Catching the wave

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‘A people are as healthy and confident as the stories they tell themselves. Sick storytellers can make their nations sick. And sick nations make for sick storytellers.’ Ben Okri, Birds of Heaven.

Alistair sinclair WEB. jpgThis was a quote I threw into the room when I presented to DDN’s national service user conference in Birmingham in February – because I believe we live in a sick nation, full to the brim with sick storytellers who dominate our mainstream media and political discourse. It’s a reflection of the deficit world we live in. A world of needs and gaps and experts that is increasingly apportioning blame to the other, the alien, the vulnerable, the undeserving poor, whether that be the Muslim, the immigrant, the benefit scrounger, the homeless or the drug user.

We live in times of great fear and anxiety, times of austerity, and this narrative, this story, now permeates every aspect of our lives. The wealthy and privileged, rather interestingly, have got richer during these times as they’ve retreated even further into their gilded gated communities. Meanwhile the poor have got poorer and the ‘squeezed middle’, those hard-working families, anxiously scrabble to hold on in this era of zero-hour contracts, flexible working and creeping neo-liberal privatisation.

We live in interesting times, and in Birmingham I offered a perspective that I’m sharing with you now. It’s a perspective that seeks to place ‘recovery’ within a historical context, and position the future British ‘recovery movement’ as something with the potential to be positive, inclusive and, rooted in the promotion of social justice, truly transformative.

I’ll start with a little recovery history. There are many who recognise recovery as a term within the 12-step movement going back 79 years, and others who think it popped into treatment land with the drug strategy in 2010. As Larry Davidson from Yale University illustrates in The Roots of the Recovery Movement in Psychiatry (2010), recovery’s roots as a service orientation (putting aside recovery within communities for hundreds of years) can be traced back to 1793 and the groundbreaking work of Philippe Pinel and Jean-Baptiste Pussin.

In recognising the importance of mutual aid and a meaningful life, giving jobs to the inmates of a Paris asylum, Pinel and Pussin lay the foundations of the peer support we see today. In the US, Dorothea Dix (1840), a tireless advocate for the mentally ill within prisons and Jane Addams (1889), the founder of the resettlement movement, were instrumental in advancing the notion that healthy environments promote health, and their work emphasised the key importance of ‘living with’ and ‘doing with’ in communities as opposed to the usual defaul deficit setting of ‘doing to’.

The psychiatrist Adolf Meyer (1900) went on to make a number of significant observations which at the time – and perhaps still today, in some quarters – were regarded as radical. People can and do recover; even those in the midst of illness possess valuable strengths and it’s our interactions in the social world, in the everyday, that are key to recovery.

The founding of AA in 1935, with its emphasis on mutual aid and self-help, has major significance in this recovery history, as does the civil rights movement of the 1960s and the consumer/survivors/ex-patient movement of the late 1980s and early 1990s. Phil Hanlon, professor of public health at the University of Glasgow, outlines another kind of history in his book The Future Public Health (2012), which I believe also has deep significance for the British recovery movement. He suggests that there have been four waves of public health, which have brought significant improvement to health over the last 184 years.

Each new wave begins while the previous wave is at its peak. The first wave of public health (1830-1900) saw the rise of ‘classical public health interventions’ – a recognition, before the science caught up, of the importance of clean water and sanitation. In this period we see the growth of municipal power and influence, and the beginnings of the rise of the ‘expert’. The second wave (1890-1950) sees the continued ascendency of the expert, the flowering of ‘scientific rationalism’, expansion of hospitals, health visitors and the germ theory of disease. The third wave (1940-1980), born of a deep demand for change and a post-war consensus, sees new forms of social solidarity and collective responsibility leading to the creation of the NHS, the welfare state and social housing. While the fourth wave (1960-2000), which also sees the rise of neoliberalism (perhaps a partial response to the third wave?), focuses on individual risk factors and lifestyle issues.

These four waves have had a significant impact on health and continue to do so. However Hanlon is very clear, as are many others in the fields of public health, economics, environmentalism and politics (to name a few), that we are now, all of us, in an age of crisis, staring into the abyss and facing the ‘challenges of modernity’. Across the developed world and increasingly in the ‘majority world’, people are getting sicker in increasing numbers. As communities continue to fragment and social ties fray (something Bruce Alexander describes eloquently in his book The Globalization of Addiction: A study in poverty of the spirit, 2008), levels of unhealthy dependency – drugs being just one among many – and mental distress are rising dramatically.

Needs are rising and resources are dwindling. Hanlon contends that currentinterventions are failing to address societal issues because they are grounded in an acceptance of cultural norms that are fundamentally part of the problem: ‘economism (the belief that money will sort things out), individualism, consumerism and materialism’ – all of these driven and sustained by the deficit world we live in. Modern society is unequal, inequitable and unsustainable, says Phil Hanlon in The Future Public Health.

It’s not all doom and gloom and this, I believe, is why the British recovery movement, if it learns from its history and puts social justice at its heart, has a major role to play in the response to this crisis of modernity. Hanlon suggests there is a need for a ‘fifth wave of public health’ which will challenge the rampant individualistic consumerism that underpins a dominant economic model based on endless growth – a model that is taking us, as I commented in Birmingham, ‘to hell in a hand basket’. While we have been encouraged to focus on the ‘canaries in the mine’, those who are the first visible casualties of a sick society, fixing them and returning them to productive life, we have been discouraged, interestingly, from looking at the mine itself. So while we rebrand and tinker at the margins, all of us ‘users’ within a dysfunctional system, we remain silent as to the really destructive addictions.

As George Monbiot put it in the Guardian on 27 May, this issue is ‘the great taboo of our age – and the inability to discuss the pursuit of perpetual growth will prove humanity’s undoing… The inescapable failure of a society built upon growth and its destruction of the Earth’s living systems are the overwhelming facts of our existence. As a result, they are mentioned almost nowhere. They are the 21st century’s great taboo, the subjects guaranteed to alienate your friends and neighbours.’

Hanlon believes that our current system, with its acceptance of modernity’s ‘norms’ and overriding emphasis on the objective (evidence and science) at the expense of the subjective (the many meanings found within the ‘I’ and the ‘we’) is failing. He calls for new ‘integrative’ approaches that will bring the subjective and objective together on equal terms, valuing the stories and wisdom found within families, neighbourhoods and communities. He suggests that we need new approaches that are ‘creative, ecological, ethical and beautiful’, which will reintegrate ‘the good, the true and the beautiful’ – grand language that needs to be turned into reality within communities, which is where I believe the British recovery movement comes in.

In positioning ‘recovery’ as the ‘remaking of meaning’, and a shift from a deficitbased world to new strength-based ways of being, it is possible to see the movement as central to the search for the ‘good, the true and the beautiful’. Where else would you start if not with those who still struggle in this deficit world, with the people who are trying to recover, with the ‘canaries’ and with the people who have managed to ‘remake’ themselves? Where else will we find the wisdom and the learning that will enable us all to deal with our damaging dependencies?

Which is why the UKRF is promoting a recovery month in September that supports movement toward a strength-based world founded on community resilience and potential; a month that will write new hopeful stories. And it’s why we’re gathering in Leicester on 26 September at an event entitled ‘Creating Narratives for the recovery movement: the good, the true and the beautiful’. We believe we will make the path by walking it. So we’ll do a little walking together. I hope some of you can join us.

Alistair Sinclair is UKRF director. The UKRF’s event, ‘Creating narratives for the recovery movement: the good the true and the beautiful’ is on 26 September in Leicester. Details at www.ukrf.org.uk