What Is The Role Of Medication In The Recovery Scenario?

Many people feel that medications can be helpful in slowing down the most difficult symptoms. While in the past, medications have been seen as the only rational option for reducing psychiatric symptoms, in the recovery scenario, medications are one of many options and choices for reducing symptoms. Others include the recovery skills, strategies and techniques listed above, along with treatments that address health related issues. Though medications are certainly a choice, these authors believe that medication compliance as the primary goal is not appropriate.

People who experience psychiatric symptoms have a hard time dealing with the side-effects of medications designed to reduce these symptoms - side effects like obesity, lack of sexual function, dry mouth, constipation, extreme lethargy and fatigue. In addition, they fear the long term side-effects of the medications. Those of us who experience these symptoms know that many of the medications we are taking have been on the market for a short time - so short that no one really knows the long term side-effects. We know that Tardive's Dyskinesia was not recognized as a side-effect of neuroleptic medication for many years. We fear that we are at risk of similar irreversible and destructive side-effects. We want to be respected by health care professionals for having these fears and for choosing not to use medications that are compromising the quality of our lives.

When people who have shared similar experiences get together, they begin to talk about their concerns about medications and about alternatives that have been helpful. They build up a kind of group empowerment that begins to challenge the notion of prophylactic medication or medication as the only way to address their symptoms. Many physicians, on the other hand, worry that people who come to them blame the medication for the illness and they fear that stopping the medication will worsen symptoms. These become fairly polarized views and amplify the hierarchical relationship. People feel that if they question their doctors about decreasing or getting off medications, they will be threatened with involuntary hospitalization or treatment. Doctors fear that people are jumping on an unreliable band wagon that will lead to out of control symptoms, jeopardizing the person's safety. Consequently, talk about medication often goes on without counsel with doctors.

In a recovery based environment, more effort needs to be spent focusing on choice and self-responsibility around behavior. If the complaint is that medications control behavior and thoughts while extinguishing all pleasurable, motivational kinds of feelings, there is a need to develop a way we talk about symptoms so that each of us has many choices and options for dealing with them.

Shery Mead has developed a visual image of a car wash that has been useful to her and many others. She says:

If I think about early stages of symptoms as driving towards the car wash, there are still many choices I can make before my wheels engage in the automatic treads. I can veer off to the side, stop the car or back up. I am also aware that once my wheels are engaged in the car wash - though it feels out of my control - the situation, based on self observation, is time limited and I can ride it out and will eventually come out on the other side. My behavior, even when I am "white knuckling it" through the car wash, is still my choice and in my control. This kind of process has helped others define triggers, watch their automatic response, develop self critical skills about their own defense mechanisms, and ultimately even ride out the car wash better. Although medications can be helpful in making it through the car wash without ending up in a dangerous situation, there are many more proactive skills that help each of us develop our own techniques, making personal responsibility a more desirable outcome.

What Are The Risks And Benefits Of Using A "Recovery" Vision For Mental Health Services?

Because the feelings and symptoms that have been commonly referred to as "mental illness" are very unpredictable, our health care professionals may fear that we will "decompensate" (a nasty word to many of us) and may put ourselves or others at risk. Health care professionals become fearful that, if they do not continue to provide the kind of caretaking and protective services they have provided in the past, people will become discouraged, disappointed and may even harm themselves. It must be recognized that risk is inherent in the experience of life. It is up to us to make choices about how we will live our lives and it is not up to health care professionals to protect us from the real world. We need our health care professionals to believe that we are capable of taking risks and support us as we take them.

More clinicians working in a recovery based environment will enjoy the positive reinforcement of successful experiences in working with people who are growing, changing and moving on with their lives. The recovery focus and the increased wellness of more of us will give health care professionals more time to spend with those who experience the most severe and persistent symptoms, giving them the intense support they need to achieve the highest levels of wellness possible.

In addition, health care professionals will find that instead of providing direct care for people who experience psychiatric symptoms, they will be educating, assisting and learning from them as they make decisions and take positive action in their own behalf. These caregivers will find themselves in the rewarding position of accompanying those of us who experience psychiatric symptoms as we grow, learn and change.

The implications of a recovery vision for services to adults with severe "mental illness" will be that providers of services, instead of coming from a paternalistic framework with often harsh, invasive and seemingly punitive "treatments," will learn from us as we work together to define what wellness is for each of us on an individual basis and explore how to address and relieve those symptoms which prevent us from leading full and rich lives.

The hierarchical health care system will gradually become non-hierarchical as people understand that health care professionals will not only provide care, but will also work with a person to make decisions about their own course of treatment and their own lives. Those of us who experience symptoms are demanding positive, adult treatment as partners. This progression will be enhanced as more people who have experienced symptoms become providers themselves.

While the benefits of a recovery vision for mental health services defy definition, they obviously include:

• Cost effectiveness. As we learn safe, simple, inexpensive, non-invasive ways to reduce and eliminate our symptoms, there will be less need for costly, invasive interventions and therapies. We will live and work interdependently in the community, supporting ourselves and our family members.

• Reduced need for hospitalization, time away from home and personal supports, and the use of harsh, traumatic and dangerous treatment which often exacerbate rather than relieve symptoms, as we learn to manage our symptoms using normal activities and supports.

• Increased possibility of positive outcomes. As we recover from these pervasive and debilitating symptoms, we can do more and more of the things we want to do with our lives, and work toward meet our life goals and dreams.

• As we normalize people's feelings and symptoms, we build a more accepting, diverse culture.