Recovery With Severe Mental Illness

[rasselas]

Interesting essay.

The medical model tends to define recovery in negative terms. Symptoms and complaints need to be eliminated. Illnesses need to be cured or removed. Patients need to be relieved of their conditions and returned to their premorbid, healthy, or more accurately not-ill state. A comfortable treatment relationship between powerful healing professionals and helpless patients complying with orders they need not really understand results in a clear recovery.

For severe mental illness it may seem almost dishonest to talk about recovery. After all, the conditions are likely to persist, in at least some form, indefinitely. How can someone recover from an incurable illness? The way out of this dilemma is by realizing that whereas the illness is the object of curative treatment efforts, it is the person themselves who is the object of recovery efforts. The medical model handles this by making it a 2-step process. First, treat the illness, then rehabilitate the person. The net effect is often to delay recovery indefinitely while medical cures for the illness are being sought. There is also a discordance between the professionals focusing on the illness, while people focus on their entire lives. This often leads to a serious communication barrier with many people complaining that their doctors don't talk to or listen to them. The two processes of cure and recovery are, although interelated, not absolutely dependent on each other, and can and should be pursued concurrently.

Complete essay for your edification here:

http://www.village-isa.org/Ragin's Papers/recov. with severe MI.htm

 

[oneday]

Hey, Mark

Yes, it is interesting... Lots of good things in the essay. Though have to say I only have time to skim-read and to reply only a little bit cos I've got just one week to complete a funding bid that I've promised to do - and I'm miles behind and struggling....

But there's quite a lot that he's saying that I think there are problems with.

E.g. in what you quote above:

"For severe mental illness it may seem almost dishonest to talk about recovery. After all, the conditions are likely to persist, in at least some form, indefinitely. How can someone recover from an incurable illness?...."

But 'recover' from so-called 'severe mental illness' people can and do - and I'm here using the term to mean no longer using/needing medical treatment. In the West - in the case of experience of so-called 'psychosis' that gets called 'schizophrenia' (sorry about all the '...', but it means that I find all these terms problematic - to a greater or lesser extent - in the first place, so it's pretty difficult to talk in a language/using concepts I don't share). Anyway, in the West it's generally said that about a third of people recover completely from 'schizophrenia' with no residual problems that affect their quality of life/functioning, about a third recover well with some on-going problems...

...oh, here's a quote from psychologist Hermione Thornhill, from an article called 'Myths About Schizophrenia': "Myth No. 2: Once a 'schizophrenic' always a 'schizophrenic' - "Long-term studies have found that 35% of people make a full recovery. About another 35% recover enough to function independently and are self-supporting, with some residual problems. About another third [actually less: 30% by these stats] seem to have more 'chronic' difficulties, although after an average of 32 years follow-up, 90% are living independently or semi-independently, and 68% report only 'mild symptoms' like 'mild insomnia'."

So this may by the situation as it is currently in the West, but it doesn't mean that this is how it inevitably is and always will be. The rates of recovery in the 'developing' world are far far better, for instance.

I came across a blog article by a US social worker and therapist called Rod Unger which I saved a copy of a while back and really liked, it's called "Recovery: Why is it being redefined to mean “doing better but still mentally ill”? (From the ‘Recovery from Schizophrenia’ website - I hope people will have a look at it if they're interested in this topic)

As he says in his conclusion to the piece, there are no good reasons to allow mental health recovery to be redefined as, in effect, “doing a bit better but still mentally ill.”

"Nor", he says, "are there good reasons to define it as a goal that can be approached but never reached, as in notions about a person “always recovering.” Instead, we need to insist that real and full mental health recovery be understood to the best of our knowledge to be possible for everyone. Further, we need to insist that all mental health treatment be geared to support progress toward such a recovery, rather than geared to maintain people as lifetime consumers of mental health services."

Here's a bit more from him, from the intro:

Recovery: Why is it being redefined to mean “doing better but still mentally ill”? Rod Unger (From the ‘Recovery from Schizophrenia’ website)

"A lot of efforts to transform an often oppressive mental health system have focused on “recovery” and making the mental health system more “recovery focused.” Many agencies have integrated the notion of recovery into their practice, and if the use of this word were a measure of progress, we would be well on our way to system transformation! Unfortunately, what seems to be happening is that as the word “recovery” is used more and more, it seems to mean less and less. I know someone for example who is on heavy doses of an antipsychotic as well as other medications, lives in a foster care home, and spends most of his daytime hours in a mental health day treatment program, yet is assured by his case managers that he is “recovered.”

I believe that recovery remains a useful concept, but also that it will only give us leverage to change the system if we give it a clear and powerful definition, and resist efforts to water down that definition.

I would like to propose the following definition:

Recovery means having regained a meaningful life, no longer having a mental health disability, and no longer being in need of any sort of mental health treatment.

It does not mean that the person for certain will never need mental health treatment again in the future – the person might – but this is also a possibility for people who have never been diagnosed. It also does not mean that achieving a full recovery is the only way to have a meaningful life; instead, it is important to note that a person may find a meaningful life all the way along the journey to full recovery, whether or not that full recovery is ever accomplished...."

I'm with him on this, I think.

 

[Op.cit]

I really like this on Recovery from the doc. 100 Ways to Support Recovery.

Whole doc. here www.mentalhealthshop.org/document.rm?id=8914

Regards,
Op.cit

 

[Meshuggah]

I really like this on Recovery from the doc. 100 Ways to Support Recovery.

Whole doc. here www.mentalhealthshop.org/document.rm?id=8914

Regards,
Op.cit

I only skimmed through it but that version of recovery sounds very good to me.

 

[Meshuggah]

Some of Rufus May's ideas about recovery.

http://rufusmay.com/index.php?option=com_content&task=view&id=30&Itemid=33

 

[oneday]

Thanks, Op.cit, Meshuggah for those links too...

Relevant to what I was trying to say in what I posted a while back, I liked this from Rufus's article:

"Being given a diagnosis of schizophrenia was not helpful for me. It created a learned hopelessness in me and my family who resigned themselves to the established belief I would always be ill, unable to work and always need antipsychotic medication. There is a deeply held assumption that schizophrenia is a disease-like degenerative process. Thus the category of schizophrenia is associated with a failure to recover and a gradual deterioration in social functioning. It is more helpful to see each individual’s mental health as a unique and evolving story, which is importantly influenced by social and relational experiences.

"Compared with traditional diagnostic categories, a focus on individual experiences provides a better framework for understanding psychosis on both empirical and practical grounds."


Also the "important points about recovery" (adapted from elsewhere) he discusses:

1. Each person’s recovery is different.

2. Recovery requires other people to believe in and stand by the person. Other people / opportunities play an important part in enabling the person to make this recovery journey.

3. Recovery does not mean cure. It does not mean the complete disappearance of difficulties.

4. Recovery can occur without professional help. Service users hold the key to recovery.

5. Recovery is an ongoing process. During the recovery journey there will be growth and setbacks, times of change and times where little changes.

6. Recovery from the consequences of mental distress (stigma, unemployment, poor housing, loss of rights etc.) can sometimes be more difficult than recovery from the distress and confusion itself.

7. People who have or are recovering from confusion and distress have valuable knowledge about recovery and can help others who are recovering.

8. A Recovery vision does not require a particular view of mental health problems.

From “Understanding Psychotic Experience and Working Towards Recovery”, by Rufus May
http://rufusmay.com/index.php?option...d=30&Itemid=33