Mental health "recovery" is the by-word in this field today. It seems to mean an emphasis on empowerment, partnership-with-providers, and aggressive-community-treatment (ACT) more than aught-else. The term "recovery" seems nuanced from the standard (medical) definition of this word, which at this social locus denotes "remission-of symptoms" essentially. This in time may prove to be a merry source of confusion, conflict, yea competition between providers and consumers (as well as other stakeholders in mental health.) I have 'come down' of late into promotion of mental health recovery as a movement; however, it still would seem as though the potential dissonance between the movement's terms and the terms of the mental health discipline(s) will require clarification.
None of the salient definitions from the "recovery" movement that I have read suggest that there will be in all cases a total remission of symptoms. The talk of being a "survivor" in an asymptomatic state is on close examination brave utterance, and even these survivors will usually and forthrightly say that some mental health consumers remain symptomatic. On the other hand, there seems to be a waning of the old-line provider-types who see as IMPOSSIBLE recovery in psychiatry as meaning a nearly-asymptomatic state. This has to do with the veritable fact that outcomes for even the most-severe psychiatric diagnoses have become-- with treatment-- more-benign, more-favorable, more-optimistic. However, clarification of terms and agendas in both camps-- I regret that there are becoming "camps" and "sides" in this teamwork-- might help and abet constructive work in this area.
I prefer the term "empowerment" as an overall descriptive for this process with mental health consumers: this puts the discussion immediately into the realm of human/civil rights language, and this seems to be exactly what is meant when publications cite recovery as "...a way of living a satisfied, hopeful and contributing life even with the limitations of [mental] illness" (William Anthony, Ph.D., 1993)--"...the process in which people [with a mental illness] are able to live, work, learn, and participate in their communities" (the President's New Freedom Commission on Mental Health, July, 2003)-- "... a journey of healing and transformation for a person with mental illness disability to be able to live a meaningful life in communities of his or her choice while striving to achieve full human potential or personhood" (SAMHSA, ~ 2005, may have provenance from Dr. A. Kathryn Power, Director of SAMHSA at the time.) What is defined-in-context in other words is quality-of-life as well as self-determination more than the elimination/obviation of a clinical state per se. Here I think we "have something" on which to work.
Actually, on the issue of quality-of-life and self-determination, there will be little quarrel from providers. Indeed, this type of terminology is specified in-- say-- the Code of Ethics of the National Association of Social Workers (NASW.) And neither the psychiatrists nor the nurses nor the psychologists have any ethical qualms with this agenda of informed-consent-to-treatment-unless-dangerous-to-self/others. And, as I have indicated, the empiricism works into a moderation of the notions of outcome/prognosis for the mental disorders generally.
While there may be tiffs about "recovery" as full-remission to some in mental health, few anywhere would argue contra the person's best-obtainable quality-of-life OR self-determination. I think it better to use "empowerment" as the general term for this process, referring to the specifics of this type of quality and determination. Not only doe this have justification in terms of usage I have limned here, but for the civil/human rights aspects-- upon which I shall devote words in the next portion of this entry-- this word-choice seems optimum.
There was a time when mental patients were locked away into total-institutions-- euphemistically called asylums-- where for the mishap of schizophrenia or bipolar-disorder one would "do life"-- dwell incarcerated until death-- in conditions in many ways not distinguishable from prison. In about 1956 came chlorpromazine and lithium -- then the inexorable process of deinstitutionalization, after which mental health consumers went to eke out community existences-- not uncommonly very isolated/lonely existences-- on their fare of neuroleptic-and-shunning by almost everyone. For a time we were not "welcome"; to degrees this is still so, although not to the extent that existed in the 1960s-1970s with the ubiquitous urban mega-personal-care-homes (PCHs) which became the "new back wards." Until quite recently and until quite-quite recently in venues like Missouri, mental health consumers would not vote. Occasionally one finds reports that marriage is prohibited HERE AND NOW because one/both of the participants have a mental disorder. Because of the deranged killer at Virginia Tech-- slaying 32 people in pique after being jilted-- we may fully expect stricter-laws on the "book" about mental illness incarceration, and in practice more-highhanded-arrest-practices in mental health-- for which no apologies will now be given. Jailing of mental patients-- a crime-against-humanity decried by Dorothy Dix in the 19th century-- is NOW a common practice-- 25-35% of the population of people residing in jails are mentally-ill. As these impinge on "life, liberty and the pursuit of happiness"-- that which EVEN applies to those who would be "put-away"-- there ARE civil rights' aspects to this condition. The term EMPOWERMENT is thus with no reservation a "good" term to use for the real-need-- not the brave-utterance extraneous.
We consumers have a REAL rights' issue with which to deal. But with rights come responsibilities. Not all the responsibilities are subtended by the guidelines providers have occasionally in-print about "what the patient needs to do." These statements all tend to be one-sidedly-in-favor of the provider, are virtually like the bad-old-days' "yellow dog contract" not to join unions in the 1930s and prior in Kentucky coal-mining. We consumers DO need to be responsible to providers-- who have no bounden obligation to treat us like indulged babies, and can "fire"us as much a we "fire" them. But in a larger sense, I mean to say that the mental health consumer needs to expert philosophical/existential responsibility in her/his life-- which means a devotion to having the wherewithal to make informed choices about one's condition and treatment-- and to "take what happens"-- the risks for mistakes and not to project these to "that doctor, that nurse, that psychologist, that social-worker who MADE ME DO THIS MISTAKE."
I do not see enough informed responsibility-- of the existential/philosophical kind-- or of the assuming-responsibility-for-mistakes-type in the mental health consumer movement-- on which by now I have four decades of experience. NOTHING IS CHANGED if either we "let go" without service complaint a sadistic provider; NOTHING IS GAINED by feeling defensive about the actions of these 'uncaught' deranged commiters-of-mayhem who should be in the hospitals designed for such folk; ONLY FOLKLORE AND OPINION-OPINION-OPINION is uttered if we do not study mental health, our conditions, our cures, our legitimate outcomes/prognoses. All of these matters require people who will either exhibit a measure of responsibilities -- or who will be treated like babies and criminals. These terms exactly would seem to apply to the social contract which has been afforded to the mental health consumer: let us know both ourselves and our rights through empowerment; recovery-as-being asymptomatic is entirely another issue, not as important as this-first-desideratum.
--Vernon Lynn Stephens, MSSW
D.S.M. IV-TR # 296.44
Telephone-- about mental health: 1 (502) 561-5419 anytime
Email: freethink@insightbb.com anytime
posted by Louisville Hermitage @ 9:35 AM
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