The Medical Model of Illness and Recovery
The medical model is based on an observable set of symptoms that are characteristic of a specific diagnostic entity. Schizophrenia, for example, is characterized by delusions, hallucinations, disorganized speech and behavior, and other symptoms that cause social or occupational dysfunction (American Psychiatric Association, 2013). A complex brain disorder associated with an uncertain etiology, the condition spans the life course and is associated with periods of remission and exacerbation of symptoms (Lieberman et al., 2008). Typically, the medical model would define “recovery” as the absence of disease (a cure) or a return to normal function. Noting advances in neuroscience research and treatment, Lieberman et al. (2008) have proposed a definition of recovery in schizophrenia that acknowledges improvements in specific domains of outcome, such as cognitive or vocational functioning, rather than defining recovery globally.
Being in Recovery: Developing a Meaningful Life Beyond Illness
An alternative view is that being “in recovery” involves living an active, productive life despite the enduring presence of symptoms of the illness (Davidson et al., 2008). Essentially, recovery is an aspirational goal that includes a sense of hope, empowerment, self-agency, and existential or spiritual well-being (Jacobson & Greenley, 2001; Whitley & Drake, 2010). The recovery perspective has been accepted into mainstream mental health policy (Barber, 2012; Hunt & Resnick, 2015; Mulligan, 2003; President’s New Freedom Commission on Mental Health, 2003), and incorporated into the development of recovery-oriented services (Anthony, 1993; Copeland, 1997; Davidson et al., 2008; Whitley & Siantz, 2012), and interventions such as supportive employment (Drake et al., 2012; Drake et al., 1999) and supportive housing (see chapters 6 and 7, this book). The recovery movement has also led to a more equitable partnership between consumers and providers, with greater emphasis on consumer preference and active consumer participation in decision-making (see Chapter 4).
The Substance Abuse and Mental Health Services Agency (SAMHSA) has presented a working definition of recovery as “a process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their potential.” Four major dimensions that support a life in recovery include:
- 1. Health: overcoming or managing one’s diseases or symptoms, such as abstaining from alcohol and drug use, and making informed healthy choices that support physical and emotional well-being;
- 2. Home: having a stable and safe place to live;
- 3. Purpose: having meaningful daily activities, such as a job, school, family caretaking, or creative endeavors, and having the independence, income and resources to participate in society; and
- 4. Community: relationships and social networks that provide support, friendship, love, and hope. (SAMHSA, 2012)
The recovery movement parallels changes in society that have lauded examples of individuals with physical disabilities, such as Helen Keller and Franklin Delano Roosevelt (Barber, 2012, p. 278), and people with psychiatric illness, such as Nobelist John Forbes Nash, Jr. (Nasar, 1998), who overcame their disabilities and went on to forge productive lives. Moreover, there has been a trend across medicine in general to endorse person-centered care in which patients are educated about their conditions and are encouraged to be active participants in treatment (Barber, 2012).