This post is part of our #RaisingOurVoices2020 blog series. Learn more at our American Anthropological Association virtual exhibit.
By Janis H. Jenkins and Thomas J. Csordas, co-authors of Troubled in the Land of Enchantment: Adolescent Experience of Psychiatric Treatment
New Mexico is a place of beauty, diversity, and hardship. All these aspects are starkly visible in our book, Troubled in the Land of Enchantment: Adolescent Experience of Psychiatric Treatment, an ethnography of one of the most vulnerable groups in this state: adolescents who have been inpatients in a psychiatric hospital.
In the book, we follow a group of young people through the mental health treatment system under the regime of managed care, and document their struggle to have a life in the face of extraordinary conditions of precarity and affliction. The flow of our book mirrors the journey of these young people, from admission to looking towards a better future.
We begin by sketching out the ethnographic terrain of New Mexico and examining the state’s flagship psychiatric hospital for children and adolescents, as well as introducing the cohort of youth who shared their experience with us. We ask these adolescents, how did you end up here? Their responses provide what we call “admission narratives.” How they narrate these events is a critical point of entry into describing their lived experience, and is the primary experience held in common by these diverse youth from different parts of the state, all with distinct diagnostic and demographic profiles.
These stories are an entry into what exactly is troubling these “troubled youth.” We delve deeper by defining their problems across dimensions of the moral and economic milieu, research-reliable psychiatric diagnostic categories, life experiences, etiological concepts articulated by the youth and their families, conceptions of illness and normalcy, and the structured discourse of diagnosis. In one chapter, we provide a close analysis of anger, the single most prominent emotional phenomenon in the lived experience of these troubled youth. Simultaneously understandable as a symptom of illness, an emotional response to the frustrations of illness, and a human phenomenon subject to cultural variation in expression and experience, anger provides the occasion to examine in detail the experience of two of our participants, an angry boy and an angry girl.
Our fifth chapter examines the experience of psychiatric treatment as the trajectory of each person through the treatment system, defining the subjectivity of each troubled youth as someone with a psychiatric disorder or disorders. This includes their comparisons of different treatment facilities, their evaluations of whether and how treatment helped or harmed them, their use of or resistance to “coping skills,” and their experience of a dizzying array of psycho-pharmaceutical medications. We describe detailed treatment trajectories for a number of the youth, juxtaposed against their parents’ accounts.
As we end the book, we discuss these teens’ visions of their future. How can they have a life while experiencing such severe disruptions? We address the issue of hope and introduce the concept of temporal horizons to describe the physiognomy and possibility of the future across the diversity among the forty-seven lives we encountered. We conclude with an aphorism that elevates struggle to a theoretical status, alongside suffering as a fundamental human process: “recognize suffering, support struggle.” Recognizing suffering does not mean adopting a stance of sentimentality for those “poor kids.” but embracing an unflinching stance in the face of their lived experience. Supporting struggle means engaging in empathic listening and narrative interpretation of lifeworlds that are bound up in precarity and subject to structural violence.
We wrote Troubled in the Land of Enchantment to support transformative change toward healthcare equity for poor communities and regions within the United States – a country often incongruously represented as a “wealthy” nation despite its stark and ever-increasing inequality. We also hope that the book will contribute to ethnographies grounded in experiential specificity and cultural interpretation of subjectivity, and offer data relevant to those who treat troubled youth, who are responsible for developing treatment programs, or who design, implement, and assess mental health policy.