'With this book, sociologist Darin Weinberg contributes important insights into therapeutic processes applied to addiction and mental illness—or insanity, as he prefers. The book speaks to a growing interest in recovery and how it is achieved and supported. Although much of the existing recovery literature is highly programmatic and politicized, careful and critical empirical analysis of the sociocultural and interpersonal dynamic is much needed and, thus, this book is very timely.

The book is divided into two parts and contains six chapters. In the introduction, Weinberg outlines his ambition to reconcile subjectivist and objectivist positions in the sociological study of addiction and mental illness. This involves “an acknowledgement that social actors do in fact install nonhuman agents [such as biomedical notions and psychiatric diagnoses] as surrogates for human selves for a wide variety of reasons” (p. 9) and to analyze human activities in the context of particular social worlds. Unfortunately, in his discussion of this approach, Weinberg has overlooked the work of medical anthropologists such as Arthur Kleinman who, since the 1980s, have argued along similar lines. Attention to this literature might have helped the author to identify what, to this reviewer, seems a significant problem in his epistemological and analytical position: that he does not distinguish between emic and etic perspectives, as I will exemplify shortly.

Part 1 outlines the historical development of views on and treatment for addiction and mental health problems in the United States, emphasizing the rise of moral treatment in contrast to vilification and custodial containment of the insane. Weinberg introduces the notion “others inside” to designate the perception of some substance or agent existing inside the person and causing the addiction or insanity. This other inside the person is therefore morally responsible and to blame for the affliction. The notion contrasts with that of the addict or insane being personally responsible and, therefore, a categorical other—outside the moral community. Weinberg convincingly demonstrates how these notions have changed as different social groups have been seen to suffer from addiction or insanity—the more marginal the group, the more likely a member would be held morally responsible as an “other.”

Part 2 presents empirical data based on ethnographic fieldwork in the early 1990s in two recovery programs in California—one residential and the other nonresidential—for “young adult chronic patients” with a dual diagnosis. Unfortunately, Weinberg does not present the methodological detail of his fieldwork, and how he generated the data that substantiate his findings and analytical claims is therefore not very transparent. Given the ethnographic methodology, the absence of critical reflection on his role and how it might have influenced his relationships with staff and residents is a particular shortcoming. Nonetheless, the comparison between the residential and nonresidential programs points to important differences in the therapeutic practice, process, and content caused by specific environmental, physical, and institutional organizations. One particularly striking aspect is the different emphases in the recovery work with the two groups of clients, with the focus on clients in the residential setting developing retrospective biographical narratives, and attention in the nonresidential program directed to clients managing and planning living in the community.

The problem mentioned above of not distinguishing analytically between emic and etic perspectives becomes perhaps most evident when Weinberg challenges established ideas about the relationship between the self and mental illness. He argues (p. 133) that, in one of the programs, “troubles were held to have issued from sources within a resident’s person, but not from their self.” The point is that the mental illness or addiction as others inside the resident, and not the person’s self, is held morally responsible. Although this is an important insight into emic knowledge, or the local belief system, it is epistemologically wrong to claim, as he does, that theories that link the self and mental illness are therefore mistaken. In fact, his empirical observation provides further evidence to support the theoretical argument (as developed by, for example, Sue Estroff and Robert Barrett) that the notion of mental illness is closely related to the idea of a deficient or deviant type of self. The self is seen to be incapacitated by the others inside.

With Of Others Inside, Weinberg contributes to readers’ understanding of how discourses of insanity and addiction “exercise their own casual influences upon people’s experiences and upon the practical activities that comprise their worlds” (p. 204). The analytical integration of sociohistorical developments with ethnographic insights in therapeutic recovery work is the particular strength of this book.
[references, index]