Sunday, 11 May 2008

More recovery

"Recovery" can mean two different things: It can be the goal someone sets himself, and it can be the development that leads to this goal. The road is the goal, the saying goes. But if you lose sight of your goal while on the road, because you think, you have come as far as you can and therefor stop moving on, you, of course, won't get any further. You won't be on your way anymore.

Development, change, progress are possible throughout all life. Development, change are life. Also in regard to recovery. To end this development, for instance by thinking or making another individual think that further change isn't possible, that the end of the road is reached, is murderous.

I agree with Ron Unger, that, in order to prevent a further watering down of the concept of recovery, full recovery as a goal where the individual is completely independent from the system's support, has to remain the goal of every recovery-process.

One of the most pronounced opponents of such a definition of recovery is the pro-psychiatry-extremist E. Fuller Torrey. In an earlier post at his blog, Ron Unger has a copy of his own article "Mental health system due for radical change", that originally was published in The Register Guard, and E. Fuller Torrey's response to the article.

In his response, Fuller Torrey quotes the recovery-criteria Courtney Harding laid down for "The Vermont Longitudinal Study of Persons with Mental Illness" (1987):

• having a social life indistinguishable from your neighbor

• holding a job for pay or volunteering

• being symptom free, and

• being off medication.

(For more information on this and other long term outcome studies see Edward L. Knight's article "Recovery".)

To Fuller Torrey, especially the last point on the list is a red rag, and he writes: "If recovery means we are headed to a mental health system without medication ... we're all in trouble." Yes, because the core of the mental health system, i.e. psychiatry, has no other "treatment" measures to offer than medication, ECT and - luckily today on a very small scale - "psychosurgery", read: lobotomy. Any other treatment measures, such as talk therapy, are not psychiatric treatment measures, even if they sometimes are offered within the outer framework of psychiatric / community mental health treatment. Psychiatry would hardly be able to continue as a speciality if it were deprived of the most important of all of its available tools to practise social control with.

All in line with this, Fuller Torrey continues: "We need to save the mental health system. Don't let the self-righteous recovery zealots intimidate you. Do ask questions and stop the madness."

To Fuller Torrey and his followers "recovery" seems to be synonymous to "insight" - into being "chronically ill", of course - and the consequential "compliance" - with medical, neuroleptical "treatment", of course. To him "recovery" exactly means resigning oneself to one's fate and learning to live with "the limitations a chronic illness causes". While this, strictly speaking, isn't recovery but rehabilitation, at the most.

But since having to admit, that what is feared for is the continuance of one's profession, one's job, would be a little embarrassing, this position on recovery is justified through the assertion that any recovery-concept going beyond the limitations of rehabilitation "sets up unrealistic expectations for those who will never fully 'recover', no matter how hard they try, because their illness is so severe." (Sally Satel and Mary Zdanowicz, "The President's Mental-Health Commission in Denial")

My question in this context is, what it would be that could give anyone the right to deny everybody the chance for recovery, just because there may be some individuals, who it by the way is impossible to say will be, who never achieve complete independence from the system? Maybe it should also become generally forbidden to live life, since there always will be some individuals who get hurt doing it??...

You can achieve anything you want, another saying goes. This is so true! At least when it comes to personal development. The only limit to it is death, the biological kind, or the kind that is a result of being lead on a false trail and parked there indefinitely.

For myself I've chosen a definition of recovery, that leaves all possibilities for further development open without limitations. According to Ron Unger's criterion of independence from any kind of support, I could be referred to as recovered by now. But, can I lean back comfortably, claiming that I've learned how to live, with or without disability? Do I know how to live life? Do I know how to live with myself? Do I know how to live with the only "disability", the only "chronic illness" in regard to my way of being, I've ever had, which is that I am me? Have I learned everything, that can and ought to be learned? Have I reached the end of the road?

If "mental illness" corresponding to for instance Laing is seen as existential crisis, the self's attempt to start the development, the process, life as such is, if "mental illness" is seen as an attempt to find a way out of the trap of the false trail, and back to the road, the answer has to be no.

One of my riding trainers once told an anecdote from the Spanish Riding School at Vienna: An event was held on the occasion of the Commandant's retirement. A journalist asked the Commandant how long time it takes to learn how to ride a horse. The Commandant answered: "Yah, let me see: I had the best trainers you can imagine, was allowed to ride the most well-trained horses you can meet with, and I was talented. Under these circumstances, I'd guess at about 200 years."

I'm not recovered. I am recovering: I'm learning to live with myself. Learning to live life. I'll continue learning for, at least, the next 200 years yet - or more, since I haven't always had the same advantageous circumstances as the Commandant. And actually I enjoy being on the road!


Anonymous said...

I suspect E. Fullofit wouldn't like my kidney doctor because my kidney doctor supported my taking the chance of seeing how well I could do off of dialysis for a time rather than tell me there was no chance it would work even though there was very little chance it would work. I lucked out and have been off far longer than either of us thought possible, a year and 2 months now. And that's with a real, chronic illness and a situation in which telling me I didn't have a chance would have been correct 95+% of the time.

Stealing people's hope steals lives.

Marian said...

"E. Fullofit"... awesome :)

"Recovery from psychosis (...) doesn't enter into psychiatric language at all - this being the biggest difference in regard to somatic medicine, where 'recovery even from cancer in its final stage is persistently aimed at'. It is above all a difference in the professionals' view of things, that, if adopted by the patient, takes a disastrous effect." -Jakob Litschig, Swiss ex-psychiatrist, therapist and PE (=Psychosis Experienced)

One of many facts about psychiatry that make me wonder what the business really is about: helping people in crisis, or, well, social control?? A rhetoric question, as far as I'm concerned.

Good to hear that you're doing so well, Alison!