Recovery psychology/Lesson3

NOTE: This page is being updated, while two other pages are being written Identity Politics and Recovery Theory. The prior to discuss rhetoric and philosophy of social groups and the latter to discuss psychological theory.

Behavior: anything that a living organism does-Journal of behavioristic psychology

People do recover from mental illness-Journal of humanistic psychology

People are living organisms--recovery psychologist

Journal of Humanistic Psychology Vol 45 Number 3 Summer 2005

What is mental health recovery?

Generally, the recovery movement refers to the idea that the body tries to heal itself self from all illnesses naturally; there would be no reason to think that the brain is separate from the body; as more and more science has come to favor the emergent property theory of the mind-brain problem. The Brain being an organ will also try to heal naturally; the recovery movement focuses on those things that will assist this natural healing.

The President's New Freedom Commission On Mental Health defines recovery as "the process in which people are able to live, work, learn, and participate fully in their communities. For some individuals, recovery is the ability to live a fulfilling and productive life despite a disability. For others, recovery implies the reduction or complete remission of symptoms"

John M. Kane, M.D. Treatment Strategies to Prevent Relaspe and Encourage Remission from The Journal of Clinical Psychiatry Volume 68 2007 Supplement 14 p.27-30 states that: Recovery, in general, refers to sustained asymptomatic functioning without relaspe. This will drastically conflict with others concepts of recovery.

Liberman RP, Kopelowicz JV, Ventura J, et al. Operational Criteria and Factors related to Recovery from Schizophrenia International Review of Psychiatry 2002 volume 14 p.256-272 speaks of UCLA recovery criteria which is made up the following domains symptom remission, appropriate role functioning, daily living skills, and social interaction (similar to Partnership In Recovery.)

The idea of creating a recovery criteria is seen as being upsetting to some, while seen as beneficial to others. The question that is seen as valid by these persons is how does a clinician know that their work is done if recovery can not be as noticed as was the illness.

Various people will define recovery as something different, although most agree on certain principles which are the same. Recovery is living a meaningful quality life, despite a psychiatric condition. To many it is about a reduction in prescribed psychiatric medication. While to some degree it is about those who use the mental health services having a voice as in any other form of consumer psychology. It may address issues of mental freedom.

Studying the Stages of Change from James O Prochaska and Carlo C. DiClemente’s Stage may help explain the choice to recover or why a person choses to recover. An effective tool of psychotherapy is Motivational Interviewing which is used to assist the person recieving therapy to come to the decision that they want to change their behavior; i.e. recover.

"Recovery is the rule, permenent disease the exception."--Dorothea Dix 1854

Co-occurring Disorders

Similar to Alcoholics Anonymous and other 12-step recovery groups, things like peer support and some concept of recovery exist. However there is a difference between "abstaining" from the action of "using" substances; which means not doing something (i.e. remission) which is termed as recovery and mental health recovery, in which a person does something mentally health (opposite of remission or abstaining.) Once known as dual diagnosis, the term co-occurring become more popular in usage to describe a psychological disorder with a substance abuse disorder. In the past the two were considered separate and treated as such. The prior term dual diagnosis can refer to developmental disability and psychological disorder (mental illness.) While the oldest extremely well known recovery group that employs a form of peer support was probably Alcoholics Anonymous and other 12-step groups for substance abuse, the 12-step philosophy is primarily rooted in an abstinence policy. A person with co-ocurring disorders may need to abstain from street drugs while using psychiatric medications. This is looked down upon by 12-steppers. Other resources such as Recovery Inc, Dual Diagnosis Anonymous and Double Trouble have developed as a 12-step philosophy that allows its members to use psychiatric medication. It is interesting to note, that while there is a move to use only person-first language, that the terms CAMI and MICAA (sometimes MISA) used to be or are sometimes used to describe persons with co-occurring disorders. CAMI standing for Chemical Abusing Mentally Ill and MICAA standing for Mentally Ill Chemical Abusers, and Addicted. A CAMI implies a person who generally is more of a substance user and may have an AXIS II diagnosis of personality disorder but not fit the criteria of mentally ill, despite the fact that a personality disorder is just such an illness. A MICAA or a MISA (Mentally Ill Substance Abuser) would fit more the criteria of a person with a psychological disorder (or mental illness) who is said to "self-medicate" their illness with substances. Although these labels are not person first and maybe seen as derogatory the concepts are still important to consider in understanding the dynamics of intra-stigma of persons in recovery.

Daniel Fisher Videos and Articles

Recovery is a fact of Psychological Disorders

Myth: Individuals with psychological disorders do not recover.
Fact: Studies and personal reports have documented that individuals with psychological disorders can often recover or “be in recovery” and lead meaningful lives.
Myth: The more severe the symptoms, the less likely recovery will occur.
Fact: The process of recovery and “being in recovery” can take place regardless of the extent and duration of symptoms. Everyone’s recovery is personally defined (this parallels the personally defined disorder-See Mental Illness-psychological)
Myth: If recovery occurs, a diagnosis of psychological disorder must be incorrect.
Fact: The recovery process can take place for each diagnosis or type of disorder.
Myth: Treatment and services are always the same for each specific psychological disorder.
Fact: Unlike the many years of indoctrination from clinical psychology, one size does not fit all persons with a particular disorder. There are many different ways for recovery to occur and there are many different individuals who can assist in a persons recovery, however many of these accept the stigmatization of others with psychological disorders.
Myth: Individual needs and personal goals can not be addressed until the symptoms of a psychological disorder are eliminated.
Fact: Regardless of the level of severity, it is essential to listen and respond to a person with psychological disorder stated goals at each point of their journey toward recovery.
Myth: Recovery is an end point or a “cure”
Fact: So far recovery is an ongoing process with ups and downs, starts and stops, on the way towards living a meaningful life. Someday, with research in to recovery, we may become closer to finding a cure for psychological disorders. In the past there was no research in to recovery, instead containment without quality of life being considered.

"...it is safe to say that as many as eighty percent may be expected to recover"--Thomas S. Kirkbride M.D.

SEE Recovery is Real
SEE PDF from School of Social Work University of Wisconsin-Madison
SEE Article entitled The clinimetric approach to clinical psychology by Elena Tomba, Giovanni Andrea Fava speaks of recovery from psychological disorders in a quantifiable measurement.
SEE Bridges to Recovery

Mental Health Consumers Talk to Kent State Students

Recovery is not remission

Positive symptoms are the behaviors or features that are present as a result of a psychological disorder. Negative symptoms are behaviors or features that are absent as a result of a psychological disorder. Remission is the absence of positive symptoms in psychological disorders, meaning that a person’s abnormal behavior(s) has stopped occurring. Where as, recovery is more about the return of normal behavior(s) or the absence of negative symptoms. Remission is a clinical term for a state of absence of disease activity in patients. This does not describe a qualitative feature that is recovery in terms of psychosocial factors. If a person is "in remission" from a serious mental disorder, they are for the most part temporarily asymptomatic with regards to positive symptoms; recovery is concerned with both positive and negative symptoms. This does not mean that any of the conditions or consequences of sociological determinants of mental illness have sudsided. A person who is no longer delusional, hallicinating or depressed may still not have social skills, employment, or meaningful purpose, but may very well be in remission. Although some may mistakenly dilute the meaning of the word recovery.

A good article to read that makes this point is: Harding, C. (2004). Remission vs. recovery: Two very different concepts. Conference presentation at Reclaiming Lives: What Professionals Need to Know About Assessment, Planning, and Treatment for People Who Appear to be Stuck on the Road to Recovery, Boston University Center for Psychiatric Rehabilitation at the Sargent College of Health and Rehabilitation Sciences, April 13, 2004.

other authorities on the subject

Side effects of medications are not considered positive or negative symptomology for psychological disorders, despite the abnormal behavior and morbid reactions that result from long term usage of the medications. Those who work in mental health that see remission as the goal of treatment, feel these side effects are an acceptable trade off for persons with a disorder. This differs for those who seek out recovery as an outcome, having acknowledged that recovery from the side effects is often more difficult that recovering from the targeted disorder.

For Example: In the case of the diagnosis of schizophrenia. The positive symptoms of schizophrenia are delusions, hallucinations, disturbances of thought, language and communication, disrupted motor coordination or awkward body movements. Negative symptoms for schizophrenia are affective flattening or flat affect, avolition, alogia and anhedonia.

To say a person has this diagnosis of schizophrenia is to say that they have all or most of these symptoms present.
The person with this diagnosis is prescribed medication. The prescribed medication is very likely to cause side effects.
These side effects. are equivalent to the same kind of abnormal behavior, that is defined as a psychological disorder.
The medication is likely to stop positive symptoms, but not address negative symptoms. This is Remission.
So to be in remission from schizophrenia, a person does not have delusions, hallucinations, disturbances of thought, language and communication, disrupted motor coordination or awkward body movements, but may still have affective flattening, avolition, alogia and anhedonia along with the possible additional psychological disorder of pharmacological side effects. It is important to note here, that sometimes the side-effects of these medications include: Hallucinations, thought disorder, delusions, psychosis, depression and many other conditions which are 100% identical to the symptoms of the treated illness.
Behaviors and Cognitive processes such as willingness, choice, decision making, coping, accepting, dealing with, living with...or even stopping the positive symptoms and the side effects could be clinically assessed by using assessment tools similar to those that found the diagnosis of schizophrenia. Of course holding the regard to these processes, that they are personally defined expierinces of the coping person, (just like the personally defined distress that was diagnosed) however it can be to some degree objectively observed as "how much drooling on one's self or blurred vision is an individual going to tolerate?"
The expierince, behavior or phenomena that can be observed also in the terms of the developmental steps of regaining emotional reactivity (instead of flat affect,) the development of desire or discovering a self-drive or motivation to pursue meaningful goals (which is the absence of avolition,) the intiation of speech (instead of alogia) and the intentional seeking of pleasure and enjoyment (instead of anhedonia.) These behaviors require active choice making that many persons with psychological disorders have lost the ability to make. No person can make these choices for the person to recover. Since mental health social workers have done research in Psychiatric Rehabilitation and they have found that addressing the negative symptoms has a greater impact on changing the behavior associated with a persons positive symptoms, than addressing the positive symptoms directly, this new prespective has been termed as a recovery model. Qoutable from textbooks from Boston University This is Recovery.
With all abnormal behaviors absent, the confounding side effects from psychopharmacology (new psychological disorder) being absent, and all the so-called normal behaviors being present, a person who is no longer meeting the criteria of abnormal as in abnormal psychology, the truth still remains that those who support the concept of recovery still say that this does not mean the person is cured of a psychological disorder. See Rosehan in Remission, See Patricia Deegan What Will Endure ?, Also see Moral Development of the mental health profession and compare to deinstitutionalization with respect to typical antipsychotic medications and atypical antipsychotic medications. This requires critical thinking and reflection on the cultural psychology of the mental health profession. In sociology there is the principle of human interaction does not occur in a vacuum. If we only categorise, evaluate, assess, diagnose, label, and treat clients with psychological disorders, as if we are outsiders, and fail to acknowledge our role as service providers is due the same analytical scrutiny for study, we are failing the practice of scientific ethics. The industry can not be "outside the microscope" and claim its validity. For example: The CATIE study has proven newer atypical antipsychotic medications to be safer than older first generation medications. The newer medications are more coducive to the concept of recovery, than older medications which brought about remission with adverse side-effects.

Comparing mental health recovery to recovery from common medical disorders

The recovery concept has its implications for all medical sciences. See EBM and EPB Being person-centered, having patient empowerment, patients becoming educated about their conditions, self-advocacy, peer support organizations for those surviving or coping with the condition, the right to a consumer influence on the policy making of pharmacuetical companies and other professional organizations, the idea of having hope, living despite an illness, patients being allowed to have choice... For an example of the recovery paralells to the treatment of Pulmonary hypertension see Susie Dodson: Chapter 1 - Susie's Journey to Stay Alive, Susie Dodson: Chapter 2 - Landing in the Right Place, and Susie Dodson: Chapter 3 - The Determination to Live, See Peer Network for Pumlonary Hypertension, See also Cancer Treatment Centers of America and Cancer recovery, See also Norman Cousins, See Psychonueroimmunology, See Patch Adams

Faces of Recovery

Recovery Lectures

Northern Birmingham Mental Health NHS Trust and The International Mental Health Network Videos:
Recovery Section 1 Part 1 from virtualward on YouTube
In this video is an opening discussion on the Recovery concept, why recovery is important, that recovery is an individual and unique process, and that recovery is never done alone. It discusses how the Clinical view is different from Recovery view drawing on the work of William Anthony's 1991 Basic Assumptions of Recovery Oriented Mental Health System. One of the first understandings is that to recover, professional intervention is not always a must. Recovery can occur without professional intervention. Those who have left or escaped the mental health system, have returned in good recovery.
Recovery Section 1 Part 2 from virtualward on YouTube
In this part of the video the discussion on treatment and training for treatment, the importance of updated information. The former DSM (DSM-III) diagnostic description of Schizophrenia of being a illness of permenent deterioration, this information was based on data collected from crisis situations and hospitalizations. Courtney Harding and John Strauss studied the whole life course of people with schizophrenia, not just in the hospital, are quoted as saying "Only two-thirds of these people with the most serious disorders were indistinguishable from the general population" while one-third may have continued to experience noticable episodes of illness.
Recovery Section 1 Part 3 from virtualward on YouTube
This part continues on with the work of W. Anthony, C. Harding, J. Strauss, etc. Recovery from consequences from mental illness is much harder than from the illness itself. Mental illness is a disease that causes proverty, not by being a disease, but by the stigma and prejudices against the person with a mental illness. Discussing cultural diversity in psychiatric recovery. In Italy many people live with their families up until the age of 30; whether or not they are diagnosed mentally ill or not. (Imagine that! not hating your parents after 18 years!) However, the need for work, job, employment etc. has been found to a universal component for recovery from mental illness.
Recovery Section 1 Part 4 from virtualward on YouTube
Further the discussion of persons in recovery from mental illness in the world of work. When asked what was the most important support in helping a person recover 1. Family and friends, 3.Pets, 6. mental health professions 12. medications and as Courtney Harding was researching the 65% of people taking medication were doing better than others. She thought this was a significant factor. She was discussed this with a consumer who was doing great in her recovery. The consumer had a massive arsenal of medication from the pharmacy over fifteen years. It was found out by Courtney Harding that the consumer was not taking the medication but storing it up. When Harding asked this person "why are you spending your money every month to get these meds?" the answer was "to keep them off my back" basically the consumer lived with a certain level of fear that if she did not get this medication, there would be problems (external to herself or her illness)
Recovery Section 2 Part 1 from virtualward on YouTube
What is a Warm line? The process of recovery through using peer support and consumers working with consumers. You can only show a person how to walk down a road that you have walked down. What is helpful and what is not, redefining boundaries to fit the recovery model.
Recovery Section 2 Part 2 from virtualward on YouTube
Discussing the overlaying of trauma on the mental health sexual trauma, trauma, and peer support. It is found women recover from trauma by confiding in other women, the problem being most services in the past were not designed with gender being respected or considered. Many rules in placed in the mental health system prevent sharing of recovery stories, which prevents recovery. Disclosure became necessary for recovery. In Oregan seventeen psychiatrists applied for a jobs for a consumer run mental health organization. Mental health organizations prior to the development of peer support intiatives were the biggest discriminators who refused to hire the consumers of mental health services.
Recovery Section 2 Part 3 from virtualward on YouTube
The discrimination of mental health systems not hiring service users in the past, the core of recovery being understanding and taking responsibility for one's own life, where other professionals may know this intellectually they may not on a personally level. The process of recovery mirrors recovery from not psychiatric disorders. Many young people expeirince their first psychotic episode during the time when their age cohort has split away from them at the time when peer connections are the most critical. Process of greiving that loss of peer cohort is important to recovery. The nature and normal process must be encouraged. The risk is that the person may become stuck in the place of trauma, there may be a long term chronic loss of motivation. The system is an anger producing situation, one needs to express anger to get healthy. The mental health system is often a dam that holds back peoples anger. (See Kubler-Ross and Spaniol.) Class consciousness, what has happened to people like me. Advocacy for social change.
Recovery Section 2 Part 4 from virtualward on YouTube
People who have the name "the" as their middle name: Howie the Harp was one of the greatist advocates of the homeless, Kate the Great tells her story about London Psychiatric Hospital. Future is just more of the same, bottoming out the spark of recovery "I choose to live" no longer willing to allow others to control her life. Never hospitalised again. This video shifts from the American speaker to two other speakers abroad. The concept of recovery from Schizophrenia, two views that debate whether or not people recover from Schizophrenia. Research shows that between 45% and 60% do recover from Schizophrenia.
Recovery Section Part1 from virtualward on YouTube
Recovery Section Part1 from virtualward on YouTube
Recovery Section Part1 from virtualward on YouTube
Recovery Section Part1 from virtualward on YouTube
Recovery Section 4 Part1 from virtualward on YouTube
Recovery Section 4 Part2 from virtualward on YouTube
Recovery Section 4 Part3 from virtualward on YouTube
Recovery Section 4 Part4 from virtualward on YouTube
The views of Australians British and Americans on the need for recovery, the acceptance for the illness, a need for change for others, recovery can be slow, there are series of recoveries, not just one recovery, there are very many different forms of recovery. The need to recognise the person with the illness as much if not more than the symptoms of the illness.

Essay Questions on Recovery Lecture

Elizabeth Kubler-Ross developed the "Five Stages of Grief." In the video Recovery Section 2 Part 4 from virtualward on YouTube above the speaker Larry, tells of a womans recovery in the terms of the greiving process, not unlike the five stages of grief, these five stages are not linear. This is one model of the recovery process, do all recovery expeirinces conform to this paradigm?
Are all persons with and with out diagnosed mental illness in recovery from some kind of problems, illness or issues?

Recovery Psychology as an applied science

see Mary Ellen Copeland WRAP
see Fred Frese Psychology in Psychiatry-Recovery Project This is at University of Ohio at Akron, Ohio.
see Helen Mayberg does research seeking out recovery as an outcome.
see Recovery Innovations of Arizona Recovery Education Center

In reflective summary on recovery

Article on Pat Deegan's Web page
Recovery is as much about the rights of persons with psychiatric conditions, as much as it is about anything else. Here is a suggested reading list
In discussion on Cancer recovery one will find the concepts of hope, empowerment etc. being mentioned, terms like recovery, survivor also apply. See Cancer Treatment Centers of America and Compare feeling of hopelessness given to patient by doctors attitudes as in the story of Patricia Deegan intial response to diagnosis of mental illness
The Allegory of the Cave
A Clinician says "The patient's driving behavior is in remission" not that "The individual has parked their vehicle in the appropriate parking space." Why do you think this is?

Research Methods in Psychology

Recovery psychology must challenge the proponents of the recovery movement, whom are primarily social workers not psychologists, to address recovery as a quantifiable and measurable behavior, phenomena, events or occurrence; as things that do actually happen. The claims about recovery are that, recovery is qualitative not quantitative. The fallacy here is that the experience of the psychological disorder and the features of diagnosis are quantified and measured empirically, not just qualitative, subjective or abstract according to the clinical sciences. In order to measure "recovery" as a thing that happens it should be measured using the same criteria, rules and logic that applied to establishing the fact that there is a disorder. Behavior is defined as anything that a living organism does. (Defining Human Behavior from Behavior Modification Raymond G. Miltenberger,2004) Behaviors have one or more dimensions that can be measured and quantified. These dimensions are frequency which is how often a behavior occurs, duration which is how long a behavior occurs, intensity which measures the amount of force put in to the behavior and latency which would be a measure of the respose time after stimulation. These dimensions are common to all behaviors are not limited to illness or disorder, according to psychology. According to the science of psychology this definition of behavior is used to determine abnormal or disordered behavior from normal or well ordered behavior. Behavior can be observed and measured. All behavior has an impact on the environment, including physical or social environment. All behavior follows the scientific laws of basic behavior principles. Lets re-evaluate that statement: People do recover from mental illness. Do is an action verb. Action implies behavior...yet those who push the concept of recovery, say it is qualititative and not quantiative. If we evaluate the majority of literature categorised under the heading of mental health recovery, we see a discussion of service provisions not recovery behavior. Recovery psychology would separate itself from positive psychology at this juncture; where positive psychology focuses on the "good things in life" and "happiness" recovery psychology studies the struggle or the process of getting there. Both are aimed at getting to mental wellness and away from illness. (Recovery...Das ding in a sinch) The opposite logical operation of the statement that recovery is qualitative would be that a psychological disorder is not quantitative. (in other words x-3=4 find the value of x if a person posessing no mathematical ability once so ever can figure the numer 7 they can either dismiss or validate this concept of recovery) What is studied in qualitative results is the service provision (i.e. psychiatric rehabilitation, recovery oriented services, recovery model, social work, evidence-based practices etc.) There seems to be confusion between recovery the person does and the work of the mental health staff being called recovery.

What hinders recovery?

Anti-recovery?

Closing the gap

Patricia Deegan Humanistic Psychologist known in the "recovery community" or "recovery movement" has invented a course called the "Hearing Voices" training. In this training persons who do not hear voices (have auditory hallucinations) are asked to hear headphones and listen to tapes. On these tapes are recordings of people who hear "voices" speaking the sounds, noises and voices that they have heard. The purpose of this training is to teach or allow persons who do not hear voices understand what a person expeirinces while hearing voices. Humanistic Psychology is concerned with Human expeirinces; Patricia Deegans "Hearing Voices" training is concerned with teaching persons who have never had a "mental illness" expeirince what the expeirince is like.

Does this have a Biological application? Can "non-mentally ill" persons who are simulating the expeirince of "hearing voices" have fMRI, PET and CT scans comparable to persons who naturally "hear voices?"
Does this have an application for Cognitive psychology? Can mental processes be studied on a non-voice hearing person who simulates "hearing voices" be studied?
What about Behavioristic studies on simulated "hearing voices" subjects versus naturally "hearing voices" subjects? How is the behavior similar and how is it different?
First a question is asked in science...then a hypothesis is made, then the expeiriment is designed to test the hypothesis, then results are observed...but if one accepts the "recovery doctrine" hook-line-and-sinker, without asking questions, then recovery as a science will become stagnent. Humanism is fine. The "expeirince" is fine to discuss; but does not address "recovery" in all it's aspects. If nobody asks the question, there can be no progress. Prehaps this suggested research could yeild no significant discoveries; then again it could yeild the new discovery that proves the statement "recovery does not mean cured" to be wrong and a cliche of the past.

Building the Science of recovery?...hmmm, are they thinking? On yet another page ,qouting the Commission on Mental Health it says: Science has shown that having hope plays an integral role in an individual's recovery. It would logically follow that there needs to be more science, imagine if the science of physics would have stopped in the days of electronic typewriters, where would the internet be right now? Recovery is a doing action. Research on recovery seems to be the direction of the science.
Most of the talk about "Recovery" as a concept is Social work (Rehabilitation, service provision, health care intiative or other beuaracracy etc.) Which is like the work of a licensed professional industrial welder, who might know a thing or two about thermodynamics (Thermodynamics is the science of heat and things getting hot.) A officially recognized expert PhD in Thermodynamics is not a licensed welder and may know nothing about how to use a welding machine. A welder may not neccessarily even know half what a person studying thermodynamics might know, in order to be a competent welder. This is how psychiatric rehabilitation (in analogy welding) can be compared to recovery psychology (in analogy thermodynamics) which studies a natural phenomena that is not dependent on human intervention, such as recovery (in analogy heat.)
It is the belief that psychology in studying psychological disorders, has spent far too much time and energy speaking about deviant, abnormal, clinical, psychopathology, deviant pathology, symptomology, disordered and the whole list of synonyms that mean mentally disturbed or disordered. The APA prints various journals all with corresponding names, for each one there is branch of psychology taught at colleges and universities, with of course textbooks which such titles. Meanwhile an executive order was signed in 2001 by the US president ordering for the an Education campaign about recovery from psychological disorders. "Where do people get their educations from? Should not the National Campaign on Education be on college campuses?" So far SAMSHA and Department of Health and Human Services, along with many Universities are doing research and educational materials (Science to Services), which still do not directly address the ions transmitting across the synapses in person recovering from psychological disorder. see Neuroimaging see any textbook that carries information on psychological disorder
The state of California has passed a law requiring all mental health professionals to recieve a minimum of 12 hours of training regarding the recovery model.