Despite the growing interest in recovery as a topic for policy and research, only a few sociologists have explicitly focused on mental health recovery in their work (Jacobson 2004
; McCranie 2010
; Markowitz 2005
; Watson forthcoming; Yanos, Knight, and Roe 2007
). Despite this, there are lines of sociological research that have investigated a number of factors demonstrated to be central to the recovery process. For instance, research on social stress has demonstrated the importance that resources such as coping, social support, and mastery have on mental health outcomes (Avison and Turner 1988
; Mirowsky 1995; Wheaton 1999
). Research on social integration has demonstrated the positive and negative influences social roles, community ties, and social support can have on mental health (Cornwell and Waite 2009; Yang 2006
). Social stratification research has demonstrated the association between social inequalities and mental health disparities (see Williams and Collins 1995
). Research in the area of stigma has demonstrated the significant power that negative cultural views regarding mental illness can have on diagnosed individuals (Phelan 2005
; Wright et al. 2007
All of these lines of research have implications for understanding recovery in that they have illuminated the social conditions that can harm or improve mental health. However, the majority of studies in these areas have focused on mental health and illness within the broader population or trying to understand how specific social phenomena apply to individuals who have already demonstrated a susceptibility or resilience to mental illness and have largely overlooked the consequences of mental illness that can affect recovery (Markowitz 2005
; Pescosolido et al. 2007
). There have been relatively few studies investigating the effects of social factors on the mental health outcomes of individuals diagnosed with SMI who are attempting to manage their illness. In fact, sociologists have been criticized for moving away from studying people living with SMI in favor of studying the “worried well” (Mulvany 2000
; Pescosolido et al. 2007
), i.e., individuals in the broader society who display mental health symptoms but do not have diagnosable disorders. Those who study stigma and labeling are an exception, as a number of sociologists who conduct research in this area are concerned with consumers’ attempts and ability to manage the negative effects of mental health diagnoses in their lives.
It is disconcerting that sociologists have paid little attention to mental health recovery considering the significant influence sociological work had in: helping to expose the problems associated with institutional treatment (Goffman 1961
; Street 1965
); demonstrating that SMI was more pervasive and not as degenerative as once thought (Carpenter and Kirkpatrick 1988
; Harding, Zubin, et al. 1987
); and encouraging the growth of the MHCSM (Scheff  1999
; Szasz  1984
). Sociologists have an opportunity to continue this tradition of influence through the study of recovery. As most work being carried out in other disciplines is concerned with recovery outcomes, sociologists can have the most impact by engaging in research that aims to understand the recovery process. This research should aim to address such issues as: (1) the way recovery is defined in political and professional discourse; (2) individuals’ personal experiences of recovery and the meanings they associate with it; (3) and the social processes that occur within the context/environment of recovery (which connect the political, professional, and personal realms).
Qualitative social psychological methods set within a symbolic interactionist framework are the best suited for this task because of their ability to focuses on the (1) meaning/understandings of recovery and (2) social processes involved in the creation of those meaning/understandings (Blumer  1986
), both of which have been recognized to be essential in moving the study of recovery forward (Amering and Schmolke 2009
; Anthony 1993
; Borg and Davidson 2007; Laudet 2007
; Onken et al. 2007
). While this tradition of research was strong in the sociology of mental health at the beginning of the sub discipline, it has been largely abandoned over the last twenty years in favor of more quantitative epidemiological and etiological approaches to studying mental health (Pescosolido et al. 2007
; Schwartz 2002
). While quantitative approaches can be useful for studying recovery, they are limited in their ability to understand the how and why of the recovery process through their focus on individual outcomes and an overreliance on psychologically predefined variables that ignore the meanings and experiences individuals associate with the recovery process (see Schnittker and McLeod 2005
; see Schwartz 2002
In the previous sections I have demonstrated how recovery has been socially constructed through research, advocacy, and policy. In the sections that follow I present an argument for a social psychological study of recovery that takes into consideration the meaning and experience of recovery at the individual level and the service context in which recovery happens.
The Meaning and Experience of Recovery
While the disability perspective of mental illness has found its way into the broader policy and treatment discourses, empirical research has been slow to catch up. The majority of scientists who study recovery continue to use biomedical approaches rooted in Kraepelin's theories of schizophrenia and the disease concept of addiction when investigating recovery from these disorders respectively. In order for the scientific domain to catch-up with social developments, there needs to be a greater appreciation of recovery as a social phenomenon and the process recovering persons go through as they attempt to manage their disorder(s) (Davidson 2003
). Additionally, the traditional discipline-based silo approach to investigating mental health and substance abuse ignores the complex relationship between these two disorders and the lived experience of individuals who have dual diagnoses.
Recognizing this, researchers have drawn attention to the fact that we need to make greater efforts to understand recovery as it is experienced in consumers’ everyday lives because the majority of people living with SMI today are attempting to manage the symptoms of their mental health problems in combination with other areas of their lives in community settings (Borg and Davidson 2008
; Davidson 2003
; Davidson and White 2007
). Additionally, the community context in which mental health recovery happens leaves the possibility of wider variation in the recovery experiences than there was in the era of institutionalization. This stresses the need to understand mental health recovery as a unique process that can vary between individuals and the personal meaning that those individuals attach to it (Davidson 2003
; Mueser et al. 2002
From this point of view, individual consumers’ understandings are more important than mental health professionals when investigating the recovery process. Despite this, the majority of research conducted on mental health recovery today continues to investigate it as an outcome defined by medical professionals. This tide is starting to turn as a few studies conducted within the past decade have attempted to understand recovery from the consumer point of view (Borg and Davidson 2008
; Davidson 2003
; Liberman and Kopelowicz 2005
; Topor 2001
). Discussing the need for more research to be conducted in this area, David Loveland, Katie Weaver Randal, and Patrick Corrigan (2005)
have pointed toward the need for new techniques aimed at developing this understanding. Symbolic interactionism's focus on meaning, interactional processes, and the “self” holds promise for filling this need.
Research set within a symbolic interactionist framework can help move the study of recovery forward by: contributing to attempts to create a recovery definition that takes consumers’ individual situations into account; developing better understandings of the social consequences of mental illness through consumer understandings and experiences of recovery; and making visible the connections that exist between the structural factors that affect mental health and the recovery process as it is experienced by individuals. Nora Jacobson (2004)
used a symbolic interactionist approach to investigate issues similar to these in one of the few sociological studies of recovery. Jacobson's work highlights the personal, professional, and political issues at stake in the development of recovery-oriented mental health policy in Wisconsin during the late 1990s. Sociologists engaging in work such as this can have a significant impact on recovery-based policies and practices by providing guidance to organizations such as SAMHSA (2005
that are currently struggling to develop stronger definitions of recovery for policy and practice purposes, such as SAMHSA.
The Measurement of Mental Illness and the Recovery Experience
A second argument for a sociological study of recovery is that the way in which sociologists conceptualize mental health and illness makes them more sensitive to consumers’ actual experiences. Most researchers would agree that the severity of mental illness can vary within and between individuals; however, there is an overreliance on assessment methods that conceptualize mental health and illness as discrete categories. Though sociologists often use categorical assessment methods, the discipline as a whole recognizes the importance for distinguishing the subtle variations in mental health severity that exist within and between individuals (Wheaton 2001
). This propensity within the discipline is rooted in an understanding that diagnostic mental health categories are the result of historical and political processes, as well as what sociologists recognize as a lack of objective evidence for the existence of “true” mental illness (Kessler, 2002). Because of this, sociologists are more likely than researchers in other disciplines to conceptualize and measure mental health and illness as continuous variables.
Supporting the use of continuous assessment, sociologist Corey Keyes (2002)
has demonstrated that mental health and illness are likely to exist along two separate continuums. Defining mental health as a “syndrome of symptoms of positive feelings and positive functioning in life” (p. 208), Keyes has demonstrated that symptoms of mental health are only modestly, negatively correlated with those of mental illness. His findings refute the view implied by categorical assessment methods that mental health and illness are simply opposites, which has important implications for recovery research.
Because researchers in other disciplines are more likely to view mental health and illness as discrete and opposing categories they are more likely to view recovery as an outcome that is equated with mental health. This is problematic considering that consumers’ experiences demonstrate that mental illness and recovery can and often do co-exist (Amering and Schmolke 2009
; Anthony 1993
; Borg and Davidson 2008
; Davidson 2003
). Because of this, the continuum perspective of mental health and illness is more compatible with the process perspective of recovery discussed above. As such, sociologists are more likely to capture the variations in functioning that have important implications for the recovery process. Hilary Thomas (2004)
has discussed how micro-sociological approaches such as those employed by symbolic interactionists can benefit the study of recovery by investigating the incremental processes related to it. Studies taking this focus can provide guidance for more quantitative sociological investigations by helping to develop continuous measurement scales that are (a) more reflective of consumers’ actual understandings and experiences of recovery and (b) not completely based in psychological or medical concepts as a result.
Understanding the Context of Care
There is a long line of sociological research that has helped to illuminate connections between the social structure and mental health outcomes (see Schwartz 2002
). Most of this research has focused on the way in which different structural arrangements expose different social groups to varying amounts of stress (McLeod and Lively 2007
). This research has been invaluable for bringing attention to the connections between social factors such as poverty, homelessness, racism, low education, and lack of social support and higher rates of mental illness among disadvantaged groups. Additionally, large community studies have helped reconceptualize the course of mental illness by demonstrating that recovery can and does happen for individuals living with SMI (Carpenter and Kirkpatrick 1988
; Harding, Strauss, et al. 1987
). While research in these areas has been successful in demonstrating that a connection between individual mental health outcomes and the larger social arrangements exists, it has not addressed how these connections are facilitated in a way that is useful for understanding recovery as a process. One area where sociologists have the potential to provide a significant contribution in this regard is through organizational research.
Recovery from mental illness in the United States is generally guided by some form of institutionalized treatment modality or programming. Organizations that provide mental health services link consumers to the larger social structure through their policies (federal, state, local, and organizational) and practices, which are constructed through larger political and professional processes. Therefore, research on organizations that provide mental health services has the potential to uncover the processes through which the structure of society affects consumers’ recovery.
Most of the research that has been carried out on mental health organizations has focused on the effects of external social forces on organizational processes without making the connection between these processes and consumer outcomes. In her study of CARE, a public sector mental health facility, Teresa Scheid (2003) demonstrated how external pressures that moved the facility towards managed care created tensions for professionals that negatively affect the level of care provided to consumers. Studies such as these are valuable because they highlight how the larger social structure affects organizational processes; though, they do not highlight how these processes affect individual consumers. Research highlighting the connection between these processes and consumer outcomes will provide a more complete picture of mental illness, mental health, and recovery. A quote from Steven Onken et al. (2007)
demonstrates why an investigation of these connections is necessary:
The dynamic interaction among characteristics of the individual (such as hope), characteristics of the environment (such as opportunities), and characteristics of the exchange between the individual and the environment (such as choice), can promote or hinder recovery. (P. 10)
Therefore, sociological research can make a significant contribution to the study of recovery by paying greater attention to the consumer interactions that occur with and within social institutions and the effects this has on individual consumers (McLeod and Lively 2007
; Schnittker and McLeod 2005
; Watson forthcoming).
Qualitative methods can help uncover the social interactions and processes that shape the perceptions, meanings, and emotions that affect recovery. As an understanding of this processes develops, sociologists can make stronger connections between the beginnings and endpoints of the recovery process, provide greater theoretical and translational value that can shape future research and practice, and create bridges between the sociology of mental health and questions regarding recovery that are shaping the larger field of mental health studies (McLeod and Lively 2007
; Onken et al. 2007