politics of the hap


The Promise of Recovery: A polemic.
November 17, 2014, 10:46 pm
Filed under: Mental health, Recovery, Uncategorized | Tags: , ,

Talk presented at recent seminar at the Faculty of Health and Social Care at The Open University.

Recovery has become popularised in mental health care as a means of empowering service users to construct their own identity and meaning of recovery. Recovery is a term often used indiscriminately but what does it mean to recover? The strength of recovery apparently lies in its ability to mean different things to different people allowing people to construct their own version of a meaningful life. However I will argue in this presentation that the shift in emphasis to the individual in the rhetoric of recovery has meant that recovery becomes the responsibility of the individual. As recovery becomes an individual obligation or requirement, the promise of recovery rather than freeing people to construct their own meaning serves to reaffirm existing norms on how to function and manage mental distress in order to obtain the good life. 

Recovery, as I am sure many of you are aware, has become increasingly popular in mental health care services. Services now describe themselves as ‘recovery-focused’ and ‘recovery orientated’, Recovery colleges that provide a variety of courses for service users are being set up across the country. An increasing academic interest in recovery in mental health care has lead to the creation of a number of seminars and conferences and research networks, and is what has brought us all here today.

In my own PhD research I am exploring how recovery from grief is understood and experienced. My interest in recovery has led me to learn about the uses of recovery more broadly in mental health care and also to speak with several current and ex-mental health service users each with differing views on recovery.

So what does recovery actually mean? In brief the use of recovery appears to have emerged from the psychiatric survivors movement, where recovery referred to the right to live with mental distress rather than see it as something to overcome.

However many definitions of recovery have been proposed with no universal agreement on what recovery should look like. This is in part because recovery was intended to be self-defined.

Most descriptions tend to focus on building hope, creating a new identity, having a meaningful life, and taking control over one’s life.

South London and Maudsley’s (SLAM) Recovery College prospectus defines recovery as:

Recovery is about people with mental health difficulties having the same opportunities in life as everyone else. It is about a personal journey towards a meaningful and satisfying life. It is about hope, control and opportunity. It is about living as well as possible.

Another example taken from a report entitled ‘Making recovery a reality’ published in 2008 by the Sainsbury centre for mental health describes:

(Recovery) can only be resolved if the person can discover – or rediscover – their sense of personal control (‘agency’) and gain a belief in the future (hope). Without hope they cannot begin to build their lives.

However since recovery’s incorporation into mainstream mental health care a number of more specific models such as the ‘recovery star’ have been developed which predefine the parameters of recovery.

The Recovery star includes the following dimensions:

  1. Managing mental health
  2. Physical health and self care
  3. Living skills
  4. Social networks
  5. Work
  6. Relationships
  7. Addictive behaviour
  8. Responsibilities
  9. Identity & self-esteem
  10. Trust and hope

There is also the new ‘Wheel of well-being’ which contains 6 elements: body, mind, planet, place, people, spirit. And another model called the Tree of life, all of which are taught at the recovery colleges.

The point I wish to highlight here is in these models recovery is given outcomes and priorities that are not set by the service user themselves but by the NHS trust delivering the service.

I would argue these priorities are reliant on an assumed understanding of what constitutes a good life and living well. The recovery colleges for instance deliver courses on how to stop smoking, how to eat better, and how to get a job. In these models of recovery there is an implicit judgement over how one should successfully live out their personal lives.

As one participant I interviewed in my research commented, in the recovery model it is as though you need to recover from being yourself. Daily activities such as taking a shower, or walking outside, and eating a balanced diet become ‘self-care activities’ rather than just living.

By establishing markers of recovery such as the recovery star it becomes possible for the relevant medical authority to make a judgement on whether or not someone is recovered.

People then become responsible for adhering to prescribed ways of governing their lives, but the medical authority still remains in tact – as psychiatrists become recovery experts and mental health care becomes ‘recovery orientated’ and ‘recovery focused’.

A contradiction then arises as recovery is described as a unique individual journey to self-control and autonomy over one’s life yet it is taught and learnt via a set of experts and in adherence to a set of predefined criteria.

As SLAM’S recovery college prospectus states:

“The workshops and courses we run aim to provide the tools… to help you become an expert in your own recovery.”

And whilst recovery is claimed to be a co-production, if someone fails to reach recovery the blame is squarely on the individual.

Again from the SLAM Recovery college prospectus:

“Treatment and support from mental health professionals can be helpful but every person with mental health problems can become an expert in their own self-management. Whatever challenges you face, recovery involves finding the personal resourcefulness and resilience to take back control over your life and what happens to you.”

If something bad might happen then, something that might not fit within the recovery model, the blame will then fall on the individual because in this understanding recovery is always possible, no matter how serious the person’s difficulties you just need to find your inner ‘resourcefulness’.

This is the promise of recovery: you can get better according to pre-existing normative ideas of what a satisfying good life is, because the only thing that needs changing is you and how you currently live your life and we (being the relevant medical authority) are here to tell you how to do that.

This obligation to recover thus becomes a way to abdicate responsibility for mental distress elsewhere, that is to the person experiencing the distress themselves.

It is for this reason amongst others that the recovery model has come under criticism from service users and others working within mental health care. Recovery is seen as a way to cut back on services, to eradicate long-term care, where referring people to recovery colleges is a way to discharge them quicker.

For an increasing number of people then, recovery is a shiny gloss on an unchanged system that remains unequal in practice and which shifts responsibility to live a certain way on the service user.

A group of people have formed on Facebook to express their disapproval at the way recovery has been appropriated in a group they have called ‘Recovery in the bin’. The members of this group contend that ‘recovery’ has been colonised and used to discipline and control people with mental distress and argue for a ‘Social Model of Madness’, placing mental health within the context of the wider class struggle.

Some of the group have claimed the title of “UnRecovered” to replace “Recovered”, to express their rejection of what they see as a neoliberal intrusion on the word ‘recovery’ that has been redefined, and taken over by marketisation, an capitalist values.

To recover from mental illness, to adhere to the model of recovery, involves a considerable amount of work on behalf of the service user. To recover involves a range of activities such as attending recovery colleges, completing recovery plans, taking medication, getting a job, sustaining good relationships with others, eating well, not smoking, creating a new identity, being mindful and taking walks in nature.

People using mental health services are increasingly finding themselves obligated to undertake this sort of ‘recovery-work’ in the promise of becoming well.

Yet the promise of recovery possesses a cruel contradiction in that the highly prized ability to become autonomous and have self-control to manage one’s life is only possible through submitting to experts who help people navigate their way through to recovery.

The service user is taught how and what to desire all in the name of self-fulfilment and individual freedom.

And because recovery is always possible it can only be the individual’s failure of will or resilience if they are seen to relapse or fail to recover in the terms that have been proposed.

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