Recovering from Depression
Submitting Institution
University of WestminsterUnit of Assessment
Allied Health Professions, Dentistry, Nursing and PharmacySummary Impact Type
HealthResearch Subject Area(s)
Medical and Health Sciences: Clinical Sciences, Public Health and Health Services
Summary of the impact
Our research elaborated for the first time how people actually go about
recovering from depression. The work moved the field on from rhetoric
advocating a `recovery ' approach, to elucidating what that practice
actually entailed for patients. Amongst other contributions, we worked out
the signposts involved in recovery, the `tools' used, and the potential of
patient stories to contribute to recovery. This work had a number of
direct impacts with consumers, practitioners, charities and policy makers.
The National Institute of Clinical Excellence incorporated our work
extensively into their guidance on depression (2010), and consumers
`shared' it globally e.g. via Facebook.
Underpinning research
The initial data was collected in 2003-04 by Professor Damien Ridge
as a senior researcher (University of Oxford). However, the specific
recovery analysis and concepts were developed at the University of
Westminster by Ridge from 2006 onwards. The project at Westminster was the
first to rigorously analyse systematically collected narratives
specifically about how people attempt to recover from depression. The
usual definition of recovery is "building a meaningful and satisfying
life, as defined by the person themselves..." (Shepherd, Boardman et
al. 2008). Although recovery as a concept in mental health was advocated
decades ago (Anthony 1993), and is now used by government authorities like
the NHS, previously, scant attention was paid to fleshing out what this
optimistic rhetoric actually meant for people with depression.
Currently, the main influential recovery research was published in a well
cited paper (Ridge and Ziebland, 2006). In this work we specially showed
that recovery variously involved telling a better story about oneself;
adopting a `recovery' attitude; using `recovery tools' (e.g. medication,
counselling, sharing peer stories); creating personal space to develop
insights; needing to engage with `authentic' subjectivities of the self;
coming to terms with a `false self'; and re-writing the story about
depression story as less detrimental than previously imagined (e.g. as a
necessary wake-up call, a spiritual quest, a biochemical change in the
brain). The research also revealed that `coming out' for those with
depression (and as part of recovery) shared the language and tasks that
sexual minorities advocated from the 1960s (Ridge & Ziebland, 2012),
e.g. feeling vaguely different as a child; needing to dis-identify with
depression and recast it as commonplace or advantageous; contending with
feelings of shame and pride; and coming out of the depression `closet').
We also found that recovery for men frequently involved a re-assertion of
a dominant masculinity (Emslie, Ridge et al. 2006), e.g. by re-casting
depression as a heroic battle, and less commonly by challenging masculine
hegemony, e.g. by celebrating sensitivity and creativity.
Ridge is now applying these narrative and recovery concepts more widely.
He was subsequently funded to investigate the role of meditation in men's
distress; how to alleviate distress in men in primary care settings; how
those ageing with HIV cope in terms of their mental health (MRC/ESRC), as
well as understanding the role of Western herbal practice in women's
distress (MMDB Charity). Ridge is now collaborating with researchers at
the University of Oxford (Sue Ziebland) to understand how patients morally
construct anti-depressant use in terms of their recovery. He is also
pooling his data with new data from Australia to understand the interface
between depression, work and recovery (Prof Renata Kokanovic, Monash
University, Melbourne).
References to the research
Ridge, Damien T. & Ziebland, S. (2006). The old me could
never have done that: How people give meaning to recovery following
depression. Qualitative Health Research, 16, 8, 1038-1053.
Ridge, Damien T. (2009) Recovery from Depression Using the
Narrative Approach. Jessica Kingsley Publishers, London, UK. ISBN
9781843105756
Ridge, Damien T. and Ziebland, Sue (2012) Understanding
depression through a 'coming out' framework. Sociology of Health and
Illness, 34 (5). pp. 730-745.
Lomas, Timothy and Cartwright, Tina and Edginton, Trudi L. and Ridge,
Damien T. (2012) I was so done in that I just recognized it very
plainly, "You need to do something"': men's narratives of struggle,
distress and turning to meditation. Health, OnlineFirst . ISSN
1363-4593
Ridge, Damien T. and Emslie, Carol and White, Alan (2012) Understanding
how men experience, express and cope with mental distress: where next?
Sociology of Health & Illness, 33 (1). pp. 145-159.
Emslie, Carol and Ridge, Damien T. and Ziebland, Sue and Hunt,
Kate (2006) Men's accounts of depression: reconstructing or resisting
hegemonic masculinity? Social Science & Medicine, 62 (9). pp.
2246-2257.
Grants
• £142,000. Ridge, D. and Peters, D. for `Men's stress and
distress clinic', funded by Nelsons, 2012-2014.
• £95,554. Green, J., Ridge, D., Whitehouse, J. for `How women
experience herbs and herbal practice for distress', funded by the Make My
Day Better Charity. 2011-2015
• £221,004 for Experiencing and Managing HIV/AIDS in Later Life. Funded
by the Medical Research Council/Economic and Social Research Council's
Life Long Health and Wellbeing scheme. Rosenfeld, D., Ridge, D.,
Anderson, J., and Catalan, J. 2011-2013
• Ridge, D. £70,000 for `Black and minority ethnic carers and mental
health', funded by the Dept. of Health, 2007-2008.
Details of the impact
The National Institute of Clinical Excellence (NICE) subsequently adopted
Ridge & Ziebland's (2006) recovery research extensively into their
guidance on the treatment and management of depression in adults in the UK
(2010), see:
http://www.nice.org.uk/nicemedia/live/12329/45896/45896.pdf.
More than 10 pages of this NICE guidance are devoted to Ridge's research
on depression and recovery. More than this, the recovery work was widely
taken up by the consumer mental health movement, and is summarised or
reproduced in full on many hundreds of consumer and information websites
throughout the world (a Google search for the Ridge & Ziebland journal
paper turns up 15,000 hits). For example, the award winning `Working
Together' service user organisation has reproduced Ridge & Ziebland's
research in full (see http://www.workingtogetherforrecovery.co.uk/recovery_library.htm)
so that consumers can benefit. Further, key charities and health sites
have commissioned Professor Ridge to translate his recovery findings for
consumers (e.g. see CALM (Campaign Against Living Miserably): http://www.thecalmzone.net/help/issues/depression/
and the Healthista health channel:
http://www.healthista.com/mind/how-to-spot-depression-in-man/).
In terms of professional practice, many commentators noted that the work
moves the field beyond the current rhetoric advocating a general `recovery
approach' (see below). In terms of specific contribution to insight,
McKenzie (2009) notes that the main value of the work is the `scholarly'
approach taken to `establishing the therapeutic potential of narrative.'
McKenzie (2009) notes that while the NHS requires mental health
practitioners to adopt a recovery model in their work, `[Ridge] provides
significant signposts as to what that practice might contain.' Therapy
Today called the book `an excellent addition to the literature on
this subject' (Townsend 2009). One practitioner wrote "This book opened
new horizons to the area of depression"
(http://jameswoodward.sdnet.co.uk/review-ridge.htm).
Writing in Pulse magazine for GPs, Dr Clare Etherington, said of the work,
"essentially hopeful, enjoyed reading... stimulated thought about everyday
practice." The book was given 5 out of 5 stars by the practice-based Nursing
Standard (Vol 26, no. 47, 2012). Nursing Standard
subsequently commissioned and funded Ridge (2012) to translate his
findings into a step-by-step guide for nurses, describing how nurses could
operationalize recovery for patients with depression (Nursing
Standard, 26 (47). pp. 35-40. ISSN 0029-6570).
Ridge is regularly invited to talk to, and write for, consumers directly
about how they can recover from depression. So for example, he talked
directly to users on the Sky TV `ChrissyB Show' about how they could
recover based on his research. The ChrissyB show regularly has over 10,000
viewers, and there are over 260 views of his Sky `recovery from
depression' video on Youtube (http://www.youtube.com/watch?v=it79DRfuXB8).
In addition, Ridge regularly talks about recovery, translating his
research, for his popular Huffington Post blog. So when Ridge disseminated
his research on recovery via his own blog, the public avidly shared it:
207 people shared it on their Facebook page, a further 620 people shared
it by `liking' the page on Facebook, and 63 people tweeted the article
amongst their networks, effectively ensuring that the research went global
(http://www.huffingtonpost.co.uk/professor-damien-ridge/depression-creating-hope_b_2997084.html).
The CALM recovery page discussed above was also shared by 132 people via
Facebook, and is read by many thousands more every month. An event, `Living
or Just Surviving,' was held on the 8th of October 2013
at the University of Westminster, and this translated the recovery
research for a broad audience of 150 public attendees (Eventbrite
statistics). The CALM charity subsequently made Professor Ridge a Trustee,
acknowledging the very high value of his recovery and mental health work
to the public, and in particular its value in helping suicidal men, many
of whom are depressed.
McKenzie, R. 2009. Book Review: Recovery from Depression Using the
Narrative Approach. Scottish Journal of Healthcare Chaplaincy 12
(2):65.
Townsend, Jackie. 2009. Book Review: A narrative approach to depression.
Therapy Today 22 (6).
Sources to corroborate the impact