Mental health

Is Mental Illness Recovery a Choice?

“Mental illness is not a choice, but recovery is.” While this image floating around on Pinterest originated with Healthy Place, I couldn’t figure out the original source of the quote (if, in fact, it is a quote from another source), but seems to have been around for a while. Anyway, I don’t really agree, so I thought I’d write about it.

The first part of it is good; mental illness isn’t a choice. I would add that remaining ill/symptomatic isn’t a choice, but people seem less likely to be able to grasp that bit. I’ve read in various places (including a book I recently reviewed) that staying depressed, or anything else, is a choice. Really, now?

Lack of effective treatment

The only way that staying ill could possibly be a choice would be if some magical form of treatment worked for 100% of people, 100% of the time. The current reality isn’t even in the same hemisphere, much less the same ballpark as that.

That means that if we chose to define recovery as full remission of symptoms, it’s not going to be in the cards for a whole bunch of people who are waiting for that treatment magic wand to come along and replace the at-least-it’s-better-than-nothing kind of deal that’s currently available.

Psychosocial recovery

What about psychosocial recovery, which is a popular concept these days? It means different things to different people, but MentalHealth.gov‘s definition is:

…A process of change through which individuals improve their health and wellness, live a self-directed life [and] strive to achieve their full potential.

The site also identified four major dimensions that support recovery: health, a home, purpose, and community.

Based on that definition, recovery is a process rather than an endpoint, which fits in with my own personal notion of recovery as being a direction rather than a destination. And sure, sometimes the choice is available to head in that direction, and if it is, that’s fantastic. But it’s not always.

When symptoms are awful and you’re trying hard to keep yourself from flying apart at the seams and/or offing yourself, choosing recovery is about as realistic as choosing happiness, which I could rant all day about. Sometimes that kind of choice is a privilege that’s just not accessible for some people.

Dialogue within the mental illness community

I’m not sure what Healthy Place was trying to accomplish with this graphic. Given the nature of the Healthy Place site, I’m guessing it was well-intended. I don’t think it’s actually doing harm in the sense of conveying inappropriate messaging to a non-mentally ill audience.

Within the mental health community, there’s a sometimes odd mix of different viewpoints. Take anti-medication attitudes, for example; I would estimate that there’s at least as much of that coming from within the mental illness community as from outside. While diversity of opinions is a good thing, attitudes like recovery is a choice can be problematic if other people start to internalize it.

We’re probably more alert to stigmatizing messaging coming from people who don’t have a mental illness, and not so quick to critically evaluate messages from within. Being active in the mental illness community online, there’s a lot more exposure to this diversity of views than I’ve ever had in the “real” world. It’s certainly been an eye-opening part of my online experience since I started blogging 3 years ago.

I suppose that where I’m going with this is that there’s not a lot of black and white with mental illness. One person’s experiences and views may feel totally foreign to someone else. There’s room for all of it, but there needs to be some critical thinking and recognition that there is no one right way. The choices that are available aren’t the same for every person all of the time, and it’s okay if people can’t make the choices others expect them to.

What are your thoughts on recovery as a choice?

COVID-19/mental health coping toolkit from Mental Health @ Home

The COVID-19/Mental Health Coping Toolkit page has a wide range of different resources that can help make coping a little easier.

84 thoughts on “Is Mental Illness Recovery a Choice?”

  1. Wow! Recovery as a choice? If it were this simple we would all be in recovery and remission. No more depression, no more mania, no more food disorders, etc. etc. Recovery for me is an act you take on with faith that things may become more manageable but there is no guarantee. It is certainly not the will of the patient to recover that is the major issue here. The issue is more complex and includes efficacy of meds, access to talk therapy or other forms of therapy, self-stewardship of all kinds including 12-step meetings if that is your thing, and being honest about where you are on your illness trajectory. Recovery as a choice sounds like rainbows and unicorns are in control of my future! Is that really the case?

  2. Perhaps it should say that getting help is a choice? Recovery is a possibility. Recovery is never a given of course but if you don’t try you never will. There are so many quotes like this that offer false hope – I believe they do more harm than good in many cases. I agree there is no black and white of course – everyone’s road to recovery is uniquely there own – there is no one size fits all approach when it comes to mental health. Great thought provoking post. Thanks for sharing 🙏

  3. Yeah, that’s ridiculous. When I was suicidal in 2007, I was seriously about to go off the deep end, and I turned to everyone in my life at the time, and they all bailed on me. I was called a drama queen by my mom and told to choose happiness by my sister and yelled at by my dad (“We can’t afford the hospital!”) and told my an old family friend to more or less get over it already. Just for anyone reading this,I NEVER say I’m suicidal unless I’m really suicidal. I’m not a manipulator who’d say it for any other reason. I just truly had no quality people in my life at the time, except maybe my dad, who dropped the ball. These attitudes and reactions are very harmful and borderline cruel.

    Getting away from suicide into the issue of treatment being a choice for mental illness rather than suicide per se, it’s still wrong. As a paranoiac, I still walk around my neighborhood unable to make eye contact with neighbors and make small talk or conversation with them. It’s not my attempt to be hurtful, it’s not personal, and it’s not even hostility on my end; but when they try to talk to me and I’m not receptive (which only happens if I’m feeling really, really good), then I shut down and keep walking and feel guilty. The attitude that I’m “choosing” to continue acting that way, and that that’s the wrong choice, really rub me the wrong way times a million. I can’t ever be that person who hangs out with the neighbors. It’s not who I am.

    To a certain extent, I like the quote because it indicates that people should proactively seek help, which all of us here at your blog probably do. But then the quote has an implication that if the treatment isn’t working 100%, it’s our fault?!? Uhuh. No. Some things can be medicated away (from person to person) and some things are innate and must be lived with. Anyone who expects me to be 100% well-adjusted probably won’t stay in my life for long. (Ahh, that sweet moment where a new friends discovers my dark side…)

    Great blog post!!

    1. I don’t believe that it can be put into 2 categories “medical cindition” and “innate”. I rather see it from a generational and family system point of view and that is very flexible and complex.
      We all have had to deal with traumatic experiences, either through accidents or horrible events to lack of nurturing and unhelthy relationship experiences.
      Me for example, I struggle with several traumas and have found grace in exploring and sharing my story all the while learning to cope with life in healthier ways and becoming more vulnerable with a trusted community of brothers and sisters.
      I also disagree with the saying that there is no hope. It depends on what you hope for. If you hope for complete restoration in a sinful world. That is doomed to fail. Anything finite will inevitably rob us of our hope.
      What we all need is a living hope with a true purpose (as was mentioned in the post) and fixed identity.
      The purpose needs to be something that is true regardless of our doing, because being exhausted by my mental weakness, I wonder if there is anything that I am good enough for. What good do I have to bring? The answer there too needs to be found in something transcendant and universally true to never die even though we doubt and though we fail. So we will persevere and get back up.
      Finally there is a need to know who I am. And that is where the journey really starts for all of us who struggle with mental health. What defines me? My diagnosis and death sentence? Or the sure hope that lies ahead that things will get easier with time and ultimately will all end in the culmination of beauty, love and glory.
      Thanks for the post. Really good to read.

      For more of my story: http://www.thethinkingaddict.com

  4. I’ve been doing some reading and work around the idea of positive psychiatry and mental health. I like the terminology of mental distress as opposed to mental illness. The focus is on personal recovery not clinical recovery and each persons personal recovery is unique and holistic. Mental distress is not viewed as being sick, it is a human experience… extreme but common. I like that recovery focuses on the strengths of the individual, not on what is wrong and how to cure it. People with mental distress or illness or whatever we choose to call it can live a full, meaningful life with symptoms. I kind of like this approach to recovery. I don’t think I’ll ever be ‘cured’ but I can learn from each experience, build on my strengths and use it to find my own way forward. That’s my own personal recovery.

  5. Recovery as a choice. From having psychotic episodes where I literally tried to kill myself and a loved one, do not spell out recovery as a choice. Granted, that was a particularly difficult time… but, my point is mental illness is full of moments like this (where you have a loss of control over your symptoms). For instance, I can control a bowel movement, I cannot control invasive thoughts and being depressed or psychotic.

  6. Ashley, my thoughts about it is recovery is both a choice, sometimes mandatory.
    Parents who have a teenager that is of age, they cannot force the teen to go into treatment for recovery.
    Then there are those who are deemed a danger to themselves and the community. There is no choice for them. They are admitted, maybe not for recovery, but basically to keep them and others safe.
    I can see the pro’s and the con’s of this issue.

  7. I think a lot of material I’ve seen for people newly diagnosed with depression and anxiety and for those around them presents those illnesses as completely curable, if you give them time and put in the work. This may be reassuring for the newly diagnosed, but is harder for those who are treatment resistant or frequently relapse. I’ve felt in the past that psychiatrists and therapists have given up on me for being treatment-resistant and I wonder if it is partly because they feel I’m a problem patient who must be doing something wrong for their techniques not to work.

    1. There’s certainly value in telling people newly diagnosed that recovery is possible, but when it’s held up as an impossible standard like you said, it’s really not helping anyone.

  8. I think a quote like that can end up doing damage, especially to someone who is trying hard to overcome their Mental Health Condition and the difficulties that arise from it.

    Medication doesn’t work for everyone
    Finding the right therapist is vital

    So much of recovery is trial and error.

  9. I guess for me recovery is a process rather than an end result. I’m learning to live more quietly within my emotional and mental needs. It’s not easy but I’m now far more content than I’ve ever been before. I still get stressed but having space to recharge and actually allowing myself to recharge has made all the difference. So for me recovery is owning who I am and trying not too think about what other people think.

  10. If it were a choice, then everyone would be mentally healthy. This is as dangerous as saying cancer is a choice. I think it’s a way for supposedly healthy people to distance themselves from complex issues. Another good one is “being gay is a choice?” O rly? And when did the speaker choose to be straight? Lol

  11. Ugh it’s such a slippery slope… i believe you can be on the road to recovery but i grapple with it as a true destination that can be maintained indefinitely. Unless your mental health is situational and you have healthy self esteem i think it’s hard pressed to ever be a choice.

  12. I think you can chose to accept treatment when it works for you. You’ll still need to do a lot of the work in healing yourself. You can recover within your means and between the boundaries given to you. It’s not all in our hands.
    In my opinion the quote misses that part.

  13. We have much less hope than we did 6 months ago before COVID, not that it was a cake walk then. Treatment is harder for us now since there’s no regular face-to-face therapy. We haven’t given up. We try. Still, we are definitely our own barrier sometimes, which is to say we were programmed not to seek help or admit we are impaired from experiencing society’s” normal” life. Acceptance would bring us more peace.

  14. I think it’s rather harmful to say that recovery is a choice. The concept of recovery is so cookie-cutter and is thrown around so much these days. Recovery doesn’t look the same for everyone, and it shouldn’t. One person who recovers, perhaps, goes back to work after a long period of illness and should not be compared to the person whose recovery looks like just being able to stay stable for a little while. Mental illness is a continuous thing that we go through, and is often lifelong.

  15. Is recovery a choice? To ME? Yes and no. One can do the utmost they can to accept their mental illness and to cope with it. They can strive to fit into society as much as possible IF they want to. I don’t feel, however, that ‘recovery’ is so black and white as to be an ‘either/or option. As you pointed out ‘recovery’ means different things to different people. The implication that a ‘recovery switch’ can be thrown and suddenly one is ‘normal’ (whatever that is) is false and to me, raises unrealistic expectations. Which are damaging and may well send the patient right back to the start. To me? Recovery is a journey, a process and the destination is life long with the end uncertain.’

      1. So true! We had a discussion in my former MHE about recovery, we were taking it seriously, but the point is one has the right to feel aptitude for some undertakings before some doctor says remission. Because they never may be remission or the best of doctors can say remission when it is not. I was in remission for one year out of eighteen, and if I had been waiting for someone to say I am doing good, I would never finish my degree, publish things, travel whatever else I ever did.

  16. My view: choosing to recover is *necessary* for recovery, but it isn’t *sufficient*. Lots of other things have to line up too.

    Let’s assume that some people’s depression is heavily affected by diet, but they may not be aware of that. This seems likely to be the case for me, up until a few weeks ago.

    Before then, I could be doing everything perfectly in my ideal recovery plan, but it still wouldn’t have been enough. So in what sense would I be choosing my illness? It was almost entirely out of my hands… until I discovered the link with food.

    Energy levels are a huge factor. When you’re depressed, your energy levels are running on empty a lot of the time. So who has the cast iron willpower to force themselves to recover when they can barely even get out of bed? Not many of us.

    I used to waste so much energy blaming myself for my illness. Now I see that it wasn’t my fault, I wasn’t lacking in some way or just lazy. I was ill, just like someone with cancer is ill.

    And with depression, when you blame yourself, you can make things even worse.

    Really, it’s kindness, love and acceptance we need when we’re depressed, not memes which seem to imply we ought to be trying harder.

  17. There’s another element to this too… I think there’s good scientific basis for believing that we don’t truly have free will, even if we feel like we do. That means that NOTHING in life is actually a free choice. Every event, no matter how big or small, is preceded by an unbroken chain of causation which stretches back to the beginning of the Universe. Lots of people feel troubled by this possibility, but I’ve spent a lot of time thinking about it (thanks to Sam Harris) and I now find it very freeing. There’s no point ruminating about the past because it literally would be impossible for it to have happened any other way. And there’s no point worrying about the future because it’s already written.

  18. This statement resonates deeply with me: “Recovery is a process rather than an endpoint …” How does one make such a choice for recovery? Free will? Almost certainly, not alone, or without proper mental health support/diagnosis. I like to claim “my choice” was based on my willpower, but that would exclude my doctor, therapist, friends, family and God.

  19. It’s unfair people still think mental health is a keyboard with multiple buttons, you push them and change the whole situation. the words choice shouldn’t be attached to mental health at any stage. if it was this easy nobody would be suffering.

    can i reblog this post?

  20. I feel like you can choose to take steps toward recovery, but whether those steps help you recover can vary greatly. I have trouble with binge eating and depression and both of these diseases can affect people for different reasons and in different ways. Recovery really is a learning curve, not just a simple task you go and do.

  21. Wow, if only recovery was a choice! I know when I first became unwell many years ago, I chose to recover and tried many routes such as massage, hypnotherapy, mindfulness……………. and medication.

    While I’ve had some success with a huge combination (mindfulness, medication,breathing techniques and other coping skills), mental illness remains. Yes, I can cope with it, in the main, but it’s hard work constantly keeping on coping.

    Of course, I choose recovery because it’s crippling living with mental illness but I know I’ll never recover fully, whatever that means.

  22. For me I use the words being healthy in my mental health rather then recovery. Part of my being healthy iss seeing my psychiatrist and taking my meds.

  23. when given recovery tools that act like a crutch … you heal regardless. it’s comparable to being as broken as a bone. you will have new growth regardless but possibly crooked if not healing with proper support. then learn to walk again.. you must put in hard soul grinding effort but its you, only you that ultimately does make the choice to recover.

  24. Oh Ashley, this is a seriously good quality post – provocative and profound too – well written and observed. A deep thinker. Is recovery a choice? Yes and no ….. if it was easy – we would have no serious problems in life – l have known people be so negative even when on the road to recovery that they refuse to allow recovery entrance to their mind – therefore they are refusing choice to recover.

    Might sound wrong – l’ll explain using another example ..

    I remember a good few years ago and by this l am referring to 2014, so six years ago now. I was unemployed and l had to go and sign on to receive unemployment benefit… the agent l saw asked me various questions .. and when l told her l was on the spectrum, and had Asperger’s she responded with this …… ‘Last year l broke my leg in a skiing accident, but l recovered and you will do too, it’s your choice to and not use not wishing to recover as an excuse!!”

    I was taken aback by this and l answered with, “I was born with Asperger’s, but it doesn’t stop me from working, all l said was l didn’t do well in large crowds of people, not that l was refusing to work!!

    But it was her insistence that l was refusing to allow myself time to recover like it was a deliberation to be an Aspergian, like l had a choice!!

    I have never used any disorder, my Aspergers, my breakdown, my bipolar, any previous depression to stop me from pressing forwards. If l could bounce back from a depression like it wasn’t there l would leap at that opportunity as would many others but some don’t and they are more happy to be unhappy than recover.

    My choice of recovery is to remain positive as often as l can … you see l think that when we hit a great deep and dark depression, it never truly goes – but we work with it, we have good and bad days, great days but the choice to continue to keep recovering is ours and we should take it – that’s where the choice is.

    1. I agree, sometimes people choose not to pursue recovery. But I would argue that sometimes the effects of illness are such that recovery isn’t a choice that’s available.

      1. I don’t disagree on that Ashley, nit at all .. l was thinking of three people who l knew once, no longer because their deliberate negativity proved too much – but they were recovering, but if they recovered, they would not get the attention they wanted. So they deliberately refused to allow recovery and made themselves iller on purpose.

        It annoyed me, because they were getting help for something they were pretending with and there were and always will be people that genuinely need the support.

  25. This post has generated so much discussion! Thanks for getting us all jump-started!

    I was just going to add that I like using the term remission for my mental illness. My propensity toward the illness is still there, there are some things I can do like exercise and eat right to help mitigate these risks. But if the depression/anxiety/mania comes back for a time, it can be expected – no surprise there. What is not expected or what is not a given is how I choose to react if remission does not stay in place for good. There are often little bubbles of anxiety that pop up here and there which means the remission is not a steady state but something to strive for even if there is a break-through of symptoms from time to time. Most important is the compassion to have for yourself if things don’t go your way. Having love for yourself even when crazy stuff is happening is the goal.

  26. I agree with you in this aspect. I mean why do people even say that recovery is a choice. When someone is having it all at the same time like mishaps, a lot of problems, depression, stress, traumas etc. You can’t just expect him/her/them to see the light in their situation, can you? Not all people are same. Their way to deal life is different. Their reaction to stimuli are different. So if someone chooses recovery, well good! But people can’t judge other person who doesn’t seem to find any energy to go towards their journey of recovery. This statement sounds kind of judgemental towards us, the mentally ill people.

  27. For me recovery was a choice… to a point. I was depressed for years and medication and counseling didn’t actually help me. It was like getting into a rubber dinghy in a stormy sea. Certainly safer but didn’t get me any closer to dry land. When I chose to start actively creating a less toxic lifestyle instead of treating depression as an illness, my life was transformed. So for me it isn’t necessarily a choice to get better, but it can be a choice to start paddling in the direction of the shore. (But sure you can’t just choose to be on dry land and appear there) hope what I’m trying to convey comes across. 🙂

    1. I’ve never fracked up a comment before lol. Recovery is a myth. just like saying my gay sun is in a phase.. healing can sssdega

Leave a Reply