Skip to main content
main-content
Top

About this book

For most of us, the term 'recovery' in mental health implies hope and normality for those suffering from emotional distress. It is understandable why recovery has therefore become a significant goal for mental health services.

But what does recovery mean for those who are struggling to see it through? Is the emphasis on recovery always a positive thing. This book takes a critical sociological look at personal and public assumptions and understandings. In particular:

• It explores what the recovery movement signifies today, offering readers a critical, reflexive view of its scientific, policy and political consequences.

• It considers what recovery means from social, medical and patient perspectives, and the implications of these conflicting views.

• It reveals some of the risks and benefits for people with mental health problems encountering a system that expects them to recover.

Offering a comprehensive and thought-provoking overview of the concept of recovery from mental illness, this book is a must-have for students studying mental health across a range of subjects, including Sociology, Social Work, Psychology and Nursing.

Table of Contents

Introduction

Abstract
For all the effort made to find solutions for the incorrigible problem of ‘serious mental health problems’ (the current styling for the age-old category of ‘madness’), clear answers are rare. As Mike Slade suggests in the quote above, there are a variety of ways to reach the goal. Some treatments that appeared to be so promising (drug therapies) have helped some people, yet some people have gained little relief and others have been harmed. Some people with a psychiatric label resist or ignore efforts to normalise their difference and make others more comfortable with them. However, some other patients would like desperately to find solutions and hope. Those who work in mental health services seek solutions to the madness and misery that affect people and disrupt communities, and they often struggle within resource-poor settings to support people who need help. Our efforts here to be critical of the idea of recovery are not meant to be critical or dismissive of individuals who suffer from problems nor of the people who work with them. But in order to evaluate the empowering potential of the idea, we must be honest about its traps and weaknesses, particularly those that might be convenient to ignore.
David Pilgrim, Ann McCranie

1. Recovery from what?

Abstract
The notion of recovery from mental health problems springs from a post-Enlightenment assumption that madness and misery are undesirable pathological states amenable to improvement. As Twain suggests above, ‘cheering’ someone else up could even have a benefit for the self. ‘Recovery’ suggests a return from an unhappy place of alienation from others or even from the self. The recovering person may be seen as one who is undertaking an existential journey in the resurrection imagery of Dylan Thomas’s verse above. They have travelled to that unhappy place and they are now awaiting, or already using, a return ticket to ‘normality’. That return to the moral territory of everyday reasonableness, expected of adult citizens, could be attributed to the efforts of patients or to their informal or paid carers or to some negotiation between these parties. However, along with the notion of recovery comes the assumption that the return ticket is actually available. Recovery is now on offer to — perhaps even an expected undertaking of — all of those deemed by themselves or others to be mentally disordered.
David Pilgrim, Ann McCranie

2. The different meanings of recovery

Abstract
We turn now from our discussion of the underpinnings of our understandings of madness and misery and reorient ourselves more with the last 20 years and current state of affairs for ‘people with serious mental illness’. Of the many institutional changes that can be used to enhance our understanding of recent years, there is the continuing centrality of psychotropic medication, with a decreasing reliance on long-term hospital institutionalisation. However, many have argued that ‘softer’ forms of institutional arrangements such as group homes and residential facilities (Bellack and Mueser, 1986) and even harsher ones in the forms of prisons and jails (Pepper and Massaro, 1992) constitute a form of trans-institutionalisation. There are dramatic shifts and cuts in funding for services (Frank and Glied, 2006; Grob and Goldman, 2006; McCrone et al., 2008), which have left the system even more resource-hungry and eager to accept cost-effective alternatives.
David Pilgrim, Ann McCranie

3. The landscape of recovery-oriented services and their evidence base

Abstract
To this point, recovery has been discussed as a concept, primarily. We have explored the history and the various shades of meaning attached to the idea. As Jacobson and Greenley address above, the specifics of what is done in recovery are another matter. There are a number of efforts to tie the idea of recovery (with the various ideas that might be attached to it) to actual action for, and on behalf of, individuals who are deemed to be psychologically abnormal. We will discuss some of these specific types of ‘recovery’ activities, paying special attention to the different shades of meaning attached to them. We will discuss ‘self-management’ of illness, consumer/user/survivor representation and involvement in the system, specific clinical approaches, treatments and other activities. We will also discuss the ways in which the mental health service research field has responded to ‘recovery’ and how that has intersected with a growing interest in ‘evidence-based’ practice in mental health.
David Pilgrim, Ann McCranie

4. Recovery, risk management and fiscal burden

Abstract
This chapter focuses on the contradictions created by therapeutic optimism in the countervailing context of a ‘risk society’ (Beck, 1992). Once mental disorder is designated as a medical condition, like any other, then efforts at facilitating help could be framed like aiding a patient’s recovery from a broken arm. However, this position disavows the role played by mental health professions: they are agents of the State, with particular legal powers to remove liberty without trial and to manage risk to others, not just patients themselves. As the quote above suggests, from the perspective of the State, treatment may need to happen with or without the consent of the ‘disordered’. The whole question about risk management in mental health services will be discussed in this chapter in order to problematise the assumption of therapeutic optimism and its expression now in the dominant provider-preferred notion of ‘recovery’. As we discussed in Chapter 2, what we mean by ‘therapeutic optimism’ is a belief in the efficacy of treatments, services, supports and systems of care to effect change for individuals with a diagnosis of mental disorder.
David Pilgrim, Ann McCranie

5. Evaluating recovery policy

Abstract
In this chapter, we pick up points raised in Chapter 2, and follow through others from Chapter 4, in order to consider recovery in practice in more detail. It may seem odd to imply, in the title of this chapter, that recovery policy and rhetoric might represent anything other than a positive prospect for people with a diagnosis of mental disorder. But the latter contains a very wide social group and implies a mental health policy, which like others is rife with unintended consequences. As we noted in Chapter 1, there is certainly a distinction to be made between people who experience profound unhappiness on the one hand and those who speak oddly and act in an unintelligible way on the other, thereby unnerving those around them. The Berlin Runaway-House referenced above (Weglaufhaus) is a refuge for the homeless seeking protection from the ‘psychiatric violence’ of the treatment system while gaining support from peers. As Bruckmann suggests, help in this case might be support and sympathy, not forcible commitment.
David Pilgrim, Ann McCranie

6. Reflecting sociologically on recovery

Abstract
Whether we think of recovery as a ‘polyvalent concept’ (Pilgrim, 2008) or as a ‘working misunderstanding’ with the attendant ambiguity implied above (Hopper, 2007), it is clear from the preceding chapters that sociologically oriented readers will have much to reflect on. Indeed there is so much to consider that it might be difficult at times to see the wood for the trees, despite the deceptive simplicity of the word. As an ordinary word of the English language, ‘recovery’ can be invested with many meanings for many reasons, which resonates with the interest work of a variety of social groups. These meanings then are framed in accordance with group ambitions and can be thought of therefore as forms of ‘ideology’ within the tradition of Marx or, more ambiguously, forms of ‘discourse’ or ‘discursive practice’ in line with the more recent advice of Foucault.
David Pilgrim, Ann McCranie
Additional information