Understanding and Misunderstanding Recovery
Fast forward a year, and Paul definitely looks like he’s on the mend. Indeed, people start talking to him about being ‘in recovery’. Paul nods, but when one of us talks to him about what he understands by this, he’s not very sure. And he’s not the only one. For a word that is used so commonly in relation to mental distress, there is very little consensus for what ‘recovery’ actually means.41,42 Largely due to the prolonged period of service user activism, the recovery movement rearticulated what had been a dominant understanding of recovery as the alleviation of mental health symptoms and a consequent return to wellness. Instead recovery became about building a meaningful and satisfying life, as defined by the service user. It came to refer to social inclusion, meaningful and satisfying social roles, even if experiences of distress are still present in the person’s life. However, it has been argued that the idea of recovery has been removed from its roots in psychiatric survivor activism.43
For example, Harper and Speed44 suggest that there are three versions of recovery that are commonly understood at present: a biomedical version, based on symptomatology; a more socially oriented approach focused on quality of life; and the psychiatric survivor movement approach focused on liberation rather than cure.
Harper and Speed suggest that there are key issues with the way in which ‘recovery’ is now understood, and these are that it is still based on a model of deficit and sustains the subordinated status of the service user. Here, individual journeys, whether understood as recovery from symptoms or recovery as personal experience, tend to be journeys focused on changes in identity that do not speak to the questions of inequality, social injustice and social marginalisation that can be so intimately related to misery. They would likely contest Svanberg and colleagues’ framing of recovery as simply having a positive sense of self whether or not mental health is present. That recovery isn’t just about people but about social, economic and political processes. Paul’s experience sits in these debates. He has come to define recovery as having less pronounced symptoms.
Recovery is a contested concept. For Ridgway,38 it is about people breaking through the frozen state of suspended animation and being able to once again participate in social life. Here people heal themselves of the notion of being an outsider and leave behind the alienation that comes not from the misery but from the boring, barren, lifeless treatment environments into an acceptance that the personal context relies on a thousand events and many mysteries that may not be understood by the user or others. If helplessness and isolation are the core experiences of psychological trauma, then empowerment and reconnection are the core experiences of recovery.45
We would suggest that it is better to understand that there are as many recoveries as there are people. Recoveries have personal, collective and political dimensions; that they can incorporate experiences of social reconnection, empowerment and inclusion; that meaningful inclusion, as defined by people themselves, is key; and that who you speak to will depend on what version of recovery you might get.
In our current audit culture, leaving definitions open and variable does not facilitate the development of coordinated national services, accountability, consistency of practice and understanding. The notion of many recoveries makes it difficult for health managers, medics, psychologists and psychiatrists to provide a consistent framing of knowing and treating misery. But this perhaps addresses the heart of one of the key tensions between statutory professional and bureaucratic needs and the needs of those experiencing misery. And so we have instead a series of misconceptions about misery that sustain a statutory system to treat people. The fictions revolve around naming misery, what causes it, treating it and recovery. Sometimes these fictions serve people well; very often they don’t.