The pedagogy of recovery colleges: clarifying theory

Citation

Oh, H. (2013), "The pedagogy of recovery colleges: clarifying theory", Mental Health Review Journal, Vol. 18 No. 4. https://doi.org/10.1108/MHRJ-07-2013-0026

The pedagogy of recovery colleges: clarifying theory

Article Type: Editorial From: Mental Health Review Journal, Volume 18, Issue 4.

The first Recovery College in the UK was pioneered in 2009, and has since been replicated with enrollment reaching the hundreds. At Recovery Colleges, students register for an array of classes that include: maintaining residency, dealing with debt, living with bipolar, understanding psychosis and schizophrenia, among other topics. As an alternative to the debilitating and paternalistic nature of traditional psychiatric care, Recovery Colleges emerged as a more empowering model of service provision (Perkins et al., 2012). While I agree that education carries certain advantages over therapy, I want to make clear that Recovery Colleges operate according to a specific kind of education, not the conventional pedagogy found in most classrooms and lecture halls. I believe proponents of Recovery Colleges acknowledge but never explicitly articulate this point, and so in this commentary, I intend to briefly discuss the history of the education model in recovery, and distinguish emancipatory education from what is normally found in places of learning in order to clarify the ethos of Recovery Colleges.

The history of education and recovery

We in the field of mental health seldom think of the work we do as pedagogy; however, educators for quite some time have observed the similarities between therapy and teaching (Cohen, 1988): both activities are concerned with human improvement, which is profound, complex, and at times seemingly impossible work; both activities involve a great deal of vulnerability such that the success of the therapist/teacher hinges on the success of the patient/student; both activities involve a great deal of mystery and uncertainty around how and why the patient/student grows and improves over time, and how the therapist/teacher can even tell. But over the years, therapy and education have diverged in psychiatric services, with the former leaning toward the elimination of symptoms and deficits, and the latter focusing more on the development of competencies and strengths (Perkins et al., 2012).

As the recovery movement gained momentum toward the end of the twentieth century, Transformative Learning Theory emerged contemporaneously, but in the separate field of adult education. Transformative Learning Theory aimed to shift the basic premises of thoughts, feelings, and actions of adult learners through critical reflection and discourse (Mezirow, 1991), inspiring people to dismantle oppressive assumptions about themselves and the world, and to reconstruct new belief systems. This was akin to the recovery movement's goal of inspiring self-awareness, potentiality, agency, power, and choice in people with mental illnesses (Onken et al., 2007). As such, Transformative Learning was well suited to describe the process that people with mental illnesses must go through to shed oppressive labels and take on new identities as competent and courageous human beings living and thriving despite the effects and side effects of illness. And so in 2000, William Anthony and Lori Ashcraft established Recovery Education Centers in Boston and Phoenix, respectively (Ashcraft and Anthony, 2005), which combined Transformative Learning with self-management principles (Cook et al., 2012) to allow people to work toward understanding and dealing with their mental illness in a more empowering way.

Recovery colleges are descendants of these Recovery Education Centers (the terms are synonymous in the UK) and function in the same spirit of practice. Similar to Recovery Education Centers, an important element of Recovery Colleges is the principle of co-production, which is the notion that people with mental illnesses possess valuable experiences that should inform how psychiatric services are organized and administered. Thus, Recovery Colleges endeavor to involve people with mental illnesses in curriculum development as well as in the instruction of courses. Further, Recovery Colleges hold to the belief that students can articulate for themselves what they want to learn and what works well for them in managing and living with mental illness. The area of confusion, from an educator’s standpoint, is that these Recovery Colleges look nothing like what we normally see in places of learning.

Emancipatory education

Rachael Perkins et al. (2012) describes the advantages of education over therapy, but what makes her argument somewhat complicated is her broad use of the term “education,” which evokes images of students sitting at their desks, raising their hands when called upon, jotting down notes in preparation for an exam that will be designed and evaluated by the instructor. These images are clearly inconsistent with the practices found in Recovery Colleges, but the truth of the matter is, most schools across the globe operate this way. Primary and secondary schools grapple with the pressures of meeting state and national performance expectations, which not only inhibits creative pedagogy and innovative curriculum development, but pressures schools to eliminate “less essential” programs that do not pertain to math or science, such as art, music, and other extracurricular activities. As much as teachers want to engage students in an active discovery of knowledge, what often pervades the classroom is didactic instruction, where the teachers expeditiously dictate a prescribed body of information to students who are expected to memorize and recite this information on standardized exams. This situation is not unlike the struggle that mental health practitioners face while implementing recovery-oriented services in a managed care environment, where recovery-oriented services languish in the face of demands to minimize costs and advance measurable outcomes (specifically symptom remission).

More often than not, schools, colleges, and universities adhere to what Paulo Freire (1970) describes as a “banking” model of teaching where the teacher acts as an intellectual authority who deposits knowledge into the student, such that the student merely serves as a receptacle to passively contain the knowledge. Anthony and Ashcraft (2010) seems to describe the disempowerment that can occur in traditional psychiatric services in a way that resembles the banking model of teaching:

In a traditional ‘treatment’ relationship, the power has been with the staff and the assumption has been that they know what is best for the person; the staff's job was to manage and control people who receive services. More often than not, people have been agreeable to this, and in fact, have given whatever power they may have to the “treaters” and waited to be “fixed”.

What then do Recovery Colleges resemble? Freire endorsed a more egalitarian model of teaching that he calls “problem-posing dialogue,” which is when the teacher acknowledges the student's authority, and engages in discourse with the student to raise critical consciousness. In true problem-posing dialogue, the teacher regards the student as an equal, and together they decide what to learn and how to learn it. This co-production is a central theme of Recovery Colleges and represents one of the unique instances in which Freire’s problem-posing dialogue is realized in practice. I want to stress, however, that problem-posing dialogue is difficult to achieve, since it requires skillful instructors and considerable institutional support. So, Recovery Colleges are in many ways unfamiliar to many of us, as they look different from what we commonly understand as education. It would be wrong to assume that we should make mental health services look more like schools; the work is in fact much deeper than that. Recovery Colleges aim to undo the damages caused by years of stigmatization, discrimination, and exclusion. This will take time and commitment, as liberating pedagogy must inspire people to author their own stories of redemption.

Concluding remarks

If we are to advance the education model in mental health services, we must recognize that pedagogy is an incredibly complex activity, one that requires a tremendous amount of dedication, skill, and reflection. We as practitioners should start viewing ourselves as educators, since learning appears to be such a central part of recovery and teaching seems to be increasingly important in the work we do. However, I must stress that we are not to engage in a traditional kind of pedagogy, such that we dictate the course of treatment while silencing the people we are supposed be helping. Even our honest efforts can impart hidden, implicit, and unintended lessons of oppression. Instead, we must invite people into problem-posing dialogue, working collaboratively with them to support their journeys through life. This will require us to become adventurous learners, to open ourselves up to the people we serve and to the many things they have to teach us, as they discover and actualize the possibilities that exist within themselves.

Hans Oh

References

Anthony, W.A. and Ashcraft, L. (2010), “The recovery movement”, in Levin, B., Petrila, J. and Hennessy, K. (Eds), Mental Health Services: A Public Health Perspective, 3rd ed., Oxford University Press, pp. 465-79
Ashcraft, L. and Anthony, W.A. (2005), “A story of transformation: an agency fully embraces recovery”, Behavioral Healthcare Tomorrow, Vol. 14 No. 2, pp. 12-22
Cohen, D.K. (1988), Teaching Practice: Plus Ca Change, National Center for Research on Teacher Education
Cook, J., Copeland, M., Jonikas, J., Hamilton, M., Razzano, L., Grey, D., Floyd, C., Hudson, W., Macfarlane, R., Carter, T. and Boyd, S. (2012), “Results of a randomized controlled trial of mental illness self-management using wellness recovery action planning”, Schizophrenia Bulletin, Vol. 38 No. 4, pp. 881-91
Freire, P. (1970), Pedagogy of the Oppressed, Herder and Herder
Perkins, R., Repper, J., Rinaldi, M. and Brown, H. (2012), “Recovery colleges”, available http://recoverydevon.co.uk/newsitetest/download/IMRoc_Briefing_Recovery_Colleges_final.pdf at: (accessed 23 August 2013)
Onken, S.J., Craig, C.M., Ridgway, P., Ralph, R.O. and Cook, J.A. (2007), “An analysis of the definitions and elements of recovery: a review of the literature”, Psychiatric Rehabilitation Journal, Vol. 31 No. 1, pp. 9-22
Mezirow, J. (1991), Transformative Dimensions of Adult Learning, ERIC