“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 this mental illness recovery 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. Remaining ill/symptomatic also 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’d 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. Mental illness life is complicated, and all kinds of things besides just the symptoms themselves get dragged into it. 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?
The Coping Toolkit page has a broad collection of resources to support mental health and well-being.
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?
I don’t think there are any rainbows and unicorns, and it’s as complex as you described.
Agree with you 100%…!
I am in recovery from alcohol, going on 26 years. I would never say that I am in recovery from my “mental health” issues.
Yeah, some things will always be an ongoing process.
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 🙏
Thanks for your comment! I agree, there are things we can do, and things that we may not be able to do. And part of the journey is figuring out the difference.
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.
That’s so important to figure out what perspective is a good fit and what recovery looks like for you.
And in addition … I definitely need my meds! 😂
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.
So true.
Very true
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.
I completely agree that involuntary treatment is sometimes necessary, but that doesn’t necessarily lead to any form of recovery.
No it doesn’t. I witnessed some who were brought in by the police, they were only there to keep them from doing harm. A nurse had to sit outside their room, many of those brought in were in restraints the whole time. They didn’t interact with the others who were in treatment.
Not a good situation to be in.
I agree Ashley!
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.
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.
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.
I totally agree.
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.
I think that sounds like a very good approach.
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
Exactly!
In addition, if you live in the US, you will find the financial wall prevents the extremely impoverished from access to better treatment. Sure there are clinics but those places are like fast food. They don’t listen to you. They give you medicines that wreck your nervous system. They give you whatever makes you shut up so you’re easier to deal with. You may still be screaming and suffering on the inside but now unable to tell anyone. There are people who are on disability who can only get Medicare/Medicaid. Guess what, psychiatrists do not have to accept any form of insurance! Most of the new ones charge cash only! The ones who really suffer (who are immensely poor because of it) cannot afford it. If you are lucky and bug the ever-living-crap out of the system then you may run into one psychiatrist who will just help you even if you don’t have the money. In my case, my illness was due to brain damage acquired from severe prolonged stress and physical abuse (blunt force trauma) over many years – from which I was unable to escape (don’t want to get into it). It has been 2 years since I have been able to feel any amount of joy from anything. Music and spirituality were my life. It always lifted me out of any hell I was dealing with. On the day I woke up and suddenly realized I could no longer enjoy music or worship, my whole world changed and I saw the ugly shadow ‘neath both myself and others. The way I was treated by the people I trusted was disgusting. But people face their own ignorance and challenges in a variety of ways. If you look at your children, your pets and feel absolutely nothing for them – suddenly they are strangers, logic only takes you so far. You need that ability to bond emotionally. After 70 (yes! 70!) failed medication trials, years of CBT, EMDR, DBT (it even cost my ability to meditate as I used to be very good at it then started blacking out and going into fugue states) multiple hospitalizations where the staff just dismissed everything, exercise no longer worked. Eating healthy no longer worked. At the very last moment I reached out to my then therapist when I was suicidal and she told me she “didn’t have time for my bullshit”, which sent me into shock but, more importantly, validated that I was a burden, even to my therapist. So, I overdosed and hung myself. I was found 24 hours later barely hanging onto life. I have no memory of the days I spent in the ER. My life has become a waking nightmare. I no longer reach out to people because I can’t afford not one more stressor. But I survived. I was sexually assaulted in the hospital and administered a medicine that is on my ALLERGY LIST, which they ommitted from the discharge papers to save their own skins. My therapist told me she now “couldn’t trust me anymore” so I got kicked out. One of us almost died while the other one is a “victim”? Utter boolsheet! My next therapist found out I was trans then started deadnaming and harassing me if I’m “sure” and asking me all manner of intrusive and irrelevant sexual questions that had nothing to do with the treatment. He finally came out and expressed his disgust for transgender people. He also lied to his supervisor and me about what he did. I presented evidence to the contrary and he FUCKING THREATENED ME. I now see his supervisor (the therapist who trained him) and have had zero problems with her. All I asked was to be addressed in person by my preferred name … Not a human sacrifice. Even after the legal change, I was being called by that name! (Yes, I live in the deep South) I hated that I lived because I just woke back up to this nightmare. I have given up. I’m just waiting to die. I no longer care about purpose. I have no family or friends and have lost my appetite to make any more as I have come to realize that people will only make me feel even more suicidal so it’s better to be alone. I am seeing a new psychiatrist who has, so far, decided to push the paperwork to try to get me set up for ketamine infusions but at $400-$1,000 a session, he tells me straight-up it’s a “lucrative business”. I appreciate the blunt honesty. He says the kind of illness I have – since it was caused by brain damage – is almost impossible to treat and that many patients do end up committing suicide. He knows the hospitals make my PTSD worse and add more stress. We have reached an agreement.
But when some ignorant asshole tells me it’s a fucking choice, I want to strangle them for not acknowledging (or at least considering) the sheer amount of hell I had to go through in trying to find a treatment to give me back my ability to feel happiness from music, worship and nature. It’s like they just ASSUME I’m THAT incompetent. I’m fucking 41 years old, college-educated and have survived shit most people will never see in a complete lifespan! Do not speak to me as if I am some ungrateful teenager! Do you have any idea what it takes to wake up and know that you have no family -no one – and can no longer derive joy from anything, and to face a world full of people who don’t believe you, are insensitive assholes, invalidate you, assume things before asking, have zero idea what they are talking about but don’t realize it, patronize you, vilify you for your illness (“Your crying is scaring me” -ARE YOU FUCKING SERIOUS???) I have forgotten what happiness even feels like. I have forgotten what hope feels like. I have forgotten what God feels like. What love feels like. The only thing I have for people who say dumb shit like: “Mehhhh, getting treatment is a choice” is anger the size of a nuclear warhead from being fed-up with the constant ignorance and ivory-tower arrogance. I want THEM to live this nightmare so that they fully understand that their over-generalized views are completely false. Believe me,I used to have hope, too.
But this existence is not a place where hope will do you any good.
I have straight-up told my doctor if we don’t find something to cure this anhedonia by the end of the year that I’m taking my life and this time I won’t be found. Don’t preach that I’ll go to hell or be forced to reincarnate. My last NDE showed me those are absolute lies. Also, it’s fear-mongering. No and will grieve me. No one will miss me and I want it that way. I’m done. I’m fucking done. All I wanted was to be able to feel positive emotions. That’s literally all I wanted. I refuse to “learn to love the taste of shit” not after everything I’ve lost and been through. Not while privileged people get to feel positive emotions and have families. What right do they have to lecture me? They have not had to survive this. And before you pull out the victim-blaming BS and tell me it’s my fault I don’t have a family because I’m such an asshole, I didn’t start out as one. I was always a glass-half-full kind of person, and my family orphaned me when I was a small child. They had a habit of creating children and giving them away after severely abusing them. That was not my fucking fault. I thought it was for decades. It took therapy to help me to understand it wasn’t. I didn’t have the heart or resources to bring more children into this world. I didn’t trust that I could be a decent parent. I didn’t want to risk causing more damage. So, yeah. Everyone is telling me “Oh well, guess you’ll die alone”. I think about how many elderly have children who just dump them in homes where they are abused and have their rights taken away. I have made my peace with dying in the woods. I have no more ambitions. I have no desire for anyone or anything. I have lost my taste for life. If this one last attempt fails then I’m done. Seems like I’m the only person who has come to peace with it. I am sovereign! I have the right to decide whether I live or die and the right to face whatever consequences lie waiting for me because of that decision. In my case, no one will be hurt. Everyone gets what they want. Sometimes dead really is better.
Wow, that’s quite the horrendous shitstorm you’ve been through.
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.
I agree.
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.
I agree, there’s a subtlety that the quote just doesn’t capture.
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.
I’m glad you’re not giving up. ❤️❤️❤️
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.
I absolutely agree.
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.’
If there is a magic recovery switch, I wish someone would tell us where they’re hiding it.
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.
Waiting around for the okay from other people would make it rather difficult to live life.
Anyone who has been VERY sick and who does their part to seek out recovery finds a guaranteed road of obstacles lying in wait for them. One had to wade though multiple doctors who just don’t give a crap, those who refuse to take complicated cases, complications with medications, FINDING the proper CLASS of medications, FINANCIAL walls… the list goes on. Treatment is a bloody QUEST, AFAIAC! It can take YEARS to find one that works. Illness will show you the true vice and virtue of those who you hold near and dear. It is the ultimate litmus test when it comes to testing those who truly live by their word or are just all talk. It sickens me the amount of the general public who believe treatment is such a one-and-done magic pill. If your illness is mild and you are lucky then it is, but this is not often the case. I have spent time in the bowels of old asylums (I’m not young). The people in there are the ones you don’t see – the ones who are too far gone to even be portrayed in media. You never forget them. Their suffering STAYS with you. It makes you realize just how limited mental healthcare really is. It is a stark reminder that we have a very long way to go. There are more lives lost, not because they did not seek help but because the “help” caused more damage. I will never forget their faces. I will never forget their screams.
A choice…. if only it were that simple. 🙁 <3
Yup.