Components of Recovery
Recovery has only recently become a word used in relation to the experience of psychiatric symptoms. Those of us who experience psychiatric symptoms are commonly told that these symptoms are incurable, that we will have to live with them for the rest of our lives, that the medications, if they (health care professionals) can find the right ones or the right combination, may help, and that we will always have to take the medications. Many of us have even been told that these symptoms will worsen as we get older. Nothing about recovery was ever mentioned. Nothing about hope. Nothing about anything we can do to help ourselves. Nothing about empowerment. Nothing about wellness.
So what does recovery from a mental disorder look like?
You will recognize your own recovery when you start experiencing one or more of the following:
There is hope.
A vision of hope that includes no limits. That even when someone says to us, “You can’t do that because you’ve had or have those symptoms, dear!” – we know it’s not true. It is only when we feel and believe that we are fragile and out of control that we find it hard to move ahead. Those of us who experience psychiatric symptoms can and do get well. I (Mary Ellen) learned about hope from my mother. She was told she was incurably insane. She had wild, psychotic mood swings unremittingly for eight years. And then they went away. After that she worked very successfully as a dietitian in a large school lunch program and spent her retirement helping my brother raise seven children as a single parent and volunteering for a variety of church and community organizations.
We don’t need dire predictions about the course of our symptoms – something which no one else, regardless of their credentials can ever know. We need assistance, encouragement and support as we work to relieve these symptoms and get on with our lives. We need a caring environment without feeling the need to be taken care of.
Too many people have internalized the messages that there is no hope, that they are simply victims to their illness, and that the only relationships they can hope for are one-way and infantalizing. As people are introduced to communities and services that focus on recovery, relationships change to being more equal and supportive in both directions. As we feel valued for the help we can offer as well as receive, our self-definitions are expanded. We try out new behaviors with each other, find ways in which we can take positive risks and find that we have more self-knowledge and more to offer than we were led to believe.
It’s up to each individual to take responsibility for their own wellness.
There is no one else who can do this for us. When our perspective changes from reaching out to be saved to one in which we work to heal ourselves and our relationships, the pace of our recovery increases dramatically.
Taking personal responsibility can be very difficult when symptoms are severe and persistent. In these cases, it is most helpful when our health care professionals and supporters work with us to find and take even the smallest steps to work our way out of this frightening situation.
Education is a process that must accompany us on this journey.
We search for sources of information that will help us to figure out what will work for us and the steps we need to take in our own behalf. Many of us would like health care professionals to play a key role in this educational process – directing us to helpful resources, setting up educational workshops and seminars, working with us to understand information, and helping us to find a course that resonates with our wishes and beliefs.
Each of us must advocate for ourselves to get what it is we want, need and deserve.
Often people who have experienced psychiatric symptoms have the mistaken belief that we have lost our rights as individuals. As a result, our rights are often violated, and these violations are consistently overlooked. Self-advocacy becomes much easier as we repair our self-esteem, so damaged by years of chronic instability, and come to understand that we are often as intelligent as anyone else, and always as worthwhile and unique, with special gifts to offer the world, and that we deserve all the very best that life has to offer. It is also much easier if we are supported by health care professionals, family members and supporters as we reach out to get our personal needs met.
All people grow through taking positive risks. We need to support people in:
- making life and treatment choices for themselves, no matter how different they look from traditional treatment,
- building their own crisis and treatment plans,
- having the ability to obtain all their records,
- accessing information around medication side effects,
- refusing any treatment (particularly those treatments that are potentially hazardous),
- choosing their own relationships and spiritual practices,
- being treated with dignity, respect and compassion, and,
- creating the life of their choice.
Mutual relationship and support is a necessary component of the journey to wellness.
The nationwide focus on peer support is a result of the recognition of the role of support in working toward recovery. Throughout New Hampshire, peer support centers are providing a safe community where people can go even when their symptoms are most severe, and feel safe and secure.
Beyond this, peer support holds few, if any, assumptions about people’s capabilities and limits. There is no categorizing and no hierarchical roles (eg. doctor/patient), with the result being that people move from focusing on themselves to trying out new behaviors with one another and ultimately committing to a larger process of building community. The crisis respite center at Stepping Stones Peer Support Center, in Claremont, New Hampshire, carries this concept a step further by providing around-the-clock peer support and education in a safe, supportive atmosphere. Instead of feeling out of control and pathologized, peers support one another in moving through and beyond difficult situations, and help each other learn how crisis can be an opportunity for growth and change. An example of this was when a member who was having lots of difficult thoughts came into the center to avoid hospitalization. His goal was to be able to talk through his thoughts without feeling judged, categorized or told to increase his medication. After several days he went home feeling more comfortable and connected to others with whom he could continue to interact. He committed to staying in and expanding on the relationships that he built while in the respite program.
Through the use of support groups and building community that defines itself as it grows, many people find that their whole sense of who they are expands. As people grow they move ahead in other parts of their lives.
Support, in a recovery based environment, is never a crutch or a situation in which one person defines or dictates the outcome. Mutual support is a process in which the people in the relationship strive to use the relationship to become fuller, richer human beings. Although we all come to relationships with some assumptions, support works best when both people are willing to grow and change.
This need for mutual and appropriate support extends into the clinical community. Though clinical relationships may never truly be mutual, or without some assumptions, we can all work to change our roles with each other in order to further move away from the kinds of paternalistic relationships some of us have had in the past. Some of the questions health care professionals can ask themselves in this regard are:
- How much of our own discomfort are we willing to sit with while someone is trying out new choices?
- How are our boundaries continuously being redefined as we struggle to deepen each individual relationship?
- What are the assumptions we already hold about this person, by virtue of his/her diagnosis, history, lifestyle? How can we put aside our assumptions and predictions in order to be fully present to the situation and open to the possibility for the other person to do the same?
- What are the things that might get in the way of both of us stretching and growing?
Support begins with honesty and a willingness to revisit all of our assumptions about what it means to be helpful and supportive. Support means that at the same time clinicians hold someone in “the palm of their hand,” they also hold them absolutely accountable for their behavior and believe in their ability to change (and have the same self-reflective tools to monitor themselves).
No one is beyond hope. Everyone has the ability to make choices. Even though health care professionals have traditionally been asked to define treatment and prognosis, they have to look through the layers of learned helplessness, years of institutionalization, and difficult behaviors. Then they can creatively begin to help a person reconstruct a life narrative that is defined by hope, challenge, accountability, mutual relationship and an ever changing self-concept.
As part of our support system, health care professionals need to continue to see if they are looking at their own roadblocks to change, understand where they get “stuck” and dependent, and look at their own less than healthy ways of coping. Health care professionals need to relate to us that they have their own struggles and own that change is hard for all. They need to look at our willingness to “recover” and not perpetuate the myth that there is a big difference between themselves and people they work with. Support then becomes truly a mutual phenomenon where the relationship itself becomes a framework in which both people feel supported in challenging themselves. The desire to change is nurtured through the relationship, not dictated by one person’s plan for another. The outcome is that people don’t continue to feel separate, different and alone.
Mary Ellen Copeland, Ph.D. is an author, educator and mental health recovery advocate, as well as the developer of WRAP (Wellness Recovery Action Plan). To learn more about her books, such as the popular The Depression Workbook and Wellness Recovery Action Plan, her other writings, and WRAP, please visit her website, Mental Health Recovery and WRAP. Reprinted here with permission.
Copeland, M. (2018). Components of Recovery. Psych Central. Retrieved on September 23, 2020, from https://psychcentral.com/lib/components-of-recovery/