A Psychiatrist Looks at Recovery And Finds it Wanting

By Dr David Laing Dawson

There is something to be said for challenging our attitudes and shaking up our systems every decade or so, trying to improve them. Improve them, review them, discuss them, reorganize them, improve them. Even if it is really only putting old wine in new bottles. The new bottles can create a buzz, some excitement, add some energy, or, to use one of those terrible management phrases, achieve “stakeholder buy-in.”

But language is important, especially when we use unassailable words, feel good words to hide something quite different. The Pro-Life Movement. Who could object to that? Until you realize it is really an anti-choice movement, and that it ignores the reality of the suffering and deaths of millions of young women around the world.

And in all our systems, not least in Mental Health and Mental Illness treatment, we are fond of forming a myriad of committees and steering groups, planning groups, focus groups that create a language of their own, and formulate, vote on, and sanction such meaningless phrases as,

“Co-occurring issues and conditions are an expectation, not an exception.
The foundation of a recovery partnership is an empathic, hopeful, integrated, strength-based relationship.
All people with co-occurring conditions are not the same, we all have a responsibility to provide co-occurring capable services.
When co-occurring issues and conditions co-exist, each issue or condition is considered to be primary.
Recovery involves moving through stages of change and phases of recovery for each co-occurring condition.
Progress occurs through adequately supported, adequately rewarded skill-based learning for each co-occurring condition or issue. ”

–and then, on paper, design the most cumbersome and impossible organizational structure to carry out this mission, this formulation.

I get tired just thinking about it.

Usually such organizations and arrangements are wasteful but benign and fall by the wayside in a few years. But a few can be both wasteful and destructive.

Now the “recovery movement”, or “recovery model.” Who could object to the word “recovery”?

Until you look closely at it’s origins and implications.

It comes from addiction services, their philosophies and jargon. An alcoholic who no longer drinks is “an alcoholic in recovery”, or a “recovered alcoholic.” Similarly an addict. It is a useful term used in that context, I think, for it implies quite reasonably that if the alcoholic no longer drinks he is recovered, but still vulnerable. His recovery may end if he takes glass to mouth. And it also implies, quite clearly, that reaching that point of recovery and maintaining that point of recovery is primarily his own responsibility, an acknowledgement that ultimately he, the alcoholic, has the power within his own hands (with a little help from his friends) to choose to be and stay “recovered”.

But the “Recovery Model” as it crept over to mental illness, carried with it an anti-medical tone, a clear implication that we doctors and nurses did not pursue a goal of recovery for our patients. We were in the business, it implied, of maintaining illness, and thus maintaining our positions of power and our paychecks. A trifle insulting to say the least.

I, and all the people in our professions I know, are delighted when one of our patients really succeeds. Drops back to visit after graduating from High School, or University. Comes in to show me her brand new baby girl. Comes in and says, “I’m doing fine doc, just need my prescription renewed.” Sends me a card from his travels in Europe.

Well, I can get over the insult and their pejorative use of the term “medical model”.

It is those other implications of “the recovery model” that can be quite damaging. It does carry an implication, as with alcoholism, that the mentally ill person, this person suffering from schizophrenia, has within his own hands, his will power, the way he conducts his life, the means to “recover.” It implies that those who don’t recover are simply not trying hard enough. It implies that if you have to take a lot of drugs to stay well you are not trying hard enough. And, it must, by it’s own convictions, ignore, banish from view, those with very serious mental illness who can hope for some quiet, some peace, some contentment, some happiness, some dignity, a relationship, some activity that gives them a sense of value, but never full recovery.

We would all like our patients to recover, to become well, to be able to live full lives with minimal suffering. Fine. But the “Recovery Model” with its emphasis on hope and prayer and peer support and its mantra that everyone can “recover” (with hard work and a little help from his friends) provides a foundation of easy denial for our politicians, our civil service, and our managers.

Often, through history, one can find that the theories of the day, regarding the human condition, are really rationalizations, comforting explanations for the terrible realities of the day. The Recovery Movement is a theory, a formulation, a rationalization for this day. It allows us to believe all mentally ill could get well if they really wanted to, just as all alcoholics could stop drinking if they wanted to or had to (with a little help). It allows us to ignore the millions of mentally ill now living in our prisons and flop houses, on the street and under bridges.