The problem with the ‘recovery’ conversation in mental health

By 2030, mental health problems will be the primary cause of morbidity and mortality in many countries, with depression becoming the leading cause of disease burden globally. Considering this frightening statistic, it is important that we leverage language appropriately and tactfully when it comes to raising awareness about this important cause.

Language can be a powerful tool when it comes to raising awareness among the public about debilitating illnesses, like mental health problems, but it can also be used, whether intentional or not, to further marginalise individuals who are suffering from poor mental health. In the 1950s, for example, people with a mental illness were commonly described as ‘weak’, ‘bad’ or ‘insane’, which often resulted ostracisation and institutionalisation, along with fear from the public.

"There is still some way to go in understanding how our attitudes and language can impact the quality of life for those suffering from poor mental health"

However, since then, there have been great efforts to find treatments for a variety of mental illnesses, such as depression and anxiety. This is in part due to the increase in awareness of the prevalence and incidence of mental illnesses around the world.

Today, in stark contrast to the stigma surrounding ill mental health in the 1950s, characters suffering from mental health issues are often portrayed in a variety of movies and television shows. Campaigns are also headed up by celebrities who tell their own personal stories in a bid to further the conversation on mental health. Additionally, companies, including our own, are doing more to safeguard the mental health of its employees, viewing this as a core part of staff wellbeing. This Illustrates the dawn of a new era of openness. However, there is still some way to go in understanding how our attitudes and language can impact the quality of life for those suffering from poor mental health.

The ‘pathway to recovery’

One word frequently used in mental health is ‘recovery’, meaning to return to a ‘normal’ state of health, mind or strength. This is often seen as the ultimate goal for those suffering from ill mental health, but is this realistic or an unobtainable achievement?

Healthcare professionals and members of the mental health community are raising concerns over such terms being used to describe the ‘recovery pathway’ for people struggling with mental illness as it can set unattainable goals for them, their carers and the public.

"At least half of those that ‘recover’ from their first episode of depression will experience one or more episode(s) in their lifetime"

As more research and information comes to light, the importance of focusing on the ‘pathway to recovery’ rather than ‘recovery’ itself is becoming clearer. This distinction is important because those who struggle with a mental illness, such as depression, often experience more than one episode of it in their lifetime. They will also have to go through a sometimes-lengthy trial-and-error process with anti-depressants. The American Psychiatric Association [4], for example, found that at least half of those that ‘recover’ from their first episode of depression will experience one or more episode(s) in their lifetime.

Relapse does not mean failure

Mental illness is not straightforward. It cannot be easily diagnosed and treated within a single physician’s appointment, and is usually messy, fluid and does not fit easily into binary categories, which makes diagnosis and treatment complex. Often, two mental illnesses present together. For example, depression and anxiety frequently go hand-in-hand and present together in primary health care settings [2].

Most importantly though, focusing just on ‘treating’ mental illness can increase the shame and stigma felt by those who ‘fall off the wagon’, which can further relegate them to the margins. The desire to then reach out for help also decreases when people with mental illness feel misunderstood or ashamed, with some reporting feeling like a ‘burden’ or ‘failure’ as a result of their relapse.

"By educating the public, people with mental illness and carers on the ‘pathway to recovery’, it becomes easier for everyone involved in the process to help manage the illness and better cope with potentially reoccurring episodes of mental illness"

The narrative widely told in both the media and in academia typically describes an individual who has ‘recovered’ from a one-off episode of depression at some point in the past. This can contribute to increased feelings of shame and stigma for those who experience ill mental health as they are not visible in these forums, which can, in turn, result in them internalising their thoughts and feeling like they’re ‘defective’ when they relapse. Most importantly, it can prevent them from seeking help.

By educating the public, people with mental illness and carers on the ‘pathway to recovery’, in which relapses are anticipated and seen as part of the treatment (‘recovery’) journey, it becomes easier for everyone involved in the process to help manage the illness and better cope with potentially reoccurring episodes of mental illness.

Chrissie Hodge, a patient with OCD, explains how this idea has helped her manage her own mental health. She says: “The best way to pre-emptively cope with relapse is to understand that relapse is possible and likely. This can eliminate that unwanted fear that it may or may not happen. To understand the likelihood and plan for it puts you ahead of the game.”

A holistic approach to treatment

Rather than focusing on ‘recovery’ from a mental illness, it is more productive to focus on its management and maintenance. This promotes the thinking that mental illnesses are often a result of complex interactions in between the biological, psychological and social (biopsychosocial) spheres rather than a one-off illness, like strep throat let’s say, that can be easily treated with a course of antibiotics.

Treatment for mental illness instead requires a holistic approach that takes into account how each sphere interacts with one another and in turn, affects people who experience mental illness. This also includes understanding how the spheres need to be addressed in order to help those struggling with ill mental health so that they can better manage their condition.

For example, if a depressed person is continuously involved in precarious work and lives in unstable, low-income housing, trying different anti-depressants will not ‘cure’ them if their work and housing situation did not improve. All factors need to be taken into account to see how they might impede an individual’s ability to progress towards ‘mental well-being and wellness’, and to figure out what types of support might need to be offered outside of medication alone (such as job support, welfare benefits, etc.).

The advantage of understanding mental health disorders as a fluid and continuously changing ‘pathway to recovery’ takes into account the ambiguity that is found in mental illness diagnoses and medications. This can make a real difference to the lives of survivors and their loved ones as it allows for more holistic care to be offered to those struggling, ultimately improving their quality of life.