Recovery: beyond mere survival

Sir: David Whitwell (Psychiatric Bulletin, October 1999, 23, 621-622) argues that ‘recovery’ is a myth, promulgated by over-optimistic therapists of all persuasions. If ‘recovery’ means getting back to exactly how you were before (as he argues), then no doubt he is right, at least for many people with significant mental health difficulties. But the mental health world needs optimism — not over-optimism, that a person can rebuild a satisfying, hopeful life and contribute to society despite the continued presence of mental health problems. Indeed, this is precisely how recovery is defined in the now extensive American literature: there is no way back to life before problems started, but there is a way forward (Deegan, 1988; Anthony, 1993; Young & Ensing, 1999).

The experience of physical disability shows just how powerful this type of ‘recovery’ can be, even in the face of the most extreme impairment. After Jean-Dominique Bauby's massive stroke he could only move one eyelid, his sole means of communication. There is no doubt that he would have agreed with Whitwell's interviewee who said that ‘I will never be the same person again’. However, he was able to find some meaning and purpose, however, limited, in his highly restricted new life in ‘writing’ what the Financial Times described as, “one of the great books of the century” (Bauby, 1997).

As Patricia Deegan (1988) puts it:

“Recovery does not refer to an end-product or result. It does not mean that my friend (with quadriplegia) and I were ‘cured’. In fact, our recovery is marked by an ever-deepening acceptance of our limitations. But now, rather than being an occasion for despair, we find that our personal limitations are the ground from which spring our own unique possibilities.”

Whitwell's interviewees at times seemed to be equivocal about whether they had, in fact, ‘recovered’ — an ambivalence from which Whitwell concluded that they did not think they had recovered. Here there seems to be some confusion between recovery as an ongoing process and ‘being recovered’ as an end-point. Deegan (1988) makes precisely this point when she argues that recovery does not mean ‘cure’, it is not an end-point — ‘recovered’ — but a continuing journey:”…an ongoing process. It is a way of life. It is an attitude and a way of approaching the day's challenges” (Deegan, 1992).

The challenge for service providers is how to reduce the barriers which impede the re-building of a person's life. How to help people to gain more opportunities: for work, income, friends and social networks. Whitwell also illustrates the importance of helping people to appreciate the “strength they have derived from the damage they have sustained and overcome”.

People ‘disabled’ by mental health problems can do more than just ‘survive’. If the Disability Rights Commission, coming into force in April 2000, succeeds in breaking down some of the barriers of discrimination faced by mental health service users; and if professionals follow the National Service Framework recommendation to support users in gaining social inclusion — then chances for recovery could increase. Not cure, but new meaning.