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| Responsibility in the Awareness Stage: The Need to Take Control |
Responsibility in the Awareness Stage: The Need to Take Control
In the Moratorium stage, the person has the sense of having no control over his or her life. He or she has forfeited responsibility: their treatment, and their lives generally, are in the hands of carers and professionals. However, the person is experiencing an existential crisis; life lacks meaning and purpose and he or she has lost the sense of personal coherence. The second stage of recovery is heralded by an awareness of the need to take control of one’s life, and this suggests that, even though the person may not have formulated clear goals, the individual is acutely aware that his or her life is ‘going nowhere’.
For some, it was the feeling of not making progress in their mental health. Being a receiver of treatment was not enough – they realized that they would need to do more for themselves:
What I can say about my recovery is that I had to accept that I played a role in my wellness . . .. I knew I had to have a working relationship with a therapist and accept my part of the job. I carry with me today the question I was asked several years ago:
‘Are you ready to be well?’ I wasn’t then, I am now. (Greenblat, 2000, p. 245) I now realize that I needed to take some responsibility for my recovery; I can’t just wait for the pills to save me . . .. It hasn’t been easy to change, but I’ve begun to make a start and I see some hope where I saw none before. (Anonymous, 1994a, p. 14)
I was very frustrated waiting for this psychiatrist to perform the necessary miracles . . . I faced the fact that if my situation was going to improve, I would have to do it myself.
(Chovil, 2005, p. 70)
Nor does control of symptoms constitute recovery. Recovered consumers realized that more was required, and it had to come from themselves. Fox (2002), describes how, after the medication started to work, she still questioned whether to ‘embrace the world of thought or to continue to believe in [her] inner voices’ (p. 365). She eventually made a conscious choice to let go of the world of voices and ‘embrace the world where [her] children and mother were’ (p. 365).
Even in the midst of illness, some people experienced an awareness that they had to decide to be well. After a failed suicide attempt, Watson (1994) tells, ‘I vowed ‘‘never again’’ I would endure to the end’ (p. 70). While Simon, quoted in Thornhill, Clare and May (2004), related how something just ‘dawned on him’ and he decided to let go of being mad. Simon described the feeling as like a moment of ‘grace’.
As we discussed in the previous chapter, personal empowerment is needed in order to take responsibility. The power differential that exists in some therapeutic relationships can hinder the personal empowerment of the consumer. However, the actions or attitude of the mental health practitioner can enable a person to take charge of their recovery. Leibrich (1997) illustrates the subtle nature of the power imbalance, and how simply this can be overcome with a personcentred approach:
But one day something changed. I was assigned to a therapist who said the most astonishing thing. In all the time I had been unravelling inside, no-one had ever said this: ‘Let me come in there with you. Show me what its like.’ (p. 38)
Leibrich goes on to explain that for the first time she felt safe to talk about what was going on inside, and she ‘began to emerge’ (p. 38).
A compelling example of the effects of an empowering attitude among staff is provided by one of the case studies reported by Davidson and Strauss (1995). After 15 years of schizophrenia involving eight hospitalizations, divorce and unemployment, ‘Mr. J’ turned his life around when an aide on the inpatient unit pointed out to him that he could still make something of his life if he so wanted. Mr J reported that this restored some hope for a better life, and placed responsibility for change on his own shoulders. Five years later he was studying, parenting his young child, working two part-time jobs, socializing with a number of friends and his cognitive functioning had improved considerably. This is a powerful illustration of a turning point.
Frankl (1984) pointed out that only the individual has the power to imbue his or her life with meaning by setting meaningful goals. He maintained it was the responsibility of everyman to make life meaningful in this way, and moreover, that this is the primary motivating source in human beings. The stories of consumers illustrate how powerful this drive is, when, in the midst of serious mental illness, individuals will look deep within themselves to find the resources to take on that responsibility. The significance of even tiny acts of personal responsibility is illustrated by Betty (Davidson and Strauss, 1992), as she talks about her new-found ability to ‘nurture’ herself, by listening to jazz music on the radio: ‘I turn it on, I’m responsible, I enjoy the music, I make notes and draw while I’m hearing it . . . then I turn it off . . .’ (p. 138). Betty explains the importance of doing this herself, and for herself, thus providing evidence that she is capable of having control over some aspect of her life (Davidson and Strauss, 1992).
Betty’s experience reveals the importance of a sense of control and autonomy in recovery from serious mental illness. A sense of control has also been found to be an important factor in recovery from serious physical conditions, such as chronic illness (Jaffe, 1985; Sidell, 1997) and acquired disability (Dunn, 1996), as well as traumatic events (Taylor, 1983) and bereavement (Stroebe and Stroebe, 1993). The ability to ‘choose life’ in the most debilitating circumstances is illustrated by Simpson (1982, cited in Jaffe, 1985). Simpson was recovering from a coma, which left her with almost total amnesia as well as physical disabilities. She was in a deep depression after returning home and felt victimized: ‘I felt that for arbitrary reasons I was being picked on and abused.’ Seeing no escape, she wondered if she could just lie down and die. However, she wrote, ‘One must squeeze the victim out of oneself . . .
In the Moratorium stage, the person has the sense of having no control over his or her life. He or she has forfeited responsibility: their treatment, and their lives generally, are in the hands of carers and professionals. However, the person is experiencing an existential crisis; life lacks meaning and purpose and he or she has lost the sense of personal coherence. The second stage of recovery is heralded by an awareness of the need to take control of one’s life, and this suggests that, even though the person may not have formulated clear goals, the individual is acutely aware that his or her life is ‘going nowhere’.
For some, it was the feeling of not making progress in their mental health. Being a receiver of treatment was not enough – they realized that they would need to do more for themselves:
What I can say about my recovery is that I had to accept that I played a role in my wellness . . .. I knew I had to have a working relationship with a therapist and accept my part of the job. I carry with me today the question I was asked several years ago:
‘Are you ready to be well?’ I wasn’t then, I am now. (Greenblat, 2000, p. 245) I now realize that I needed to take some responsibility for my recovery; I can’t just wait for the pills to save me . . .. It hasn’t been easy to change, but I’ve begun to make a start and I see some hope where I saw none before. (Anonymous, 1994a, p. 14)
I was very frustrated waiting for this psychiatrist to perform the necessary miracles . . . I faced the fact that if my situation was going to improve, I would have to do it myself.
(Chovil, 2005, p. 70)
Nor does control of symptoms constitute recovery. Recovered consumers realized that more was required, and it had to come from themselves. Fox (2002), describes how, after the medication started to work, she still questioned whether to ‘embrace the world of thought or to continue to believe in [her] inner voices’ (p. 365). She eventually made a conscious choice to let go of the world of voices and ‘embrace the world where [her] children and mother were’ (p. 365).
Even in the midst of illness, some people experienced an awareness that they had to decide to be well. After a failed suicide attempt, Watson (1994) tells, ‘I vowed ‘‘never again’’ I would endure to the end’ (p. 70). While Simon, quoted in Thornhill, Clare and May (2004), related how something just ‘dawned on him’ and he decided to let go of being mad. Simon described the feeling as like a moment of ‘grace’.
As we discussed in the previous chapter, personal empowerment is needed in order to take responsibility. The power differential that exists in some therapeutic relationships can hinder the personal empowerment of the consumer. However, the actions or attitude of the mental health practitioner can enable a person to take charge of their recovery. Leibrich (1997) illustrates the subtle nature of the power imbalance, and how simply this can be overcome with a personcentred approach:
But one day something changed. I was assigned to a therapist who said the most astonishing thing. In all the time I had been unravelling inside, no-one had ever said this: ‘Let me come in there with you. Show me what its like.’ (p. 38)
Leibrich goes on to explain that for the first time she felt safe to talk about what was going on inside, and she ‘began to emerge’ (p. 38).
A compelling example of the effects of an empowering attitude among staff is provided by one of the case studies reported by Davidson and Strauss (1995). After 15 years of schizophrenia involving eight hospitalizations, divorce and unemployment, ‘Mr. J’ turned his life around when an aide on the inpatient unit pointed out to him that he could still make something of his life if he so wanted. Mr J reported that this restored some hope for a better life, and placed responsibility for change on his own shoulders. Five years later he was studying, parenting his young child, working two part-time jobs, socializing with a number of friends and his cognitive functioning had improved considerably. This is a powerful illustration of a turning point.
Frankl (1984) pointed out that only the individual has the power to imbue his or her life with meaning by setting meaningful goals. He maintained it was the responsibility of everyman to make life meaningful in this way, and moreover, that this is the primary motivating source in human beings. The stories of consumers illustrate how powerful this drive is, when, in the midst of serious mental illness, individuals will look deep within themselves to find the resources to take on that responsibility. The significance of even tiny acts of personal responsibility is illustrated by Betty (Davidson and Strauss, 1992), as she talks about her new-found ability to ‘nurture’ herself, by listening to jazz music on the radio: ‘I turn it on, I’m responsible, I enjoy the music, I make notes and draw while I’m hearing it . . . then I turn it off . . .’ (p. 138). Betty explains the importance of doing this herself, and for herself, thus providing evidence that she is capable of having control over some aspect of her life (Davidson and Strauss, 1992).
Betty’s experience reveals the importance of a sense of control and autonomy in recovery from serious mental illness. A sense of control has also been found to be an important factor in recovery from serious physical conditions, such as chronic illness (Jaffe, 1985; Sidell, 1997) and acquired disability (Dunn, 1996), as well as traumatic events (Taylor, 1983) and bereavement (Stroebe and Stroebe, 1993). The ability to ‘choose life’ in the most debilitating circumstances is illustrated by Simpson (1982, cited in Jaffe, 1985). Simpson was recovering from a coma, which left her with almost total amnesia as well as physical disabilities. She was in a deep depression after returning home and felt victimized: ‘I felt that for arbitrary reasons I was being picked on and abused.’ Seeing no escape, she wondered if she could just lie down and die. However, she wrote, ‘One must squeeze the victim out of oneself . . .
Choose for vigor. Opt for life.’ This same attitude of choosing between life and death can be seen in those who have recovered from serious mental illness:
At age 40, I reached a point in my life where I knew there were only two choices: to live or to die. Dying would be an easy way out of the relentless chattering that continued in my head. Living would take courage. (McDermott, 1994, p. 65)
Responsibility, personal empowerment and agency reflect the growing sense of an agentic self (Davidson and Strauss, 1992) that occurs in the Awareness stage, along with the realization of the possibility of a positive identity.
At age 40, I reached a point in my life where I knew there were only two choices: to live or to die. Dying would be an easy way out of the relentless chattering that continued in my head. Living would take courage. (McDermott, 1994, p. 65)
Responsibility, personal empowerment and agency reflect the growing sense of an agentic self (Davidson and Strauss, 1992) that occurs in the Awareness stage, along with the realization of the possibility of a positive identity.
