Discuss Recovery Model

Please read: Recovery Model of Mental Illness: A Complementary Approach to Psychiatric Care

I’d like to hear others’ thoughts about the article. It says that drugs are not enough.

It says:

The recovery model aims to help people with mental illnesses and distress to look beyond mere survival and existence.

It encourages them to move forward and set new goals. It supports the view that they should get on with their lives, do things and develop relationships that give their lives meaning.

The model emphasizes that, while people may not have full control over their symptoms, they can have control over their lives.

Recovery is not about ‘getting rid’ of problems but seeing beyond a person’s mental health problems, recognizing and fostering their abilities, interests and dreams. It argues against the traditional concepts of mental illness and social attitudes, which often impose limits on people experiencing mental ill health. Health professionals often have reduced expectations, while families and friends can be overly protective or pessimistic about what someone with a mental health problem will be able to do and achieve. Recovery is about looking beyond those limits to help people achieve their own goals, aspirations and dreams. Recovery can be a voyage of self-discovery and personal growth; experiences of mental illness can provide opportunities for change, reflection and discovery of new values, skills and interests.

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Although this article is from 2015 and is from the UK, I can say that many parts of it ring true in hindsight as to how my daughter’s road to recovery started. Her path to a “new life” was kickstarted by a court order, but follow up included many things from this paragraph:

“The process of engagement and consequent recovery is strongly linked to social inclusion. A key role for mental health and social services is to support people to regain their place in the communities, take part in mainstream activities and utilize opportunities for growth along with everyone else. There is growing evidence that supports the contention that taking part in social, educational, training, volunteering and employment opportunities can support the process of individual recovery.”

Her recovery was aided by testing and coaching and job placement from the State of Florida Dept that helps handicapped individuals. It took awhile to get her up to going there. That mentoring, including a placement counselor from the Boley Centers (a huge organization which helps those with severe mental illness) was KEY to her being the new person she is today. With or without medication, they would have helped her, but I had to get her up to being willing to leave the house and talk to strangers.

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@oldladyblue I think you nailed it with the quote you found in the article. It’s really perfect. Says it all in one paragraph.

How to help our family member to do it? And the younger the better. One thing I know for sure is that doing nothing is a bad idea. How many times do we hear on this board about family members who have aged into their 40s and 50s and haven’t gotten the kind of help you gave as an example?

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When my daughter is under medication that wasn’t effective, I relied on positive emotional well-being to get her through the day. It has worked well so far. She is aware of her auditory hallucinations and is managing it quite well, i.e. it does not affect her daily activities. She still has difficulties socializing and has paranoia about people tracking her through the phone. Most importantly, she’s happy feeding the birds in our backyard, making sure that there’s plenty of water during the heatwave and recently taking care of an abandoned kitten and had just completed building a kernel for it all by herself. The sense of accomplishment and ability to care for others is probably just as important as the remedy that medicine provides.

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How lovely @Chong that your daughter is caring for animals and managing her hallucinations well. I think that is really nice.

Yes, @caregiver1 doing something is always better than doing nothing. But this article is spot on in my opinion as to what most helped my daughter (at my gentle insistence).

Also, I found that changing what I was doing, if no improvements were happening, is a good idea too. Mostly I judged by little baby improvements. Getting our loved ones to care for something outside of themselves and their normal environment is a good place to start.

The article makes a lot of sense. It is the social integration and the conversations which can result in positive change. Drugs can do a lot of harm, especially long term.

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I think they need and can benefit from counselors. Every one can. As they have someone to throw out stuff too which wont judge them, can help them clarify thoughts and give support on thoughts and feedback. They dont kick them out, fire them, guide them to do things that are bad for them.
Also the theory of mental health issues being caused by abuse, can help them deal with abuse, and or if its chemical to remind them its important to stay on medication.
For some if they can establish a long term relationship could help… my son was recently suicidal as he wouldnt take medications, or go to counceling, and became more and more depressed, and said he is having too many thoughts in his mind…which Ive learned can be the voices which are like a lot of them coming at once and confusing them…

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One thought I have about this is that a person’s basic nature is not going to change whether they have SZ or not. Any attempt to try to change someone’s basic nature because the common wisdom says that’s what is good for them is doing them a disservice as well as being futile.

And it might actually backfire in that a person might think they failed because they didn’t meet expectations that were put upon them.

If someone had few friends and was introverted as a child before they showed signs of SZ, I don’t think it’s necessarily a good idea to try to improve their social life as part of recovery.

What is one constant, I think, is vocational counseling to try to help someone maximize their potential to earn a living. A vocational counselor who specializes in helping people with SMI would be useful.

I think you have to be careful when talking about a person’s “general nature” where mental illness or other brain injury is involved. Most would say thoughts and feelings change as a result of SMI, and aspects of “general nature” shift along with them. And I feel regardless of treatment (or because of treatment or non-treatment) some of these changes are permanent, be they physical, chemical or experiential.

Socialization is in part a learned skill and introverts in particular have to get over themselves at times and act against their “general nature” to get what they want or need out of life—especially a vocation. Parents of neurodivergent children on the autism, ADHD and other spectrums fought to have their children “mainstreamed” for this reason and others rather than treat them as fragile flowers to be put in walled gardens.

No one expected me to become a social butterfly, but therapists, parents and peers encouraged me toward social spheres of vocational, avocational and personal growth. At times it was difficult and emotionally painful building an emotional support system outside of my family, but necessary to achieve sustainable independent living— which to my eyes should be a primary goal of any parent. The withdrawal of my prodrome and the stigma of disease took its toll on my preexisting circle of friends and robbed me of opportunities to expand it when I needed it most—whether I knew it or not. And I needed additional enrichment to rebuild and expand it.

I’m not sure I understand your concerns of fostering social engagement backfiring. Most people in recovery are starting almost from scratch socially, and thus have little to lose. If they strive and fail, there will be more opportunities to build resilience and perhaps later succeed, but there’s little or no chance of advancement if you don’t try. I feel there’s such a natural inertia to negative symptoms that it’s hard to over-encourage engagement—short of stressing someone into relapse.

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@Maggotbrane For myself, I find that I don’t need to have much of a support system, but I do need to have intimacy with at least one other human being, which would be my wife.

My son had an intimate relationship and got married, but it went horribly south and afterwards he had his first of 3 psychotic episodes and hospitalizations.

building an emotional support system outside of my family, but necessary to achieve sustainable independent living— which to my eyes should be a primary goal of any parent

That’s true. I worry about pushing him to socialize more and adding stress. Help with socialization might better be done in the hands of a psychologist. He doesn’t get much guidance with that from his psychiatrist who mostly, I think, asks how things are going and adjusts meds. He was seeing a psychologist but stopped during one of his psychotic episodes. I’ll ask him how he feels about starting that up again. Surely that person would spend time talking about how to make friends.

Finding a Meetup group to go to would be an easy start.

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My understanding was the recovery model is considered goal-oriented and “consumer” or self-directed. For some social contact is an indirect goal, as most activities require some form of social interaction. There’s a difference between encouraging and “pushing” a person. I recall quite clearly asking my therapist why I wasn’t getting this and that out of my life and how I might achieve some of these goals, and she told me with exasperation and utter frustration, she’d been telling me all along— GO OUT AND INTERACT WITH PEOPLE WITH COMMON INTERESTS! Only then did it sink in—very little happens in your life if you don’t go outside your room and interact with people— even if having a “social life” isn’t your primary goal.

That interaction can be quite minimal, yet still have an impact. I recall an exercise from my hospitalization that struck me odd at the time, but in retrospect simple, yet compelling— during morning calisthenics/chair exercises they had us turn to our neighbor and smile. It was a reminder that sometimes it’s necessary to minimally acknowledge our fellow human beings, even if it’s perfunctory or performative.

To me the crux of implementing “The Recovery Model” isn’t a lack of goals, but a lack of an understanding what sorts of practical steps are required to inch closer toward these goals. And that’s something that caregivers, psychologists and others can help with.

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Most needs lists include the following in one form or another: 1) Survival; 2) Friends; 3) Fun; 4) Freedom; and 5) Empowerment, which I usually think of as developing a vocational skill that you can exchange for money in our market economy.

Everyone, whether they have SZ or not, has to find a way to get these needs met. People with SZ have a harder time of it as they probably have lost a lot of confidence due to the illness and the negative effects.

I’m going to see if my son would be willing to see a psychologist again to get some assistance with moving forward beyond the baseline of healing his mind with drugs.

He’s being titrated down from a very high dose, so whatever the maintenance dose is going to be hasn’t been decided yet, but that’s another story.

Another reason to get on with recovery is that we caregivers aren’t going to be around forever to care for our family members. After we’re gone they’re going to have to take care of themselves.

Long-term isn’t going to first on people’s minds when they are dealing with a crisis or some kind of unacceptable behavior, but if a person is relatively stable then recovery is the next thing to think about.

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I was thinking how difficult a process socialising can be for all of us, and can result in negative and stressful experiences. Nevertheless we cannot survive without some degree of socialisation. Relationship can always be improved upon and in the open dialogue approach due attention will be paid to how significant persons interact and the feelings that are invoked. Also many voices mean many ideas and shifting thoughts and feelings.

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