What Does it Mean to “Get Better?”

For six years I struggled with an eating disorder before making the decision to pursue treatment. After that it still took another year and a half before I considered myself to be in recovery. I didn’t wake up one day and realize that I no longer had an eating disorder anymore; it was a slow abatement of the features of the disorder, which plagued me for so many years, as a result of a combination of nutrition counseling, support groups, psychiatric medication, therapy, and resilience.

Because recovery in mental health is an ongoing process, it can be difficult to recognize what it actually looks like. Sometimes recovery happens so gradually that we’re not even aware that our minds and bodies — because our bodies can also suffer when we are struggling with a mental-health issue — are in the process of healing. That can make it difficult to be able to answer the question: “how will I know when I’m actually better?”

The History of “Recovery”

According to the Substance Abuse and Mental Health Services Administration (SAMHSA), “recovery is a process of change through which people improve their health and wellness, live self-directed lives, and strive to reach their full potential” in four areas: health, home, purpose, and community.

Mental health recovery does not necessarily mean a total relief from symptoms or a return to pre-diagnosis status quo, and it also does not necessarily mean simply tolerating or “learning to live with” the symptoms of a mental disorder, though this may be the case for some people. When it comes down to it, the definition of recovery has changed over time, and recovery can look different for different people.

Historically there was skepticism about whether recovery from a mental illness was possible, even from mental health professionals. Those struggling with mental-health issues were hospitalized or institutionalized in asylums, or returned to their families with the expectation that they would be a “burden” on their loved ones for the rest of their lives.

It was the advent of talk therapy, pharmacological treatments, and other evidence-based practices for mental disorders that advanced the belief in the concept of mental health recovery and mitigated the hopelessness that followed diagnoses.

The Recovery-oriented Model Today

Mental-health professionals approach recovery very differently than they did decades ago.There are, however, measures used to define recovery today that can still be problematic and that perpetuate stigma.

Looking at the recovery process as an entirely linear path can only lead to disappointment. It signals to those who live with mental illness that if their recovery doesn’t mirror that of others, then they haven’t “recovered,” or aren’t making progress.

Even for some of the most stigmatized, difficult to treat mental illnesses, diagnosis is not a dead end.A long-term study from 1987 found that up to 65% of those diagnosed with schizophrenia who went through a ten-year comprehensive treatment program had progressed significantly or recovered in areas of symptom severity, self-efficacy, social relationships, and work.

This was a major realization for mental health treatment providers who, more often than not, predicted poor outcomes for people with schizophrenia. Many of these individuals may live differently than they did before being diagnosed with schizophrenia, but they were still able to find meaning and significance in their lives after diagnosis.

Mental-health professionals Gretchen Grappone and Melinda Fox write in Evidence-based Mental Health Practice that it is crucial for anyone with a tie to the world of mental health to “take the time to contemplate recovery and our personal or professional reactions to it.…Progress toward recovery is not simply about reducing the symptoms of a mental illness, but also about regaining or attaining meaningful roles, relationships, and activities.”

At the forefront of all of this lies hope — the belief that recovery really is possible — from both the individual who is struggling with mental-health issues as well as their therapist and loved ones.

Recovery Takes All Forms

In my work with my own clients, many of whom struggle with chronic or persistent mental illnesses, recovery may look like taking medication, engaging in weekly psychotherapy sessions, pursuing supportive housing or other public benefits, or joining a community or support group of individuals who are struggling with similar issues. But most importantly, recovery is achieving a level of personal, professional functioning that supplies you with a life that gives you meaning.

As I periodically reflect on the personal journal from my own recovery process, I see that only gradually was my eating disorder no longer a daily struggle. I had fewer symptoms, and I had better tools to manage those that remained. My relationships improved, I made better and healthier decisions, and I felt more like myself.

Some people with mental-health issues may experience their symptoms more acutely, or they may feel completely “back to the way they were” before they were diagnosed with their mental illness. I still have thoughts about food or my body that are leftover from the days during which I struggled, but I am able to reach for the coping mechanisms I developed in therapy to keep these thoughts in check.

These thoughts may go away entirely one day, or they may not; that does not mean I’m not still in recovery. You’re in recovery when you say you’re in recovery — and the path may meander.