Saturday, 3 May 2008

Recovery vs. rehabilitation

"How should 'recovery' be defined?" asks Ron Unger in his latest blog entry from April 28th, 2008, taking on the increasing watering down of the original notion of "recovery".

With Ron's kind permission, I translated his entry and posted it on my Danish blog, opposing it to the definition of "recovery" the Danish mental health system in the shape of some of its biggest (media-) hot shots propagates. In particular in the article "Recovery og rehabilitering i pykiatrien" (Recovery and rehabilitation in the mental health system) by, among others, Lene Eplov Falgaard and Henrik Day Poulsen.

"Is recovery a completely new way of managing mental illness, which the mental health system hasn't had room for previously? Or is recovery just a new word for psychiatric rehabilitation?" the article's authors (all psychiatrists) ask introductory.

Subsequently, the authors define recovery as follows:

"Recovery is described as a deeply personal, unique process, where it is aimed at, that a person can live a satisfying life, even with the limitations a chronic illness causes." (my emphasis)

Correspondingly, the article's authors conclude, that the concept of recovery is nothing but "old wine in new bottles", nothing but the mental health system's well-known rehabilitation.

That which the article describes as "recovery" is not recovery, the conclusion thereby being incorrect, Ron Unger's blog entry makes clear. His entry also makes clear, why it is so important to adhere to the original recovery-concept, without allowing neither psychiatry nor any misunderstood sympathy toward certain users' needs to water down the notion and definition of recovery.

As a follow-up to Ron's blog entry, I posted some further information and thoughts on "recovery" at my Danish blog:

The definition of recovery Day Poulsen et al. make use of in their article "Recovery og rehabilitering i psykiatrien" is borrowed from and jumbled according to "Recovery from mental illness: The guiding vision of the mental health service system in the 1990s" (pdf) by William A. Anthony. The article was originally published in Psychosocial Rehabilitation Journal (my emphasis), 16(4), 11-23. William Anthony is the executive director of the Center for Psychiatic Rehabilitation (my emphasis) at Boston University.

In his article, Anthony describes recovery as "a deeply personal, unique process of changing one’s attitudes, values, feelings, goals, skills and/or roles. It is a way of living a satisfying, hopeful, and contributing life even with limitations caused by the illness." Note that Anthony doesn't make use of the term "chronic". Nonetheless, neither he, from his position as the executive director of a state-funded institution, that works hand in hand with psychiatry, thinks, that recovery is anything else than a person learning to live with a disabling illness, that keeps him/her dependent on the services of the system (medication) for life. This short it can be said, which Anthony on his part uses several pages of extremely pathetic rhetoric to say.

According to Anthony, the difference between rehabilitation and recovery is simply this, that rehabilitation is the service the system offers to make a person recover. Thus it is the system that rehabilitates, while it is the individual who recovers. This easily rehabilitation and recovery can be made two sides of the same thing, and the concept of recovery be emptied of its original meaning - just to fill it with psychiatry's meaning, excluding the possibility of full recovery from psychosis beforehand, as psychiatry always has done and still does. With this end in view, Anthony doesn't even mind to claim, that "recovery" from physical illness or injury doesn't necessarily require becoming independent from social and/or medical services. Exactly the claim Ron Unger right on calls "deceitful and incompetent". And of course, it is exactly this definition the Danish mental health system, represented by among others Day Poulsen, conjures up from the top hat. In a desperate attempt to make the concept of recovery acceptable to the system.

Thus, both Anthony and the Danish article carefully avoid to bring up full recovery, i.e. complete indepence from the system (medication), as the ultimate goal of every recovery-process. While people like Dan Fisher either never have been "really" psychotic ("misdiagnosed"), or are wrong to believe that it can't happen at any time again, just because they accidentally (!) are capable of doing without the system's support ("medicine") for a period: Psychosis by definition is a chronic condition; full recovery is not possible.

That which for the system is problematic, unacceptable, with the recovery-concept is not so much the idea that people may be able to recover fully. The most problematic, unacceptable, is the fact that often it is everything but the medical treatment, that makes full recovery a possibility.

If it was the medication helping people to recover, the system right away would agree to full recovery being possible, even for psychosis. But it isn't. On the contrary. More often than not, it is exactly people who either avoid medication at all, or, at least, use it very economically and periodically, who achieve full recovery. The higher dosage over the longer time, the smaller the chance for full recovery becomes.

The same has to be said about the biological model, medication is based upon: The greater belief in biology, the smaller the chance for full recovery. Usually, full recovery is achieved in line with realizing which originally caused crisis, on an existential level. Without self-/awareness rehabilitation, "social recovery", is possible. But not full recovery, or which may be called real recovery.

Ron Unger's blog entry is a reaction to which Daniel Fisher expresses for instance in his article "A New Vision of Recovery: People can fully recover from mental illness; it is not a life-long process", where he certainly delimits "the Empowerment Vision" of recovery (full recovery, although...) from a "Rehabilitation View", but not without admitting medication a certain legitimacy even in context with "the Empowerment Vision". It is this reduction of demands, this stretch of the original concept of recovery, Ron Unger very rightly protests against.

It thus has to be concluded, that there is rehabilitation in the mental health system, while there is recovery beyond it. "Recovery" still isn't recognized nor accepted in the mental health system other than as a new term for rehabilitation. While the original concept more or less consistently still is denied acceptance. At the risk of sinking into oblivion. Especially if we continue to allow ourselves to be captivated by psychiatry's pathetic rhetoric.


Edward Cejka said...

it would be great if that really is a cure for cocaine. This would be a great breakthrough that would help industries such that Addiction Rehab New York in curing their patients.

Marian said...

Hi Edward, IMO (and experience) most rehab programs, New York or elsewhere, and certainly those based on and pushing the twelve-step nonsense, are barking up the entirely wrong tree when they label which in truth is a coping strategy an "illness" that needs to be treated and, if possible, cured. Where there's no illness, there can be no cure. While a harmful coping strategy certainly can be made conscious and changed. Although it would have to be done by the individual themselves, so it doesn't necessarily feed a whole industry.