Back in the 1990s, I remember sitting in the grounds of a big ex-asylum being spoken to about recovery by a well-intentioned psychiatric nurse. I wanted to smoke, so I sort of went along with what he was saying, nodded a bit, but something felt wrong. Wasn’t he saying I should buck up and get well quickly somehow? And if I didn’t, wasn’t that somehow my fault? That was not to be the only time I heard about recovery. Indeed, it’s been the big buzzword in mental health pretty much ever since. The 90s were labeled – rather optimistically – as the ‘decade of recovery.’ More recently, recovery has been placed slap bang central in mental health policy. Is supporting recovery pretty much good common sense? Or is the term being misused to pressure those suffering to behave in certain ways?
Recovery Propaganda is Everywhere
Recovery has been defined as “a personal journey of discovery which involves making sense of, and finding meaning in, what’s happened; becoming an expert in your own self-care; building a new sense of self and purpose in life; discovering your own resourcefulness and possibilities and using these, and the resources available to you, to pursue your aspirations and goals.” Those in favour of the notion of recovery tend to see it as a mighty leap-forward for mental health services. Rather than seeing mental distress as based on deficits, they argue, people are now given access to stories of those who have moved beyond their ‘mental illness’ inspiring hope and the possibility that a diagnosis doesn’t mean a stilted, squashed life of appointments and medication. In this new paradigm, professionals and patients are storied as equals, with professionals ‘experts by profession’ and clients ‘experts by experience.’ ‘Co-production’ is the slogan, with everyone seeming to commit to work together to give some agency back to patients to start their own healing journey.
Most recently, Recovery Colleges have begun to spring up all over the country, offering a variety of half-day courses on ‘understanding’ psychosis, bipolar, self-harm, eating well and such like, that service users can cherry-pick to aid them on their ‘personal journey.’ There are some glowing reviews of recovery colleges: “The prospectus outlines opportunities for learning and puts you in control. You choose what might help you. That is empowering. At an individual learning planning meeting you are welcomed. The graduation is a special occasion which marks group and personal achievement and success,” one attendee comments. So far, so great. However despite the psychiatric propoganda, many see the notion of recovery as contentious, damaging and divisive.
Recovery Masks the Nature of Long-term Pain
There are two different strands of critique. Some argue that however complex the competing definitions of recovery, they invariably set up a ‘have or haven’t recovered’ dichotomy that can leave people to feel they have failed when they continue to suffer. Iris Benson, a service user and carer representative, puts her critique this way “I understand I’m not recovered. I live well with my mental ill health. You can live a meaningful fulfilling life with a mental illness, I’m living proof. It’s possible. You need the right help & support in place.” Psychologist Jamie Hacker Hughes, who identifies as having Bipolar Affective Disorder, concurs with Iris’s point: “I know that I feel better but I don’t know that, actually, in the future, depending on what happens to me, I am not going feel worse again. It’s not black-or-white, it’s grey, varying shades of grey… it’s a continuing process.” Jamie makes the crucial point that even though recovery may be defined as an ongoing journey in principle, actual outcome measures are crude and defining. “When I ran an Improving Access to Psychological Therapies (IAPT) service” he continues “I discovered the IAPT way of seeing recovery was as something that can be quantified with a very few questionnaires, ones IAPT probably chose because they were free, which operate with a cut-off score where you are either not in recovery, moving to recovery or in recovery, and are then discharged, and then your treatment is finished. Whereas we all know with psychological health, as someone who has had their own personal experiences, it’s not as cut or dry as that. It just doesn’t work with a one-size fits all questionnaire.”
Recovery is Used to Discharge People
Nearly everyone I speak to agreed that recovery ideas are being misused to discharge people who, frankly, need more long-term input than a now broken NHS can afford. A senior service lead puts it this way: “Listen, recovery colleges do great work. But all of us know, the NHS is seriously underfunded and we have to discharge people who really continue to need our help. So sometimes we send people to try to give them something at least to help them manage by themselves.” Patients here are fed a ‘narrative of progression’ to mask a problem which is deeply political. Should life continue to prove difficult, if the ‘certificate of success’ award on graduation not hold up against the pressures of life, the onus is left in a sense of failure at an individual level. And a sense of failure isn’t so great for mental health by anyone’s definition.
Recovery has Become Cleansed and Whitewashed
A second strand of lobbyists argue that recovery has been co-opted to cleanse it of its radical potential to challenge mental health services. Recovery is often storied as a progression from the survivor movement of the 60s and 70s which – like other civil rights movements – attempted to reverse the gaze back on powerful oppressors to show how ideas like coercion, illness, and normacy screw people up in the first place. However, as, prominent activist Jacqui Dillon puts it: “There is a danger that as recovery becomes more widely embedded in services, the concept is being colonised, so that its most radical aspects are assimilated, and it simply becomes another method of controlling and coercing people, meanwhile, insidiously maintaining the status quo under the guise of offering something innovative and empowering.” Psychologist Dave Harper agrees, arguing that though the strengths building model associated with Recovery Colleges appears progressive, it is still associated with the idea something is deficient in the individual: “we need to be a bit more curious because we need to look at language and words in context in relation to their implicit other meaning. So if you ask people to define what being well means or being happy, people always talk about the notion of illness, or being sick. And if you talk about strengths, you are implicitly implying that there are weaknesses and the unsaid bit of that can be a bit tricky. So the almost manic focus on strengths has an unsaid bit about it.” Dave continues “everyone wants to be positive about recovery, but… recovering from what, whose recovery and whose judging these things. And these differences come up again and again.” Harper is at pains to state there is some great work being carried out under the recovery banner, but that he has ongoing concerns about ‘responsibilisation’ or “the way people are made responsible for their problems and the solutions for that problems, and that therefore means if people find it difficult to change, it might not be said explicitly, but covertly, and implicitly people feel it’s their fault.”
Recovery has been Co-opted for Professional Interests
Perhaps the most powerful critique of recovery, though, is offered by the Recovery in the Bin collective. They provide eighteen principles of ‘unrecovery,’ which adds to a first demand that “no one is put under unnecessary pressure or unreasonable expectations to ‘recover’ by mental health services.” In their view, recovery ideas have been co-opted by professional interests, replacing a ‘social model of madness’ which acknowledges that capitalism and neoliberalism place people under ”intolerable social and economic conditions, due to the effects of social and economic circumstances such as poor housing, poverty, stigma, racism, sexism, unreasonable work expectations, and countless other barriers.” They continue that recovery has been “a gift to neoliberalism to excuse the withdrawal of the welfare state.” “There are the lives lost and the lives destroyed, it’s insulting to speak of recovery when so many live in fear of destitution.” The collective argues that the focus on tools such as ‘recovery stars’ in recovery colleges – which measures outcomes through how well a person can ‘manage their mental health’ and their ‘living skills’ – produces a “narrow and judgmental view of wellness and self-definition” which at best only allude to the structural problems which create madness. Rather brilliantly, they proffer an alternative ‘unrecovery star’ which points to things like poverty, homophobia, trauma and economic equality that the evidence base shows us clearly link to the chances of experiencing, and getting over, mental distress. Whilst the ‘unrecovery star’ points to the need for collective action, protest and consciousness-making, the ‘recovery star’ – used in many recovery colleges – points to good self-management, and becoming a good citizen who eats well, sleeps well, has nice (probably heteronormative) relationships, and a job.
Recovery Ignores Inequalities
This is all too obvious if we look at the prospectuses of recovery colleges. They offer a welcome focus on hope, inspiration and trajectory, but it is painfully obvious how political leanings whitewash what is and what isn’t on offer. Let’s take a few lines from the Tower Hamlets prospectus which – hallelujah – is one of the few that mentions ethnicity or diversity. It reads: “As Tower Hamlets is a culturally diverse and dynamic community, we have developed a session focusing on diagnoses which particularly affect people living here. The session will cover depression, bi-polar disorder and schizophrenia.” This area of East London is one of the poorest, most ethnically diverse boroughs in the UK. Yet though the increased incidence of diagnoses is registered, there is no mention of the politics around this – for example the increased chances of, as a young black man, being sectioned, dangerously overmedicated, and arrested, which link so clearly with history of oppression and racism. This is staggering given our knowledge that BME communities often don’t engage with psychiatric services because their history, their culture, is so foreclosed. It would have been an unthinkable omission a few years ago when institutional racism was higher up the mental health policy agenda. Similarly, we find a twelve-hour course on ‘How to find a Flat and Maintain a Tenancy’ and a one-day workshop on ‘How to Manage the Transition from Secondary to Primary Care’ as if this is something the individual should now achieve or fail at, masking the dramatic cutback in mental health funding, which is leaving many to be discharged too early, suddenly support-less, often after decades of care. Whilst recovery colleges open up hope, optimism, and skills to many, in being co-produced by professionals there is an obvious bias towards less psychiatry-challenging aspects of the (massive, heterogenous) service user community. This no doubt suits the State, and regimes of governmentality whereby the individual takes in ideas that they should self-improve – leaving the government scot-free.
Recovery has Become about Normalisation
If we really want progressive services, we must recognise that working alongside professionals is going to subtly shape what is on offer, appeal to some, and put off others. Co-production isn’t enough. We must fund survivor-led recovery colleges that can offer a variety of courses to include those which reject professionals involvement entirely rather than serve a subset of the community. Of course, some would offer many of the courses offered by existing recovery colleges, and might bring in professionals. Telling those who feel they would benefit from ‘managing symptoms courses’ that they are alienated from the true social nature of their distress can end up recreating the ‘false consciousness’ accusatory culture of the 70s. However, if funding were also to go to those who reject the core tenets of psychiatry, recovery colleges might be very different. Organisers are likely, for a start, to reject the notion of ‘colleges’ and ‘courses’ in the first place, laden as they are with business mentality. There are alternative education and artistic models to draw from, such as the techniques for individual, social and political change offered by the Theatre of the Oppressed. But, more, the creative, challenging, unique methods of personal-political change so present already in parts of the survivor movement – but so squeezed, financially and discursively – as notions of recovery come ever-increasingly under the neoliberal hammer.
When hope and inspiration are packaged as unique properties of the Recovery Movement, it’s tempting to go along with some quite problematic ideas, just as it is tempting to nod along – well, for me at least – to get a chance to have that one cigarette. But language gets inside us, and these transactions of compromise – so common to life as a patient – squash the chance for real, liberatory ideas of mental breakdown and breakthrough. Ideas which see both problems and solutions lying squarely in the communities that we live in, rather than in an isolated, laminated certificate left somewhere on the floor.
Compromise or liberation? None of the above. More oppression. Recovery porn.
Strangely enough, the uncertainty about the prospect of recovery is glossed over. Like you have pointed out recovery is ideal, however, there are many who battle on going symptoms and residua by acknowledging that not everything is right or even normal. There is a great deal of emphasis placed on certainty and conformity to what is supposedly normal and this itself might be counterproductive in the mental health context because not much in the mind realm is understood. Our faculties themselves are inexplicable, our characteristics changeable, leaving “illness’ a very very dynamic phenomenon! Perhaps acknowledging uncertainty in consumer prognosis as well as the setting of goals within policy making might lead to a ‘plasticity’ that is healthier. The reasons behind another inexplicable human movement such as spiritual seeking is completely unexplained, and we believe that empirical evidence isn’t the only way to the resolution of mental anguish!!
http://www.insightopen.com/2015/03/spirituality-mental-illness/
Many thanks,
Ajit
Thanks, Jay, for this excellent summary. This is a slide I often use in presentations:
Recovery themes
Connectedness (including support from others and feeling part of the community); hope and optimism about the future (including belief that recovery is possible); identity (including overcoming stigma); finding meaning in life (including the experience of ‘mental illness’); and empowerment (including taking personal responsibility, focusing on strengths, and taking control of one’s life) (Leamy et al 2011)
I then point out that the recovery themes are more or less the exact opposite of the messages conveyed by psychiatric diagnosis. So – it is legitimate to ask what people are meant to be recovering FROM – the ‘illness’, or the diagnosis (and associated ‘treatment.’) What an irony. First we mess you up (let me hasten to add, often with good intentions…) and then we turn round and tell you it’s now your job to ‘recover’ from what we’ve done. Lucy Johnstone
No, the NIMH guys are trying to steal a page from the complementary guys, who have aimed for this for decades. Since our Important Folk in psychiatry fear professional humiliation and degradation if they used complementary treatments, they’re stuck with simple-minded optimism, as they feel compelled to believe the actual treatments have no value and therefore the practitioners’ enthusiasm is the real cause of their success. Of course, with the same old treatments, you get the same old results: patient goes to medicated Twilight Zone and “denying (or refusing) treatment” goes into patient’s file and practitioner gets feeling of superiority be (s)he’s not a chump who doesn’t know what’s good for him/her.
“Recovery has been defined as ‘a personal journey of discovery which involves making sense of, and finding meaning in, what’s happened; becoming an expert in your own self-care; building a new sense of self and purpose in life; discovering your own resourcefulness and possibilities and using these, and the resources available to you, to pursue your aspirations and goals.’”
That’s a pretty good definition, imo. To me, aside from ‘recovering,’ I also found core healing by realizing how life education comes from our experiences, and how my experiences led me to realize that I was not the person being mirrored back falsely and negatively (stigma); but that, really, who I am inside–how I ‘work’–is really none of anyone’s business, other than, perhaps, those to whom I am closest and intimate, with whom I choose to have a personal relationship. Negative mirroring is always a projection, by nature, and in the case of mental illness, the system as a group projects negatively. We are never that, in our true spiritual essence, so the system is operating in full delusion, by definition.
Once I got this, my health and life turned a big corner, and I was able to discern toxic vs. healthy environments, and I walked away from the toxic and started to create health in my self and in my community. I believe we all have this capability, if we learn to believe in ourselves, rather than to buy into what others project. Full ownership of one’s life is what heals us at the core.
I worry about all sorts of people, yourself included, making mincemeat of the English language, Alex. I believe it was Henry David Thoreau who once said, “Simplify, simplify, simplify.” Recovery, first off, means recovery of something that was lost. A ball in a ball game, for instance, is recovered from the opposing team or from out of bounds. Should a person lose his or her wits, then it is recovery of wits. Ditto, reason. On the other side of the coin, there is madness. If one loses his or her madness, then there is something to be said for recovery of that, too. Of course, not according to the state, with its mind-control cops, who place a high premium on law and order for maintaining the status quo.
I’m chuckling a bit because I honestly don’t know what to say about this. I was simply expressing my perspective, from my experience. “Mincemeat of the English language,” hmmm. Can’t wrap my head around this, sorry.
I am trying really hard to understand the hostility behind simple disagreements and differences in perspective. There’s not even an attempt to understand where a person is coming from before shooting them down. It shouldn’t lead to accusations of this and that, but it virtually always seems to around here. What on earth is the deal, here? It’s aggravating, but also fascinating to me at this point.
I’d think about this when envisioning what is a healing environment.
Sorry if I sounded hostile, Alex, that wasn’t my intent. I’m just aggravated about such matters as SAMHSA endeavoring to “redefine” “recovery” in a such way to please all people. You don’t get a definition that way. Instead you get mysticism, and for me, an atheist, I’ve got an automatic aversion to that sort of thing.
I can understand recovery as a journey, perhaps, but that’s by taking a slight detour of the dictionary. I’m knocking it only because I’ve heard it, and heard it, and heard it, and heard it. Okay, maybe that works for you. I made my journey time ago, and the destination I arrived at was recovered, past tense. I think all too often what we’ve got are people “in recovery”, that is, “recovering” but never “recovered”. Stuck in a process that would have a beginning, a middle, and an end, but that never finally arrives at that end.
If anybody wants to get there, well, not taking pharmaceuticals worked for me. I imagine tapering off might work for others.
I agree that if people are perpetually ‘in recovery’ then there is no end. I also agree that these issues of “healing” and “recovery” cannot be institutionalized, to me that is a given, it’s just all too personal. What is appropriate and helpful for one person may be completely off-base for another.
I highlighted that particular statement because it spoke to me, personally, and it’s how I approach my own life and practice, and both have been successful. I don’t really connect with the phrase “in recovery,” that has no meaning for me, it’s abstract.
One either feels in balance and content in life, or not, I don’t compromise this, either with myself or with clients. If you’re not happy, change something. And that always best begins internally. Once we learn that, then recovery will happen in full force, along with core healing. You only move forward after that.
I believe that, in any event. It may not be the belief of another, and I would respect that. But I certainly cannot relate, nor would I be able to work with that person in any capacity, because we’d be at odds all the time about what is possible.
But I don’t see the reason why they couldn’t have a reasonable and open dialogue, simply to develop a sense of compassion for and kindness toward the collective of humanity, regardless of our differences in belief.
Frank
What you state here is what I’ve felt about all this “recovery” hype that’s inundating us. As you and I both know, the system doesn’t want recovered people for then they wouldn’t be a source of money. I hear this “you’re in recovery” being told all the time to the so-called “patients’ in the so-called “hospital” where I work. They never tell them that it’s possible to be recovered. When they’re discharged they all leave with a big brown bag of the toxic drugs.It’s disgusting.
Chill out man. English die soon. Me glad. Shit change. Death to the formal lexicons of the white ruling class.
All power to articulation then whenever you should feel a need to communicate. Otherwise, keep a sharp eye out for the mind police. They will lock people away for not being, in their opinion, communicative enough. Word salad though is not very nutritious. Very upchuck-able.
“Recovery” is not a very helpful term because it presumes “upset”. The “mental illness” industry is very good at making problems out of people. Were we talking “recovery” from the mental health system by both consumers/patients and mental health workers/professionals, the gig would be up. “Recovery” has become “non-recovery” because, given this buzz-word, the industry can expand like hotcakes, and into perpetuity.
The therapeutic state is apparently growing by leaps and bounds. Now we’ve got “recovery colleges”. Sort of like “mental health” colleges I would imagine. Parenthetical existence has never had a better moment. Institutions now have “treatment malls”. These “treatment malls” are rather what one might refer to as “reeducation camps”. The idea is to get people to see the error in their biology, and to have it chemically corrected. What do you get in these “treatment malls”? Propaganda. Why? One of the ruses used to get people out of institutions in the past has been an “absence of treatment” within the psychiatric prison itself. Given these propaganda mills, especially as they are now called “treatment malls”, it is harder to make such a claim in a court of law. Custodial “care” has been replaced by “mental health” propaganda.
The other side of “learned helplessness” is the institution where “helplessness” is learned. No matter how you cut it, when “recovery” is actually “non-recovery”, it’s not going to come up smelling like roses. Destroying one large physical institution doesn’t destroy all the little mini-facilities that come to succeed it. The problem is this little game of not accepting people as they are. There is no end to it unless you make an end to it.
“Recovery” is one of those nebulous terms like “psychotherapy,” which implies disease while not necessarily fully embracing the medical model.
Generally we “recover” from something bad that has happened to us, not just from “diseases”; Laura Delano’s website “Recovering From Psychiatry” is an example of “recovery” not being inherently a “mental health” concept.
But “Recovery Colleges”? Give me a break!
The author also has a flawed concept of history. No one talked about a “survivors'” movement in the late 70’s: the terms used were, alternately, “mental patients liberation movement,” psychiatric inmates’ liberation movement,” and “anti-psychiatry movement.”
The true movement had pretty much disappeared by the time of the formations of SCI and MFI, which were admirable holding tactics in a dark time during which the political gains of the late 70’s – early 80’s had been thwarted by co-optation; however, MFI was neither an anti-psychiatry group nor exclusively composed of “survivors.”
BTW the principles put out by the In the Bin Collective are pretty radical given the times, and worth reading. While still immersed in the medical model to a good degree, some of the points are well-taken and applicable to the anti-psych movement.
I can assure you oldhead that Recovery in the Bin is not remotely pro-medical model, (I am one of founding members): http://recoveryinthebin.org/
I will definitely check out your site, your perspective at first quick glance seems incompatible with psychiatry (a good thing). It was mainly some of the terminology I had some issues with, and will reexamine. Good to know you’re there, thanks for the heads-up.
Btw I was actually referring to the 18 principles on the “Free Psychotherapy Network” site that was linked to above along with yours; I didn’t realize they weren’t the same.
Joanna — Your whole perspective at “In The Bin” seems pretty right-on. I am unfamiliar with how psychiatry operates in the UK (and was initially unaware you all were from the UK, duh) so pardon my seeming ignorance, it’s actually real ignorance. Anyway…
Many of us will never be able to ‘recover’ living under these intolerable social and economic conditions, due to the effects of social and economic circumstances such as poor housing, poverty, stigma, racism, sexism, unreasonable work expectations, and countless other barriers
Yeah, that’s sort of how I feel about the term “survivor” — sort of like, what time is it now? There’s also the point made by BPDT that some people don’t have an initial point of “wellness” to return to following “recovery,” i.e. there’s little to recover.
Anyway I like your 18 point manifesto, we need to start working on one over here. I had briefly forgotten that it’s only Americans who are so pathetically clueless about basic Marxist/anti-capitalist analyses and hope you all stick around to help with the c-r. My regards to Jay as well, glad to learn about this stuff. Those “Recovery Stars” sound outrageous! 🙂
Thanks for writing this, Jay. Definitely sharing this with people I know IRL.
When I visit my daughter in institutions, I’m used to an infinite number of ways in which rules and restrictions designed to make life convenient for a small army of people paid to babysit are couched in terms of recovery, as if the rules and restrictions were for my daughter’s benefit not the other way around. I have a small litmus test: anything forced or coerced has nothing to do with recovery!
In a way the whole idea of “recovery” from mental health problems is a misnomer… the sequence imagined is, 1) The person was initially or formerly psychologically well and healthy; 2) The person “fell ill” or got worse from this initial elevated or good state; 3) The person reaches “recovery” by getting better (again).
This meaning is inescapable because the “re” part of the word recovery clearly implies returning to or regaining a lost former state of wellness.
But this is completely not a fit for the experience of most severely distressed people. Most severely troubled people have never been truly emotionally well, never truly been dependent and secure in relationships, never truly had a well-established identity for very long. Trauma, neglect, abuse, stress, and poverty predominate in the upbringings of most people who get labeled “schizophrenic”, “bipolar”, and “borderline”. “Recovering” to the horror of their past lives before they got labeled would be no recovery at all for most of these people.
Thus I’d say the use of the word “recovery” should be abolished to the dustbin of history and replaced with something like “achieving a healthy identity” or “attaining emotional wellness” or “becoming psychologically mature for the first time” or “living the life you want”.
In Kernberg, Rinsley, Masterson, Searles, and Volkan’s psychoanalytic self-object terms, the process of developing to a state of relative psychic health from a psychotic or borderline state can be pretty clearly conceptualized… in Kernberg’s object relations phases, it could be conceptualized as moving from his stage 1 to his stage 3 (from Searles’ out-of-contact to his therapeutic symbiotic phase), or as moving from his phase 2/3 to his phase 4 (from Searles’ ambivalent symbiotic to his individuation phase). Most people who become psychotic as young adults have never been truly well or had a secure identity, so recovery is not the right word for them… there is nothing solid to recover to; a new self needs to be built. In terms of defenses, the transition could be understood as moving from using primarily fusion / all-bad splitting to using primarily all-good splitting and/or integration and repression. This requires having sufficient experiences with real good aspects of the external object world to be able to psychically play in the “good object” position, to be the good breast in a manner of speaking. This is what severely distressed people probably need most, sufficient loving, trusting, supportive relationships to move through the symbiotic stages and develop an identity.
In these articles below, I wrote about how these phases of personal development could be understood in object relations language:
https://bpdtransformation.wordpress.com/2015/03/19/23-the-borderline-narcissistic-continuum-a-better-approach-to-understanding-diagnosis/
https://bpdtransformation.wordpress.com/2015/10/19/27-the-kleinian-approach-to-understanding-and-healing-borderline-mental-states/
In other words, recovery is partly a covert reinforce of the disease/defect/biological model. It assumes wellness, then “illness” triggered by brain chemistry/genes within the individual, then hopefully “recovery” to a state of “normality”, i.e. to the way our fellow human automatons operate. But recovery is not an apt word for “becoming well”, “developing an identity”.
In my opinion, “recovery” should be replaced with two terms:
“Salvation”
and
“Deliverance”
These were the two words Ronald Fairbairn felt were most appropriate to the subjective need of those individuals with severely suffering souls needing to come to feel well.
OK BPD prepare to be annoyed. I’m going to start pointing out more often the careless ways you constantly throw around “mental health” terminology and psychiatric stereotypes in hopes that you’ll start to see what you’re doing.
In a way the whole idea of “recovery” from mental health problems is a misnomer
Just like how in the biggest way the term “mental health problems” is a misnomer? — which of course you know, so I don’t get it — are you just feeling lazy about the quotation marks or is it more? Because you can’t assume people know what you mean.
Most severely troubled people have never been truly emotionally well, never truly been dependent and secure in relationships, never truly had a well-established identity for very long.
This is shrink-think, which begins by positing an undefinable category (“severely troubled people”) and then making categorical statements about people you decide fall into it.
In Kernberg, Rinsley, Masterson, Searles, and Volkan’s psychoanalytic self-object terms, the process of developing to a state of relative psychic health from a psychotic or borderline state can be pretty clearly conceptualized
Maybe so, but why bother? Again, “studies” which start out taking terms like “psychosis” seriously are already flawed and missing the point.
Most people who become psychotic as young adults have never been truly well or had a secure identity
More with the psychiatric/psychoanalytic generalizations.
Amidst all this there is nonetheless a good point made, i.e. that “recovery” presumes an original state of well-being which may never have existed. But the constant references to others’ psychobabble doesn’t help to enlighten the discussion.
Oldhead, it doesn’t bother me what you say. In your thinking, apparently, identifying any sort of demarcated categories, or naming one state of being as different from another is potentially offensive or problematic. One almost has the feeling sometimes that giving any experience a name is offensive to you. I imagine this is because you were harshly labeled and mistreated by those in psychiatry who attacked your identity with labels in the past… but that does not mean that all who use words to describe loose groups do so without justification or with bad intent.
Let me respond to your points,
I don’t feel lazy about quotations marks; I forgot on this occasion, big deal! I’m not perfect. Give me a break dude…
About the “severely troubled people” having more problems than the population in general… there is an aspect of reality to these statements, loosely understood… People who get labeled “schizophrenic” and “borderline”, invalid illnesses as those labels are, very frequently have experienced abuse and trauma compared to people not given those illusory labels, and have certainly experienced loving relationships with parents less securely than people not given these labels. The ACE study and the many John Read studies back this up. The data is there, associations can be made, although they have to be made carefully, keeping in mind the serious weakness of psychological research relative to real sciences, something you correctly point out…
I think about these phenomena empathetically in terms of experiences experienced by certain people at certain times, not in terms of illnesses. People are experiencing real things, some people at a given time are more similar to one another than to others, and we can use words to describe those similarities and differences, but should do so carefully. I reject your characterization of my words as “shrink think”. Not everyone comparison between groups is objectifying and harmful.
And Oldhead, if you think that the work/conceptualizations of authors like Volkan, Searles, Kernberg, Rinsley etc is so flawed… kindly enlighten me on this: 1) Have you even read their writing (If not, they’ve done great work to help traumatized people, and their understanding of how to help traumatized people is very deep and empathic. That’s we should “bother” and take seriously their way of thinking, even if we don’t agree with it totally). ? 2) You say they (and I) are missing the point – and what is that point? It’s all well and good to criticize me, but don’t be afraid to come out and give your own opinions and positions.
Better luck annoying me next time.
One point at a time, & I’m not trying to “bother” you but to communicate:
In your thinking, apparently, identifying any sort of demarcated categories, or naming one state of being as different from another is potentially offensive or problematic. One almost has the feeling sometimes that giving any experience a name is offensive to you. I imagine this is because you were harshly labeled and mistreated by those in psychiatry who attacked your identity with labels in the past
You are correct. There are no valid “categories” of behavior. This is what people have been recently recognizing and referring to as “decontextualization.”
This has nothing to do with any personal experience of mine with psychiatry (again with the assumptions). I couldn’t have cared less what words they may have used, my problem was with the incarceration and forced drugging.
More to come.
People who get labeled “schizophrenic” and “borderline”, invalid illnesses as those labels are, very frequently have experienced abuse and trauma compared to people not given those illusory labels, and have certainly experienced loving relationships with parents less securely than people not given these labels.
But when you say “people who get labeled schizophrenic” you’re just creating another label, or a meta-label, if you then purport to “study” supposed characteristics of “people who get labeled schizophrenic” as though it’s a valid category. “People who get labeled schizophrenic” might be worth studying in the sense of “people who get hit by trucks,” i.e. as victims of random life-changing events imposed on them externally, but not as victims of diseases or disorders (however mislabeled).
As for the statement itself, people who are traumatized often flip out one way or another; but not everyone who is traumatized exhibits behavior which qualifies for a fraudulent “diagnosis.” And sometimes they have fond memories of their childhood, just as sometimes they don’t, because again it’s a meaningless “category.” So whether or not someone who has been “diagnosed” has also been traumatized in other ways (I would posit that we all have, some are just better at suppressing it), to create a field of “research” to explore the vicissitudes of the supposedly complex, mysterious causes of human misery is what I call besides the point, regardless of what one-on-one help to others a particular “researcher” may be able to provide as a human being.
Ultimately this whole struggle comes down to our quest to recover our innate human capacities of love, empathy, and cooperation which have been stripped away by capitalism, turned into commodities and sold back to us (along with lots of torture & poison) in the guise of “therapy” and “treatment” — not just to come up with an “alternative” modality of “other”-izing people based on their thoughts, feelings and behavior.
We appear to have spent the nineties in basically the same cloned treatment facility. What was the first thing you learned coming in? Fake it till you make it. Once they decide they know your story, anything short of that, and they will make life hard for you. I’m just going to skip the dehumanization, abuse, subjugation, and humiliation. How do you leave a treatment facility and expect to survive in the outside world? It doesn’t just fail to prepare you, it actually moves you backwards. You now have limited of any outside social relationships, you don’t know how to form them, you aren’t sure how to manage conflict… Hell, because we were not allowed any news… I didn’t know who the president was.
Management– is what they’re doing though-in reality– and what they’ve always done and hung their hat on– recovery is psychological healing and awareness–stolen- from psychology- in the late sixties early seventies–along with the care baton– so we were recovering–when that recovery was stolen– and turned into management– now the same thieves want to steal what they stole– or destroyed- in their beginning– which in effect was the late sixties early seventies– when all the rich people made it trendy because it excused all their faults for them– the owned the money and the press– and have been selling it ever since– which is why we’ve got such a sick planet and people- we’ve just spent the last thirty fourty years becoming it– thanks to government-psychiatry mental health and all the vested– sick and misery sellers.
Thanks for the blog, Jay, I agree this new approach does deserve scrutiny. Despite my belief it’s important for the psychiatric profession to take a more hopeful approach. And get out of the business of lying to people, and trying to convince them they have “lifelong, incurable, genetic mental illnesses,” which require a lifetime of drugs, claimed to cure a non-existant “chemical imbalance.” Especially since these drugs are actually medically known to create the “mental illness” symptoms they purport to cure, which makes this even more egregious behavior. Since, this type behavior is actually nothing more than a heinous form of gas-lighting of a person, which is “mental abuse,” not “mental health care.”
But, if the “recovery” concept is being used to deny services, that is completely immoral and wrong. Especially, since recovery from the illnesses caused by psychiatric drugs, and the psychiatric industry’s lies, defamation and degradation, can take a long time to recover from, especially if one has limited resources. And, especially since the benzos, for example, have withdrawal effects known to last years. And withdrawal from the neuroleptics can create a drug withdrawal induced super sensitivity manic psychosis.
I absolutely agree, in regards to what the psychiatric industry is purporting to heal, with their toxic torture drugs and invalid stigmatizations, “both problems and solutions [lie] squarely in the communities that we live in, rather than in an isolated, laminated certificate left somewhere on the floor,” or in any one person’s brain.
A more radical view of recovery would be something like, “Learning to deal with the shit that’s been and continues to be heaped on me by this insane society I have to live in.” “Recovery” is almost always from the effects of oppression and mistreatment, not some mystical “mental health disorder.” I suppose we also have to “recover” from our own overwhelmed initial or habitual reactions to said oppression, but the mental health world’s view of “recovery” is “no one is to blame,” which is accurately translated into, “It’s your problem, not ours, you figure it out, except that you have to keep taking our drugs.”
More specifically, “recovery” in the mainstream is often defined as “having your symptoms under control so you can live a somewhat more normal life instead of being in the hospital and bugging everyone so often.” In other words, staying on your meds and staying out of trouble. To recover WITHOUT the mental health system, or DESPITE the mental health system, or FROM the mental health system itself is all inconceivable to most of the insiders.
“Recovery” has become a loaded term, and we need a new one, one that doesn’t allow cooptation by the very system of oppression that almost always contributed massively to the “mental health symptoms” arising in the first place. “Recovery” without presenting the context of systematic societal oppression is more disempowering than the system just being honest and saying, “We want to control you so you won’t waste our time and resources and annoy those of us enjoying our privileged status.” At least that’s something you can wrap your head around and fight against if need be.
—- Steve
Well stated Steve! I appreciate your judicious use of the word sh*t because if one has a loved one in the mental health system, one has to deal with a huge pipeline of bull sh*t from the big Pharma marketing executives who masterminded clever marketing campaigns that dumbed down American consumers, to the lowest paid mental health worker whose entire job consists of traveling door-to-door ensuring that a patients on Assisted Outpatient Treatment (AOT) are taking their meds. Kind of like ‘Meals on Wheels’ only it’s more like ‘Pills against your Wills” If I was a compassionate, knowledgeable and curious psychiatrist I would either be angry and despairing at the depths to which our mental health system has sunk or really, really embarrassed by my profession and my colleagues’ failure to address legitimate concerns coming from more and more critics.
I love it – “I’m here from PAW – Pills Against [your] Wills!] They could have a big puppy holding out a little white paper cup with a couple of Abilify inside.
I agree with you, I don’t see how psychiatrists as a group aren’t ashamed and embarrassed by their apparent complete lack of ability to deal with the problems they are supposed to handle. Perhaps the problem is that most of the “compassionate, knowledgeable, and curious psychiatrists” quit the profession early on and choose to engage in a more ethically clean and effective profession, leaving mostly the hyperauthoritarian, the slow-witted and the sociopathic to ultimately get their degrees.
Sorry if that’s insulting to the handful of ethical psychiatrists out there. I really appreciate you folks fighting the good fight, but you shouldn’t have to fight so hard for the obvious!
—- Steve
As someone who identifies as being a “survivor” of mental health services in the UK, I was initially enthused by the talk of “recovery” I do believe the word has now out lived its usefulness as there are too many interpretations.
An article that may be of interest is
http://www.ono.ac.il/wp-content/uploads/2014/04/Uses-and-Abuses-of-recovery.pdf
Yes, when I first came across the term I was interested in what seemed a hopeful concept too. It was Ron Coleman’s book, Recovery an Alien Concept. Basically he thought that recovery was not considered possible in the mental health system for people diagnosed with schizophrenia or bipolar disorder (never mind whether these are spurious concepts or not – obviously I believe they are).
He got out the bin with the help of the hearing voices movement and maybe other things. So then he started teaching recovery. Mainly it consisted of getting to know people in distress really well and offering them emotional and practical support.
There maybe mixed feelings about Coleman’s work however what he was on about is not what is on offer in most places these days. Healthcare Trusts talk about The Recovery Agenda, but they offer the same old nonsense as they always have: drugs, patronising fortnightly chats with social workers and neglect in the community is what most people I know get. But now there is an added pressure to look after yourself slightly better, do voluntary work, move towards getting a job. Then there are government assessments to see if you are worthy of your benefits. If you fail you have to appeal or apply for jobseekers allowance and then go through the humiliations heaped on all claimanats by the Job Centre which seem to get worse ever year.
Meanwhile, if you actaully sit down with people who are trapped in these services and actually listen to them for an hour most of them will actaully tell you what drove them mad and what is distressing them in their lives right now – not that most of the workers do that, they are not trained, selected or supervised to do so.
That is a patronising nodding dog approach that uses a term points towards an idea that meant something hopefull 10 or 15 years ago but is now a form ticking exercise for psychiatric social workers.
I try and make providers accountable for their practice. If they are saying they are “recovery” focused then they need to demonstrate this, several years ago I was involved developing a benchmark for “recovery” orientated services. It’s using the weapon of “evidence base” which services claim to be beholden to, and finding recovery based evidence, and it is out there.
I won’t quibble but the 90’s were known as the decade of the brain (not recovery). I must ask, from what is it that folks are “recovering?” Certainly not the unproven phenomena known as “mental illness.” I contend that we recover our self. As my life spiraled deeper into the realm of mental patient, I lost more and more of my self. I lost my self-esteem, my self-confidence, my self-assurance, and all sorts of other aspects of self. For me, recovery meant to regain that which I had lost, some stupidly and voluntarily surrendered to authority and some forcibly taken by that authority. I had to regain my sense of self and the confidence to be my own expert on my own life.
Think about it. Imagine two soldiers returning from war with a single leg. You go visit with them and one reports that he’s anxious to get out and resume his life to the fullest. The other batters you with his self-pity over the fact that he lost his leg. You might honestly report that one is recovered and the other is not and yet neither regained their leg. What then might you mean by “recovery?”
One of my heroes is Tony Iommi, lead guitarist of the heavy metal band, Black Sabbath. Tony worked in a factory and the last day on the job before going full-time with the band, he lost the finger tips of his right hand. He would melt plastic and press the scalding hot material over his fingertips and then take a file to shape them to be able to play. He found he could no longer play right handed so he switched to playing left handed. Despite these handicaps, Tony became one of the best guitarists in the world and responsible for most of the heavy metal licks we hear today.
Would you say he’s “recovered?” He certainly never got back his fingertips. I believe he’s recovered and that’s why he’s my hero. He didn’t let anything stop him and he’s living a full and productive life of his choice despite any so-called limitations. It proves to me that “recovery” is more about your attitude toward yourself and others than it is about anything physical like controlling symptoms.
Tony is 68 years young and touring at the moment with Ozzy and the band. He’s overcome cancer and is a real model for hope and never giving up.
I recovered my self. I don’t talk about “being in recovery” as if it’s a life-long process. I made it. That doesn’t mean that life won’t construct more obstacles to overcome but if those are “recoverable” then I’ll recover each of them on their own.
Hi Jay,
I’m pleased to tell you that a group of trainee Approved Mental Health Practitioners in Birmingham thought this post was absolutely superb today. New ideas to them that seemed to instantly resonate with their feelings of disillusionment and concern. They also liked the work of RITB, too.
Jonathan
Jay,
You’ve got good territory assigned to the needs and purposes of this feminist take on relating facts to material differences, and coming out of the forays one fast swoop at a time. I mean, of course, that you stand to represent sanity for how it splinters and announces the turning point in emerging viewpoints, mindful of however they have unhelpfully turned in upon themselves and started into aggrandizing points of commonality much too soon. Since you invite thematic takes on all the “vital signs” you detect, and let the diagnoses roll off the tip of your tongue, you definitely have issued your very articulate challenge and stung hard at the middle of the rollicking fanatical insiders.
Jay, you were missed at Mad Studies in Lancaster!
I do some workshops problematising recovery (it is (becoming) the dominant paradigm in Australia and I like a definition of recovery by an Australian survivor, Bill Moon – “A good life, as determined by me.” And yes, as some have noted – for many of us this is something we’ve never had to “re”-cover.
I also wanted to add that I think this recovery focus is often misattunement to where people are at – people are in pain, but service providers often desperately want to be “helpful,” to “make a difference in people’s lives,” but are unable to sit with the shit of it, and to engage in the sociopolitical action that is needed in response to this shittyness. I had a friend suicide earlier this year – she was poor, queer, had a disability and was constantly negotiating heterosexism, ableism, discrimination, and chronic pain (she couldn’t’ afford to get the injections she needed for pain-relief), and struggled to find meaningful employment (work that didn’t make her want to die). When she disclosed that she was suicidal, she was carted off to hospital where they demanded “recovery goals” and got her to do all sorts of Recovery-oriented paperwork. I honestly think it was the last straw – to be in such desperate pain and to be met with this perky, do-gooder stuff, instead of someone able to sit with the despair and to recognise the structural issues. Hospitals pride themselves on being “recovery-oriented” like it’s a gold star for being very good. And people die. I sincerely wish she’d been given the money that was wasted on this “recovery-oriented” hospital stay. Perhaps then she could’ve had some space to figure out where to next…
This. So much this.
Don’t know how this got resurrected but it seems appropriate considering that the National Coalition for “Mental Health Recovery” is telling people to support the Murphy bill (Senate version).