Disease management asks you to make changes despite who you are. The recovery model invites you to change because of who you can become.
The disease management model stains your identity with “what you got.” The recovery model liberates your identity with what you can overcome.
In the disease management model you are the source of deprivation. In the recovery model you are the source of strength.
Both see the reality of distress and misery in life although their accounts of it may widely differ. Only the recovery model sees the reality of transformed life.Identity is a major key in life.
Everything from the car we drive to the food we eat to the clothes we wear is sold on the basis of what it says about the kind of person we are. The identity of mentally ill is for many a “spoiled identity. ” It is not something likely to win many hearts. As one friend said, “If the mental health system sold cokes we would all be drinking pepsi.”
For an industry devoted to helping people change psychiatry (disease management) has precious little idea why people change. They believe that is simply a matter of giving the information about what someone needs to do in an expert fashion and they will do it. If they dont then they lack motivation. And if they are chronically unmotivated then, according to the “gunslinger” wing of psychiatry you threaten them till they see the error of their ways and show they will behave.You couldnt even sell toilet paper like that.
It is a significant problem in the mental health system that many of the people it serves just dont buy into it. For many people the problem is not that they dont know they have a problem. Its that the system that serves them doesnt know it does. You frequently hear people talk of the lack of insight people with mental health issues. Maybe the problem has less to do with the identification of the problem and more to do with a lack of faith in the solution.
This is from an earlier post:
Many people find the mental health system intolerable or even useless because of what they believe it says about the kind of people they are. The mental health system makes sense of mental health issues in such a way that it speaks predominantly about the “judgement of mental illness.” It tells them the most they can expect is a diminished life dealing with a life long affliction that will probably only get worse. It tells them they will be forever dependent on professional treatment and often that they will have to take medication for the rest of their life. The medication helps many, but for many others doesnt work nearly as well as advertised and in fact has side effects that are dangerous and drastically affect the quality of daily life. The disease concept is justified as a way to tell people it isnt their fault, but fault or not, leaves many feeling that their lot in life is to be forever left out of good things and marked as somehow deficient and not as really human as other people. If they accept this “judgement” for many it also means they are in danger of being treated with prejudice by those around them and perhaps excluded from relationships and groups they formally were part of. They also find that many of the people who try to help them are suspicious of their commitment to making a better life. They tend to believe that “mental patients” cant be trusted and really dont want to change. They talk about some people as “frequent flyers” and often dont believe the people they are trying to tell to change are likely in the end to do the things necessary to change.
For some people a lack of faith in the value of the message of the medical or disease management system is a statement of faith in their own value.The recovery model does not minimize the distress or misery someone lives in. Neither does it romanticize unhappiness. But what it also doesnt do is minimize the chance of life getting better. It knows bad times are real.
It just doesnt believe bad times need be the only real times. Part of its narrative is the story of countless others who have made it. It is an identity of success, connection and community. The medical model tries to sell a model of chronic failure, isolation and loneliness. Its no contest.
How many people find in the message that the disease management system gives them that life has purpose and possibility, that they have the capability to find it and build on it, that people care for them and welcome connection to them, that they belong and that they are more than what is hard for them to do? How many living within the system feel like what is important to them is important and that this is an opinion shared by the people who provide help to them?
Identity is a crucial distinction between the medical model and recovery model. And so much of life is simply a function of the person we believe ourself to be and the person we feel it is possible to become.