The notion of ‘recovery’ has permeated discourses in mental health policy in the last 20 years or so, to the extent that it is a key plank in the NICE guidance for many mental disorders. Recovery does not simply mean the amelioration of symptoms, or ceasing the need for treatment, but rather concerns the patient regaining control of their lives, in a way that is on their terms. This is often despite continuing to suffer form a mental health problem.
Recovery as it is used today has an interesting conceptual history, emerging not from the mental health profession but rather from service users in the US who felt abused by psychiatry, powerless in the treatment they were subjected to. (Its history dates far further back than this, but I am thinking primarily of the current “recovery movement” that dates to the 1950s/60s). They thus struggled against the prevailing medical model of their conditions, arguing that what they wanted was to be able to live well, not merely to cope but to flourish in their lives in spite of their symptoms or problems. Its guiding principle was that of hope: the idea that one could lead a meaningful life and ought not to be consigned to the societal dustbin on account of mental ill health. This is a very sketchy and brief account that overlooks the complex political environment in which the recovery movement emerged, but it is clear that it has gained power as a user-led movement challenging the orthodoxies of medical psychiatric treatment.
Surely then it is a laudable aim to incorporate ‘recovery’ into policy, and it should be seen as progress in the battle to improve both mental health services and perceptions of those who need them? Yes and no. As with many concepts that crop up and gain currency in the political mainstream (I’m thinking of ‘wellbeing’ as a personal favourite), recovery is rather vague in its meaning, and thus runs the risks of being co-opted by the very powers it was meant to challenge. While recovery is intended to be a user-led process of finding hope and gaining control, without a grasp of it conceptual and historical roots it risks mutating into a vacuous tick-box notion that is ‘delivered’ by health services, and that would, on my view, be a terrible mistake.
This is why I’m very interested in a new book published in the OUP series International Perspectives in the Philosophy of Psychiatry, the contents of which has been summarised in Durham’s Medical Humanities blog here:
Understanding where the notion of recovery came from, why it emerged, and what its power can be is, I think, crucial to the project of taking it seriously. Recovery is precisely the kind of concept that the philosophy of psychiatry should be tackling, and the book is advertised as appealing to a wide range of people from philosophers to critically engaged clinicians and researchers, service users, caregivers and policy makers. I’m really pleased to see such an addition to the growing IPPP series.