edited by Ruth O. Ralph and Patrick W. Corrigan. Washington, DC, American Psychological Association, 2004, 288 pp. $49.95.
This book is edited by two psychologists and written by a total of 19 contributors, including psychiatrists, psychologists, social workers, and, indirectly, individuals who are in recovery of their own. I would have appreciated more biographical and more accurate information on the professional contributors.
The authors address the concept of recovery from mental illness as distinguished from cure. Recovery is a process, not an endpoint. The first two chapters provide an overview of recovery as a consumer vision and research paradigm. They contend that neo-Kraepelinian thinking, to which psychiatry is prone, can destroy hope in people diagnosed with schizophrenia. In the chapter on research methods, they discuss the epistemological perspectives from which researchers view data. They feel that the positivistic scientific method may not be suitable for study of the recovery model because recovery from mental illness is a nonlinear process that encompasses many domains of human life. It necessarily involves the activity of the patient at every step. Empowerment of the patient is a key factor.
Chapters 3–7 explain and discuss models of recovery. Chapter 3 summarizes nine long-term studies of outcome that support a generally optimistic view of the natural history of schizophrenia. Liberman and Kopelowicz set out to define recovery in the next chapter. Their criteria cover symptoms, independence, work or school and social ability. I found their discussion of cognitive remediation and training to compensate for cognitive impairment particularly relevant in light of a recently published work on rehabilitation of the severely mentally ill, which describes techniques for cognitive remediation and compensation devised by neuropsychologists as well as the experimental science that is the basis for the interventions (1).
Chapter 7 is a clear exposition of the recovery model and the focus of the book. Its rationale is the need for all people, whether they are mentally ill or not, to help themselves as opposed to being treated as dependent and helpless. A woman with schizophrenia is quoted as asking the question, “Why don’t you ever ask me what I do to help myself?” (p. 147). The authors state that the principle underlying this model is that the patient knows best what he or she needs to do to recover. The authors have come to the conclusion that the mentally ill are pretty much like the rest of the population except to the extent that patients are surrounded by a “toxic social milieu”(p. 165). Also cited are societal obstacles to recovery, including stigma, poverty, and political oppression. The authors do not disparage psychiatry with its emphasis on symptom control through psychopharmacology, but they argue for a much broader and more optimistic approach. It seems to me that the recovery model depends on principles of which we have been aware all along, but many of us have been pessimistic about their value in treatment.
Chapter 8 deals with the question of what settings are most conducive to recovery. The authors use Schizophrenics Anonymous to illustrate mutual self-help groups and their role in the process of recovery. Schizophrenics Anonymous is analogous to Alcoholics Anonymous, but the big book is blue, not black, and there are six steps, not 12. The next chapter describes an approach to promoting recovery from childhood sexual abuse using “concept mapping” (p. 211). The abuse survivors brainstorm to construct a visual map of what they feel they need to accomplish by way of freeing themselves from the consequences of their experiences of abuse. The final chapter undertakes to compare and contrast the processes of recovery from addiction and severe mental illness. The authors look at the experience of mutual-aid groups and recovery-advocacy groups for addiction and how they may be applicable to the long-term rehabilitation of the severely mentally ill.
This volume is a clear, fairly concise exposition of the concepts underlying the recovery-model approach to psychiatric illness and treatment. I believe that it is more than wortwhile reading for any and all psychiatrists.
1.Spaulding WD, Sullivan ME, Poland JS: Treatment and Rehabilitation of Severe Mental Illness. New York, Guilford Publications, 2003
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