CLINICAL HANDBOOK OF SCHIZOPHRENIA

55. Recovery 569often learn lessons, make gains, and further their development. Recovery, in this sense,is the person’s active effort to internalize the faith that change and renewal are stillpossible, and even to find new meaning in the extreme situation of trauma. Accordingto this approach, the potential for growth implies that recovery can be seen as a developmentalprocess and continuum through and along which new capabilities canemerge. At least one such capacity includes striving beyond personal recovery to thecollective recovery of a group that for most of history has been grossly deprived ofrights, neglected, and robbed of hope. This form of collective recovery is manifestedthrough advocacy, activism, and striving for institutional change.Recovery as Institutional ChangeIn the 1970s, there appeared early advocacy efforts by individuals who have since cometo refer to themselves as ex-patients, ex-inmates, psychiatric survivors, or consumers orusers of mental health services. Having left or been released from mental hospitals, theseadvocates became living proof of the research findings described earlier, demonstratingand arguing that people with schizophrenia and other serious mental illnesses can, andshould be entitled to, have a life beyond that of a “mental patient.” As advocates intenton reforming psychiatric policy and practice, leaders of the consumer movement had littleinterest in the conceptual or empirical distinctions employed in clinical research, drawingmore from their own firsthand experiences of illness, incarceration, and success in recoveringtheir lives. For these people, the categories of abnormal and normal, illness andhealth, were not nearly as black and white as research and diagnostic practice at timessuggested. In fact, the lines between these categories seemed fuzzy and permeable at best,and arbitrary and political at worst. As a result, their agenda was not so much gettingbetter, or getting over a psychiatric disorder such as schizophrenia, as figuring out how tolive a safe, dignified, and meaningful life given whatever hand they had been dealt. Forguidance in this process, they had to go outside of the mental health service system to findexamples in populations that had managed adversity. It was within the context of thisagenda and this movement outside of mental health services that another concept of recoveryemerged.Advocates of this approach emphasize that the recovery movement is first and foremosta civil rights movement, but this emphasis is quickly lost or overlooked in clinicalsettings, where the focus typically remains on disorder, deficit, and disability. Cliniciansoften focus primarily on minimizing and/or containing pathology. But from the perspectiveof the person with the psychiatric disability, the focus on deficits and pathology notonly is overly narrow and limited in its utility but it also misses the very point of the civilrights argument. It would be pointless for society to accord people with disabilities therights and responsibilities of citizenship if those rights and responsibilities were contingenton indviduals overcoming their disability first. It is in the presence of enduring disabilitythat these rights become most pressing and relevant. Similarly, it is when peoplewith schizophrenia are most disabled by the illness that their civil rights and responsibilitiesbecome most pressing and relevant. Recovery speaks primarily to the person’s rightsfor social inclusion and self-determination, irrespective of the nature or severity of his orher psychiatric condition. In this sense, recovery refers to the rights to access and to joinin those elements of community life the person chooses, and to be in control of his or herown life and destiny, while remaining disabled. It also speaks to the need to work towarda redistribution of power in the mental health system in particular and in society in general,so that persons diagnosed with schizophrenia have a meaningful say in the way theyare treated both within the mental health system and in society at large.