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Recovery in Mental Illness: Beyond Being "Symptom-Free"


What is Recovery?

The dominance of the medical model in mental health often reduces recovery to merely reaching a certain score on rating scales like the Patient Health Questionnaire-9 (PHQ-9), which is commonly used to measure depression. This narrow perspective overlooks other vital aspects of recovery beyond clinical response, as shown by many studies (Andresen et al., 2003; Jorge-Monteiro & Ornelas, 2015). Some of these overlooked facets of recovery include:
  • Hope for the future.
  • Re-establishment of a positive identity.
  • Establishment of personally meaningful goals.
  • Taking responsibility for one’s life.
  • Feeling included and connected to others.
  • Feeling empowered.
  • Contributing to community life.
Building on this broader understanding, recovery involves managing one’s mental illness, transcending its negative impacts, and striving for a meaningful life. The concept of recovery can vary among individuals, and some common expressions people use to describe their recovery include the following statements (Jorge-Monteiro & Ornelas, 2015):

Personal goals, hope, and purpose
“I like myself.”
“I have an idea of who I want to become.”
“Something good will eventually happen.”
“I am hopeful about my future.”
“I continue to have new interests.”
“I have a desire to succeed.”
“I have my own plan for how to stay or become well.”
“I have goals in life that I want to reach.”
“I believe I can meet my current personal goals.”
“I have a purpose in life.”

Managing the help needs
“I know when to ask for help.”
“I am willing to ask for help.”
“I ask for help when I need it.”

Supportive interpersonal relationships
“Even when I don’t care about myself, other people do.”
“I have people I can count on.”
“Even when I don’t believe in myself, other people do.”
“It is important to have a variety of friends.”

Beyond symptoms
“Fear doesn’t stop me from living the way I want to.”
“I can handle what happens in my life.”
“I can handle stress.”
“Coping with depression is no longer the main focus of my life.”
“My symptoms interfere less and less with my life.”
“My symptoms seem to be a problem for shorter periods of time each time they occur.”

Stages of Recovery

Recovery may occur over time, especially if a mental illness has been severe, recurrent, or chronic. The literature breaks down the recovery process into 5 stages (Andresen et al., 2003):

1. Moratorium: In this stage, you are in denial that you have a mental illness and feel confused, hopeless, and may isolate yourself.

2. Awareness: In this stage, you begin to have a glimmer of hope for a better life and for recovery.

3. Preparation: In this stage, you resolve to start working on recovery. This involves taking stock of your intact self, your values, strengths, and weaknesses. It also consists of educating yourself about your mental illness and the types of treatments.

4. Rebuilding: This is the stage where you do the hard work of recovery. You set and work toward personally valued goals, and you also review old goals and reassess your values. You take responsibility for managing your mental illness and for taking control of your life. It also involves taking risks, suffering setbacks, and coming back to try again.

5. Growth: This is the final stage of recovery and can be considered the outcome of the recovery process. In this stage, you may not be completely free of symptoms, but you have a good handle on how to manage your mental illness and stay well. You learn to be resilient in the face of setbacks, have faith in your ability to pull through, and maintain a positive outlook. In addition, you live a whole and meaningful life, look forward to the future, have a positive sense of self, and feel that the experience of managing your mental illness has made you a better person than you might otherwise have been.

Key Elements of Recovery

While clinical recovery indicators, like minimal symptoms on rating scales, are vital for measurement-based care, recovery is most effective when tailored to your personal goals and values. Research indicates that there is little correlation between recovery as defined by consumers and the clinical measures used by professionals. In one study, individuals who progressed through self-identified recovery stages did not consistently show improvement in most clinical scores at those stages (Andresen et al., 2010). Therefore, measurement-based care, which relies on objective clinical assessments, should also include the subjective aspects of an individual’s recovery goals and values. 

Recovery includes essential components (Duggal, 2016). Understanding your mental illness enhances your ability to advocate for yourself when consulting with mental health professionals. This ensures your treatment team recognizes your preferences and values, helping you achieve your goals. Paternalistic healthcare, where providers make decisions for patients, is now outdated. You are an equal partner in your healthcare choices. You deserve to be treated with dignity and respect, and you have the right to refuse any treatment you don't agree with. 

Patience is crucial during recovery. For example, antidepressants for depression often take four to six weeks to show full effects, although some improvements might be seen after two weeks. Therapy, on the other hand, might require more time to become effective. It's important to find a balance between allowing your treatments enough time to work and not delaying a change if a different approach might be more beneficial. 

In summary, recovering from mental illness involves more than just being “symptom-free.” It also includes leveraging your personal strengths to handle daily stressors, using them in innovative ways as part of a wellness plan. 

Visit Dr. Duggal’s Author Page to explore effective self-management strategies for enhancing mental health and well-being.

HARPREET S. DUGGAL, MD, FAPA

REFERENCES

Andresen, R., Oades, L., & Caputi, P. (2003). The experience of recovery from schizophrenia: towards an empirically validated stage model. Australian and New Zealand Journal of Psychiatry, 37, 586-594.

Andresen, R., Caputi, P., & Oades, L. G. (2010). Do clinical outcomes measures assess consumer-defined recovery? Psychiatry Research, 177(3), 309-317.

Duggal, H. S. (2016). The complete guide to self-management of depression. Archway Publishing.

Jorge-Monteiro & Ornelas, J. H. (2015). Recovery assessment scale: testing validity with Portuguese community-based mental health organization users. Psychological Assessment, http://dx.doi.org/10.1037/pas0000176







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