About the authors xi

Foreword by Jon Strang xiii

Preface xvii

Acknowledgements xix

Part I Recovery in Historical Context

1 Introduction: Recovery from schizophrenia 3

Overview 3

Early conceptualizations of schizophrenia 4

Diagnostic systems and prognostic pessimism 6

Empirical evidence for recovery 7

The persistence of a pessimistic prognosis 13

The real possibility of recovery 17

The emergence of the ‘recovery’ movement 18

What do we mean by ‘recovery’? 20

Conclusion 22

Summary 22

2 Conceptualizing recovery: A consumer-oriented approach 23

Overview 23

Developing a consumer-oriented model of recovery 24

The search for common ground 25

Meanings of recovery in the literature 25

Consumer descriptions – psychological recovery 28

Diverse opinions on some aspects of recovery 31

Four component processes of recovery 34

A definition of psychological recovery 40

Steps along the journey of recovery 41

Five stages of psychological recovery 45

Conclusion 45

Summary 48

Appendices 48

Part II Elaboration of the Model: From Hopelessness to Flourishing

3 Moratorium: The first stage of psychological recovery 53

Overview 53

Negative symptoms or psychological sequelae? 53

Hope in the Moratorium stage: Hopelessness 54

Responsibility in the Moratorium stage: Powerlessness 57

Identity in the Moratorium stage: Loss of sense of self 59

Meaning in the Moratorium stage: Loss of purpose in life 63

Conclusion 65

Summary 66

4 Awareness: The second stage of psychological recovery 67

Overview 67

Hope in the Awareness stage: The dawn of hope 67

Responsibility in the Awareness stage: The need to take control 70

Identity in the Awareness stage: I am not the illness 72

Meaning in the Awareness stage: Need for a purpose in life 74

Conclusion 76

Summary 76

5 Preparation: The third stage of psychological recovery 77

Overview 77

Hope in the Preparation stage: Mobilizing resources 77

Responsibility in the Preparation stage: Taking autonomous steps 79

Identity in the Preparation stage: Taking an internal inventory 81

Meaning in the Preparation stage: Reassessing goals 83

Conclusion 85

Summary 85

6 Rebuilding: The fourth stage of psychological recovery 87

Overview 87

Hard work and hopefulness 87

Hope in the Rebuilding stage: Active pursuit of personal goals 88

Responsibility in the Rebuilding stage: Taking control 90

Identity in the Rebuilding stage: Self-redefinition 93

Meaning in the Rebuilding stage: Valued goals 96

Risk-taking, perseverance and resilience 99

Conclusion 100

Summary 101

7 Growth: The fifth stage of psychological recovery 103

Overview 103

Hope in the Growth stage: Optimism about the future 103

Responsibility in the Growth stage: In control of life and wellbeing 105

Identity in the Growth stage: An authentic self 107

Meaning in the Growth stage: Living a meaningful life 109

Resilience, personal growth and wisdom 111

Conclusion 113

Retrospective overview 114

Summary 114

8 Common questions regarding the stage model of psychological recovery 115

Overview 115

Ten questions that have been raised about the model 115

Conclusion 120

Summary 120

Part III Measuring Recovery

9 Recovery-oriented outcome measurement 123

Overview 123

Why the need for measures of recovery? 123

Approaches to operationalizing recovery in research 125

Assessing outcomes in routine clinical practice 126

Outcome measurement from the consumer perspective 127

Measuring consumer-defined recovery 128

Measures based on the stage model of psychological recovery 129

Concluding comment 135

Summary 135

Part IV Towards a Positive Future

10 Psychological recovery and positive psychology 139

Overview 139

A scientific approach to recovery 139

Hope 140

Meaning and purpose 140

Responsibility 141

Identity 142

Resilience 142

Strengths 143

Values 143

Autonomous goals 144

Growth 144

Wellbeing 145

Living with illness and flourishing 145

Summary 146

11 Reflections and future directions 147

From wellness to wellbeing 147

Applications of the model 148

Recovery measures in clinical work, evaluation and research 151

Current and future research directions 152

A word about words 153

Afterword 155

References 157

Index 179

Many countries have introduced policies that stipulate mental health services be ‘recovery-oriented’. However, there is no widespread accepted definition of recovery, an understanding of the process, and how services are to become recovery-oriented, or consensus on how recovery should be assessed. Where conceptual models have been proposed, they tend to be complex and do not lend themselves readily to routine use and research purposes.

This book presents a consumer-orientated, stage-based model of psychological recovery from serious mental illness, synthesizing stories of lived experience to provide a framework for clinical work and research in the field of recovery. Each stage of the recovery process is illustrated with patient experiences, which are then placed in the context of existing theory in fields such as trauma, hope, self-determination, identity, and wellbeing. Three measures of recovery are also presented, providing recovery-based additions to the array of outcome measures commonly used in mental health settings.

Placing recovery within the growing field of positive psychology, this book fills a need in the mental health professional community for a succinct model of recovery from mental illness. It offers a thorough grounding in the history of the concept of recovery, a deep appreciation of the mental health consumer’s experience of psychological recovery, an understanding of the conceptual model, and an awareness of the issues surrounding recovery measurement.

This book addresses an international challenge in relation to recovery: how to bring empirical investigation to the consumer-developed understanding of recovery. The authors rise to this challenge superbly. They rightly position recovery as arising from the lived experience of people who use mental health services, and then develop an empirically-based understanding of the stages and processes of recovery. This empirical work has been internationally influential and the detailed description will be of wide interest. The authors then contextualise their work within the field of positive psychology and well-being research –areas which will directly inform the evolution of mental health services in the 21^st Century. I recommend this book, and hope it is widely read.
—Mike Slade, Researcher (researchintorecovery.com) and Author of ‘Personal Recovery and Mental Illness’

This book begins by examining the history of schizophrenia, and discerning the roots of pessimism in its outlook. The authors then introduce the concept of recovery, and their own model of its process, which is via a series of stages, which they show can be measured and used in treatment. One great value of a work such as this is that it injects factors that are often lacking in treatment environments, and sometimes in the minds of service providers, namely hope and optimism. As such, this book will be, or should be, of interest to all those who work with people with serious mental illnesses.
—Tom Trauer, Professor, Department of Psychiatry, University of Melbourne, Australia

This is an exciting and important book that is sure to stimulate dialogue and debate within the rapidly growing international recovery movement. Based on years of interviews of, and conversations with, people with first-hand experiences of recovery conducted by leading recovery researchers in Australia, this book offers the beginning of a road map for the recovery journey that will be found useful by people with serious mental illnesses, their loved ones, and mental health practitioners alike.
—Larry Davidson, Professor of Psychiatry, Yale University