CLINICAL HANDBOOK OF SCHIZOPHRENIA

568 VIII. SPECIAL TOPICSatric disabilities. Examples drawn from the broader disability field provide a more concreteglimpse into what this concept of recovery adds to current approaches. In the caseof paraplegia, for instance, several things need to be in place for persons who have losttheir mobility to resume the activities they enjoyed prior to the accident or illness. Themost obvious—therefore, the most often overlooked—requirement is that people notwait to regain their mobility before pursuing these and other activities. This is occasionallyreferred to as acceptance of the trauma and disability, but for many people such anotion of acceptance connotes resignation and despair. The same has been true in mentalillness, with many people refusing or being reluctant to accept the diagnosis of schizophreniabecause of the helplessness and hopelessness—as well as the stereotypical pessimisticprognosis—associated with it.An alternative conceptualization is that people need not wait to regain their mobilityto resume their lives. Although it is not preferable, it is nonetheless possible to have a lifewithout use of one’s legs. Once people acknowledge that they cannot simply sit aroundand wait to regain their mobility, a next important step is to be fitted for, and learn touse, prostheses or other compensatory devices, such as a wheelchair. No matter how wellthey learn to maneuver the wheelchair, however, certain activities remain extremely difficult,if not impossible, to resume unless other environmental accommodations are made.Understanding this crucial point has been a major contribution of the independent livingmovement led by people with physical disabilities, and a source of inspiration for the consumer/survivormovement in mental health. Beginning with passage of the American RehabilitationAct of 1973, the independent living movement established that society hadan obligation to promote the independence and self-sufficiency of people with disabilities.Fulfilling this obligation involved making public spaces accessible to people who usedwheelchairs or other compensatory devices. Without curbs cut into sidewalks and barsinstalled in bathrooms, for example, the world had remained fairly restricted for peoplewho used wheelchairs. Similarly, without Braille signs posted on doors and elevators, andwithout the mandate that service dogs be allowed in public spaces, people who had losttheir vision had very limited access to the kinds of lives they wanted to lead in the community.The independent living movement successfully established that for people withthese and other disabilities, issues of access and accommodation were fundamental to therights and responsibilities of citizenship. Although they do not restore people’s mobilityor vision, they can and do restore people’s lives as valuable and contributing members ofsociety. The same should be true, according to the mental health recovery movement, forpeople with psychiatric disabilities.Recovery from the Trauma of Mental Illness and Its AftermathExploratory qualitative research shifted attention from the more objective, public, andobservable domains to the more subjective, private, and personal ones. This researchdrew attention to complex interactions between the person and the disorder, revealinghow the person is both influenced by as well as influences the course of his or her disorder.From this perspective, schizophrenia and many of its common social and personalconsequences, such as stigmatization, discrimination, rejection, loss of job andstatus, loss of social roles and valued identities, unemployment, poverty and isolation,are experienced as traumatic events that generate profound changes. Accordingly, recoveryis not defined as a return to a previous condition, but rather as an active processof confronting and working through or integrating the trauma, so that it has a lessdestructive impact, enabling the person to continue to live a personally meaningful lifedespite the trauma. While striving to overcome the pain of these many losses, people