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A Sociological Approach to Recovery - Inspired by Pierre Bourdieu In examining the development of initiatives established to promote the vision that recovery from mental illness in the mental health system in Denmark from 2000-2005, I based my MA-thesis on the theories of the French sociologist Pierre Bourdieu. With this sociological approach the organizing of recovery-orientation can be understood as ways of social practising that transform traditional hierarchies between users and professionals in the mental health system. This happens especially through a strengthening of the current development of decentralized governing and users’ influence in the planning and organization of mental health services. Through a powerful symbolic construction of recovery from mental illness – proposing to abolish the focus on illness and diagnosis, users are to a certain extend conceived as individual experts on their own recovery. Thus relations of “symbolic power” within the mental health system are in some ways transformed. On the one hand the expertise and efforts of users in managing and coping with symptoms receives recognition, and on the other hand a tendency to devalue medical psychiatric expertise and treatment, and upgrading humanist professional treatment. In order to understand the impact of this development, one must consider the possibility that users who are not “judged” experts, who do not appear to cope with their symptoms or manage their psychosis, tend to be excluded from participation in the services that are currently provided in Denmark to promote recovery. The analysis I conducted for the MA-thesis shows that psychiatric modes of diagnosis play an important role in the in- and exclusion of users from the various programmes established in Denmark to promote recoveryorientation. Recoveryorientation can be conceived as a powerful tool, proposing new treatment opportunities and new perspectives of health and hope, but at the same time practically influenced by definitions of symptoms and psychosis. The founding phenomenon of psychiatry (doxa); mental illness as an individual suffering to be diagnosed and treated individually – remains relatively unchallenged. Even though, the development of recoveryorientation puts into focus the struggles between groups of users and professionals arguing for shared responsibility and legitimate influence (power) in the organization of mental health services. Thus the forthcoming challenge could be defined in terms of finding ways of “treating” and supporting social networks, through the creation of inclusive services, which do not a priori exclude users on the grounds of psychosis or lack of ability of symptom management, e.g. establishing social-help groups where the main focus is to create community, integration, activities – recovery as social integration. When the social and practical aspects of recoveryprocesses are stressed from a sociological approach, it is exposed that recovery is a personally rather unique, but not in-dependent and individual phenomenon: It is created in the practical interplay between objective social opportunities of inclusion, participation, network and so forth of every person and on the other hand the personal, subjective patterns of ideas, opinions, thought and action (which Bourdieu labelled habitus). Every time we take part in practices (e.g. self-help groups, educational recovery-programs or network therapy) where we share believes, experiences, involves our selves, we adjust, change and work on perceptions, believes and ideas, and our social opportunities of education, work, influence and participation slightly changes. Thus, recovery can be grasped as a practical phenomenon of small, but not meaningless actions, thoughts done in the social interaction with others – continuously reshaping our patterns of thought and perception (habitus). The social practices that seek to promote recovery can be viewed as productive tools of symbolic power; producing new meaning and understanding; new identities. In relation with the norm that recovery is no normalizing pressure, the (hidden) but effective norm of recovery is individual efforts and will. In line with both the perceptions of Bourdieu and Foucault such modern forms of power, function not through pressure or force, but simply through our own efforts and will to develop, reshape and work on our opinions, perceptions and patterns of action. A thorough examination of the practical strategies of working with recovery shows that recoveryorientation takes place using both traditional psychiatric norms and categorizations of illness, symptoms, psychosis etc. which can be grasped as more authoritarian, objectively defined forms of power and on the other to a wide extend make use of modern, subjective forms of power through self-definitions. Thus recovery orientation can be conceived not as a total abolishment of traditional, psychiatric forms of power but more likely as the development of practices taking place in intermediation between traditional, (psychiatric) norms of illness and normality and subjective norms of health, normality and hope. These are some of the issues exposed, when examining recovery orientation from a sociological point of view. Get an overview of the thesis in the abstract below, or download the full thesis (public pdf-version), at:
Abstract of MA-thesis on recovery orientation Inspired by previous humanist critics of the authoritarian and medical practices of psychiatry and studies of the course of mental illness, users of mental health systems and professionals assert the possibilities of recovery from mental illness. These critics contend that mental health systems are affected by a notion of mental illness as a chronic phenomenon, which is incorporated in psychiatric modes of diagnosis. Inspired by this, some users and professionals in Denmark argue for psychiatric services that are particularly supportive of the user’s efforts in recovery and more oriented towards what users regard as important in order to recover. During the last couple of years different attempts have been made in order to promote the vision that recovery from mental illness is possible in the mental health system in Denmark. The thesis "Recoveryorientation in Psychiatry" is an attempt to produce insight into how these strategies of “recovery-orientation” are carried out, and how this is related to change and reproduction of the struggles for the power to define and intervene with mental illness in the mental health system in Denmark. With inspiration from the theories of Pierre Bourdieu, this is done by constructing and examining opposing strategies related to recovery-orientation in the mental health system; which is labelled the “field of psychiatry”. The study takes its point of departure in two observational studies, one is a recovery course held by the Danish users’ organization, and the other a psychiatric unit in the Copenhagen Hospital Corporation. These two observational studies are analyzed as examples of how recovery is on the one hand introduced along with a specific psychological self-help method, and on the other hand integrated as part of the values of traditional psychiatric practices. Besides the two observational studies different kinds of empirical documents are analyzed in order to show how participants make use of different approaches regarding recovery. The first part of the analysis outlines five main strategies of working with recovery: Didactical methods of consumer based teaching, network therapy, integration of recovery as a value in psychiatric services, occupational training and courses based on self-help method. The second part shows how participants make use of different approaches associated with mental illness when perceiving recovery. The analysis reveals a struggle between views valuing the user’s experiences and efforts and psychopathological and neurobiological views emphasising the impact of mental illness on cognitive capabilities and valuing psycho-pharmaceutical treatment. The third part of the analysis examines how the strategies of working with recovery and the current regime of approaches make possible change and reproduction in relations of defining and intervening with mental illness when working with recovery. The thesis concludes that transformations occur in terms of users, therapists and nurses receiving recognition and access to positions of symbolic power when working with recovery. Furthermore, the thesis concludes that a tendency to in- and exclude users on the basis of psychopathology, combined with a tendency not to perceive recovery-orientation as a strategy of intervening with mental illness as defined by psychiatry, tend to reproduce dominant psychiatric ways of practising.
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