Images taken in Argyll and Bute psychiatric hospital – which is still in use.
Over the past few years this word ‘recovery’ has found powerful new meanings within certain groups of people who have been treated within some parts of our health care system. It has become the label for a challenge to the dominant medically driven hegemony within psychiatry in particular, but has also found deep resonance amongst people who have struggled with addictions.
There is a shift at hand in the power dynamics within the system that has the whiff of revolution. All of us who are involved in working with people in some form of mental distress or using some kind of therapeutic process would do well to sit up take notice.
The concept of ‘recovery’ grew out of the lived experience of people who had experienced mental ill health, and perhaps more tellingly, had come through the psychiatric system. They described a process of treatment that often went something like this;
Loss of role and identity
As a result of illness and the separation that the stigma of illness enforces, people experiencing acute mental ill health start down a path of being stripped of who they are.
- First people lose their job/career
- As a result of which they struggle to hold on to possessions- home, car etc
- The stigma of this puts a huge strain on relationships- and so they will lose friends
- Perhaps they may also lose their life partner, and because of this also lose close contact with children
- In all of this, it is incredibly hard to hang on to a sense of personal identity and self worth
- Some people lose the ability to make choices, either through the limiting effects of the above losses, or because these have been taken away by the legal-medical system
New role and identity
For the best of reasons, society sought to find a solution to the mental distress, and so medicalised it- giving the power to detain and to treat primarily to the medical profession. They developed huge institutions, and billions were invested in drugs. The hope was that people might be made better, or if they could not be cured at very least they should be cared for and safe.
So people in mental distress were given a new role and identity-
- They became patients, clients, service users
- If they behaved well, they were ‘compliant’
- If they resisted they were showing signs of ’challenging behaviour’
- If they tried to play the system they were labelled as ‘manipulative’
Treatment
Meanwhile, the system applied a model of care based largely on other forms of medicine. First your condition is assessed, then it is diagnosed and finally it is treated with scientific evidence based treatments. If you did not get better, then alternative treatments were used. If you still did not get better, then it became a little more problematic. Perhaps we needed higher doses, or more radical treatments. Or perhaps you were treatment resistant, and as such, not much could be done for you and the rest of your days might be lived out in a kind of half life- subject to constant care plans, risk assessments and packages of care.
People who had been through this process – the loss of who they were, then becoming a ‘patient’ – these people started to tell stories to one another. They were convinced that the system was not working- iIt certainly was not working for them. Some even questioned the very core assumptions that psychiatry was based on. They pointed out that despite the so called advances in science, the outcomes for people diagnosed with mental illness were largely unchanged.
Some of this began to gather together around what came to be called the ‘Hearing Voices Movement’.
However, possibly the most significant thing to emerge from this is what has come to be called the ‘Recovery Movement’. Recovery as a personal journey rather than a medical process. A journey based on hope and personal growth both in the presence and absence of symptoms.
The Scottish Recovery Network defines recovery like this-
People can and do recover from even the most serious and long-term mental health problems. Recovery is a unique and individual experience and while there may be common themes and experiences, no two people’s recovery journeys will be identical.
We describe recovery as follows:
“Recovery is being able to live a meaningful and satisfying life, as defined by each person, in the presence or absence of symptoms. It is about having control over and input into your own life. Each individual’s recovery, like his or her experience of the mental health problems or illness, is a unique and deeply personal process.”
This from the Mental Health Foundation-
Research has found that important factors on the road to recovery include:
- good relationships
- financial security
- satisfying work
- personal growth
- the right living environment
- developing one’s own cultural or spiritual perspectives
- developing resilience to possible adversity or stress in the future.
Further factors highlighted by people as supporting them on their recovery journey include:
- being believed in
- being listened to and understood
- getting explanations for problems or experiences
- having the opportunity to temporarily resign responsibility during periods of crisis.
The challenge this presents to professional ‘helpers’; therapists, social workers, nurses and doctors, should not be underestimated. It is not just a change of language that is being proposed, but rather a root and branch change to what we are about. It requires a power shift away from the professionals, and back to the individuals themselves.
What is even more challenging is the idea that the whole system of psychiatric classification, diagnosis and treatment, driven as it has been by the medical model and the multinational pharmacology companies is being re-evaluated. The old divisions between ‘psychosis’ and ‘neurosis’ are being eroded and replaced by a return to ideas of how we might respond to trauma and develop coping behaviours.
As part of this transition, a number of helpful tools have been developed, intended for use by individuals themselves, with support only if they feel this necessary. Here are a selection-
Wellness Recovery Action Planning (WRAP)
DREEM (Developing Recovery Enhancing Environments Measure)
SRN Narrative project- stories of recovery and hope
One more resource to mention which might be of particular use to those of us who work for organisations who provide direct support and intervention to people with mental health problems – The Scottish Recovery Indicator is a tool that can be used by staff and users of the service to rate how ‘recovery focussed’ the organisation is. Using it can be rather sobering!
It can open up all sorts of doors.



















BlogoSquare