The Theory of Recovery Psychology/The Recovery Model/Chapter One/Part 3
The field of psychiatric rehabilitation emphasizes the treating of the consequences of the illness rather than treating the illness itself. This has helped those working in the mental health care field better understand the full impact of psychiatric conditions. In the 1980’s proponents of psychiatric rehabilitation such as Mikal Cohen, William Anthony, Robert Paul Liberman and Marianne Farkas have emphasized this full impact in the terms of significant functional limitations, disabilities or handicaps. The World Health Organization (WHO) had already developed a model of illness which not only discussed the illness itself but consequences of that illness. Using the WHO classification system that recognized mental illness in the terms of impairment, dysfunction, disability and disadvantage came to be known as the psychiatric rehabilitation model. Mental health treatment attempts to treat the symptoms of illness. Rehabilitation has been more directed at maximizing the health of the individual. Eliminating or suppressing the symptoms does not necessarily lead to improved role functioning. Nor does a decrease in an individuals disability lead to a reduction in symptoms, although it is entirely possible and severe impairment does not have to be permanent. Two strategies of the practice of psychiatric rehabilitation which are similar to physical rehabilitation of physical disability are personal skills development, and environmental support development. This basic philosophy is common in the rehabilitation of both mental and physical disabilities. It is based on the idea that persons with disabilities need to achieve their goals and fulfill their roles in life. These interventions are designed to lessen the dysfunction and are assumed to lessen the disability. A major intervention that has helped persons with psychiatric disabilities is societal rehabilitation. The Americans with Disabilities Act (1990) and the recent effort to achieve health benefit parity between those with physical and psychiatric disabilities. Recovery Research Recovery is a multi-dimensional concept. There is no single measurement for it. It has to be studied by measuring many different measurements that estimate the various components (Anthony 1991). A comprehensive operational definition of recovery must include normative levels of social and occupational functioning; such as independent living, and remission or non-intrusive psychiatric symptoms.
Psychological data collected for the research of recovery is expanding the language of recovery research. Healing, self-determination and empowerment are important anticipated results of this research (Anthony 2002). The suggested working guide for outcome research targets the following domains of recovery; instrumental role functioning, subjective well being, self-esteem, psychosocial adjustment, quality of life, health status and symptomology (Rogers, Farkas & Anthony 2005).
Recovery from mental illness is a non-linear process; there are no A-B-C-D-E-F stages in recovery. For each person recovery is different and an individual process. A person in recovery can jump from A to D to B to C in their process. Recovery does not have one starting point, or one destination. Whether it’s number one, number five, or number thirty on the task list, the goal is to just start moving forward in any area, in any increment. (Crowley, 1997 Report of the Wisconsin Blue Ribbon Commission on Mental Health) Since recovery is non-linear so is the study of it. Psychiatric rehabilitation practitioners use evidence based practices. The scientific method may be useful in psychology research, but a majority of psychology research with regards to mental illness has been to study the medical aspects of mental illness. The empirical rationale for the recovery model is based on qualitive studies, instead of quantitive studies. The anecdotal evidence from accounts peoples own recovery, the long term outcomes studied in research by Courtney Harding, and research studies of community integration of persons recovering in the areas of living, learning, working, socialization and vocational skills are the crux of this research. Written testimonials by former mental patients have appeared for centuries. These writings, according to historian of medicine Roy Porter, “shore up that sense of personhood and identity which they feel is eroded by society and psychiatry” (Porter, 1987). What distinguishes the contemporary wave of writings is their critical mass, organizational backing, and freedom of expression from outside the confines of the institution. Deinstitutionalization, the emergence of community supports and psychosocial rehabilitation (PSR), and the growth of the consumer and family advocacy movements all paved the way for recovery to take hold (Anthony, 1993). The concept of recovery continues to be defined in the writings of consumers. These lay writings offer a range of possible definitions, many of which seek to discover meaning, purpose, and hope living with mental illness (Lefley, 1996). However, these definitions do not imply full recovery, in which full functioning is restored and no medications are needed. Instead they suggest a journey or process, not a destination or cure (Deegan, 1997). One of the most prominent professional proponents of recovery, William A. Anthony, summarized consumer writings on recovery with the following definition: "...a person with mental illness can recover even though the illness is not cured...[Recovery] is a way of living a satisfying, hopeful, and contributing life even with the limitations caused by illness. Recovery involves the development of new meaning and purpose in one’s life as one grows beyond the catastrophic effects of mental illness" (Anthony, 1993). The definitions of recovery from consumer writings vary somewhat but all have degree of commonality. “One of the elements that makes recovery possible is the regaining of one’s belief in oneself” (Chamberlin, 1997). “Having some hope is crucial to recovery; none of us would strive if we believed it a futile effort. . .I believe that if we confront our illnesses with courage and struggle with our symptoms persistently, we can overcome our handicaps to live independently, learn skills, and contribute to society, the society that has traditionally abandoned us” (Leete, 1989). “A recovery paradigm is each person’s unique experience of their road to recovery...My recovery paradigm included my reconnection which included the following four key ingredients: connection, safety, hope, and acknowledgment of my spiritual self”(Long, 1994). “To return renewed with an enriched perspective of the human condition is the major benefit of recovery. To return at peace, with yourself, your experience, your world, and your God, is the major joy of recovery” (Granger, 1994).