In this series, I dig a little deeper into the meaning of psychological terms. This week’s term is mental illness recovery.
The word recovery can have various connotations depending on the context. It began to gain popularity in the context of mental health in the late 1980s and early 1990s, when it was used by the ex-patient/psychiatric survivor movement. Its usage has become common in mental health services, and various mental health-related government agencies claim to have some degree of recovery orientation.
Defining recovery
According to the Mental Health Commission of Canada (MHCC), “‘Recovery’ does not necessarily mean ‘cure’; rather, it focuses on people recovering a meaningful life in their community while striving to achieve their full potential.” Recovery is unique for each individual and draws upon strengths. In the recovery process, individuals with mental illness are empowered and enabled to live a meaningful life. Principles that support recovery include hope, empowerment, self-determination, and responsibility.
The recovery process
Recovery is described a little differently by different organizations. Here are a few perspectives.
Mental Health Commission of Canada
The MHCC developed a set of guidelines for recovery-oriented mental health services. These were built around several key dimensions, including:
- Creating a culture and language of hope.
- Recognizing that recovery is personal and unique, and requires consideration of the whole person. There is a focus on strengths, autonomy, and self-determination.
- Recognizing that recovery occurs in the context of one’s life, which is impacted by such factors as social supports, social determinants of health, and stigma.
- Taking into account the diverse needs of all groups within Canada including Indigenous peoples, LGBT individuals and racialized communities.
The MHCC explains that recovery-oriented approaches break down power imbalances between those with mental illness and treatment providers, and recognize the experiences, insights, and expertise of people living with mental illness.
Mental Health Foundation
The Mental Health Foundation, a non-profit organization in the U.K., describes the recovery process, which:
- “provides a holistic view of mental illness that focuses on the person, not just their symptoms
- believes recovery from severe mental illness is possible
- is a journey rather than a destination
- does not necessarily mean getting back to where you were before
- happens in ‘fits and starts’ and, like life, has many ups and downs
- calls for optimism and commitment from all concerned
- is profoundly influenced by people’s expectations and attitudes
- requires a well organised system of support from family, friends or professionals
- requires services to embrace new and innovative ways of working”
The Mental Health Foundation also identifies a number of factors that support recovery, including good relationships, financial security, satisfying work (it was not specified whether this was volunteer as well as paid), personal growth, the “right living environment” (although it doesn’t specify what this is), and developing resilience.
MentalHealth.gov
The U.S. government site MentalHealth.gov identifies four dimensions of mental health recovery: health, home, purpose, and community. The Substance Abuse and Mental Health Services Administration (SAMHSA) identifies ten guiding principles of recovery: respect, hope, person-driven, many pathways, holistic, peer support, relational, culture, addresses trauma, and strengths/responsibilities. Hop back across the Atlantic, and the Scottish Recovery Network uses the CHIME acronym to describe common themes of recovery: Connectedness, Hope and optimism, Identity, Meaning, and Empowerment.
What does it look like in practice?
Clearly, multiple agencies in multiple countries are talking the talk of recovery, but does it actually mean anything? Does the real meaning of recovery get buried under these dimensions and principles and acronyms? And do the voices of those of us with mental illness get drowned out by the voices of those who want to tell us what recovery is?
I work in a concurrent disorders (mental health and addictions) program that has recovery right in the name. Yet I see precious little recovery in the implementation, and often considerable paternalism. The program leaders might know the language of recovery, but their decisions don’t show any real understanding. I think that in many ways, it’s even worse to be recovery-oriented in name only rather than not claiming a recovery orientation in the first place, because it contributes to misunderstandings about what recovery actually is. It becomes something that professionals hijack and take away from those of us living with these illnesses.
In some ways, I’d prefer to set aside definitions of recovery entirely and say it’s whatever the individual living with the illness believes it is for them. I used to think that my own recovery would involve being symptom-free, but I’m not sure that’s realistic, so now I’m looking to be able to engage in meaningful activities that give me a sense of purpose.
What does mental illness recovery mean for you? What do you think of what the various organizations are saying about it?
References
- Mental Health Commission of Canada.(2009): Toward Recovery and Well-being: A Framework For a Mental Health Strategy For Canada
- Mental Health Commission of Canada (2015): Guidelines For Recovery-Oriented Practice
- Mental Health Foundation: Recovery
- MentalHealth.gov: Recovery is Possible
- Scottish Recovery Network: What helps
- Substance Abuse and Mental Health Services Administration (2012): SAMHSA’s Working Definition of Recovery
- Wikipedia: Recovery approach
Ashley L. Peterson
BScPharm BSN MPN
Ashley is a former mental health nurse and pharmacist and the author of four books.
Recovery, for me with co-occurring illnesses, means receiving support from the circle of support I built, living in a way that aligns with coping instead of using alcohol, being able to offer others support because my condition is in remission and being able to find a common ground between having illnesses and living life to the fullest. Being that I have abused drugs and alcohol and also have bipolar it may not be easy to achieve a full recovery but all I can do is try to fulfill the above and make my recovery my own.
I think recovery can also involve integrating coping, so it’s part of how we approach life rather than something we grasp at when things get hard.
Hmmm, yes I feel that our mental health system is not very recovery oriented. A good psychologist or counselor should have the aim of setting their clients free to work on their own, eventually, but it seems that we have set up a system of dependence. While some patients will need life-long care, there are many people who could have independent lives with the right care.
I agree.
I think a contributing factor is that medical training is so focused on ‘cure’, at least in the early years, that anything less than cure is felt as kind of a personal failure on both the doctor and patient’s part. Patients who are exposed to others with ongoing problems which can’t be cured seem to be much more accepting of that and to come up with more constructive solutions than doctors, who I think in their heart of hearts are still aiming for cure and in some ways are pushing away those patients who make them feel like a failure – maybe not on a conscious level but I’m pretty sure it’s there underneath. My first exposure to the idea of recovery as opposed to cure was my brother in law’s involvement in AA, and I’ve found the whole idea that you keep trying and that setbacks and relapses are just expected parts of the process quite helpful in dealing with my own mental health problems.
Perspective shifts in medical training are definitely slow to happen.
Hmmm… recovery was moving over 900 miles away from what i thought was home. Now i am home.
I’m glad!
Thanks Ashley… i think another aspect is the therapy relationship… that is another part that helped me on the road to recovery. I figured out what i needed and that was to run away from what was killing me…
It’s great that you were able to find the courage to follow through on that.
Partly luck! Partly, i am so tired of this shxx!!! What have we got to lose? I would have died miserable… at least now i will die happy.
I hope you find what you need… if you haven’t already. ❤️❤️❤️🕊🎶
Yay for happy!
At my last lot of therapy I was told that one aim of therapy was to enable me to live life without the need for therapy (I’m paraphrasing), meaning that I just needed to be sufficiently better to be able to manage my illness on my own. I can see how one could be eternally on the therapy treadmill waiting for a state of full recovery/remission/cure but in the UK the NHS has insufficient funding for many things but especially mental health services so people are discharged before they’re ready and left on waiting lists for a very long time.
Lost my train of thought, so I’ll just say that for me recovery is:
– being able to manage without external support
– being able to function with daily living
– being enthusiastic about things I enjoy and doing them
– being able to sleep
and having a general feeling of contentedness
If I can have all of these then I’m good, keep taking the meds, keep minimising stress and keep doing all the things that are good for me and my recovery.
Btw I think your goal of engaging in meaningful activities and having a sense of purpose are great things to aim for.
If I could get being enthusiastic back that would definitely feel like a huge step towards recovery.
I also used to think recovery would be being symptom-free, but I don’t think that’s going to happen for me either. And I’m sure the NHS has something on paper similar to the things you quoted, but I haven’t really experienced that. Lots of paternalism, and sometimes being treated as a number, just someone on the waiting list to cross off. And very little hope or optimism.
It’s bad enough when the illness takes away hope and optimism; it certainly doesn’t help when service providers don’t have it either.
**thought