Critical Perspectives on Mental Distress – promoting recovery

Duration: 8.48 mins

Speakers: 

Interviewer, Patricia Caplen 

Professor Philip Thomas, Institute of Philosophy, Diversity and Mental Health, University of Central Lancashire, UK. 

How can your perspective help to promote people’s recovery? 

I think that’s another very interesting and quite difficult question and again, I would respond to that partly in a similar way to the way I responded to your previous question and that’s by issuing a disclaimer and the disclaimer that I would issue here is to say, I think the first thing that it’s really important professionals get into their heads – and this is a lesson I found really difficult to learn – is that a great majority, well not majority, a large number of people get over and recover from severe distress. I would even say, ‘despite professional interventions’. A couple of years ago, Pat Bracken and I wrote a book called ‘Post-Psychiatry’. In the process of writing that we examined in great detail some of the literature on recovery because it’s a really interesting and important concept.  As a result of doing that detailed reviewing the literature on recovery, I became absolutely convinced that often professional knowledge and professional expertise can be a barrier to recovery for people.  Not always and a lot of people who use mental health services do get over and do find professional interventions, whether they’re from psychiatrists in the form of medication or cognitive therapy or whatever, very helpful. But I think it’s important that we use a little bit of humility here as professionals and recognise that many people recover without professional help and support.  And I think that that makes sense too if you look at the origins of the word ‘recovery’ because the word ‘recovery’ is a complex word and it has a number of different meanings, but the meaning that I find the most powerful and in one sense the most attractive, is the meaning that service users and survivors have given to ‘recovery’ from within their own struggle as a movement to change the way that society regards them.  I see that the whole notion of recovery in that sense as being very closely tied to the struggle of mental health service users and survivors as a form of social action, as political action, to challenge the negative views that the rest of society has of people who need to use mental health services and attracts psychiatry labels.   And one of the things that really concerns me is a growing tendency over the last 10, 15 years for the notion of recovery to become taken over and colonised by professionals, by psychiatrists, psychologists and social workers, and we have, you know, stages of recovery now being built into people’s care plans in ways that I’m not sure that that’s an ethical way of thinking about how recovery should take place. You can’t prescribe recovery people as you could prescribe them Olanzapine or you could prescribe them a short course of focused CBT, let’s say.  Recovery is a complex phenomenon and again, some of the really important work here has actually interestingly been done by a psychiatrist, an American psychiatrist in particular, a guy called John Strauss who was a professor at Yale who’s now retired. But some of John Strauss’ work on recovery I think is really very informative because he draws attention to the complex routes that people have to recovery and the complex trajectories that recovering from a condition like schizophrenia is not like recovering form influenza or recovering from a broken leg. The sort of journey, the trajectory that you have over time is one that’s complex, is marked by steps forward and steps backward and isn’t clear-cut in the sense of it being a gradual improvement.  So that said, with those sorts of caveats, what can we do to facilitate recovery?  Well again, I think this is where meaning is so important. In the book what we draw attention to towards the end of the book is how meaning and the importance of actually being able to understand your experience in your own terms, does appear if you look at the service user led research literature on recovery, appears to be one of the most important things.  So if you take that as a yardstick in terms of how, as professionals, we might work with people in ways that can help rather than hinder recovery, I think the first thing to say is to place our professional knowledge and expertise in the background and to try to work with the person who’s going through the distressing experience, or experiencing psychosis, in a way that can help them to make sense of the experience in their own ways.  And that may involve a number of different things.  It may for example involve us as professionals doing things that actually seem rather unconventional and not particularly traditional, like taking somebody to – let’s take the example of [0:06:25] possession because I think that is a really good example. In Bradford, at Linfield Mount Hospital over the last few months there’s been a very interesting project there working with young Muslim men who are acutely psychotic where an Imam comes onto the ward and works very closely with the men, but also alongside the clinical team, so that he’s helping them to develop an understanding of their experiences within an Islamic framework, whereas the clinical team there is also working in a bio psycho-social framework. I see no reason at all why those two very, very different approaches should not sit comfortably alongside each other for the benefit of those young men, even though it may mean as staff we’re actually having to be exposed to ideas and concepts that are really alien and seem very, very strange to us.   The most fundamentally important point here I think, and I’m going to refer to a quote from a survivor, a well-known survivor, a man called Ron Coleman who many people may have read and heard of, and one of the points that Ron Coleman makes about his own recovery is that he was only able to recover when he had a voice of his own to be able to speak and articulate his own understanding about his voices and his experiences in his own way.  And I believe that’s probably true for everybody, so being able to place people in situations, expose people to systems of understanding that they’re able to make sense of their experiences in their own way so that they can have a voice for themselves, I think is the single most important step in recovery. 

Thank you so much.  That’s been so fascinating.       

END OF RECORDING