GUEST BLOG: The Evolution of the Concept of Recovery

Recently I overheard two senior mental health officials discussing recovery. One said, “I think recovery is a very important concept.” The other replied, “I agree,” and then he whispered, “But what is it?”

Indeed, we have a field and a society that have been highlighting the importance of recovery—and that have had little agreement about its meaning.

The New Freedom Commission stated: “We see a future when everyone with a mental illness will recover.” This vision has inspired many to advocate for recovery at the state and national levels. In 2006, SAMHSA published the 10 Components of Recovery. The Recovery to Practice initiative represents the next step in implementing recovery.

In this new era of healthcare reform, however, we need a broader concept of recovery. We need a concept that gives hope to those of us labeled with a psychiatric diagnosis—and that at the same time can be understood by the rest of society.

Most persons with a variety of other disabilities cannot relate to the concept of recovery. Many think our concept of recovery means that people in wheelchairs will walk or that people with autism will be able to relate socially the way most everyone else does. These are not the primary goals of the independent living movement.

To frame recovery more broadly, we need to go beyond a narrow medical definition of mental health issues. For many years, professionals and researchers have described mental illness as a severe form of mental disorder, characterized by a permanent biological defect and a chemical imbalance from which recovery rarely occurs. In the eyes of this group, recovery would occur only if there were a cure. Countless studies have been carried out to define the supposed biological basis of mental illness. No consistent deficit has been found. It was believed that at best the illness could go into remission, during which the symptoms are managed. This is the maintenance model, which leaves persons who experience distress feeling hopeless.

Recently, through a dialog by the Steering Committee of the Recovery to Practice initiative, we have drafted a broader description of recovery:

[T]he recovery paradigm views mental health issues as challenges that a person can grow beyond through the assistance of culturally appropriate, trauma-informed services and natural supports in the process of the person building a full and gratifying life in the community of his or her choice.

This description fits with the goals mapped out for persons with all disabilities in the Americans with Disabilities Act signed into law 20 years ago:

1. Equality of opportunity
2. Full participation [in the community]
3. Independent living [consumer control and consumer choice of services and supports]
4. Economic self-sufficiency

This broader definition of recovery can also span the fields of mental health and substance use. In the substance use field, these elements are vital aspects of recovery. 

- Daniel Fisher, M.D., Ph.D., 

Executive Director, 

National Empowerment Center

The 20th Anniversary of ADA

This week, we celebrate the 20th Anniversary of the Americans with Disabilities Act (ADA).The ADA is a broad civil rights law designed to provide a clear and comprehensive national mandate for the elimination of discrimination against individuals with disabilities. Like the Civil Rights Act of 1964 that prohibits discrimination on the basis of race, color, religion, national origin, and gender, the ADA seeks to ensure equal opportunity for people with disabilities. It does not guarantee equal results, establish quotas, or require preferences favoring individuals with disabilities over those without disabilities.

When people think about the ADA, they think about removal of physical barriers with ramps and curb cuts. In its first twenty years, the ADA has made advances in starting to remove these physical obstacles. After twenty years, we have still not achieved even the federally mandated physical accommodations. Now, as we face the future, we need to eliminate other, more pervasive barriers-the stigma and discrimination that prevent social integration.

Has the ADA eliminated discrimination against individuals with disabilities? No. It has provided a valuable tool for responding to some forms of discrimination. There are many who opposed the ADA, just as there are still those who oppose the Civil Rights Act of 1964.

I have a “non-visible” disability, which makes it possible for me to “pass” in many situations, but, despite the passage of the ADA, in these last two decades, I have experienced discrimination in employment, healthcare and other areas of my life.

I am a person who experiences severe and persistent mental illness. I will not be cured. Although I am an advocate for recovery, I am not “in recovery” from my brain. I cannot abstain from “being bipolar“, as one abstains from substance addiction behaviors. I am not defined by my illness, but it is a prism, through which I experience the world. This is a fundamental part of who I am, as much as my ethnic heritage. It is a biologically-based disease, like diabetes. I did not survive it, as some survive breast cancer. If I had breast cancer, I would receive substantially better health care and support services.

Most people who experience mental illness are afraid to publicly disclose their illness. Stigma keeps them “closeted” for fear of rejection by family and friends, isolation or firing at their workplace, and discrimination in participating in politics, recreation, housing, religion or in self-determination. Despite civil rights legislation and the public disclosures of many famous people who experience mental illness, this discrimination is commonplace.

Today, we celebrate the civil rights landmark of the ADA, but it is only the first step in achieving true equality. For more information, go to http://www.ada.gov/ for the most comprehensive referral site for information on all aspects of the ADA.

--Kristen Frame
Compeer Coordinator