Self-governance, psychotherapy, and the subject of managed care: Internal Family Systems therapy and the multiple self in a US eating-disorders treatment center

Abstract

A B S T R A C T"The self" has seen a surprising resurgence in recent anthropological theorizing, revitalizing interest in whether and how it can be studied ethnographically. These issues are brought to the fore by a newly popular psychotherapy technique, Internal Family Systems therapy (IFS), as practiced in a US eating-disorders clinic. There, clinicians and clients negotiate tensions between this model's understanding of a multiple, refracted self and managed-care companies' insistence on personal responsibility. In considering the moral and pragmatic work of IFS in the clinic, a new critical anthropology of selfhood illuminates the vectors through which economic and political commitments become imbricated in the self. They do so in ways that resist both psychologism and subjectivism while holding them in productive-albeit sometimes troubling-tension. [eating disorders, managed care, anorexia, self, neoliberalism, psychotherapy, United States] I nternal Family Systems therapy (IFS), a psychotherapy technique developed in the 1980s by psychologist Richard Schwartz, is increasingly popular in the United States for treating personality disorders, mood disorders, and eating disorders. The theory behind IFS is unusual among US therapies in that it envisions "the self" as a dynamic, evolving, adapting, and open system of subpersonalities or "parts" that operate in ever-changing relationships with one another and the outside world. The self in IFS is not a singular or bounded thing but, rather, a process that emerges from a complex of internal relationships among constantly changing "parts." Agency, accordingly, is not localized within a fixed, singular core but is distributed and mutable, shifting among different subpersonalities depending on the setting, circumstances, and interactions at hand. This figuring of the self and agency has profound implications for how IFS practitioners understand and treat psychopathology.Three aspects of IFS merit anthropological attention. First, the model's recent surge in popularity in the United States might tell us something about the clinicians and clients to whom it appeals, especially in the context of health-care policy reform. Second, the process of becoming an IFS therapist (which is both lengthy and expensive) speaks to the convergence of structures of care and structures of finance, as therapists are obliged to become "therapreneurs"-continually pursuing additional trainings, new certifications, and new specializations so that they can offer more marketable niche treatments. Third, the everyday practice of IFS foregrounds questions about how selves are locally enacted and understood within competing models of moral responsibility.Engaging with IFS, I ask two sets of questions: ethnographic and theoretical. The ethnographic questions are, how do tensions between the IFS model of distributed agency and the managed-care emphasis on personal responsibility unfurl in everyday practice? What might these tensions tell us about how economic processes shape understandings of p...

Time and Relational Possibility: Cultural Anthropology in 2017

“…In much of this research, it is the ideological work of producing particular kinds of relations that comes into focus. We see this in a series of essays that consider the subjectivities that emerge in healthcare encounters (Alunni ; Duncan ; Lester ; Tessier ; Venkat ; Wardlow ; Zucker ) and in political protest (McGill ; Weiss ), as well as in essays about friends (Miller ), neighbors (Neumark ), and community (Brison ), and essays that consider kinship in relation to microfinance and social enterprise (Huang ; Kar ), adoption screening (Leinaweaver, Marre, and Frekko ), state policy (Sun ), and technology (Kocamaner ).…”

The Guard's Dilemma: Social Roles and Therapeutic Experience for Inpatient‐Guards in Tijuana's Community‐Based Addiction Treatment

“…The fundamental social divide between staff and inpatients in total institutions breaks down at Alas, creating the potential for internal conflict in terms of self‐orientational processes and behaviors (Hallowell 1955; Lester 2017). 14 For inpatients who straddle the distinction between staff and inpatient as both rule enforcers and equals on the path to recovery, many situations arise in which they must consciously consider the perspectives of both their social roles.…”

Introduction

“…The future is being structured, Guyer argues, through "formal calendrics of financial debt and benefit, self-renewal as a citizen, or insistent work schedules" (ibid.). Punctuated time, enacted mercilessly in audit cultures (Strathern 2000), structures of indebtedness (Han 2012), or liberal notions of self-governance (Lester 2017), empties futures (Dzenovska 2018) and produces feelings of nostalgia (Narotzky 2016) and exhaustion (Knight 2016). Under these conditions, hope should not be mistaken for a manifestation of potentiality.…”