Paper short abstract:

Based on fieldwork in England & Kenya, I examine settings where community—i.e., experiences of mutual responsibility, reciprocal care, belonging—is core to treatment. Here mental healthcare is reframed as a social accomplishment rather than technology of the self: community is both context and cure.

Paper long abstract:

The late-20th c. deinstitutionalization of psychiatric treatment in North America and Western Europe was based on the premise that it would be more cost-effective and more humane to have mental patients live in their own home, replacing confinement within the “total institution” of the asylum (Goffman 1961) with one-to-one outpatient treatment, family reunification, and—ideally—social reintegration. In Thatcher’s UK, this approach became known as “care in the community”, conjuring images of support, communal engagement, and belonging. While the term persists, its promise has not: disproportionate numbers of people living with mental illness are profoundly socially isolated, often with little amelioration of their symptoms (Leff 1997). However, the rise of medical research into health impacts of loneliness and recent experiments in “social prescribing” suggest a different role for (the) community in mental healthcare. Based on fieldwork in the UK and in Kenya, this paper explores a series of settings in which community itself—i.e., the subjective experience of collective being-in-relation, including mutual responsibility, reciprocal care, and intersubjective belonging—forms a core element of treatment. In the logic and practice of such therapeutic communities, mental healthcare is reframed as a social accomplishment rather than a technology of the self: far from a mere setting for treatment, here community emerges as both context and cure.