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This is the pre-print author’s copy of the book review published as
Coffey, M. (2010) Book Review of Slade, M. ‘Personal recovery and Mental Illness: a guide for mental
health professionals’ in Journal of Psychiatric and Mental Health Nursing, 17(8): 757-758.
The final and definitive version can be found by the following the link below
http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2850.2010.01567.x/abstract
Book Review for Journal of Psychiatric and Mental Health Nursing: Personal Recovery and Mental
Illness: a guide for mental professionals by Mike Slade, Cambridge University Press ISBN
978052174658 pp275. Price £35.00 ($63.00)
Recovery…it’s a word weighed down with much expectation and a desire for something different
than that currently available in mental health services. It is a word that should perhaps be heard as
an optimistic and positive clarion call to those working in mental health and those using these
services. It seems too to cause much bewilderment, scepticism and confusion and has led many
researchers to grapple with the task of elucidating the different forms of meaning attached to the
term.
Recovery in at least one of its guises is something that people do and which workers can facilitate.
However, much opinion suggests that mental health services, as currently configured, actually work
against achieving recovery. That is, people recover in spite of services rather than because of them.
As a mental health nurse I have often struggled to reconcile this reality with the motivation of
wanting to help people that prompted me to enter the profession more than 25 years ago. It
appears true to say that many workers are bedevilled with a form of therapeutic pessimism.
Socialised perhaps into thinking and acting as if people with mental illness are forever condemned to
a life of low expectations, vulnerability and discrimination, workers in some circumstances can
appear to have largely given-up hope. Workers may even be settled into a cosy professional world
where it is a lot easier to claim ownership of one particular version of reality and ignore the more
challenging task of helping people regain their independence, build their self-esteem and ultimately
achieve lives where mental illness is only one small part of who they are, rather than their central
identity. Despite the promise suggested by moves towards community care and more libertarian
ideals of participation and involvement, it appears that the underlying ethos of care and treatment
remains largely unchanged since the advent of the asylums almost 200 years ago. I paint a gloomy
picture, I know. To be fair, it can be said that many workers are genuinely interested in helping
people (even if the way they do this itself perpetuates a fundamental error in the system) but are
often hampered themselves by the very organisation that is meant to provide care (Fadden, 1997).
For the last 20 years or so, there has been a steady flow of papers published by both people with
mental ill-health and researchers across the globe that have challenged these traditional pessimistic
views of mental illness. They remind us that recovery is a possibility and a daily occurrence for many
people. It involves, as Koehler and Spaniol (1994) indicate, a process of recovery from the illness and
in tandem, a recovery from the consequences of the illness.
The increased interest has prompted an upsurge of activity in researching and writing about
recovery in an attempt to capture and describe more clearly what this elusive concept actually is,
and how it can best be developed. At the start of his excellent book, Mike Slade unashamedly
argues that his is an attempt to convince, crystallise and catalyse workers to engage with the notion
of recovery and grasp the possibilities promised by recovery-oriented services. He does more than
simply this however; he shows too how it can be accomplished.
This book is organised into four sections. First the context of recovery is addressed by outlining the
nature of mental illness in relation to clinical, disability and diversity models of understanding. Slade
deals with these even-handedly, critically even, so that the merits and deficits of each model as he
sees them, are laid bare. He eschews easy or trite conclusions and in this way his style invites you to
read further and explore for yourself the extended task of creating new understandings about the
complexity of health and social care provision. In recognising the tensions around the word
‘recovery’ Slade proposes a distinction between clinical recovery – in the sense of a medical cure,
and personal recovery- a highly individualised process of rediscovering and rebuilding a sense of self
as separate from the illness. It is perhaps not a new observation and whether it works for the
purposes of exploring the concept of recovery is perhaps down to individual preference. I can see
the benefits of the distinction but was less sure that this achieved an adequate reflection of the
changes in thinking required by service providers in re-orienting provision towards a recovery idea.
Slade’s argument is that attempts at clinical recovery can be toxic and contribute much to the misery
of the mentally ill. Indeed this seems to be correct for a significant group of those in contact with
services. His distinction between clinical and personal recovery works here however to allow him to
make the case for a primary focus on personal recovery in which clinical recovery is just one part of
the process.
In the second section of this text Slade outlines chapter by chapter what he calls ‘five justifications
for giving primacy to personal recovery’ (p.43). Here in careful detail he presents a highly-reasoned
and well-supported case for epistemological, ethical, effectiveness, empowerment and policy
rationale. Slade makes his case with scholarly ease, grounded in a deep understanding of the
intricacies of professional knowledge. He is not afraid to court controversy either, referring at one
point to risk management in mental health services as discriminatory (p.177), while noting the
disproportionate attention and calls for compulsion and control directed towards those with mental
ill-health. Slade instead proposes a more balanced approach which goes against the risk-aversive
trend in mental health services so that people are supported in their positive risk-taking.
By far the largest section of the book is given over to fifteen chapters on what is required of
recovery-focused services. Those familiar with the recovery literature will see many recognizable
themes here, but for the most part Slade attempts to keep his focus on the practical, that is on what
can and should be done. From chapters on relationships to self-management he provides the basis
for workers to get to grips with an understanding of recovery that they can use to inform and
develop their practise. His recognition of gaps in the evidence-base may also prove useful for those
keen on researching in this field. This section also has some curious choices and omissions. So for
instance a very short chapter on spirituality which Slade feels is crucial to a recovery vision but little
on ethnicity and culture, or even sexuality. Perhaps these are subsumed under the discussion on
identity, but then one wonders why not spirituality too? The last section of this text does not duck
the challenges of delivering recovery but instead rises to them in outlining seven actions that seek to
transform mental health organisations into recovery-focused services.
Running through this text there is a thread of twenty-six case studies drawn from the authors study
tour of international mental health services. These case studies serve to enliven the text and
demonstrate real world application of the concept of recovery. Reading through them one gets a
sense of the potential of recovery to truly transform the lives of people, that is those with mental ill-
health and by extension those working with them.
Slade however is no idealist. His book is grounded in an understanding of the challenges faced by
unconvinced or demoralised workers and services entrenched in traditional practices. His text is in
many ways a direct challenge to address the organisation and delivery of mental health provision so
that it more directly promotes and sustains the possibility of recovery and affords people the
opportunity to live ordinary lives.
This is a slim but densely packed book. The cost may put-off a wider readership but the content
should not. It deserves to be read and find a place on the bookshelf of every mental health team. It
continually rewards a chance dip into its pages. As a source text it will be invaluable to those
teaching and learning about the subject and also teams interested in re-aligning their working
practices. Its scope is wide and one would hope its reach will be long.
References
Fadden G. (1997) Implementation of family interventions in routine clinical practice following staff
training programs: a major cause for concern. Journal of Mental Health. 6(6): 599-612.
Koehler, M. and Spaniol, L. (1994) Personal experiences of recovery. Boston. Center for Psychiatric
Rehabilitation
Michael Coffey, PhD, RMN
Lecturer
School of Human and Health Sciences
Swansea University
