‘Recovery’ in mental health: who judges, on what grounds, with what evidence, and which arguments?

The medical humanities have contributed greatly to research that addresses – conceptually, historically and empirically – whose perspective(s) are (and should be) privileged when judging the contours of illness and health. One research arena in which these questions currently have particular salience and urgency is that of research on ‘recovery’ in mental health.

The October 2012 issue of the open access journal World Psychiatry (the official journal of the World Psychiatric Association) features a forum on “Consumer Models of Recovery: Issues and Perspectives”. In the target article “Issues and developments on [sic] the consumer recovery construct” Alan Bellack and Amy Drapalski argue that while the ‘consumer recovery model has had increasing influence on mental health practices in the United States, Western Europe, and several other countries’, the model’s adoption has derived from ‘political decisions rather than empirical evidence of [its] validity … or its value for treatment services’. They argue that ‘the recovery construct’ has hitherto been ‘poorly defined’, and that there remains a need for reliable and valid measures on which to ground future research. Their article documents their development, therefore, of the Maryland Assessment of Recovery in Serious Mental Illness (MARS), at the same time as it critiques the consumer construct of recovery.

The short responses to the target article interrogate some of the epistemological, conceptual, philosophical, practical, sociological, political and geographical premises on which Bellack’s and Drapalski’s argument is grounded. In so doing, the responses adumbrate some of the current lines of research and argument that surround the vexed, rich term ‘recovery’. This term is characterized by both semantic density and a complex history – which, arguably, has not yet been fully excavated.

The responses juxtapose the diverse insights of consumer (or service user) researchers and/or activists (Sylvester Katontoka on “Consumer recovery: a call for partnership between researchers and consumers“; Jan Wallcraft on “Consumer models of recovery: can they survive operationalism?“; Mary O’Hagan on “Recovery: is consensus possible?”; Rangaswamy Thara on “Consumer perceptions of recovery: an Indian perspective”; and my “The vicissitudes of the recovery construct;  or, the challenge of taking ‘subjective experience’ seriously”); clinical psychologists who are investigating ‘recovery’ both conceptually and empirically (Mike Slade on “Recovery research: the empirical evidence from England”; Paul Lysaker and Bethany Leonhardt on “Agency: its nature and role in recovery from severe mental illness”); and psychiatric researchers who are investigating stigma (Matthias Angermeyer and Georg Schomerus on “A stigma perspective on recovery“) or specialize in rehabilitation in psychosis (Robert Liberman on “Recovery from schizophrenia: form follows functioning”). I shall not say more here about the substance of the responses, but merely note that the editors have certainly succeeded in eliciting some responses that knock very hard against others.

The journal World Psychiatry is to be congratulated for curating a forum on ‘recovery’ that includes several responses that privilege consumer/service user perspectives. I cannot, however, but help notice the ordering of the responses to the target article: the first response is by the rehabiliation psychiatrist, then come those from the clinical psychologists and the other psychiatrists, and then come those by consumer researchers (those who ‘represent’ the postcolonial spaces of Indian and sub-Saharan Africa are at the end).  The journal in which these responses are published is of course an international psychiatry (rather than clinical psychology or social science journal); nonetheless, I do not think I am overstating the case to note that this order cannot but serve to consolidate some of the traditional hierarchies of expertise and of centre/margin just at the point at which the journal – by investigating ‘recovery’ from multiple perspectives – arguably intends to unsettle them.

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