Should we talk about ‘hope’ or ‘remission’ rather than recovery, when dealing with serious mental illness?
My heart hurts today. My friend Laura Pogliano has lost her 22-year-old son Zac, who had paranoid schizophrenia. Both Laura and Zac were tireless and passionate advocates for ending the stigma of mental illness. Their story was featured in USA Today’s “Cost of Not Caring” series, where Laura described herself as a “fortunate” mother — fortunate because despite personal bankruptcy, she had been able to obtain treatment that seemed to be working for her son. This tragic turn reminds all of us mothers just how fragile life is for our children who have serious mental illness. As a parent of a child with bipolar disorder, my worst nightmare is what happened to Laura and her son.
There’s a popular quote floating around mental health advocacy circles: “Mental illness is not a choice. But recovery is.” I know people will disagree with me, but today, I’m tired of that sentiment, and I wish we would retire the word “recovery.” When local and national mental health policy is shaped by high-functioning consumers who have been able to manage their illnesses rather than by the sickest patients and their families, it’s the equivalent of only allowing stage 1 cancer survivors to drive the narrative and take most of the funds. While their courage is admirable and their struggles are genuine, too often, we lose sight of those who are suffering the most. They become invisible to us, marginalized on the streets or in prison. Or they die young, like Zac.
I wish we would stop talking about recovery and replace it with a more useful, less stigmatizing word: hope.
Here are five reasons I wish we would stop using the word “recovery” for serious mental illness.
- Not everyone recovers. The word “recovery” has become central to mental health care, from the top down. In fact, the Substance Abuse and Mental Health Services Administration’s stated mission is that “People recover.” With serious mental illness, that’s not true. People recover from head colds. They recover from chicken pox. They recover from situational depression. They even recover from trauma. But some diseases are lifelong. Like diabetes, or Parkinson’s disease, or multiple sclerosis, serious mental illness is a lifelong, chronic health condition.
Recovery and its partner phrase, behavioral health, imply that mental illness is a choice. Mental illness is not a choice or a character flaw. The focus on “behavioral health” unintentionally stigmatizes the very people that SAMHSA is meant to help: those with serious mental illness.
The word “recovery” suggests that people need to return to a “normal” state, rather than embrace their differences. What does a person with bipolar disorder or autism need to “recover” from? When people realize they are not their diagnoses, they can start to find things that actually work to help them live successful and productive lives. That’s hope, not recovery.
The concept of recovery increases stigma, both within and outside the mental health community. Again, if people recover, why aren’t you recovering? It must be a choice you are making, or something you’re doing wrong. Some people tell you the medications you take are preventing you from recovery. Others tell you that your choice to stop medication is preventing you from recovery. Who is right? Hope is a universal concept that embraces a wide range of possibilities. Recovery seems dependent on a prescribed set of treatments that may not work for everyone.
Recovery is an unrealistic standard for any chronic illness, including mental illness. We would never apply the blanket expectation of recovery to any other chronic illness or disability. With cancer and autoimmune disorders, we use the term “remission” to describe a life-threatening systemic illness that with luck and treatment has been stopped in its tracks. With other chronic illnesses like diabetes, we talk about managing the illness. But with mental illness, we expect people to “choose” recovery, even when they are experiencing psychosis, or when their disease steals their ability to make rational choices.
Behavioral health is an important concept for everyone. We should all focus on our behavioral health: on diet, exercise, mindfulness, good sleep habits. But behavioral health is not mental illness. Mental illness is physical illness. For people with serious mental illness, behavioral health alone will not “fix” or “cure” the chronic condition, and for us to expect otherwise is unrealistic and cruel. We need to focus on effective treatments, not inaccurate judgments about what we “believe” or “feel” mental illness is. It’s a very real health challenge, with real and sometimes devastating consequences for those who live with it and their families.
Let’s keep talking about behavioral health for everyone. But let’s stop talking about recovery for serious mental illness and start celebrating people whose brain disorders cause them to live with health challenges comparable to those experienced by cancer patients. The word we need, in the face of so much loss, is hope. Mental illness is not a choice. But hope is. Even in the face of tragedy, today I choose hope.