Recovery: is consensus possible?

I did not feel comfortable reading Bellack and Drapalski’s paper. Perhaps this is because my journey to this point has been different from theirs. Mine started with lived experience of major mental distress and mental health services in my late teens and twenties. Since then I have applied the values of the international consumer/survivor movement to urge services and wider society to respect the madness experience, facilitate pathways through it and treat us as equal citizens. In a word, these values sit on a platform of self-determination. As a mental health commissioner in New Zealand, I had a responsibility to help articulate what a recovery approach means in the national context. This included a critique of medical and other deficits approaches, a questioning of compulsory treatment and promoting social justice as a key to recovery; these themes are not always strong in the international recovery literature 1.

The core of my discomfort probably arises from the fact that I do not sit on the same side as the authors in the “broad church” of people who sign up to recovery. Bellack and Drapalsky seem to be in the aisle which lacks a deep critique of the dominant beliefs and structures that drive service and societal responses to madness. For some of us who were educated primarily through our lived experience and the analysis of the consumer/survivor movement, a critique of these beliefs and structures is essential for the transformation of services and societies so that they support recovery.

Bellack and Drapalski describe recovery as a model, but I have always seen it more as a philosophy. A model is a template, process or design that guides what people do, whereas a philosophy in this context is a set of beliefs that guides the moral value we ascribe to what people do. A model can be empirically tested, but a philosophy can only be argued because of its fundamental nature. I believe we should determine the moral value of a model of practice before we apply empirical research to test its efficacy. This put me at odds with Bellack and Drapalski’s lament that because the “recovery model” is based on personal accounts, qualitative studies and political consensus statements, it is vague and hard to test. This may be frustrating for some research psychologists who seem to rate empiricism over values, but it does not worry me.

I also felt the authors were slightly critical of consumer/survivor leaders and academics for failing to come up with a tidier ensemble of data for them to analyse and test. If this is the case, I believe their criticism is ill-founded. Although there are a growing number of consumer/survivor academics (and who knows – the authors may count themselves among them), they are a tiny, scattered and poorly resourced group. To my knowledge, there are no departments of user/survivor studies anywhere in the world, but of course there are hundreds of well-resourced psychology departments.

I am not against aggregating people’s experiences or measuring indicators of recovery in individuals or populations, but I get the impression that the authors’ primary loyalty is to the application of a rather reductionist form of science, whereas mine is to the honouring of lived experience and to justice in service systems and in wider society. This is why the authors and people with a worldview close to mine might have difficulty reaching a consensus on how to apply research to recovery, but it is important that we try.