How Did We Get Here? Further Reflections on Recovery in Mental Illness

By Dr David Laing Dawson

When trying to understand society’s, or a country’s, concepts, thoughts, approaches to, treatment of, mental illness, we can look at medical and scientific progress: This is the “march of progress” approach to understanding history – our advances in diagnosing and treating mental illness over the past hundred years. But history also tells us that attitudes toward mental illness have always been influenced by the economics of the time (only when we can feed our own children do we have the capacity to worry about our strangely behaved neighbour), our preoccupations of the time (being at war leaves few resources for the mentally ill), and, finally, the folk wisdom of the era.

Folk wisdom – the thoughts, rationales, explanations, assignments of responsibility and blame that linger in our consciousness long after being modified or disproved by science. Our brains are programmed to look for causation, a way of understanding an event, and, wherever possible, to ascribe blame. We also quite naturally and quickly look for a cause, a thing to blame, that we ourselves can avoid.

It is reported that a man younger than myself dies suddenly. I can’t help it. I search the report for cause, and relax when I find that he was a heavy smoker, which I am not. A woman is assaulted after midnight in a sketchy part of town. We know it’s wrong, but our brains immediately ask, “What was she doing there?” The child is behaving badly. We immediately think, “He could use some better parenting.”

It is always surprising to hear nurses blame the full moon for a perceived increase in the number of patients flooding the emergency room, though this “lunacy” has been thoroughly debunked by science. And otherwise intelligent people continue to ascribe perceived behavior to an astrological sign, or numerous other semi-mystical notions of alignment, karma, vapors, chakras, auras, and miasma.

Most of all it is comforting to think that if we behave well, and morally, and kindly, pray before bedtime, and avoid certain pleasurable but dangerous substances, we can also avoid dis-ease, illness, and a fall from grace.

We know that alcoholism and addiction include an action taken, engaged in, by the sufferer, engaged in willfully, of free will, and that recovery from addiction will entail a mind set, a decision, a commitment, a major effort on the part of the sufferer. So with alcohol and addiction programs this process is supported, encouraged, often through peer support, non-judgmental encouragement, soul searching, an acknowledgement of weakness, a trust in a “higher power”, and even, in some programs, forms of confession and penance. When we talk of treatment for alcoholism and addictions we are really using the word “treatment” to mean a complex sophisticated form of persuasion. We don’t really have a treatment for those two problems beyond persuasion and support.

In the post WW II era, our mental hospitals became “psychiatric hospitals”, and, a few years later, at least one ward in most general hospitals became a psychiatric ward, or colloquially, a “psyche ward”. This naming was important. It acknowledged a medical specialty, and a group of diseases treated by that specialty, much like an orthopedic department, a gynecology wing, a surgery ward. In fact the federal funding in Canada to support general hospital psychiatry wards (via federal provincial transfer payments) was a considered effort to acknowledge mental illness as illness, deserving of the same attitudes, funding, and professional support as “physical” illnesses.

Through the 1970’s and 80’s it appeared to be working. Programs were developed, new more effective medications were developed, attitudes were changing, physical facilities were improved, and maybe, we thought, this de-institutionalization will work.

Mind you, addictions got short shrift from the mental health system in those years (though the hospitals were psychiatric hospitals, the overall system of care was still called “the mental health system”). Generally addicts and alcoholics were told that they would have to get those problems attended to before we could help them with their mental illnesses. They had to first attend detoxification programs and then alcohol and addiction programs, which often had little patience for either mental illness or psychiatric treatment.

So detox centers, alcohol and addiction treatment programs developed apart from and separate from psychiatric wards and hospitals. And from these centers the “recovery model” developed. The word alone is nothing but positive, but it contains all the implications and expectations and attitudes outlined four paragraphs above. It implies that full recovery is possible, if you put in the effort. Peer support, will power, the power of positive thinking, goal setting, avoiding negative thinking, take life a day at a time, take responsibility for yourself……..

And, absolutely, for addictions and alcoholism, recovery can be defined as a life free of alcohol and drugs, and it is certainly achievable.

And through all this, our folk wisdom, that wisdom that often governs legislation and attitude, maintained a conviction that, ultimately, alcoholism and addictions are the sufferer’s responsibility. If he does not get well, or clean and sober, he is culpable, or at least, ultimately, to some degree, the architect of his own fate. And folk wisdom was shifting to believe that this is not true for schizophrenia, manic-depressive illness, depression or anxiety disorder. These are illnesses requiring treatment. They are usually chronic illnesses. Full and complete recovery is rare, though medications can alleviate symptoms and prevent relapse. There is nothing the sufferer can do on his own to prevent or stop these illnesses. And for these illnesses we do have actual treatment.

And then…. actually I’m not sure how this happened…. but somehow the bureaucrats and perhaps a few idealists, managed to bring these two systems under one much more economical roof. Three words were lost in this recent transition: “psychiatric”, “illness”, and “hospital”.

And suddenly we now have a multitude of “Centers for Addiction and Mental Health”.

And while this undoubtedly saves money, and perhaps serves better those who suffer both addictions and mental illness, it has had, in my opinion, some very negative unintended consequences.

1. The recovery model, well suited to addictions, has been foisted upon those suffering from mental illness.
2. The stigma of mental illness has been entrenched by the use of the paradoxical euphemism “mental health”.
3. We have inadvertently allowed the folk wisdom of acknowledging personal responsibility for addictions (blame) to rub off on those suffering from diseases of the brain, those suffering from schizophrenia and manic-depressive illness.
4. And ultimately it has allowed us well-meaning citizens to feel comfortable that now, not in 1950 or 1960 or 1970, but now, in 2014, our jails and prisons are filled with the seriously mentally ill.