Many people are dissatisfied with our current mental health system and yet true change is rare. The combined forces of inertia, politics, reimbursement procedures, bureaucracy, liability fears, and hopelessness often seem too formidable to overcome. They can, however, be vanquished if we work under a banner of clearly articulated vision and values. Deinstitutionalization proved that. I believe that banner now should be passed on to recovery.

When I try to explain to others why I work as a psychiatrist with people with serious mental illnesses, I talk about recovery. I talk about people like John who has recovered in the year and a half since I met him. He has manic depressive illness with periods of severe psychosis and homelessness and a severe substance abuse disorder. He had repeatedly lost everything in life due to these conditions, but was ready to try again. He had just gotten out of a locked program after about a year and moved into a board and care. Since I met him he’s stayed on medication, Lithium and Risperidone, except for an experiment we did together trying to get off Risperidone. He has worked a strong substance abuse recovery program going regularly to several meetings a week. He has a sponsor, and is now working step six. With my assistance, his conservatorship was dropped and he moved in with his old girlfriend, also in recovery. He began working as a computer data entry clerk for us part time and within several months was doing very well and felt limited by this job. He returned to college and took computer classes and got all A’s. He now has a full time job working with computers making $2,500 a month and is off social security. He is also engaged to be married. In my opinion, he is recovering.

We often confuse recovery with cure. People can recover. Illnesses can be cured (well mostly only infections or broken bones, but that’s another story). You can, however, recover without any effective treatment for your illness (e.g. recovering from a stroke, or a heart attack). Take Christopher Reeve, for example. I think he’s recovered even though his spinal cord is still broken. In fact, it perfectly possible to recover without having an illness at all. You can recover from a serious divorce, a parent’s death, being raped; all kinds of terrible things. We get such tunnel vision with our pervasive medical model and get so busy treating illnesses that we never focus on if the person is being helped with their recovery. Therefore, it may be easier for us to conceptualize and define recovery for someone without an illness like a friend recovering from a divorce.

My present conceptualization is that recovery has four components: (1) hope, or a positive vision for the future, (2) empowerment, (3) self-management, and (4) a meaningful role or niche in life.

Applying this conceptualization to my friend recovering from a divorce, here are four cliches I’d use. First I’d help him by trying to give him hope for the future. "Things will work out. You’ll get over her, you’ll find someone else. Plenty of women would want

you." (I was touched when a women recently told me her five year old son had triggered her recovery from a divorce by saying, "It’s alright mommy. You and me can make it without daddy.") Second, I’d empower him by saying, "You’re a good guy. You’ve got a lot going for you. Plenty of women will want you. You just have to get out and meet them. I think you’re really learned from this and grown from this "experience." I’d support him doing things to change his emotions and his life. "Come on, you can hang out with me for awhile. We can even go out together to meet women. I know someone you might like." Third, if months later he’s still relying on me to take him out, that’s not recovery. That’s being taken care of. "Hey man, you’ve got to start going out on your own. You can’t rely on me for everything. I’ve seen you with women. You’re o.k., you can do it." Fourthly, he’d have to find a role in life. "Being single’s not that bad. You still get to see your kids and they love you. You’re doing well at work. Your life’s o.k." I would submit that these are all familiar cliches because they reflect how we naturally view recovery when it’s removed from the medical realm. I think we’d also all agree that if my friend achieved all four things, he’s recovered from his divorce.

These same four components also apply to people recovering from severe mental illnesses. Unfortunately, when they’re moved back to a medical realm they begin sounding rather unscientific, and difficult to assess, and certainly not reimbursable. Nonetheless, they form a solid value core by which to assess our own practice and techniques, our relationships and our outcomes, and even our program design and system structures. They can be woven together into an effective banner for promoting and evaluating changes in our mental health system.

I find that when I look over many of the things I’ve written in the last several years, they fall into two categories: (1) papers trying to define and expand upon one of these components and (2) papers applying this recovery value set to a particular aspect of my work (e.g. substance abuse or family issues). The banner is gradually becoming clearer and clearer with important pieces fitting together often in surprisingly integrated ways.

I think that this banner can be used to promote change in two ways: (1) On a personal level individual mental health workers, and people with mental illnesses (and even administrators) can be exposed to stories about each of these components and about specific practices and relationships relevant to them. Often a presentation structured in this way feels rejuvenating or even inspiring since it touches on the feelings that led us into this work in the first place and that have kept us going since. Old dying embers can be relit. Many people respond to this approach by saying I’ve given voice to a lot of thoughts and feelings they’ve always had, but that they’ve neglected for a long time. (2) This conception can be used on a program or administrative level to form mission statements, value statements, principles and purposes for mental health services. Then we can discuss if what we’re doing is serving these values or harming them. Some things may be a necessary evil, while others are good targets for efforts at change. One administrator told me that what he really liked about our program was how clearly he could see the application of our values to our practice. Value-driven reforms especially when supported from above can have real power.

When the task force that led to the Village being formed first started, they were advised not to just complain and criticize. Instead they were advised to identify things they liked and things they wanted. "Tell me," the Lieutenant Governor said, "Does anything work?" I think we are ready now to answer that recovery works and here’s what it is and here’s how we can promote it. It can be a powerful positive force for change in a way that criticism and complaints never could be. It can be our banner. Let’s sew it together.