A few years ago, while working with families supporting people experiencing severe mental distress in eastern Indonesia, I met a young man whose life had gradually narrowed to the walls of his own house.
For months he had barely spoken. His parents described him as “not the same person anymore.” Neighbors whispered that something had disturbed his spirit. A distant relative suggested taking him to a traditional healer. When the family finally managed to bring him to a hospital several hours away, the doctors offered a diagnosis and medication.
Each of these responses carried its own explanation for what had happened to him.
In the village, his condition was understood through spiritual disturbance. In the clinic, it became a psychiatric disorder. Yet in both settings, one question seemed strangely absent: what would it actually mean for this young man to recover?
Would recovery mean the disappearance of symptoms? The ability to take medication regularly? Or something else entirely—perhaps the return of ordinary life: sitting with neighbors again, helping his family in the fields, being seen not as a patient but as a person.
The question stayed with me long after that encounter: who gets to define recovery?
Psychiatric Recovery: An Incomplete Picture
In contemporary discussions about mental health, the word recovery has become almost unavoidable. Governments speak of recovery-oriented services, clinicians design recovery plans, and international organizations promote recovery frameworks as a humane shift from older institutional models. The language appears compassionate and progressive. Yet beneath this consensus lies a question that is rarely examined closely: who actually defines what recovery means?
Within mainstream psychiatric systems, recovery is typically understood through clinical indicators. A person is said to be recovering when symptoms diminish, when medication stabilizes mood or behavior, and when hospitalizations become less frequent. These indicators allow health systems to measure outcomes and organize treatment. But they also reveal a particular way of interpreting suffering—one that locates distress primarily within the individual and positions medical intervention as the central pathway toward healing.
This clinical definition is not entirely misguided. Psychiatric care and medication have brought relief to many people experiencing severe distress. Yet when recovery is defined mainly through symptom reduction and treatment compliance, something essential tends to disappear from view: the social world in which suffering takes shape and in which recovery must ultimately unfold.
Exporting “Recovery” to the Global South
Across much of Southeast Asia, mental distress rarely emerges in isolation from the broader conditions of everyday life. Rapid urbanization, labor migration, economic precarity, and widening social inequality have reshaped family structures and community relations across the region. These transformations have created new forms of uncertainty and psychological pressure, particularly among young people navigating unstable employment and fractured social support systems.
Yet such realities rarely enter the language of diagnosis.
Once distress is translated into clinical categories—depression, psychosis, bipolar disorder—the analytical gaze often shifts inward. Attention turns toward brain chemistry, cognitive patterns, and behavioral symptoms. Treatment focuses on medication, psychotherapy, and clinical monitoring. The social conditions that often give meaning to suffering—poverty, migration, family breakdown, social exclusion—fade into the background.
The medical anthropologist Arthur Kleinman famously distinguished between disease and illness: disease referring to the biomedical malfunction identified by clinicians, and illness referring to the lived experience of suffering embedded in culture and social life. Modern psychiatry, Kleinman argued, has often prioritized disease while neglecting illness—the meanings that people themselves attach to their suffering.
This distinction remains deeply relevant today. Mental distress is not merely a biological event; it is also a moral and social experience. It shapes how individuals relate to their families, communities, and societies. To reduce such experiences solely to diagnostic categories risks stripping them of their broader context.
Critics of contemporary psychiatry have long pointed to this tension. The psychiatrist Thomas Szasz argued decades ago that the concept of mental illness often functions as a metaphor through which societies manage deviance and suffering. While his position remains controversial, it forced a difficult question into public debate: when distress is medicalized, what social realities might be obscured?
More recently, scholars such as Derek Summerfield have warned that the global expansion of Western psychiatric frameworks can sometimes obscure the political and economic conditions that generate distress in many parts of the Global South. In these contexts, emotional suffering is frequently intertwined with poverty, displacement, social violence, and structural inequality—conditions that cannot be adequately addressed through clinical treatment alone.
These critiques do not deny the reality of psychological suffering. Rather, they challenge the assumption that suffering can be fully understood or resolved within biomedical frameworks.
This tension becomes particularly visible when we examine what recovery actually looks like in everyday life.
Recovery in South Asia and the Restoration of Social Life
In many communities across Southeast Asia, recovery is not defined primarily by the disappearance of symptoms. It is defined by the restoration of social life.
Families often play a central role in this process. In regions where formal mental health services remain limited, relatives frequently become the primary caregivers for individuals experiencing severe distress. They accompany them through periods of crisis, manage the practical realities of daily living, and attempt—sometimes with limited resources—to rebuild a sense of belonging.
Yet caregiving itself often carries forms of emotional exhaustion that remain largely invisible. During one family support session in Manggarai, a caregiver quietly shared that for years she often cried alone at night after her son experienced episodes of relapse. Even within her own family, she rarely spoke openly about the fear, shame, and exhaustion she carried each day. In many communities, such burdens are expected to be endured silently.
What gradually changed for her was not the disappearance of difficulty, but the realization that other families carried similar experiences. Through community support groups, she slowly began speaking more openly about her frustrations and fatigue. Later, she reflected that for the first time in years, she no longer felt entirely alone in caring for her son.
Community acceptance also shapes the trajectory of recovery. Stigma can isolate individuals long after their symptoms have subsided, preventing them from finding work, forming relationships, or participating in social life. Conversely, when communities create space for reintegration—through work opportunities, social rituals, or simple acts of recognition—individuals often regain a sense of dignity that no clinical intervention alone can provide.
I was reminded of this during a small vocational activity organized through a self-help group in a village in eastern Indonesia, where several participants spent afternoons making rosaries ahead of the Catholic month of May. At first, some participants seemed hesitant and unsure whether they could complete the work on their own. But as the sessions continued, they began helping one another arrange beads, tie strings, and correct mistakes together.
What stayed with me was what happened afterward. Some participants continued making rosaries at home and began showing them to neighbors and relatives who visited. Caregivers later shared that people in the village slowly started coming not to talk about illness, but to look at the rosaries they had made. The shift may have seemed small, but it subtly changed how some individuals were seen within the community—not only as patients, but as people capable of creating, contributing, and participating again in social life.
Work, in particular, frequently becomes a turning point in recovery. The ability to contribute to family and community life restores a sense of purpose and agency. As the sociologist Allan V. Horwitz has argued, mental distress is often deeply tied to disruptions in social roles. When those roles are restored, psychological healing can begin to take root.
In some communities, these forms of participation begin through very ordinary routines. I met one young man who, after months of withdrawing almost entirely from social life, slowly began helping his mother feed livestock behind their house. His family later described these small routines—not simply symptom reduction—as the moments when recovery first began to feel visible again.
These forms of recovery rarely appear in clinical records. They unfold gradually through relationships, responsibilities, and everyday interactions. Yet they are often the most meaningful indicators that a person’s life is beginning to stabilize again.
Managing Symptoms or Restoring Lives?
This gap between clinical definitions and lived experience raises an uncomfortable possibility: that modern mental health systems may sometimes succeed in managing symptoms while failing to restore lives.
The question becomes even more complex in societies where cultural interpretations of distress coexist with biomedical frameworks. In many Southeast Asian communities, mental suffering may be interpreted through spiritual or relational narratives—disturbances in social harmony, ancestral imbalance, or moral disruption within family life.
Such interpretations can sometimes lead to harmful practices, but they also reflect an important insight: suffering is rarely experienced purely as an internal malfunction. It is embedded within relationships, histories, and systems of meaning.
Anthropologists and social psychiatrists have repeatedly emphasized that healing processes must engage with these contexts rather than bypass them. When mental health care focuses exclusively on the individual brain, it risks overlooking the social foundations of recovery.
Recovery, after all, does not occur in isolation.
In several villages where I worked, community volunteers regularly visited families supporting relatives experiencing severe mental distress. Officially, these visits were intended to monitor conditions and provide basic psychosocial support. But in practice, they often became something much simpler and more human.
Sometimes a volunteer would sit quietly in the kitchen drinking coffee while family members spoke about financial pressures, fear of relapse, or the exhaustion of caregiving. In some homes, these conversations were the only moments when caregivers felt able to speak openly about what they were experiencing. Over time, the presence of these volunteers slowly changed relationships within the village itself. Families who once felt isolated gradually became more connected to the people around them.
In this sense, recovery was not built only through treatment, but also through the gradual experience of being listened to again.
Recovery is built through everyday acts of recognition: a family member willing to listen without fear, an employer willing to offer work, a community willing to welcome someone back after a period of crisis. These moments of reintegration are rarely dramatic, but they often mark the true turning points in a person’s life.
Recognizing this reality does not require abandoning psychiatric care. Clinical services remain essential for many individuals. But it does require expanding the conversation about recovery beyond the narrow boundaries of symptom management.
Mental health systems must begin to engage more seriously with the social determinants of distress—poverty, inequality, migration, stigma—and with the relational environments that make recovery possible. Without addressing these dimensions, treatment risks becoming a form of symptom management detached from the realities of people’s lives.
In the end, the question of recovery is not merely a clinical matter. It is also a political and social one.
If recovery is defined solely by medical institutions, it will continue to be measured through diagnostic scales and treatment compliance. But if the voices of those who live with mental distress—and the communities that support them—are allowed to shape the meaning of recovery, then recovery may come to reflect something far more fundamental: the restoration of dignity, belonging, and participation in collective life.
And that returns us to the question we began with:
Who defines recovery?
Jeremy Santoso
Jeremy Santoso is a Program Manager for Community Health at Ayo Indonesia, a non-governmental organization working in eastern Indonesia to support people with psychosocial disabilities and their families. His work focuses on community-based mental health support, social inclusion, and strengthening local networks of care in rural communities.