Community interdependence: the path to sustained recovery

The recovery movement has made wonderful progress over the past 15 years in getting people thinking about and starting the recovery journey. Our next important step is to create a pathway that enables each recovering person to sustain healing and well-being by learning, growing, and contributing to the larger community—a community where reciprocal relationships build an interdependent network of ongoing natural support.

While attending the 28th Rosalynn Carter Mental Health Symposium, a symposium with the theme, “Beyond Stigma: Advancing the Social Inclusion of People with Mental Illnesses,” I had the opportunity to participate in one of several working groups. This one, led by Ron Manderscheid, was tasked with exploring the interface between inclusion and isolation; between dependence and interdependence; and the space between past recovery achievements and the next steps needed to make recovery real in the community.

It’s not about fixing the community, or is it?

While the contributions of the group were interesting, I began to be troubled by what a number of the group members were saying. They seemed to be focused on creating community acceptance of those who are recovering from mental illnesses, and thinking about this challenge in terms of a research study design. I wanted to scream.

I didn’t want to talk about fixing communities. I wanted to talk about how people in recovery could be prepared to play valuable roles, about how they could build social capital, and about how, through a reciprocal process of give and take, they could take ownership of their rightful places in communities of their choice and, in so doing, sustain and strengthen their own recovery processes.

So, I wondered, why was this group of really smart people going down the same old path of trying to fix the community? Couldn’t they see that recovering people need to take responsibility for creating their own value in the community? (I’ve learned through painful experience that just blurting this sort of thing out would cause ME not to be part of a community, so I bounced my leg, sighed frequently, and drifted off to my own thoughts about the subject, checking back in now and again to see if anything had changed. It hadn’t.)

My colleague, psychiatrist Ken Thompson, explained to me that the purpose of the work group was to identify how we might take a population based, public health approach to behavioral health. He pointed out that Ron was asking us how we would know if a community was doing all it could to create opportunities for people to stay well through participation. Ken agreed with my assertions that people in recovery need to learn how to contribute to their communities. He even agreed that their recovery hinged on it. But he pointed out that communities need to be willing recipients ready to provide opportunities for the give and take relationships that are vital to sustaining recovery. OK, I get it.

“Ask not what your community can do for you...”

On the second day of the working group, Ron asked me to share my ideas with the group. He could see how my position could complement the work of the group. If, on one hand, we could encourage communities to become accepting and strengths-based and, on the other, we could prepare recovering people to make valuable contributions, we could lick this stigma/discrimination thing.

In retrospect, I wish I had had the presence of mind to preface my comments with the words of JFK at his 1960 inaugural speech, “Ask not what your country can do for you, but ask what you can do for your country.” At the time, President Kennedy wasn’t talking about how to sustain recovery, but in my mind, this is exactly the approach that we people on the road to recovery need to be adopting. It’s not about what our community can do for us, but what we can do for our community. When we approach the challenge in this way, we begin to create a valued role for ourselves to play: we become contributors. So long as we remain receivers, rather than contributors, we continue in a position of impotence—powerless to take ownership of our rightful position in the community.

I told the work group about my own personal “community” that I give and take with. Like many of us these days, it is more virtual than geographical. At the core of my community are my husband, my dog, our housemate and my brother. They love me and I can count on them. There is a guild of bead artists in Phoenix to which I belong.

Then, there are my spiritual associates—a random collection of people who exchange spiritual resources and support each other through all sorts of situations. Then there’s my work, which includes communities of associates from around the world who share ideas, resources, and solutions. There’s my 12-Step group that meets twice a week. I guess I can count Amazon as part of my community, since I rely on them heavily for materials and information. Google is a regular player in my life as well as a few websites that I visit regularly for various reasons.

With the exception of Amazon and Google, all of the members of my community would change the way they relate to me if I stopped being a contributor and just became a receiver. At first, they would be curious, but then they would think something was wrong with me. They would start taking care of me and may even begin to try to manage and control me. In time, my membership in the community would come into question. This isn’t a unique situation: it’s what happens when we don’t contribute to our communities.

So contribution—giving, not just taking—is not just a nice thing to do, it is imperative if we are to sustain our recovery. When we contribute in ways that cause others to value us, we tend to be our best selves because we don’t want to lose our good standing in the group. When we are valued by others, we begin to value ourselves; we relate to our strengths and we repeat them because we like the feeling of being valued. This is how we build social capital and sustain our recovery.

I finished my presentation by pointing out that programmatic efforts to advance community inclusion have often taken the form of encouraging people to take from a community at the expense of creating ways for them to give back. Taking without giving cannot support the type of interactions necessary for community interdependence and inclusion. Is it possible, I asked, that this taking approach reflects stigmatizing attitudes of those who do not believe that people in recovery have a valuable contribution to make?

Ron concluded the group by pointing out the complimentary synergy between creating communities that are safe and welcoming places to contribute, and creating abilities and confidences within people so they can contribute in ways that are valued. I learned a lot from the interchanges in the group and have continued to think hard about what needs to happen next, mostly on the side of preparing people to contribute.

Olmstead got the ball rolling ...

Let’s step back in time for a moment and trace the history of our efforts to address this situation. In 1999, two things happened that set the stage for community inclusion: The Supreme Court “Olmstead” decision, and the Surgeon General’s report on mental health. Both of these events recognized the benefits associated with community inclusion. The Olmstead decision declared that people who could benefit from community living should be able to do so. The Surgeon General’s Report on mental health took steps to operationalize the intent of the Olmstead decision. It focused on helping people recover and integrate into the community and identified stigma and discrimination as significant barriers to this integration.

These two ground breaking events put teeth into the movement to treat people in the community instead of sending them off to institutions. Then, in 2003, those teeth were sharpened by the President’s New Freedom Commission report, which declares that “recovery is possible; recovery is the goal.” This report builds a strong case for recovery being linked to community integration.

Since then we have done all kinds of things to address stigma and discrimination, but we haven’t done much to change the things that would have the most impact—ourselves. Here are a few examples to illustrate my point:

•    Our traditional approaches to treatment do not role model interdependence in the relationships staff members have with people in recovery. Implicit in the definition of integration and interdependence is mutuality—a reciprocal relation between interdependent entities that are mutually dependent. Generally, staff members do not see themselves as being dependent on the people they serve; they do not approach relationships with them from a mutual perspective. This is bound to change with healthcare reform, since people will have more power to choose where and from whom they will receive services. Staff members who create interdependent and recovery-oriented relationships with people are the ones who will continue to be employed.

•    We often create programs that separate people from the community, the place that they need to learn and practice interdependence. Instead of creating “retreats” where people can avoid the real world, we need to create circumstances where people can:

o    learn to be comfortable with vulnerability and authenticity;
o    see the value of and apply skills in giving as well as taking;
o    help and support each other, and practice receiving the same in return.

The trick is to strike a balance between the giving and the taking. Some of us know how to take, and we wear others out with our taking and neediness. Others are more comfortable giving so they can always be the strong one who knows everything. The interdependence needed for meaningful community inclusion comes from being able to do both well. Here are some skills we can role model and teach people to be comfortable with so they can become a valuable member of their communities:

•    Knowing how to give to others in ways that make us both stronger
•    Knowing how to take in ways that appreciate the giver without becoming dependent or demanding
•    Expressing one’s real self in ways that others can appreciate
•    Appreciating the uniqueness of others
•    Asking for help and support without becoming clingy
•    Offering support to others while supporting their independence
•    Recognizing one’s resentment and self righteousness that can interfere with belonging

We all want to be part of something. We want to belong somewhere. Our sense of belonging is an innate human need that has its roots in survival. If we can learn to belong and mobilize the longing we have within us to be close to others, we can begin to understand and draw from the strength of community. Belonging to any community requires not only an intention to belong, but social skills and a meaningful role to play. Once people have a role to play that has value to them and others, they have an entrance into community that reinforces an identity.

The idea of belonging is hardly a new one. In the 1600s, John Donne wrote that “No man is an island.” In 1929, Mahatma Gandhi captured a similar thought, writing that,

“Interdependence is and ought to be as much the ideal of man as self-sufficiency. Man is a social being. Without inter-relation with society, he cannot realize his oneness with the universe or suppress his egotism. His social inter-dependence enables him to test his faith and to prove himself on the touchstone of reality.”¹

No matter the words or language used, both are right. Community interdependence ought to be the ideal.

Reference
    1     Gandhi, Mohandas Karamchand. Young India, March 21, 1929, p. 93 viewed 1/3/2013 at https://www.mkgandhi.org/momgandhi/chap91.htm.