Therapeutic Inequalities - (Anthropologies of American Medicine: Culture, Power, and Pra) by Talia Rose Weiner

Book Synopsis

Argues that self-management approaches for depressive disorders ask the most from those with the least

Therapeutic Inequalities offers a powerful and timely critique of the U.S. mental healthcare system, uncovering how structural disparities are maintained--and often hidden--through the widespread promotion of "self-management." Drawing on two years of ethnographic fieldwork and community-engaged research, the volume traces how "self-management"--a treatment model that encourages patients to regulate their own conditions--has gained prominence in the care of mood disorders like depression.

As mood disorders have become leading causes of disability in the United States, public health officials have embraced a biomedical framing that casts them as brain diseases. While this medicalized approach has helped to reduce stigma, it has also justified shifting responsibility for care onto individuals, especially those already disadvantaged by systemic racism, poverty, and the erosion of public mental health infrastructure.

Weiner shows how the logic of self-management aligns with neoliberal ideals of personal responsibility, while obscuring the broader conditions that shape mental health outcomes. Far from simply diagnosing the failures of the current system, Therapeutic Inequalities asks what a more humane, interconnected model of care might look like. It calls for a radical reimagining of both mental health and personhood--one that values empathy, community, and the recognition of our shared vulnerabilities.

Review Quotes

"An engaging first-person account of practicing psychotherapy in our American landscape of harsh class inequality. Weiner delivers an expert critique of the neoliberal logics that seep into the inner worlds of patients and thwart the highest ideals of mental health professionals. The book is clinical ethnography at its finest."--Paul Brodwin, University of Wisconsin-Milwaukee

"Exceptionally smart and insightful, Therapeutic Inequalities critically examines the foundational concept of "self-management" in American mental health care. Weaving together careful ethnography and sophisticated theoretical engagements, Weiner skillfully argues that, while meant to empower patients to be active participants in their own recoveries, an emphasis on self-management effectively obscures complex power arrangements that can ultimately derail healing...A powerful and persuasive book whose insights not only contribute to explorations of psychiatry as a cultural technology, but also move the needle on how we think about mental health recovery."--Rebecca J. Lester, author of Famished: Eating Disorders and Failed Care in America

"Put together a sophisticated theorist and an arresting storyteller and you have Therapeutic Inequalities. While self-management in therapeutic practice may seem straightforward, with deft and nuanced analysis Talia Weiner illuminates its failings and potentials - from the therapy room to the arenas of politics and culture. A tour de force."--Kenneth J. Gergen, Swarthmore College

"With compassion, candor, and a deep ethnographic attunement to its entwined sites, Therapeutic Inequalities does the very thing it cogently calls for: re-integrating occluded social and material realities into our understanding of relationality and the self in psychotherapy (and beyond). It will be a model for future clinical ethnographic work."--Elizabeth Nickrenz, author of Living on the Spectrum: Autism and Youth in Community

About the Author

Talia Weiner is Assistant Professor of Psychology in the Department of Anthropology, Psychology, and Sociology at the University of West Georgia. This work emerges from her dissertation in Comparative Human Development at the University of Chicago, which won the William E. Henry Memorial Award for best dissertation of the year in the department.