partial recovery, full recovery, and “better than well”

December 11, 2022
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Experiencing Recovery, 2012 Norman E. Zinberg Memorial Lecture, William L. White

…historically the mental health field has had a very well-defined definition of partial recovery but literally no definition, until very recently, a full recovery from severe mental illness. We now have long-term studies of the course and trajectory of schizophrenia and bipolar disorder, for example, that are really challenging that, and really beginning to signal the emergence of the concept of full recovery from some of the most severe complex psychiatric disorders.

On the addiction side, in contrast, we’ve had a very well-defined—a reified, if you will—concept of full recovery and no concept of partial recovery. In fact, it’s almost heresy to even begin to talk about a legitimized concept of partial recovery within the addictions field.

There’s a third concept within this framework that Ernie Kurtz and I ran into. We began to find scientific evidence in lots of anecdotal reports from therapists about people who got better than well. What I mean by better than well is that these are not people that we simply extracted the pathology out of their lives, but these are people who, not only went on to recover, but they went on to live incredibly rich lives, in terms of the quality of their life and service to their communities, and these are people who would later begin to talk about addiction and recovery was for them a blessing.

Experiencing Recovery, 2012 Norman E. Zinberg Memorial Lecture, William L. White

As Bill points out, there was a time when full recovery from addiction eclipsed partial recovery and was used to delegitimize partial recovery.

During this time, mental health advocates felt limited and trapped within a system that felt no obligation to facilitate (or even hope for) full recovery. They clamored for a system of care that would offer pathways to full recovery.

There’s considerable energy around models of partial recovery from addiction, but there is resistance to distinguishing between types of recovery, which results in tension between full and partial models. It also makes it difficult to discuss the quality of life implications for these types and explore the varieties of endpoints patients may seek and treatment/recovery models may be associated with.

I think the fear is that distinguishing between types represents a return to the delegitimization of partial recoveries. That is a risk. But, failure to distinguish comes at the expense of the opportunity for people to make informed choices about their recovery pathway and its implications for what they want in the other spheres of their lives. It also precludes exploration of pathways to that “better than well” (or, transcendent) type of recovery.

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