When it was originally conceived, the concept of “recovery” was truly radical. For centuries, mental “illness” was seen as an individual, moral failing that one could not recover from, often requiring lifelong professional intervention through imprisonment or institutionalization. During the late 20^th century though, leaders with lived experience in the survivor movement asserted that people can recover from mental health and substance use disorders, play an important role in their own recovery, and lead fulfilling, self-directed lives in the community. This shift in thinking and clinical practice was revolutionary, resulting today in more than 50 million American adults, or about 15 percent of the country, in recovery today.

As renowned political philosopher Hannah Arendt once wrote, however, “The most radical revolutionary will become a conservative on the day after the revolution.” It has been almost 100 years since “recovery” was first described in the Big Book of Alcoholics Anonymous, published in 1939. Despite significant advancements during that time, recent studies show that less than half of all adults with mental health conditions and substance use disorder receive treatment. In light of that, as we celebrate National Recovery Month, it is helpful to revisit “recovery,” examine its strengths and limitations, and consider where to go from here, grounded in the experience of survivors, such as myself, who have mental health disabilities.

How Do you Recover from Yourself?

“Recovery” today is widely defined in the U.S. as “a process of change through which individuals improve their health and wellness,” “overcoming or managing one’s disease(s) or symptoms…by making informed, healthy choices that support physical and emotional wellbeing.” To most, this definition may seem reasonable. As someone with a physical disability, however, who also considers my mental health condition a disability (as recognized by the Americans with Disabilities Act), this definition is problematic.

Since the 1960s, disability activists have debunked the idea that disabilities are illnesses or diseases that can be overcome if you just try hard enough. According to the World Health Organization, “disability is part of being human,” and the “problem” is not the disability itself but the “interaction between individuals with a health condition, such as cerebral palsy, Down syndrome, and depression, with environmental factors including negative attitudes, inaccessible transportation and public buildings, and limited social support.”

I have lifelong bipolar disorder, and I do not overcome it any more than I overcome the fact that I am biologically female. It is just a part of who I am — a part of being human that sometimes needs to be managed, not cured, or overcome. What needs to be cured and overcome are the economic, political, and social barriers that push me to the extremes of my bipolar disorder and impair my functioning. For example, every time I change jobs and, therefore, health insurance, gaps in care force me to switch my therapist and psychiatrist, which always leads to a decline in mental health.

Given the way “recovery” is currently conceptualized and sometimes implemented in clinical practice, folks with mental health disabilities and our families can be set up for failure. We are often told that the problem that needs to be fixed is us (our condition) and that if we just get this medication or that therapy and make these better lifestyle choices, we will somehow overcome our “illnesses” and “get better.” I was once admitted to a partial hospitalization program (PHP) and told that if I complied with my medication changes and made more progress on things like having good sleep hygiene and getting out of my “rational and emotional mind” and into my “wise mind” that I could get better. The onus to fix the problem was on me. And apparently, I fixed the problem because on the last day of the program they gave me a “graduation” party and a warm cookie to celebrate.

However, the problem is that you never graduate from having bipolar disorder, and someone can have the “wisest mind” ever and still experience a mental health crisis because of systemic disparities they have little to no control over. What I needed wasn’t a warm cookie, but help addressing the root cause of my crisis — the hostile work environment that landed me in the hospital in the first place. The PHP program simply recommended that I quit my job and find a new one, which is a privileged thing to say to someone who may not have the financial means to do so.

Reframing Recovery and the Locus of Control

To effectively address the root causes of the mental health crisis in this country, it is helpful to consider the ways a traditional medical model has made its way into the clinical practice of recovery and explore alternatives that start with the premise that the person — and their mental health disability — is not the problem. Such an approach could be modeled after the one developed by Carol Gill, PhD, at the Chicago Center for Disability Research, which reframes disability using an interactional or socio-political model. Using Dr. Gill’s framework:

Overcoming Systemic Marginalization

Important efforts are underway to address some of the economic, political, and social barriers contributing to the mental health crisis, highlighted by the recent finalization of rules implementing the Mental Health Parity and Addiction Equity Act. Too often, though, that work is divorced from the day-to-day realities of people with mental health disabilities, and we rarely learn about it during our treatment. What if PHP programs made it standard practice to introduce participants to their state’s Protection and Advocacy System? Perhaps people could then learn during treatment about their right to reasonable accommodations at work for their mental health disability or how to file an Equal Employment Opportunity Commission complaint. Perhaps then, recovery could be defined as a process of change through which all individuals receive the regular mental health care they need without interruption, as well as the assistance to join in collective efforts to overcome the systems that marginalize them.

The fact that I, as someone with bipolar disorder, can live and work in the community today instead of an institution, and even have the freedom to pen these thoughts, is a testament to the historical and ongoing power of the recovery movement. As National Recovery Month comes to an end, let us commit to having hard discussions about the unintended consequences of recovery as it is currently conceived. Let us challenge ourselves to set new goalposts for what recovery should be.