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SAMHSA couldn’t quite manage to really support full recovery

SAMHSA just came out with a new document called “SAMHSA’s Definition and Guiding Principles of Recovery – Answering the Call for Feedback.” 

While the document sounds very positive when read superficially, it seems to me it is still contaminated with the kind of thinking which actually makes it harder for people to achieve a full recovery.

The document rightfully recognizes and highlights “the importance of hope as the catalyst to the recovery process.”  But it then goes on to downplay the hope that anyone might fully recover and so no longer be defined in relationship to “their” mental disorder.

It does this by defining recovery as “A process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential.”  While this sounds positive and all, it is important to note that they are defining recovery as a “process” and not a possible endpoint.

If one thinks about the common sense meaning of the term recovery, for example recovery from a cold, or from a broken bone, there is both a process of recovery, and an end state of being recovered.  During the process of recovery one can still be defined as having the cold or the broken bone, though it is less pronounced as the recovery process proceeds:  then at the end of the process, one is recovered, and the cold or broken bone is history.

I think SAMHSA’s definition deliberately downplays the possibility, or hope, that people can achieve that kind of recovery in regard to mental disorders.  In doing this, they are lining up with a defective mental health system that has long been criticized for lacking exits – for example, there is a DSM criteria for being diagnosed with bipolar, schizophrenia, etc., but no criteria for being diagnosed as having recovered, and people are routinely discouraged from even thinking along those lines.  SAMHSA’s current definition offers hope that one can enter a process of recovery, but no hope at all that one can finish the process and eventually be as or more healthy mentally than before one was diagnosed, or as or more healthy mentally than other individuals who were never diagnosed.

I also dislike the aspect of the definition where they say that recovery is the process in which individuals “live a self-directed life, and strive to reach their full potential.”   I think we humans generally attempt to live a self directed life, and strive to reach our full potential.  This stuff is not unique to “recovery.”  By reframing this normal human striving as part of the process of recovery, SAMHSA is creating the expectation that an individual will always have to strive against the “mental disorder” to reach his or her full potential, and this reduces hope that the person can ever come to not be defined by the disorder.

A person who is recovered on the other hand will still have to strive to meet his or her full potential, but that will just be the striving that we all have to do, it isn’t defined in terms of the “disorder” that one once seemed to have, and it is a process of life, not of recovery from a disorder.

SAMHSA goes on to say that “Recovery pathways are highly personalized.  They may include professional clinical treatment; use of medications; support from families and in schools; faith-based approaches; peer support; and other approaches.”  This is all true as far as the recovery process goes – people do recover in many different ways – but if SAMHSA had been willing to discuss the end point of recovery, it might have had to look at how completing recovery would have to include getting to a place of no longer needing treatment.  After all, one doesn’t need cold medication when one has finished recovery from the cold, or a cast when one has recovered from a broken bone.  If SAMHSA had opened up a discussion about how the mental health system should work toward complete recovery, instead of just getting people engaged in the process of recovery and then stuck forever in that process, it then would have been forced to address the topic of how to help people get to a point where they don’t need treatments like medications, how to get off medications, etc.  And this is apparently too controversial for SAMHSA to take on.

Finally, while SAMHSA does mention the need to address trauma in the recovery process, it fails to address the possibility that trauma may have played a causal role in creating the “disorder” that the person experienced, and the importance of recognizing that fact in recovery.  The document merely states that trauma can be a “precursor” to the disorder, as though it just happened to go along with it.  Apparently SAMHSA is still bowing to those who want to see mental disorders as strictly biological, and would be too threatened by any recognition that trauma can cause the experiences and behaviors that get diagnosed by the DSM.

SAMHSA is certainly more progressive than many other agencies, but at the same time, it is way behind where it should be.  I look forward to the day when SAMHSA can help the mental health system orient itself toward recognizing that people’s “mental disorders” often have their origins in what happens to them, and toward helping people fully recover to a point where they don’t need treatment and they don’t need to define themselves as being in a process of recovery, but instead just in a process of living.

6 comments… add one
  • Thans, Ron, for your well-thought out insights. When I hear the word “hope” mentioned in the context of recovery from schizophrenia, I always interpret the word as a negative, that whoever says it really does not believe it. My son’s psychiatrist (not his current one), in response to my own fears about his future, said, “well, there’s always hope,” and believe me, this did not comfort me. He obviously didn’t think my son would get better. I think the word “hope” should be banished from the vocabulary of anyone treating someone for schizophrenia. As you so properly point out, let’s discuss the exit plan.

    • Hi Rossa,

      I think what you are getting at is the way some professionals will talk about “hope” in the way people talk about miracles: they have no idea how recovery could happen, or how to work toward it, but it makes them feel good to think it might be a possibility. While what we need are helpers who actually have a few ideas about how people might recover, and who can provide real assistance in doing so. I wouldn’t advocate for eliminating use of the word “hope” but I definitely think we need more professionals who can provide assistance that really supports hope instead of just talking about it.

      • Yes, people do tend to talk about hope the way they talk about miracles. I was a regular churchgoer and I never paid attention to miracles until I experienced the trauma of having my son diagnosed “schizophrenic.” Suddenly, I got very interested in what the Bible had to say about miracles. When I considered in more depth what Jesus actually did, I realized that he actually “cured” the mentally ill and I began to get the idea of how he brought these healings about. Then I began to wonder why modern medicine tells me that schizophrenia is incurable while still claiming that it believes in miracles. (The church also fails to believe in the miracles that Jesus performed since it tends to see the mentally ill the way doctors see them.) To make a long story short, this realization sent me down a path of holistic healing practices and beliefs.

  • Does the master want to lose his slave? No. It is against the masters interest to give freedom to his slave. Maybe the master can not give freedom to his slave, the slave has to take his freedom.

  • In case you don’t understand what I mean. Thomas Szasz says what I mean on youtube in this video at 1 hour and 8 minutes.

    or click on “my website” it might work as I put the link there also.

  • Hi Ron and Rossa,

    I suspect that the doctors and big pharma, who are largely in cahoots with one another, do not really want to promote true recovery. After all, what would they do without a constant and continually replenishing market for their enormously profitable drugs? I am dead serious, not being a conspiracy theorist. I would also raise the point, as I have in my own blog, that psychiatric “treatments” of the sort to which I have been subjected have themselves caused overwhelming trauma, almost to the point of PTSD.

    Thanks for a great discussion. I will be returning to read more.