February 1st, 2014

Recovery thoughts for the day

There are new faces everywhere in the hospital and I am not just talking about new patients or staff. Just the other day, I ran into Jimmy Carter in the chapel and a colleague swears she caught a glimpse of Audrey Hepburn in the beauty salon. Larry Bird and Michael Jordan were into a fierce one on one match up in the gym while coach John Wooden smiled serenely from the sidelines. These are just a few of the celebrities who have been spending time with us over the past several months as part of a new recovery initiative spearheaded by our chief operating officer.

Every day, our chief sends us a recovery thought for the day that we use as a springboard for discussion at our community meetings. These words of wisdom come from world leaders, actors, sports figures, religious leaders, captains of industry, inventors, scientists, writers and others whose names I should probably know but don’t.

It’s all part of the recovery philosophy that drives treatment in our new facility and seeks to inspire in people with serious mental illnesses the hope that they can achieve personally meaningful goals. Other concepts central to recovery include empowerment, patient centered care and the importance of supportive relationships, coping strategies and a strengths based approach to life. The recovery movement, generally considered to have begun in the field of substance abuse treatment, was started by consumers who, by sharing their personal stories, made it clear that recovery was possible not only from addictions but also from serious mental illness. The professional literature, most notably in the field of psychiatric rehabilitation, began to incorporate the concept of recovery in the early 1990s. In subsequent decades, recovery concepts have been supported by research and the approach broadly adopted in the U.S. and other countries. While some tensions still exist between more traditional medical approaches to the treatment of mental illness and recovery-inspired, consumer-driven strategies, it seems safe to say that we have entered a new era of collaboration between mental health professionals and people with mental illness.

Those of us who began our professional training in the early days of de-institutionalization recall a more paternalistic tone and practice of treatment for the mentally ill. We were cautioned never to tell our patients their diagnoses and, whenever possible, to avoid stating or implying that their conditions were related to flawed structures or functions of their brains. We shunned words like “schizophrenia” and “brain disease” to avoid reifying the disturbed patterns of thought, feeling and behavior that brought people to the hospital. We thought that as long as people believed they could take control of their distressing experiences and change themselves, they would preserve their hope and motivation to do so. As Shakespeare observed, “The fault, dear Brutus, is not in our stars, but in ourselves.”

It is not so much that we failed to understand the importance of personal narratives but that we did not give sufficient emphasis in treatment to certain key elements of all human stories. In the early days of the biopsychosocial model, our understanding of the “bio” or physical underpinnings of mental illness was still developing. We knew enough to prescribe powerful medicines but still too little to be able to explain what they were supposed to do to help our patients recover. We also had little experience of what recovery involved or what a person in recovery looked like and, judging by past outcomes, we almost certainly would have set the bar too low.

We have come a long way in our understanding and treatment of mental illness in the last 40 years but there is still much to be done. The new hospital provides a bright, clean, rich environment that honors the importance of both privacy and community. Patients have their own rooms as well as places and routines that foster social interaction and sharing with peers and staff. Treatment groups offer a blend of information about mental illness with the opportunity for participants to share their own personal stories of recovery. Every morning at community meeting, we discuss the thought for the day.

The Buddha tells us, “The secret of health for both mind and body is not to mourn for the past, not to worry about the future…but to live the present moment wisely and earnestly.” We are trying and we can use all the good advice and help we can get. We are grateful to Sir Winston Churchill, who fought his own battles with depression, for reminding us that “a pessimist sees the difficulty in every opportunity,” while “an optimist sees the opportunity in every difficulty.” We are looking for those opportunities, for those chances to operate from our strengths no matter how much our weaknesses threaten to immobilize us.

Here, legendary basketball coach, John Wooden, gives us the instruction and encouragement we need in his typically straightforward way. “Do not let what you cannot do interfere with what you can.” Buoyed by our progress but discouraged by inevitable setbacks, we listen finally to writer Robert Brault. “Always when judging who people are, remember to footnote the words, ‘So far.’”

Alan Bodnar, Ph.D. is a psychologist at Worcester State Hospital and a consultant in the field of leadership development.

By Alan Bodnar Ph.D.

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