CLINICAL HANDBOOK OF SCHIZOPHRENIA

570 VIII. SPECIAL TOPICSA RECOVERY REVOLUTION IN MENTAL HEALTH?The first noticeable step in the direction of institutionalizing recovery in mental health inthe United States was the landmark 1999 publication of the Surgeon General’s Report onMental Health, which marked the entry of this notion of recovery into mainstream mentalhealth services and education, with its insistence that all mental health services be consumer-and family-oriented, and have as their overarching aim the promotion of recovery(U.S. Department of Health and Human Services, 1999). Expanding on this position, thePresident’s New Freedom Commission on Mental Health—whose report was entitledAchieving the Promise: Transforming Mental Health Care in America (U.S. Departmentof Health and Human Services, 2003)—even more forcefully advocated for “fundamentallyreforming how mental health care is delivered in America” (p. 4) to be reoriented torecovery. In the opinion of the New Freedom Commission, even the term fundamentallyreforming was inadequate for capturing the magnitude of the changes required by a recoveryorientation, resulting in their eventually settling on the term transformation. Continuingthis momentum, the most recent policy statement contained in the Federal ActionAgenda (U.S. Department of Health and Human Services, 2005) for implementing theNew Freedom Commission recommendations takes this rhetoric one step further:“Transformation . . . is nothing short of revolutionary. . . . It implies profound change—not at the margins of a system, but at its very core. In transformation, new sources ofpower emerge and new competencies develop” (p. 4). Clearly, if holding out hope werethe only requirement for clinical improvement of people with schizophrenia, and offeringthem the most effective interventions available for reducing symptoms and enhancingfunction, there would be no need for this kind of rhetoric; there would be no “revolution.”So what does the revolutionary nature of transformation involve? What is revolutionaryabout it? And why is now the time for such a revolution?Considering the perspectives of the civil rights and independent living movements,the revolution seems fairly straightforward. The various civil rights movements establishedthat people of color did not need to be white, women did not need to be men, andlesbian/gay/bisexual/transgendered individuals did not need to be solely heterosexual tobe considered, treated as, and accorded all of the rights and responsibilities of full citizenship.Similarly, as noted earlier, the independent living movement made this case for peoplewith disabilities, insisting that it is in the presence of enduring disability that peoplemost need to be guaranteed their rights to inclusion in community life and self-determination.Extrapolating to schizophrenia, the point would be that people living with psychosisdo not need to be cured of their illness, do not need to become “normal,” to pursue theirlives in the community alongside everyone else. This does not mean merely that they canno longer be confined to hospitals against their will. It also means that they can maketheir own decisions, follow their own dreams, and participate in activities they enjoy orfind meaningful in settings of their choice (within the limitations imposed by their resourcesor lack thereof), as they are.A story may help to make this point concretely. The story of a woman, Celeste (namechanged for anonymity purposes), who was 33 years old and enjoyed sewing, and whoreceived different services from the same agency with different results, may be illustrativehere.Celeste’s first clinician viewed her difficulties in managing her illness, obtainingemployment, and having a social life as being due primarily to her mental illness. AlthoughCeleste expressed an interest in working, the case manager believed that shecould not yet work, because she still experienced the hallucinations and paranoia