Therapy in the Age of Self Management and Public Abandonment: A Conversation with Psychological Anthropologist Talia Weiner

Talia Weiner is a psychological anthropologist, licensed professional counselor, and assistant professor of psychology at the University of West Georgia.

As a medical and psychological anthropologist, her work focuses on the intersection of social-structural forces and how those forces show up in lived experience, particularly in relation to mental health care. Weiner studies these and other topics with students in the Clinical Ethnography Lab within the University of West Georgia’s psychology program.

Weiner has an upcoming book titled Therapeutic Inequalities: Mood Disorder Self-Management in Chicago, scheduled for release Jan. 6, 2026, through NYU Press’s Anthropologies of American Medicine: Culture, Power, and Practice series.

In this interview, Weiner discusses how conservative sociopolitical trends influence psychology and mental health care—how, for example, people with bipolar disorder are expected to monitor and manage themselves in ways that are not only unrealistic but also blur the lines between self and disease.

 

The transcript below has been edited for length and clarity.

 

Micah Ingle: Tell us about your trajectory in psychology. The psychology/anthropology/human development program at the University of Chicago appears to be quite unique. What has your journey been like, and what are the central concerns in your work?

Talia Weiner: Thank you so much, Micah. I really admire Mad in America, and it’s great to get to have this conversation with you as an alumnus of the West Georgia psychology department.

I’m going to start by going back a couple of decades to my undergraduate studies. I went to Swarthmore College, which is a small liberal arts college. I double majored in Psychology and English. I knew that I felt like these two disciplines were somehow connected, but I didn’t really have a language for talking about how.

I actually didn’t know anything about anthropology at the time. For some reason, it never occurred to me during college to take an anthropology class.

But I was really lucky because within Swarthmore’s otherwise pretty traditional psychology department were these two professors who were completely outside of the mainstream, and they were hugely influential on me.

Jeanne Marecek and Ken Gergen trained me to think about things like the role of language and narrative in our psychological experiences, and to interrogate the cultural, sociological, historical, and political bases of our given psychological categories.

I didn’t realize it at the time, but I was getting an education in critical psychology and psychological anthropology.

It took a long time before I came to fully appreciate how very much outside of and really almost antithetical to the project of mainstream western psychology my undergraduate training had been under Gergen and Maracek.

A few years after I graduated from college, I started thinking about applying to PhD programs. I remember talking to Jeanne on the phone and her advice being pretty much, don’t get a doctorate in psychology department, just don’t do it. You’re going to face constant invalidation about your methods, your approaches, your sort of foundational beliefs.

She suggested, among a few other ideas, that I look into this interdisciplinary department of comparative human development at the University of Chicago, which is where I ended up.

The faculty members are a mix of psychologists, anthropologists, sociologists, biologists, and a few education folks. They train you to be interdisciplinary, but also to try to be intelligible to some discipline. They said, find one primary disciplinary hat to wear based on the topics you work on, the methods you use, how you read and write, and the conferences you attend. Try to fit in somewhere.

For me, that disciplinary hat, that intellectual home ended up being psychological anthropology. One of the things that drew me to the human development department was that, for a while, it was actually accredited—not by the APA, but by this other organization, so that you could simultaneously train in anthropology and clinical psychology. Then, when you graduated, you were qualified to sit for licensure as a clinical psychologist.

They called this the clinical track, and through it, we had these several cohorts before me of these really cool hybrid therapist-anthropologists who emerged and went out into the world. That just seemed to me like such a great, valuable combination. Who wouldn’t want a therapist who’s also an anthropologist?

I was planning to do this program, the clinical track, but unfortunately, it ended up getting discontinued early in my time in the PhD, which was sort of a blow because I by then had decided that that was what I wanted, to have one foot in anthropology and the other foot in clinical practice and to be able to speak across those fields.

I decided to pursue two degrees at once: the PhD in comparative human development at UChicago, specializing in psychological anthropology, and then a separate master’s degree in relational psychoanalytic psychotherapy elsewhere in Chicago.

Really, it was that decision, in the context of what was going on in Chicago at the time with public mental health care, which I’ll talk about in a bit, that set the stage for the research that became the basis of my dissertation and later my book.

 

Micah Ingle: Your upcoming book is a deep dive into how conservative political structures influence mental health practice, as well as the lived experiences of service users and therapists at different clinical sites in Chicago. What inspired you to tackle this topic? I know you conducted anthropological and ethnographic fieldwork on mental health practice and activism in Chicago. I’m imagining that this project has both scholarly and personal dimensions.

Talia Weiner: It definitely has both of those dimensions. In the first and second years of my PhD program, we were required to conduct a trial research project, essentially a small-scale pilot study that could eventually become part of our larger dissertation project.

I didn’t know much about Chicago at that time, so it was mostly for personal reasons that I decided to conduct participant observation in a mood disorder support group that met once a week in the basement of a building.

I started to notice that every week, the support group members would talk about and try to enact this thing that they called self-management, which I came to understand meant to them this notion that if they were really diligent, they could somehow learn to observe, anticipate, and ultimately exercise control over their own mood disorders—which they tried to conceptualize as diseases that were separable from quote-unquote “who they really were”.

Fast forward a couple of years to late 2011, and Chicago elects neoliberal mayor Rahm Emanuel, whose first order of business is to introduce a budget that proposes to shut down six of Chicago’s twelve public mental health clinics.

Chicago used to have a very renowned and unusual system of mental health centers that were actually run by the city’s Department of Public Health. They were designed to meet the needs of poor and uninsured clients. Some of them had already been cut in the past, but there were six—mostly in these working-class, predominantly non-white neighborhoods. They were really important to the people who used them.

Emanuel says, Okay, we’re going to slash it from twelve down to six. For the remaining six, we’re going to pare down their services to the bare bones.

Right at the same moment that the City Council of Chicago unanimously approves this budget, all 50 aldermen give it the green light, and the Chicago Department of Public Health starts dismantling the clinics.

Meanwhile, the Occupy Wall Street movement is gaining momentum throughout the U.S., and a grassroots activist coalition forms, comprising consumers of a public mental health clinic in a working-class African-American neighborhood near the University of Chicago, which was slated for closure.

This coalition decides to occupy its clinic in protest of the upcoming closure. They bring in enough materials to barricade themselves inside the clinic for, I think, weeks or maybe a couple of months even, but they end up getting arrested within a few hours, spending the night in jail.

However, this mental health coalition endured, and to this day, they’re still working really hard to fight the city to reopen and expand the public mental health centers.

I was definitely gaining a deeper understanding of Chicago—the activism scene, the politics, and the inequalities—a lot more than when I was just getting started. In 2012, I joined the mental health coalition because I would often walk by an encampment they had set up next to the building that used to be the clinic.

The coalition is composed of consumers of the clinic or former consumers, but also allies of various kinds. I joined the mental health coalition, and I also started my clinical training program at this school in downtown Chicago. I was constantly moving between these very disparate class settings.

I went to a psychoanalytic school where my instructors were adjuncts at the school but mainly treated middle-class patients in private practice. Then there was my clinical internship site, located at an outpatient community mental health agency serving working-class clients. Then I was doing these political actions with the mental health coalition.

It started to occur to me that you really can’t begin to understand the meanings and outcomes of managing or self-managing a mental illness without considering the sociological context of that management.

At the psychoanalytic institute, it was a given that patients needed ongoing relational support in order to successfully manage their mental health issues. Whereas in agency settings, the focus and goal of treatment was always oriented towards increasing the client’s independence, so that ideally they would eventually not require the support of a therapist.

Then, among members of the mental health coalition, of course, self-management took on this really dire, literal meaning, because their struggle was one for basic inclusion in the face of total public abandonment.

I would say that the project evolved alongside my increasing familiarity with the political and economic landscape of Chicago, as well as the professional trajectory of therapists, who are actors who transition between different class modes. They move from agency work with the poor early in their careers to private practice with the middle class later on.

I ended up embodying this through my own training. I had to navigate through the race- and class-stratified geography of the mental health care system, and that’s how the project developed.

 

Micah Ingle: So the central topic of your book does revolve around this notion of self-management. What is self-management?

Talia Weiner: Self-management does a lot of heavy lifting in the book. In the most narrow and literal sense, it refers to a self-help treatment model: the one that the members of the mood disorder support group are constantly invoking. It’s a model that purportedly empowers patients to objectify and regulate their own conditions.

Self-management as a clinical paradigm was initially developed for the treatment of chronic physiological conditions, such as arthritis. Later, it was applied to mental illnesses, as psychiatry increasingly embraced a biomedical framing of its disorders—as diseases of the brain that are likened to physiological conditions and therefore should be manageable through the same technologies.

However, what I aim to demonstrate in the book is that the clinical paradigm of self-management reflects a broader ideological project of self-management that serves to both sustain and obscure various forms of structural inequality in U.S. mental health care.

I thought I’d just read a small excerpt from the book since there is a section called What is Self-Management:

“Self-management can take an economic, political, narrative, organizational, or clinical form. It is a mode that is at times actively claimed by, at times forced upon, and often subtly diffused into its subjects.

Highly resonant with neoliberal ideals of individual sovereignty, self-management in each of its forms retains the quality of bestowing moral agency upon the individual by means of a kind of political economic mystification that eclipses the social networks and structural constraints in which the individual is embedded.

Moreover, the duty to exercise sovereign self-management in the contemporary United States—to triumph over various forms of structural vulnerability through autonomous acts of agency, entrepreneurship, and rational choice—is disproportionately placed on the shoulders of individuals or communities who, by virtue of their socio-political positioning, are far from truly sovereign.”

 

Micah Ingle: You described this self-management project as self-defeating. Can you explain why that is?

Talia Weiner: I talk about self-management in the book at specific points as being something that patients or clients do, and also as something that other kinds of actors, specifically therapists, are compelled to do.

In the case of clients, I discuss self-management as being self-defeating in the sense that if it’s practiced strictly as described and intended, as in the bipolar self-management workbook, then the better you are at doing it, the more you end up demonstrating how impossible it is.

For example, in the mood disorder support group, clients would perform their expertise as self-managers. In a way, I felt like that was one of the reasons to go to the support group meeting—to do self-management—and that was a way to stay on top of things.

They would perform their expertise as self-managers by expressing constant suspicion and doubt over the validity of their own moods, their plans, and their ideas.

Someone would say in a meeting: I’m feeling really angry about this parking ticket that I got that I shouldn’t have gotten, but I don’t know if it’s an actual legitimate anger or if I’m becoming hypomanic and I need to adjust my medications.

Or one time, this really intelligent guy who had dropped out of graduate school because of his mental health issues said to me:

“A few weeks ago, it occurred to me that I could do a project, I could write a paper on my own… I just had an idea, and it seemed interesting, and it would give me something to do. As I’ve gotten more medicated, that idea has slipped away from me. Is that me losing a thread of mania, or is that the drugs completely just squashing me flat?”

Then he says, “I don’t know. Would another person in my situation—I’m on disability—would another person want to do some work? Or would they be okay with basically doing nothing? Mostly what I do with my day is nothing, and I don’t know.”

What I mean by self-defeating here is that we see that these practices of hyper-rational self-interrogation don’t instantiate the isolable, authentic self or agent of sovereign self that the self-management paradigm promises for support group members.

Instead, it blurs self and disease. It divides the managing subject into fragmented selves, creating uncertainty—and ultimately distress.

Later in the book, I begin examining the structurally impossible situations that therapists often find themselves in. I argue that they turn to a professional narrative of self-management in an attempt to recover a sense of themselves as moral agents.

Specifically, I look at the different forms of discursive labor that therapists undertake to alleviate the guilt that they experience when they follow the normative professional trajectory of putting in time working at an agency with poor clients at the beginning of their careers, followed by then transitioning into better compensated private practice with middle-class patients once they’re qualified to sit for licensure.

There’s a chapter in the book where I do a close reading of the narratives that three different therapists shared with me about their transition from agency work to private practice. I look at the strategies that each of the therapists uses to organize their narrative in a way that allows them to feel that they acted ethically and agentively.

I argue that the narrative self-management strategies that they use, which I describe respectively as sublimation, class dis-identification, and bargaining, are successful to that end, but the success comes at a cost.

They produce a kind of structural alienation that prevents the therapist from recognizing and naming the actual structural causes of their “decision”, which isn’t really a decision, to leave agency work for private practice.

 

Micah Ingle: Throughout your book, you talk about these self-management demands—demands for autonomy and individual sovereignty. You pose this against what you call a cybernetic model of agency. What is the cybernetic model?

Talia Weiner: When I talk about cybernetics, I like to go back to anthropologist Gregory Bateson’s fantastic 1972 essay about Alcoholics Anonymous, which is called The Cybernetics of ‘Self’.

In this essay, Bateson writes that the first two steps of Alcoholics Anonymous’ 12-step approach do something really profound. He says that when alcoholics take the first two steps—we admit we are powerless over alcohol and we come to believe that a power greater than ourselves could restore us to sanity—they’re accomplishing a major epistemological correction.

They’re moving from what Bateson calls the myth of self-power to a view of the self and its actions as embedded within broader systems or relationships.

It’s a shift away from our deeply held ideologies of western individualism—that say that we can and should be able to autonomously control ourselves through sheer willpower, the pull yourself up by the bootstraps, mind-over-matter mentality that undergirds self-management and a lot of neoliberal policies—to an understanding of self as total system, which Bateson reminds us doesn’t coincide usually with the boundaries of the individual body.

There’s a passage I really like where Bateson asks us to consider a blind man with a stick. Where does the blind man’s self begin? At the tip of the stick, at the handle of the stick, or at some point halfway up the stick?

Then he says these questions are nonsense because the total self-corrective unit of “blind man with stick”, which thinks and acts and decides, is a system whose boundaries do not at all coincide with the boundaries of either the body or what is popularly called the self or consciousness.

In my book, I argue that the move from an autonomous to a cybernetic model of self and agency is not only a matter of epistemological correctness. It is also a matter of epistemic justice.

A model that suggests we are all interconnected, that we all require ongoing social support, and that our agency is always partial and distributed turns out to be a lot more humane and livable than one that suggests we should figure it all out on our own.

Yet what I found in my research is that psychiatry and psychotherapy, and really our contemporary society in general, tend to systematically offer that cybernetic model only to the middle class, while demanding impossible, complete autonomous self-management from those who have the least.

Moreover, when we—meaning experts and clinicians, etc.—justify these epistemic injustices through self-managerial discourses that obscure the structural inequalities, we end up imputing to different classes of patients disparate subjectivity so that it begins to seem right and therapeutically appropriate to say that middle class patients are in need of long-term relationally supportive therapeutic interventions, while working-class clients benefit most from self-sufficiency and independence.

 

Micah Ingle: A big focus in your book is specifically on mood disorders like bipolar disorder. What insights did you come to when looking at the relationship between bipolar and self-management?

Talia Weiner: Bipolar disorder kind of occupies a funny position in psychiatric ontology. It’s classified as a mood disorder, not a thought disorder. It often is regarded as more manageable than, say, schizophrenia. But at the extreme, mania can look just like psychosis. Fundamentally, as anthropologist Emily Martin has written, being known as a bipolar person throws one’s rationality into question.

Yet the self-management paradigm, which is considered to be very well suited to individuals with bipolar disorder, demands a kind of hyper-rational self-surveillance and self-control that would arguably be impossible for anyone to perform, let alone a person living with that diagnosis.

I think the biggest insight that I gained from looking at the relationship between bipolar and self-management was that, in doing self-management with dedication and a sort of expertise, bipolar self-managers show us the limits of the paradigm.

Sometimes they end up inadvertently creating alternative cybernetic models of personhood and agency. It’s a story about the conditions of possibility for unmaking our own unlivable ideologies and embodying an outside to them, or creating an otherwise.

 

Micah Ingle: You make some really nuanced arguments in your book around community mental health and agency work in contrast to private practice therapy, in particular psychoanalysis. I’m curious if there are any takeaways from comparing and contrasting these different fields of clinical practice?

Talia Weiner: At one level, the big takeaway seems to be that private practice psychoanalysis with the middle class really offers a lot more of these models of personhood and agency and social and relational support that are ultimately going to lead to flourishing and success.

Whereas agency models tend toward—and I’m not saying that every therapist I knew in agencies did this, only—but tend toward interventions that are short-term, independence-oriented, and that ultimately naturalize disparities.

There’s a section in the book where I describe a training I attended, where I learned how to write service notes for 15-minute increments of work we did with clients at agencies for Medicaid reimbursement.

During the training, we learned about two types of billing codes that we could use. One was a community support individual, and the other was therapy/counseling. We were informed that, most of the time, given our clients’ needs and the type of work we would be doing with them, the community support individual would be the appropriate choice.

Now, undeniably, there were fundamental differences between what a lot of agency clients needed from a therapist and what, say, a patient in private psychoanalysis was looking for. A lot of the time, the agency clients did need community support, in the sense that they needed help finding stable housing or looking for a job.

But sometimes there would be an agency client who wanted more of a relational, introspective type of therapeutic process. Therapists were allowed to provide this—there was nothing stopping you from giving it—but the norms and procedures at the agency would almost work against that, making it seem as though the agency client was dispositionally better suited to the short-term community support staff.

Sometimes, there were reasons related to billing protocols that underpinned the notion that an agency client was better served by one type of intervention over another.

However, the problem was that those reasons were often forgotten, and the treatment differences became naturalized as simply more therapeutically appropriate. The problem was not that treatment differences exist in and of themselves.

As I wrote in the book at one point, when the continuity of market relations and care is presumed and institutionally demanded, rather than interrogated, we run the risk of naturalizing structural inequalities that could instead be named and problematized.

All of that said, toward the end of the book, I do complicate the argument by pointing out that there may be some things about cybernetic selfhood that agency work can actually teach us, if we were to expand our notions in a way that allowed what we do at agencies to be part of that.

I argue that what we usually describe in agencies as “case management”, which is a substantial component of the work that we do with agency clients, acknowledges and allows a kind of material entanglement of client, therapist, and material world that psychoanalytic practice assiduously avoids. Meaning that a lot of what we do with clients at agencies would be considered inappropriate enactments in psychoanalytic therapy.

While there are good reasons to uphold those boundaries much of the time, perhaps it would be okay for private practice therapists to occasionally model a type of work that recognizes and intervenes in the patient’s structural material world conditions.

There’s actually a lot of talk within psychoanalytic communities about social consciousness and what its place is in social justice. Maybe if those sorts of norms were shifted a bit, then we could find new ways for psychoanalysis to handle the social and the structural differently.

 

Micah Ingle: Speaking of social justice, and also a term that you mentioned earlier, epistemic justice, can you speak to what you envision might help the field in terms of the self-management problems that you noticed in Chicago, but also more generally? How do we move in the right direction, away from these structural inequalities and contradictions? You do mention in your book something called structural competency training.

Talia Weiner: This is something that I’m still really thinking about and want to leave the book as an opening to that conversation. I’m compelled to think about structural competency, which is a newer notion that suggests clinicians may not be the best suited to treat an individual for a problem that lies in the social or structural context. But I know that there are also important critiques to structural competency that I don’t want to minimize.

A lot of times when clinicians are writing about and talking about structural competency, they think quite a bit about the structural barriers and issues in the lives of the patient, which is, of course, important and good.

But I thought that maybe what we need is a form of structural competency and clinical training that turns its gaze more reflexively toward the problematic social structures, institutions, and policies impeding clinicians’ practice, in addition to those that more directly impact patients.

Such an approach might equip therapists who are caught in the sorts of binds that I describe in the book with some critical tools to identify moments of structural impasse within their own professional activities. It might also help them articulate, if not necessarily resolve, how their local institutional practices might be undermining the provision of structurally competent care.

This, in turn, could provide therapists with options other than the individual self-management of structural constraints and the disavowal of market logics. I don’t think that the burden of structural recognition and change should fall only, or primarily, on therapists. They’re pretty constrained actors.

I think that training therapists to collectively recognize and acknowledge social structures in their own workplaces, and to genuinely engage with their own limited set of options rather than automatically seeking to overcome or erase them, could paradoxically point the way to the beginning of alleviating these deeply entrenched social inequalities.

 

Micah Ingle: Your book was eye-opening to me, as someone who has been immersed in a lot of the theory that you talk about, but hadn’t seen it fleshed out so intimately in relation to people’s lived experience. I just wanted to say thank you. What’s next for you? Are you planning on continuing some of the themes of the book or moving in another direction?

Talia Weiner: I first started attending those mood disorder support group meetings in Chicago in 2009. Rahm Emanuel won the election in 2011. The clinic shut down in 2012. I did the bulk of my ethnographic research from 2013 to 2015, graduated with my PhD in 2017, and now it’s 2025. The book is finally coming out at the end of this year.

I undertook several small projects during my postdoctoral studies in Cleveland and with a research collective at the onset of the pandemic. But really, it’s mainly been the Therapeutic Inequalities project for over a decade, and so I am really excited to start something new.

At this point, I have two barely sketched-out directions that I’m considering. One of them I have been calling, “Still COVID-ing in a Post-Pandemic World”. While the majority of institutions and individuals in the U.S. regularly discuss the COVID-19 pandemic as an event firmly situated in the past, various “counterpublics” have emerged and mobilized around the identity category of “still COVID-ing.”

This is something that I’ve personally been involved with. I have spoken to people in these still COVID-affected communities who really appreciate the idea of an ethnographer who has been part of the community all along, providing a more accurate representation of the experiences.

I could do research examining the contours of still COVID-ing as a form of subjectivity and community, looking at how notions of mental health and illness, science, politics, and society are shaped by an existential and epistemological positioning that is out of sync with mainstream consensus reality.

That’s one idea. I will also confess that there’s a tiny part of me that has thought about jumping into the conversations happening right now around AI and mental health care.

A couple of months ago, Mad in America covered a study from Dartmouth that tested whether AI could replicate the tone and empathy of peer support, which it describes as a model of care built on shared lived experience.

Disturbingly, but probably not all that surprisingly, a lot of the time people couldn’t tell the difference between a supportive message written by a human and one written by generative AI, which raised some questions around notions of empathy—and what it might mean if empathy is completely decoupled from things like presence, mutuality, and shared vulnerability.

I’m currently in an institutional context where there’s a lot of pressure to feel optimistic about AI and embrace a spirit of collaboration, or at least to accept that this is the future, whether we like it or not.

I even have a few colleagues who are therapists who see innovations with artificial intelligence and mental health care as something to celebrate.

Part of me would like to gain access to spaces where these ideas and technologies are being developed and be the ethnographer in the room.

Maybe even thinking of the model of peer support in particular, which, as you know, is already a pretty fraught topic with plenty of interesting questions surrounding its ethics.

It could be interesting to consider what other forms of relationships might be modeled by an experience of empathy from a chatbot. Maybe, as one of my AI-positive colleagues suggested to me, we need to look more to theorizations of interspecies connection—like Donna Haraway’s notion of companion species.

Perhaps the metaphor of peer support is not entirely accurate, but there may be another kind of relationship where empathy takes on a different meaning.

I’m definitely looking forward to jumping into another project as soon as the book is entirely out. That’s really everything I know for now. Thank you so much for taking the time today.

 

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