Wednesday, October 13, 2010

In defense of recovery—and some objections

Bias against the recovery model persists
(from Recovery to Practice Weekly Highlights, on the internet by Larry Davidson, PhD, Oct. 12.)

“The fact that the recovery concept is perceived by some people to be anti-professional or in conflict with medical or clinical practice is an unfortunate legacy of the origins of the movement in the early days of de-institutionalization. As previously noted, the recovery movement in mental health was first and foremost a civil rights movement founded and led by people in recovery themselves. Many of the founders of this movement had been mistreated in the mental health system of the mid–20th Century, most often being hospitalized and medicated against their will, and suffering a range of indignities, humiliations, deprivations, and abuses in understaffed and overcrowded, largely custodial institutions.

“It therefore is no surprise that some of the early rhetoric of the recovery movement came across as anti-professional and as calling into question, if not blatantly critical of, the medical and clinical care that was being provided at the time. In the process of reclaiming their rights to full citizenship and community membership, ex-patient advocates denounced the system of care that had made their advocacy necessary. It had been mental health institutions and professionals acting as agents for society that had taken away their liberty and subjected them to unhelpful, and at times extremely injurious, treatments. It was therefore these same institutions and professionals who became the focus of their criticisms and of their efforts to reform practices that they viewed as performing social control, rather than medical or clinical, functions.”

My comment: I see this as an apology for the rude behavior of the radicals in the consumer movement, going back 20 years ago when they disrupted meetings when they could. Some of the radicals took up the recovery movement while others never came around in their sourness against the doctors and forced treatment they experienced as sick people. Just keep a perspective about this.

The “medical model” of care as more than medicine
(also by Larry Davidson in the same Recovery to Practice Weekly Highlights as above)

“More recently, another source of the perception that the recovery movement is anti-professional stems from complaints expressed about mental health professionals’ use of the so-called “medical model”. This, too, is an unfortunate legacy of the history of psychiatry over the last 40 or so years, during which the neurobiological model of mental illness and its treatment were ascendant to the point of overshadowing other perspectives. As a result, the term “medical model” came to be used to criticize and disparage an overly narrow focus on the presumptive biological nature of mental illness and on the almost exclusive reliance by some segments of the field on psychiatric medications as the only effective treatment.

“But most physicians, including psychiatrists, are not trained in such a narrow version of a “medical model”. The “medical model” in which all health care professionals—regardless of discipline—are trained is a bio-psycho-social model that addresses the biological components of disease and disability, but also incorporates factors and interventions that speak to the psychological and social dimensions of human health and illness as well. Such a holistic “medical model” is compatible with the vision of the recovery movement, which focuses on the whole person, even though there may remain some differences in emphasis.

“In fact, recovery mostly incorporates medical approaches in its holistic focus. One distinction is that the primary focus of the bio-psycho-social model is on the pathophysiology of disease, deficit, and dysfunction, although there remains room in such a model for the active role of the person in adapting to or recovering from a given condition. As a model for self-care, the recovery model, in contrast, focuses less on the causes of disease (which remain poorly understood) and more on what a person can and may need to do to deal with and overcome his or her difficulties. Rather than conflicting or competing, it is possible to view these models as complementary and as having much to offer each other in exchange.”

My comment: I thought all the doctors in the universe accept the medical model of care whether it's schizophrenia or brain tumor or tennis elbow. Davidson gives it a spin away from the conventional sense that means to me treatment in accord with good medical practice and knowledge of what works best. That means in treating schizophrenia, for example, that priority goes to medicine as the best travelled road we take, not talk therapy alone. The medical model may also be holistic but Davidson's recovery model is more than that. As explained on his website, it features among other things a transcendent self-esteem on the part of patients who figure they are entitled to recover, and they have the right to tell the doctor what to prescribe. While negotiation is good, stubbornness is not.

Parents struggle mightily to get their mentally ill son or daughter to the doctor. From what we learn, someone who won't budge for any reason may not realize they are sick, which Davidson doesn't take into account. And someone who refuses care becomes a greater liability to the public, a high cost and a danger. Nevertheless, the recovery adherents don't want any interference with free choice and it is out of this hubris that they run into difficulty. That's when the headlines and tragedies arise. The radical consumers really don't want doctors and medicine to govern their life and Davidson has been supporting their free choice. Neither do they want, for example, electroshock therapy, Kendra's Law provisions for assisted outpatient treatment, nor hospital restraints. I don't think the medical model is in their vocabulary at all despite the smooth way it's presented by the professor. (Roy Neville)

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