The Concept of Recovery

An exciting recent addition to PsyR thinking has been the development of a concept of recovery. The idea of recovery represents optimism about the future. Because the conditions associated with a severe mental illness are often lifelong, it was necessary to adopt a new conception of recovery that could coexist with the illness and its symptoms. Today, the concept of recovery from severe mental illness, with its promise of hope for the future, is becoming widely accepted.

Based on models of rehabilitation and recovery from physically handicapping conditions, a number of researchers and scholars have helped to develop a concept of recovery for severe mental illness (Anthony, 1993; Davidson & Strauss, 1992; Deegan, 1988; Jacobson, 2001; Onken, Ridgway, Dornan, & Ralph, 2002; Ridgway, 2001; Smith, 2000). For many conditions, recovery refers to a cure. In the context of a lifelong mental illness, recovery refers to a reformulation of one's life aspirations and an eventual adaptation to the disease. Nationally known consumer advocate, Patricia Deegan, Ph.D., and William Anthony, Ph.D., the director of the Center for Psychiatric Rehabilitation at Boston University, have both spent considerable time and energy spreading the concept of recovery throughout the PsyR community. Both Deegan and Anthony believe that the first step a person must go through in the recovery or rehabilitation process is acceptance of the handicap or disability. For a person with a cyclical mental illness, this step alone may take years. Deegan (1988) believes that to achieve an effective recovery the individual has to develop a new world view that incorporates one's mental illness as part of his or her reality. Dreams and aspirations may have to be modified to include the mental illness. Deegan points out that helping someone achieve this kind of fundamental change in self-concept is an important aspect of the PsyR practitioner's task.

This fundamental change in self-concept implies awareness of several other important aspects of the recovery process. Deegan (1988) stresses that one of the most important new ideas is that recovery and rehabilitation are not linear processes. People going through these types of changes naturally experience setbacks and temporary failures. When doing better, it is very tempting to forget or ignore the idea that one has a severe mental illness (Fox & Geller, 2004). Real recovery is a journey that requires exploring new ideas and new self-concepts and that means being open to failure, disappointment, and possible relapse. By this logic, PsyR services that do not make realistic allowances for failure do a disservice to people in recovery.

Another corollary of the recovery concept is that each person's road to recovery is unique. Because recovery is based on developing a new self-image, we might assume that there may be as many roads to recovery as there are people. The uniqueness of each person's rehabilitation has a direct bearing on PsyR services. Effective programs respect diversity and provide many individualized services for their service recipients. "One size fits all" services may be easier and more efficient to operate but, especially in the long run, they are inherently less effective at helping persons recover.

Because the core task that the recovering person needs to accomplish is the development of a new and positive sense of self or self-image that incorporates his or her mental illness, other consumers also have an important role to play in the recovery process. Consumers who have achieved a positive self-image despite their illness serve as role models and they provide evidence that it can be done. Role modeling is a fundamental PsyR strategy. An aspect of Bandura's social learning theory (1977), which is covered in more depth in Chapter 5, role modeling is the principle way individuals learn to behave in different settings or environments. At the core of many PsyR approaches, role modeling is a powerful tool for providing both hope and specific strategies to achieve goals. The staff members of effective PsyR services, for example, act as role models for their service recipients. This is one reason why many PsyR professionals strive to reduce the barriers between themselves and their clients as much as possible. For example, staff members may dress less formally and share in everyday functions and chores as a means of emphasizing their similarities with the individuals they are serving.

The concept of recovery is bolstered by the increasing progress being made in psychiatry and psychiatric rehabilitation. This progress is seen in a number of different developments:

• The results of landmark longitudinal studies on the outcome of schizophrenia (e.g., Harding, Brooks, Ashikaga, Strauss, & Breier, 1987; described in Chapter 3)

• The introduction of improved medications that have better results in terms of decreasing both symptomatology and side effects for many consumers (described in Chapter 3)

• The identification of evidence-based practices that reliably produce positive outcomes for consumers. Supported employment may be the best example of this (see Chapter 9).

• The debunking of many of the myths about schizophrenia and mental illness that support continued stigma against people with mental illness (e.g., Harding & Zahniser, 1994).

The concept of recovery embodies the optimism and hope that underlie the entire PsyR enterprise. The goal of recovery for every individual with mental illness is an important element in the definition of the PsyR profession.

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