One of the most popular ideas in mental health is something that we can hardly define – recovery.
Our ideas of recovery seem to constantly change. Recovery is now part of international and Canadian policy on mental health. Yet it is difficult to understand what recovery is. The idea varies across mental illnesses, addictions and treatment methods.
Across the world, there are different answers to the questions: What does it mean to recover from mental illness or addiction? How can people recover from mental illness or addiction? And even, can people recover from mental illness or addiction?
The pursuit of definitive answers to these questions has given rise to the recovery movement. The recovery movement is a social movement working to change the understanding of mental illness across the world, according to Larry Davidson, a Yale University professor and author of Roots of the Recovery Movement.
It is not clear specifically how or where the recovery movement developed, but Davidson says that the recovery model is very Western, and focuses on the individual. He says we need to be mindful of other cultures who are focused more on the community than the individual.
“One of the shortcomings of the concept of recovery and the recovery movement is that it’s hazy,” says Sean Kidd, a clinical psychologist with the Centre for Addiction and Mental Health.
Studies in the 1970s showed that most individuals diagnosed with schizophrenia go on to live meaningful and productive lives. This idea is at the core of the recovery movement. One of the achievements of the recovery movement is the integration of people with lived experience as part of the overall mental health and addiction system, and training opportunities for mental health and addiction staff to learn about recovery.
Some of the movement’s values are less murky. In the recovery movement, “recovery” does not mean symptoms or struggles disappear forever. It means personal or psychological recovery – learning to lead a meaningful life, while still living with mental illness and its symptoms.
In this, recovery includes focusing on strengths, while acknowledging weaknesses. It encourages people to take calculated risks towards leading a meaningful life.
Recovery lies in decreasing and preventing symptoms or unwanted behavior, while increasing and promoting wellbeing and strengths. Studies have supported the benefit of focusing on strengths instead of avoiding things that trigger symptoms – including in mental health services.
Davidson says common mental health stigma, like expectations of instability, unpredictability and dangerousness, decrease the opportunities for those with mental illness to lead a meaningful life.
Mike Slade, a professor at the University of Nottingham, says there is a gap between policy and reality for recovery. He says individuals with mental illness, even in mental health settings, are still not viewed as full citizens. He says they are not seen as “one of us” by those without mental illness.
But disability rights-advocate Patricia Deegan believes recovery should not mean sacrificing identity.
When she was 18 years old, a hospital psychiatrist told Deegan, who lives with chronic schizophrenia, “If you take medications for the rest of your life and avoid stress, then maybe you can cope.” To her, recovery did not mean becoming “normal.” Deegan pursued a doctoral degree and became one of the leading figures of the recovery movement.
Kidd explains that this stigma also exists at a systemic level. He says legal and bureaucratic policies reinforce stigmatizing ideas, like dangerousness or criminality.
“When the police are called to bring someone to the hospital, no crime is committed, nonetheless, there is a documentation – a police file,” he said.
Systematic issues also exist within treatment itself, says Kidd. He says that not every doctor approaches a patient with the idea that recovery is possible.
“(This message runs) counter to the evidence,” he says.
He highlighted schizophrenia as a field where doctors may approach a patient assuming they will not be able to recover. Yet, he says, most people with schizophrenia are able to make major progress in their recovery. Many are able to have a family, job, or volunteer position, whether they still hear voices or not.
Identifying and addressing this approach is another goal of the recovery movement.
“We have to assume (that all patients) are probably one of the larger group of people that has some potential (to recover),” he says.
Bill White, an emeritus senior research consultant, focuses on recovery from addiction and substance use.
“(The recovery movement) can inject the experiential knowledge of more than 23,000 Americans in long-term recovery into research, clinical, and policy discussions,” White says. “If there is an untold story within the addictions arena at public, policy, and clinical levels, it is the story of long-term recovery.”
Though experts agreed that there is great progress made, they all expressed that is a long way to go – particularly when it comes to stigma.
Both Kidd and Slade said one of the best ways to combat stigma is through contact with those with mental illness. Especially when the experience defies stereotypes. Slade also encouraged people to engage in “one conversation at a time.” In other words, every conversation we have about mental health is important and reducing stigma is not something that can change overnight.
Davidson and White emphasized the importance of community supports and positive educational campaigns, without misleading negative portrayals of individuals with mental illness.
Hope is one of the main messages of the recovery movement and that this is what, at least in part, made the movement popular. Yet, it is still not clear how to best implement and think about recovery.