Marit Borg

Processes of recovery in serious mental illness: Findings from a multinational study

ABSTRACT As part of a growing literature describing processes of recovery in psychotic disorders, this report presents findings of an intensive, international study. Open-ended qualitivite interviews were conducted in Italy, Norway, Sweden, and the United States with a total of twelve individuals who have experience of recovery in psychosis. All interviews were translated into English and transcribed. Investigators from each of these countries collaborated in analyzing the interviews and identifying common elements across the twelve narratives. Themes were identified in each of the following areas: 1) how the individual deals with his or her difficulties; 2) the role of material resources; 3) the various roles of formal and informal health systems; 4) the roles, and absence, of significant others; and 5) the roles of social and cultural factors. Salient themes included the persons determination to get better, establishing a degree of self–control, and struggling to achieve a normal life; the need for material resoures and a sense of home, and the importance of going out and engagging in normal activities; the benifits, and costs, of medication, involvement in mutual support/user groups, and participation in various psychosocial interventions; the need to be accepted as, and to accept oneself as, a normal person who exists beyond the psychosis; the impact of stigma and discrimination, and the imortance of having ones rights respected and returning to a meaningful social role through work and/or positive relationships outside of the formal mental health system. Cultural differences between participants from each country were noted primarily in the nature of the opportunities and supports offered rather than in the nature of the processes described. In closing, implications of these findings are considered both for future research on processes of recovery and for making clinical practice more recovery-oriented.

Not just an individual journey: social aspects of recovery

BACKGROUND Recent literature on recovery describes the process as deeply personal and unique to each individual. While there are aspects of recovery that are unique to each individual, this article argues that focusing solely on these overlooks the fact that recovery unfolds within a social and interpersonal context. MATERIALS Drawing from qualitative data, this article describes aspects of recovery that involve the contributions of others, the social environment and society. DISCUSSION These aspects of recovery include relationships, adequate material conditions and responsive services and supports. CONCLUSION The authors consider the implications of these social factors for transforming psychiatric research and theory as well as for recovery-orientated practice.

Others: The Role of Family, Friends, and Professionals in the Recovery Process

Relationships have a tremendous impact on how people recover from schizophrenia. Previous research has focused on the role of clinicians in these supportive relationships, but the current study finds that these relationships can occur within the mental health system, the family, or out in the community. Regardless, it is very important for people in recovery to feel as if they are supported and cared for. In qualitative interviews, we examine the specific aspects that characterize other peoples actions when helping in the recovery process. First, for both professionals and family members, being “there” and available seemed to help people in recovery. Secondly, people helped by doing more than was expected of them, sometimes by lending money or doing something extra to help out the person in recovery. Thirdly, people helped by doing something different than what was expected of them. For professionals, this might mean that they break a minor rule. These factors helped people in recovery feel like they were special, chosen, and “worth” doing something extra for. #Affiliation reflects lend author

The Social Nature of Recovery: Discussion and Implications for Practice

This article provides an interpretation of the key issues that emerged from the research, attempting a possible synthesis of the different themes described in the other papers and beginning a map of recovery as an ongoing interpersonal and social process. From a subjective point of view, there is a dimension of ‘social experience’, which implies the reconstruction of self and the importance of social life as a major goal. Recovery as an interactive journey requires an entire social context ‘provided with meanings’, rather than simply building social ties and relationships within a network. Socialization in a real environment means social inclusion, like efforts made of gaining the status of effective citizenship, in terms of rights, opportunities, and responses to social needs. Therefore, what citizenship is really about seems to be ‘recovery in a social context’. In this framework, a community service can act as a sort of mediator, an agent for integration, recognizing the uniqueness of those processes. #Affiliation reflects lead author.

Toward Caring for Oneself in a Life of Intense Ups and Downs: A Reflexive-Collaborative Exploration of Recovery in Bipolar Disorder

In this article, we discuss processes of recovery in bipolar disorder. We utilized a hermeneutical-phenomenological approach developed within a reflexive-collaborative framework to examine what individuals do to promote improvement and positive change in their own lives. The study was designed and carried out in collaboration with an expert-by-experience group of 12 coresearchers with firsthand experiences of mental distress and recovery. In-depth interviews were conducted with 13 participants who acknowledged having lived and dealt with a bipolar disorder. Four core themes were drawn from our analysis: (a) handling ambivalence about letting go of manic states; (b) finding something to hang on to when the world is spinning around; (c) becoming aware of signals from self and others; and (d) finding ways of caring for oneself. Interrelationships between the four themes, along with limitations, strengths, and implications of the study are discussed.

Arenas of Recovery for Persons with Severe Mental Illness

We analyzed informant narratives in terms of the benefits of spending time within various community arenas, including service user organizations, advocacy agencies, the bowling alley, and universities. Themes contributing to recovery from severe mental illness included the understanding and acceptance infromants both gave and received from others, spiritual fulfillment, and even experiences of anger as mechanisms of empowerment to counter social discrimination and neglect. Involvement across various community arenas and the themes it elicited relative to recovery were understood in terms of developing more durable and advantageous understandings of the self. #Affiliation reflects lead author.

What Makes a House a Home: The Role of Material Resources in Recovery from Severe Mental Illness

ABSTRACT Informants in the present study identified poverty, unemployment, substandard living conditions and homelessness as being among the major struggles they faced within their recoveries from psychosis and depression. In considering the benefits of material resources, many informants discussed the notion of having a home, referring to it as a place for growth, development, and control; a means for balancing the need for socializing with privacy; and having a place to long for and dream about. All informant narratives suggested the importance of having a secure base from which to launch efforts towards recovery. By contrast, informants varied in their explanations of what transforms the physical structure of a house or an apartment, into a place that feels like a home.

Facilitators and barriers in dual recovery: a literature review of first-person perspectives

Purpose – The co-occurrence of mental health and substance use problems is prevalent, and has been problematic both in terms of its complexity for the person and of the challenges it poses to health care practitioners. Recovery in co-occurring mental health and substance use problems is viewed as with multiple challenges embedded in it. As most of the existing literature on recovery tends to treat recovery in mental health and substance use problems separately, it is critical to assess the nature of our current understanding of what has been described as “complex” or “dual” recovery. The purpose of this paper is to identify and discuss what persons with co-occurring mental health and substance use problems describe as facilitators and barriers in their recovery process as revealed in the literature. Design/methodology/approach – The method used for this study was a small-scale review of the literature gleaned from a wider general view. Searches were conducted in CINAHL, Psych info, Medline, Embase, SweMed...

Walking alongside: collaborative practices in mental health and substance use care

BackgroundAlthough the importance of collaboration is well established as a principle in research and in theory, what it actually means for practitioners to collaborate in practice, to be partners in a collaborative relationship, has thus far been given less attention. The aim of this study was to identify key characteristics of the ways in which mental health practitioners collaborate with service users and their families in practice.MethodsThis was a qualitative action research study, with a cooperative inquiry approach that used multi-staged focus group discussions with ten mental health care and social work practitioners in community mental health and substance use care. Thematic analysis was applied to identify common characteristics.ResultsWe identified three major themes related to practitioners’ experiences of collaborative practices: (1) walking alongside through negotiated dialogues, (2) maintaining human relationships, and (3) maneuvering relationships and services.ConclusionsIt appears that even with the rich knowledgebase that has developed on the merits of collaborative relationships, it continues to be challenging for practitioners to reorient their practice accordingly. The findings of this study indicate that the practitioners focus on two types of processes as characterizing collaborative practice: one focusing on conversations among practitioners and service users and their families and the other focusing on management and control among health care providers, service sectors, and service users (i.e., inter/intra-system collaboration).

The role of work in recovery from bipolar disorders

Being in recovery from bipolar disorder involves work-related concerns. The specific aims of this study are to: 1) understand the role of work in recovery from bipolar disorders, and 2) understand how people with such disorders deal with work-related challenges. These topics are examined from the stance of the recovery process, in which work-related activities were explored. Semi-structured, qualitative interviews were conducted with persons who had experienced recovery from bipolar disorder. Analysis was performed through thematic and phenomenological analysis, with hermeneutic phenomenology and reflexive methodology as a framework. The findings are presented through the following themes: 1) many types of work – finding meaning and a focus; 2) helpful roles and contexts – to be much more than a person with an illness; 3) making work possible – the role of supportive relationships and supportive medications, and 4) the costs of working too much – finding a meaningful and healthy balance.