[di meliora]

WARNING, this post talks about recovery and may be offensive to some for various reasons including a belief that recovery is beyond their capacity.

Recently, I came across a joint position paper about: A common purpose: Recovery in future mental health services http://www.scie.org.uk/publications/...apers/pp08.pdf

Two sections on recovery piqued my interest:

3.2 Defining recovery

There is not yet a succinct or universally accepted definition of recovery. In ordinary speech, recovery is often equated with cure, a return to how things were before the illness or injury occurred, a process of getting back to normal, but by this definition few, if any, who experience severe mental illness recover (Whitwell, 2005). However, for severe mental health problems, and in reality all long-term conditions, outcomes are more complex and are described both by resolution of symptoms, impacts on life domains affected by illness, and growth and development of other valued life experiences. Some professional definitions of recovery distinguish between ‘complete clinical recovery’, with total absence of symptoms, and ‘social recovery’, which means the ability to live a more or less independent life even if symptoms remain. The current concept of recovery includes both of these but has moved from professional definitions towards self-definition, such that the concept and experience of personal A common purpose recovery is not limited by the presence or absence of symptoms, and disabilities, nor the ongoing use of services. The concept of personal recovery pivots around considerations of how to live and how to live well in the context of long-term mental health conditions. How to develop a strong and satisfactory personal identity that is not defined by illness is a key issue, for example: ‘just because you have a diagnosis of schizophrenia doesn’t mean that you have to be a schizophrenic’. This way of thinking about recovery engages with the seemingly paradoxical assertion that you can be well even if you have a long-term illness, or as the Stanford University selfmanagement course put it, ‘Living a healthy life with chronic conditions’ (Cooper and Clarke, 2005).

Thus recovery has been defined as, ‘a deeply personal, unique process of changing one’s attitudes, values, feelings, goals, skills and roles. It is a way of living a satisfying, hopeful, and contributing life even with limitations caused by the 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).

Based on her personal experience, Deegan (1988) defines recovery as, ‘a process, a way of life, an attitude, and a way of approaching the day’s challenges’. The recovery literature (Allott et al, 2002; Ralph and Corrigan, 2005) similarly describes being in recovery as an ongoing process, which involves gaining or regaining many aspects of life that are usually taken for granted, and may be lost or severely compromised by mental illness. Recovery may involve many stages, and inevitably setbacks and uncertainty, and has been described as, ‘an uncharted, unpredictable, and personal journey’ (Antony Sheehan, preface to the National Institute for Mental Health in England (NIHME) Inspirations, a calendar of recovery, 2002).

The American Psychiatric Association’s position statement, ‘endorsing and strongly affirming the application of the concept of recovery’, gathered many of these viewpoints and emphasised that recovery-based practice is based on broad partnerships that seek to uphold hope and maximise quality of life:

The concept of recovery emphasises a person’s capacity to have hope and lead a meaningful life, and suggests that treatment can be guided by attention to life goals and ambitions. [The recovery approach] recognizes that patients often feel powerless or disenfranchised, that these feelings can interfere with initiation and maintenance of mental health and medical care, and that the best results come when patients feel that treatment decisions are made in ways that suit their cultural, spiritual, and personal ideals. [The recovery approach] focuses on wellness and resilience and encourages patients to participate actively in their care, particularly by enabling them to help define the goals of psychopharmacologic and psychosocial treatments.… The application of the concept of recovery requires a commitment to a broad range of necessary services and should not be used to justify a retraction of resources. (APA, 2005)

The issue of definition and personal redefinition, in particular from being chronically ill to ‘in recovery’, lies at the heart of a recovery-based approach to long-term conditions. The meanings that are attributed to experiences and the stories that are told about them assume a particular importance in confirming illness or supporting wellness. There is also a shift of emphasis from clinical and social recovery to personal recovery, as valued and defined by the individual.

Recovery is the process of regaining active control over one’s life. This may involve discovering (or rediscovering) a positive sense of self, accepting and coping with the reality of any ongoing distress or disability (Faulkner and Layzell, 2000) finding meaning in one’s experiences, resolving personal, social or relationship issues that may contribute to one’s mental health difficulties, taking on satisfying and meaningful social roles, and calling on formal and/or informal systems of support as needed (Leibrich, 1999). Services can be an important aspect of recovery but the extent of the need for services will vary from one person to another. For some people, recovery may mean exiting from mental health services either permanently or for much of the time. For others it may mean continuing to receive ongoing forms of medical, personal or social support that enable people to get on with their lives.

3.3 Themes in recovery

Engaging with a move towards recovery-based practice takes in far wider considerations than familiar concerns about giving or receiving effective treatment. It is about engaging with the complexities of lived experience and seeking to constructively support an increased possibility of recovery outcomes. The recovery literature has arisen largely from personal experience with more recognisably scientific evaluation and theory following later, and although rich in personal meaning it remains light on systematic analysis. The dynamics and essential components of the recovery process have yet to be fully understood or evaluated but the process of recovery has been recurrently associated with a number of core themes (Deegan, 1988; Onken et al, 2002; Turner-Crowson and Wallcraft, 2002;
Allott, 2005; Ralph and Corrigan, 2005; Roberts and Wolfson, 2006). Taken together, these themes do not so much define recovery as sketch out the map on which recovery journeys are lived, and suggest directions for research, evaluation and the development of recovery-based practice and services.

Key themes include the following:

1 . Recovery is fundamentally about a set of values related to human living applied to the pursuit of health and wellness.
2 . Recovery involves a shift of emphasis from pathology, illness and symptoms to health, strengths and wellness.
3 . Hope is of central significance. If recovery is about one thing it is about the recovery of hope, without which it may not be possible to recover and that hope can arise from many sources, including being believed and believed in, and the example of peers.
4. Recovery involves a process of empowerment to regaining active control over one’s life. This includes accessing useful information, developing confidence in negotiating choices and taking increasing personal responsibility through effective self-care, self-management and self-directed care.
5. Finding meaning in and valuing personal experience can be important, as is personal faith for which some will draw on religious or secular spirituality.
6. Recognising and respecting expertise in both parties of a helping relationship which recontextualises professional helpers as mentors, coaches, supporters, advocates and ambassadors.
7. Recovery approaches give positive value to cultural, religious, sexual and other forms of diversity as sources of identity and belonging.
8. Recovery is supported by resolving personal, social or relationship problems and both understanding and realistically coming to terms with ongoing illness or disability.
9. People do not recover in isolation. Recovery is closely associated with social inclusion and being able to take on meaningful and satisfying social roles in society and gaining access to mainstream services that support ordinary living such as housing, adequate personal finances, education and leisure facilities.
10. There is a pivotal need to discover (or rediscover) a positive sense of personal identity, separate from illness and disability.
11 . The language used and the stories and meanings that are constructed around personal experience, conveyed in letters, reports and conversations, have great significance as mediators of recovery processes. These shared meanings either support a sense of hope and possibility or carry an additional weight of morbidity, inviting pessimism and chronicity.
12 . Services are an important aspect of recovery but the value and need for services will vary from one person to another. For some people, recovery is equated with detaching from mental health services either permanently or for much of the time. For others, recovery may be associated with continuing to receive ongoing forms of medical, personal or social support that enable them to get on with their lives.
13 . Treatment is important but its capacity to support recovery lies in the opportunity to arrive at treatment decisions through negotiation and collaboration and it being valued by the individual as one of many tools they choose to use.
14. The development of recovery-based services emphasises the personal qualities of staff as much as their formal qualifications, and seeks to cultivate their capacity for hope, creativity, care and compassion, imagination, acceptance, realism and resilience.
15. In order to support personal recovery, services need to move beyond the current preoccupations with risk avoidance and a narrow interpretation of evidence-based approaches towards working with constructive and creative risk-taking and what is personally meaningful to the individual and their family.

The concept of recovery has been talked about before at length here. Objective views on what constitutes recovery are going to be controversial. Who is going to be making the decision about whether someone is recovered?

The healthcare provider will want a lower standard of recovery since a more stringent one will mean the provider must continue to provide benefits. Big Pharma may have a different view since recovery is not profitable. The politicos view those with illnesses as budget items.

What about the consumer? The model talks about empowering consumers subjectively to define their own recovery. The question remains whether the consumers will be allowed to. If the healthcare providers and our concerned representatives stop the funding, who really is deciding who has recovered?

[Open Eyes]

A long time ago I watched a program that showed an experiment where researchers wanted to see what would happen if a monkey was presented with very little maturnal warmth and interaction. So they substituted a normal mother with nothing more than a cold metal mother. It was very hard to watch the result of that experiment. And though it was so many years ago that I viewed that documentary, I can still remember so much of it as if I had watched it recently. The monkey simply could not adapt or participate when exposed to a group of other monkeys that had a normal mother and could interact with each other. The monkey became so upset and frightened that they removed it from the cage of social monkeys and put it back in isolation with the metal mother where it just clung to that metal mother. The monkey really didn't know what to do other than that.

I think about the depth of that and what that means in terms of human beings. I remember how in that experiment everything that resembled anything nourishing in the way of affectionate interaction was taken away.The monkey did receive nourishment, but it was without any kind of maternal
like nurturing it was provided very rigidly. As a result an extreme consequence was noted. The infant was capable of surviving but that was all it had managed, there was no capacity to do anything more but cling to a metal dummy.

In human beings, if we really look, we can observe a variety of incapacities depending on the way a human child is nurtured. A human child will respond with little interaction with a mother if there is a substitute source of warmth and interaction provided through a father, a sibling a teacher a friend etc.
From the very beginning within a family a human being's perceptions of interacting is effected and formed. So for every human being born their mental health depends on their immediate environment and what takes place in that environment. Even if a human being is born with a genitic challenge of some kind the outcome and well being of that human being depends on what that human being is taught, tended, and nurtured around whatever challenge is presented.

We address so many different challenges in human beings today and we have this manual that expresses groups of conditons and symptoms divided into what is known as disorders. We try to develope ways of understanding these different disorders and search for ways to provide treatment both by developing drugs and methods of addressing how to nurture the various humans that present different disorders. When the terms recovery, healing, finding happiness, sense of well being, and assisting in presenting any kind of treatment that helps each human to attain ability to thrive, there is still an ongoing question of our acuracy in applying proper treatment.

This article talks about healing, therapy verses no therapy and sends a message that isolation impedes progress when it comes to learning how to function in a sense of quality to life. The overall message addresses a need to recognize that there can be a productive way to address life even with limiting mental illness. There are key words missing in much of the language and information presented and one key word that is paramont is adaptation. All human beings are designed to adapt and will do so either in ways that are considered healthy or damaging. Healing itself must include clear guides to help someone to understand how to adapt out of bad adaptations with permission that conveys a message where someone truely understands that it is truely ok to adapt without feeling guilty or damaged.

Personally, I agree that we can learn to adjust to life and become productive even though we may experience a mental illness, or some kind of lack. But, there has to be a guide, an availability of some kind of nurture to each person who struggles with any kind of psychological struggle. In my own observance of that study done so long ago, I truely feel that as human beings we cannot just expect someone that struggles with any kind of mental illness to just know how to heal on their own.

With any mental illness as well as a lack of early nurturing there is always going to be a desire to isolate due to a deep sence of lack. So it is important that each individual be provided with a way to address and understand what may have impeded their personal progress in their past. The application of a medication cannot be used to substitute for a nurturing that is absent in a human being that presents issues with coping in society.

Each human being that presents a personal struggle must truely be educated in a way that helps that person LEARN what may not have been provided to help them interact properly. Each human being is a unique puzzle and it is very important that each human being be addressed as a whole puzzle and not just a person who presents mental illness of some kind.

Therefore, education is very important to each individual, education that provides whatever is needed for each person to truely see their own missing peices without interpreting these missing pieces as meaning the only answer is isolation and disfunction for the rest of their lives.

This must include each person to access their personal history of how they were raised and effected by their personal family environment. The origins of all perceptions must be addressed and recognized. If that can take place with therapy to address whatever is not there with ways to accept and learn new healthier perceptions a person can find ways to heal.

Ofcourse I am addressing all those that are at a point where they are old enough to recognize there is some form of mental illness that needs to be treated.

The real answer is educating every parent in how to provide the proper nourishment in the first place. And it is also important to be able to identify any special needs presented by a child so that they can learn from an early age how to compensate and thrive.

Our ability to identify the different challenges that are presented in a manual
to be used as a guide still has limits. There is still much we do not know.
We are learning everyday about the human brain. And as we are learning we are also learning that humans are adaptable and can thrive despite imperfections that may be present. So HOPE should remain in each of us. And we all must consciously be nourished and nurtured with a message that says, yes, we are not perfect, however we can learn to adapt and we are truely designed to do just that.

Open Eyes

[Gus1234U]

fascinating posts, both of you~! what a lovely topic, i hope there are many who post in reply.

i personally come from the "Rehabilitation Model of Consumer Empowerment". It is both good and bad that the terms are so vague,, good because it allows for such flexibility, bad because it does not support accountability.

the Rehab Model is one in which the person seeking to regain lost functions or opportunities decides on priorities, methodologies, and services, after having been given the opportunity to learn about what is available to them. it postulates that healing what can be healed, and supporting what cannot be, with assistive devices, specialized services, and accommodations, is the most effective and integrated way to maximum recovery.

alas, as with so many "soft services", the peer support groups and agencies are underfunded and over stressed. many people who could benefit from seeing persons like themselves using rehab modules are unaware of their existance. this is mostly due to the distain, or denial, of the "medical community" to refer and educate. it is up to us to spread the news among those who are isolated, newly diagnosed or disabled.

there are Independent Living Centers across the nation, affiliated with the Division of Vocational Rehabilitation, their mission is to support and assist any person with a disability to learn about, find, access, and retain services, supports and accommodations which will help them to maximize their self development, independence and social integration.

i personally support the 'Cross-Disability' support model, as so many of us face the same kinds of barriers, and need the same kinds of supports, both medical, social, educational and emotional. please help spread the word, there is help out there, rehabilitation is possible, what ever one may call recovery, it too is a reality.

best wishes, Gus

[Open Eyes]

"WARNING, this post talks about recovery and may be offensive to some for various reasons including a belief that recovery is beyond their capacity". quoted above

If you are a person that truely feels that you cannot "recover" your oppinion may not be a terrible oppinion. If someone has dislexia, ADHD or other conditions that present a challenge where conventional learning is not effective, there are proven ways to "adapt" in spite of these limitations.

The word truely needed is not that of "recovery" but that of "ability to adapt" and as I mentioned above, that is something we are all designed to do.

I raised a child that has dislexia and she did not respond to conventional ways of learning. My daughter could be given a list of five things to do and her brain could only remember three things and not retain or process the ability to do five or more consecutive functions. My daughter was also not able to listen to a word that had multiple syllables and process these syllables in her brain in proper order to sound out a possible spelling of a word. My daughter also learned not just by seeing or observing but by doing and doing.

My daughter was lucky because I knew enough as her mother that her father was diagnosed with dislexia so while raising her I really paid attention to her ability to learn. My daughter was very capable of repeating and memorizing at an extremely early age. At the age of only 1 my daughter memorized the alphabet by listening to me sing it to her repeatedly. I also thought that she was reading at an early age, however she wasn't really reading, she had just memorized the stories I had read to her. As with most children my daughter had her favorite story that she wanted me to read every single night. My daughter remembered every word spoken on every page that went along with a picture. But, my daughter was not actually reading.

My daughter did struggle in school when it came to looking at words and sounding them out towards learning how to read. Had there been no offer of adapting around that inability my daughter would have truely struggled to learn and flourish in school.

I was very lucky that there was a study being done at Yale on dislexia so that her specific difficult areas could be identified to me. However there was not a real course on how to compensate for the lack. I had developed my own way of helping my daughter learn by accessing her ability to memorize and I read to her every night and that resulted in her increasing her cognitive ability above her age level for the rest of her life.

As time went on and my daughter had to learn words the only way she could learn them was by memorizing them. I helped her do that by surrounding the words with stories that aided in her capacity to memorize words and how they were spelled. And I also had to help her overcome the limits of a list that meant thinking about remembering five or more things. I also used stories there too so that it was no longer a list to be remembered but a story and often funny stories using our everyday pets, people friends etc.

I supported my daughter in also taking riding lessons and that also required her to remember more than just a few things. And there was also presented to her a procedure of jumping a course of fences in different orders and their were eight fences in every course that she jumped and the order would be changed each time she took her horse or pony in a competition of jumping. My daughter was able to memorize every course, rarely did she forget an order. I was amazed that she could do that as many children would have difficulty remembering the order of fences to be jumped. One day I asked her how it was that she could remember the different courses so well. She replied to me that she learned that she could do everything in threes. So how she worked it out in her brain was, 1,2,3 and 4,5,6,and 7,8, and off which means riding away from the course.

My daughter has a high IQ and she does remarkably well and has a good job. That was all possible because in her early years she was guided beyond her disabilty to ADAPTATION in other ways of learning and progressing.

Often we are told that it is not always about how we fall in our attempts in life, but how we rise again. What this really means is how we learn how to "adapt" in spite of whatever happens in our lives.

I am spending time here with this thread because in my time here at PC I have come to know many who feel that they are never going to RECOVER, or HEAL and feel STUCK or feel DAMAGED. And while we cannot change our past and the memories of our past, the path is not about RECOVERY. The real path has to be more about how to Adapt and Readapt with every challenge we are presented with.

I have to say, I am struggling myself with my own issues. As I look back at my own life I can see many struggles. I can see one life that was presented with many challenges, some of which were extremely disruptive. I can see things I didn't understand and situations that troubled me and I didn't really have answers to many questions and I didn't always know how to react appropriately because there really wasn't an example that showed me how. But I did survive and I did adapt in many ways.

I DO have a disorder/damage with a name and I don't exactly know what it means entirely. I am trying to learn what it means and find a way to understand it. Once I find a way to understand it, I have come to recognize that all I can really do is learn new ways to adapt and progress and give myself permission to do just that.

So for anyone that has any kind of disorder, it is not really about recovering per say, life is about change, constant change and constantly learning and adapting which takes place all of our lives. Even if someone adapted poorly in their past, that doesn't mean they cannot learn better ways to adapt now. Yes, it is still very challenging but we at least have to give ourselves permission to do what we are designed to do, learn new ways to adapt to our environments. Adapting is also about being willing to learn and actually do, even if doing is only a little at a time.

My daughter is always going to have dislexia and all her life she will be challenged to continue to learn new things in order to survive. The one thing that she will have is a learned ability to adapt, she will make mistakes as we all do, but her own ability to suvive will come from knowing that she has adapted in her past and therefore should be able to do so all her life.

Open Eyes

[Tosspot]

Wow - good stuff in all these posts. For me recovery is an attitude, a state of being, an awareness of an illness and trying to progress and live happily with it. I will never be cured of my mental illness(es) but have learned to live with it and better myself because of it. There are, and will be times where I can't function at a socially acceptable level, but I will be in recovery because I am always working towards my ideal self (which is totally unattainable, I don't believe in human perfection) but its the progress that counts!

[venusss]

ad dyslexia and ADHD. I know for sure I am dysletic... quite heavily, I believe. Learned to work around it, even if school caused me minor trauma and I get oversensitve when people comment on the way I read out loud or write...

but I think it is quite minor holdback. Imho today the "disability" attitude goes too far and I honestly get annoyed at people who don't bother with their spelling using the "I am a dysletic card". Guess what, I am too and I cannot read your mess of writting!

ADHD... have traits, probably have it, but does not matter now. Annoyed the hell out of teacher back in middle school... (I wonder what annoyed them more. My supposed "not paying attention" or that I still got the answers right on tests, so they could not powertrip all over me).

Again.... ADHD is not such a big issue once you learn to adapt and live with it.


Ad cure... well, I chose to avoid the consumer role for obvious reason... informed choice and all. And for me, it is not an option at the moment. I am not saying nobody can profit from the "system". But... informed choice should be the key. It annoys me when people spout "trust your doctor". (but it could be because my grandmother trusted her GP and she is dead by his fault... (and she is not the only person who is dead due to his negligience). But if the said doctor has office full of pharma clocks and pens... then healthy distrust is... healthy. If they tell you "you are depressed, here's your prescription" the minute you walk in the door, then run for your dear life.

For me recovery is getting to the point where my problems are not a problem. I am so much better off than I was few years ago. I still need to learn a lot... but I doubt i can learn that within the mainstream (why would they want to teach people how to learn them to cope when they can hook them up with promise of cure and "normal"?).

[elliemay]

I believe even Freud indicated that the goal of psychoanalysis was to achieve "ordinary human misery".

The man did make some good points I think.

[di meliora]

Excerpt:

The death instinct is a controversial and troubling aspect of Freud's thinking, but we can see it arising inevitably from the physicalist tradition to which he, in large part, belonged. Of all the streams of psychoanalytic theory, only the Kleinian school seems to have taken up the death instinct with any degree of enthusiasm, and even here Melanie Klein developed the concept in her own way, as innate destructiveness. For Freud the death instinct was primarily an expression of "an urge inherent in organic life to restore an earlier state of things", so that a primal state of non-life appeared to be the ultimate historical aim of all life Sulloway, 1979 p.413). Destructiveness was a secondary manifestation. W.B. Yeats' poem The Wheel, published in 1928, expresses the Freudian view most eloquently:

Through winter-time we call on spring,
And through the spring on summer call,
And when abounding hedges ring
Declare that winter's best of all;
And after that there's nothing good
Because the spring-time has not come –
Nor know that what disturbs our blood
Is but its longing for the tomb.

In his summarising paper Psycho-Analysis (1926) Freud declared that psychoanalysis offered a science of man and his unconscious mind rather than a mode of psychotherapy. He had come to believe that the power and persistence of the death instinct provided a firm counterweight to therapeutic zeal. But then we must remember that therapeutic zeal was quite foreign to Freud's nature. At the very beginning of his psychoanalytic work, in Studies in Hysteria, he had declared soberly the aim of psychoanalytic therapy was to turn "hysterical misery into ordinary human unhappiness." (Emphasis added.) http://psychoanalysis.mylithio.com/d..._helmholtz/pdf

So then, if we cannot achieve a primal state of non-life at least there is hope for ordinary unhappiness. Of course, the controversy over recovery will involve a determination to see if our unhappiness is sufficiently ordinary.

[unaluna]

like all this.