R e

c o

v e

r y

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

R e

c o

v e

r y

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

R e

c o

v e

r y

Let’s hear from Raymond, whose story illustrates the points Dr. Anthony

makes about how the system can contribute to “chronicity.”

Is Recovery Possible?

49%35269DeSisto (1995). Maine

57%22.5140Ogawa (1987). Japan

62-68%32269Harding (1987). Vermont

62-68%35186Tsuang (1979). Iowa

53%37289Ciompi & Muller (1976).

57%22502Huber (1975). Germany

53-68%23208Bleuler (1972). Zurich

Outcome# YrsSizeStudy

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

……but these findings are not new.but these findings are not new.

McLean Hospital 1818-1830

59% of 732 were discharged as recovered, much improved, or improved

Bloomingdale Asylum, NYC

1821-1844

60% of 1,841 patients admitted discharged as “cured or “improved”.

Worcester State Lunatic Asylum

1833-1840

80% of those ill less than a year recovered.

Pennsylvania Hospital for the Insane

1841-1882

8,546 admissions. 45% cured and 25% improved on discharge

Worcester study completed in 1880

1833-1846

984 discharged patients. 58% remained well throughout their life.

Robert Whitaker, Mad in America and Gerald Grob, Mad Among Us

The results of Moral Treatment in the 1800s

“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

Moral Treatment Practitioners…. Moral Treatment Practitioners…. a value on the persona value on the person

R e

c o

v e

r y

“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

Moral Treatment Practitioners….Moral Treatment Practitioners….a value on the persona value on the person

R e

c o

v e

r y

“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

Moral Treatment Practitioners….Moral Treatment Practitioners….HOPEHOPE

R e

c o

v e

r y

Moral Treatment Practitioners…. Moral Treatment Practitioners…. a value on environmenta 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

R e

c o

v e

r y

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)

R e

c o

v e

r y

Our Definition of Recovery

Remembering who you are

and using your strengths to become all you were meant to be.

R e

c o

v e

r y

Don’t forget

Where you came from

Where you’ve been thus far

Its so easy

To leave scars

When you forget

To remember who you are

for the hard times

to remember

Who you are

Disappointment

Difficulties

Disappointment

Diagnosis

Difficulties

Disappointment

Diagnosis

Disease

Difficulties

Disappointment

Diagnosis

Disease

Disabled

Difficulties

Disappointment

Diagnosis

Disease

Disabled

Disempowered

Difficulties

Disappointment

Diagnosis

Disease

Disabled

Disempowered

Disenfranchised

Difficulties

Disappointment

Diagnosis

Disease

Disabled

Disempowered

Disenfranchised

Demoralized

Difficulties

Disappointment

Diagnosis

Disease

Disabled

Disempowered

Disenfranchised

Demoralized

Dysfunctional

Difficulties

And the

And the

perso

n has

perso

n has

disap

peare

d

disap

peare

d

A person

A person

Assets

And the

And the

perso

n

perso

n

com

es b

ack

com

es b

ack

and g

ets

and g

ets

even

big

ger!

even

big

ger!

A person

Abilities

Assets

And the

And the

perso

n

perso

n

com

es b

ack

com

es b

ack

and g

ets

and g

ets

even

big

ger!

even

big

ger!

A person

Abilities

Assets

Achievements

And the

And the

perso

n

perso

n

com

es b

ack

com

es b

ack

and g

ets

and g

ets

even

big

ger!

even

big

ger!

A person

Authentic

Abilities

Assets

Achievements

And the

And the

perso

n

perso

n

com

es b

ack

com

es b

ack

and g

ets

and g

ets

even

big

ger!

even

big

ger!

A person

Authentic

Abilities

Authority

Assets

Achievements

And the

And the

perso

n

perso

n

com

es b

ack

com

es b

ack

and g

ets

and g

ets

even

big

ger!

even

big

ger!

A person

Authentic

Abilities

Authority

Autonomous

Assets

Achievements

And the

And the

perso

n

perso

n

com

es b

ack

com

es b

ack

and g

ets

and g

ets

even

big

ger!

even

big

ger!

R e

c o

v e

r y

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.

What People Recover From.

The torture and oppression

by the phenomenon of mental illnessThe stigma of mental illness:

•Social attitudes

•Professional attitudes

•Internalized personal attacks

Low expectation & lack of hope

from professionals

Side Effects

of Medications

Environments that

are not stimulating Lack of commitment from service

systems and politicians

Lack of accommodation/

support for disabilities

when

re-entering the world

Lack of opportunities for Growth

Experience of dehumanization and degradation and spirit breaking

Numerous Losses

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

Poverty and/or Homelessness

By permission of Dr. Kaly

R e

c o

v e

r y

Recovery Pathwaysfrom our experience

• Hope

• Choice

• Empowerment

• Recovery Culture

• Spirituality; meaning and purpose

R e

c o

v e

r y

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. Rosen’s words, “schizophrenia is degenerative, over time you’re getting worse.”

Recovery Pathway 1: Hope

R e

c o

v e

r y

Hope

• Hope is the beginning.• It’s 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”.

HOPE

R e

c o

v e

r y

A person comes to our crisis service. They are crying,

frightened and filled with despair. How can you communicate hope?

R e

c o

v e

r y

In the movie “The Beautiful Mind” this dramatic scene illustrates the

consequences and the fear associated with not having the choice.

Recovery Pathway 2: Choice

abandonmentoverprotection

No choice•Coercion and force

•No recovery•Person disappears

Recovery Pathway 2: Choice

•No support•Hospitalization, jail,

homelessness•No recovery

•Person disappears

The Old Story

abandonmentRelationship

•Mutual responsibility•Engagement•Support/love

•The person reappears

Recovery Pathway 2: Choice

The Recovery Story; Its about Relationship

overprotection

abandonment=

•Mutual responsibility•Engagement•Support/love

•The person reappears

Recovery Pathway 2: Choice

The Recovery Story; Its about Relationship

Recovery

R e

c o

v e

r y

Recovery Pathway 2: Choice

• “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.

"It is "It is our choicesour choices that show what we truly are, that show what we truly are, far more than our abilities."far more than our abilities."

J.K. Rowling (1965 - )J.K. Rowling (1965 - )Harry Potter and The Sorcerer's StoneHarry Potter and The Sorcerer's Stone

R e

c o

v e

r y

Recovery Pathway 2: Choice

Question:

What about risk?• Risk sharing not risk management

• Risk prevention plans• WRAP crisis plan

• Advance Directives

The freedom to chooseand the right to make mistakes

R e

c o

v e

r y

• 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 person’s job; they have to have the power.

Recovery Pathway 3: Empowerment

Recovery Pathway 3: Empowerment

The ability to perform;

to produce the results I want.

Entitlement

Empowerment

Enlightenment

old belief was

Ability; discovering my gifts and strengths

Disability; being a victim

looking for someone to take

care/fix me.

Empowerment corresponds to the level of personal responsibility and accountability.

Personal

Responsibility

Victim

Disempowered

Personal

Responsibility

Victim

Disempowered

Responsible Accountable

0% 70% 100%

ResponsibleAccountable

0% 30% 100%

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.

R e

c o

v e

r y

Recovery Pathway 4: Recovery Culture

The belief that “recovery is a fact” invites us to transform our service

environments and culture.

R e

c o

v e

r y

Recovery Culture

• Create relationship. Provide support.

• Create community. People find a valued social role.

• Celebrate diversity.

• Maintain a positive level of consciousness.

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

Pow

er

Force

God-View Life-View Level Log Emotion Process

Self Is Enlightenment 700 + Ineffable Pure Consciousness

All-Being Perfect Peace 600 Bliss Illumination

One Complete Joy 540 Serenity Transfiguration

Loving Benign Love 500 Reverence Revelation

Wise Meaningful Reason 400 Understanding Abstraction

Merciful Harmonious Acceptance 350 Forgiveness Transcendence

Inspiring Hopeful Willingness 310 Optimism Intention

Enabling Satisfactory Neutrality 250 Trust Release

Permitting Feasible Courage 200 Affirmation Empowerment

Indifferent Demanding Pride 175 Scorn Inflation

Vengeful Antagonistic Anger 150 Hate Aggression

Denying Disappointing Desire 125 Craving Enslavement

Punitive Frightening Fear 100 Anxiety Withdrawal

Disdainful Tragic Grief 75 Regret Despondency

Condemning Hopeless Apathy 50 Despair Abdication

Vindictive Evil Guilt 30 Blame Destruction

Despising Miserable Shame 20 Humiliation Elimination

Death 0

+

_

R e

c o

v e

r y In the movie “What About

Bob?” Dr. Marvin’s negative level of consciousness (anger) creates disaster. Bob, on the

other hand, experiences joy and has good fortune.

R e

c o

v e

r y 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 wasn’t until he found the power of love that he had the energy to overcome and fully recover.

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

R e

c o

v e

r y

Now let’s listen to Pat Deegan describe the beginning of her

recovery process.

R e

c o

v e

r y …the best is yet to come!