Recovery in Mental Health: Reshaping Scientific and Clinical Responsibilities

This is a rich and stimulating book that covers a broader field than we would ordinarily consider the "recovery" concept to encompass. There are sections dealing with health promotion, resilience, the effects of stigma, and the involvement of consumers of psychiatric services in the design and conduct of mental health research. There are a number of definitions of the recovery concept, but the following example, in which the authors summarize Davidson and colleagues (1), is particularly illuminating: "Recovery does not necessarily imply an improvement or elimination of symptoms and deficit, but rather relates to a learning process that enables people to live with long-term limitations and teaches them how to cope or compensate for them and to participate in community life as actively and satisfactorily as possible" (p. 45).

The authors, a psychiatrist and a psychotherapist, reveal their enthusiasm for the topic of consumer-oriented services throughout the book (and in the postscript, they describe what drew them to the subject). They present a wealth of information from around the world, referenced with care. The book, originally in German, has been beautifully translated and updated for the English-language edition. As we read about consumer-developed recovery programs from the United States, Australia, and several European countries, recovery-oriented treatment systems from Scotland to Ohio, and the global involvement of the World Psychiatric Association, it becomes apparent that the recovery concept has had a significant impact on service delivery in a large number of developed countries, often with government support. America's earlier consumer-driven reform movement, the Mental Hygiene Movement of the early 20th century, did not have this broad an impact. This is something we cannot afford to ignore, particularly since, as with the Mental Hygiene Movement, the stimulus for the recovery concept has been the perception of widespread deficits in the adequacy of psychiatric care.

The authors are not biased reporters, and they deal with each issue with balance and thoughtfulness. They are appropriately cautious about recent attempts to prevent psychosis through early intervention. Issues such as consumer empowerment and involuntary treatment are handled with delicacy from the perspective of both the patient and the clinician. Nor do the authors recommend, as some mental health policy makers have done, that we rely on subjective reports of quality of life or related measures in designing treatment programs, pointing out that subjective and objective data of this type are often at wide variance with one another. They do endorse, however, the expanded use of qualitative research and suggest, somewhat caustically, that psychiatry's emphasis on evidence-based research might be better regarded by consumers and family members if the results of, say, rehabilitation intervention research were more widely adopted in practice.

Although the recovery concept has diffused as a social movement and hence will not necessarily be based on scientific evidence, this book offers ample research data on the central components of the model. We are shown the evidence for the substantial recovery rate from schizophrenia, and we recognize the reason for the optimism that is fundamental to the approach. One of the most robust findings in schizophrenia research since the time of Eugen Bleuler is that a significant proportion of those with the illness will recover completely and many more will regain good social functioning. We learn about the merits of consumer empowerment in improving outcomes from serious mental illness and how we can help it happen. We discover how consumer involvement in treatment benefits both the peer-provider and the recipient. A growing body of research supports the concept that empowerment is an important component of the recovery process and that consumer-driven services and a focus on reducing internalized stigma are valuable in empowering the person with schizophrenia and improving outcomes from the illness.

As practitioners, what should we take from this book? The authors would want us to offer hope rather than unfairly negative prognoses. They would encourage us to eschew paternalism and to partner with our patients in making treatment decisions, offering them choices as a route to empowerment. They would expect us not only to treat our patients with dignity and respect but to insist that our coworkers do so, whatever the setting. And they would want us to bear in mind that psychiatrists have been criticized by a distinguished leader in the field as being sources of "iatrogenic stigma" of mental illness for ignoring some of these very precepts (2).