The Recovery Model and Modern Psychiatric Care: Conceptual Perspective, Critical Approach and Practical Application

Abstract

The recovery model is a model that allows an individual to take back control of his life. It was primarily developed for serious mental disorders for which the biomedical model precluded any possibility of “real recovery” and control over life by individuals with mental disability. From a biopsychosocial viewpoint, the recovery model shifts the treatment objective from reducing symptoms to real integration and assignment of meaning of the life of individuals and their participation on equal terms in society. In other words, the perception is that recovery-as-healing goes beyond the concept of “therapeutic accompaniment” and “care”, as formulated by Racamier (Le psychanalyste sans divan. La psychanalyse et les institutions de soins psychiatriques. Payot, Paris, 1970, Les schizophrènes. Payot, Paris, 1980, Le génie des origines: psychanalyse et psychoses. Payot, Paris, 1992), and is transferred into modern psychotherapeutic concerns about psychoses. In any event, that requires a change in culture and how psychiatry is practised. In other words, it requires the individual to function as a user of mental health services, as an “expert user” when it comes to his own illness and not as a passive user who complies with treatment guidelines. This change must be accompanied by a simultaneous change in the way services are structured and operate, and in the more general attitude of the community, so as to accept difference and to make individuals adjust to the “norm” of a condition for integration. This chapter explores the history and conceptual meaning of the recovery model and ends with critical remarks about how it has been applied at both Greek and international level. This path is accompanied by presentation of a clinical case to show how the recovery model can be used in practice.

Annex 1. Key elements of the recovery model

Key elements of the recovery model
Element	Description	Sources
Renewed hope and commitment	The feeling of hope and trust in the probability of a renewed sense of self and purpose, which is accompanied by a desire and incentive to do things, is vital for recovery. This sense of hope can come from within oneself or from others who believe in the potential of the individual, even if he does not believe in himself	Davidson et al. (1997, 2001), Deegan (1996a, b), Fisher (1994), Jacobson and Curtis (2000), Jacobson and Greenlay (2001), Mead and Copeland (2000), Smith (2000), and Young and Ensing (1999)
Redefining oneself	The most essential aspect of recovery is perhaps the one relating to redefining oneself and re-evaluating mental illness as a part of a diverse identity that each of us has and not as the dominant social role of the “mental patient”	Davidson and Strauss (1992), Deegan (1996a, b), Fisher and Ahern (2000), Hatfield (1994), Pettie and Triolo (1999), Ridgeway (1999), Spaniol and Koehler (1994), and Young and Ensing (1999)
Reintegrating the illness	The first step towards recovery is frequently described as recognition and acceptance of the limitations the illness imposes and discovering talents, gifts and abilities that allow the individual to pursue and achieve life goals despite the existence of the disability	Deegan (1988, 1993), Hatfield (1994), Munetz and Frese (2001), Ridgeway (1999), Sayce and Perkins (2000), Smith (2000), Sullivan (1994), and Young and Ensing (1999)
Involvement in activities and roles that provide meaning	By expanding into and occupying normal, functional social roles (such as spouse, employee, student, taxpayer, friend) and contributing creatively to the community which the individual himself chooses, the patient lays the foundations for his own recovery	Anthony (1993), Davidson et al. (2001), Jacobson and Greenley (2001), Lunt (2000), Ridgeway (1999), and Young and Ensing (1999)
Addressing stigma	Individuals must recover from the social consequences and social stigma and from the effects of the illness itself. Recovery includes developing resilience to stigma and/or actively fighting against it	Deegan (1996a, b), Houghton (2004), Perlick (2001), and Ridgeway (1999)
Regaining control	Individuals must take primary responsibility for transforming themselves from people with disability into people in recovery. Regaining control over one’s own life contributes to the treatment through a redefined sense of self as an agent and effective subject. Opportunities must be available to people who make choices and people who need to have choices, from which they can choose. People must also be given opportunities to succeed and fail	Anthony (1993), Bassman (1997), Baxter and Diehl (1998), Deegan (1988, 1996b), Fisher (1994, n.d.-a), Frese et al. (2001), Hatfield (1994), Jacobson and Curtis (2000), Jacobson and Greenley (2001), Leete (1994), Lehman (2000), Lovejoy (1982), Lunt (2000), Mead and Copeland (2000), Munetz and Frese (2001), Ridgeway (1999), Smith (2000), Walsh (1996), and Young and Ensing (1999)
Empowerment and exercising rights of citizenship	As the sense of empowerment and control over one’s own life emerges, people in recovery begin to demand their rights (such as the right to decide where they will live, who they will love, how they will spend their lives) and assume responsibility for themselves (by paying taxes, voting, volunteering) like any other citizen does	Fisher (1994, n.d.-b), Jacobson and Greenley (2001), Munetz and Frese (2001), Ridgeway (1999), Walsh (1996), and Young and Ensing (1999)
Managing symptoms	Although full remission of the symptoms is not necessary, the ability to manage one’s symptoms in some way is a vital condition for recovery. Recovery includes good and difficult times, setbacks and successes and moments when the symptoms may be more or less under control. The change lies in the individual’s active involvement in the treatment and his choice to manage his own symptoms, so that they are under his control instead of him passively accepting the services he receives	Deegan (1996b), Fisher (1994), and Ridgeway (1999)
Support from others	Recovery does not happen in isolation. Showing independence in the community where someone has chosen to live and the support he may received from others and from the models one chooses for oneself, be they family members, friends, professionals, members of the community or peers, encourages the individual to overcome difficult moments and reinforces good ones	Baxter Diehl (1998), Fisher (1994), Jacobson and Greenley (2001), Mead and Copeland (2000), Ridgeway (1999), Smith (2000), Sullivan (1994), and Young and Ensing (1999)

1. This table has been adapted from Davidson et al. (2005)