The Lost Social Context of Recovery Psychiatrization of a Social Process

Abstract

From being a concept questioning the core of psychiatric knowledge and practice, recovery has been adopted as a guiding vison for mental health policy and practice by different local, national, and international organizations. The aim of this article is to contextualize the different understandings of recovery and its psychiatrization through the emergence of an individualizing and de-contextualized definition which have gained a dominant position. It ends with an attempt to formulate a new definition of recovery which integrates people in their social context. Research results from various follow-up studies showing the possibility of recovery from severe mental distress have stressed the importance of societal, social and relational factors as well of the person's own agency when facing their distress and reactions from their environment. These researches were published in the 1970s and 80s; a period of struggle for liberation from colonialism, of struggle by women and black people for their civil rights, and a time of de-institutionalization of services directed toward the poor, elderly, handicapped, prisoners, and people with mental health problems. Recovery research pointed at the central role of individuals in their recovery journey and it was understood as a personal process in a social context. However, with neo-liberal political agenda, the personal role of individuals and their own responsibility for their well-being was stressed, and contextual understandings and the role of social, material and cultural changes to promote recovery faded away. Thus, during recent decades recovery has been mostly defined as an individualistic journey of changing the persons and their perception of their situation, but not of changing this situation. Contextual aspects are almost absent. The most quoted definition accepts the limits posed by an illness-based model. This kind of definition might be a reason for the wide acceptance of a phenomenon that was initially experienced as a break with the bio-medical paradigm. Recently, this dominant individualized understanding of recovery has been criticized by service users, clinicians and researchers, making possible a redefinition of recovery as a social process in material and cultural contexts.

You realise you are better when you want to live, want to go out, want to see people: Recovery as assemblage

“…It might be a prison or a working place in the woods. Recovery is about collecting the good stories about places and people that include the psycho-socio-material contexts ( Topor et al, 2020 ) and at the same time remembering how bad it once was.…”

“…He describes how people having mental health problems suffer from ‘material deprivation’ because they often live in poor neighbourhoods and poor housing conditions, resulting in social exclusion and non-recovery (Boardman, 2011). To specifically include the social and material perspective, Topor et al (2020) suggested a social model to understand recovery: Recovery is a deeply social, unique and shared process in which our living conditions, material surroundings, attitudes, values, feelings, skills, and/or roles are changing.It is a way of living satisfying, hopeful, and contributing lives, together with others even though we may still experience distress, unusual experiences and troubled or troubling behaviour. 1 Recovery involves engaging in new material and social contexts and in open dialogues where new understandings of the situation we find ourselves in are created as we move beyond a psycho-social-material crisis.…”

11. Opgaveglidning og ansvarsforskydning i konkurrencestaten

“…Personens hverdagsliv og lokalmiljø, fellesskap, samspill og samarbeid med andre og levekår vies stor oppmerksomhet. Det handler om å ta kontrollen tilbake, finne mening og leve det livet personen ønsker og kan Topor, Bøe & Larsen, 2022).…”

Supporting recovery in persons with stress-related disorders: A reflective lifeworld research study of health care professionals in primary health care in Sweden

“…The initial meaning of recovery integrates persons in their social context but has over the years been diluted and taken a more individualistic form. In recent years explanation of recovery as only a personal journey has re-evolved to include the person´s social context were social aspects as relationships and living conditions are considered as important for recovery (Topor et al, 2011 , 2022 ). In a modern recovery-oriented practice, it is important as a health care professional to have a holistic approach.…”