People who have been diagnosed with mental health problems are recovering from the multi-faceted catastrophe of that experience. This is likely to include the following:
- the multiple and often recurring traumas of the symptoms themselves
- the treatment of the illness, including the side-effects of medication and the stigma associated with contact with mental health services.
- negative attitudes and prognoses of professionals ('You have a chronic illness.', 'You will not be able to work.' 'You'll always need help, drugs.' and so on).
- lack of appropriate skills in professionals, (whose primary concern is typically the relief of symptoms), to help people to rebuild their lives
- devaluing and disempowering services which encourage passivity, where `them and us' attitudes prevail, and where the physical environment is often depressing and inadequate
- lack of opportunities to engage in valued activities in line with interests and aspirations
- the many manifestations of discrimination and social exclusion.
Too often, mental health workers do not fully appreciate the range of traumas experienced by people with mental health problems. Professional training and practice - whether it be in medicine, nursing, social work, psychology, or occupational and other therapies - typically focus on the problems associated with the 'illness' itself. The impact of the other sources of trauma with which the person must grapple typically receive scant attention. As Spaniol et al (1997) showed:
- `This has left many people with mental illness feeling devalued and ignored and has resulted in mistrust and alienation from the mental health system.'
'It is these multiple and interlocking traumas that have such a devastating impact on people's lives, often leaving them disconnected from themselves, from friends and family, from the communities in which they live, and from meaning and purpose in life. Unless mental health workers understand and address this complex range of barriers, we may inadvertently impede recovery by alienating people from the services that are supposed to assist them.'
Spaniol et al (1997) describe four types of impact that the trauma associated with a diagnosis of mental health problems can have on an individual: loss of a sense of self; - loss of power; - loss of meaning; - and loss of hope.
With time and experience, everyone develops a sense of who they are: this sense of self is profoundly challenged and fragmented by the experience of mental health problems (Estroff 1989). Within each person who has faced mental health problems there remains a persistent, healthy self trying to sur vive. But this is all too easily eclipsed by the identity of 'mental patient; which tends to mask all other identities. Often, mental health workers know little about people's lives prior to their illnesses, knowing them only during their 'mental patient' phase.
From a psychosocial perspective, chronicity involves the transformation of a prior, enduring, known and valued self into a devalued, passive and dysfunctional self (Estroff 1989, Davidson & Strauss 1992). This has a profoundly
negative impact on the recovery process. A person's sense of self affects t he whole range of their vocational, intellectual, social, emotional and functioning (Davidson & Strauss 1992). Recovery involves integrating what has happened to you into your former sense of self and developing a new valued and valuable sense of identity. If no one understands and values the 'you' that is now masked by the identity of 'mental patient, then you become isolated and alienated from others.
The experiences of diagnosis and using mental health services involves loss of agency, choice and the ability to determine your own interests. Symptoms can erode a person's sense of control, and this loss of confidence is compounded by services where the `expert knows best' (Bockes 1989). The prevailing view is that people with mental health problems are not able to determine what is best for themselves remains widespread. If no one else believes that you can help yourself, then it is difficult to see yourself as able to do so. Recovery is about active agency : - retaining or taking back control over your life. Unless mental workers can help people to take back control, we impede the recovery process.
Meaning in life is connected to the various roles that we adopt. Mental problems all too often result in loss of valued roles as worker, wife, mother, foot ball player, etc. People see their non-disabled peers doing the things that they had planned to do - going to college, getting married, pursuing their careers, - while they are left behind. Often it is believed that such roles are beyond the reach of people with mental health problems. And if everyone tells you that you cannot do things, you have two choices. You can believe what they say and give up, or you can reject their bleak prognostications, further isolate yourself from former friends, family and mental health services, and keep trying. If, as mental health workers, we cannot be optimistic about the possibilities for meaningful and valued lives for people with mental health problems, then we impede flat recovery process.
The accumulation of traumatising and devaluing experiences that typically accompany mental health problems can lead a person to abandon hope. If a person can see no possibility of a positive future then it is all too easy to give up trying to do anything at all. Lovejoy (1982) emphasised that recovery is impossible without hope. It is hope that provides the courage to change, to trust others and to try things out. It is not surprising that high levels of 'hopelessness' when a person first experiences mental health problems are predictive of a poor outcome (Aguilar et al 1997). The challenge seems too great. People give up. Without hope, rebuilding your life is not possible. If mental health workers cannot foster hope, then they cannot assist in the recovery process. Hope is the key to recovery (Adams & Partree 1998).
Recovery Principals
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