When the recovery concept emerged in different long-term follow-up studies in the end of the 1970s and in the beginning of the 1980s,1,2,3,4,5 psychiatric circles were highly skeptical.
Because of these studies, the image of schizophrenia as a “chronic,” “life-long” disease was problematized, because these new studies emphasized that people could in fact recover. About 20-30% of those diagnosed with schizophrenia experienced total recovery of symptoms, functions and social life. The same amount of people were in a process of recovery. Even if most of this research dealt with schizophrenia, the idea was that if one could recover even from this “chronic illness,” then the chances to recover from other “disorders” were that much greater.
Additionally, this research clearly showed that socio-cultural factors were related to recovery.
In a follow-up study in Vermont, Harding et al.3 studied a group of persons diagnosed with schizophrenia with long and repeated stays in hospitals and living in back-stage wards in a state hospital. These persons did not improve enough to leave their wards after being treated with the first-generation neuroleptics. However, they were offered a long-term rehabilitation program and some of them could leave the hospital already after a few months. Coming out, they were offered a range of residence alternatives and on-going rehabilitative support in the community. At follow up, after 32 years, 68% did not display any sign of schizophrenia. 50% was not using neuroleptics. Analysing these data, DeSisto et al.6 stressed the importance of hope, relational continuity, and a working collaboration between user and professional for sustained recovery.
A WHO study5 showed that the chances to recover were higher in low-income countries compared with high-income countries, despite the big gap between the facilities in the health care services. Hypotheses to explain these differences in recovery rates included family structure, conditions in the labor market, and different cultural explanations of mental health problems.7
Even Warner’s review4 of follow-up studies in the 20th century finds a relatively high occurrence of recovery throughout this period despite the repeated introductions of different treatment interventions. Warner demonstrated that the percentage of people recovered or in recovery decreased in the 1930s, and the only explanation he could find was the economic depression—evidence that societal issues are responsible for recovery rates. He also found that the use of first-generation neuroleptics in the 1950s (sometimes called the “psychopharmacological revolution”) did not improve recovery rates at all.
Consequently, these studies underline the structural, cultural, and relational factors impacting recovery and the unclear connection to psychiatric treatment.
If the possibility of recovery from “severe mental illness” was a direct challenge to the established psy-knowledge, the lack of a clear connection between specific treatment interventions and recovery was a second blow to it.
Once the possibility of total and social recovery, even for people diagnosed with schizophrenia, was established, the research focus moved to the process of recovery. One of the most important contributions made by research on recovery is the understanding of people diagnosed with “severe mental health problems” as not merely victims of an “illness” but as agents in their own lives. Research on recovery processes and people’s stories about their own recovery show how they tried to cope in different ways with their difficulties or “symptoms”, and also how they dealt with their families and friends, as well as professionals from social and mental health agencies. In addition, many had found their own ways of dealing with unwanted effects of medication.
Until then, and still often, the person was characterized by his/her shortcomings, deficiencies, disturbances, disabilities, and lack of sense of reality. The fact that the same person could also be seen as an agent in his/her own life might be considered a third blow and can be compared to a Copernican revolution in the psy-field. Recovery no longer revolved around the medical profession but had several centers outside the medical galaxy.8
This conception of people as agents in their own recovery process also contributed to a recognition of these people’s rights as citizens, which included their right to participate in planning and decisions about the interventions they received.
This understanding, stressing the individual and his/her agency, was formulated in Bill Anthony’s often mentioned definition of recovery from 1993.9
Recovery is a deeply personal, unique process of changing one’s attitudes, values, feelings, goals, skills, and/or roles.
It is a way of living a satisfying, hopeful, and contributing life even within the limitations caused by illness.
Recovery involves the development of new meaning and purpose in one’s life as one grows beyond the catastrophic effects of mental illness.
An Updated Definition
But even if this definition is often quoted, it is not unobjectionable, as it focuses mainly on changes inside the individual. This risks forgetting the first lessons of recovery studies about the importance of people’s societal, social, and material conditions. It also disregards the research pointing at the importance of money, social relationships, environment etc. in a recovery process.10,11,12,13,14 Therefore, we think it would be possible and justifiable to update Anthony’s definition of recovery.
We have identified three basic assumptions implicit in Anthony’s definition that we would like to challenge and propose alternatives to.
Firstly, Anthony’s definition describes recovery processes as an individual, personal process which leaves aside the previous discoveries of recovery research about the importance of relational, cultural, material, and societal contexts around people. We propose that recovery is a basically social process.
Secondly, the definition describes recovery processes as an internal psychological process and disregards the person’s material and social living conditions. We propose that recovery always happens in specific situations, at specific places where social and material conditions are crucial.
Thirdly, the definition frames the recovery processes in an illness model. We propose a social model as more adequate to understanding recovery processes.
Recovery is a question of social transformation as well as of personal reformation. Therefore, we think we should combine the individual aspects with social aspects such as relations with others and living conditions, and propose the following redefinition:
Recovery is a deeply social, unique and shared process in which our living conditions, material surroundings, attitudes, values, feelings, skills, and/or roles are changing.
It is a way of living satisfying, hopeful, and reciprocal lives, together with others even though we may still experience distress, unusual experiences and troubled or troubling behaviour. 15
Recovery involves engaging in new material and social contexts and in open dialogues where new ways of understanding and handling the situation are created as we move beyond the psycho-social-material crisis.
However, the proposed redefinition is not only about words, but also has important implications for what recovery-oriented practices and research should be about. A recovery-oriented work should include societal challenges on social reforms, and social work to offer decent living conditions and thus diminish inequalities when it comes to economy, housing, schools, and local environment. To quote Priebe:
What should be done? Obviously, in order to achieve substantial improvements in public mental health, we require societies to change and implement all those factors that promote mental health: societies should provide safe and supportive upbringing conditions; secure peace within and between countries; eradicate poverty; guarantee good education; strive for full employment; promote social cohesion and functional communities; and have little social inequality. These requirements are clear and unequivocal, no more research needed.16
Changes might be the result of a person’s initiative, but also from his/her social network, from different agencies, but also from the state creating better opportunities regarding health, social, and unemployment benefits.
Changing our environment may imply various initiatives. At a personal level it can be about leaving some social settings (work, school, leisure activities, and even family) and entering new ones. This could also imply changing material surroundings (new apartment/house, new neighbourhood). It could also mean changes within the social relations you are in. Such social transformations also change the lives of each of us. Having a home, for example, does not only mean having a roof over your head. It means having enough money to keep it nice; it is about the location, and access to shops, health care services, and cultural events.
To focus on the individual is important, but not enough. The individual is social, and we need both perspectives to continue our journey.
Research in different countries about “Supported Socialization” shows that improved economic conditions for people with severe mental problems might reduce what are usually perceived as symptoms of “illnesses” and “disorders,” paving the way for reciprocal relationships.10,17,18 In the same way, “Housing First”19 and “Individual Placement and Support,”20 both based on the social needs of users, have proven to be important stepping stones in recovery processes. In “Open Dialogue” we find a fundamentally social approach to mental health problems, aiming to change social relations and understandings of the situation for those involved.21,22
No person can exist independently of social and material surroundings. One might suggest that the life of a person is intrinsically intertwined in and dependent on social life, from intimate relations to the societal level. Social places and spaces are needed to develop a sense of self and to recover. Recovery, then, involves changing—and having the social right to access opportunities to change—our environments just as much as changing ourselves.
We have presented a new definition of recovery based on the discussion above. But we should consider this definition as we might consider recovery itself: As a process. And at the same time, whilst in this process, conceding: “This is how far we came this time.” This does not mean that the definition is final, only that others may continue.
“He also found that the use of first-generation neuroleptics in the 1950s (sometimes called the ‘psychopharmacological revolution’) did not improve recovery rates at all.” This would likely be because the antipsychotics/neuroleptics can create the positive symptoms of “schizophrenia,” like psychosis and hallucinations, via anticholinergic toxidrome. And they can create the negative symptoms of “schizophrenia,” via neuroleptic induced deficit syndrome. But, of course, most psychiatrists claim ignorance of this reality, despite being taught this in med school.
“in order to achieve substantial improvements in public mental health, we require societies to change and implement all those factors that promote mental health: societies should provide safe and supportive upbringing conditions; secure peace within and between countries; eradicate poverty; guarantee good education; strive for full employment; promote social cohesion and functional communities; and have little social inequality. These requirements are clear and unequivocal, no more research needed.”
Someone needs to educate the “mental health” system, since they believe those of us who disagree with never ending wars, stand against child abuse, and don’t want psychiatrists to poison us or our children, or a psychologist to steal all our money with a BS “art manager” contract, are the problem.
“Changing our environment may imply various initiatives. At a personal level it can be about leaving some social settings (work, school, leisure activities, and even family) and entering new ones.” Yes, our family had to leave my childhood religion because the systemic child rape covering up, never ending war promoting, attempted thieving and thieving, “mental health” workers bought out my childhood religion, and turned it into a child rape covering up, thieving, religion.
https://www.indybay.org/newsitems/2019/01/23/18820633.php?fbclid=IwAR2-cgZPcEvbz7yFqMuUwneIuaqGleGiOzackY4N2sPeVXolwmEga5iKxdo
https://www.madinamerica.com/2016/04/heal-for-life/
https://books.google.com/books?id=xI01AlxH1uAC&printsec=frontcover&source=gbs_ge_summary_r&cad=0#v=onepage&q&f=false
I do hope the “mental health” workers will some day get out of the child abuse covering up business, as well as stop supporting the never ending globalist banksters’ wars. Distress caused by 9/11/2001, in 2001, was NOT “distress caused by a chemical imbalance in my brain” alone, as the “mental health” workers believe. Legitimate concern about the abuse of my child was not caused by a “chemical imbalance” in my brain either. And love, not psychiatric drugs, are what help a child abuse survivor heal and thrive, contrary to the belief system of the lunatic psychiatrists. The “mental health” system is a big part of the problem, not a part of the solution, unfortunately.
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Thank you for this excellent piece. Two things:
1) It is great to see your references to psychiatry’s PR buzz words like “severe mental illness” in quotation marks. Those words are key to psychiatry’s colonization of our emotional lives, how we think about ourselves and what we do about our problems. This is the same PR trick politicians use all the time to herd voters to rush in whatever direction suits them.
Examples: Years ago, Republicans took a pretty rational law – taxing inheritances above $5,000,000 – and portrayed it as an arbitrary and confiscatory thing by labelling it a “death tax.” Later, Maryland enacted a small fee for people and businesses with paved driveways and parking lots, to help pay for the damage to the Chesapeake Bay caused by the runoff of polluted water from paved surfaces into the bay. Politicians re-labelled this “the rain tax,” implying “big government” over-reach in taxing us for the rain that fell on our heads.
As long as you can dictate the words people use, you can control how they think. Writers at Mad In America shoot their own cause in the foot when they use mental illness, mental health, diagnose and disorder, in pieces arguing against the medical model. Those are psychiatry’s brand names, the things they want to stick in the minds of “consumers'” as they decide whether to take a pill versus seeing a counselor. It’s basic ad-biz, and it works – that’s why Pharma spends more each year on “promotion” than on research.
Imagine writing to support humane treatment of asylum seekers at the U. S. border, while calling them “illegals” (or, per our (not) Glorious Leader, “rapists and murderers”). We should not reinforce psychiatry/Pharma propaganda by using their own key buzz words.
2) Thank you for your reference to the WHO study. It is very heavy reading, but I recommend their final report, Recovery From Schizophrenia – an International Perspective. I didn’t even try to hang in for all the graphs and statistical analyses – Robert Whitaker summarizes it in Anatomy of an Epidemic. But I could get through some of their chapters and their statements of conclusions. As Whitaker points out, not only were recovery rates in developing countries better than in developed countries, but there was a consistent correlation – the developing countries used fewer psych drugs, and Agra, India, the study center with the lowest use of the drugs, also had the best recovery rate of all.
The most striking thing: the WHO concluded, as you say, that family structure, etc. influence outcome, but they did not choose to notice an obvious possible factor – the less psych drugs, the better the outcome. So even a publication from the WHO, via Oxford University Press seems to have been too intimidated by psychiatry/Pharma’s hegemony to tug on Super Man’s cape by mentioning the obvious.
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Posting as moderator: Just a reminder that most MIA articles are either already on the internet or are submitted by folks who are telling their own stories or summarizing their own research. MIA doesn’t decide whether the author uses quotations around certain “mental health” related terms except when it is an article published by MIA itself.
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“…psychiatry’s brand names, the things they want to stick in the minds of “consumers’” as they decide whether to take a pill versus seeing a counselor. It’s basic ad-biz, and it works – that’s why Pharma spends more each year on “promotion” than on research.
Imagine writing to support humane treatment of asylum seekers at the U. S. border, while calling them “illegals”….”
Excellent Peter.
“Mental health” became one of the leading buzz/biz words. It is the great entangler and ensnarer in an endless loop of debates and research. And the biggy, dollars.
After all, “mental illness” became a crime. The only “illness” to be treated as such, so everyone is terrified of not being “mentally well”
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“Because of these studies, the image of schizophrenia as a “chronic,” “life-long” disease was problematized, because these new studies emphasized that people could in fact recover.”
Eugen Bleuler coined the term “schizophrenia” to replace the earlier “dementia praecox” specifically because people did recover. Weren’t those psychiatrists in the 70’s and 80’s aware of this? I suppose since the standard practice of a daily 10mg dose of haldol became common practice, they had to reassess.
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I question the use of the obfustacory term “problemetized.” Why don’t we just say the image of ‘schizophrenia’ as a “Chronic life-long disease” was disproven? Or shown to have no scientific basis? Or exposed for the subjective and prejudicial term that it is? Or something like that.
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“Schizophrenia” is either a life long chronic disease or it’s not. A person with a diagnosis of “Schizophrenia” either remains long-term chronically mentally ill or they don’t.
Psychiatric drugs In my experience are disabling to the extent that a person cannot function normally when they take them, and psychiatric drugs also have withdrawal syndromes which can make it almost impossible for a person to stop taking them.
I think the fact that doctors are not aware of the overall problems with psychiatric drug treatment and dependency and long term outcomes, indicates how poor the standard of “Mental Health medicine” is.
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Doctors are aware of the drugs.
I have a feeling that I’m going to have to use quotation marks around the word “doctor”, at least in the context of how we used to think of doctors as being in the “health” category.
Fascinating that “doctors” are okay with a person losing complete insight, or lack verbalizing due to chemicals.
And the same docs talking about alcohol addiction, plus “insight”
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70% of those labeled “schizophrenic” used to get back on their feet or “recover” before pharma psychiatry.
Now it’s below 16% and only because they really lowered the bar for what counts as a decent life. And the life expectancy post diagnosis is roughly cut in half.
But the “mental health” industry likes it fine. More treatments to sell and more long term “consumers.”
Pretty annoying when two thirds of your buyers find they can lead better lives drug free and you need to drum up new ones. At that rate how are you going to expand your turf?
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And that figure of 60-70% is still valid for those living in “developing” countries where they haven’t yet discovered the wonders of “modern psychiatry” and don’t hand out drugs to everyone who has any kind of difficulty.
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Yes indeed. The Open Dialogue system in Lapland have an even higher recovery rate than 60 – 70%. And, it seems, a higher employment rate (for their patients) than the national average. The “secret” to their success seems to elude most psychiatrists.
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Perhaps some caring people don’t have a time limit for people to change.
“Okay you have 24 hours to get over your distress or we will shoot or inject. Your choice.”
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Hey, they give us two whole weeks to get over our spouse dying. That’s pretty generous, don’t you think?
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Steve I imagine a couple shrinks discussing this.
“So Bob, how long do you think you’d grieve if your wife died?”
“I dunno Bill. It took me less than a week to get over her leaving me. Too many hangovers from partying.”
Both laugh.
“I can’t imagine grieving more than a week for mine. Ten days tops.”
“I never grieve over losing anyone. Emotional attachment is a sure sign of mental illness. My dog died today. No big deal. I did what any sane person would. Put the carcass out with the weekly trash and added ‘visit the pound’ on my things to do list.”
“Let’s say fourteen days tops. I can’t imagine loving anyone so much you grieve them that long unless you’re severely mentally ill.”
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C’mon though, it is very bad for business to be focused on someone who isn’t even around anymore, plus it has an effect on the productivity of others around you. We can’t be so self-obsessed.
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In my opinion there is no such thing as “Schizophrenia”. The reason I was able to come off strong psychiatric drugs (and recover) was because I was able to find a way to deal with my Neuroleptic Drug Withdrawal Anxiety.
Prior to coming off strong Psychiatric drugs I was diagnosed as ‘the worst schizophrenic in Ireland’.
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(If a person can recover from ‘Schizophrenia’ with basic Psychotherapy then this would be the way forward).
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Would it be appropriate to offer psychotherapy with the aim of helping a trans person or a homosexual recover?
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Homosexuality is ingrained and “normal,” and transgenderism is self-defined; neither constitutes a disease or objective “condition,” so there is nothing to “recover” from.
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Yes, isn’t it interesting that once the fraud of the psychiatric theories is gaining weight, they regularly change the names of both their disorders, and their drugs. Thus the term “schizophrenia” was replaced by the earlier “dementia praecox.” “Bipolar” replaced the term “manic depression.” “Antipsychotics” replaced the term “neuroleptics.” And the drugs in that class come under many names.
It’s all a bunch of fraud. And by regularly changing the words they use, they obscure the historic, and continuing, truth of their systemic crimes. Psychiatry and psychology are completely corrupt industries.
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This perpetuates the illusion that there is “progress” being made and that with new “evidence-based” research we are discovering more “scientific” terms with which to describe fraudulent “illnesses.”
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PSYCHIATRIC DRUGS CAUSING “ILLNESS”
https://www.theguardian.com/healthcare-network/2014/oct/28/tackle-mental-health-inequality-black-people
CLAIM
“..Black men in Britain are 17 times more likely than white counterparts to be diagnosed with a psychotic illness…”
NONSENSE
Black Men are NOT 17 times more likely to suffer from Genuine “Psychosis” as white men, but once they enter the psychiatric system they are as likely as anyone else to remain “PSYCHIATRIC”.
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“Changing our environment may imply various initiatives. At a personal level it can be about leaving some social settings (work, school, leisure activities, and even family) and entering new ones.”
I don’t think the success of Open Dialogue in Western Lapland was to tell their patients to disown their family, give up their job or academic pursuits, friends, hobbies, etc. and move to another city / country.
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Thanks for the excellent article about recovery. As a psychiatrist who has embraced the concept for quite some time and has been mentored by peer specialists I deeply appreciate it. Stressing the social determinants of health in the process of recovery is essential both at a policy level and on the ground.
However, I would like to stress a fundamental issues which as professionals often we tend to neglect. in our work in the field of recovery, we should always try our best to to involve individuals with “lived experience”(individuals who are managing their recovery and are willing to help others).Speaking about recovery without their involvement and necessary lead could translate our efforts into the typical hierarchical academic approach which would minimize the concept of recovery as a “consumer lead process” and which has been correctly criticized by the recovery movement multiple times. Thanks again for your efforts in illustrating and making more popular the principles of recovery.
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“Steve I imagine a couple shrinks discussing this.
“So Bob, how long do you think you’d grieve if your wife died?”
“I dunno Bill. It took me less than a week to get over her leaving me. Too many hangovers from partying.”
Both laugh.
“I can’t imagine grieving more than a week for mine. Ten days tops.”
“I never grieve over losing anyone. Emotional attachment is a sure sign of mental illness. My dog died today. No big deal. I did what any sane person would. Put the carcass out with the weekly trash and added ‘visit the pound’ on my things to do list.”
“Let’s say fourteen days tops. I can’t imagine loving anyone so much you grieve them that long unless you’re severely mentally ill.”
LOL Rachel.
I guess you can write a play. Totally.
Are there shrinks named Bob and Bill? They would definitely be referred to as “Bobert”.
And “Billiam”, past tense of course.
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Psychiatry is an institution and men found out long ago that profit could be made from people who became insane. When i was a little girl i knew because i wasn’t a boy i had limitations. My world surrounding me and my mother’s issues in her marriage to my dad and my dad’s abusive behavior led me to spend long hours wishing everyone on earth would disappeear and that i would have the whole world just to myself.
It is men who have created psychiatry and male scientists who have created the drugs to force onto people who lose touch with reality and who have suffered abusive childhoods. It was my brother who suggested i first contact a psychiatrist because he wanted to learn the truth about the meds having been involed with psychiatry too. Then after i had a few admissions and being drugged myself he asked me the question. Do i think psyche meds work. I said i didn’t. The next we knew he topped himself.
My very brave mother kept me away from abusive doctors and although she could never leave my dad because she hadn’t the means financially she did protect me until during another breakdown and being vulnerable my brother suggested i contact one. The road my life took then led me to social exclusion and a marriage that basically wasn’t a happy one. I had a son. Of course his childhood was affected because of my breakdowns due to my husband not being able to support us financially or in any other way for that matter.
He died of lung cancer ten years ago. Before this i ended the marriage. I have been attempting for ten years to become drug free. I have finally made it. I actually didn’t even know the man i married. It wasn’t until years of living with him i realised what he was and why he married me.
As long as it remains a man’s world institutions and societies and relationships will be created by people who are totally out of touch with mother nature and just how to create environments that bring sacred childhoods to thrive.
The difference with men and women is that women create life and in a man’s world we are penalised for it.
I miss my mother very much and i cherish her memory. I don’t miss my husband whatsoever. I live for my son now. I could never protect him unfortunately. We both get by. I hated my father. My son is a beautiful person and we support one another. I am devoted to helping him stay well. I am also aware of the world he too lives in this man’s world which has nothing to offer him whatsoever in which we both have existed. The most i can hope for is that he gets by. I know i will now.
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Thank you for sharing your struggles and your success! I so agree with you about the world that we men have created!
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Ohh Bippy, I love this. There is so much beauty in your comment. Thank you
for sharing this.
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