Dec 12, 2012

Defending Recovery

There's a report floating around the internet these days claiming that "recovery" thinking threatens the health of people with mental illness. The report claims that the sickest among us have no capacity to recover, and if  you don't fully subscribe to the biopsychosocial/medical model of mental illness, you are depriving people of needed access to medical treatment. It's a lock-up or medicate piece along the lines of what you might read from the Treatment Advocacy Center. Pete Early reacts to it here. I wrote a comment on that post, and another to an earlier Huffington Post blog by Marvin Ross. 

The author of this report, Lembi Buchanan, deserves praise for her activism, which is grounded in support of her husband's survival from a very difficult experience of mental illness. She told Marvin Ross that her husband of 40 years would not be alive today if it hadn't been for involuntary hospitalization, medication and treatment on occasions when he has had psychotic episodes. She said that her husband is grateful for having been saved from suicide and for the support that has kept  him in good health.

What I like about Mrs. Buchanan's report is the opportunity it provides to review what we believe about recovery and the role of treatment in extremely difficult circumstances. The theoretical limits of recovery is an issue worth exploring.  I know that some people are not comfortable with the concept -- and even I have some trouble with it, which I have written about before.  What I don't like about Mrs. Buchanan's report is the way she mischaracterizes today's recovery movement by claiming that today's recovery-oriented groups and today's anti-psychiatry groups are essentially the same.

Recovery may have started out connected with anti-psychiatry, but it's a mistake to jam the two concepts together today.

Recovery literature is less than fifty years old. Authors like Judi Chamberlin, who created the language of the recovery movement, were reacting against psychiatric hospitals that operated as very coercive "total institutions."  Thomas Szasz was inventing antipsychiatry at roughly the same time. Chamberlin quoted Szasz, and even E. Fuller Torrey (who was a Szasz follower at the time) in her 1978 book On Our Own.

Recovery and anti-psychiatry are separate concepts these days. Psychiatrists, healthcare administrators and insurance companies have all signed off on recovery, with recovery being the notion that people can get better, decide what's important for them, and assert control of their lives. Recovery even has a SAMHSA-approved cousin, whose name is shared decision-making. At least on paper it seems the bad old days of one-sided, white-coated, doctor-driven psychiatry are gone. Even inside hospitals, care is meant to be person-centered.  In many hospitals today, few decisions are made without the patient's buy-in, participation or consent -- or a court order. 

Sadly, people with mental health conditions still get to the point where they're not safe. Most of the time, these are not people fully engaged in recovery. People pursuing recovery, with or without medication, usually know what they must do when they are getting into trouble. The people I worry about are those the system fails to help when they show up in emergency rooms asking for help, and those the system fails to detect or engage, the people who have disordered lives, clusters of sub-clinical trouble symptoms, who never get diagnosed until they are drugged or drunk, suicidal or psychotic, out of control, blatantly unsafe and possibly a threat. Society needs to be able to respond appropriately. Jails are no help, so we need hospitals, and community-based solutions.

As I worked through my own recovery, and later, when I ran a substance abuse treatment program that supported people who did not respond to AA, I came to realize that diagnosis and labels essentially did not matter in the lives of non-clinicians. What matters in recovery is engaging in the struggle, finding a path for moving forward. An hour or two of training lets anyone spot signs of trouble in people's lives. The real work follows, connecting people with a clinician who can do a real work-up and help create a treatment and recovery path that works for that individual.

So here's where I have ended up. Pro-recovery, pro-science, pro-therapy, pro-psychiatry, pro-choice, pro-wellness, and anti-coercion (to a point). Neutral on meds.  Unfortunately, some people need treatment, imperfect as it may be, at times when they don't want it. The anti-psychiatry folks are the experts on how offensive and distasteful involuntary treatment is. It would be great to have workable, effective alternatives that can be funded with healthcare dollars, but right now, we have what we have, and it's certainly not perfect either.

But recovery is nobody's threat.

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