Trusting Oneself and Others
The element of trust is described by Eric Erikson as the fundamental first step in any major developmental step in life. Erikson called this basic trust, because of the need for establishing it at the deepest level. During periods of severe emotional distress, many people withdraw emotionally from those around them, and also from themselves. This withdrawal is probably part of a primitive survival mechanism called conservation-withdrawal, such as when fright causes an animal to go into a state of paralysis. In humans, this kind of withdrawal poisons relationships and can evolve into paranoia if left unchecked.
Trust can be reestablished by interaction with consistent, caring, empathetic persons over time -- the glue of human relationships. Face-to-face interactions are vital to build trust because emotions are communicated more effectively through nonverbal than verbal communication.
Self-determination is almost uniformly cited as vital to recovery. Self-determination is the difference between a person managing his or her own life vs relying on others to manage it. Dr. Harry Stack Sullivan expressed the centrality of the person's own initiative in recovery when he said that if the reorganization of a person's psyche during early psychosis "leads the patient to the foreconscious belief that he can circumvent or rise above environmental handicaps, and if this belief is the presenting feature of a comprehensive mental integration, his recovery proceeds."
Unfortunately, when people make bad decisions, the mental health system becomes responsible in society's eyes for their decisions, interfering with the development of confidence in one's self. Furthermore, the lack of an understanding of one's own feelings makes it difficult to make decisions in line with one's true self.
Believing You'll Recover and Having Hope
Emotional crises sever one's sense of existing through a durable past, present, and future. Instead, durability is replaced with a series of fleeting moments that could easily be blown away. It is essential that people in distress be able to temporarily borrow a sense of more permanent existence from the people around them. This relationship also allows one to borrow the hope of having a future. In this context, it is particularly sad that many well-meaning mental health workers paint a bleak future, when exactly the opposite is what is sorely needed.
Believing in the Person's Full Potential
Many participants in our study emphasized the importance of having someone who "believed in me." All independently reported having at least 1 person like this. Often, the less trained staff members, such as residential or rehabilitation workers, were the ones who communicated this level of belief in the person. One subject said he could detect "belief signals" from the people who understood him. "These were people who believed in my capacity to get a life, to take responsibility, and to change."
Harding also cites this dimension of relationships as vital to recovery. The consumers in her Vermont study "reported they received the greatest benefit when they were told that someone believed in them: 'Someone believed in me, someone told me I had a chance to get better.'" To Harding, this illustrated the importance of hope and showed that hope was connected to the natural self-healing capacities of people.
Connecting at a Human, Deeply Emotional Level
Those who recovered had connected with mental health professionals at an emotional level rather than seeing them as authority figures. One person described her therapist as human, fallible, open to correction, and not god-like. Another person emphasized the importance of humor. It was very important that his caregiver "would keep me laughing when I saw him...he made me laugh." The importance of these connections is highlighted in the peer support literature, which shows that peer support reduces symptoms, enlarges social networks, and enhances quality of life.
Appreciating That People Are Always Making Meaning
Dr. Bertram Karon provides a good example of "making meaning" in a description of the therapy he used to treat a man diagnosed with schizophrenia. One of the man's symptoms was frequent bowing. When Dr. Karon asked the man why he was bowing, the man said that he was not bowing. The therapist demonstrated the bow and said, "But you do this and this is bowing." The man repeated, "I don't bow."
When Dr. Karon asked what he was doing; the man replied, "It's balancing." Dr. Karon asked, "What are you balancing?" The man replied, "Emotions." Dr. Karon asked, "What emotions?" The man replied, "Fear and loneliness." When he was lonely he wanted to get close, so he leaned forward. But then the leaning forward got him too close to people and he pulled back by straightening up.
Having a Voice of One's Own
When people lack a voice and a sense of self, they are more likely to experience severe emotional distress. One subject said that her paranoia disappeared when she was able to speak up to her boss regarding her concerns on the job. Additional research has shown that people are able to learn to cope with hearing voices when they feel stronger than their voices, have more of a voice in their social environment, and are able to discuss their voices more readily with others.
Validating All Feelings and Thoughts
During one of my most distressed periods, I spent an incredible day with a friend who supported me in an exquisitely validating fashion. She was able to spend time with me without judging me. Later she told me that there were things I said while I was in distress that did not make sense but I was a good friend so she felt it was important to be with me. She trusted me and still does.
Following Meaningful Dreams
One person, who had experienced many, frequent hospitalizations, reported that pursuing her dream of helping other people had made the difference in her life. She now felt she had a reason to get up in the morning and that she had a purpose in her life. She has become a residential counselor and has not been hospitalized in several years.
Dr. William Anthony has emphasized that setting goals that reflect the person's own dreams is a core value in psychiatric rehabilitation. The need for medical patients to play a central role in their treatment has also been cited recently in the Institute of Medicine Report, Crossing the Quality Chasm.
Relating With Dignity and Respect
One participant stated, "The key ingredients for me on my journey to recovery are being treated with dignity and respect, having a mentor, using peer support, and knowing people who really understand and who have been there." Another person spoke of a doctor who meant a great deal to him: "He respects everyone, no matter who they are."
On the basis of these findings, we have developed a model to describe how severe mental illness occurs and how people recover. We call this the Empowerment Model of Recovery (Figure).
Given the right mix of relationships, attitudes, and resources, people with mental illness can fully recover by (re)gaining control of the central decisions of their lives, learning to live with intense emotions, and developing the skills and relationships they need to establish a major social role. This model consists of 3 different experiences that can occur in response to distress: healing, transformation, and recovery.
People can and do recover from even the most severe forms of mental illness, such as schizophrenia and bipolar disorder. However, the time and resources involved are much more extensive than for those who have received supports sufficient to help them go through transformation. Survivors have united around the goal of genuine recovery as outlined in this Empowerment Model.
The concept of recovery is quite different from that of remission or rehabilitation. Remission and rehabilitation are not the major goals of consumers today. Remission means the absence of symptoms while the person remains mentally ill. As the New Freedom Commission report stated, people should recover a full life, not simply achieve symptom reduction. Similarly, rehabilitation, although a useful component of recovery, is only a portion of recovering a life. Rehabilitation means that an individual can learn to function in society and still remain mentally ill, in the same fashion as a person with a spinal cord injury can. However, mental illness is reversible.
NEC and other groups are diligently working to implement the transformation to a recovery-based system recommended by the New Freedom Commission. Toward that end, NEC has developed an educational program called PACE (Personal Assistance in Community Existence) to help shift the culture of mental health from institutional thinking to recovery thinking.
Source: Recovery From Schizophrenia: From Seclusion to Empowerment
Schizophrenia, Psychosis, Recovery, The Recovery Based Model, Hope for Schizophrenia Sufferers