15 August 2010

mental health - Recovery is not treatment

"Recovery" is not a "treatment modality". For at least three decades [longer, if you go back to Clifford Beers] advocates, ex-patients and dispassionate observers have repeatedly argued that people can and often do, "recover" from long lasting disabling, debilitating conditions and experiences.
     At the same time, the idea was scoffed and dismissed by high ranking administrators and clinicians, citing [still] the ghosts of Kraepelin and Beuler as the rationale for why such an idea was untenable. "People don't recover from 'mental illness.' Their lives are lost and so is any hope for them doing much better" the clinical careerists would steadfastly maintain.
     Little or no thought was given to asking patients in mental hospitals what might be their wishes, hopes, dreams, or aspirations to achieve.
     Bean-counting bureaucrats spoke of "bed spaces," "treatment modalities" and "managed care." They asked drug companies when "the next miracle drug cure" would get people out of institutions and back on the streets.
     The standard response to those who had different ideas about treatment, care or rehabilitation, was to ignore them, keep them from the decision making process and to demean and invalidate the critical voices that offered options.
     Now, times have changed. Budget constraint called for innovation and "outcomes." Major funding sources started telling them that "recovery is good"! Gradually, those same clinicians and bureaucrats who walk past patients without seeing them took up the call.
     However, while the language has been embraced, other obstacles remain. "Clients" get wheedled and cajoled to large group meetings and say the process is "patient driven." Abusive staff and practices continue unabated. Known wrongs that take place fail to get "substantiated" when only patients witness those wrongs.
     How can this be? That bureaucrat driving his new custom SUV to the workplace while the patient gets penalized by Title 19 with "spend-downs" on maybe less than $500 a month. Patient driven huh!
     Folks, you don't have a clue.
     Admittedly, the samples mentioned oversimplify the problems inherent in social injustice and lack regard for people with mental illnesses. Administrators, Nurse Educators and other who shape professional opinion are still no different than the society at large. But my point would be the same no matter what quick capsule glimpse got noted.
     Recovery is not a treatment modality! The reasons people can and do recover are many and multifarious. But they come as much [or more] from within.
     "Recovery" may or may not include taking medications. For John Nash [the subject of the film A Beautiful Mind] they by and large did NOT, no matter what the film said.
     "Recovery" may or may not include assistance from mental health programs. In the case of survivors in the Vermont Longitudinal Study in 1987, for a goodly number it was in spite of what services the "system" provided.
     Recovery is a process It involves learning to live with complex and inexplicable phenomena [that many may call delusional], of freedom from unrealistic pressures to "get over" that phenomena within discrete time frame, and of being considered, cared for and loved as a fellow human being by others. Simple as that.
     How much more difficult this is to achieve in a society and culture that does not value those souls who are not immediately responsive to time-motion-study lifestyles. So challenging to those who drive efficient bureaucrats to distraction with abstruse, and often unexplainable questions. In the long run, it may call for dramatic and complete changes in cultural attitudes and norms, not something so easy to implement when it isn't even discussed.
     So...if you, the fashionably dressed mental health careerist can grasp this, then next time you wish to speak to someone -anyone, even one of your professional colleagues- about "Recovery" for people with living dramatic, even severe, cognitive / perceptual dissonance, then do so only after you actually drop your important paperwork and pre-occupation with meetings and give someone the time, energy and effort to sit with and actually get to know some of those persons who walk past you daily, but of whom you only know by diagnosis. Incidentally, it's a whole lot cheaper than funding the psycho-pharmaceutical companies, but takes longer to see results.
     Now that would be a step toward recovery.

SOME RESOURCES: Clifford Beers' A Mind That Found Itself, National Empowerment Center, MindFreedom, Mary Ellen Copeland's Self-help Strategies


  1. Bravo! for your post about recovery and "treatement" - very well put!

  2. The only truly helpful person I ever encountered was a Voc Rehab counselor who got me back into school. I graduated and then got a job, all without pharmacology or psychotherapy, two things that I have personally found to be really pointless.