Recovery as an organising construct – Bill White interviews Larry Davidson

UnknownI have just been reading a Bill White interview of Larry Davidson – the two people who have most impacted on my work – and I was very interested by Larry’s response to these two questions about the mental health field. What is said is of course highly relevant to the addiction field.

Bill White: How is the emergence of recovery as a new organizing paradigm changing the design and delivery of mental health services in the United States?

Larry Davidson: I think the biggest change that the recovery paradigm has introduced, and the change that poses the most difficulty for traditional clinicians to understand and accept, is that recovery is primarily the responsibility of the person rather than the practitioner.

In the past, we practitioners thought we were responsible for “treating” people, for fixing people, and that after we fixed them, or cured them, they would then go back to their lives and go about their business.

What the recovery paradigm has taught us is that people are active agents in their own lives whether well or ill, and that recovery does not come about through their passively following the instructions or guidance of others, no matter how well-trained or well-intended those others may be.

We cannot “do” recovery to or for other people. We cannot make decisions for people and expect them to learn how to make better choices for themselves.

So practitioners need to move from an expert/authority position to that of a consultant or coach, and while these roles are much more effective and gratifying, they are not the role that most practitioners were trained for.

Bill White: What have you found to be the major sources of resistance to the emergence of recovery as an organizing concept?

Larry Davidson: In addition to needing to cede power and authority over the person’s life back to the person him or herself, the other major sources of resistance seem to stem from the discriminatory attitude our respective disciplines, or the field as a whole, has had toward persons with serious mental illnesses.

Pat Deegan has described this attitude as one of “mentalism,” as it parallels other “isms” like racism and sexism, and other forms of prejudice.

Practitioners have a hard time believing that persons with serious mental illnesses can still be competent, intelligent, mature adults. They have a hard time viewing people with serious mental illnesses as worthy of love and capable of loving others.

It’s as if accepting that people with psychotic disorders are still human beings – with all of the rights to respect, dignity, and autonomy that come with that – poses some fundamental challenge to how people understand the meaning of their own lives.

If this person can be irrational, can talk nonsense (either by not making sense or by describing experiences I and others don’t typically have, like hearing voices), and cannot seem to complete school or hold down a respectable job, and if he or she is still worthy of dignity and respect, then what do I work so hard for?

It seems like in some ways, persons with serious mental illnesses may be one of the few remaining groups of people who it is acceptable to look down on in order to feel good about ourselves. We can no longer discriminate against people of different races or sexual orientations, and we can no longer discriminate against women, even though of course we still do.

But it can be very difficult for practitioners to understand that we have, and continue to, discriminate against persons with serious mental illnesses in the same way.

And because practitioners seldom have the opportunity to see people recover over time, they remain skeptical of the possibility of recovery, not believing that you can lead a normal life while still having a mental illness.

But this, too, is changing, as more practitioners see more and more people in recovery, and as more people in recovery become visible role models.