to hear that story,” he said. People needed a reason for hope.  In fact, I have met user-survivor advocates from Nepal and sub-Saharan Africa who are using recovery stories to ask for more mental health care.[vi]

Go Stories, go!

And so, while recovery stories are not perfect, we need them. Finding love, acceptance and connection with others is perhaps one of the most critical challenges for people seeking recovery from extreme states.20–22  Recovery stories told in a situation where a person retains autobiographical power, or editorial control, can help. Let’s keep working to make sure that recovery stories are told in ways that are meaningful for the people producing them and not overwritten by institutional or neoliberal priorities[vii], but let’s not throw away the whole enterprise.  Perhaps if we made more efforts to encourage non-institutional, “recovery stories” from diverse people living in cultures outside of the Global North, we would not be so quick to worry about the homogenization and institutionalization of recovery narratives, and we could focus on bring better mental health care, in the real sense of the word care, to all.

 

Neely Myers, is an Assistant Professor of Anthropology at Southern Methodist University and an Adjunct Assistant Professor of Psychiatry at University of Texas Southwestern Medical School. She is on Twitter @neelymyers

 

References Cited

  1. Myers, N. L. Recovery’s Edge: An Ethnography of Mental Health Care and Moral Agency. (Vanderbilt University Press, 2015).
  2. Woods, A., Hart, A. & Spandler, H. The Recovery Narrative: Politics and Possibilities of a Genre. Cult. Med. Psychiatry 1–27 (2019). doi:10.1007/s11013-019-09623-y
  3. Myers, N. L. N. L. Update: Schizophrenia across cultures. Curr. Psychiatry Rep. 13, 305–311 (2011).
  4. Myers, N. A. L. Recovery stories: An anthropological exploration of moral agency in stories of mental health recovery. in Transcultural Psychiatry 53, 427–444 (2016).
  5. Blacksher, E. On being poor and feeling poor: low socioeconomic status and the moral self. Theor. Med. Bioeth. 23, 455–70 (2002).
  6. Charlton, J. I. Nothing About Us Without Us: Disability, Oppression, and Empowerment. (University of California Press, 2000).
  7. Chamberlin, J. On Our Own: Patient-Controlled Alternatives to the Mental Health System. (McGraw-Hill , 1978).
  8. Jacobson, N. In Recovery: The Making of Mental Health Policy. (Vanderbilt University Press, 2004).
  9. McLean, A. Empowerment and the psychiatric consumer/ex-patient movement in the United States: contradictions, crisis, and social change. Soc. Sci. Med. 40, 1053–1071 (1995).
  10. Myers, N. A. L. & Ziv, T. “No One Ever Even Asked Me that Before.” Autobiographical Power, Social Defeat and Recovery among African Americans with Lived Experiences of Psychosis. Med. Anthropol. Q. 30, 395–413 (2016).
  11. Myers, N. A. L. Toward an applied neuroanthropology of psychosis: the interplay of culture, brains and experience. Ann. Anthropol. Pract. 36, 113–130 (2012).
  12. Luhrmann, T. M. Social defeat and the culture of chronicity: or, why schizophrenia does so well over there and so badly here. Cult. Med. Psychiatry 31, 135–172 (2007).
  13. Kleinman, A. Moral Experience and Ethical Reflection: Can ethnography reconcile them? A quandary for ‘the new bioethics’. Daedalus Fall 1999, (1999).
  14. Myers, N., Sood, A., Fox, K. E., Wright, G. & Compton, M. T. Decision Making About Pathways Through Care for Racially and Ethnically Diverse Young Adults With Early Psychosis. Psychiatr. Serv. 70, 184–190 (2018).
  15. Myers, N. L. Beyond the “Crazy House”: Mental/Moral Breakdowns and Moral Agency in First‐Episode Psychosis. Ethos 47, 13–34 (2019).
  16. Mattingly, C. Moral Laboratories: Family Peril and the Struggle for a Good Life. (University of California Press, 2014).
  17. Luhrmann, T. & Morrow, J. Our Most Troubling Madness. (University of California Press, 2016).
  18. Biehl, J. G. Vita: Life in a zone of social abandonment. (University of California Press, 2005).
  19. WHO, W. H. O. Mental Health Atlas 2011. (2011).
  20. Mead, S. & Hilton, D. Crisis and Connection. Psychiatr. Rehabil. J. 27, (2003).
  21. Saks, E. The Center Cannot Hold: My Journey through Madness. (Hyperion, 2007).
  22. Nudel, C. Firewalkers: Madness, beauty and mystery. (2009).
  23. Lambert, J. Digital Storytelling Cookbook. (Digital Diner Press, 2010).
  24. Lambert, J. Digital Storytelling: Capturing Lives, Creating Community – Joe Lambert – Google Books. (Routledge, 2013).

 

 

[i] For my purposes, “culture” refers to ways of life, or things held dear, including: the social order (institutions, hierarchies and social agreements like morality); environment (place, space, time); and meaning making systems (history, religion, myth, science, traditional healing, western biomedicine).

[ii] Here, we might take this quite literally from the Latin etymological roots, as re-cognize, or “know again,” “learn again.”

[iii] See, for a counterexample, Woods, Hart and Spandler’s (2019) important notes on Strawson’s work on the non-narrative self and the ways that “narrative self-articulation is a social, institutional or therapeutic imperative” that may be “highly unnatural” for some people.

[iv] For example, young black me in the U.S. are three times more likely to be diagnosed with a psychotic disorder than the white population.

[v] See, for example, Robin Hammond’s photographic essay, Condemned: https://www.robinhammond.co.uk/condemned-mental-health-in-african-countries-in-crisis/.

[vi] See, for example, https://frontpageafricaonline.com/health/liberias-mental-health-service-users-shine-at-global-mental-health-meeting-in-south-africa/

[vii] Storycenter does really good work in this area, and has developed a trauma-informed Digital Storytelling process to empower communities to self-advocate for social justice for the past 25 years.23,24

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