Is our current emphasis on RECOVERY actually hurting the sickest among us?
A Canadian advocate argues that it is.
In her report, The Emergence of the Recovery Movement: Are Medications Taking a Back Seat in the Road to Recovery? Lembi Buchanan writes:
“Recovery proponents support a consumer-driven, psychosocial holistic model that promotes hope, self-determination, empowerment, respect, responsibility and spiritual healing to enable people living with mental health problems and illnesses to lead meaningful and productive lives whether or not they are symptom-free. They dismiss the essential role of medications for individuals who are severely disabled by their illness and incapable of managing their own recovery.”
Buchanan warns that many proponents of the recovery model reject the “biomedical model of mental illness,” which identifies serious mental illness as being biological and genetic in origin. Instead, they promote a feel-good philosophy that anyone and everyone can recover without medication if they learn to see their mental illness merely as a sign that they are different, not necessarily physically ill.
“Consumer survivors believe that they are likely to achieve more successful outcomes if they participate in their own treatment decisions. The majority reject the emphasis of the biomedical model of the mental illness, involuntary commitment and coercive treatments. For them, recovery represents a movement away from pathology, illness and symptoms to health, strengths and wellness. They also believe that freedom of choice for the patient is recognized as a basic right. The patient, not the physician, is considered the expert when it comes to treatment options. Many believe that there is no need for a clinical evaluation and evidence-based medical treatment.”
Continuing, she notes:
“Causes and classification of mental illnesses are considered irrelevant since social factors are believed to be the main contributors to the course of the disease and the labeling of mental illnesses is offensive and discriminatory….a key objective of the recovery movement is to help people overcome the negative impact of a diagnosis of mental illness by normalizing mental illness to reduce stigma… Schizophrenia has been described merely as a “mental health difficulty” rather than a complex brain disease that requires pharmacological intervention as well as specialized supports and services…
Today, there is more reason than ever before to believe in the possibility of wellness for people diagnosed with psychotic disorders such as schizophrenia and bipolar disorder. The introduction of more effective and safer antipsychotic agents has greatly improved the promise of recovery for these individuals. Drug therapy continues to be the most effective means of treating psychotic symptoms of mental illness and preventing relapses in the future.
However, the mental health community continues to be divided. Not everyone considers the appropriate use of pharmacological interventions as a crucial aspect of treatment for people diagnosed with severe mental illnesses. Rather than embracing the advances in neuroscience research along with new and innovative medications with fewer adverse side effects, the recovery model reflects many of the anti-psychiatry sentiments of the 1960s that questioned the fundamental assumptions and practices of psychiatry as well as the therapeutic benefit of psychiatric medications…
“The recovery model may be appropriate for individuals with mild to moderate mental health problems – 17 percent of the (MI) population – who can take responsibility for their actions. However, the recovery model does not accommodate the needs of individuals with severe mental illness – three percent of the population – who may lack insight into their illness and are unable to make appropriate treatment choices.”
Is the recovery movement, which is becoming the cornerstone of our mental health system and is now spreading into Canada and other countries, being promoted by anti-psychiatry and holistic healers who are bamboozling the public? Is it, by its nature, anti the medical model?
I’d like to hear your opinion.
Here’s mine.
There is much about the recovery movement that I support. I believe it is important for us to provide community based services such as housing, jobs, and clubhouses that are not necessarily linked to the medical model. I believe that building self-esteem, fighting stigma, and empowerment can help speed recovery. I’m proud that my son is a peer to peer counselor. His work matters.
But I also believe that mental illnesses are real and are biologically and genetically based, even though we lack the scientific knowledge to adequately explain the cause of them. I know from my experiences with my son that medications are essential for his recovery. I know there are people who are severely ill who are convinced that there is nothing wrong with them. Many of them are dying on our streets. Others are in our jails and prisons for crimes that were committed because of their illnesses. I’ve documented that in my book. Because of this, I believe that involuntary commitment is necessary, although I also see it as a sign of our failure to help someone who is sick before we must intervene. I believe we need better laws to protect persons who are sick but also get them help before they become dangerous.
I believe that persons who are anti-medication are as narrow-minded as persons who believe that all we have to do is stick a pill into a person’s mouth to heal them. One size doesn’t fit all. Healing the mind, I believe, also requires offering HOPE and necessities such as housing.
Today’s Washington Post contains a story about Michael English, a promising young man who hanged himself in a District of Columbia jail cell where he was awaiting a psychiatric review after stabbing a friend.
“Michael English’s parents repeatedly asked authorities for help with their son, at times seeking to protect family members from him. Even English’s probation officer told a court last year: “This officer is extremely concerned about Mr. English’s well-being, as well as the safety of the community.”
His mother, Margaret English, said her son’s death is an example of how difficult it can be to help someone with a pronounced mental illness, even when family members and criminal-justice workers know the person is a danger to society and himself.”
Compromise is not a popular word right now in Washington. It is a tragedy that neither extreme in the ongoing battles between the anti-psychiatry forces and those at the other end of the spectrum cannot find enough common ground for us to create a system that meets the individual needs of a person such as Michael English.
About the author:
As someone diagnosed with a severe mental illness who voluntarily takes medications i care very much about these discussions. Like you, I am not anti-medication and support many things of the recovery movement. Where I differ, though, is that i do not support forced treatment for people with a severe mental illness who are not violent and/or have violated no laws.
You asked, “Is the recovery movement, which is becoming the cornerstone of our mental health system and is now spreading into Canada and other countries, being promoted by anti-psychiatry and holistic healers who are bamboozling the public?”
Personally, I do not see this happening. What i see, and what really scares me, is that it seems to be moving more in the other direction toward more forced treatment – i.e. TAC’s push toward more laws making it easier to force medications on people who do not want them (AOT, is a good example). i keep a close eye on the laws in my state and if my state had more funding to implement AOT, I probably would never have gone back to see a psychiatrist out of fear that this could be used against me at some point. i do not want to be afraid of my psychiatrist as i don’t feel that would lead to a good working relationship. There have been a couple of medications I have refused to take and my psychiatrist has honored that (i.e. Zyprexa because the risk of diabetes is not worth it to me. Diabetes is in the top 10 causes of death, and is also a quality of life issue, so while other may be ok with that risk, i’m not ok with it). It’s really scary to think of the laws changing and making it possible for him to force Zyprexa on me because he decided i lacked insight, since i disagreed with taking it. I believe that even with a diagnosis of severe mental illness, I should get to decide if i want to risk diabetes or not. Unfortunately, advance directives for people with mental illness don’t mean jack, so I have no way to protect my wishes if the laws change making it easier to forcibly medicate people just for being sick.
You wrote,”I believe we need better laws to protect persons who are sick but also get them help before they become dangerous.”
The problem is that no one can accurately predict who will become dangerous, so what do we do? Do we forcibly medicate all persons diagnosed with a severe mental illness who refuse treatment? I have not broken any laws and I’m not violent, so how would my rights be protected if we make it even easier to forcibly treat? It cannot be assumed that just because someone refuses or discontinues medication that they lack insight, because patients with other illnesses do the same thing with regularity. And, antipsychotics do have some nasty side effects, so patients should be able to say no risking those side effects.
I would support persons with a severe mental illness who violate a law being treated in the mental health care system, rather than the criminal justice system, but it becomes a lot more dicey when you talk about forcibly intervening because someone “might” become dangerous at some point. Then, we risk violating the rights of those who have done nothing other than be diagnosed with a mental illness. The patient is guilty by association, not because of anything they’ve done. i don’t think that’s the right thing to do, and will lead to more people avoiding treatment out of fear.
i do understand and emathize with the tragic examples listed, but we cannot make it easier to violate the rights of individuals with severe mental illness who have not been violent and/or have not broken any laws in order to try and save some who might.
Treatment, in AOT, doesn’t have to mean meds. But it does have to include supervision, because psychosis is a moving target for a lot of people, and can unpredictability lead to violent acts in very nonviolent people. So if a person wants to stay psychotic they need frequent reality checks. You make excellent points, and my feeling is that we should offer supervised housing options for ill people who don’t want meds. Given an option, though, most folks prefer not to be so psychotic. Diet and exercise have to be part of “treatment” so diabetes doesn’t get a foothold.
Schizophrenia has been described as a “mental health difficulty?!” Schizophrenia is a serious neurobiological illness with potentially devastating consequences. There is no one size fits all treatment option for people with this illness. The biopsychosocial approach works best. Medications play a significant role in treatment for most people, as they do for people with other significant illnesses such as diabetes and hypertension and cancer. To deny that medications CAN be helpful to some people is really detrimental. We see people every day with Schizophrenia who are truly tortured by hallucinatory or delusional material. We see people homeless, victimized or in jail as a result of untreated mental illness. Discouraging people from working with doctors and treatment teams who specialize in this field is very sad and dare I say, cruel. Ideally, there would be shared decision making.The patient-doctor relationship is vital. We have plenty of people who refuse to take meds and we cannot force them. And, really, most of us would never want to force meds. That is never optimal. But discussions hinting that Schizophrenia and Bipolar Disorder and other neurobiological illnesses can best be treated by “thinking good thoughts” or something similar really does such a disservice to the most vulnerable among us.
Of course there will be some people who do just fine without medications, but they are the exception to the rule.
Thank you for bringing up this topic. We will use it as a springboard for conversation at our next treatment team meeting.
Another great piece. The consumer movement has done a great job at holding the pharmaceutical industry’s feet to the fire and a good job at criticizing the medicalization of normality. (However others through championship of Trauma, Lived Experience, etc. have contributed medicalizing normality) The main effect of the movement as a whole has been to encourage the diversion of resources and treatments away from those with serious mental illness and they are therefore complicit in the very tragedies they claim to oppose: incarceration, homelessness, hospitalization, early death, victimization, etc.
As someone that fought for years to find out the truth of my illness, I find it very irresponsible and a downright criminal to label a person with a mental illness when ” we lack the scientific knowledge to
adequately explain the cause of them”.
After years of telling my Dr’s that something was wrong. I was sent to a Psychiatrist and put on medication. I explained many times that I was not depressed or in need of medication but I was told that I needed it and it was part of my denial. I was diagnosed as Bi-Polar, OCD and with a personality disorder.
I took the meds, believed in the Dr’s. They were doing nothing but making me feel worse. After years of treatment with these meds, I decided it was time to take matters into my own hands. Because of my insurance at the time I had to request permission to go “Out of Network”. I went to a well known and I respected Hospital and within two days found out what was really wrong with me.
It was a thyroid disease, no mental illness, yet I already had been on the meds for years and had the label. I was quickly treated for Graves Disease. I informed my regular Dr’s. and took myself off of the medication. They never told me I could and did become suicidal. Then I was admitted to the hospital as a suicidal patient and put back on the meds that I never needed to begin with and then the Dr. decided I needed ECT treatments.
I totally disagree with your comment’s and always will until there is a real test that can determine mental illness, Not just an opinion or a Dr’s inability to find out what is really wrong with a person. I also found that Dr’s tend to blame everything on female issues. This total lack of knowledge ruined my life. I lost my daughter, my husband, my home, my memory. I have nothing now except my voice. No home of my own, no ability to think if stress is involved and I count on my daughter to fill in my memories with her. I don’t even know how many more I have lost.
I would not recommend anyone listen to anyone that uses the words mentally ill without doing major research of your own. Then you will find out as quoted above that there is no real test just a lack of scientific evidence.
This is what I call cruel, torture and playing God with the lives of others.
VERY IMPORTANT!! No psychiatrist should treat a person without a recent medical review. Although technically psychiatrists are doctors, all ill people should see an internist first!
My Primary Care Dr. was specialized in Internal Medicine and Gastroenterology. I was also sent to a several other specialist. Before being referred to a Psychiatrist.
When I requested an “Out of Network” (out of state) second opinion I was sent to an Endocrinologist and another Gynecologist. I guess they just could get it out of their head that it was a “female” problem.
It was two days after I returned that my Primary Dr. got the results and knew exactly what was wrong. So, I guess even though it should be important to a Dr. some choose to form their own opinion. My Psychiatrist that I had been seeing for five years and also had the new medical records was not even contacted when I went to the hospital. The Dr. on call had all of my information and could have easily had my current medical records within minutes.
Thank You for your kind advice. However, unfortunately it didn’t matter in my case.
Mrs Buchanan mischaracterizes today’s recovery movement. Recovery started out connected with antipsychiatry, 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 or recovery group that works for them.
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.
— Paul Komarek
I found this discussion to be one of interest because of the excellent writing each person has contributed on this topic.
Recovery is a personal journey and should ideally be tailored to each individual’s unmet needs. Many people need medications, talk therapy, family and peer support as they work toward their unique recovery, while others require bits and pieces of treatment modalities. Nothing should be ruled out, all options should be available to pursue when working toward recovery.
Terri
Different groups within that movement differ on their stance on medication. I was part of a movement supported by my state (I live in the US), and we never told people that medication was bad or unnecessary. When discussing medication, we suggested ways of tactfully advocating for medication changes due to inefficacy or impairing side effects, how to ask questions about treatment, improving relationships with providers, etc.
However, we did not tell people they absolutely had to take their medication OR ELSE (provided it wasn’t someone on a court order). We made it clear that as long as they weren’t in court-ordered treatment, they had the right to take or not take a medication. We would not stop working with them if they choose to forgo medication. Benefits and risks would be addressed.
There are groups that are blatantly anti-psychiatry, but I think some appear that way but aren’t necessarily. They tend to be more anti-involuntary treatment. Can’t blame them for that.
As a proponent of the recovery movement and a practicing psychiatrist, I want to make clear that I support informed choice as far as all treatments. I prescribe medications for some of the persons that I serve, but I also tell them they may not need medications for the rest of their life. My approach is holistic, with medications being one of the tools they may find helpful.