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LESSON 1
The Recovery Model


Recovery Model

The mental health field in the United States is undergoing a quiet revolution. Former patients and other advocates are working with mental health providers and government agencies to incorporate spirituality into mental health care. While the significance of spirituality in substance abuse treatment has been acknowledged for many years due to widespread recognition of the therapeutic value of 12-step programs, this is a new development in the treatment of serious mental disorders such as bipolar disorder and schizophrenia. The incorporation of spirituality into recovery is one of four hallmarks of the recovery model that is becoming increasingly accepted as the reigning treatment approach in the mental health fiedl.

A second perspective that distinguishes the recovery model from prior approaches is the assumption that people can fully recover from even the most severe forms of mental disorders. It creates an orientation of hope rather than the "kiss of death" that diagnoses like schizophrenia once held. One hundred years ago, Emil Kraepelin,MD, identified the disorder now known as schizophrenia. He described it as dementia praecox, a chronic, unremitting, gradually deteriorating condition, having a progressive downhill course with an end state of dementia and incompetence.

However, researchers in in the past two decades in Japan, Germany, Switzerland, Scotland, France and the USA have established that people diagnosed with schizophrenia and other serious mental disorders are capable of regaining significant roles in society and of running their own lives. In fact, most persons with serious mental disorders do recover. Robert P. Liberman, MD, Professor of Psychiatry at UCLA School of Medicine notes that there is strong evidence that persons, even with long-term and disabling forms of schizophrenia, can 'recover,' that is, enjoy lengthy periods of time free of psychotic symptoms and partake of community life as independent citizens. Daniel Fisher, MD, PhD, a former patient, now a psychiatrist, and internationally renowned advocate for the recovery model, maintains that "Believing you can recover is vital to recovery from mental illness." Recovery involves self-assessment and personal growth from a prior baseline, regardless of where that baseline was. Growth may take the overt form of skill development and resocialization, but it is essentially a spiritual revaluing of oneself, a gradually developed respect for one's own worth as a human being.Often when people are healing from an episode of mental disorder, their hopeful beliefs about the future are intertwined with their spiritual lives, including praying, reading sacred texts, attending devotional services, and following a spiritual practice.



The belief that one can recover from mental disorder is well established as an important aspect factor affecting outcome. Daniel Fisher, MD, PhD, a former patient, now a psychiatrist who is one of the most vocal advocates of the recovery model, has noted that,

Although it is encouraging that Western medicine is beginning to acknowledge the central role of a positive belief in recovery in the area of physical disorder, it is disturbing that psychiatry does not see the wisdom of such an attitude for mental disorder. Even though the weight of personal testimony and epidemiological studies argues that most people are able to regain a productive role in society and recover from mental disorder, the mental health field in particular persists in a belief that mental disorder is a permanent condition.
Daniel Fisher,MD,PhD Believing you can recover is vital to recovery from mental disorder

Empowerment Center Recovery Articles by Daniel Fisher, MD, Ph.D, Laurie Ahern and others.

 

Recovery versus Medical Model

The medical model tends to define recovery in negative terms (e.g., symptoms and complaints that need to be eliminated, disorders that need to be cured or removed).

Mark Ragins, MD observed that focusing on recovery does discount the seriousness of the conditions.

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 persons themselves who are the objects of recovery efforts.

Drawing on the 12-step approach to recovery from addictions, Dr. Ragins outlines an alternative to the medical model approach.

1. Accepting having a chronic, incurable disorder, that is a permanent part of them, without guilt or shame, without fault or blame.
2. Avoiding complications of the condition (e.g. by staying sober).
3. Participating in an ongoing support system both as a recipient and a provider.
4. Changing many aspects of their lives including emotions, interpersonal relationships, and spirituality both to accommodate their disorder and grow through overcoming it.

This focus on self-directed treatment is the third distingquishing feature of the recovery model. Treatment professionals act as coaches helping to design a rehabilitation plan which supports the patients' efforts to achieve a series of functional goals. Their relationship often focuses on motivating and focusing the patient's own efforts to help themselves. What is important, particularly during the initial stages of interaction is that professionals afford dignity and respect to those in their care.

REQUIRED QUIZ EXERCISE 1: Problems with Current Model

 

In Recovery: Changing From A Medical Model To A Psychosocial Rehabilitation Model Mark Ragins,MD argues that despite clear evidence of the growing efficacy of treatments and more benign outcomes than traditionally thought, a problem in how recovery is perceived is due to: a) our conceptual model of treatment and recovery b) the inherent nature of the conditions c) very few psychiatrists treating people with serious mental disorders d) all of the above.

Record your answer for later insertion into the Quiz.

.EXERCISE: Listen to Webcast
The Recovery Vision: New paradigm, new questions, new answers.

This webcast from Boston University's Center for Psychiatric Rehabilitation reviews the empirical knowledge underlying the vision of recovery.
Dr. Courtenay Harding, known for her groundbreaking research in the field of recovery, reviews the evidence for recovery and its implications.
Dr. William Anthony, one of the pioneers in the field of recovery-oriented rehabilitation, discusses how recovery research must change the paradigm of the field and the questions we ask.
Ms. Judi Chamberlin, an internationally known psychiatric survivor and advocate of individuals with a mental disorder label, discusses the implications of the emergence of the vision of recovery for the roles of consumers and non-consumers.
Dr. Marianne Farkas, researcher, staff developer, educator and consultant in recovery oriented psychiatric rehabilitation for over 20 years, addresses how the emergence of a new paradigm will pose challenges for the development of mental health and rehabilitation systems.

REQUIRED QUIZ EXERCISE 2: Mental Disorders

According to the first presenter from the World Health Organization in The Recovery Vision: New paradigm, new questions, new answers, how many people around the world have a mental disorder a) 100 million b) 200 million c) 500 million d) unknown

Record your answer for later insertion into the Quiz. (If for some reason you have trouble accessing the webcast, just skip this item by inserting "skip" in the Quiz. You only need to complete 75% of the quiz items.)


REQUIRED QUIZ EXERCISE 3: Recovery Model

The recovery model a) is based on the medical model b) maintains that full recovery is possible c) seeks membership in the American Psychiatric Association d) is opposed to the use of medication

Record your answer for later insertion into the Quiz.

Example of a Recovery Oriented Clinical Program

New Recovery Center at Boston University is an example of a program that has adopted a recovery model. Their curricular options include such courses as Connectedness: Some Skills for Spiritual Health, Hatha Yoga, and Intro to the Internet. Matriculated students take at least two of these semester-long classes, as well as a Recovery Seminar --a guided exploration of personal recovery that is the center's flagship course.

Recovery has so much to do with quality of life. And that may not necessarily mean going back to work or going back to school. It may mean developing friendships, belonging to a church, having a healthy body and a healthy mind. I think we've gotten so secular in the way we provide services -- focusing on either work or school.

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