Recovery, Mad Pride, and Revolution

This is an excerpt from an article titled “Recovery Versus Mad Pride: Exploring the Contradictions” originally published on Mad in America by Ron Unger, LCSW on 5/14/2019. See the full story here.

I’ve been intrigued by the way the battle against mental health system oppression has drawn on two important and powerful ideas — which happen to contradict each other!

One is the idea that people can “recover” from mental health problems. Asserting the possibility of recovery has been key to fighting back against the oppressive belief that certain people will always be “mentally ill” and will need to resign themselves to a limited life as a mental patient, etc.

The second idea is that people may not have to change to be OK and valuable — that people can even be proud of what has been called madness! Mad pride helps people fight back against the oppressive notion that one has to be “normal” to be acceptable, and that mental diversity means illness.

The Concept of “Recovery”

Compared to mad pride, recovery has been much more widely embraced. It has even been embraced by much or most of the mental health system — though often what is embraced is just the word itself, and not the possible reality! But because of its popularity, it has also been more widely critiqued, and some have even advocated that we stop using the word altogether.

Critiques of “Recovery”

One common critique is that the word “recovery” implies that one must have been ill in the first place, and so this word should not be used when the problem never was an “illness.” However, people do “recover” from many things that aren’t an illness … so “recovery” is not something unique to those who have been psychiatrically labeled.

A stronger critique of the notion of recovery points out that recovery involves going back to something, while many prefer to see their life as going forward. John Herold for example talks about wanting to move toward “discovery” and not “recovery.”  I agree with that up to a point, but I also notice that we often have to go back to something we had possessed previously in order to move forward overall. For example, if I used to know how to face people and maintain friendships, but then I seemed to have lost that ability during an emotional crisis, I may want to recover the skills and habits I had before so that I can then get on with my life and move into that wider process of discovery.

Then there’s the problem of the word being co-opted to mean something much less than real recovery. For example lots of mental health programs use the recovery word, but their practices remain targeted towards lifelong drugging and containment of the person, with “recovery” apparently meaning only getting to where the person won’t be in crisis so much. … [However], I think our best strategy is to continue to emphasize the true meaning of recovery and to contrast truly recovery-oriented treatment with that which is not.

“Clinical” versus “Personal” Recovery

Adding complexity to discussions of recovery is the distinction between “clinical recovery,” or no longer experiencing “symptoms,” versus “personal recovery” which has been defined as “recovering a life worth living.”

Interestingly, within standard care, “personal recovery” is often framed as the proper goal because of a belief that “clinical recovery” is not possible. In other words, it is believed that the person will always have symptoms and will always be less than healthy than others because of that, but they may still learn to “recover a life worth living” despite continuing to be ill. …

But there is a deeper and more valid reason to focus on personal recovery rather than clinical.  That’s because the experiences that the mental health system called “symptoms” may not be a problem at all once the person learns to live with them.

Hearing voices for example may be benign or even helpful once the person learns to relate to them differently. And once experiences no longer cause problems, there is no longer a need for drugs or any kind of treatment to manage them.

The Concept of “Mad Pride”

Of course, it’s the idea that people don’t need to change, and that their differences may be OK or even something quite valuable, that is basic to that idea that sometimes seems in opposition to recovery: mad pride.

From a radical mad pride perspective, there is only mental diversity, and not any mental problems, disorders, or illnesses. People do best when they accept and become proud of themselves as they are rather than try to change. If people have problems, or seem to be disabled in some way, it’s just because society has failed to accommodate their differences, and so it’s society that needs to change.

But what are the problems with this kind of radical mad pride perspective?

One issue is that if I am suffering in some way, while believing that there is nothing wrong with me but only problems with others, and if it’s also true that I don’t have the power to make others change, then I am stuck with my suffering. Working on recovery from a problem may not require accepting that one is ill, but it at least requires accepting that something needs to be changed; but pride is the opposite of believing in a need for change. …

On the other hand, the notion of radically accepting ourselves just as we are can often seem to be the very core of peace of mind and mental healing. So it can all seem quite complex.

Mental Health “Revolution”

One metaphor for madness is that of revolution. Revolution overthrows the existing order — then anything is possible, which is both great and terrible. Revolution is both something to be proud of, when it is necessary and when it works out well, and it is something to recover from, so that order can be restored.

When we over-value sanity, we stick with an existing order in rigid ways that can be oppressive. When we over-value madness, or revolts against sanity, we can get lost in disorder. Life though works best at the edge of chaos and order, so it may require both rebellion against order and efforts to recover order. …

If we follow this line of thinking, it follows that there are no final answers as to when a focus on change and recovery is best, versus when it might be better to instead be proud of one’s current state and perspective, even if it is somewhat “mad.” Instead, we will be more open to exploring what might fit or seem healthy, or not, in any given situation. And we will be open to the possibility that whatever we choose now, we will later be called upon to choose the opposite.

When we are too sure that our side is right, that “God is on our side,” we end up at war with our opposite. People who are too sure that their current mental view or version of sanity is correct will go to war against that which opposes it, be they voices or other people who are seen as mentally wrong. But going to war just makes everything more extreme, and prevents the “peaceful revolutions” that are possible when people realize that their current polarity is just one side of a more complex picture.

What would mental health treatment look like if it balanced an awareness of the need for “recovery” with an awareness that people also sometimes need to go “out of their minds” to resolve problems that they haven’t been able to solve otherwise, or maybe that their entire culture has not been able to face and resolve?