Leah Rokeach LCSW

These days, people are talking about recovery from mental illness. This is a great step forward. What does recovery mean? There are many perceptions and definitions of recovery. When we look at the recovery literature, we see that it has been variously used to mean an approach, a model, a philosophy, a paradigm, a movement, a vision and skeptically, a myth. This understandably creates ambiguity and confusion. William Anthony M.D. Director of the Boston Center for Psychiatric Rehabilitation, states that in the last several decades, several sources of data have converged to demonstrate that people with severe mental illness are achieving higher roles of functioning, subjective well- being, and adjustment than had previously been considered, and that severe mental illnesses are not universally deteriorative. One source of information has been the writing of people with severe mental illnesses. Another source of knowledge is the synthesis and dissemination of long term- outcome studies, which suggestedthat a significant percentage of people with severe mental illnesses were dramatically improving over time. According to Courtney Harding, PhD., director of the Center for Rehabilitation and Recovery, at the Coalition of Behavioral agencies in New York City, there are 10 national and international longitudinal studies of 22 to 37 years duration investigating the recovery and community integration of people with schizophrenia and other severe mental illnesses.

Dr. Anthony is credited with the most widely accepted definition of recovery. He argues that the person with a mental illness can recover even when the illness is not cured, and the process of recovery can proceed in the presence of continuing symptoms and disabilities. From this view point,the focus is "wellness" and not " illness". Thus, Dr. Anthony says:

"Recovery is a deeply personal, unique process of changing one's attitude, values, feelings, goals, skills and or 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 beyond the catastrophic effects of mental illness."

This shows us, that because recovery is a personal and unique process, a personal journey, everyone attaches his/her own personal meaning to recovery. It denotes a severely mentally ill person's potential for growth, healing and community integration. We also see from this definition, that recovery is not a cure, and is not an end result. It also shows that it is a transformation of the self, wherein one both accepts ones' limitations and also discovers a new world of possibility. Patricia Deegan PhD. , who recovered from schizophrenia writes, " this is the paradox of recovery, that in accepting what we cannot do or be, we begin to discover who we can be and what we can do.Thus, recovery is a process, and a way of life. It is an attitude and a way of approaching the day's challenges. It is not a perfectly linear process".

However, certain concepts or factors are common to recovery. These are: hope, believing in the person, self-confidence, self-help, education/knowledge about the illness and the symptoms, empowerment, medication/treatment, support, employment/meaningful activities, and coping strategies. Most important recovery is gaining social success and personal accomplishment in those areas that the person defines as important for him and/or herself.

People ask : " how does this happen?", "how does this process start"?"Does it really happen?"

The following is therecovery storyofJ., a31 year old man, who was diagnosed with schizophrenia paranoid type at age 20, while in college. He did well in high school, was chosen to be the valedictorianat his high school graduation.After his graduation, he went off to college to pursue his dream of becoming a journalist.In the middle of his second year of college he became suspicious of his roommates and didn't trust them. He became suspicious of his class mates and believed that they were talking about him. He started to hear voices that told him he was no good, will never graduate college, will never amount to anything.Hedid not feel safe anywhere, so he stayed in his room. His parents picked him up from the university and took him directly to a hospital where he was admitted to the psychiatric unit. The psychiatrist told him that he had schizophrenia, paranoid type, it is a disease of the brain and he must to take medications the rest of his life. He also told him that he cannot go back to college, or work because he needs to avoid stress. CRASH,CRASH, his dreams and hopes were destroyed.

" I was suspicious of people and overwhelmed with sadness and hopelessness. I didn't see a future for myself and it was very hard to face daily challenges and make it through the day. Although my family especially my parents, were supportive, I could see the sadness in their faces and I would often see my mother crying when she thought I am not watching. The end of my dreams, were also the end of her dream to see me settled in my profession with a wife and children. I was treatedby a number of psychiatrists, but their focus was always on my symptoms. The diagnosis assigned to me became my identity, I felt that I lost myself, I,the human being did not exist.For close to 8 years, I attended many different day programs. Whenever I felt extremely overwhelmed and the voices became loud and unbearable, I became frightened, and I admitted myself to the hospital. . Although I knew that taking medications isimportant , there were times that I would refuse to take them. About two years ago, after my discharge from my fifth hospitalization I was referred to a new psychiatrist and a new therapist. I was always suspicious of therapists and never stayed longer than a few sessions.

The first step on the journey to recovery starts with the relationship with the professional helpers, especially the therapist. Being met with hope, optimism and a sincere belief that the person with mental illness has the potential and ability to get a life, to take responsibility and to change despite the disability,is of central significance in many people's accounts of recovery. Another important factor in the recovery relationship is showing the client that the therapist never gives up, no matter how many "bumps" are encountered on the journey.Accepting failures and setbaks are part of the recovery journey and are used as educational experiences.

." The focusof the therapy with my new therapist was on my wishes, my dreams and my goals. At first I was very skeptical about the whole concept of recovery, of learning strategies to cope with my delusions and voices. I was also fearful of disclosing to my therapist that I still harbored the dream of going back to school. I love writing, but I haven't picked up a pencil and paper since I was forced to leave school. I was certain that if I told my therapist that my dream is to go back to school and work,she would tell me that I am delusional and tell my psychiatrist to increase my medication. However once I started to feel safe, and to trust her, I told her that my dream is to go back to school, Her answer to me was, "great, this is a wonderful goal to work on. I believe you can do it". For the first time I felt hopeful, Like a light bulb going on, I felt that my therapist believed in my potential and I began to develop confidence in myself. This was the first step on my journey to recovery. I am learning coping strategies for my symptoms. My voices are bothering me, but I am learning strategies to manage them, to challenge them and how to be in control of them. I learned the importance of medication in my life, and I always take them.My therapist gives me reading material about men and women who are on their journey of recovery.These stories are very inspiring,, and nurtures my hope to reclaim my life. At the present time, I attend a few groups at a dayprogram, but most important I am doing volunteer work in a nursing home three afternoons per week, and I write an article in their weekly bulletin. Helping other is giving me meaning in my life, but even more important, for the first time in ten years I am doing what I love, writing. I know that I have a long and difficult journey ahead of me. I continue to experience days that are, scary and difficult I use self-help techniques I learned to feel better. If it doesn't work I reach out for help. Most important, I am determined, to do whatever it takes to rebuild my life."

We see, as per Dr. Anthony's definition of recovery, that it is a unique personal process of changing one's attitude, values, feelings, goals. He also says it involves new meaning and purpose in life, of living a satisfying and contributing life with limitations caused by the illness. J. started this process, his journey, but he still has a long road to travel. However he is hopeful, optimistic and feels capable of making the changes toward more satisfaction and success in his life.

Why are some people not getting better? Dr. Harding ,quoted above,tells us that "we need to take a second, third and fourth look. We need to do whatever it takes to discover what is hindering their progress."

People with mental illness have the same wishes, dreams, hopes and aspirations like all of us. They are people just like people in general. We need to afford them all that is available to help them move on with their life, help them to recover. Patricia Deegan, quoted above, one of the most eloquent spokesperson on recovery states ,"The concept of recovery is rooted in the simple yet profound realization that people who have been diagnosed with a mental illness are human beings."

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Leah Rokeach is psychotherapist in private practice with a specialty in Psychiatric Rehabilitation and Recovery. She can be reached at [email protected] , or by phone 1 (917) 670 - 7148.