Recovery in mental health: Reshaping scientific and clinical responsibilities.
This book is an English translation of Amering and Schmolke's German publication (2007). World Psychiatric Association has given its umbrella cover to it and it has been written in a way to cater to the needs of researchers, policy makers and mental health professional along with professionals of other specialties and users of the mental health services. An attempt has been made to capture the current understanding and trends in the most discussed, contested and dissented field in mental health 'recovery' in disorders of psychiatric origins and its consequences for both, the services providers and the users. The topic has contemporary significance and is written by two distinguished authorities who had first-hand experience of the ongoing efforts in helping mentally ill patients to regain their full potential.
This book is compilation of eight chapters besides foreword, reference, index and other introductory pages. Throughout, the authors have succinctly utilized case vignettes and user accounts to drive home the message of plausibility of recover in mental health. The first chapter explains the reasons behind the genesis of this book. Chapter two deals with the newer developments in user-led and user-controlled research that is prerequisite to a multi-perspective evidence-base for policy and resource collaboration with service providers thus helping to manage the menace of stigma, discrimination and marginalization of those with serious emotional disorders.
The defining details come flowing from chapter three where the authors give a wonderful description of recovery and the various components of the process of recovery in its ecological framework. The mental health professionals must weight the pros and cons of the currently available models of treatment approach as they are responsible for both the welfare of the patients as well as to the society at large.
The fourth chapter is a passionate description of the various models propounded by the 'survivors' (ex-psychotics) or one-time users of the psychiatric services who citing their personal experience as evidence, are now pioneers advocating for sweeping mental health reforms in the form of a paradigm shift in approach with 'hope' as a pre-condition for recovery. Several models of 'recovery' in vogue around the world are described, e.g., Ron Coleman (An alien concept), Fisher and Ahern (Empowerment model), Pat Deegan (Hope), Copeland's Wellness recovery action plan (WRAP). The authors are overwhelmed with the idea of recovery neglecting other aspects that are indispensable to the overall management of the emotional disorders. For example, coercive policing from one perspective is warranted care from another; one perspective's unwanted interference is another's duty of care; one perspective's lack of insight to impairment and illness is another's suppressed choice and discounted agency. Also, most of the work is concentrated around recovery in those with chronic severe (that lack insight) mental health problems leaving behind the major chunk consisting of mentally deviant offenders, personality disorders, and other common emotional disorders of anxiety and depression.
In the next (fifth) chapter authors discuss their optimism of achieving recovery taking the oft quoted case of a psychotic illness i.e., schizophrenia, as an example. In the first third, the authors discuss at length the inimical misconceptions and myths surrounding schizophrenia, namely incurability, chronicity, endogenous, and erroneous belief of synonymy of absence of treatment and well-being. In the middle third, issues that have a bearing on treatment (insight, compliance, capacity and coercion) and the treatment itself are discussed. In the end comes the most dreaded question facing the psychiatric services since the inception of psychiatry-stigma and discrimination. Author's lucid account of their understanding of stigma and its origins and how to overcome it (strategies of social inclusion) is to be appreciated. The hazard of social inclusion is that recovered patients will concurrently and disproportionately be exposed to pathogenic socio-economic forces (e.g., poverty and unemployment) that are bane of human civilization since ages and are part of the mainstream that the patient is being invited into.
The next two chapters discuss the implications of embracing of the concept of recovery in scientific and clinical terms. The involvement of service users in scientific research of recovery as a 'process' is the theme of the sixth chapter. The need to develop methods and instruments to assess models and outcomes of recovery along with identification of their active effective components has been stressed throughout. The seventh chapter highlights the clinical responsibilities of the mental health professionals in the changing recovery-oriented environments. It describes the transformation of mental health care system in terms of recovery-oriented services, recovery-oriented mental health programmes, recovery-oriented practice guidelines, and recovery-oriented trained manpower.
The last chapter is an emotional spill from the authors where they try making an impression of what 'recovery' means.
This book on the whole makes an interesting reading and the effort of bringing out this book is laudable as there is paucity of written material in the field of recovery in mental illness, an area that is brushing through the thought streams of mental health service users, professionals and policy-makers alike. The work has global perspective and relevance and is a timely addition to the understanding of the concept of recovery in psychiatry that is rapidly catching the fancy of professionals, policy-makers and people throughout the world. It is all the more relevant to all the mental health stakeholders, including those in India, as psychiatry is expanding its horizons and is shaping up fast, and it should be kept in mind that the biomedical model of recovery, community-oriented social psychiatry and the current model of recovery from invalidation have blurring boundaries and are not mutually exclusive. This work is neither a textbook nor very exhaustive in its contents but nonetheless can act as a stimulus for the interested novice to go deeper into the subject. Authors though succeeded in driving home their point that recovery is a process independent of the symptom level of the patient but associated skepticism winds of change bring with them will persist for some time to come. At the same time, one must remain aware of the inherent amalgamation of the anti-psychiatry ideology, consumerism and modern concept of 'recovery'.
Ajit Awasthi & Navendu Gaur
Department of Psychiatry
Postgraduate Institute of Medical Education & Research
Chandigarh 160 012, India
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|Author:||Awasthi, Ajit; Gaur, Navendu|
|Publication:||Indian Journal of Medical Research|
|Article Type:||Book review|
|Date:||May 1, 2011|
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