xxAACP Newsletter, Volume 12,
Number 2, Spring 1998
Editor's Column: Recovery and Responsiblity
Recovery in the addiction community has its roots in the twelve step movement. It became clear to the founders of Alcoholics Anonymous that beating back the disease of alcoholism was much more than establisheing abstinence. Many of the slogans and concepts developed through the twelve step movement originate from the recognition that addictive disorders create thought processes and conditioned responses that have far greater power than any physiologic manifestations of dependence. There was also recognition that alcoholism, and subsequently other addictions, were illnesses without cures, that once affected by the disease, individuals would always be affected by it. This gave rise to the first step which tells addicts that they must accept their powerlessness over the illness ... that they cannot change their disability any more than the amputee can grow a new limb.
With this recognition came another, that changes in thinking and life management were required to control the impact of the illness on the addicted individual. People with these illnesses must come to understand that they must manage their illness if they hope to establish or re-establish a productive life. While in active addiction, obligations and discomfort are actively eschewed and blame for the resulting lack of effectiveness is placed externally. Recovery can only be attained as the individual learns to understand and embrace personal responsiblity and the challenges that come along with it. The people and thoughts in addicts' lives which enabled them to escape responsibility are the enemies of recovery and obstruct the establishment of dignity and hope. Recovery became an active process, internally driven, but relying on the wisdom and support of others to establish its stability.
The concepts developed by Recovery Inc. have many similarities to those developed by the addiction community, most notably in the area of personal responsibility for change and coping with illness. The emphasis on changing thought processes is striking in its resemblance to cognitive-behavioral therapies, rational emotive therapy, and the homespun wisdom of the twelve step formulations, although it originated independently. Its reliance on peer support rather than professional dependence is a feature that has a reiteration in more recent developments within the consumer movement.
Recovery processes have recently become incorporated into the thinking of the mental health services consumer movement, and have been adapted to the unique circumstances of those persons who suffer from mental illness. The consumer/survivor movement has arisen from the tradition of paternalism in the mental health treatment community and, frequently, coercive treatment. Persons with severe mental illness have often been infantalized and considered too impaired to meaningfully participate in decisions about their lives and treatment. Here again, the concept of powerlessness seems to have some relevance, but in a very different context. For many in this movement, acceptance of powerlessness is antithetical to the establishment of healthy and productive lives. Empowerment has, in fact, become one of the organizing principles for the concept of recovery in the mental health community.
Is there a common thread that runs through the various conceptualizations of recovery and how can the seeming paradox between powerlessness and empowerment be reconciled? The ability to take on responsibility for the management of one's life and one's illness would represent the major theme of the recovery play. In this drama, regardless of who the actors may be, one must break free of the bonds which impede growth, change, and self sufficiency. In this process, there needs to be a recognition that the challenges will be great and discomfort will inevitably be part of the script. The dramatic moment arrives with the recognition that from self discipline comes liberation.
While the ideas of powerlessness and empowerment appear contradictory, they both have significant roles in recovery and must be negotiated simultaneously. Accepting powerlessness over one's illness implies the recognition of a problem of disability, and the impossibility of getting a new set of cards in the middle of the game. This process requires surrender of any grandiose fantasies that illness does not exist or that it is not a force to be reckoned with or that it can be controlled individually. In the addiction tradition it has always implied an understanding that one must rely on forces greater than one's self to regain control of life. Ironically, this surrender leads to renewed potency and the process of accepting assistance establishes independence. One must give up control in order to achieve it. Power is conferred not by the treatment community so much as by entry into the fellowship of peers engaged in a mutual struggle.
The contradictions of the recovery process are often sources of confusion, but the complexities of this process parallel the complexities and contradictions of a life which is engaged and vital. As such, it is an aspiration that is unifying in its universal applicability. We don't need to have a DSM-IV diagnosis in order to recognize those things we fear and attempt to avoid confronting. We don't need to have a drug addiction to understand the difficulty of accepting responsibiliy for shaping our lives rather than clinging to passivity.
I had the pleasure recently of participating in day long dialogue between consumers and mental health professionals that took place in Pittsburgh, as one of many sites across the country. Although many of us started the day caught in old stereotypes regarding our roles, most of us did begin a recovery from that dependence and started the process of understanding our similarities rather than our differences. Clearly, we must all take responsibility for healing the wounds that have resulted form old conceptions of health and illness. Once accomplished, we can relish the liberation that inevitably accompanies a recovery such as this.
Wesley Sowers, MD
Editor
sowers@connecttime.net
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