Personal recovery and socio-structural disadvantage: A critical conceptual review

Abstract

Despite its seeming breadth and diversity, the bulk of the personal (mental health) recovery literature has remained strangely ‘silent’ about the impact of various socio-structural inequalities on the recovery process. Such an inadequacy of the empirical literature is not without consequences since the systematic omission or downplaying, at best, of the socio-structural conditions of living for persons with lived experience of mental health difficulties may inadvertently reinforce a reductionist view of recovery as an atomised, individualised phenomenon. Motivated by those limitations in extant scholarship, a critical literature review was conducted to identify and critique relevant research to problematise the notion of personal recovery in the context of socio-structural disadvantage such as poverty, homelessness, discrimination and inequalities. The review illuminates the scarcity of empirical research and the paucity of sociologically-informed theorisation regarding how recovery is shaped by the socio-structural conditions of living. Those inadequacies are especially pertinent to homelessness research, whereby empirical investigations of personal recovery have remained few and undertheorised. The gaps in the research and theorising about the relational, contextual and socio-structural embeddedness of recovery are distilled. The critical review concludes that personal recovery has remained underresearched, underproblematised and undertheorised, especially in the context of homelessness and other forms of socio-structural disadvantage. Understanding how exclusionary social arrangements affect individuals’ recovery, and the coping strategies that they deploy to negotiate those, is likely to inform anti-oppressive interventions that could eventually remove the structural constraints to human emancipation and flourishing.

Paying Attention to Women's Ageing Bodies in Recovery From Substance Use

“…A tendency to judge people who use drugs, plus the stigma associated with injecting drug use and bloodborne viruses is such that some people may be reluctant to discuss health issues anticipating some form of felt or enacted stigma from others ( 43 ). Furthermore, emphasising personal responsibility for their health, risks disregarding the political, economic and socio-cultural circumstances of people's lives ( 44 ). Maya, age 42, recommended that practitioners working with older women who use drugs should remember, “ We are people with complex issues and often very challenging histories, not necessarily of our own making.”…”

Recovering Context in Psychiatry: What Contextual Analysis of Service Users' Narratives Can Teach About Recovery Support

“…For example, the genre of lamentation, centered around social (status) loss, was solely represented by people recruited in community centers in deprived neighborhoods. We therefore endorse the plea of Karadzhov ( 73 ) for better documentation and contextualization of socio-demographic characteristics in recovery research, in order to assess the impact of social inequalities on the recovery process. Lastly, qualitative studies such as these are not intended, nor suitable for generalization to the population (statistical generalization).…”

The Lost Social Context of Recovery Psychiatrization of a Social Process

“…Recently the most common understandings and definitions of recovery (Anthony, 1993 ; Leamy et al, 2011 ) have been criticized for their individualistic and normative aspects (Harper and Speed, 2014 ; Karadzhov, 2021 ; https://recoveryinthebin.org ), as they do not mention the importance of social living conditions such as financial resources, housing and general living conditions (Harper et al, 2015 ). The critics have highlighted the social character of mental health problems and recovery, but also of the mental health field itself (Topor et al, 2011 ; Tew et al, 2012 ; Rose, 2018 ; Rose and Kalathil, 2019 ; Karadzhov, 2021 ). Materialities (Larsen et al, 2021 ), places (Duff, 2012 ; Doroud et al, 2018 ), and social relations (Topor et al, 2016a ; Price-Robertson et al, 2017 ) have also been stressed as missing in recovery research.…”

“…This individualization and “responsabilization” came to affect our understanding of recovery and what kind of support people needed (Rose, 2014 ). However, few recovery studies problematized these changes; instead, most integrated an individualized and de-contextualized perspective (Duff, 2012 ; Karadzhov, 2021 ). The newly discovered capacities of persons with a diagnosis of severe mental problems were turned against them and used as an argument to reduce the supporting interventions directed to them in order not to create what were defined as negative dependencies instead of interconnectivity, solidarity and brother/sisterhood and the user as a consumer in a free market (Mills, 2014 ; Rose, 2014 ; Woods et al, 2019 ).…”

“…But the psychiatrization of recovery to an individual and mostly cognitive process may have contributed to the acceptance of Anthony's vision by international, national, and local agencies as it does not question the pillars of the dominant bio-medical model in “The decade of the brain “(1990–1999) and then “The century of the brain” (Mills, 2015 ; Karadzhov, 2021 ). If social and societal factors can cause and cure an “illness,” as the results from follow-up studies from the end of the twentieth century showed, then this illness might not be an illness, but a form of distress transformed/constructed as an illness.…”