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When it comes to adopting the recovery model, the 2020s feel like they’re already slipping away. They aren’t, of course, but they’re the decade to finally fulfill a promise psychiatry actually has the ability to keep.
We know the biomedical model doesn’t work. Biopsychiatrists spent billions trying to show the supposed biogenic origins of mental illness. In doing so, psychiatry failed to care for patients by establishing better (some would say humane) treatments and systems based on rehabilitation and (yes) recovery. As Thomas Insel put it in his book Healing: Our Path from Mental Illness to Mental Health,
“I spent 13 years at NIMH really pushing on the neuroscience and genetics of mental disorders, and when I look back on that I realize that while I think I succeeded at getting lots of really cool papers published by cool scientists at fairly large costs—I think $20 billion—I don’t think we moved the needle in reducing suicide, reducing hospitalizations, improving recovery for the tens of millions of people who have mental illness.”
This has led some to fault Insel, but I admire him for talking about this publicly and trying to rectify the situation in his current work in biotech. How many professionals—particularly doctors, researchers, and other clinicians—admit when they’re wrong?
For three centuries, we’ve been recovering—if we’re in the right conditions with physicians who believe we can. In The Roots of the Recovery Movement in Psychiatry: Lessons Learned, Professor of Psychiatry at Yale Medical College and champion of recovery Larry Davidson and his colleagues write about the wisdom of Philippe Pinel, a physician, and Jean-Baptiste Pussin, governor of the hospital Bicître in Paris, in the eighteenth-century. Pinel and Pussin argued the “insane” could recover. (Davidson states that this was the first time the word recovery was used in relation to those with mental illnesses.) The two men developed traîtement moral, a psychiatric practice that asserted that patients, who were viewed by others as demonic or bestial, shouldn’t be chained or abused and should receive psychological care.
This method of treatment was rooted in the belief that patients could not only recover but also recover so completely that they could return to the hospital and be employed to help others in their journeys to wellness—an early example of peer support. (Pussin had once been a patient at the hospital before he became governor, albeit for tuberculosis.)
And it worked. The hospital boasted a recovery rate of 90 percent if—and this was a big if—patients were not treated at another hospital first. Why? Because they knew that physical abuse and the emotional toll of being told you’re beyond help and denied your human rights compounds mental illness and leads to a person’s deterioration. Traîtement moral showed that recovery depends on restoring hopefulness to patients and treating us as people, not seen as our illnesses.
In addition to showing that recovery from mental illness was possible and that those with lived experience can and do help those who are still suffering, Pinel also introduced three pivotal realities that we still have trouble accepting: 1) anyone can suffer from mental illness, 2) mental illness occurs in response to external events (it’s not solely biological), and 3) it isn’t all-encompassing.
Pussin and Pinel knew that one of the most important determiners of mental health recovery is work. Work—having purpose and meaning. Even those with serious mental illnesses can work with the right support. Pussin and Pinel employed former patients to work in the hospital and on the grounds. But—and this is crucial—the work had to be the patient’s choice and interest. Davidson and his colleagues write, “For Pussin, meaningful work was considered the primary route to cure, and for Pinel effective hospitals could only be ‘founded on the basis of interesting and laborious employment.’” (50)
We already have one potential career path for those with lived experience of mental illness: mental health peer support specialists. Peer Support Specialists are those with lived experience of mental illness and/or substance abuse who have fully recovered and now support patients move toward wellness by helping them access resources, decide what recovery will look like for them, and develop their own recovery plans. Instead of hearing only from “experts,” patients get the perspective of someone who’s been through what they’re going through and has fully healed.
Physicians and mental health professionals are overworked and already don’t have time to meet with many in need of care. Employ those with lived experience of mental illness to be part of the clinical team. One caveat: the Peer Support Specialist has to be welcomed onto the team, which hasn’t always been the case.
Recovery and the value of peer support have slowly made their way into academia: John Strauss and Larry Davidson at Yale (Davidson ran the Program for Recovery and Community Health for twenty-five years); William Anthony at Boston University; and John Gilmore at the University of North Carolina School of Medicine. Although the Yale program and others help secure some funding and lend recovery research an air of prestige, that funding is a fraction of what’s poured into yet more studies trying to prove the biological origins of DSM diagnoses.
Pharma still has its tentacles in psychiatry. Even if we were to purge all academic psychiatrists and patient advocacy groups of their conflicts of interest, pharma influences clinicians, those in the most direct contact with patients.
But we are moving in the right direction. In 2021, SAMHSA opened its Office of Recovery to enforce its commitment to giving every American the chance to heal from mental illness and psychiatric conditions. It named September National Mental Health Recovery Month to declare publicly that there is hope.
If you or someone you love has received a psychiatric diagnosis, empower yourselves by learning the truth about how they work, so you can receive the best care.
Read all available chapters of Cured.