Therapeutic Inequalities

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.