Unrecovery As KerPlunk!


We have all played Kerplunk I hope. But as a recap there is a tube with holes, sticks are crisscrossed holding up some balls, and the trick is to remove the sticks without all the balls falling.

Our mental health is like a game of Kerplunk, and our issues are a combination of the balls and sticks. ‘Recovery’ is the ability to remove the sticks without the balls falling. As a slight adaptation to this analogy some of the balls can be removed by moving sticks, and ‘life’ adds balls all the time. The sticks are ‘safety’ adaptations that stop all the balls falling at once.

This game of Kerplunk is mostly played by us alone (in our own minds), so in this analogy the game is played in a room on your own. But we can always hear people telling us which sticks we ‘should’ remove, whilst we are sitting there looking at the problem, even though these people are not in the room with us. Government policy also demands we remove sticks, and moreover can add balls (as can other aspects of life), as well as remove sticks if we don’t keep an eye on them.

Unrecovery practices are an ad hoc practice, that is a temporary solution to keep control of our own Kerplunk game, knowing that a wrong move can send all the balls falling. ‘Bad’ recovery is one size fits all and insists on this or that stick must be removed, and then blames you when the balls fall. ‘Good’ Recovery, and other therapeutic practices, listens to your knowledge of what you can see of the game, and merely supports you with your autonomy whilst you play the game. This latter ideal however from our observation seems to be at odds with current government policy and market/ capitalist needs, as it doesn’t meet the outcomes measures of outside forces.

For those who don’t know the term, that I have added some changes to the games with sticks and balls being added and removed whilst you play, like a Heath Robinson machine, is what is called an assemblage. Unrecovery is an ad hoc practice with which to deal with such an assemblage.

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I Won by Sam Ambreen

{CN for suicide, self harm, mental health}

13 months after my personal independence payments were cut, I won my 2nd tribunal. 13 months of crowdfunding my rent. 13 months of reducing my food intake, buying the cheaper brand, going without, and feeling humiliated but on Friday, a panel ruled in my favour. There was no objection from the DWP representative who, I could have sworn, was even crying at one point. I felt bad for scowling at her after that!

I self harmed 4 times during that period, when I absolutely could not comply with the measures I’ve worked at to protect myself. I dissociated more frequently. I got as far as buying the instruments I would need to end it. Drew up a plan. Resisted writing the suicide note because that would make it final, and only because the people around me pulled through when I shared my invasive thoughts (a thing I was only able to do because I’d been taught, by my first therapist). They reminded me I’d managed to survive this long because people wanted to help me. They made me think about the people who look to me for strength and how my demise would impact on them. I didn’t really care in that split second but when the feverish urges passed I felt a bit sheepish I’ll admit. People do take strength from my courage.

When the DWP cut me off and sent me their decision, they said they were not disputing the fact that I had these disabilities just whether or not I qualified for personal independence payments. 13 months on and I’ve just been told I do. So was it really necessary to put me through this? What is its purpose otherwise? Survival of the fittest? It’s not strictly true anymore though is it? I’m nowhere near the fittest but I have recourse; to advocates, to friends who work in the public sector and health professionals who actually listen. Perhaps this mum didn’t?

Even with all the support I have, I came the closest I ever have to ending it. I didn’t enjoy asking for help, again and again, I was isolated and lonely as a result. I might be an anarcho-communist but I still have the hardwiring of a society that celebrates charity as a virtue but not if you’re on the receiving end. The shame still lingers. I didn’t want to die, I felt I had no other choice.

Recently I read about a young woman called Holly Cowlam who took her own life when she was diagnosed with depression. Holly had been studying psychology and so had some understanding of mental health. I get the sense, because she knew her chances in life would be greatly affected, as they are in a society that demonises mental health, she felt she had no other option. I know what that’s like; the shame and hopelessness. I refused to acknowledge my own mental health for 20 years, telling myself I was stronger than those others who had succumbed. In the end, you can’t really prevent it. I am the sum total of all the violence and treachery inflicted on me but with the right support, and freedom, and protection, I know I can get better.


What I do not need, and could have really done without, was being treated like I’m making it up. As a repeat victim of sexual and domestic violence, gaslighting is a straight up trigger for my PTSD. Being treated like I am insignificant and somehow asking for more than what is my right, having paid into a system for many years and on an emergency tax code more often than not (I did a lot of temp work because I was sick even then only I wouldn’t admit it) eventually wore me down in a way my mental and physical conditions do not, because I believe I can overcome them (to an extent). I needed time and space to heal not to be hindered by a cruel and abusive process.

Advocates for humanity must ramp up the pressure on this government and demand justice for all those who’ve needlessly died in our country. The architects of social cleansing must be tried for their crimes against our humanity.

You can judge a country by the way it treats its animals/poor/prisoners/women/disabled folk.

Republished (23/02/19) by kind permission, Sam Ambreen blogs at Left At The Lights

If you need help dealing with the DWP see our Advice Links page.

Note: PIP application processes generally require disclosure of diagnoses, medication, and supporting evidence, making it significantly discriminatory and arduous for many people. Professionals are often uninformed about how best to help people, this is a good guide.

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The unRecovery Excellence Framework #uREF2019 – A request for peer reviewers.


Recovery in the Bin would like to invite allies and peers to review a list Rita Bins has collated of publications that reference Recovery in the Bin!

What did Rita do? (Methods)

Rita collated a reference list after making a public request on Twitter and after systematically searching google scholar, google news and google search.  These tools were chosen as they are freely available to all on the internet – they are not hidden behind paywalls and do not need to be accessed via membership of an academic institution.

Rita decided that she would include all types of publications in her reference list, respecting and privileging all forms of publication democratically.  This included peer reviewed journals, books and textbooks, theses, reports, magazine and newspaper articles, blogs, presentations and posters.

To be included in this list, all publications were required to reference Recovery in the Bin OR explicitly name Recovery in the Bin (via a secondary citation or without providing a reference).  All publications by Recovery in the Bin were excluded.

What can I do to help Rita?

Please contact us via email recoveryinthebin@gmail.com or by Twitter DM @RITB_ if you notice that your publication has been omitted from Rita’s work.  Or indeed, if you have any corrections.  The full reference list can be found here.

What will Rita do next?

Once we have received feedback from our allies and peers, we will publish the unRecovery Excellence Framework #uREF2019 as a blog in due course.

We will also be working behind the scenes, under Rita Bins’ leadership, to synthesise and analyse what people are saying about us.  We will be publishing the methods and results of our survivor led scoping review in a journal.  Rita Bins is an unacademic with some impressive methodological and literary skills.

Rita would like to thank all translators who have supported this work:

Andreas Vedeler – Danish and Norwegian.

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Neopaternalism – New Wave Paternalism In UK Mental Health Services


Artwork by: @JADEELIZB

Neopaternalism refers to the practice, often seen in MH services, of professionals imposing their versions of ’empowerment’ and ‘independence’ etc. on individuals in their care regardless of the individuals own views. Typically, ‘independence’ in this context is near synonymous with discharge or cuts to care provision.

Neopaternalism prioritises the professional’s worldview, agenda, values and goals. As such, it mirrors traditional paternalism, but the content and language used is different. Emphasis on independence in neopaternalism is often framed as contrasting to traditional paternalism in which providing care is perceived as restricting a person’s liberty and autonomy. However, this obscures the fundamental similarity in which both approaches impose the powerful’s agenda on the less powerful.

Neopaternalism is in some ways worse than traditional paternalism, which at least resulted in some care. Traditional paternalism involved helping by ‘doing to’ an individual in their perceived best interests, whether or not the individual found it helpful. Neopaternalism involves ‘helping’ by not doing anything (supposedly ‘empowering’), whether or not the individual finds that helpful. Neopaternalism is oppression skulking behind an empowerment façade.

Neopaternalism pervades the co-opted neoliberal recovery approach which is every bit as coercive as other models: there is an obligation to recover, find certain things helpful & failure to do so is pathologised by both services (PD) & alternative models (sick role). Underlying neopaternalism is pressure on individuals to fulfil neoliberal policy outcomes, conflating individual/citizen needs with government agendas.


“We’ve decided for you that you must not be dependent on us. Your opinion doesn’t matter because we are doing this for you, in your best interests. We are empowering you by discharging you to promote your independence. You must take responsibility. Nb We will not admit it has anything to do with neoliberal ideology or cuts”

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The RITB-Warwick-Edinburgh Neoliberal Mental Wellbeing Scale

Building on the Warwick-Edinburgh Mental Wellbeing Scale (WEMWBS), The RITB-Warwick-Edinburgh Neoliberal Mental Wellbeing Scale (RITBWENMWBS), is a 25 point scale that has not been validated on any population. We expect the scale to be used widely nationally and internationally in all recovery orientated mental health services.

It draws on the total lack of evidence base for the items it measures, to rate Recovery™ Dependency and Conformity. It is the individual’s responsibility to measure their Recovery outcomes so a score sheet will not be made available. This will empower individuals and ensure the scale forms a meaningful addition to their recovery journey. Or else…

Click to embiggen image HERE or download your own PDF copy to fill in>>>RITB-Warwick-Edinburgh Neoliberal Mental Wellbeing Scale

The RITB-Warwick-Edinburgh Neoliberal Mental Wellbeing Scale 1

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Problems With The ICD-11 Classification Of Personality Disorder @WHO #ICD11


By Dr. Jay Watts, Social Psychiatry, Queen Mary, University of London,

The forthcoming International Classiffication of Disease, 11th revision (ICD-11), includes a reconceptualisation of the categorisation of personality disorders with an explicitly expansionist objective. The ICD working group assumes this is a positive step, yet the grounds for this assumption are unclear.

Personality disorders will no longer be classified categorically, but rather using dimensions of severity— mild, moderate, or severe.1 An additional category of personality difficulty will be demarcated not as a disorder, but as the equivalent of a z-code in ICD-10—ie, a non- disease factor that affects health status and encounters with health services. Following assessment of severity, clinicians will then have the option of specifying one or more of five domain trait qualifiers: negative affectivity, anankastia, detachment, dissociality, and disinhibition. ICD-11 will include new guidance for personality disorders to be diagnosed during childhood, albeit with caution, as they had previously been “inappropriately set at late adolescence or early life adult life”[1]. Additionally, the revision will include a borderline pattern qualifier that is not dissimilar to the symptom profiles outlined in ICD-10 and the Diagnostic and Statistical Manual of Mental Disorder, 5th edition.

In their proposals, WHO are neglecting to incorporate progress in alternative approaches. The Hierarchical Taxonomy of Psychopathology transdiagnostic system follows quantitative nosology to its logical conclusion, side-stepping construct validity problems by focusing on internalising, externalising, detachment, thought disorder, and somatisation, as they apply across the spectrum of psychiatric diseases [2]. The #TraumaNotPD movement reframes borderline as a form of complex trauma, evidenced not only by a robust literature connecting childhood trauma and the psychosocial environment with identity disturbance and interpersonal difficulties [3], but also patient testimonials supporting the benign face validity of such an approach.

With the publication of ICD-11, it is likely that more patients than before will be told they have a personality disorder. An explicit aim of the WHO remit for the ICD working group was to increase the diagnosis of personality disorder, on the basis that only around 8% of patients in the UK received this diagnosis, despite suggestions that prevalence of personality disorder is about 40–90% for inpatients and outpatients with psychiatric disorders [1]. The only eld study of ICD-11 diagnosis in practice looked at prevalence in 722 patients presenting with either health anxiety or anxiety and depressive disorders, or inpatients with psychiatric disorders. It showed not only that ICD-11 led to more patients being diagnosed with personality disorder (292 [40·4%] of 722) than did ICD-10 (244 [33·8%] of 722), but also that an additional 248 (34·3%) of the 722 patients were classified as having personality difficulties.2 Thus, 540 (74·8%) of 722 patients were diagnosed as having personality difficulty or disorder [4]. The assumption from WHO is that diagnosis using ICD-11 will prevent patients receiving treatments that they might not benefit from, introduce new treatments, and decrease the stigma that can be associated with personality disorders. However, no evidence as yet supports these assumptions.

In a systematic review investigating personality disorder diagnosis and different clinical populations, a diagnosis often procured negative effects on identity and hope(similar to a diagnosis of psychosis) and did not provide functional utility (such as access to treatments) [5]. This is because the idea of a personality disorder often prejudices clinicians to situate symptoms of distress as manipulative, attention-seeking, and wilful6 and enables disdainful, neglectful, and sometimes even abusive responses that would be recognised as gross misconduct elsewhere in the mental health system, such as ignoring or disbelieving suicidal ideation [7].

The shaping effects of labelling someone as having personality disturbance or disorder appear to be entirely absent from consideration in the revision of the classification of personality disorder, with little or no consultation with service-user led organisations best placed to comment on real-world implications. Clinicians see treatment outcome less optimistically if they are told that someone has borderline personality disorder [8]. Patients have regularly reported that being diagnosed with a personality disorder is the ultimate character slur [9], leading to realisation of every worst fear one has had about themselves, and often reinforcing messages from abusers that they are inherently problematic [10]. To impose this discourse on even more patients, including adolescents, risks setting up a self-fulfilling prophecy by which expectations of a negative trajectory are established, and subsequently met.

Expansionism becomes more dangerous still when we consider that an explicit aim of the WHO working group was to develop a proposal that could be used in low-resource settings by people who are health workers with minimal professional training [1]. Encouraging such a cursory approach to personality diagnosis not only promotes negative thinking regarding differences in mental health and problematic norms, but also gives clinicians in severely overstretched services worldwide a ready signifier to block access to care to anyone who makes them uncomfortable, challenges them, or complains [11]. This will exacerbate discrimination against those from low-income settings, or with a poor education, who are more likely to meet diagnostic criteria for a personality disorder [12].

Borderline pattern has also been included in ICD-11. There is no scientific basis for inclusion, with “noticeable absence of evidence it’s a uni ed syndrome”, and overlap with mood, stress, and dissociation, rather than personality disorders [1]. Indeed “when an assessment was made of borderline features” in the modelling of personality traits “the domain structure seemed to disintegrate, and examining the full implications of this involved a great deal of the group’s time and early studies” [1]. Retention of borderline as a so-called hand- me-down diagnosis not only undermines the scientific claims of the new dimensional model, but also ensures that even patients who find diagnosis legitimising are disadvantaged, being coupled with a diagnosis that is openly contested.

Borderline has only been included in ICD-11 because of relentless campaigning from lobbyists, starting with a letter from the European Society for the Study of Personality Disorders in 2016, followed by campaigning from both the International and the North American Societies for the Study of Personality Disorders [1][13]. This led to a separate working group, though the Chair of the ICD-11 committee chose to exclude himself [1], having written “nothing about it is driven by personality. The very name borderline personality disorder betrays an abrogation of diagnosis” [14]. The discourse from WHO is that the pragmatic compromise of including a borderline pattern to assuage these lobbyists is now unanimous [1]. Unanimous for whom? Certainly not patients, the majority of whom are traumatised women who remain largely unheard and ideologically restricted (coshed) by this most misogynistic of classifications [7] and who cannot take refuge in a narrowly de ned new diagnosis of complex post-traumatic stress disorder, as so many had hoped.

1 Tyrer P, Mulder R, Kim YR, Crawford MJ. The development of the ICD-11 classiffication of personality disorders. Annu Rev Clin Psychol 2019; published online Jan 2. DOI:10.1146/annurev-clinpsy-050718-095736.

2 Kotov R, Krueger RF, Watson D,et al. The hierarchical taxonomy of psychopathology (HiTOP): a dimensional alternative to traditional nosologies. J Abnorm Psychol 2017; 126: 454–77.

3 Giourou E, Skokou M, Andrew SP, Alexopoulou K, Gourzis P, Jelastopulu E. Complex posttraumatic stress disorder: the need to consolidate a distinct clinical syndrome or to reevaluate features of psychiatric disorders following interpersonal trauma? World J Psychiatry 2018; 8: 12–19.

4 Tyrer P, Crawford M, Sanatinia R, et al. Preliminary studies of the ICD-11 classiffcation of personality disorder in practice. Personal Ment Health 2014; 8: 254–63.

5 Perkins A, Ridler J, Browes D, Peryer G, Notley C, Hackmann C. Experiencing mental health diagnosis: a systematic review of service user, clinician, and carer perspectives across clinical settings. Lancet Psychiatry 2018; 5: 747–64.

6 Black DW, Blum N, Pfohl B, et al. Attitudes toward borderline personality disorder: a survey of 706 mental health clinicians. CNS Spectr 2011; 16: 67–74.

7 Phillips S, Stafford P, Turner K. Personality disorder in the bin. 2017. http://aspd-incontext.org/wp-content/uploads/2016/11/PDintheBin- London-PS-KJT-3.5.17-1.pdf (accessed March 28, 2019).

8 Lam DC, Poplavskaya EV, Salkovskis PM, Hogg LI, Panting H. An experimental investigation of the impact of personality disorder diagnosis on clinicians: can we see past the borderline? Behav Cogn Psychother 2016; 44: 361–73.

9 Shaw C. The most savage insult. Equilibrium Magazine 2012; 46: 23–26.

10 Gary H. A diagnosis of ‘borderline personality disorder’. Who am I? Who could I have been? Who can I become? Psychosis: Psychological, Social and Integrative Approaches 2018; 10: 70–75.

11 Recovery in the bin. A simple guide to avoid receiving a diagnosis of ‘Personality Disorder’. Clinical Psychology Forum 2016; 279: 13–16.

12 Coid J, Yang M, Tyrer P, Roberts A, Ullrich S. Prevalence and correlates of personality disorder in Great Britain. Br J Psychiatry 2006; 188: 423–31.

13 Reed GM. Progress in developing a classiffication of personality disorders for ICD-11. World Psychiatry 2018; 17: 227–29.

14 Tyrer P. Borderline personality disorder and mood. Br J Psychiatry 2014; 205: 161–62.

First Published in The Lancet

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Neoliberal Mental Health Rating Scale

dial nlb

0-29: Totally inadequate life, which does not address the requirements of capitalism. Shows extensive understanding of how to be a productive worker but wilfully resists. Pervasive political engagement on the Left, including direct action. Rejects A-B marches (the only state-sanctioned form of quasi-protest). Has a bustcard tattooed on arm.

30-39: Mostly inadequate life which involves some mildly productive labour, but does not show much evidence of embracing capitalism or working towards improving economic productivity.

40-49: Poor life, which shows some evidence of economic productivity and understanding of what needs to be done, but lacks conscientiousness. Frequent A-B march attendee.

50-59: Satisfactory contribution to capitalism, showing an awareness of the need to make bosses rich and belief in the constructs of “meritocracy” and “social mobility”. However, shows some evidence of political engagement on the Left and dissent.

60-69: Good work, which treats capitalism with the respect it is due. However, still some mild political engagement, including attendance at A-B marches.

70-79: Excellent work, which displays exceptional contribution to bosses’ salaries including developing novel approaches to economic growth. No political engagement beyond laughing at socialist ideas expressed on BBC Question Time.

80-100: Outstanding economically productive work in virtually all areas of life. Married. Straight. Two children. Owns north London house. Donates to established neoliberal parties and corporate charities – in line for OBE for doing so. Has enabled multiple chief execs to buy yachts. Has a tech startup which will revolutionise mental health in corporate environments, seed capital for which came from remortgaging house. Vocal advocate of mindfulness in schools initiatives. Did a TED talk on helping others achieve their potential.

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