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| Responsibility in the Rebuilding Stage: Taking Control |
Responsibility in the Rebuilding Stage: Taking Control
Through setting and working towards goals, the person begins to actively take control of his or her life; not only management of symptoms, but also enlisting social support, improvement of self-image, handling social pressures and building social competence. This involves empowerment in treatment decisions, learning to recognize and manage symptoms, making autonomous choices about career or other goals, and gaining control over all aspects of one’s life: ‘We rebuilt our lives on three cornerstones of recovery – hope, willingness and responsible action’ (Deegan, 1988, p. 56). Even those who found that medications worked well for them expressed the necessity of taking an active role in psychological recovery:
Medication can help alleviate some of the symptomology, but the illness still remains and we have to deal with it. Medications make it possible to work toward a more productive life, but medication doesn’t do the work, we do! (Anonymous, 1994b, p. 25) An integral part of the recovery process is taking control of one’s treatment decisions and illness management. Learning to manage symptoms and to take control of the illness by identifying warning signs is the foundation of recovery. As Leete (1989), says: Many of us have learned to monitor symptoms to determine the status of our illness, using our coping mechanisms to prevent psychotic relapse or to seek treatment earlier, thereby reducing the number of acute episodes and hospitalizations. (p. 199)
Through setting and working towards goals, the person begins to actively take control of his or her life; not only management of symptoms, but also enlisting social support, improvement of self-image, handling social pressures and building social competence. This involves empowerment in treatment decisions, learning to recognize and manage symptoms, making autonomous choices about career or other goals, and gaining control over all aspects of one’s life: ‘We rebuilt our lives on three cornerstones of recovery – hope, willingness and responsible action’ (Deegan, 1988, p. 56). Even those who found that medications worked well for them expressed the necessity of taking an active role in psychological recovery:
Medication can help alleviate some of the symptomology, but the illness still remains and we have to deal with it. Medications make it possible to work toward a more productive life, but medication doesn’t do the work, we do! (Anonymous, 1994b, p. 25) An integral part of the recovery process is taking control of one’s treatment decisions and illness management. Learning to manage symptoms and to take control of the illness by identifying warning signs is the foundation of recovery. As Leete (1989), says: Many of us have learned to monitor symptoms to determine the status of our illness, using our coping mechanisms to prevent psychotic relapse or to seek treatment earlier, thereby reducing the number of acute episodes and hospitalizations. (p. 199)
The attitude and support of the mental health professional can provide the impetus for this process. Weingarten (2005) tells of the effect of being ‘put in the driver’s seat’:
The first pillar in my recovery foundation came when my therapist . . . put me in the driver’s seat in my efforts to recognize the problems I was experiencing . . . What emerged from this effort was a three-step coping method: identifying, evaluation and doing something to offset the problems. (p. 77)
A number of consumers recounted the symptom management measures they learned and practiced. For example, reframing voices . . .
I am, however, coming to understand that what sounds to me like an outside commentary is from my own thinking . . . I can rephrase it to myself. I shift from third person to first person. (Greenblat, 2000, p. 244)
stress management techniques . . .
Coping mechanisms may include withdrawing and being alone for a while; obtaining support from a friend; socializing or otherwise distracting myself from stressors; organizing my thoughts through lists; problem-solving around specific issues; or temporarily increasing my medication. (Leete, 1989, p. 200) and changing self-defeating behaviours . . .
So I switched to being a social smoker, only taking marijuana once every few weeks. Then on the 28th March, 1986 I decided it was getting me nowhere and I gave it up forever. I gave up nicotine on 29th April 1987 and then a year later I gave up alcohol.
(Roman, 1994, p. 43) Later, Roman explains: ‘It was because I had been so ill and don’t want to be that ill again, that’s given me the strength to give up [substance use]’ (p. 43).
Taking responsibility for one’s life involves taking risks. Deegan (1996b) points out that risk-taking is an important aspect of personal growth, and to protect a person from taking risks is to deny a human right:
Each person must find what works for them. This means that we must have the opportunity to try and to fail and to try again . . .. Professionals must embrace the concept of the dignity of risk, and the right to failure if they are to be supportive of us. (p. 97)
The process of personal development by taking responsibility for one’s choices is amply illustrated by Henderson (2004), who says, ‘I’m taking responsibility for yself, setting goals and challenging myself to do more, taking risks. I feel like a ‘real person’, taking on the responsibilities of adulthood’ (p. 68). Furthermore, taking risks and persevering through set-backs are important processes in rebuilding personal empowerment, as Koehler (1994) explained:
Prevailing as I did through these challenges brought to my awareness that with determination and commitment such as mine there’s a lot of power and ability in the disabled that’s waiting for an opportunity to prove itself. (p. 22)
However, taking responsibility does not preclude accepting the help and advice of others. Rather, involving others when necessary is an act of responsibility in itself. Choosing to use mental health resources after recognizing signs of developing symptoms is a reflection of responsible action by the consumer, for example, ‘I know my healthy personality and I know when my illness is interfering with it. I take precautions and alert my treatment team when I am slipping out of balance’ (Anonymous, 1994b, p. 25). And also:
However, now I do not just take medication or go to the hospital. I have learned to use medications and to use the hospital. This is the active stance that is the hallmark of the recovery process. (Deegan, 1996b, p. 96) The support of others during recovery can be important in enabling the person to build their agency and empowerment. Some consumers recognized the need to trust others’ observations of their wellness, rather than to rely totally on their own perceptions. For example, Henderson (2004) relates:
I’m now very aware that I cannot rely on purely subjective thoughts and feelings to determine the state of my mental health. I hope I will remain trusting of others to clue me in when I seem headed for problems. (p. 85)
Fox (2002) values the opportunity that she now has of a new life, and uses professional monitoring of her symptoms to ensure she stays in control:
I amaware that I must be careful with my illness. I must take care of myself and must be monitored . . .. I recognize I have been given a second chance at life and try never to take it for granted. (p. 363)
Taking on responsibility for one’s life necessarily involves suffering set-backs and having the courage to learn from one’s mistakes: Fortunately, through many years of trial and error, I have learned what medication works for me and when to take it to minimize side effects based on my daily schedule.
(Leete, 1989, p. 199)
Perseverance in the face of challenges and set-backs gradually builds resilience. One consumer described how he dealt with uncertainty about himself with others, and about discussing his medical or employment history: But as you continue to face these issues, often in more challenging situations, you get better at it and it becomes less of a burden. At the same time, I realize that I must proceed here in an orderly fashion, while being constantly aware of any mood shift. (Anonymous, 1994a, p. 17) Weingarten (2005) describes persevering with work through difficult times, while battling for 19 years with untreated dysthymia:
I managed to hold down many part-time and full-time jobs. I knew I wasn’t functioning at my best but I pushed through the depression and anxiety and proved to myself that I could be effective even when I was less than 100%. This was an important step and it was risky. (p. 78)
Taking control of one’s life involves more than controlling symptoms and identifying goals. Another important aspect of taking responsibility is taking care of the self in order to maintain psychological strength for the battle for recovery. Many approaches to wellbeing may be utilized in this process:
It took me eight years to learn all the things I needed to learn in order to regain my mental health. It wasn’t just changing my eating habits, or taking vitamins that did it. It was a combination of many things that I had to learn to change me so I could be healthy. (Schmook, 1998, p. 3)
This includes keeping active and involved in enjoyable activities. Participants in Young and Ensing’s (1999) research warned against ‘living the illness’, allowing it to sap all of one’s energy. One participant noted the need to find a focus outside of the illness: ‘I’ve been a person that just stayed in suspended animation for so long I find it’s helpful just to go somewhere. Just do something, anything’ (p. 227).
In the Rebuilding stage then, the person puts into action the nascent sense of agency that was rediscovered during the Awareness stage and nurtured during the Preparation stage. The person begins to exercise choice and to demonstrate control over his or her life and management of the illness. Taking responsibility for one’s wellbeing, health, and life as a whole demonstrates an inherent drive towards growth, as described by Deci and Ryan (2002). In articulating Self Determination Theory, Deci and Ryan claim that autonomy, or the opportunity to make self-determined choices, is a basic need for personal growth (Deci and Ryan, 2000, 2002). This is reflected in the work of Davidson and Strauss (1992), who described the utilization of the rediscovered agentic self to become an active and responsible agent in one’s recovery.
The first pillar in my recovery foundation came when my therapist . . . put me in the driver’s seat in my efforts to recognize the problems I was experiencing . . . What emerged from this effort was a three-step coping method: identifying, evaluation and doing something to offset the problems. (p. 77)
A number of consumers recounted the symptom management measures they learned and practiced. For example, reframing voices . . .
I am, however, coming to understand that what sounds to me like an outside commentary is from my own thinking . . . I can rephrase it to myself. I shift from third person to first person. (Greenblat, 2000, p. 244)
stress management techniques . . .
Coping mechanisms may include withdrawing and being alone for a while; obtaining support from a friend; socializing or otherwise distracting myself from stressors; organizing my thoughts through lists; problem-solving around specific issues; or temporarily increasing my medication. (Leete, 1989, p. 200) and changing self-defeating behaviours . . .
So I switched to being a social smoker, only taking marijuana once every few weeks. Then on the 28th March, 1986 I decided it was getting me nowhere and I gave it up forever. I gave up nicotine on 29th April 1987 and then a year later I gave up alcohol.
(Roman, 1994, p. 43) Later, Roman explains: ‘It was because I had been so ill and don’t want to be that ill again, that’s given me the strength to give up [substance use]’ (p. 43).
Taking responsibility for one’s life involves taking risks. Deegan (1996b) points out that risk-taking is an important aspect of personal growth, and to protect a person from taking risks is to deny a human right:
Each person must find what works for them. This means that we must have the opportunity to try and to fail and to try again . . .. Professionals must embrace the concept of the dignity of risk, and the right to failure if they are to be supportive of us. (p. 97)
The process of personal development by taking responsibility for one’s choices is amply illustrated by Henderson (2004), who says, ‘I’m taking responsibility for yself, setting goals and challenging myself to do more, taking risks. I feel like a ‘real person’, taking on the responsibilities of adulthood’ (p. 68). Furthermore, taking risks and persevering through set-backs are important processes in rebuilding personal empowerment, as Koehler (1994) explained:
Prevailing as I did through these challenges brought to my awareness that with determination and commitment such as mine there’s a lot of power and ability in the disabled that’s waiting for an opportunity to prove itself. (p. 22)
However, taking responsibility does not preclude accepting the help and advice of others. Rather, involving others when necessary is an act of responsibility in itself. Choosing to use mental health resources after recognizing signs of developing symptoms is a reflection of responsible action by the consumer, for example, ‘I know my healthy personality and I know when my illness is interfering with it. I take precautions and alert my treatment team when I am slipping out of balance’ (Anonymous, 1994b, p. 25). And also:
However, now I do not just take medication or go to the hospital. I have learned to use medications and to use the hospital. This is the active stance that is the hallmark of the recovery process. (Deegan, 1996b, p. 96) The support of others during recovery can be important in enabling the person to build their agency and empowerment. Some consumers recognized the need to trust others’ observations of their wellness, rather than to rely totally on their own perceptions. For example, Henderson (2004) relates:
I’m now very aware that I cannot rely on purely subjective thoughts and feelings to determine the state of my mental health. I hope I will remain trusting of others to clue me in when I seem headed for problems. (p. 85)
Fox (2002) values the opportunity that she now has of a new life, and uses professional monitoring of her symptoms to ensure she stays in control:
I amaware that I must be careful with my illness. I must take care of myself and must be monitored . . .. I recognize I have been given a second chance at life and try never to take it for granted. (p. 363)
Taking on responsibility for one’s life necessarily involves suffering set-backs and having the courage to learn from one’s mistakes: Fortunately, through many years of trial and error, I have learned what medication works for me and when to take it to minimize side effects based on my daily schedule.
(Leete, 1989, p. 199)
Perseverance in the face of challenges and set-backs gradually builds resilience. One consumer described how he dealt with uncertainty about himself with others, and about discussing his medical or employment history: But as you continue to face these issues, often in more challenging situations, you get better at it and it becomes less of a burden. At the same time, I realize that I must proceed here in an orderly fashion, while being constantly aware of any mood shift. (Anonymous, 1994a, p. 17) Weingarten (2005) describes persevering with work through difficult times, while battling for 19 years with untreated dysthymia:
I managed to hold down many part-time and full-time jobs. I knew I wasn’t functioning at my best but I pushed through the depression and anxiety and proved to myself that I could be effective even when I was less than 100%. This was an important step and it was risky. (p. 78)
Taking control of one’s life involves more than controlling symptoms and identifying goals. Another important aspect of taking responsibility is taking care of the self in order to maintain psychological strength for the battle for recovery. Many approaches to wellbeing may be utilized in this process:
It took me eight years to learn all the things I needed to learn in order to regain my mental health. It wasn’t just changing my eating habits, or taking vitamins that did it. It was a combination of many things that I had to learn to change me so I could be healthy. (Schmook, 1998, p. 3)
This includes keeping active and involved in enjoyable activities. Participants in Young and Ensing’s (1999) research warned against ‘living the illness’, allowing it to sap all of one’s energy. One participant noted the need to find a focus outside of the illness: ‘I’ve been a person that just stayed in suspended animation for so long I find it’s helpful just to go somewhere. Just do something, anything’ (p. 227).
In the Rebuilding stage then, the person puts into action the nascent sense of agency that was rediscovered during the Awareness stage and nurtured during the Preparation stage. The person begins to exercise choice and to demonstrate control over his or her life and management of the illness. Taking responsibility for one’s wellbeing, health, and life as a whole demonstrates an inherent drive towards growth, as described by Deci and Ryan (2002). In articulating Self Determination Theory, Deci and Ryan claim that autonomy, or the opportunity to make self-determined choices, is a basic need for personal growth (Deci and Ryan, 2000, 2002). This is reflected in the work of Davidson and Strauss (1992), who described the utilization of the rediscovered agentic self to become an active and responsible agent in one’s recovery.
