Recovery Model of Mental Illness: A Complementary Approach to Psychiatric Care

Byline: K. Jacob Medicine, in keeping with its status in society, always had a paternalistic culture. Doctors listened to patients' concerns, examined them, ordered laboratory investigations, diagnosed disease, prescribed medication and prognosticated about course and outcome. While they did explain the issues to their patients, medical perspectives and opinions guided their decisions. Patients were expected to follow their advice. The prevalent paternalistic culture within the medical profession often dismissed patient perspectives and did not take kindly to objections or different points of view. Psychiatry with its focus on symptoms and functioning developed elaborate assessments, standardized interviews and rating scales to document and monitor psychopathology. These appraisals measured positive and negative psychotic symptoms, depression and anxiety, cognitive deficits, as well as functioning. The early success of psychotropic medication in reducing symptoms of psychosis and ameliorating anxiety and depression led to optimism among mental health professionals that people with these conditions will recover from their mental illness and lead normal lives. Five decades later, mental health professionals accept that a significant proportion of people with mental disorders continue to have persistent and disabling symptoms and are unable to get back to their previous occupations and social roles. However, the quest for newer psychotropic medication also meant a continued focus on residual symptoms and deficits. Psychiatry conceptualised phases of illness into acute, maintenance and continuation domains. It suggested concepts like relapse, recurrence, remission and recovery based on symptoms profiles over time. sup1 Psychiatric models tended to view recovery from mental illness similar to that seen in physical diseases. Despite the power, influence and dominance of psychiatric concepts, once taken as standard, they have gradually began to face opposition. sup2 The late 20 supth century saw substantial changes in medicine and society. Contradictions between social consensus and individual values and between the larger and pervasive institutional contexts and social policies led to a re-examination of issues. sup3 The general discomfort with and opposition to governmental and institutional authority led to a review of perspectives related to mental illness. The empowered and vibrant user movement in the west argued for different perspectives and approaches. The recovery model views mental illness from a perspective radically different from traditional psychiatric approaches. A Different Perspective on Recovery For many people with mental illness, the concept of recovery is about staying in control of their life rather than the elusive state of return to premorbid level of functioning. Such an approach, which does not focus on full symptom resolution but emphasises resilience and control over problems and life, has been called the recovery model. sup4,5,6 The approach argues against just treating or managing symptoms but focusing on building resilience of people with mental illness and supporting those in emotional distress. While there is no single definition of the concept of recovery for people with mental health problems, there are guiding principles, which emphasise hope and a strong belief that it is possible for people with mental illness can regain a meaningful life, despite persistent symptoms. Recovery is often referred to as a process, an outlook, a vision, a conceptual framework or a guiding principle. There is evidence to suggest that self-management strategies based on the recovery model may have more value than models based on physical health. sup4 An analysis of the main themes in recovery based research suggest that the dominant themes from the stakeholder perspectives were identity, the service provision agenda, the social domain, power and control, hope and optimism, risk and responsibility. …