Recovery and Mental Illness
This past month marks the release of the third edition of the Illness Management and Recovery program. The program in many ways reflects the new recovery philosophy for people with severe mental illness. In this excerpt, the authors trace the origin of this movement and its definition of recovery.
Sometime in the 1970s and the 1980s, mental health clients, or "consumers," began to demand respect from professionals and argue for the right to be involved in decisions about their own treatment. The mental health consumer movement emerged as a protest against traditional, paternalistic treatment approaches and continues today. These clients also objected to the professions often pessimistic predictions on the long-term outcome of mental illness, both because these predictions were wrong and because of their unintended "spirit-breaking" effects.
Members of the consumer movement further argued that traditional, medical definitions of recovery were outdated and no longer useful in the mental health field. They emphasized the need for a more nuanced approach to understanding recovery that would have greater relevance and meaning to clients with a mental illness. Essential to this new viewpoint on recovery was an awareness of each person's unique experience of mental illness, including the process of learning how to cope with it and move on with life. Rather than defining recovery in terms of remission from symptoms and impairments, the term recovery came to be used to describe the process of learning how to live a rewarding life in spite of any ongoing difficulties related to mental illness.
One broad definition of this new concept of recovery provided by William Anthony, the director of Boston University Center of Psychiatric Rehabilitation deserves mention:
"Recovery involves the development of new meaning and purpose in one's life as one grows beyond the catastrophic effects of mental illness."
Anthony's definition emphasizes that life continues after a person has developed a mental illness and acknowledges how establishing personal meaning in one's life is a critical task of recovery. The importance of making meaning in one's life following the onset of a mental illness has also been emphasized by many others, as has the potential for continued human growth. Thus, this new view of recovery is more akin to "recovering one's life" or "recovery in mental illness" than it is to medical recovery from a disease.
This new understanding of recovery also highlights the subjective aspect of the recovery experience. Consider the following description of the recovery process, provided by Patricia Deegan, a mental health consumer and professional who has written extensively about recovery:
"Recovery is a process, a way of life, an attitude, and a way of approaching the day's challenges. It is not a perfectly linear process. At times our course is erratic and we falter, slide back, regroup, and start again... The need is to reestablish a new and valued sense of integrity and purpose within and beyond the limits of the disability; the inspiration is to live, work, and love in a community in which one makes a significant contribution."
The new way of looking at recovery recognizes the uniqueness of every person's experience of mental illness and the importance of each person determining what recovery means to him or her. In addition to describing the subjective experience of recovery, Deegan also addresses the varying types of changes mental health client's desire as a part of the recovery process. The 2003 President's New Freedom Commission on Mental Health describes recovery in a similar manner:
"Recovery is the process in which people are able to live, work, learn, and participate fully in their communities."
Not surprisingly, this definition reflects common human needs that everyone, not just people with a mental illness, has. These needs include:
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a safe place to live, physical health, sufficient income
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a sense of well-being
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good relationships (e.g., with family, friends, intimate partners)
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work, school, and/or parenting
As this new way of viewing recovery has taken root, a growing body of literature on the nature and experiences of recovery has emerged. Several themes can be identified that provide a broader understanding of the meaning of recovery to people with a mental illness. These themes include hope, self-determination, respect, and the nonlinear nature of recovery.
