The Challenge of Recovery

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Overview

• Part I Background on Recovery
• Is Recovery Possible?
• What is Recovery?
• Part II Recovery Pathways
• Part III A Vision of Transformation Creating
  the Future
• Part IV Recovery in Practice
• Part V Recovery Coaching

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Who started the idea of recovery?

• People speak out and write about recovery
  experiences
• Research findings support the fact of recovery
• Vision of recovery described by rehabilitation
  educators Dr. Anthony
• Changes in our historical understanding
• New definitions of diagnosis
• New thinking about chronicity ?

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Lets hear from Raymond, whose story illustrates
the points Dr. Anthony makes about how the system
can contribute to chronicity.
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Is Recovery Possible?
Harding used the medical criteria for recovery
no current signs and symptoms of any mental
illness, no current medications, working,
relating well to family and friends, integrated
into the community, and behaving in such a way as
to not being able to detect having ever been
hospitalized. Harding
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but these findings are not new.
The results of Moral Treatment in the 1800s
Robert Whitaker, Mad in America and Gerald Grob,
Mad Among Us
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Moral Treatment Practitioners. a value on the
person

• I have nowhere met, except in romances, with
  fonder husbands, more affectionate parents, more
  impassioned lovers, more pure and exalted
  patriots, than in the lunatic asylum A man of
  sensibility may go there every day of his life,
  and witness scenes of indescribable tenderness to
  a most estimable virtue. 1801. Philippe Pinel.
  Paris France

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Moral Treatment Practitioners.a value on the
person

• If there is any secret in the management of the
  insane, it is this respect them and they will
  respect themselves treat them as reasonable
  beings, and they will take every possible pain to
  show you that they are such give them your
  confidence, and they will rightly appreciate it,
  and rarely abuse it.
• 1833. Samuel Woodward, M.D., Worchester Asylum

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Moral Treatment Practitioners.HOPE

• I think it is not too much to assume that
  insanity is more curable than any other disease
  of equal severity more likely to be cured than
  intermittent fever, pneumonia, or rheumatism.
• 1843. Samuel Woodward, M.D., Worchester Asylum

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Moral Treatment Practitioners. a value on
environment
It should never be forgotten that every object
of interest that is placed in or about a hospital
for the insane, that even every tree that buds,
or every flower that blooms, may contribute in
its small measure to excite a new train of
thought, and perhaps be the first step towards
bringing back to reason, the morbid wanders of
the disordered mind.. Thomas Kirkbride, M.D.
1841. Pennsylvania State Hospital
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What does RECOVERY mean?

• A common human experience.
• Developing new meaning and purpose in life. (W.
  Anthony, 1993).
• Develop and further rebuild important connections
  (L. Spaniol)

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Our Definition of Recovery

• Remembering who you are
• and using your strengths to become all you were
  meant to be.

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Dont forget
To remember
who you are
Where you came from
Where youve been thus far
Its so easy
for the hard times
To leave scars
When you forget
to remember
Who you are
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D List
Deficit Based
Disappointment
Difficulties
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D List
Deficit Based
Diagnosis
Disappointment
Difficulties
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D List
Deficit Based
Disease
Diagnosis
Disappointment
Difficulties
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D List
Deficit Based
Disabled
Disease
Diagnosis
Disappointment
Difficulties
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D List
Disempowered
Deficit Based
Disabled
Disease
Diagnosis
Disappointment
Difficulties
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D List
Disenfranchised
Disempowered
Deficit Based
Disabled
Disease
Diagnosis
Disappointment
Difficulties
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D List
Demoralized
Disenfranchised
Disempowered
Deficit Based
Disabled
Disease
Diagnosis
Disappointment
Difficulties
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D List
Dysfunctional
Demoralized
Disenfranchised
And the person has disappeared
Disempowered
Deficit Based
Disabled
Disease
Diagnosis
Disappointment
Difficulties
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A List
Asset Based
A person
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A List
Asset Based
And the person comes back and gets even bigger!
Assets
A person
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A List
Asset Based
And the person comes back and gets even bigger!
Abilities
Assets
A person
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A List
Asset Based
And the person comes back and gets even bigger!
Achievements
Abilities
Assets
A person
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A List
Asset Based
And the person comes back and gets even bigger!
Authentic
Achievements
Abilities
Assets
A person
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A List
Asset Based
And the person comes back and gets even bigger!
Authority
Authentic
Achievements
Abilities
Assets
A person
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A List
Asset Based
Autonomous
And the person comes back and gets even bigger!
Authority
Authentic
Achievements
Abilities
Assets
A person
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What We Know . . .

• Recovery is an up-and-down process.
• Symptoms may remain, but people still RECOVER!
• Symptoms are less troublesome and happen less
  often.
• Recovery can happen whether or not we still take
  medication.
• Recovery does not mean that one did not have a
  mental illness.
• Recovery from the consequences of being ill is
  often harder than recovering from the illness
  itself.

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What People Recover From.
Lack of opportunities for Growth

• Trauma of
• Psychosis
• Admission Process
• Relating Stories
• Care in Hospital
• seclusion,
• restraint,
• forced medication
• Assaults

• Co-morbid disorders
• Childhood Trauma
• Sexual Trauma
• Drug Alcohol Dependence
• Personality Disorder

Side Effects of Medications
Numerous Losses
Lack of accommodation/ support for disabilities
when re-entering the world
Experience of dehumanization and degradation and
spirit breaking
Low expectation lack of hope from
professionals
Lack of commitment from service systems and
politicians
Environments that are not stimulating

• The stigma of mental illness
• Social attitudes
• Professional attitudes
• Internalized personal attacks

The torture and oppression by the phenomenon of
mental illness
Poverty and/or Homelessness
By permission of Dr. Kaly
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Recovery Pathwaysfrom our experience

• Hope
• Choice
• Empowerment
• Recovery Culture
• Spirituality meaning and purpose

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Recovery Pathway 1 Hope

• In the movie The Beautiful Mind John Nash
  hears what Pat Deegan refers to as the prophecy
  of doom. Notice how Professor Nash struggles to
  hold on to hope, I can do this, in spite of Dr.
  Rosens words, schizophrenia is degenerative,
  over time youre getting worse.

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Hope

• Hope is the beginning.
• Its a thought that things can get better and a
  feeling of courage with a spark of new energy.
• Creates a turning point.
• Hope means I can have dreams.
• A vision of a better future there are no
  limits.
• Someone else can hold the hope. And there was
  this person.

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HOPE
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A person comes to our crisis service. They are
crying, frightened and filled with despair. How
can you communicate hope?
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Recovery Pathway 2 Choice

• In the movie The Beautiful Mind this dramatic
  scene illustrates the consequences and the fear
  associated with not having the choice.

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Recovery Pathway 2 Choice
The Old Story
overprotection
abandonment

• No support
• Hospitalization, jail, homelessness
• No recovery
• Person disappears

• No choice
• Coercion and force
• No recovery
• Person disappears

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Recovery Pathway 2 Choice
The Recovery Story Its about Relationship
Relationship
overprotection
abandonment

• Mutual responsibility
• Engagement
• Support/love
• The person reappears

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Recovery Pathway 2 Choice
The Recovery Story Its about Relationship

Recovery
abandonment

• Mutual responsibility
• Engagement
• Support/love
• The person reappears

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Recovery Pathway 2 Choice
"It is our choices that show what we truly are,
far more than our abilities." J.K. Rowling (1965
- )Harry Potter and The Sorcerer's Stone

• The more I choose, the more I recover.
  (Kristina)
• Because, making choices is how we
  remember/discover who we are.
• Recovery value each person is the expert in what
  works for them.

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Recovery Pathway 2 Choice
The freedom to choose and the right to make
mistakes
Question What about risk?

• Risk sharing not risk management
• Risk prevention plans
• WRAP crisis plan
• Advance Directives

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Recovery Pathway 3 Empowerment

• Resistance is the beginning of getting power
  back finding my voice.
• Resistance fosters Resilience. The person begins
  to come back and remember who they are.
• Recovery is the persons job they have to have
  the power.

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Recovery Pathway 3 Empowerment
Disability being a victim looking for someone
to take care/fix me.
old belief was
Entitlement
The ability to perform to produce the results I
want.
Empowerment
Enlightenment
Ability discovering my gifts and strengths
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Empowerment corresponds to the level of personal
responsibility and accountability.
Victim Disempowered
Personal Responsibility
Responsible Accountable?
100
30
0
Personal Responsibility
Victim Disempowered
Responsible Accountable ?
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100
0
Personal responsibility is a willingness to be
the source of the results in your life. Personal
accountability is a willingness to own the
results in your life.
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Recovery Pathway 4 Recovery Culture
The belief that recovery is a fact invites us
to transform our service environments and culture.
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Recovery Culture

• Create relationship. Provide support.
• Create community. People find a valued social
  role.
• Celebrate diversity.
• Maintain a positive level of consciousness.

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Map of Consciousness David Hawkins, M.D.,Ph.D.
Power

_
Force
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In the movie What About Bob? Dr. Marvins
negative level of consciousness (anger) creates
disaster. Bob, on the other hand, experiences
joy and has good fortune.
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In the movie A Beautiful Mind Professor Nash
gradually recovers from very serious psychiatric
experiences using the level of reason. But
what John Nash discovers is that it wasnt until
he found the power of love that he had the energy
to overcome and fully recover.
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Recovery Pathway 5 Spirituality

• Spiritual expression is not a symptom of a mental
  illness
• Connecting within and beyond the self.
• Finding meaning and purpose
• Develop spiritual competence
• Meditation, contemplation, prayer
• Spiritual practices
• Service to others.
• Treating each other with kindness and respect

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I finally realized that Im not alone in my
journey and that a lot of people have experienced
what I went through. During this time, thanks to
my girlfriend, I discovered the Lord. I got
baptized again and became a born-again Christian.
I realized God will also be there for me through
thick and thin, like my family and my girlfriend.
Finally, I got my job with META in the WELL
program and have been doing that job almost a
year and nine months. It felt so good to give
back to the community my experiences and to hear
theirs. I still hear voices to this day, but I
dont listen to them. I know Ive come a long
way and still have a long way to go, but the
future is bright and I couldnt be happier. Sal
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I was waiting for the bus the other day it had
just finished sprinkling and there were still
lots of clouds in the sky. I happened to look
beyond the traffic and there was the most
beautiful sunsets I believe Ive ever seen. It
was brilliant with streams of light shooting out
in several directions. I was spellbound. and in
that moment I felt something that was both inside
me and out there at the same time. not sure how
to describe it, but for a moment I felt connected
to the beauty in that sunset, and in fact, to
everything around me. I think that was God
somehow connecting with me William
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I have been in and out of hospitals many, many
times I can attribute my recovery to two
things. One is META Services for teaching me
about recovery and believing it is possible.
That I actually can be a productive human being.
The second is Buddhism. In meditating I find
peace. Within Buddhist teaching everything and
everyone deserves respect. In practicing this it
has taught me to respect myself, who I am, where
I am and where I am heading. Buddhism also teach
empowerment. While chanting one visualizes what
one needs, wants, peace, and wisdom. It also
teaches cause and effect which promotes taking
personal responsibility. Chet
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After numerous hospitalizations, over fifty
arrests, three separate prison sentences and more
rehabs and treatment centers than I can count, I
finally realized I needed to change. My life
started changing with Alcoholics Anonymous. The
program led me to an understanding of faith and
trust in God. That is when I was able to start
turning my life around. I had realized that I
was a terrible manager for myself. I sought God
out to let him manage my life for me. By
starting to do Gods will instead of my own, I
found a church, the Bible, church activities and
classes and people who had what I wanted
spiritually. This enabled me to start giving
back to society what I did not realize I had
taken. Finally, I have a glimpse of what is
going on, and the best part of my life is
definitely ahead. Helping others with love is an
important key for my success. Marc
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Moving on.

• So what is my job?

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Staff Influence on Recovery

• Staff have a profound influence on each persons
  recovery process.
• .and there was this person.
• Since there are no predictors as to who is most
  likely to recover, lets give everyone the
  benefit of the doubt.
• Staff can create an environment of hopefulness
  that promotes recovery.

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Now lets listen to Pat Deegan describe the
beginning of her recovery process.
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the best is yet to come!