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Culture, Medicine, and Psychiatry

, Volume 42, Issue 3, pp 628–646 | Cite as

Care Wounds: Precarious Vulnerability and the Potential of Exposure

  • Lauren Cubellis
Original Paper
  • 130 Downloads

Abstract

What does it mean to offer care when the act of caring is wounding to its giver? For peer specialists—individuals with lived experience as patients in the psychiatric system—this question shapes how they use their own histories to provide support for individuals experiencing psychiatric crisis. Peer support is unique in the way it draws on empathetic resonance and depends on carefully deployed vulnerability; where one connects with others through the recognition of shared experience and mutual hurt. For peers, care works when this guidance, reassurance, and "being with"—all of which draw upon their own stories of traumatic history and variegated suffering—mitigate the present crisis being experienced by another. Drawing on twenty-eight months of fieldwork with a peer-staffed crisis respite center in the eastern United States, I argue that the peer specialist becomes the embodiment of a novel intersection of intimacy and compensation; one that poses vulnerability not as a consequence, casualty, or risk factor in the commodification of care, but as its principle vector of resonance and the assumption on which it is based. For peers, care that works—in that it creates a mutual resonance for the recipient—becomes simultaneously care that wounds its giver.

Keywords

Care Precarity Mental health Peer support Homelessness 

Notes

Compliance with Ethical Standards

Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

References

  1. Allison, Anne 2013 Precarious Japan. Durham: Duke University Press.CrossRefGoogle Scholar
  2. Austin, Elizabeth, Aditi Ramakrishnan, and Kim Hopper 2014 “Embodying Recovery: A Qualitative Study of Peer Work in a Consumer-Run Service Setting.” Journal of Community Mental Health 50:879-885.CrossRefGoogle Scholar
  3. Bateson, Gregory 1971 “The Cybernetics of ‘Self’: A Theory of Alcoholism.” Psychiatry 34: 1-18.CrossRefGoogle Scholar
  4. Berardi, Franco 2009 The Soul at Work: From Alienation to Autonomy. South Pasadena, CA: Semiotext(e).Google Scholar
  5. Berger, John 1967 A Fortunate Man: The Story of a Country Doctor. New York: Vintage International.Google Scholar
  6. Biehl, João 2012 Care and Disregard. In A Companion to Moral Anthropology. Didier Fassin, ed., pp. 242–263. New York: Wiley-Blackwell.Google Scholar
  7. Brodwin, Paul 2013 Everyday Ethics: Stories from the Frontline of Community Psychiatry. Berkeley: University of California Press.Google Scholar
  8. Brown, Phil, Stephen Zavestoski, Sabrina McCormick, Brian Mayer, Rachel Morello-Frosch, and Rebecca Gasior Altman 2004 “Embodied Health Movements: New Approaches to Social Movements in Health.” Sociology of Health and Illness 26 (1): 50-80.CrossRefGoogle Scholar
  9. Buch, Elana D 2013 “Senses of Care: Embodying Inequality and Sustaining Personhood in the Home Care of Older Adults in Chicago.” American Ethnologist 40 (4): 637-659.CrossRefGoogle Scholar
  10. Cain, Carole 1991 “Personal Stories: Identity Acquisition and Self-Understanding in Alcoholics Anonymous.” Ethos 19 (2): 210-253.CrossRefGoogle Scholar
  11. Castillo, Enrico G., Bowen Chung, Elizabeth Bromley, Sheryl H. Kataoka, Joel T. Braslow, Susan M. Essock, Alexander S. Young, Jared M. Greenberg, Jeanne Miranda, Lisa B. Dixon, and Kenneth B. Wells 2018 “Community, Public Policy, and Recovery from Mental Illness: Emerging Research and Initiatives.” Harvard Review of Psychiatry 26(2):70-81.Google Scholar
  12. Cowie. Helen and Patti Wallace 2000 Peer Support in Action: From Bystanding to Standing By. London: SAGE Publications Ltd.Google Scholar
  13. Csordas, Thomas J. 1993 “Somatic Modes of Attention.” Cultural Anthropology 8 (2): 135-156.CrossRefGoogle Scholar
  14. Davis-Floyd, Robbie and Christine Barbara Johnson, eds. 2006 Mainstreaming Midwives: The Politics of Change. New York: Routledge.Google Scholar
  15. Desjarlais, Robert 1997 Shelter Blues: Sanity and Selfhood Among the Homeless. Philadelphia: University of Pennsylvania Press.CrossRefGoogle Scholar
  16. England, Paula 200. Emerging Theories of Care Work. Annual Review of Sociology. 31: 381–399.CrossRefGoogle Scholar
  17. Estroff, Sue E. 1985 Making it Crazy: An Ethnography of Psychiatric Clients in an American Community. Berkeley: University of California Press.CrossRefGoogle Scholar
  18. Folbre, Nancy 1994 Who Pays for the Kids?: Gender and the Structures of Constraint. New York: Routledge.CrossRefGoogle Scholar
  19. Folbre, Nancy. 2002. The Invisible Heart: Economics and Family Values. New York: The New Press.Google Scholar
  20. Garcia, Angela 2015 “Serenity: Violence, Inequality, and Recovery on the Edge of Mexico City.” Medical Anthropology Quarterly 29 (4): 455-472.CrossRefGoogle Scholar
  21. Glenn, Evelyn Nakano 2010 Forced to Care: Coercion and Caregiving in America. Cambridge: Harvard University Press.Google Scholar
  22. Gordon, Suzanne, Patricia Benner, and Nel Noddings 1996 Caregiving: Readings in Knowledge, Practice, Ethics, and Politics. Philadelphia: University of Pennsylvania Press.Google Scholar
  23. Greenberg, Michael 2017 Tenants Under Siege: Inside New City’s Housing Crisis. The New York Review of Books. August 17.Google Scholar
  24. Han, Clara 2011 “Symptoms of Another Life: Time, Possibility, and Domestic Relations in Chile’s Credit Economy.” Cultural Anthropology 26 (1): 7-32.CrossRefGoogle Scholar
  25. Hart, Michael 2011 “For Love or Money.” Cultural Anthropology 26 (4): 676-682.CrossRefGoogle Scholar
  26. Hinton, Devon E. and Laurence J. Kirmayer 2013 “Local Responses to Trauma: Symptom, Affect, and Healing.” Transcultural Psychiatry 50 (5): 607-621.CrossRefGoogle Scholar
  27. Hochschild, Arlie Russell 1983 The Managed Heart: Commercialization of Human Feeling. Berkeley: University of California Press.Google Scholar
  28. Hopper, Kim 2003 Reckoning with Homelessness. Ithaca: Cornell University Press.Google Scholar
  29. Hopper, Kim 2007 “Rethinking Social Recovery in Schizophrenia: What a Capabilities Approach Might Offer.” Social Science & Medicine 65 (5): 868-879.CrossRefGoogle Scholar
  30. Hopper, Kim 2016 Remarks on Care. In Annual Meeting of the American Anthropological Association Minneapolis, November 19.Google Scholar
  31. Intentional Peer Support 2014 Intentional Peer Support Facilitators Manual 2014. West Chester, NH: Intentional Peer Support.Google Scholar
  32. Jain, S. Lochlann 2014 Malignant: How Cancer Becomes Us. Berkeley: University of California Press.Google Scholar
  33. Jones, Nev, Casadi “Khaki” Marino, and Marie C. Hansen 2015 The hearing voice movement in the United States: findings from a national survey of group facilitators. Psychosis 8(2):106–117.Google Scholar
  34. Kleinman, Arthur 2012 “Caregiving as Moral Experience.” The Lancet 380: 1550-1551.CrossRefGoogle Scholar
  35. Lester, Rebecca 2013 “Back from the Edge of Existence: A Critical Anthropology of Trauma.” Transcultural Psychiatry 50 (5): 753-762.CrossRefGoogle Scholar
  36. Lester, Rebecca J. 2017 “Self-governance, Psychotherapy, and the Subject of Managed Care: Internal Family Systems Therapy and the Multiple Self in a US Eating-disorders Treatment Center.” American Ethnologist 44 (1): 23-35.CrossRefGoogle Scholar
  37. Lester, Rebecca 2018 Famished: Paradoxes of Care in American Eating Disorders Treatment. Berkeley: University of California Press.Google Scholar
  38. Livingston, Julie 2012 Improvising Medicine: An African Oncology Ward in an Emerging Epidemic. Durham: Duke University Press.CrossRefGoogle Scholar
  39. Lovell, Anne M. 1997 The City is My Mother: Narratives of Schizophrenia and Homelessness. American Anthropologist 99 (2): 355-368.CrossRefGoogle Scholar
  40. Luhrmann, Tanya M. 2001 Of Two Minds: An Anthropologist Looks at American Psychiatry. New York: Vintage.Google Scholar
  41. Luhrmann, Tanya M. 2007 “Social Defeat and the Culture of Chronicity: Or, Why Schizophrenia Does So Well Over There and So Badly Here.” Culture, Medicine, Psychiatry 31 (2): 135-172.CrossRefGoogle Scholar
  42. Mauss, Marcel 2000. The Gift: The Form and Reason for Exchange in Archaic Societies. New York: W.W. Norton.Google Scholar
  43. McLean, Athena 2000 “From Ex-Patient Alternatives to Consumer Options: Consequences of Consumerism for Psychiatric Consumers and the Ex-Patient Movement. International Journal of Health Services 30 (4): 821-847.CrossRefGoogle Scholar
  44. Mead, Shery and Mary Ellen Copeland 2000 “What Recovery Means to Us.” New York: Plenum Publishers.Google Scholar
  45. Mead, Shery and David Hilton 2003 “Crisis and Connection.” Psychiatric Rehabilitation Journal 27 (1): 87-94.CrossRefGoogle Scholar
  46. Mead, Shery and Cheryl MacNeil 2005 “A Narrative Approach to Developing Standards for Trauma-Informed Peer Support.” American Journal of Evaluation 26: 231-244.CrossRefGoogle Scholar
  47. Mead, Shery and Cheryl MacNeil 2006 Peer Support: What Makes it Unique? International Journal of Psychosocial Rehabilitation, 10 (2): 29-37.Google Scholar
  48. Millar, Kathleen M. 2014 “The Precarious Present: Wageless Labor and Disrupted Life in Rio de Janeiro, Brazil.” Cultural Anthropology 29 (1): 32-53.CrossRefGoogle Scholar
  49. Muehlebach, Andrea 2013 “On Precariousness and the Ethical Imagination: The Year 2012 in Cultural Anthropology.” American Anthropologist 115 (2): 297-311.CrossRefGoogle Scholar
  50. Myers, Neely Laurenzo 2015 Recovery’s Edge: An Ethnography of Moral Agency. Nashville: Vanderbilt University Press.Google Scholar
  51. Myers, Neely Laurenzo 2016 “Recovery Stories: An Anthropological Exploration of Moral Agency in Stories of Mental Health Recovery.” Transcultural Psychiatry 53 (4): 427-444.CrossRefGoogle Scholar
  52. Mol, Annemarie 2008 The Logic of Care: Health and the Problem of Patient Choice. New York: Routledge.Google Scholar
  53. Mol, Annemarie, Ingunn Moser, and Jeannette Pols 2010 Care in Practice: On Tinkering in Clinics, Homes and Farms. London: Transcript-Verlang.CrossRefGoogle Scholar
  54. Mosher, Loren R. 1992 “The Social Environmental Treatment of Psychosis: Critical Ingredients.” In Psychotherapy of Schizophrenia: Facilitating and Obstructive Factors, edited by A. Webart and J. Culberg, 254-269. Oslo: Scandinavian University Press.Google Scholar
  55. Mosher, Loren R. and A.Z. Menn 1978 “Community Residential Treatment for Schizophrenia: Two-year Follow-up.” Hospital and Community Psychiatry 29: 715-723.Google Scholar
  56. Mosher, Loren R., V. Hendrix, and D.C. Fort 2004 SoteriaThrough Madness to Deliverance. Philadelphia, PA: Xlibris.Google Scholar
  57. Rapp, Rayna and Faye Ginsburg 2011 “Reverberations: Disability and the New Kinship Imaginary.” Anthropology Quarterly 84 (2): 379-410.CrossRefGoogle Scholar
  58. Rhodes, Lorna 1995. Emptying Beds: The Work of an Emergency Psychiatric Unit. Berkeley: University of California Press.Google Scholar
  59. Robbins, Joel 2013 “Beyond the Suffering Subject: Toward an Anthropology of the Good.” Journal of the Royal Anthropological Institute 19 (3): 447-462.CrossRefGoogle Scholar
  60. Roitman, Janet 2013 Anti-Crisis. Durham: Duke University Press.CrossRefGoogle Scholar
  61. Scheper-Hughes, Nancy and Anne M. Lovell 1986 “Breaking the Circuit of Social Control: Lessons in Public Psychiatry from Italy and Franco Basaglia.” Social Science and Medicine 23 (2): 159-178.CrossRefGoogle Scholar
  62. Stan, Sabina 2012 “Neither Commodities nor Gifts: Post-socialist Informal Exchanges in the Romanian Healthcare System.” Journal of the Royal Anthropological Institute 18: 65-82.CrossRefGoogle Scholar
  63. Stevenson, Lisa 2014. Life Beside Itself: Imagining Care in the Canadian Arctic. Berkeley: University of California Press.Google Scholar
  64. Stewart, Kathleen 2012 “Precarity’s Forms.” Cultural Anthropology 27 (3): 518-525.CrossRefGoogle Scholar
  65. Stone, Deborah 2000 Caring by the Book. In Care Work: Gender, Labor and the Welfare State. MadonnaHarrington Meyer (ed.), pp. 89–111. New York: Routledge Press.Google Scholar
  66. Wool, Zöe H. 2015 After War: The Weight of Life at Walter Reed. Durham: Duke University Press.CrossRefGoogle Scholar
  67. Zelizer, Viviana A. 2007 The Purchase of Intimacy. Princeton: Princeton University Press.Google Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Anthropology, Campus Box 1114Washington University in St. LouisSt. LouisUSA

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