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.
