Is Recovery Possible?

Thoughts on Recovery – Part 1/5 Exploring the concept of Recovery in MH

Introduction: Global attention is increasing on both – the magnitude of suffering as well as the discrimination experienced by some 970 million people suffering from a mental health or substance use disorder around the world. This in turn highlights the dire need to create reasons for hopefulness in the context of mental health in the 21^st century – a facet well acknowledged by the WHO, who as early as at the turn of the century made the clarion call to “stop exclusion and dare to care”, urging the world community that it is open minds that can potentially lead to opening doors to positive possibilities in recovery, thereby alluding to the need for more creative and constructive conversations in the matter.

Recovery @ MHAT: The notion of recovery has a central place in MHAT  vision – a world where the community is engaged in offering high-quality, recovery-oriented, mental health care for the poorest of the poor. MHAT recognizes the need for a continuously evolving recovery vision based on new paradigms, new questions and new answers founded on ground-breaking research, evidence and their implications. MHAT aims to be among the pioneers in creating systems of psychiatric care, based on recovery-oriented principles.

Realism in Recovery: When thinking about a patient who has recovered, expectations may be on the lines of “complete recovery” as indicated by:

1. The patient is completely off medications
2. The symptoms have gone away completely
3. He or She is able to be gainfully employed
4. They are able to relate and interact effectively with other people
5. They are able to live in the community by playing their roles effectively
6. They are able to behave in a way that would never reveal that they once had a serious psychiatric disorder

Perhaps there is no harm in having such high aspirations when aiming for recovery. These ideals may even emerge naturally in the minds of caregivers (as well as clients whose cognition has not been significantly impaired). Also, they can serve as pointers of the ultimate direction to head in, which can help measure if recovery is actually happening. However, obsession and inflexibility with these notions of recovery, can be more harmful than helpful because: 

1. Evidence of recovery cannot be engineered to occur in a certain way, at a certain time
2. Obsession with high recovery ideals can make caregivers demotivated early on
3. Recovery is often slow, non linear and dependant on several factors
4. What we can control, are the activities and not the results (like in all things)
5. Valuable incremental progress tends to get discredited when expectations are high

Process, Faith and Patience:  From our experience recovery involves creating an environment (through the right set of interventions and education) that more likely sets clients on a journey, of which the salient/primary aims is – the minimizing of disruptive effects of the illness so as to help clients “come back to life” by getting more and more effective at playing the roles they once played or those expected of them by a reasonable society. The key point here is the age-old wisdom, “focus on the process and not the results”. Clients and Caregivers, if they can get themselves to agree to embark on a journey where they focus on the things to be done while giving time for the results, are more likely to see positive results. And during the time of waiting, they may focus on quality-controlling and building discipline into the activities that support recovery. One of the most valuable lessons to learn is the value of patience and faith.

Reasons for Optimism: Do people actually ever recover from being seriously mentally ill? Fortunately, there is compelling evidence! even of complete recovery among patients who have been on long term psychiatric rehabilitation. Notably there used to be a belief concerning psychiatric illness that “One-third get better one-third get worse and one-third stay the same”. Stunningly some of these results are from studies done on the bottom 3rd section of the population- the ones who were believed to be getting worse.

In the next blog we will discuss on what such studies teach us about rehabilitation and resilience.