Developmental Stages Important in Recovery

There is much to commend in the suggested change in paradigm outlined by APA President Steven Sharfstein, M.D., in his column in the November 4, 2005, issue. It should be noted that recovery is a concept that has been widely accepted in substance abuse/addiction circles and is integral in the trauma literature, for example, Judith Herman's book Trauma and Recovery is some 20 years old. Perhaps the change in paradigm is overdue.

In my experience a major element in working with patients afflicted with a major mental illness is that for various reasons they have dropped off the developmental trail, most notably in the area of maturation of affects. Not identifying affect signals correctly and not developing language to be able to talk about these signals retard or distort the process of desomatizing affect signals. When children evolve into the preadolescent and adolescent stages and are threatened by affect signaling, their capacity to function in important roles, especially with peers, is curtailed and thus their maturations delayed or arrested. The concept of recovery should include recovering one's capacity to grow and develop in relationships—something that requires an increasing maturing of affects. I'm hopeful that our colleagues will join this debate to refine and integrate the concept of recovery into psychiatric practice.