Dec 23, 2015
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Overview
Part I Background on Recovery– Is Recovery Possible?– What is Recovery?
Part II Recovery Pathways
Part III A Vision of Transformation; Creating the Future
Part IV Recovery in Practice
Part V Recovery Coaching
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Who started the idea of recovery?
• People speak out and write about recovery experiences
• Research findings support the fact of recovery
• Vision of recovery described by rehabilitation educators; Dr. Anthony– Changes in our historical understanding– New definitions of diagnosis– New thinking about chronicity
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Let’s hear from Raymond, whose story illustrates the points Dr. Anthony
makes about how the system can contribute to “chronicity.”
Is Recovery Possible?
49%35269DeSisto (1995). Maine
57%22.5140Ogawa (1987). Japan
62-68%32269Harding (1987). Vermont
62-68%35186Tsuang (1979). Iowa
53%37289Ciompi & Muller (1976).
57%22502Huber (1975). Germany
53-68%23208Bleuler (1972). Zurich
Outcome# YrsSizeStudy
Harding used “the medical criteria for recovery”: no current signs and symptoms of any mental illness, no current medications, working, relating well to family and friends, integrated into the community, and behaving in such a way as to not being able to detect having ever been hospitalized….” Harding
……but these findings are not new.but these findings are not new.
McLean Hospital 1818-1830
59% of 732 were discharged as recovered, much improved, or improved
Bloomingdale Asylum, NYC
1821-1844
60% of 1,841 patients admitted discharged as “cured or “improved”.
Worcester State Lunatic Asylum
1833-1840
80% of those ill less than a year recovered.
Pennsylvania Hospital for the Insane
1841-1882
8,546 admissions. 45% cured and 25% improved on discharge
Worcester study completed in 1880
1833-1846
984 discharged patients. 58% remained well throughout their life.
Robert Whitaker, Mad in America and Gerald Grob, Mad Among Us
The results of Moral Treatment in the 1800s
“I have nowhere met, except in romances, with fonder husbands, more affectionate parents, more impassioned lovers, more pure and exalted patriots, than in the lunatic asylum… A man of sensibility may go there every day of his life, and witness scenes of indescribable tenderness to a most estimable virtue.” 1801. Philippe Pinel. Paris France
Moral Treatment Practitioners…. Moral Treatment Practitioners…. a value on the persona value on the person
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“If there is any secret in the management of the insane, it is this: respect them and they will respect themselves; treat them as reasonable beings, and they will take every possible pain to show you that they are such; give them your confidence, and they will rightly appreciate it, and rarely abuse it.”
1833. Samuel Woodward, M.D., Worchester Asylum
Moral Treatment Practitioners….Moral Treatment Practitioners….a value on the persona value on the person
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“I think it is not too much to assume that insanity is more curable than any other disease of equal severity; more likely to be cured than intermittent fever, pneumonia, or rheumatism.”
1843. Samuel Woodward, M.D., Worchester Asylum
Moral Treatment Practitioners….Moral Treatment Practitioners….HOPEHOPE
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Moral Treatment Practitioners…. Moral Treatment Practitioners…. a value on environmenta value on environment
“It should never be forgotten that every object of interest that is placed in or about a hospital for the insane, that even every tree that buds, or every flower that blooms, may contribute in its small measure to excite a new train of thought, and perhaps be the first step towards bringing back to reason, the morbid wanders of the disordered mind..”
Thomas Kirkbride, M.D. 1841. Pennsylvania State Hospital
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What does RECOVERY mean?
• A common human experience.• Developing new meaning and
purpose in life. (W. Anthony, 1993).
• Develop and further rebuild important connections (L. Spaniol)
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Our Definition of Recovery
Remembering who you are
and using your strengths to become all you were meant to be.
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Don’t forget
Where you came from
Where you’ve been thus far
Its so easy
To leave scars
When you forget
To remember who you are
for the hard times
to remember
Who you are
Disappointment
Difficulties
Disappointment
Diagnosis
Difficulties
Disappointment
Diagnosis
Disease
Difficulties
Disappointment
Diagnosis
Disease
Disabled
Difficulties
Disappointment
Diagnosis
Disease
Disabled
Disempowered
Difficulties
Disappointment
Diagnosis
Disease
Disabled
Disempowered
Disenfranchised
Difficulties
Disappointment
Diagnosis
Disease
Disabled
Disempowered
Disenfranchised
Demoralized
Difficulties
Disappointment
Diagnosis
Disease
Disabled
Disempowered
Disenfranchised
Demoralized
Dysfunctional
Difficulties
And the
And the
perso
n has
perso
n has
disap
peare
d
disap
peare
d
A person
A person
Assets
And the
And the
perso
n
perso
n
com
es b
ack
com
es b
ack
and g
ets
and g
ets
even
big
ger!
even
big
ger!
A person
Abilities
Assets
And the
And the
perso
n
perso
n
com
es b
ack
com
es b
ack
and g
ets
and g
ets
even
big
ger!
even
big
ger!
A person
Abilities
Assets
Achievements
And the
And the
perso
n
perso
n
com
es b
ack
com
es b
ack
and g
ets
and g
ets
even
big
ger!
even
big
ger!
A person
Authentic
Abilities
Assets
Achievements
And the
And the
perso
n
perso
n
com
es b
ack
com
es b
ack
and g
ets
and g
ets
even
big
ger!
even
big
ger!
A person
Authentic
Abilities
Authority
Assets
Achievements
And the
And the
perso
n
perso
n
com
es b
ack
com
es b
ack
and g
ets
and g
ets
even
big
ger!
even
big
ger!
A person
Authentic
Abilities
Authority
Autonomous
Assets
Achievements
And the
And the
perso
n
perso
n
com
es b
ack
com
es b
ack
and g
ets
and g
ets
even
big
ger!
even
big
ger!
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What We Know . . .• Recovery is an up-and-down process.
• Symptoms may remain, but people still RECOVER!
• Symptoms are less troublesome and happen less often.
• Recovery can happen whether or not we still take medication.
• Recovery does not mean that one did not have a mental illness.
• Recovery from the consequences of being ill is often harder than recovering from the illness itself.
What People Recover From.
The torture and oppression
by the phenomenon of mental illnessThe stigma of mental illness:
•Social attitudes
•Professional attitudes
•Internalized personal attacks
Low expectation & lack of hope
from professionals
Side Effects
of Medications
Environments that
are not stimulating Lack of commitment from service
systems and politicians
Lack of accommodation/
support for disabilities
when
re-entering the world
Lack of opportunities for Growth
Experience of dehumanization and degradation and spirit breaking
Numerous Losses
Trauma of:
•Psychosis
•Admission Process
•Relating Stories
•Care in Hospital
•seclusion,
•restraint,
•forced medication
•Assaults
Co-morbid disorders:•Childhood Trauma•Sexual Trauma•Drug & Alcohol Dependence•Personality Disorder
Poverty and/or Homelessness
By permission of Dr. Kaly
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Recovery Pathwaysfrom our experience
• Hope
• Choice
• Empowerment
• Recovery Culture
• Spirituality; meaning and purpose
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In the movie “The Beautiful Mind” John Nash hears what Pat Deegan refers to as “the prophecy of doom”. Notice how Professor Nash struggles to hold on to hope, “I can do this,” in spite of Dr. Rosen’s words, “schizophrenia is degenerative, over time you’re getting worse.”
Recovery Pathway 1: Hope
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Hope
• Hope is the beginning.• It’s a thought that things can get better and a
feeling of courage with a spark of new energy.• Creates a “turning point”.• Hope means “I can have dreams”. • A vision of a better future; there are “no limits.”• Someone else can hold the hope. “And there was
this person”.
HOPE
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A person comes to our crisis service. They are crying,
frightened and filled with despair. How can you communicate hope?
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In the movie “The Beautiful Mind” this dramatic scene illustrates the
consequences and the fear associated with not having the choice.
Recovery Pathway 2: Choice
abandonmentoverprotection
No choice•Coercion and force
•No recovery•Person disappears
Recovery Pathway 2: Choice
•No support•Hospitalization, jail,
homelessness•No recovery
•Person disappears
The Old Story
abandonmentRelationship
•Mutual responsibility•Engagement•Support/love
•The person reappears
Recovery Pathway 2: Choice
The Recovery Story; Its about Relationship
overprotection
abandonment=
•Mutual responsibility•Engagement•Support/love
•The person reappears
Recovery Pathway 2: Choice
The Recovery Story; Its about Relationship
Recovery
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Recovery Pathway 2: Choice
• “The more I choose, the more I recover.” (Kristina)
• Because, making choices is how we remember/discover who we are.
• Recovery value: each person is the expert in what works for them.
"It is "It is our choicesour choices that show what we truly are, that show what we truly are, far more than our abilities."far more than our abilities."
J.K. Rowling (1965 - )J.K. Rowling (1965 - )Harry Potter and The Sorcerer's StoneHarry Potter and The Sorcerer's Stone
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Recovery Pathway 2: Choice
Question:
What about risk?• Risk sharing not risk management
• Risk prevention plans• WRAP crisis plan
• Advance Directives
The freedom to chooseand the right to make mistakes
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• Resistance is the beginning of getting power back; finding my voice.
• Resistance fosters Resilience. The person begins to come back and remember who they are.
• Recovery is the person’s job; they have to have the power.
Recovery Pathway 3: Empowerment
Recovery Pathway 3: Empowerment
The ability to perform;
to produce the results I want.
Entitlement
Empowerment
Enlightenment
old belief was
Ability; discovering my gifts and strengths
Disability; being a victim
looking for someone to take
care/fix me.
Empowerment corresponds to the level of personal responsibility and accountability.
Personal
Responsibility
Victim
Disempowered
Personal
Responsibility
Victim
Disempowered
Responsible Accountable
0% 70% 100%
ResponsibleAccountable
0% 30% 100%
Personal responsibility is a willingness to be the source of the results in your life.
Personal accountability is a willingness to own the results in your life.
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Recovery Pathway 4: Recovery Culture
The belief that “recovery is a fact” invites us to transform our service
environments and culture.
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Recovery Culture
• Create relationship. Provide support.
• Create community. People find a valued social role.
• Celebrate diversity.
• Maintain a positive level of consciousness.
Map of Consciousness David Hawkins, M.D.,Ph.D.
Pow
er
Force
God-View Life-View Level Log Emotion Process
Self Is Enlightenment 700 + Ineffable Pure Consciousness
All-Being Perfect Peace 600 Bliss Illumination
One Complete Joy 540 Serenity Transfiguration
Loving Benign Love 500 Reverence Revelation
Wise Meaningful Reason 400 Understanding Abstraction
Merciful Harmonious Acceptance 350 Forgiveness Transcendence
Inspiring Hopeful Willingness 310 Optimism Intention
Enabling Satisfactory Neutrality 250 Trust Release
Permitting Feasible Courage 200 Affirmation Empowerment
Indifferent Demanding Pride 175 Scorn Inflation
Vengeful Antagonistic Anger 150 Hate Aggression
Denying Disappointing Desire 125 Craving Enslavement
Punitive Frightening Fear 100 Anxiety Withdrawal
Disdainful Tragic Grief 75 Regret Despondency
Condemning Hopeless Apathy 50 Despair Abdication
Vindictive Evil Guilt 30 Blame Destruction
Despising Miserable Shame 20 Humiliation Elimination
Death 0
+
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Bob?” Dr. Marvin’s negative level of consciousness (anger) creates disaster. Bob, on the
other hand, experiences joy and has good fortune.
R e
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Nash gradually recovers from very serious psychiatric experiences using the level of “reason”. But what John Nash discovers is that it wasn’t until he found the power of love that he had the energy to overcome and fully recover.
Recovery Pathway 5: Spirituality
• Spiritual expression is not a symptom of a mental illness
• Connecting within and beyond the self.• Finding meaning and purpose• Develop spiritual competence
– Meditation, contemplation, prayer• Spiritual practices
– Service to others.– Treating each other with kindness and
respect
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Now let’s listen to Pat Deegan describe the beginning of her
recovery process.
R e
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