Review of Families on the Edge: Experiences of Homelessness and Care in Rural New England By Elizabeth Carpenter‐Song, Cambridge, MA: MIT Press. 2023. 176 pp.

Claudia Strauss

Pitzer College

“Homeless” or “unhoused” is likely to conjure images of single people living on the streets in large US cities. Elizabeth Carpenter-Song’s Families on the Edge: Experiences of Homelessness and Care in Rural New England focuses instead on periodically unhoused families in the rural Upper Valley region of Vermont and New Hampshire. In her insightful and well-grounded account, we witness the parents’ efforts to keep their families together and maintain their mental health, challenges that are perpetually at risk in the absence of stable housing. Some families eventually reach a modicum of stability, while others are destroyed. Families on the Edge is a persuasive ethnographic argument for what we could call a nondeterministic understanding of some of the social determinants of mental health trajectories.

As a regular visitor to the area where the research took place, I have been charmed by its picturesque covered wooden bridges and town squares surrounded by well-kept Colonial homes. Hidden from tourists like me, however, are high market rates for rent that are hard to afford on the low wages from the service-sector jobs held by Carpenter-Song’s interlocutors. As she notes about this region, “Deep traditions of philanthropy and progressive politics exist alongside efforts to limit affordable housing developments” (3), which are opposed by many residents because they would destroy the “rural character” of their small towns.

Although she includes comments of other shelter residents and social service providers, Carpenter-Song’s core participants are four women and a heterosexual couple, all white, as is characteristic of that region. Their psychiatric diagnoses include PTSD, bipolar disorder, attention deficit disorder, substance use disorder, anxiety, and depression. When she first met them at the family shelter, they all had one or more children. Although most grew up in that area, they could not count on their stretched natal families or friends for housing.

Carpenter-Song’s long-term engagement with her participants, from the fall of 2009 until she wrote the book in 2021, sets her research apart. About half a year after she got to know them at the shelter, all had found other housing and left. As she explains, she could have ended her research on rural homelessness then, because the families were housed. Wisely, she recognized that being housed does not end housing insecurity. Furthermore, she wanted to stay connected to the people she had grown to care about and to document their lives. This book is the fruit of her decade-long research relationships. Four of her five core households would become homeless again during that period.

Near the end of the book, Carpenter-Song frames her study as about psychiatric recovery (145). In previous publications, she has contested biomedical views of mental illness as uncurable and invariably degenerative. This book illustrates what helps or harms people struggling with the double burden of mental illness and poverty.

Her deep ethnographic engagement leads Carpenter-Song to eschew simplistic understandings of the causal relationships among mental health, poverty, and social institutions providing services and care. She joins other medical anthropologists in challenging Foucauldian criticisms of biopower, arguing that they fail to acknowledge providers’ sincere intentions. Nonetheless, good intentions are not enough, as she shows. In Chapter 4 she offers a variety of explanations for failures of systems intended to serve those facing economic adversity and mental health challenges. Some of her interlocutors reject “psy-” understandings completely. Others appreciate therapists who are empathic and nonjudgmental, but they can only afford Medicaid-funded doctors who just “push pills down your throat” (88). Many doubt that their economically comfortable providers understand what they are going through, or they lack transportation to attend appointments, or have neither the time nor the energy to deal with their mental health when their first priority is to locate a bed for the night, childcare, or their next meal. One of Carpenter-Song’s main points is that too often institutional providers miss opportunities to provide timely supportive services that would build on people’s strengths instead of amplifying their weaknesses.

In some cases, lack of suitable housing and subsequent state intervention precipitated a downward spiral. As Carpenter-Song explains, Vermont has one of the highest rates in the nation of removing children from families and terminating parental rights when social workers suspect that the children are in danger of abuse or neglect. In the devastating Chapter 5, she shows how families forced to “parent in public” (Friedman, 2000) after they sought social services were then at risk of having their children taken away. For example, Jim and Hannah, a couple in their 40s who had some college education, had been self-supporting restaurant workers with a large, blended family, until they suffered disabling injuries. They moved to Vermont, where they knew no one, because their Southern state had cut Medicaid funding and Vermont had more generous social welfare programs. However, those programs did not sustain them. Jim was advised not to seek work while he applied for Social Security disability benefits, but then they could not afford their rent and moved to the family shelter. When the staff inquired about supports to help them care for their children, child welfare services instead took the children into state custody. Jim and Hannah kept trying to meet all the conditions for family reunification but never succeeded. Even though Jim started working, they became homeless again when their landlord refused to make the repairs required for subsidized housing, and they had to camp outdoors. Without adequate housing, they had no hope of getting their children back. Later they were able to rent a small cabin, but it was isolated. Without the routines of childcare or motivation of providing a home for their children, Hannah felt she lost what made her life worth living. She died, possibly from a combination of alcohol and pain medications she was taking to deal with her deepening depression. Carpenter-Song describes Hannah’s “loss of self,” and the worsened drug dependence of another participant who also lost custody of her children, as “a form of madness induced by navigating state systems of power in the wake of traumatic loss” (117). Carpenter-Song recognizes that both had prior mental health vulnerabilities, but she explains that they had shown the capacity and desire to overcome those problems, strengths that could have been sustained with different interventions.

The moving stories in Chapter 5 were published in an excellent 2019 Ethos article. In Families on the Edge, Carpenter-Song adds another chapter (Chapter 6) describing the happier outcomes for two other participants who managed their mental health challenges and were able to keep their families together. One woman was helped by a supportive housing program that combined subsidized housing with nonjudgmental therapy and a case manager’s assistance with, for example, picking up groceries or cleaning before housing inspections, along with the social interaction and routines provided by a job; another was helped by subsidized housing, religious faith, and a reliable life partner. In her final chapter, Carpenter-Song develops the practical lessons from her research for improving the lives of families like the ones she got to know.

The chapters of Families on the Edge are self-contained, which can be slightly annoying when we are reintroduced to the same people in each chapter, but was no doubt intended to facilitate reading them separately. Carpenter-Song’s writing is lucid and evocative, which makes the book a good choice for undergraduate courses in medical anthropology, cultural psychiatry, psychological anthropology, and social work. My only suggestion would have been to eliminate about half of the in-text citations of other medical anthropologists. Her examples are powerful enough to stand on their own.

Reference

Friedman, Donna. 2000. Parenting in Public: Family Shelter and Public Assistance. New York: Columbia University Press.