Tag Archives: Recovery Movement

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.

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

David Laing DawsonBy 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.