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 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?