Models for Recovery

At the moment individuals who experience major problems in living and attend what I believe are the misnamed ‘mental health’ services are likely to encounter one of four different models of recovery:

  • The biomedical model of mental illness and recovery
  • The rehabilitation model of mental illness and recovery
  • The empowerment model of recovery
  • The psychological model of recovery

The first two models view people’s problems as ‘mental illness’ and are based on a deficiency approach to human problems. Indeed, these two models assume that individuals with ‘mental illnesses’ will experience a progressive deterioration of mental and social functioning and that this would be carried forward from one affected generation to the next one. The good news is that this biological view of ‘mental illness’ as a disease stemming from brain malfunctioning has not been supported empirically despite the magnitude of research carried out. There is also increasing evidence that individuals diagnosed with a ‘severe and enduring mental illness’ can recover and thrive in society. Mounting evidence also shows that anti-depressants are not clinically effective and that recovery can happen with or without medication. Furthermore, adherents to these two deficiency models can in fact create obstacles to reawakening hope and responsibility for one’s own life. The bad news is the belief that ‘mental illness’ is an incurable genetic disease that continues to persist among both the general public and the mental health professionals despite the growing evidence that individuals labelled schizophrenia or bi-polar depressed can recover and contribute to society. However, more and more consumers of these two recovery models are rejecting these models’ unsubstantiated claims.

The current community rehabilitation model of recovery is underpinned by the biomedical concept of ‘mental illness’ with its reliance on psychopharmacology. The model does not include a concept of personal growth beyond the disability of ‘mental illness.’ The aim is to provide individuals with some basic living skills to have in either supervised or non-supervised residential settings.

The empowerment and potentiality model of recovery holds that ‘mental illness’ does not have biological origin but is a sign of emotional distress resulting from overwhelming stressors. This model believes that ‘mental illness’ was invented as a means of social control over individuals whose behaviour did not fit into the subjective standards of ‘normality.’ However, adherents to this model, in their vociferous rejection of the notion of mental illness, lost sight of the fact that individuals who were deeply distressed often required professional help beyond civil rights, optimism, empowerment and peer support.

The model of psychological recovery refers to the development of a fulfilling, meaningful life and a positive sense of identity based on hopefulness and self-determination. A major drawback with the model is that it is ‘silent’ on the causation, intention or even presence of ‘mental illness.’ Somehow, it fails to bite the bullet on the nature of human distress. Nevertheless, it views recovery as an on-going process of healing mind, body and spirit in a holistic way (without focusing on mental illness as a main aspect of life). Supportive and trusting relationships with others are also seen as critical for recovery. Whilst this potentiality model is an improvement on the first three models, its failure to appreciate that people’s troubled and troubling behaviours are creative and meaningful militates against its recovery aspirations.

An approach I would like to propose is a co-creational one, whereby the distressing behaviours presented are viewed with the person who is deeply troubled as creative responses to perceived and experienced threats to wellbeing. In exploring the story of the person who is emotionally overwhelmed, the professional helper acknowledges the power that the person has shown and the absolute necessity of the defensive behaviours manifested. In this way, that person is empowered from the beginning and a co-creational space is developed so that both the service consumer and the professional helper can move towards resolution of the conscious and unconscious fears that are calling for attention. The relationship with the person who is troubled needs to be of an unconditional nature and considerable patience is required of the professional helper to wait for the person to become present to his or her individual life. The emphasis is on creating the emotional, social, intellectual, creative, physical, sexual and behavioural safety for the service consumer to allow to come to consciousness what has necessarily lain hidden and to move towards new choices and actions. The depth of relationship, compassion and expressed appreciation of how the person has managed to creatively survive the slings and arrows of outrageous misfortune are critical aspects of the co-creational relationship.

Dr. Tony Humphreys practices as a clinical psychologist and is author of several books on practical psychology including The Compassionate Intentions of Illness which is co-authored with Helen Ruddle.