“Vulnerability may have its own private causes, but it often reveals concisely what is wounding and damaging on a much larger scale.”
– John Berger, A Fortunate Man
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.
Similar content being viewed by others
Notes
The Soteria model developed by American psychiatrist Loren Mosher in San Jose, California sets the bar for peer-supported respite care. Mosher designed Soteria as a 12-room home-like environment, staffed by peers and professionals, to investigate supportive milieu therapy for early acute psychosis. Mosher et al.’ analyses of the first Soteria cohort showed significantly lower relapse and medication-use rates over 2 years (Mosher and Menn 1978). For Mosher, the effectiveness of Soteria lay in guiding people through the rough weather of crisis by offering a secure port, its ability to foster new relationships, and to help individuals build independent identities (Mosher 1992; Mosher, Hendrix, and Fort 2004).
Peer support models have become increasing popular in a variety of social, medical, and educational settings. There is a rich literature in disability studies (Rapp and Ginsburg 2011), chronic and terminal diseases (Jain 2014), and school bullying (Cowie and Wallace 2000) that identify the power of peer-based relationships to buttress individual resilience. As well as a long history of anthropological interest in the peer support systems of groups like Alcoholics Anonymous, where sponsorship roles are comparable to those of Peer Specialists, though significantly different in their sometimes hierarchical and patriarchal dynamics (Bateson 1971; Cain 1991).
The work of anthropologist Neely Myers provides one of the most in-depth ethnographic accounts of psychiatric peer support networks and relationships to date. Myers’ work reveals peer support as an innovative agentive practice, and how the sense of a morally tenable self hinges on certain forms of social recognition.
The different socioeconomic and racial backgrounds of peers sometimes materialized in conflicted understandings of the nature of crisis, and felt hierarchies in the daily tasks of respite management. In more positive iterations, the personal experiences of staff as they related to race and class corresponded to specialized skill sets, with certain staff members being better equipped to work with certain guests than others.
The newness of peer support as a professionalized category means that practical realities, like certification and determining appropriate pay, are still being worked out. Statewide criteria for peer certification have been developed, and peers are increasingly included in these professionalization discussions.
References
Allison, Anne 2013 Precarious Japan. Durham: Duke University Press.
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.
Bateson, Gregory 1971 “The Cybernetics of ‘Self’: A Theory of Alcoholism.” Psychiatry 34: 1-18.
Berardi, Franco 2009 The Soul at Work: From Alienation to Autonomy. South Pasadena, CA: Semiotext(e).
Berger, John 1967 A Fortunate Man: The Story of a Country Doctor. New York: Vintage International.
Biehl, João 2012 Care and Disregard. In A Companion to Moral Anthropology. Didier Fassin, ed., pp. 242–263. New York: Wiley-Blackwell.
Brodwin, Paul 2013 Everyday Ethics: Stories from the Frontline of Community Psychiatry. Berkeley: University of California Press.
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.
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.
Cain, Carole 1991 “Personal Stories: Identity Acquisition and Self-Understanding in Alcoholics Anonymous.” Ethos 19 (2): 210-253.
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.
Cowie. Helen and Patti Wallace 2000 Peer Support in Action: From Bystanding to Standing By. London: SAGE Publications Ltd.
Csordas, Thomas J. 1993 “Somatic Modes of Attention.” Cultural Anthropology 8 (2): 135-156.
Davis-Floyd, Robbie and Christine Barbara Johnson, eds. 2006 Mainstreaming Midwives: The Politics of Change. New York: Routledge.
Desjarlais, Robert 1997 Shelter Blues: Sanity and Selfhood Among the Homeless. Philadelphia: University of Pennsylvania Press.
England, Paula 200. Emerging Theories of Care Work. Annual Review of Sociology. 31: 381–399.
Estroff, Sue E. 1985 Making it Crazy: An Ethnography of Psychiatric Clients in an American Community. Berkeley: University of California Press.
Folbre, Nancy 1994 Who Pays for the Kids?: Gender and the Structures of Constraint. New York: Routledge.
Folbre, Nancy. 2002. The Invisible Heart: Economics and Family Values. New York: The New Press.
Garcia, Angela 2015 “Serenity: Violence, Inequality, and Recovery on the Edge of Mexico City.” Medical Anthropology Quarterly 29 (4): 455-472.
Glenn, Evelyn Nakano 2010 Forced to Care: Coercion and Caregiving in America. Cambridge: Harvard University Press.
Gordon, Suzanne, Patricia Benner, and Nel Noddings 1996 Caregiving: Readings in Knowledge, Practice, Ethics, and Politics. Philadelphia: University of Pennsylvania Press.
Greenberg, Michael 2017 Tenants Under Siege: Inside New City’s Housing Crisis. The New York Review of Books. August 17.
Han, Clara 2011 “Symptoms of Another Life: Time, Possibility, and Domestic Relations in Chile’s Credit Economy.” Cultural Anthropology 26 (1): 7-32.
Hart, Michael 2011 “For Love or Money.” Cultural Anthropology 26 (4): 676-682.
Hinton, Devon E. and Laurence J. Kirmayer 2013 “Local Responses to Trauma: Symptom, Affect, and Healing.” Transcultural Psychiatry 50 (5): 607-621.
Hochschild, Arlie Russell 1983 The Managed Heart: Commercialization of Human Feeling. Berkeley: University of California Press.
Hopper, Kim 2003 Reckoning with Homelessness. Ithaca: Cornell University Press.
Hopper, Kim 2007 “Rethinking Social Recovery in Schizophrenia: What a Capabilities Approach Might Offer.” Social Science & Medicine 65 (5): 868-879.
Hopper, Kim 2016 Remarks on Care. In Annual Meeting of the American Anthropological Association Minneapolis, November 19.
Intentional Peer Support 2014 Intentional Peer Support Facilitators Manual 2014. West Chester, NH: Intentional Peer Support.
Jain, S. Lochlann 2014 Malignant: How Cancer Becomes Us. Berkeley: University of California Press.
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.
Kleinman, Arthur 2012 “Caregiving as Moral Experience.” The Lancet 380: 1550-1551.
Lester, Rebecca 2013 “Back from the Edge of Existence: A Critical Anthropology of Trauma.” Transcultural Psychiatry 50 (5): 753-762.
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.
Lester, Rebecca 2018 Famished: Paradoxes of Care in American Eating Disorders Treatment. Berkeley: University of California Press.
Livingston, Julie 2012 Improvising Medicine: An African Oncology Ward in an Emerging Epidemic. Durham: Duke University Press.
Lovell, Anne M. 1997 The City is My Mother: Narratives of Schizophrenia and Homelessness. American Anthropologist 99 (2): 355-368.
Luhrmann, Tanya M. 2001 Of Two Minds: An Anthropologist Looks at American Psychiatry. New York: Vintage.
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.
Mauss, Marcel 2000. The Gift: The Form and Reason for Exchange in Archaic Societies. New York: W.W. Norton.
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.
Mead, Shery and Mary Ellen Copeland 2000 “What Recovery Means to Us.” New York: Plenum Publishers.
Mead, Shery and David Hilton 2003 “Crisis and Connection.” Psychiatric Rehabilitation Journal 27 (1): 87-94.
Mead, Shery and Cheryl MacNeil 2005 “A Narrative Approach to Developing Standards for Trauma-Informed Peer Support.” American Journal of Evaluation 26: 231-244.
Mead, Shery and Cheryl MacNeil 2006 Peer Support: What Makes it Unique? International Journal of Psychosocial Rehabilitation, 10 (2): 29-37.
Millar, Kathleen M. 2014 “The Precarious Present: Wageless Labor and Disrupted Life in Rio de Janeiro, Brazil.” Cultural Anthropology 29 (1): 32-53.
Muehlebach, Andrea 2013 “On Precariousness and the Ethical Imagination: The Year 2012 in Cultural Anthropology.” American Anthropologist 115 (2): 297-311.
Myers, Neely Laurenzo 2015 Recovery’s Edge: An Ethnography of Moral Agency. Nashville: Vanderbilt University Press.
Myers, Neely Laurenzo 2016 “Recovery Stories: An Anthropological Exploration of Moral Agency in Stories of Mental Health Recovery.” Transcultural Psychiatry 53 (4): 427-444.
Mol, Annemarie 2008 The Logic of Care: Health and the Problem of Patient Choice. New York: Routledge.
Mol, Annemarie, Ingunn Moser, and Jeannette Pols 2010 Care in Practice: On Tinkering in Clinics, Homes and Farms. London: Transcript-Verlang.
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.
Mosher, Loren R. and A.Z. Menn 1978 “Community Residential Treatment for Schizophrenia: Two-year Follow-up.” Hospital and Community Psychiatry 29: 715-723.
Mosher, Loren R., V. Hendrix, and D.C. Fort 2004 Soteria—Through Madness to Deliverance. Philadelphia, PA: Xlibris.
Rapp, Rayna and Faye Ginsburg 2011 “Reverberations: Disability and the New Kinship Imaginary.” Anthropology Quarterly 84 (2): 379-410.
Rhodes, Lorna 1995. Emptying Beds: The Work of an Emergency Psychiatric Unit. Berkeley: University of California Press.
Robbins, Joel 2013 “Beyond the Suffering Subject: Toward an Anthropology of the Good.” Journal of the Royal Anthropological Institute 19 (3): 447-462.
Roitman, Janet 2013 Anti-Crisis. Durham: Duke University Press.
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.
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.
Stevenson, Lisa 2014. Life Beside Itself: Imagining Care in the Canadian Arctic. Berkeley: University of California Press.
Stewart, Kathleen 2012 “Precarity’s Forms.” Cultural Anthropology 27 (3): 518-525.
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.
Wool, Zöe H. 2015 After War: The Weight of Life at Walter Reed. Durham: Duke University Press.
Zelizer, Viviana A. 2007 The Purchase of Intimacy. Princeton: Princeton University Press.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
On behalf of all authors, the corresponding author states that there is no conflict of interest.
Rights and permissions
About this article
Cite this article
Cubellis, L. Care Wounds: Precarious Vulnerability and the Potential of Exposure. Cult Med Psychiatry 42, 628–646 (2018). https://doi.org/10.1007/s11013-018-9577-8
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11013-018-9577-8