|Year : 2023 | Volume
| Issue : 1 | Page : 7-8
Recovery from Mental Illness: From Social Control to the Bio-, through the Psycho-, toward the Social Essence of Recovery
Debasish Basu1, Nitin Gupta2
1 Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
2 Gupta Mind Healing and Counselling Centre, Chandigarh, India
|Date of Submission||21-Mar-2023|
|Date of Acceptance||22-Mar-2023|
|Date of Web Publication||26-Apr-2023|
Dr. Debasish Basu
Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh - 160 012
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Basu D, Gupta N. Recovery from Mental Illness: From Social Control to the Bio-, through the Psycho-, toward the Social Essence of Recovery. World Soc Psychiatry 2023;5:7-8
|How to cite this URL:|
Basu D, Gupta N. Recovery from Mental Illness: From Social Control to the Bio-, through the Psycho-, toward the Social Essence of Recovery. World Soc Psychiatry [serial online] 2023 [cited 2023 Jun 10];5:7-8. Available from: https://www.worldsocpsychiatry.org/text.asp?2023/5/1/7/374618
“Recovery from mental illness involves much more than recovery from the illness itself. People with mental illness may have to recover from the stigma they have incorporated into their very being; from the iatrogenic effects of treatment settings; from lack of recent opportunities for self-determination; from the negative side effects of unemployment; and from crushed dreams.”
Thirty years ago, in 1993, William Anthony, then the Executive Director of the Center for Psychiatric Rehabilitation at Boston University, USA, described a vision. He described recovery as a vision and dreamt that the decade of the 90s, along with being declared the decade of the brain, might also turn out to be the “decade of recovery.”
Anthony also gave the first definition of this broadened concept of recovery: “Recovery is described 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 illness. Recovery involves the development of new meaning and purpose in one's life as one grows beyond the catastrophic effects of mental illness.”
Thirty years hence, at the XXIV World Congress of the World Association of Social Psychiatry and annual meeting of the rehabilitation and social psychiatry faculty of the Royal College of Psychiatrists of the United Kingdom (UK) held at the Royal College of Psychiatrists, London, UK on 16–18 January 2023, the theme was “Recovery from mental illness – challenges and solutions from across the globe.” So, what has changed?
The accompanying special editorial by the Congress Organizing Secretaries Molodynski and Mohan covers the main highlights of the Congress, hence we will avoid repetition. We would, instead, in this very brief foreword-like editorial, recall that the concept, content, and indeed, the essence of “recovery from mental illness” has traversed a long and winding path.
In the era of mental asylums and institutionalization, there was hardly any concept of recovery; it was more of social control of the mentally ill. From there, following the movement of deinstitutionalization, psychotherapies and especially the advent of powerful pharmacotherapies, recovery became a clinician-defined, symptom-driven, biologically and clinically oriented concept of recovery. This is the “recovery” that mattered to the doctors, therapists, and administrators! It took a number of decades to shift the perspective from this “clinical recovery” to the concept of “personal recovery.” Which emphasized that recovery is a process (”journey”), not necessarily a final outcome; it is deeply personal, imbued with restoration of hope, meaning-making, sense of self and direction, even despite persisting with some symptoms of the mental illness.,, This is the recovery that mattered to the persons with lived experience of mental illness! [Table 1] lists some of the contrasting characteristics of these two perspectives of recovery from mental illness.
However, still nascent within the concept of personal recovery is the often-understated emphasis on “social” dimension of recovery as its central element, concept, indeed, as the essence of recovery. This has been recently brought out elegantly by a systematic scoping review on the “essential elements that contribute to the recovery of persons with severe mental illness.” Synthesis of 60 sources revealed the three overarching essential elements: the first of these was “relationships,” followed by sense of meaning and participation. Each of these had multiple subcomponents, such as relationship embraced not only that with the therapeutic agency but also with the significant others and with the community. Participation encompassed role playing and personal agency, while sense of meaning emphasized the personal dimension of recovery: sense of self, hope, and purpose. In a very recently published longitudinal prospective study on patients recovering from psychotic illness in Norway, the authors found that “interpersonal relationships and social interaction are central drivers of recovery.” Some have actually lamented the lost social context of recovery leading to what they feel as “Psychiatrization of a Social Process.” Finally, community-based social interventions such as housing, employment, social promotional activities, family psychoeducation, and peer-led and other interventions to support community participation have been shown to be important ingredients in facilitating recovery process.
Thus, from social control to social inclusivity and empowerment, the essence of recovery has made a significant journey over a century, and social psychiatry has an essential role to play. From all over the world, this World Congress emphasizes this central role.
| References|| |
Anthony WA. Recovery from mental illness: The guiding vision of the mental health service system in the 1990s. Psychosoc Rehabil J 1993;16:11-23.
Molodynski A, Mohan R. Recovery from mental illness – Challenges and solutions from across the globe. World Soc Psychiatry 2023;5:1-3. [Full text]
Deegan P. Recovery: The lived experience of rehabilitation. Psychosoc Rehabil J 1988;11:11-9.
Leamy M, Bird V, Le Boutillier C, Williams J, Slade M. Conceptual framework for personal recovery in mental health: Systematic review and narrative synthesis. Br J Psychiatry 2011;199:445-52.
Drake RE, Whitley R. Recovery and severe mental illness: Description and analysis. Can J Psychiatry 2014;59:236-42.
Jaiswal A, Carmichael K, Gupta S, Siemens T, Crowley P, Carlsson A, et al.
Essential elements that contribute to the recovery of persons with severe mental illness: A systematic scoping study. Front Psychiatry 2020;11:586230.
Linde J, Schmid MT, Ruud T, Skar-Fröding R, Biringer E. Social factors and recovery: A longitudinal study of patients with psychosis in mental health services. Community Ment Health J 2023;59:294-305.
Topor A, Boe TD, Larsen IB. The lost social context of recovery psychiatrization of a social process. Front Sociol 2022;7:832201.
Killaspy H, Harvey C, Brasier C, Brophy L, Ennals P, Fletcher J, et al
. Community-based social interventions for people with severe mental illness: A systematic review and narrative synthesis of recent evidence. World Psychiatry 2022;21:96-123.