Discover more from Sarah Fay
SAMHSA'S Senior Advisor Larry Davidson
Insights into recovery from the Yale professor known as the national spokesperson for recovery-oriented care
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I’m beyond thrilled to bring you this interview with Larry Davidson—the esteemed researcher, policymaker, and Yale Department of Psychiatry professor.
He’s one of my heroes. When I still thought that my recovery from mental illness had to be a fluke, I heard a talk he gave at the Hogg Foundation. In it, he discussed recovery’s long history, cited what seemed like impossible statistics of just how many people recover from mental illness, and spoke of the future of our mental health in a way that includes what I’d experienced: fully healing from mental illness. Hearing it from him legitimized my recovery.
Davidson did his doctoral and postdoctoral work at Yale University and went on the direct Yale’s Program for Recovery and Community Health for over twenty-five years. He and his colleagues have summarized the research showing that recovery is possible (even for serious mental illnesses like schizophrenia), developed recovery-oriented treatment methods and supports, and have been instrumental in making the recovery model the core of our mental health system.
He’s often referred to and thought of as the national spokesperson for recovery-oriented care. Currently, he still teaches at Yale and is a senior advisor to the Substance Abuse and Mental Health Services Administration’s (SAMHSA’s) Office of Recovery. SAMHSA launched the office “to advance the agency’s commitment to, and support of, recovery for all Americans.” In doing so, they’re doubling down on a promise made by the U.S. government over two decades ago with the first U.S. Surgeon General’s Report on Mental Health in 1999: People can fully recover from mental illness, even serious mental illness (yes, even schizophrenia) if our mental health system moves away from the biomedical model that says mental illness is biological, chronic, and hopeless to a recovery model that says people in mental and emotional distress have a future beyond maintenance and the management of symptoms.
Davidson is living proof of that. One of the more striking things he describes in this interview is the way his wife helped him when he was struggling with depression. In advising families and caregivers on what they can do, he says,
“Give your loved one some space and a chance to heal, and most likely, that will work. Just love them. That’s one of many things I can say about my wife. She never tried to fix me. She just let me know I was loved regardless of what, whether I could function or not.”
As a researcher and as a policymaker, what is recovery to you?
When it comes to mental illness, it means that the person with the condition has figured out a way to live a self-determined, meaningful, and gratifying life in the face of an ongoing condition.
Does someone who’s recovered ever move past the diagnosis or illness?
Oh yes. Many people will recover fully and not have symptoms any longer. Recovery means different things to different people, but certainly, the majority of people recover in the sense of no longer having the illness, just from an epidemiological point of view. Living with the illness is more the exception than the norm.
What do you think the biggest misconception about recovery is?
That you never have a bad day for the rest of your life.
Given its association with substance use disorders, recovery often isn’t thought of in terms of mental illness. Do we need another word for it?
There is a significant amount of confusion there, and it is unfortunate. I think it’s kind of late, though, for us to try to introduce a new word. I don’t know what that would be: mental wellness?
What’s the difference between remission and recovery?
Recovery is sustained Remission. Recovery means that you’re remitted, and you’re going to stay remitted unless they are unforeseeable circumstances where the illness might return. But recovery means you’re well in.
Can you talk a little bit about your own experience with mental illness?
Sure. I distinctly remember when my second daughter was born. I was about 26 years old, and I was sitting in a chair holding her, and I came to realize that depression wasn’t just something that happened to other people. It would account for my difficulty sleeping, my affect, my mood. I was, in fact, one of those people. I had been leading the battle for them, but it was no longer them. It was also me. It was clear that I was not able to be the kind of father I wanted to be as long as I was depressed.
I saw a psychiatrist. I started medication. I had psychotherapy, I got better, and I have had many relapses, but I haven’t had a sustained episode since then.
How do you distinguish relapse from the normal depression that goes along with the human condition?
A relapse is disabling. I think it's important to make the connection that the human condition does leave us vulnerable to what you might call depression. Most people may be depressed, but they’re not disabled by it.
What kinds of responses have you gotten from your colleagues and others in the field about your work on recovery?
That it’s cruel to set people up for disappointment. There’s a lot of ignorance associated with mental illness in our culture, and I’ve run into it many times. Fortunately, it’s getting better. I don’t hear that as much as I used to.
What do you think has changed?
There are more and more people who identify as being in recovery. It’s been a fairly successful movement in the last 20 years.
Mental health, in general, has changed. It’s not taboo anymore. In part, it’s understood as a normal reaction to abnormal circumstances, which really destigmatizes it further.
Unfortunately, with Covid and other things, there have been more than enough reasons for people to be depressed over the last several years. One silver lining of that is that depression is no longer a taboo subject. It’s no longer stigmatized. I hope that extends to all of mental health, but I know it is at least true for mood disorders.
What’s the difference between clinical recovery and personal recovery?
Clinical recovery is what used to be considered recovery. It means no symptoms, no impairments back to normal. Personal recovery means you may not have achieved that level of recovery, but you are living a meaningful, self-determined, contributing life in the face of an ongoing condition. To me, it’s recovery but to the scientific or medical world, it wouldn’t be.
What does SAMHSA’s Office of Recovery do?
It promotes anything that’s contributory to recovery, and it tries to address stigma and discrimination. It also influences the rest of SAMHSA to become more recovery oriented. I’ve worked collaboratively with SAMHSA for the last 20 years. It was just a matter. Of where I am in my career. I wanted to be able to devote more of my time to policy work and less time to sort of directing studies and giving talks and things like that. I’ve done my share.
Do you think we will move to a recovery model?
Yes, I do. I’ve seen significant progress. People having a first episode of psychosis are now talked to about recovery. That never would’ve happened 20 years ago. We would’ve been “setting people up for disappointment,” but now we know that many people have a single psychotic episode, and that's it. They go on to live normal lives. So it's been a huge change.
Do you think that recovery is being offered as an option to those with more, for lack of a better word, milder conditions like depression and anxiety?
I don’t know that they need it as much. You know, people can have anxiety or depression. They can manage pretty well without even hearing the term recovery. I think recovery’s become such an important term because it’s for a condition that people were not supposed to be able to recover from.
Many people think that major depressive disorders and anxiety disorders are lifelong and can’t be recovered from.
Really? Well, they’re just wrong. The data do not bear that out. That’s not a current, up-to-date understanding of mental illness.
Recovery from any mental illness or mental health condition is hard work. Do you think most people can do it?
Yes. And the data support the fact that most people can manage to do it. It just takes time.
Do you think the recovery model includes the biomedical model, or do you think they’re antithetical to each other?
I hope they’re not antithetical because I believe both of them are true. That’s why I take medication. There is a biological component. It’s not something I’ve chosen.
What is one thing that people can do to be empowered in the current mental health system that may or may not always offer them recovery as an option?
Peer support—finding people who are like-minded and who’ve been through similar experiences. There are many self-help groups and peer groups that function outside the formal mental health system. It could be a matter of finding one of those.
If you could say one thing to people who are struggling with serious mental illness or even emotional distress, what would it be?
Persevere. There will be an end in sight.
And what advice can you give to caregivers and loved ones?
Similar: persevere, and there will be an end in sight. Also, don’t become harassing. Give your loved one some space and a chance to heal, and most likely, that will work.
Just love them. That’s one of many things I can say about my wife. She never tried to fix me. She just let me know I was loved regardless of what, whether I could function or not.
What about the future of mental healthcare makes you most hopeful?
The reduction in stigma has really been an unexpected, very nice surprise. All of that community education work we did back in the early 2000s may have paid off.
Find more resources for mental health recovery.
Read Pathological: The True Story of Six Misdiagnoses (HarperCollins 2022)—the prequel to Cured.
Pathological was an Apple Best Books pick, hailed in The New York Times as a “fiery manifesto of a memoir,” and named one of the sixteen best mental health memoirs to read by Parade Magazine. It was featured on NPR, Oprah Daily, Salon, Forbes, The Los Angeles Times, and more.
Called “powerful, mesmerizing, and unputdownable,” Pathological recounts my twenty-five years in the mental health system. It’s a gripping, cautionary tale of what can happen when a young person negatively over-identifies with a psychiatric diagnosis and continues to do so into adulthood. Find it at your local library or buy it now.