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| Meanings of Recovery in the Literature |
Meanings of Recovery in the Literature
Fitzpatrick (2002) summarized the recovery models in use by describing them as being on a continuum, with three identifiable points: (i) the medical model; (ii) the rehabilitative model; and (iii) the empowerment model. We elucidate these three models below in order to provide a background for our own findings.
The medical model
As we discussed in Chapter 1, this model assumes that mental illness is a physiological disease and, therefore, recovery refers to a return to a former state of health: the person is cured (Whitwell, 2000). Another use of this model is in describing recovery from a single episode of psychosis. Liberman et al. (2002) put forward that the abatement of symptoms – which was posited as an operational definition of remission (Andreasen et al., 2005) – for a given period, coupled with improvements in psychosocial functioning, could be used as a definition of recovery. Longitudinal outcome studies have tended to use the medical model, focusing on symptom remission, freedom from medication, period without hospitalization and functioning (e.g. M. Bleuler, 1972/1978; Tsuang, Woolson and Fleming, 1979; Ciompi, 1980/2005; Huber et al., 1980; Harding et al., 1987a; DeSisto et al., 1995a; Mason et al., 1995; Sartorius et al., 1996; Laurenen et al., 2005).
However, the medical definition is not the one used by the recovery movement: ‘One of the biggest things I’ve had to accept is that recovery is not the same thing as being cured’ (Deegan, 1997, p. 20). Nevertheless, the medical definition is the one that is understood in common discourse. In presenting the results of a qualitative study of 57 people who considered themselves recovered, Tooth, Kalyanansundaram and Glover (1997) found that professionals often questioned whether the participants could be considered as recovered, based on their level of functioning. Confusion can occur when either health professionals or consumers infer this meaning, so it is important for clinicians and researchers to be clear regarding their own meaning of recovery (Whitwell, 1999, 2000).
Paradoxically, because the medical definition of recovery requires a return to a former state, even people who would not be described by an outside observer as having a mental illness may not consider themselves recovered. Some reasons consumers have given for this are that:
. they continue to use medication or other illness management strategies;
. they do not believe that it is possible for people with a mental illness to get better;
. they do not feel like the same person that they were before.
(Ahern and Fisher, 2001; O’Hagan, 2004; Whitwell, 1999)
In addition, people who do not believe in the possibility of recovery can interpret normal emotional responses as illness symptoms (Tenney, 2000; Fox, 2002). The fact that apparently well people, who are participating fully in society by objective standards, do not think they have recovered highlights the pervasiveness of the medical model of recovery.
Fitzpatrick (2002) summarized the recovery models in use by describing them as being on a continuum, with three identifiable points: (i) the medical model; (ii) the rehabilitative model; and (iii) the empowerment model. We elucidate these three models below in order to provide a background for our own findings.
The medical model
As we discussed in Chapter 1, this model assumes that mental illness is a physiological disease and, therefore, recovery refers to a return to a former state of health: the person is cured (Whitwell, 2000). Another use of this model is in describing recovery from a single episode of psychosis. Liberman et al. (2002) put forward that the abatement of symptoms – which was posited as an operational definition of remission (Andreasen et al., 2005) – for a given period, coupled with improvements in psychosocial functioning, could be used as a definition of recovery. Longitudinal outcome studies have tended to use the medical model, focusing on symptom remission, freedom from medication, period without hospitalization and functioning (e.g. M. Bleuler, 1972/1978; Tsuang, Woolson and Fleming, 1979; Ciompi, 1980/2005; Huber et al., 1980; Harding et al., 1987a; DeSisto et al., 1995a; Mason et al., 1995; Sartorius et al., 1996; Laurenen et al., 2005).
However, the medical definition is not the one used by the recovery movement: ‘One of the biggest things I’ve had to accept is that recovery is not the same thing as being cured’ (Deegan, 1997, p. 20). Nevertheless, the medical definition is the one that is understood in common discourse. In presenting the results of a qualitative study of 57 people who considered themselves recovered, Tooth, Kalyanansundaram and Glover (1997) found that professionals often questioned whether the participants could be considered as recovered, based on their level of functioning. Confusion can occur when either health professionals or consumers infer this meaning, so it is important for clinicians and researchers to be clear regarding their own meaning of recovery (Whitwell, 1999, 2000).
Paradoxically, because the medical definition of recovery requires a return to a former state, even people who would not be described by an outside observer as having a mental illness may not consider themselves recovered. Some reasons consumers have given for this are that:
. they continue to use medication or other illness management strategies;
. they do not believe that it is possible for people with a mental illness to get better;
. they do not feel like the same person that they were before.
(Ahern and Fisher, 2001; O’Hagan, 2004; Whitwell, 1999)
In addition, people who do not believe in the possibility of recovery can interpret normal emotional responses as illness symptoms (Tenney, 2000; Fox, 2002). The fact that apparently well people, who are participating fully in society by objective standards, do not think they have recovered highlights the pervasiveness of the medical model of recovery.
