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July 24, 2013

Recovery, not cure

Reuel S. Amdur

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In 1937, Albert Deutsch published Mental Illness in America, a history of the condition and its treatment. He noted that at the turn of the last century the mental health landscape was shaped by what he called the cult of cure. One institution after another boasted large numbers of cured patients. The cures were, of course, illusory. Cure is no longer the goal of treatment of mental illness.

Today professionals in the field talk of recovery instead. 

It involves a process of growth and transformation, moving beyond the acute distress, as the Mental Health Commission expressed it.  As part of a panel presentation at Ottawa’s Royal Ottawa Hospital last April, Nurse Heather Masson described the transformation of treatment from the old medical model to the more recovery-oriented approach.  Instead of looking at deficits, the focus is more on strengths. 

Where in the past treatment professionals did for, the preferred approach is to work with.  From a focus on disease, the emphasis is on treatment, and while the clinician was the teacher, now clinician and patient learn together.  Instead of looking for specific outcomes, now the person is allowed to determine his own goals and own measure of success.

Carlo Verdicchio, a peer support worker at the hospital, explained that if the patient simply recovers what was lost, he will just get sick again.  What is needed is movement forward, not back.  “I can’t make patients hope, but maybe they can gain hope if I can make that expectation.” If there is hope, the person may be able to move beyond self-stigmatization and may be able to see himself as more than just his illness.

Peer support workers, who have themselves lived with mental illness, have been shown to be an effective part of a mental health team.  Their utilization has been shown to reduce time in hospital, suicide rate, and substance abuse.  It has improved ability to carry out activities of daily living and has more generally had a positive impact on recovery.  Patients helped by peer support are more hopeful.  They learn coping strategies informally.

Psychiatrist Alexandra Baines illustrated the sense of recovery in contradistinction to cure by referring to spinal injury.  The condition may not be cureable, but a person can recover.  She gave the example of wheelchair basketball.

While a person may recover from mental illness, there may still be a need to take medication and may as well be a need to take part in other treatment activities.

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