I have a very personal connection to wellness and recovery as it relates to mental illness. If you haven’t read my older blog on living with depression, you can read it here. Or if you want to watch my video blog on mental illness and stereotypes that emerged in the wake of Sandy Hook, you can watch that here.
Because I have a personal connection to wellness and recovery, I suppose it should come as no surprise that it is one of my favorite areas to provide training to housing case managers, and to help homeless serving agencies truly understand and embrace. This is a four-part blog that examines wellness and recovery in the process of supporting people in housing, and working to prevent homelessness from happening again to that person/family.[serialposts]
In Part Two of this blog series on Wellness and Recovery, I want to focus on what exactly it is that people are trying to recover. There are twelve areas that need to be considered, each of which is outlined below:
Roles – we all have different roles that we play in our lives…spouse, parent, employee, sibling, friend, worshipper, mentor, teammate, etc. Many people that experience compromised mental wellness have roles re-defined in ways than how they may like them. For example, they may remain a parent, but the roles of parenting may have been taken over by a spouse or grandparent during a patch of being unwell. For some, being dislodged from employment for periods of time has distanced them from the role of being an employee and turned their role into recipient of benefits. Whatever the case, in Recovery, people are supported in reclaiming and redefining their roles in a way that makes sense for their journey towards wellness, appreciating that their illness alone does not make them incapable of performing roles that they want to in their family or society at large.
Decision-making – fundamentally there are various aspects to recovering decision-making. One aspect relates to Rights (discussed in greater detail below) where the ability to make informed decisions for oneself can be suspended during times when an individual may be considered a harm to themselves or others. Another aspect is a direct result of changing roles that can come with the experience of mental illness. I have met more than one person who, when they say things like “Go ask your mother” to their children is really reflecting where they are at in recovery and not wanting to upset the apple cart in their family. In recovery, people should be supported in making decisions again in all areas of their life – from how they engage with their mental health care team to how they choose to spend their money (and everything in between). At the core of the recovery process as it relates to decision-making is having enough information to make decisions, and the supports necessary to realize that mistakes will still occur from making decisions. A mistake is just another way of doing things. It is neither right nor wrong. Each mistake can be learned from to make future decisions better. A gradual, supported process of decision-making increases confidence in the process, while also reducing the likelihood of risks when making the decisions.
Happiness – I believe it is a rather fair statement that even people with a diagnosis other than depression are usually pretty down about the state of their mental health when they have insight. Recovering happiness is first and foremost about reflecting on the things that a person can do each every day that bring them comfort and joy, to things they can do occasionally that make them feel well. A whole range of activities will be self-determined to assist in the process of making one feel closer to happiness. In this instance, I would urge people to consider happiness to be those things that bring about contentment and inner peace in addition to outward joy or euphoria. In the recovery process, some people will also come to analyze those things in their life that are artificial happiness (perhaps using substances or hanging around with certain people that actually has deleterious consequences) and true happiness.
Rights – with instances of severe and persistent mental illness, when a person is remarkably unwell and unable to care for her/himself and may be a legitimate danger to self or others, our society has allowed for intervention against one’s will. We can debate the merits of this and the various circumstances in which it may be justified at another time. But I think you will agree that one’s rights – rights generally shared by all others under the same constitution or laws of the land – are suspended during the time of the episode. Other than criminal behavior, mental illness is one of the only other instances in most modern Western societies where people can be involuntarily detained against their will. They can also have their personal rights suspended as it relates to deciding whether or not to take medication. Restraints and medication are frequently used when a person is having a particularly serious episode and are involuntarily taken to hospital. Because so many people that have experienced mental illness (especially Axis I disorders) have also experienced a suspension of their rights at some point in their life, exercising rights and “owning” one’s rights to personhood can be very important to recovery.
Stability – many people that experienced compromised mental wellness experience instances of instability in their life. Consider being dislodged from education or employment can result in financial instability. Or consider circumstances that result in unstable living arrangements with family or even homelessness. Or consider those instances where family and friends distance themselves from a loved one because the relationship has become unstable as a result of the illness.
There are many dimensions to stability, and stability may be relative for people that have had lots of instability in her/his life. As such, stability may be best understood holistically in this context, and the state of stability should be self-defined.
Responsibilities – for a lot of people that have lived with a mental illness, they have become dislodged from several responsibilities, either intentionally (for example, a court has placed someone else in charge of their finances) or unintentionally (for example, a wife takes over responsibilities for the routine of children in the family as a way of compensating for times when the husband was unwell). It may be possible to argue that both intentional and unintentional suspension of responsibilities may have been prudent at some periods of time. However, in the recovery process it is important for the individual that has experienced compromised wellness to gain more responsibility back in his/her life. Being responsible to others increases community connectivity. Being responsible for decisions that impact life personally (for example, money) reinforces wellness.
Some may be of the opinion that a responsible person takes medication, and an irresponsible person does not. I would urge caution in reducing medication to such a seemingly binary construct. Given how complex psychotropic medications are in their impact on people, side-effects, stigma, cost, ability to store properly and safely, etc., the choice to take or not take medications may not be only related to notions of responsibility.
Well-being – “recovery” is not synonymous with “cure”. A focus on well-being is an intentional journey towards being healthier. With this perspective, an individual working on recovery has the ability to focus on an inclusive understanding of what it means to be well…emotional wellness; physical wellness; financial wellness; social wellness; intellectual wellness; spiritual wellness; recreational wellness; etc. In recovery, an individual can start to make decisions, choose activities, and relate to other people based upon those things that make them feel the most well, as opposed to being engaged based solely on what is prescribed to them or what others have recommended they must do.
Self-esteem – one of the serious tolls of experiencing compromised mental wellness is an erosion of self-esteem. This is especially true of those that have had a longer-term hospital stay as a result of their illness, and/or, have seen their relationships change dramatically as a result of the behavior that coincides with some illnesses. The stigma of mental illness is a heat-seeking missile that rocks identity and personal confidence. Through recovery, as one gains greater understanding and acceptance of oneself in the context of others, self-esteem can again grow and a firm foundation of self-esteem can be (re)created. Consider, for example, how having an apartment after a long-period of homelessness while unwell, can help bolster self-esteem. So to can social connections where the individual can be themselves. Or consider, for example, how re-entering the workforce after a period away from it when dealing with one’s mental illness, increases self-esteem.
Identity – the journey of recovery allows people that have experienced compromised mental wellness to see her/himself other than the label of her/his diagnosis. They can begin to identify again as a person of talents, interests, skills, knowledge, etc. They can begin to identify again as a family member, employee, friend, etc. Living with a mental illness is likely to be part of their ongoing identity, but it does not fully define all that they are as a person. It is simply part of who they are – and some individuals in recovery even start to see this identification as a strength, using it to assist and relate to others also on the pathway to recovery.
Potential – the experience and/or diagnosis of a mental illness can be an albatross. It can feel like a massive anchor holding back the possibility of realizing one’s ambitions or dreams. People that have a mental illness can lead a successful life and reach one’s goals. Recovery supports a personal goal-setting process where each person can identify what actions and resources they feel are necessary to allow them to reach their fullest potential. Mental illness need not be a brick wall to be confronted when actively pursuing a bright future.
Sense of purpose – because of things like stigma, disconnect from friends and family, lost employment opportunities, suspension of rights, lack of decision-making opportunities, etc., a person that has experienced compromised mental wellness can feel that their life has no sense of purpose. Many people with a mental illness merely “go through the motions” each day – alive but not really living. The recovery process can help people achieve and feel a sense of purpose in his/her life again.
Capabilities – as a whole, the recovery process supports people in achieving a range of capabilities that may have been lost, dislodged or suspended in their life as a result of the experience of the mental illness. People in recovery come to learn that they are capable of enjoying a better quality of life. They are capable of being empowered to make informed decisions on their care, support and future. They are capable of achieving self-awareness and engaging in self-directed (or at least self-informed) management of their life. People are capable of experiencing an appositive sense of belonging in community.