Inequality as a test of strength…?

Notions of recovery and resilience are ubiquitous at the moment. Resilience particularly seems to have made the jump from a concept in positive psychology material into a mainstream policy objective ranging across inequality, poverty, and community wellbeing (to name but a few). For example, the Young Foundation are working with MIND (a national mental health charity) on a ‘resilience in the community’ programme aimed at developing successful interventions for older men who are unemployed. So far so good you might be saying and we would certainly agree with the idea of engaging an excluded group. But there are a number of problems with all this talk of recovery and resilience. We argue that these approaches can function to background the role of social, political and economic exclusion in fostering inequality, the very forces they are claimed to address.

We identify three key problems. Firstly, these models are often blind to wider issues of social, political and economic inequality; instead they tend to identify deficit and the more positive resilience as a property of the excluded individual, rather than the wider society. Consider the oft-cited definition of recovery provided by William Anthony.

‘A deeply personal, unique process of changing one’s attitudes, values, feelings, goals, skills and/or roles. It is a way of living a satisfying, hopeful and contributing life, even with limitations caused by the illness. Recovery involves the development of new meaning and purpose in one’s life,’

In this definition witness how the impetus is placed on the individual to change how they think and behave (in a deeply personal and unique process), the implication being that their current attitudes and behaviours are inappropriate. Witness the further assumption that their current lives will be unsatisfying, lacking hope or contribution. Notice how the definition involves the passive acceptance of an illness. All of this framing imputes a deficit model into the definition. Furthermore, this deficit is painted as a negative character trait that must be changed. This is the second problem. Whilst claiming to draw from a more positive conception of mental health/emotional distress/psychiatric diagnosis the model continues to be framed by a deficit model, but it is a deficit model that is cast in relief against the more positive individual strengths based approach. As the Australian narrative therapist Michael White puts it “people would not understand their difficulties in life as expressions of weaknesses and deficits if there were no strengths and resources “.  Again, this is not to say that some degree of individual change might positively affect the situation of someone with a psychiatric diagnosis, but there is a problem in this contradiction in that it does not offer the radical departure from deficit approaches that it claims. Rather deficit is recast as a negative individual property which is amenable to individual change.

The third problem, again already touched upon, is that this approach obscures the links between distress and questions of social justice. This individual, deficit-reliant strengths based approach makes the idea of collective political action against poverty and inequality difficult, as issues of inequality and poverty are not framed as part of the problem. There is, as David Smail has argued, an implicit (or indeed explicit) assertion that people “can simply change through force of will despite countervailing structural factors”.

The origin of recovery as a concept is blurred and muddied. A number of commentators portray the recovery movement as emerging from the psychiatric survivor movement but it is a little more complicated than this.  Whilst survivors like the American psychologist Patricia Deegan utilised this notion, she was contrasting it with traditional — arguably more pessimistic — approaches in psychiatric rehabilitation.  This notion was taken up by professionals in the 1990s and is now a cornerstone of mental health policy in a number of countries.  A number of survivors have taken up the recovery model as they see it as providing an opportunity to reform mental health services.  However, if we reduce the history of the survivor movement to a focus on recovery we risk neglecting other important aspects of the survivor movement and the attendant policitical struggle.  An important contribution of this wider political struggle took the individual experiential nature of emotional distress and contrasted it with a medical checklist of symptoms which failed to acknowledge the person, seeing only the diagnosis. However, and this is important, this personal aspect was explicitly coupled to a political struggle, echoing Hanisch’s assertion that the ‘personal is political’. Within this survivor model of recovery, it was possible to address relations between the individual and the wider social, political and economic context. Moreover, whilst the recovery model tends to focus on the individual as the locus of change, the survivor movement emphasised the importance of people working together as a collective. By reducing the insights of the survivor movement to the recovery model we run the risk of blunting this radical edge, such that recovery comes to be about an individual strengths model, where people’s situation will only improve if they can be more resilient in the face of adversity (internally, if not externally).

There is some merit to the recovery approach, in terms of progressive politics. There is clearly a need to engage with any number of disadvantaged and excluded groups. Our concern is that without suitable critique and awareness, the utilisation of strengths based recovery and resilience models takes us too far away from the social, political and economic context, meaning we become stuck in a loop of ongoing individual transformation without the necessary attendant emphasis on collective action and on social, political and economic transformation.

This post is adapted from a recent article that appeared in the open access journal ‘Studies in Social Justice’.

About the Co-author: David Harper is reader in Clinical Psychology at the University of East London. He is a member of UEL’s Psychology and Social Change Research Group, Centre for Narrative Research and the Centre for Systemic Therapy Research. He is also a member of Psychology, Politics, Resistance, the Manchester Discourse Unit, the Soteria Network and Scientists for Global Responsibility and is part of the Advisory Group of the London Hearing Voices Project.