Canaries in a coal mine: conceptualizations and treatment of mental illness in a therapeutic community for the mentally ill

Abstract

This dissertation is an ethnography of a therapeutic community for the mentally ill conducted in the US in 1996. It begins with a review of the experimental movement in psychiatry that occurred during the late 1960s and 1970s in the U.S. Tracing the ways in which this movement is reproduced and opposed in an "alternative" treatment location, we learn that the range of treatment options for mental illness have been greatly reduced by biomedical psychiatry's hegemony.Foucault's notions of power helps to situate this therapeutic community in a web of state, local, and internal power relations. This web serves to contextualize other influences on the Community, such as the construct of community as therapy, new age philosophies, and Catholic notions of benevolence. These influences shape the Community's eclectic thinking about mental illness and care-giving practices. But, given the extensive reach of biomedical supremacy via the current political, economic, and legal landscape of mental health services, its ability to conceptualize and treat mental illness outside of the biomedical model is limited. The Community struggles with its position, caught between an unconventional therapeutic community model and biomedical hegemony.In contrast to mainstream psychiatric hospitals and institutions, where time and space are highly regulated, the Community afforded patients enormous freedom and independence. Independent, higher functioning, socially interactive patients were served well in this setting. However, patients who were socially isolated needed more structure and direction, which at times was dangerous and seemed to worsen their illness.