The recovery model from the perspective of its protagonists
In 1993, William A. Anthony published the article " Recovery from Mental Disorders: The Guiding Vision of the Mental Health Services System in the 1990s " in what was then called the Journal of Psychosocial Rehabilitation. In it, Anthony defined the concept of recovery as centered on the possibility of living a full life despite experiencing symptoms. The use of the term "recovery" implied an intentional polysemy, described in the same work. It is simultaneously a subjective and idiosyncratic process, a proposal for a new objective of mental health interventions, and a strategy for large-scale service transformation.
In this first manifesto, Anthony lays out some fundamental principles that mark the beginning of the movement. First, he emphasizes that recovery can occur without professional intervention. Therefore, it is important to understand how recovery processes unfold beyond the confines of treatment services. Furthermore, a common denominator in recovery processes is social support , and thus he proposes greater community involvement.
Despite this emphasis on the social aspect, recovery goes beyond the debate about the biological or psychosocial origins of mental disorders. In fact, some people recover (that is, manage to lead a meaningful life) from purely social problems (e.g., exile) and from biological problems (e.g., paraplegia).
Recovery is possible even with symptoms, just as the people in the previous examples (exile and paraplegia) cannot return to their place of origin or walk again, but can recover a life project within those limitations.
Recovery in mental health, in contrast to the concepts of cure or remission, sometimes even involves an exacerbation of symptoms, since for people who have been deprived of a full life, returning to daily life can be difficult, but necessary. Therefore, recovery is not linear; there are ups and downs that are part of the process. The main thing to understand is that for many people, the worst part is not the fluctuations in symptoms but the social consequences. The disorder is real, but we must give each person an opportunity to live life, even with limitations, just as we do with other disabilities. In fact, one of Anthony's most famous quotes is, "No one would be considered too blind to learn Braille."
The principles formulated by Anthony present a profound critique of the care system. While the role of mental health professionals should be to facilitate processes by which people overcome their limitations, the very structure of the system and many of the interventions within it exacerbate those limitations. Therefore, the proposal is for a new system with a more empathetic relationship with service users, one that considers their needs and aspirations beyond symptoms and diagnoses. The usefulness of psychotherapy and medication is not questioned, but rather these tools should be placed on the same level as fostering activities and interests chosen by the service user themselves. It is not simply a matter of incorporating recreational and social activities—this was already being done 30 years ago—but rather of ensuring that the people who will participate choose the activity and are involved in its organization. Nor is it about ignoring people's suffering, but about organizing the system around individual and collective needs instead of the diagnoses people receive.
An implementation with disagreements
Nearly 30 years after the article's publication, the recovery model has been partially implemented in the mental health systems of dozens of countries. This process has not been without controversy. As with other transformations, recovery as a model and movement has not been free of tensions between the capacity for large-scale implementation and the ambition to achieve the complete emancipation of service users. These disagreements have included resistance from professionals who did not understand the need for a change in the model or who believed their practice already incorporated most of its elements. But they have also included resistance from activists who felt that large-scale implementation had "colonized" the term without truly understanding its transformative intentions or even using it misleadingly. However, no one can deny that the model's emergence marked a turning point in the care received by millions of people.
Ino Moya García
One of the defining characteristics of the recovery model has been the participation of service users and their families in the design of services and interventions. This participation has empowered many people and even led to the integration of individuals with experience of mental illness who have recovered—that is, who live fulfilling lives regardless of whether they experience symptoms or not—into the healthcare workforce.
Drawing on the lessons learned from the long tradition of mutual support groups in mental health and addictions, these individuals, in addition to possessing a privileged capacity for understanding and empathy due to having been in the same place as the people they accompany, serve as a model for other people who are going through other stages of the road to recovery.
In this special issue, we want to give voice to the experiences of service users, their families, and mental health professionals who have been involved in the implementation of this model. We give a platform to people who will talk about support, self-management, training, and other elements of building a new reality in the field of mental health care.
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