Overview

2. Overview Part I Background on Recovery Is Recovery Possible? What is Recovery? Part II Recovery Pathways Part III A Vision of Transformation; Creating the Future Part IV Recovery in Practice Part V Recovery Coaching

3. Who started the idea of recovery? People speak out and write about recovery experiences Research findings support the fact of recovery Vision of recovery described by rehabilitation educators; Dr. Anthony Changes in our historical understanding New definitions of diagnosis New thinking about chronicity ? If you are using PowerPoint, when you go the next slide, the Bill Anthony video clip will play automatically. If using overheads, play the Bill Anthony video on the DVD. Dr. William Anthony is the Director of Boston University’s Center for Psychiatric Rehabilitation and a Professor in Sargent College of Health and Rehabilitation Sciences at Boston University. For the past 35 years, Dr. Anthony has worked in various roles in the field of psychiatric rehabilitation, and has been honored for his performance as a researcher, an educator, and a clinician. He is currently co-editor of the Psychiatric Rehabilitation Journal. In 1988 Anthony received the Distinguished Services Award from the National Alliance for the Mentally Ill in recognition of “…his efforts that challenge outdated ideas which limit the potential of mentally ill people. The innovative programs created through Bill Anthony’s leadershipo offer hope and opportunity.” Dr. Anthony has appeared on ABC’s Nightline and Ted Koppell characterized the BU program as a model program: “a small beacon of sanity in dealing with the problems of those whose sanity has crumbled.” In 1992 Dr. Anthony received the Distinguished Service Award from the President of the United States for his efforts in, “promoting the dignity, equality, independence and employment of people with disabilities.” Dr. Anthony has authored over 100 articles in professional journals, 14 textbooks, and severaal dozen book chapters—the majority of these publications on the topic area of psychiatric rehabilitation. If you are using PowerPoint, when you go the next slide, the Bill Anthony video clip will play automatically. If using overheads, play the Bill Anthony video on the DVD. Dr. William Anthony is the Director of Boston University’s Center for Psychiatric Rehabilitation and a Professor in Sargent College of Health and Rehabilitation Sciences at Boston University. For the past 35 years, Dr. Anthony has worked in various roles in the field of psychiatric rehabilitation, and has been honored for his performance as a researcher, an educator, and a clinician. He is currently co-editor of the Psychiatric Rehabilitation Journal. In 1988 Anthony received the Distinguished Services Award from the National Alliance for the Mentally Ill in recognition of “…his efforts that challenge outdated ideas which limit the potential of mentally ill people. The innovative programs created through Bill Anthony’s leadershipo offer hope and opportunity.” Dr. Anthony has appeared on ABC’s Nightline and Ted Koppell characterized the BU program as a model program: “a small beacon of sanity in dealing with the problems of those whose sanity has crumbled.” In 1992 Dr. Anthony received the Distinguished Service Award from the President of the United States for his efforts in, “promoting the dignity, equality, independence and employment of people with disabilities.” Dr. Anthony has authored over 100 articles in professional journals, 14 textbooks, and severaal dozen book chapters—the majority of these publications on the topic area of psychiatric rehabilitation.

4. The Messenger of Recovery Dr. William Anthony Remarks at annual conference Arizona Psychosocial Rehabilitation Services August 15, 2001The Messenger of Recovery Dr. William Anthony Remarks at annual conference Arizona Psychosocial Rehabilitation Services August 15, 2001

5. Ray’s comment, “Haldol made me into a zombie” is worth clarifying. Depending on the audience it is important here to comment that recovery does not mean that a person must stop taking medication. Most people in recovery do take medication. Ray takes Resperidol. What often does occur as people begin the recovery process is they often find they need fewer medications and lower doses. So, while we believe medication is an important tool, it is one of many tools. In fact, most people cite other tools that are now more important in helping them recover. Dr. LeRoy Spaniol at Boston University did a survey asking people what were the most important things that helped them recover. Medication was on the list, but it ranked #13. If you are using PowerPoint, when you go the next slide, the “Ray Finds Recovery” video clip will play automatically. If using overheads, play the “Ray Finds Recovery” video on the DVD. Ray’s comment, “Haldol made me into a zombie” is worth clarifying. Depending on the audience it is important here to comment that recovery does not mean that a person must stop taking medication. Most people in recovery do take medication. Ray takes Resperidol. What often does occur as people begin the recovery process is they often find they need fewer medications and lower doses. So, while we believe medication is an important tool, it is one of many tools. In fact, most people cite other tools that are now more important in helping them recover. Dr. LeRoy Spaniol at Boston University did a survey asking people what were the most important things that helped them recover. Medication was on the list, but it ranked #13. If you are using PowerPoint, when you go the next slide, the “Ray Finds Recovery” video clip will play automatically. If using overheads, play the “Ray Finds Recovery” video on the DVD.

6. Ray Finds Recovery Ray tells his story at a staff recovery training class.Ray Finds Recovery Ray tells his story at a staff recovery training class.

7. Schizophrenia Studies Bleuler, Manfred, “Bleuler Studies, Burgholz Hospital,” in The Transmission of Schizophrenia, 1968, editors D. Rosenthal and S.S. Kety. Oxford: Pergamon Press, Ltd., p 3-12. In this study, the sone of Emil Bleuler tracked 208 individuals hospitalized with schizophrenia, beginning in about 1942 and continuing for 23 years. Using the criteria established by his father and Kraeplin before him, he studied 100 males and 108 females. 68% of those with first admissions recovered. (Their symptoms disappeared or became less troublesome.) 53% of those who had had remissions recovered. “I have concluded that the prognosis of schizophrenia to be more hopeful than it has been considered,” he wrote. (This is why he changed the name of the illness from “dementia praecox,” which meant “early dementia” and implied that it led to the progressive deterioration of the brain to “schizophrenia,” implying a split in functioning in the brain.) Ciompi, L., “Lausanne studies,” in Schizophrenia Bulletin, 6, 606-618 (1980). This study followed 197 females and 93 males with the average age of 36.9 years. Using tougher rules for recovery than Bleuler, it looked at the entire lives of these individuals and still found that 57% recovered. Huber, Gross and Schuttler, “Bonn studies,” in the Schizophrenia Bulletin, 6,4, 692-705 (1980). The researchers studied 502 people who had been hospitalized for an average of 22.5 years and found that the average recovery rate was 56%. Within this large group, the researchers found that individuals fell into one of three groups. Group A recovery in all but one area; they still had delusions but they used self-control with them, worked at jobs and did relatively well. Some of them were on medications, while others were not. Group B had no signs of schizophrenia. Individuals lived in communities and functioned well except socially; they had few friends. Group C consisted of individuals who were doing well but were not working. Ogawa, K, et al, “Japanese studies,” in The British Journal of Psychiatry, 151, 678-765 (1987) The study followed 67 males and 73 females for a period of 21-17 years. 57% had a full or partial recovery. They were able to function well socially, more so than psychologically. Harding, C.M., et al, “Vermont studies,” in the American Journal of Psychiatry, 144:6, 718-726 (1987). In this Study, Dr. Harding and others observed 269 patients from the back wards of Vermont State Hospital for an average of 32 years. These individuals were the most chronically ill of all those studied. Using very strict methods, they found that half to to-thirds showed “significant improvement or recovery.” The improvements seemed to be spontaneous, for the most part coming well after treatment. Fully 45% had no psychiatric symptoms after two decades, and another 23% had lost all symptoms of schizophrenia while developing symptoms of other, more treatable mental disorders. These recoveries seem astonishing considering that the only available medications at this time were Thorazine and Haldol. Desisto, M.J., Harding, C.M., et al, “Main-Vermont comparison studies,” in The British Journal of Psychiatry, 161, 331-342 (1995). This recent study included 54 males and 45 females. Its purpose was to see if rehabilitation (in additional to medications) made recovery more possible. In Maine, where individuals received medications only, 49% improved. Summarized by Louise Loots Thornton, “Finding Hope in Schizophrenia: Healing and Hope for Everyone In the Family.”Schizophrenia Studies Bleuler, Manfred, “Bleuler Studies, Burgholz Hospital,” in The Transmission of Schizophrenia, 1968, editors D. Rosenthal and S.S. Kety. Oxford: Pergamon Press, Ltd., p 3-12. In this study, the sone of Emil Bleuler tracked 208 individuals hospitalized with schizophrenia, beginning in about 1942 and continuing for 23 years. Using the criteria established by his father and Kraeplin before him, he studied 100 males and 108 females. 68% of those with first admissions recovered. (Their symptoms disappeared or became less troublesome.) 53% of those who had had remissions recovered. “I have concluded that the prognosis of schizophrenia to be more hopeful than it has been considered,” he wrote. (This is why he changed the name of the illness from “dementia praecox,” which meant “early dementia” and implied that it led to the progressive deterioration of the brain to “schizophrenia,” implying a split in functioning in the brain.) Ciompi, L., “Lausanne studies,” in Schizophrenia Bulletin, 6, 606-618 (1980). This study followed 197 females and 93 males with the average age of 36.9 years. Using tougher rules for recovery than Bleuler, it looked at the entire lives of these individuals and still found that 57% recovered. Huber, Gross and Schuttler, “Bonn studies,” in the Schizophrenia Bulletin, 6,4, 692-705 (1980). The researchers studied 502 people who had been hospitalized for an average of 22.5 years and found that the average recovery rate was 56%. Within this large group, the researchers found that individuals fell into one of three groups. Group A recovery in all but one area; they still had delusions but they used self-control with them, worked at jobs and did relatively well. Some of them were on medications, while others were not. Group B had no signs of schizophrenia. Individuals lived in communities and functioned well except socially; they had few friends. Group C consisted of individuals who were doing well but were not working. Ogawa, K, et al, “Japanese studies,” in The British Journal of Psychiatry, 151, 678-765 (1987) The study followed 67 males and 73 females for a period of 21-17 years. 57% had a full or partial recovery. They were able to function well socially, more so than psychologically. Harding, C.M., et al, “Vermont studies,” in the American Journal of Psychiatry, 144:6, 718-726 (1987). In this Study, Dr. Harding and others observed 269 patients from the back wards of Vermont State Hospital for an average of 32 years. These individuals were the most chronically ill of all those studied. Using very strict methods, they found that half to to-thirds showed “significant improvement or recovery.” The improvements seemed to be spontaneous, for the most part coming well after treatment. Fully 45% had no psychiatric symptoms after two decades, and another 23% had lost all symptoms of schizophrenia while developing symptoms of other, more treatable mental disorders. These recoveries seem astonishing considering that the only available medications at this time were Thorazine and Haldol. Desisto, M.J., Harding, C.M., et al, “Main-Vermont comparison studies,” in The British Journal of Psychiatry, 161, 331-342 (1995). This recent study included 54 males and 45 females. Its purpose was to see if rehabilitation (in additional to medications) made recovery more possible. In Maine, where individuals received medications only, 49% improved. Summarized by Louise Loots Thornton, “Finding Hope in Schizophrenia: Healing and Hope for Everyone In the Family.”

8. …but these findings are not new. Whitaker, Robert. Mad in America; Bad Science, Bad Medicine, and the Enduring Mistreatment of the Menatlly Ill. (Perseus Publishing, 2002). p. 27 Grob, Gerald. The Mad Among Us (Harvard University Press, 1994), p. 99. Moral Treatment began in France in 1793 when Philippe Pinel guided by the work of Jean Baptiste Pussin, found that “if the insane were not treated cruelly, they behaved in a fairly order fashion. The rantings and ravings that appeared to define the mad-the tearing of clothes, the smearing of feces, the screaming-were primarily antics of protest over inhumane treatment.” Whitaker, p 20. 1796, William Tuke founded the Retreat at York, England, which provided humane, "moral" treatment of the mentally ill. “It was a simple place with gardens and walks where the ill could get their fill of fresh air. They fed patients four times daily and regularly provided snacks that included biscuits along with a glass of wine or porter. They head tea parties, at which the patient were encouraged to dress up. During the day, patients were kept busy with a variety of tasks-sewing, gardening, and other domestic activities and given opportunities to read, write, and play games like chess. Poetry was seen as particularly therapeutic.” In this gentle environment, few needed to be confined. There was rarely a day when as many as two patients had to be secluded at the same time…. In its first fifteen years of operation, not a single attendant at the York Retreat was seriously injured by a violent patient. …. “The majority had been “insane” for more that a year and many had been previously locked up in other English asylums, where they were viewed as incurable….. During the York Retreat’s first fifteen years, 70% of the patients who had been ill for less than 12 months recovered, which was defined by Tuke as never relapsing into illness. Even 25% of the patients who had been chronically ill before coming to the retreat, viewed as incurable, recovered under this treatment and had not relapsed by 1813, the year Tuke published Description of the Retreat. Whitaker p 23-24 Thomas Scattergood, a Philadelphia Quaker, visited the York Retreat and was favorably impressed. In 1811 he proposed to the Philadelphia Friends that they build a similar institution for "such of our members as may be deprived of the use of their reason." In 1812, a committee of seven Philadelphia Quakers was chosen to implement the plans for an asylum for the mentally ill. One of the seven was Isaac Bonsall, then aged 47, a successful farmer. In the ensuing five years, Bonsall’s efforts, concern, and personality must have impressed his fellow Quakers, for in 1817, "after mature deliberation" by the Managers, Isaac Bonsall and his wife Ann were appointed the first Superintendent and Matron of Friends Asylum. Several other institutions practicing Moral Treatment soon appeared; in Boston 1818 which later became McLean Hospital, Bloomingdale Asylum in NYC in 19821; Hartford Retreat in CT in 1824. The first public asylum using moral treatment opened in 1833 in Worcester, Mass and by 1841 there were sixteen private and public asylums in the US that promised to provide moral treatment to the insane. Blueprint for moral treatment.. facility was to be kept small, providing care to no more than 250 patients. It should be located in the country, the grounds graced by flowerbeds and gardens, where the mentally ill could take their fill of fresh air and find solace in tending to plants. The building itself should be architecturally pleasing… Most important, the asylum was to be governed by a superintendent who was “reasonable, humane…possessing stability and dignity of character, mild and gentle…compassionate. He would be expected to know his patients well, eat with them, and, in the manner of a father figure, guide them toward a path of reason. Whitaker p. 26. Whitaker, Robert. Mad in America; Bad Science, Bad Medicine, and the Enduring Mistreatment of the Menatlly Ill. (Perseus Publishing, 2002). p. 27 Grob, Gerald. The Mad Among Us (Harvard University Press, 1994), p. 99. Moral Treatment began in France in 1793 when Philippe Pinel guided by the work of Jean Baptiste Pussin, found that “if the insane were not treated cruelly, they behaved in a fairly order fashion. The rantings and ravings that appeared to define the mad-the tearing of clothes, the smearing of feces, the screaming-were primarily antics of protest over inhumane treatment.” Whitaker, p 20. 1796, William Tuke founded the Retreat at York, England, which provided humane, "moral" treatment of the mentally ill. “It was a simple place with gardens and walks where the ill could get their fill of fresh air. They fed patients four times daily and regularly provided snacks that included biscuits along with a glass of wine or porter. They head tea parties, at which the patient were encouraged to dress up. During the day, patients were kept busy with a variety of tasks-sewing, gardening, and other domestic activities and given opportunities to read, write, and play games like chess. Poetry was seen as particularly therapeutic.” In this gentle environment, few needed to be confined. There was rarely a day when as many as two patients had to be secluded at the same time…. In its first fifteen years of operation, not a single attendant at the York Retreat was seriously injured by a violent patient. …. “The majority had been “insane” for more that a year and many had been previously locked up in other English asylums, where they were viewed as incurable….. During the York Retreat’s first fifteen years, 70% of the patients who had been ill for less than 12 months recovered, which was defined by Tuke as never relapsing into illness. Even 25% of the patients who had been chronically ill before coming to the retreat, viewed as incurable, recovered under this treatment and had not relapsed by 1813, the year Tuke published Description of the Retreat. Whitaker p 23-24 Thomas Scattergood, a Philadelphia Quaker, visited the York Retreat and was favorably impressed. In 1811 he proposed to the Philadelphia Friends that they build a similar institution for "such of our members as may be deprived of the use of their reason." In 1812, a committee of seven Philadelphia Quakers was chosen to implement the plans for an asylum for the mentally ill. One of the seven was Isaac Bonsall, then aged 47, a successful farmer. In the ensuing five years, Bonsall’s efforts, concern, and personality must have impressed his fellow Quakers, for in 1817, "after mature deliberation" by the Managers, Isaac Bonsall and his wife Ann were appointed the first Superintendent and Matron of Friends Asylum. Several other institutions practicing Moral Treatment soon appeared; in Boston 1818 which later became McLean Hospital, Bloomingdale Asylum in NYC in 19821; Hartford Retreat in CT in 1824. The first public asylum using moral treatment opened in 1833 in Worcester, Mass and by 1841 there were sixteen private and public asylums in the US that promised to provide moral treatment to the insane. Blueprint for moral treatment.. facility was to be kept small, providing care to no more than 250 patients. It should be located in the country, the grounds graced by flowerbeds and gardens, where the mentally ill could take their fill of fresh air and find solace in tending to plants. The building itself should be architecturally pleasing… Most important, the asylum was to be governed by a superintendent who was “reasonable, humane…possessing stability and dignity of character, mild and gentle…compassionate. He would be expected to know his patients well, eat with them, and, in the manner of a father figure, guide them toward a path of reason. Whitaker p. 26.

9. “I have nowhere met, except in romances, with fonder husbands, more affectionate parents, more impassioned lovers, more pure and exalted patriots, than in the lunatic asylum… A man of sensibility may go there every day of his life, and witness scenes of indescribable tenderness to a most estimable virtue.” 1801. Philippe Pinel. Paris France Philippe Pinel, a renowned French physician in the 1700s is considered one of the founders of psychiatry. After a friend of his in 1785 went mad and ran into the countryside, where he was eaten by wolves, Pinel began visiting privately confined mental patients,. From that time Pinel devoted his time to mental illness, and in 1792 he became the chief physician at Bicêtre, the Paris asylum for the incurable insane men. There he found appalling conditions, with patients being chained to the walls - many of whom had been restrained for 30 to 40 years - treated like beasts, and put on display to the public, who paid admission to see them.  In 1793 he was appointed médecin des infirmeries of the Hospice de Bicêtre in Paris, where he was able to begin implementing his ideas on the humane treatment of the insane. At the Bicêtre Pinel had the chains removed from his patients, an event commemorated in both paintings and popular prints. Pinel did away with such treatments as bleeding, purging, and blistering and favoured a therapy that included close and friendly contact with the patient, discussion of personal difficulties, and a program of purposeful activities.  Pinel's psychiatric therapeutics, his "traitement moral,” provided the basis of what was to become Moral Treatment and represented the first attempt at individual psychotherapy. His treatment was marked by gentleness, understanding, and goodwill. He was opposed to violent methods - although he did not hesitate to employ the straitjacket or force-feeding when necessary. He recommended close medical attendance during convalescence, and he emphasized the need of hygiene, physical exercise, and a program of purposeful work for the patient. A number of Pinel's therapeutic procedures, including ergo therapy and the placement of the patient in a family group, anticipate modern psychiatric care. A statue in his honor has these words, “In a rejection of the traditional and barbaric treatment of the mad, Pinel extended the revolutionary doctrine of liberty by unchaining them and treating their condition by "moral therapy". His patients were no longer to be feared, nor ridiculed, nor pitied, but understood….. His theory, quickly taken up in England and elsewhere, was a perfect match for the contemporary climate of romantic sensibility and humanitarianism. Bolstered by a physiological science in the new fashion of phrenology, it marked the greatest transformation in the science of mentality since the middle ages."  http://www.whonamedit.com/doctor.cfm/1027.htmlPhilippe Pinel, a renowned French physician in the 1700s is considered one of the founders of psychiatry. After a friend of his in 1785 went mad and ran into the countryside, where he was eaten by wolves, Pinel began visiting privately confined mental patients,. From that time Pinel devoted his time to mental illness, and in 1792 he became the chief physician at Bicêtre, the Paris asylum for the incurable insane men. There he found appalling conditions, with patients being chained to the walls - many of whom had been restrained for 30 to 40 years - treated like beasts, and put on display to the public, who paid admission to see them. In 1793 he was appointed médecin des infirmeries of the Hospice de Bicêtre in Paris, where he was able to begin implementing his ideas on the humane treatment of the insane. At the Bicêtre Pinel had the chains removed from his patients, an event commemorated in both paintings and popular prints. Pinel did away with such treatments as bleeding, purging, and blistering and favoured a therapy that included close and friendly contact with the patient, discussion of personal difficulties, and a program of purposeful activities. Pinel's psychiatric therapeutics, his "traitement moral,” provided the basis of what was to become Moral Treatment and represented the first attempt at individual psychotherapy. His treatment was marked by gentleness, understanding, and goodwill. He was opposed to violent methods - although he did not hesitate to employ the straitjacket or force-feeding when necessary. He recommended close medical attendance during convalescence, and he emphasized the need of hygiene, physical exercise, and a program of purposeful work for the patient. A number of Pinel's therapeutic procedures, including ergo therapy and the placement of the patient in a family group, anticipate modern psychiatric care. A statue in his honor has these words, “In a rejection of the traditional and barbaric treatment of the mad, Pinel extended the revolutionary doctrine of liberty by unchaining them and treating their condition by "moral therapy". His patients were no longer to be feared, nor ridiculed, nor pitied, but understood….. His theory, quickly taken up in England and elsewhere, was a perfect match for the contemporary climate of romantic sensibility and humanitarianism. Bolstered by a physiological science in the new fashion of phrenology, it marked the greatest transformation in the science of mentality since the middle ages." http://www.whonamedit.com/doctor.cfm/1027.html

10. “If there is any secret in the management of the insane, it is this: respect them and they will respect themselves; treat them as reasonable beings, and they will take every possible pain to show you that they are such; give them your confidence, and they will rightly appreciate it, and rarely abuse it.” 1833. Samuel Woodward, M.D., Worchester Asylum Dr. Samuel B. Woodward, Superintendent of the Worcester (Massachusetts) State Hospital played an important role in the development of moral therapy, a new treatment of people with mental illness in the 1830s and 1840s In his annual reports Woodward claimed high rates of recovery. "In recent cases of insanity under judicious treatment as large a proportion of recoveries will take place as from any other acute disease of equal severity." (WSH Annual Report, 1835.) Between the years of 1833 and 1845 the percentage of recoveries of recent cases was from 82 to 91% annually. These figures were disputed later. Yet in the 1880s a long-term follow-up study by Dr. John G. Park, then Superintendent of Worcester State Hospital, found that over 58% of the people listed as recovered by Woodward between 1833 and 1846 had no further episodes of insanity in the next 50 years. (WSH Annual Report LXI, 1893.) Dr. Samuel B. Woodward, Superintendent of the Worcester (Massachusetts) State Hospital played an important role in the development of moral therapy, a new treatment of people with mental illness in the 1830s and 1840s In his annual reports Woodward claimed high rates of recovery. "In recent cases of insanity under judicious treatment as large a proportion of recoveries will take place as from any other acute disease of equal severity." (WSH Annual Report, 1835.) Between the years of 1833 and 1845 the percentage of recoveries of recent cases was from 82 to 91% annually. These figures were disputed later. Yet in the 1880s a long-term follow-up study by Dr. John G. Park, then Superintendent of Worcester State Hospital, found that over 58% of the people listed as recovered by Woodward between 1833 and 1846 had no further episodes of insanity in the next 50 years. (WSH Annual Report LXI, 1893.)

11. “I think it is not too much to assume that insanity is more curable than any other disease of equal severity; more likely to be cured than intermittent fever, pneumonia, or rheumatism.” 1843. Samuel Woodward, M.D., Worchester Asylum

12. Thomas Kirkbride, a Quaker physician, who continuously governed the Pennsylvania Hospital for the Insane, practiced Moral Treatment throughout his entire tenure. The Pennsylvania Hospital opened in 1841 in the countryside west of Philadelphia, was an opulent place. It had a lovely dining room, a day room for playing games, and even a bowling alley. Kirkbride added a greenhouse and museum, complete with stuffed birds, for the patient’s amusement. Flowerbeds and meticulous landscaping furthered the sense of pastoral comfort…. Whitaker. p. 31. Kirkbride embraced all the usual methods of moral treatment, applying them with unflagging energy. Patients, roused from their beds at 6:00AM sharp, exercised daily in the gymnasium. They often dressed well, men in suites and ties and women in fine dresses, and during the afternoon they would pleasantly pass hours in the reading parlor, which had 1,100 volumes. Teachers were hired to give classes in reading and sewing. Evening entertainment at the asylum featured magic-lantern shows, guest lectures, concerts, and theatrical performances, a parade of activities that became famous locally for their high quality. At night patients retired to semiprivate rooms that could have done a modest hotel proud. The chest of drawers, mirror, and wall paintings in each room helped patients feel respected and surrounded by comfort. Whitaker. p. 32. Dr. Thomas Story Kirkbride, who served the Pennsylvania Hospital as the superintendent from 1841-1883 created a humane and compassionate environment for his patients, and believed that beautiful settings restored patients to a more natural "balance of the senses". Dr. Kirkbride's progressive therapies and innovative writings on hospital design and management became known as the Kirkbride Plan, which influenced, in one form or another, almost every American state hospital by the turn of the century. http://www.danvers-state-ia.com/history.htmlThomas Kirkbride, a Quaker physician, who continuously governed the Pennsylvania Hospital for the Insane, practiced Moral Treatment throughout his entire tenure. The Pennsylvania Hospital opened in 1841 in the countryside west of Philadelphia, was an opulent place. It had a lovely dining room, a day room for playing games, and even a bowling alley. Kirkbride added a greenhouse and museum, complete with stuffed birds, for the patient’s amusement. Flowerbeds and meticulous landscaping furthered the sense of pastoral comfort…. Whitaker. p. 31. Kirkbride embraced all the usual methods of moral treatment, applying them with unflagging energy. Patients, roused from their beds at 6:00AM sharp, exercised daily in the gymnasium. They often dressed well, men in suites and ties and women in fine dresses, and during the afternoon they would pleasantly pass hours in the reading parlor, which had 1,100 volumes. Teachers were hired to give classes in reading and sewing. Evening entertainment at the asylum featured magic-lantern shows, guest lectures, concerts, and theatrical performances, a parade of activities that became famous locally for their high quality. At night patients retired to semiprivate rooms that could have done a modest hotel proud. The chest of drawers, mirror, and wall paintings in each room helped patients feel respected and surrounded by comfort. Whitaker. p. 32. Dr. Thomas Story Kirkbride, who served the Pennsylvania Hospital as the superintendent from 1841-1883 created a humane and compassionate environment for his patients, and believed that beautiful settings restored patients to a more natural "balance of the senses". Dr. Kirkbride's progressive therapies and innovative writings on hospital design and management became known as the Kirkbride Plan, which influenced, in one form or another, almost every American state hospital by the turn of the century. http://www.danvers-state-ia.com/history.html

13. What does RECOVERY mean? A common human experience. Developing new meaning and purpose in life. (W. Anthony, 1993). Develop and further rebuild important connections (L. Spaniol) A common human experience. Here it is good to ask people in the class to share what they have recovered from. Sharing our own stories of recovery is a way to get people in touch with the recovery experience and begins to build a bridge; the connection between us. Dr. William Anthony describes recovery “as a deeply personal, unique process of changing one’s attitudes, values, feelings, goals, skills, and/or roles. It is a way of living a satisfying, hopeful, contributing life even with limitations cause by illness. Recovery involves the development of new meaning and purpose in one’s life as one grows beyond the catastrophic effects of mental illness.” In “Recovery from Mental Illness: The Guiding Vision of the Mental Health Service System in the 1990s.” LeRoy Spaniol, Ph.D., also of Boston University, describes recovery as “a process whereby people with psychiatric disability rebuild and further develop important personal, social, environmental, and spiritual connections and confront the devastating effects of stigma and discrimination through personal empowerment.” A common human experience. Here it is good to ask people in the class to share what they have recovered from. Sharing our own stories of recovery is a way to get people in touch with the recovery experience and begins to build a bridge; the connection between us. Dr. William Anthony describes recovery “as a deeply personal, unique process of changing one’s attitudes, values, feelings, goals, skills, and/or roles. It is a way of living a satisfying, hopeful, contributing life even with limitations cause by illness. Recovery involves the development of new meaning and purpose in one’s life as one grows beyond the catastrophic effects of mental illness.” In “Recovery from Mental Illness: The Guiding Vision of the Mental Health Service System in the 1990s.” LeRoy Spaniol, Ph.D., also of Boston University, describes recovery as “a process whereby people with psychiatric disability rebuild and further develop important personal, social, environmental, and spiritual connections and confront the devastating effects of stigma and discrimination through personal empowerment.”

14. Our Definition of Recovery Remembering who you are and using your strengths to become all you were meant to be. There are other good definitions, but the one we have found fits with our work is “remembering who you are and using your strengths to become all you are meant to be.” This definition, for us, is simple to remember but gets to the core issue. This definition has provided a focus that guides our work with people so when people are having a tough time we help them remember who they are and remind them of their strengths to bring them forward. There are other good definitions, but the one we have found fits with our work is “remembering who you are and using your strengths to become all you are meant to be.” This definition, for us, is simple to remember but gets to the core issue. This definition has provided a focus that guides our work with people so when people are having a tough time we help them remember who they are and remind them of their strengths to bring them forward.

15. Don’t forget “Remember Who You Are”, Conversations with God, Disc 2. Windham Hill. Sung by Cathy Bolton. If you are using the PowerPoint, the song will continue to repeat until you press the space bar.“Remember Who You Are”, Conversations with God, Disc 2. Windham Hill. Sung by Cathy Bolton. If you are using the PowerPoint, the song will continue to repeat until you press the space bar.

31. We have a tendency to like the up part. But since we know there is also the down side, sometimes we call these relapses or crisis, we can create prevention plans that will get people through the downs. Sometimes we may be tempted to “give up” on the person during the down times… like put them in the hospital too quickly, or label them non-compliant, or even toss them out of our programs. The recovery-oriented approach has a prevention plan in place and keeps working alongside the person, knowing that the “down” is part of the growth process. Even though symptoms may remain, the person can still find ways to get on with their life, especially when the focus is on the person’s strengths and not on their symptoms. If you have a personal story or example of this, this is a good place to share what it is like for you. But, as a person recovers, some find symptoms actually disappear, but for most they do decrease. For Lisa, when she started here recovery path, she wrote out 13 pages of triggers. She was constantly in a condition of being triggered. After a year of recovering, her triggers had decreased to just three. Medication is an very important tool. May want to comment on our experience that as people recover, they develop additional coping skills and, as a general rule, the medications need to be adjusted, decreased, and some eliminated. Many people have been told that since they have recovered they must not have had a mental illness to start with. “You must have been misdiagnosed.” Recovering from the consequences is about rejection, stigma, discrimination that may have often become internalized by the person so their self talk is negative and they developed internalized stigma. Show the next slide to give examples of this. We have a tendency to like the up part. But since we know there is also the down side, sometimes we call these relapses or crisis, we can create prevention plans that will get people through the downs. Sometimes we may be tempted to “give up” on the person during the down times… like put them in the hospital too quickly, or label them non-compliant, or even toss them out of our programs. The recovery-oriented approach has a prevention plan in place and keeps working alongside the person, knowing that the “down” is part of the growth process. Even though symptoms may remain, the person can still find ways to get on with their life, especially when the focus is on the person’s strengths and not on their symptoms. If you have a personal story or example of this, this is a good place to share what it is like for you. But, as a person recovers, some find symptoms actually disappear, but for most they do decrease. For Lisa, when she started here recovery path, she wrote out 13 pages of triggers. She was constantly in a condition of being triggered. After a year of recovering, her triggers had decreased to just three. Medication is an very important tool. May want to comment on our experience that as people recover, they develop additional coping skills and, as a general rule, the medications need to be adjusted, decreased, and some eliminated. Many people have been told that since they have recovered they must not have had a mental illness to start with. “You must have been misdiagnosed.” Recovering from the consequences is about rejection, stigma, discrimination that may have often become internalized by the person so their self talk is negative and they developed internalized stigma. Show the next slide to give examples of this.

32. What People Recover From. Dr. Kaly is a psychiatrist from Australia who has traveled around the world asking people what they recover from as well as what has helped them recover. The items on this slide are the themes he has discovered. So, the power of this slide is that most of the time when people come to us, it is not only, and sometimes not even, their symptoms, but rather all these other things that they have to recover from and overcome. If you are using the PowerPoint, after you have clicked through all of these items, the final click will show all of the items interacting simultaneously demonstrating the sense of confusion and overwhelm people often feel, not know where to begin.Dr. Kaly is a psychiatrist from Australia who has traveled around the world asking people what they recover from as well as what has helped them recover. The items on this slide are the themes he has discovered. So, the power of this slide is that most of the time when people come to us, it is not only, and sometimes not even, their symptoms, but rather all these other things that they have to recover from and overcome. If you are using the PowerPoint, after you have clicked through all of these items, the final click will show all of the items interacting simultaneously demonstrating the sense of confusion and overwhelm people often feel, not know where to begin.

33. Recovery Pathwaysfrom our experience Hope Choice Empowerment Recovery Culture Spirituality; meaning and purpose Webster defines pathway as a “footpath, a beaten track, any path or course.” Our services should be built to create opportunities to help people find these pathways. As we create and keep recreating these opportunities throughout all our services recovery grows for each person. Use this slide just for an overview of the pathways and then move on to the next slides for detailed discussion.Webster defines pathway as a “footpath, a beaten track, any path or course.” Our services should be built to create opportunities to help people find these pathways. As we create and keep recreating these opportunities throughout all our services recovery grows for each person. Use this slide just for an overview of the pathways and then move on to the next slides for detailed discussion.

34. In the movie “The Beautiful Mind” John Nash hears what Pat Deegan refers to as “the prophecy of doom”. Notice how Professor Nash struggles to hold on to hope, “I can do this,” in spite of Dr. Rosen’s words, “schizophrenia is degenerative, over time you’re getting worse.” It is not the intention of this clip from “The Beautiful Mind” to characterize professionals as “harmful”. But, historically, people have been told that there was no hope for recovery, that over time they would get worse, that at best all they could expect was to “cope”. If you are using PowerPoint, when you go the next slide, the “The Beautiful Mind; No Hope” video clip will play automatically. If using overheads, play the video on the DVD. It is not the intention of this clip from “The Beautiful Mind” to characterize professionals as “harmful”. But, historically, people have been told that there was no hope for recovery, that over time they would get worse, that at best all they could expect was to “cope”. If you are using PowerPoint, when you go the next slide, the “The Beautiful Mind; No Hope” video clip will play automatically. If using overheads, play the video on the DVD.

36. Hope Hope is the beginning. It’s a thought that things can get better and a feeling of courage with a spark of new energy. Creates a “turning point”. Hope means “I can have dreams”. A vision of a better future; there are “no limits.” Someone else can hold the hope. “And there was this person”. Hope is where recovery starts. Too often, our services have not given the message of hope. In fact, we have told people with serious issues, like schizophrenia, they could not recover and at best they could expect to be “stable” or “just maintain”. We know this is not true. There is lots of hope; from the research, but also from the recovery stories of hundreds of thousands of people. The word “turning point” is being used more and more because for many people, they describe a moment when they saw new possibilities, an point of awakening, if you will. This “turning point” always involves hope. Sometimes people bring up the idea of giving “false hope”. Some people who are in recovery say that for them, having “false hope” was so much better that having no hope at all. But hope is energy and that energy begins to move people forward in ways that they may not have thought possible. And, with the fact of recovery, the hope we give is genuine, based in fact. Most recovering people remember a person who “held the hope” for them when they felt hopeless. This can be done by anyone, sometimes, the most unexpected person. A comment made by a taxi driver, police officer, grocery store clerk. “Holding the hope” is a wonderful role for professionals, perhaps one of the most important things we can do. If you are using PowerPoint, when you go the next slide, the hope video will play automatically. If using overheads, play the hope video on the DVD.Hope is where recovery starts. Too often, our services have not given the message of hope. In fact, we have told people with serious issues, like schizophrenia, they could not recover and at best they could expect to be “stable” or “just maintain”. We know this is not true. There is lots of hope; from the research, but also from the recovery stories of hundreds of thousands of people. The word “turning point” is being used more and more because for many people, they describe a moment when they saw new possibilities, an point of awakening, if you will. This “turning point” always involves hope. Sometimes people bring up the idea of giving “false hope”. Some people who are in recovery say that for them, having “false hope” was so much better that having no hope at all. But hope is energy and that energy begins to move people forward in ways that they may not have thought possible. And, with the fact of recovery, the hope we give is genuine, based in fact. Most recovering people remember a person who “held the hope” for them when they felt hopeless. This can be done by anyone, sometimes, the most unexpected person. A comment made by a taxi driver, police officer, grocery store clerk. “Holding the hope” is a wonderful role for professionals, perhaps one of the most important things we can do. If you are using PowerPoint, when you go the next slide, the hope video will play automatically. If using overheads, play the hope video on the DVD.

37. Stories from graduates at META Services Peer Support Training graduation.Stories from graduates at META Services Peer Support Training graduation.

38. A person comes to our crisis service. They are crying, frightened and filled with despair. How can you communicate hope? What we often do when a person comes in to our services is start with an “assessment”. Traditionally these assessments focus on “what is wrong”, “the problem”. This focus can have the effect of making the “problem” even bigger, by dwelling on what is not working. So, have the audience think about doing this differently. A hopeful focus can be created by “remembering who you are”, “who you really are, or were born to be”. Go back to a time when things were working better and recreate that experience. Remember how we start working on WRAP (Wellness Recovery Action Plan)…. “What am I like when I am well?” Another hopeful alternative is to create the dream. “What I can become.” “You won’t always feel this way. In fact, tomorrow will be a better day.” “There is lots of hope!” What we often do when a person comes in to our services is start with an “assessment”. Traditionally these assessments focus on “what is wrong”, “the problem”. This focus can have the effect of making the “problem” even bigger, by dwelling on what is not working. So, have the audience think about doing this differently. A hopeful focus can be created by “remembering who you are”, “who you really are, or were born to be”. Go back to a time when things were working better and recreate that experience. Remember how we start working on WRAP (Wellness Recovery Action Plan)…. “What am I like when I am well?” Another hopeful alternative is to create the dream. “What I can become.” “You won’t always feel this way. In fact, tomorrow will be a better day.” “There is lots of hope!”

39. In the movie “The Beautiful Mind” this dramatic scene illustrates the consequences and the fear associated with not having the choice. The video that follows is upsetting. It is not our intention here to say that this is how people have always been treated. But we know that still today the lack of choice leads to tragic consequences both for the person needing help as well as the person giving help. This certainly is not intended to make psychiatry or doctors look bad (although Dr. Rosen does look bad in the clip). But, it is a provocative discussion of what other options or choices could have been offered to avoid this situation. If you are using PowerPoint, when you go the next slide, the “John Nash; Against My Will” video clip will play automatically. If using overheads, play the video on the DVD. The video that follows is upsetting. It is not our intention here to say that this is how people have always been treated. But we know that still today the lack of choice leads to tragic consequences both for the person needing help as well as the person giving help. This certainly is not intended to make psychiatry or doctors look bad (although Dr. Rosen does look bad in the clip). But, it is a provocative discussion of what other options or choices could have been offered to avoid this situation. If you are using PowerPoint, when you go the next slide, the “John Nash; Against My Will” video clip will play automatically. If using overheads, play the video on the DVD.

44. Recovery Pathway 2: Choice “The more I choose, the more I recover.” (Kristina) Because, making choices is how we remember/discover who we are. Recovery value: each person is the expert in what works for them. Since recovery is “remembering who we are and becoming all we are meant to be.” making choices helps people recovery by discovering who they are. Ask someone from the audience to make a choice. “Do you like apples or oranges?” or, “Do you prefer day shifts or evening shifts”, “Which do you like better comedy or drama?” This illustrates in a simple way how people begin to define themselves and remember who they are. The risk issue comes up whenever we talk about choice. But this is how we grow. But we can we can share the risk with the person. The example of a child learning to walk. As the child takes more risk, walking skills develop. A recovery approach offers people lots of choices and provides many opportunities for them to catch glimpses of themselves through the choices they make. We have probably all had experiences with various caregivers, providers, and even family members who insist on restricting our choices because they are trying to protect us from ourselves. The myth they are operating under perpetuates the concept that a person who has been diagnosed with a psychiatric illness has impaired judgment and cannot make sound decisions. They decide to make all the choices for us, and in so doing, they take one of the most important recovery experiences away from us – choice Since recovery is “remembering who we are and becoming all we are meant to be.” making choices helps people recovery by discovering who they are. Ask someone from the audience to make a choice. “Do you like apples or oranges?” or, “Do you prefer day shifts or evening shifts”, “Which do you like better comedy or drama?” This illustrates in a simple way how people begin to define themselves and remember who they are. The risk issue comes up whenever we talk about choice. But this is how we grow. But we can we can share the risk with the person. The example of a child learning to walk. As the child takes more risk, walking skills develop. A recovery approach offers people lots of choices and provides many opportunities for them to catch glimpses of themselves through the choices they make. We have probably all had experiences with various caregivers, providers, and even family members who insist on restricting our choices because they are trying to protect us from ourselves. The myth they are operating under perpetuates the concept that a person who has been diagnosed with a psychiatric illness has impaired judgment and cannot make sound decisions. They decide to make all the choices for us, and in so doing, they take one of the most important recovery experiences away from us – choice

45. If people in the training haven’t seen the movie, or read the book, give some background. This video has three clips from the movie. In all three clips, Professor Nash experiences visual and auditory hallucinations, seeing his imaginary friends William Parcher, Charles, and baby girl. In each instance his recovery is strengthened as he makes the choice to ignore his symptoms.If people in the training haven’t seen the movie, or read the book, give some background. This video has three clips from the movie. In all three clips, Professor Nash experiences visual and auditory hallucinations, seeing his imaginary friends William Parcher, Charles, and baby girl. In each instance his recovery is strengthened as he makes the choice to ignore his symptoms.

46. Recovery Pathway 2: Choice Risk sharing not risk management Risk prevention plans WRAP crisis plan Advance Directives Since recovery is “remembering who we are and becoming all we are meant to be.” making choices helps people recovery by discovering who they are. Ask someone from the audience to make a choice. “Do you like apples or oranges?” or, “Do you prefer day shifts or evening shifts”, “Which do you like better comedy or drama?” This illustrates in a simple way how people begin to define themselves and remember who they are. The risk issue comes up whenever we talk about choice. But this is how we grow. But we can we can share the risk with the person. The example of a child learning to walk. As the child takes more risk, walking skills develop. A recovery approach offers people lots of choices and provides many opportunities for them to catch glimpses of themselves through the choices they make. We have probably all had experiences with various caregivers, providers, and even family members who insist on restricting our choices because they are trying to protect us from ourselves. The myth they are operating under perpetuates the concept that a person who has been diagnosed with a psychiatric illness has impaired judgment and cannot make sound decisions. They decide to make all the choices for us, and in so doing, they take one of the most important recovery experiences away from us – choice If you are using PowerPoint, when you go the next slide, the “John Nash Makes the Choice” will play automatically. If using overheads, play the video on the DVD. Since recovery is “remembering who we are and becoming all we are meant to be.” making choices helps people recovery by discovering who they are. Ask someone from the audience to make a choice. “Do you like apples or oranges?” or, “Do you prefer day shifts or evening shifts”, “Which do you like better comedy or drama?” This illustrates in a simple way how people begin to define themselves and remember who they are. The risk issue comes up whenever we talk about choice. But this is how we grow. But we can we can share the risk with the person. The example of a child learning to walk. As the child takes more risk, walking skills develop. A recovery approach offers people lots of choices and provides many opportunities for them to catch glimpses of themselves through the choices they make. We have probably all had experiences with various caregivers, providers, and even family members who insist on restricting our choices because they are trying to protect us from ourselves. The myth they are operating under perpetuates the concept that a person who has been diagnosed with a psychiatric illness has impaired judgment and cannot make sound decisions. They decide to make all the choices for us, and in so doing, they take one of the most important recovery experiences away from us – choice If you are using PowerPoint, when you go the next slide, the “John Nash Makes the Choice” will play automatically. If using overheads, play the video on the DVD.

47. A dialogue with META Services Peer Support Specialists on choice and personal responsibilityA dialogue with META Services Peer Support Specialists on choice and personal responsibility

48. Resistance is the beginning of getting power back; finding my voice. Resistance fosters Resilience. The person begins to come back and remember who they are. Recovery is the person’s job; they have to have the power. We use the formula “resistance = resilience = recovery”. To recover a person has to have personal power. When someone says “NO!”, this is the beginning of the person coming back. We do not label this as “non-compliance” or critically describe the “NO” as “treatment resistance” or “lack of insight”, or “lack of motivation”. We honor the resistance. We go with the person’s resistance because that is how they get the power to recover. The definition of resilience is “the physical property of a material that can return to its original shape or position after deformation….” It is “an occurrence of rebounding or springing back.” We like to use a rubber band and have people stretch it and snap it noticing how it springs back to its original shape. People are like this too. It’s a natural tendency. We don’t want to get in the way of that springing back. In fact we find ways to encourage it. Too often, our services have been designed so we have all the power. We decide the service plan. We design the program. And we expect the person will cooperate. This approach is not empowering. Recovery moves forward with the person has the power. Since recovery is the person’s job, and we can’t do it for them, they need to be empowered to do it. Once we step into a helping role, we may have a tendency to want to do things to or for the people we are trying to help. If we give in to this tendency, we inadvertently take the power for ourselves instead of giving it to the person. This may make us feel strong and competent, but it doesn’t help the person experience their own power, which is exactly what they need to do to begin the recovery journey. So how do we make sure the power stays with the person so they can recover? Discuss how sometimes staff have taken the position, “Just recover, its your job.” Using recovery as a club is demeaning and mean. We should tell people that they can recover and then help them find their power. If you are using PowerPoint, when you go the next slide, the “Empowerment” video will play automatically. If using overheads, play the “empowerment” video on the DVD. Some discussion of this video is helpful. Kristina, in the last clip, described a situation in which she was being “dramatic” and probably irritating. She cites this experience as empowering and today Kristina has recovered. We use the formula “resistance = resilience = recovery”. To recover a person has to have personal power. When someone says “NO!”, this is the beginning of the person coming back. We do not label this as “non-compliance” or critically describe the “NO” as “treatment resistance” or “lack of insight”, or “lack of motivation”. We honor the resistance. We go with the person’s resistance because that is how they get the power to recover. The definition of resilience is “the physical property of a material that can return to its original shape or position after deformation….” It is “an occurrence of rebounding or springing back.” We like to use a rubber band and have people stretch it and snap it noticing how it springs back to its original shape. People are like this too. It’s a natural tendency. We don’t want to get in the way of that springing back. In fact we find ways to encourage it. Too often, our services have been designed so we have all the power. We decide the service plan. We design the program. And we expect the person will cooperate. This approach is not empowering. Recovery moves forward with the person has the power. Since recovery is the person’s job, and we can’t do it for them, they need to be empowered to do it. Once we step into a helping role, we may have a tendency to want to do things to or for the people we are trying to help. If we give in to this tendency, we inadvertently take the power for ourselves instead of giving it to the person. This may make us feel strong and competent, but it doesn’t help the person experience their own power, which is exactly what they need to do to begin the recovery journey. So how do we make sure the power stays with the person so they can recover? Discuss how sometimes staff have taken the position, “Just recover, its your job.” Using recovery as a club is demeaning and mean. We should tell people that they can recover and then help them find their power. If you are using PowerPoint, when you go the next slide, the “Empowerment” video will play automatically. If using overheads, play the “empowerment” video on the DVD. Some discussion of this video is helpful. Kristina, in the last clip, described a situation in which she was being “dramatic” and probably irritating. She cites this experience as empowering and today Kristina has recovered.

49. We use the formula “resistance = resilience = recovery”. To recover a person has to have personal power. When someone says “NO!”, this is the beginning of the person coming back. We do not label this as “non-compliance” or critically describe the “NO” as “treatment resistance” or “lack of insight”, or “lack of motivation”. We honor the resistance. We go with the person’s resistance because that is how they get the power to recover. The definition of resilience is “the physical property of a material that can return to its original shape or position after deformation….” It is “an occurrence of rebounding or springing back.” We like to use a rubber band and have people stretch it and snap it noticing how it springs back to its original shape. People are like this too. It’s a natural tendency. We don’t want to get in the way of that springing back. In fact we find ways to encourage it. Too often, our services have been designed so we have all the power. We decide the service plan. We design the program. And we expect the person will cooperate. This approach is not empowering. Recovery moves forward with the person has the power. Since recovery is the person’s job, and we can’t do it for them, they need to be empowered to do it. Once we step into a helping role, we may have a tendency to want to do things to or for the people we are trying to help. If we give in to this tendency, we inadvertently take the power for ourselves instead of giving it to the person. This may make us feel strong and competent, but it doesn’t help the person experience their own power, which is exactly what they need to do to begin the recovery journey. So how do we make sure the power stays with the person so they can recover? Discuss how sometimes staff have taken the position, “Just recover, its your job.” Using recovery as a club is demeaning and mean. We should tell people that they can recover and then help them find their power. If you are using PowerPoint, when you go the next slide, the “Empowerment” video will play automatically. If using overheads, play the “empowerment” video on the DVD. Some discussion of this video is helpful. Kristina, in the last clip, described a situation in which she was being “dramatic” and probably irritating. She cites this experience as empowering and today Kristina has recovered. We use the formula “resistance = resilience = recovery”. To recover a person has to have personal power. When someone says “NO!”, this is the beginning of the person coming back. We do not label this as “non-compliance” or critically describe the “NO” as “treatment resistance” or “lack of insight”, or “lack of motivation”. We honor the resistance. We go with the person’s resistance because that is how they get the power to recover. The definition of resilience is “the physical property of a material that can return to its original shape or position after deformation….” It is “an occurrence of rebounding or springing back.” We like to use a rubber band and have people stretch it and snap it noticing how it springs back to its original shape. People are like this too. It’s a natural tendency. We don’t want to get in the way of that springing back. In fact we find ways to encourage it. Too often, our services have been designed so we have all the power. We decide the service plan. We design the program. And we expect the person will cooperate. This approach is not empowering. Recovery moves forward with the person has the power. Since recovery is the person’s job, and we can’t do it for them, they need to be empowered to do it. Once we step into a helping role, we may have a tendency to want to do things to or for the people we are trying to help. If we give in to this tendency, we inadvertently take the power for ourselves instead of giving it to the person. This may make us feel strong and competent, but it doesn’t help the person experience their own power, which is exactly what they need to do to begin the recovery journey. So how do we make sure the power stays with the person so they can recover? Discuss how sometimes staff have taken the position, “Just recover, its your job.” Using recovery as a club is demeaning and mean. We should tell people that they can recover and then help them find their power. If you are using PowerPoint, when you go the next slide, the “Empowerment” video will play automatically. If using overheads, play the “empowerment” video on the DVD. Some discussion of this video is helpful. Kristina, in the last clip, described a situation in which she was being “dramatic” and probably irritating. She cites this experience as empowering and today Kristina has recovered.

50. Empowerment corresponds to the level of personal responsibility and accountability.

51. A dialogue with META Services Peer Support Specialists on empowerment and self-advocacyA dialogue with META Services Peer Support Specialists on empowerment and self-advocacy

52. Recovery Pathway 4: Recovery Culture Changing a culture involves three steps: New beliefs New Actions New Experiences Taking on the new belief that recovery is a possibility for everyone will lead to new actions that then create new experiences and then further reinforce the new belief of recovery. This will create new results, recovery results, that will transform the culture. Changing a culture involves three steps: New beliefs New Actions New Experiences Taking on the new belief that recovery is a possibility for everyone will lead to new actions that then create new experiences and then further reinforce the new belief of recovery. This will create new results, recovery results, that will transform the culture.

53. Recovery Culture Create relationship. Provide support. Create community. People find a valued social role. Celebrate diversity. Maintain a positive level of consciousness. Healing happens in relationship! When we develop a helping relationship with a person, we become part of their support team. But also remember the power of choice. It is the person’s choice whether to have us on the team or not, and who else to have on their support team. Many times people do not have an adequate support team. Part of their task is to expand and enhance their support team. Mary Ellen Copeland advises that it works best when people have at least five supporters on their team. This is a good idea, but it is tough. How many of us actually have five supporters? Part of our task can be to help the person grow their support team. The more these supporters can be natural supports, the better because this moves the person toward independence and self-sufficiency. As people develop an identity as a “mental patient” they loose their valued social roles. They become disconnected from their environment. Many times our services have “taken the person out” of their valued roles. When they are hospitalized, when they live in residential programs, when all they do is come to day treatment, we disrupt their values social roles. The more we help people stay connected to their valued roles, discover and grow other roles, their identity as a “mental patient” shrinks and they recover. We can foster this by building a bridge in our services. We find ways for people to have a valued role with us. Maybe they start by setting up the meeting room, making coffee, being the greeter. They become a valued member of our community. But please don’t stop there. Help them graduate and become full citizens in the community of their choice. We also celebrate diversity in our environment. We see each other’s differences as unique and wonderful ways to experience the world. The next slide discusses “level of consciousness”. Go directly to it. Healing happens in relationship! When we develop a helping relationship with a person, we become part of their support team. But also remember the power of choice. It is the person’s choice whether to have us on the team or not, and who else to have on their support team. Many times people do not have an adequate support team. Part of their task is to expand and enhance their support team. Mary Ellen Copeland advises that it works best when people have at least five supporters on their team. This is a good idea, but it is tough. How many of us actually have five supporters? Part of our task can be to help the person grow their support team. The more these supporters can be natural supports, the better because this moves the person toward independence and self-sufficiency. As people develop an identity as a “mental patient” they loose their valued social roles. They become disconnected from their environment. Many times our services have “taken the person out” of their valued roles. When they are hospitalized, when they live in residential programs, when all they do is come to day treatment, we disrupt their values social roles. The more we help people stay connected to their valued roles, discover and grow other roles, their identity as a “mental patient” shrinks and they recover. We can foster this by building a bridge in our services. We find ways for people to have a valued role with us. Maybe they start by setting up the meeting room, making coffee, being the greeter. They become a valued member of our community. But please don’t stop there. Help them graduate and become full citizens in the community of their choice. We also celebrate diversity in our environment. We see each other’s differences as unique and wonderful ways to experience the world. The next slide discusses “level of consciousness”. Go directly to it.

54. Map of Consciousness David Hawkins, M.D.,Ph.D. This model is from David Hawkins, MD, PhD, Power vs. Force. What Dr. Hawkins has done is calibrated the energy levels associated with various levels of consciousness. Notice the “life view” and “emotion” associated with each level. For apathy the life view is hopeless and the emotion is despair. You can give examples here. Apathy… a woman who’s son has been reported missing in action in the war sits day after day in her chair staring out the window. After many months, someone comes to the door with the news that her son has been found. In apathy she does not have the energy to respond and still sits staring out the window. If she moves up to “grief”, she begins to cry. Now there is more energy and the process of recovery begins. Someone in “fear” can run like hell to defend themselves. Hawkins says there were two people in history that had levels of “enlightenment”, Jesus and Buddha. Gandhi also had a level of 700 and this level of consciousness had enough power that he alone he was able to stop the British armies without firing a shot. The pink levels are negative energy states. They attract more negatives. So we say “He’s having a run of back luck”, “nothing works out”, and so forth. The negative energy and negativelevel of consciousness just gets bigger. The level of courage is the neutral point between positive and negative levels. This is where recovery starts; the life view becomes “feasible” and the process is “empowerment”. As one moves to higher positive levels, reaching “willingness”, notice that the life-view is “hopeful” and there is “optimism”. So how does change happen? In the negative levels, change happens by force. A good example of this is the “take down” or restraint event in a psychiatric hospital. If we are operating at a level of fear or anger, we have to use to force to change behavior. BUT, in the positive levels there is so much more energy that change happens simply by the power of the level of consciousness. Imagine LOVE! That has an energy level of 500, five times the energy of the level of fear! Imagine to power of four people on a team with a level of consciousness of love… that’s 2,000 compared to the 100 of fear. There is so much power that the person is just pulled up to the recovery (positive) levels. So what does this mean for us? When we see someone in the low level of apathy, very despondent and despairing, they don’t have enough energy to move forward. So, Hawkins suggests that we “pour love into him” and that begins to move the person forward. Interesting that Dr. Hawkins calibrates the level of an Alcoholics Anonymous meeting at 500. He describes that meeting a “unconditional love”. AA says this is the principle of attraction not promotion. So, a person who has relapsed, gone out and done tragic things, comes back to the meeting and is welcomed unconditionally back to the group. The power of the group moves the person from the levels of shame and guilt right up to willingness, acceptance and recovery begins. In our lingo, we often refer to this as engagement. Imagine the power of our environment if we consistently maintained a level of consciousness of LOVE. This model is from David Hawkins, MD, PhD, Power vs. Force. What Dr. Hawkins has done is calibrated the energy levels associated with various levels of consciousness. Notice the “life view” and “emotion” associated with each level. For apathy the life view is hopeless and the emotion is despair. You can give examples here. Apathy… a woman who’s son has been reported missing in action in the war sits day after day in her chair staring out the window. After many months, someone comes to the door with the news that her son has been found. In apathy she does not have the energy to respond and still sits staring out the window. If she moves up to “grief”, she begins to cry. Now there is more energy and the process of recovery begins. Someone in “fear” can run like hell to defend themselves. Hawkins says there were two people in history that had levels of “enlightenment”, Jesus and Buddha. Gandhi also had a level of 700 and this level of consciousness had enough power that he alone he was able to stop the British armies without firing a shot. The pink levels are negative energy states. They attract more negatives. So we say “He’s having a run of back luck”, “nothing works out”, and so forth. The negative energy and negativelevel of consciousness just gets bigger. The level of courage is the neutral point between positive and negative levels. This is where recovery starts; the life view becomes “feasible” and the process is “empowerment”. As one moves to higher positive levels, reaching “willingness”, notice that the life-view is “hopeful” and there is “optimism”. So how does change happen? In the negative levels, change happens by force. A good example of this is the “take down” or restraint event in a psychiatric hospital. If we are operating at a level of fear or anger, we have to use to force to change behavior. BUT, in the positive levels there is so much more energy that change happens simply by the power of the level of consciousness. Imagine LOVE! That has an energy level of 500, five times the energy of the level of fear! Imagine to power of four people on a team with a level of consciousness of love… that’s 2,000 compared to the 100 of fear. There is so much power that the person is just pulled up to the recovery (positive) levels. So what does this mean for us? When we see someone in the low level of apathy, very despondent and despairing, they don’t have enough energy to move forward. So, Hawkins suggests that we “pour love into him” and that begins to move the person forward. Interesting that Dr. Hawkins calibrates the level of an Alcoholics Anonymous meeting at 500. He describes that meeting a “unconditional love”. AA says this is the principle of attraction not promotion. So, a person who has relapsed, gone out and done tragic things, comes back to the meeting and is welcomed unconditionally back to the group. The power of the group moves the person from the levels of shame and guilt right up to willingness, acceptance and recovery begins. In our lingo, we often refer to this as engagement. Imagine the power of our environment if we consistently maintained a level of consciousness of LOVE.

55. In the movie “What About Bob?” Dr. Marvin’s negative level of consciousness (anger) creates disaster. Bob, on the other hand, experiences joy and has good fortune. In the movie “What About Bob?”, Dr. Marvin’s level of consciousness of anger brings more disaster. Bob, on the other hand, at a level of joy, had good fortune (gets a ride in the clip, gets recognized for his achievement of being interviewed on TV, and so forth). If you are using PowerPoint, when you go the next slide, the “What About Bob” video, and excerpt from the movie “What About Bob” will play automatically. If using overheads, play the “empowerment” video on the DVD. In the movie “What About Bob?”, Dr. Marvin’s level of consciousness of anger brings more disaster. Bob, on the other hand, at a level of joy, had good fortune (gets a ride in the clip, gets recognized for his achievement of being interviewed on TV, and so forth). If you are using PowerPoint, when you go the next slide, the “What About Bob” video, and excerpt from the movie “What About Bob” will play automatically. If using overheads, play the “empowerment” video on the DVD.

56. “What about Bob?”“What about Bob?”

57. In the movie “A Beautiful Mind” Professor Nash gradually recovers from very serious psychiatric experiences using the level of “reason”. But what John Nash discovers is that it wasn’t until he found the power of love that he had the energy to overcome and fully recover. On the Map of Consciousness, the level of reason is very high, with an energy level of 400. Dr. Hawkins points out from his research that the great scientists, Newton, Galileo, Einstein, like John Nash, functioned that level of consciousness of “reason”, a very high level of energy. But Professor Nash discovered that the higher level of “love” has more power where answers can be found that cannot be discovered with reason alone. Love had the energy to help John Nash fully recover. When we make this discovery, and maintain an environment that is filled with love, or better yet, “unconditional love”, transformation is the result. If you are using PowerPoint, when you go the next slide, the “John Nash; the Power of Love”, clips from the movie “The Beautiful Mind” will play automatically. If using overheads, play the video on the DVD. On the Map of Consciousness, the level of reason is very high, with an energy level of 400. Dr. Hawkins points out from his research that the great scientists, Newton, Galileo, Einstein, like John Nash, functioned that level of consciousness of “reason”, a very high level of energy. But Professor Nash discovered that the higher level of “love” has more power where answers can be found that cannot be discovered with reason alone. Love had the energy to help John Nash fully recover. When we make this discovery, and maintain an environment that is filled with love, or better yet, “unconditional love”, transformation is the result. If you are using PowerPoint, when you go the next slide, the “John Nash; the Power of Love”, clips from the movie “The Beautiful Mind” will play automatically. If using overheads, play the video on the DVD.

59. Recovery Pathway 5: Spirituality Spiritual expression is not a symptom of a mental illness Connecting within and beyond the self. Finding meaning and purpose Develop spiritual competence Meditation, contemplation, prayer Spiritual practices Service to others. Treating each other with kindness and respect Although this may be topic that we have avoided in our treatment settings, we estimate that at least 75% of the recovering people going through Peer Specialist training indicate that spirituality played a major role in their recovery process. They aren’t talking about specific denominations, even though some of them are associated with specific religions. They are talking about a personal experience they have had with a higher power that has given them strength and courage to begin the recovery journey. How can we describe this mysterious force that beckons us to connect with and use the comfort and power of spirituality? Here’s a quote from the “The Quest” a book that provides some insight into our spiritual hardwiring: “No matter what your circumstances, past or present, there has always been the hope of connecting with “something more. Some how, tucked away in the attic of your soul, a part of you has always considered the possibility of that connection and yearned for it. Sometimes the yearning was strong and urgent. Sometimes it was so remote and hidden that it was not even identifiable. But it was always there….” Herbert Benson, M.D., author of many books on the topic, describes it as either a pull from within the individual to connect with a higher power, and/or a pull from the external power of the universe to form a spiritual connection with each person. All we can say for sure it that it continues to be an important mystery that we each explore, finding our own answers and connections. We like to talk about spirituality as “meaning and purpose”. When a person experiences serious setbacks and issues, the begin to become disconnected. Using Dr. LeRoy Spaniol’s connectedness paradigm, people loose connections with themselves, others (support), environment, and meaning and purpose in life (they forget what they are about). As people recover, they begin to remember and to develop their purpose and life starts to make sense. Service to others. While self-help is so important, service to others is just as important. Giving to someone else brings the spirit forward, helps people remember who they are, and begins the process of re-connecting. As is often said, “to keep it, you have to give it away.” The 12th step of self-help programs, begins with “having had a spiritual awakening….we tried to carry this message.” Service to others moves recovery forwardAlthough this may be topic that we have avoided in our treatment settings, we estimate that at least 75% of the recovering people going through Peer Specialist training indicate that spirituality played a major role in their recovery process. They aren’t talking about specific denominations, even though some of them are associated with specific religions. They are talking about a personal experience they have had with a higher power that has given them strength and courage to begin the recovery journey. How can we describe this mysterious force that beckons us to connect with and use the comfort and power of spirituality? Here’s a quote from the “The Quest” a book that provides some insight into our spiritual hardwiring: “No matter what your circumstances, past or present, there has always been the hope of connecting with “something more. Some how, tucked away in the attic of your soul, a part of you has always considered the possibility of that connection and yearned for it. Sometimes the yearning was strong and urgent. Sometimes it was so remote and hidden that it was not even identifiable. But it was always there….” Herbert Benson, M.D., author of many books on the topic, describes it as either a pull from within the individual to connect with a higher power, and/or a pull from the external power of the universe to form a spiritual connection with each person. All we can say for sure it that it continues to be an important mystery that we each explore, finding our own answers and connections. We like to talk about spirituality as “meaning and purpose”. When a person experiences serious setbacks and issues, the begin to become disconnected. Using Dr. LeRoy Spaniol’s connectedness paradigm, people loose connections with themselves, others (support), environment, and meaning and purpose in life (they forget what they are about). As people recover, they begin to remember and to develop their purpose and life starts to make sense. Service to others. While self-help is so important, service to others is just as important. Giving to someone else brings the spirit forward, helps people remember who they are, and begins the process of re-connecting. As is often said, “to keep it, you have to give it away.” The 12th step of self-help programs, begins with “having had a spiritual awakening….we tried to carry this message.” Service to others moves recovery forward

64. Moving on…. So what is my job?

65. Staff Influence on Recovery Staff have a profound influence on each person’s recovery process. “….and there was this person.” Since there are no predictors as to who is most likely to recover, let’s give everyone the benefit of the doubt. Staff can create an environment of hopefulness that promotes recovery. Staff have often commented, “so if it is the person’s job to recover, what’s my job?” Invite the class to offer what care givers can do to move recovery forward. Stories of recovery often include a special person (“and there was this person”) who “held the hope when there didn’t seem to be any” who provided that special love and encouragement, who simply “believed in me”, and so forth. And, again, staff can create that environment of hope, acceptance, and love that really does promote recovery.Staff have often commented, “so if it is the person’s job to recover, what’s my job?” Invite the class to offer what care givers can do to move recovery forward. Stories of recovery often include a special person (“and there was this person”) who “held the hope when there didn’t seem to be any” who provided that special love and encouragement, who simply “believed in me”, and so forth. And, again, staff can create that environment of hope, acceptance, and love that really does promote recovery.

66. Patricia E. Deegan Ph.D. is a co-founder of the Boston University Institute for the Study of Human Resilience and is Senior Director of the Joshua Tree Center for Ex-Patient Studies. Pat is a psychiatric survivor, having first been diagnosed with schizophrenia as a teenager. She received her doctorate in clinical psychology from Duquesne University in 1984. She worked as a clinical director of community based programs for the Massachusetts Department of Mental Health from 1983-1987. In August of 1988, Dr. Deegan took a position as a program director with the Northeast Independent Living Program. In this capacity she designed and implemented a model for working with people with psychiatric disabilities in Independent Living/cross disability settings. This program was nominated for a "Community Health Leadership Award" by the Robert Wood Johnson Foundation. Pat is an activist in the ex-patient movement and a co-founder of the National Empowerment Center Inc. which is a federally funded, national technical assistance center run by consumer/survivors. Between 1992 and September of 2001 she held the position of Director of Training at the National Empowerment Center, Inc. In this capacity she developed many self-help tools and resources to support people in their recovery and empowerment. Dr. Deegan also developed innovative trainings and curriculums including an audio-taped simulation of hearing voices. The "voices curriculum" has received international acclaim and is used to train police officers, psychiatrists, mental health workers and family members to work more compassionately with people diagnosed with mental illness. Pat has given keynote addresses, lectures, and workshops across the United States, Canada, Europe, Scandinavia, Australia, New Zealand and Israel. She has 27 published papers on topics related to recovery and empowerment as well as many articles that have been featured in newsletters and on websites. Pat's papers have been have been translated into Spanish, Hebrew, French, Portuguese, Dutch, Norwegian, Swedish and German. If you are using PowerPoint, when you go the next slide, the “Pat Deegan” video will play automatically. If using overheads, play the video on the DVD. Patricia E. Deegan Ph.D. is a co-founder of the Boston University Institute for the Study of Human Resilience and is Senior Director of the Joshua Tree Center for Ex-Patient Studies. Pat is a psychiatric survivor, having first been diagnosed with schizophrenia as a teenager. She received her doctorate in clinical psychology from Duquesne University in 1984. She worked as a clinical director of community based programs for the Massachusetts Department of Mental Health from 1983-1987. In August of 1988, Dr. Deegan took a position as a program director with the Northeast Independent Living Program. In this capacity she designed and implemented a model for working with people with psychiatric disabilities in Independent Living/cross disability settings. This program was nominated for a "Community Health Leadership Award" by the Robert Wood Johnson Foundation. Pat is an activist in the ex-patient movement and a co-founder of the National Empowerment Center Inc. which is a federally funded, national technical assistance center run by consumer/survivors. Between 1992 and September of 2001 she held the position of Director of Training at the National Empowerment Center, Inc. In this capacity she developed many self-help tools and resources to support people in their recovery and empowerment. Dr. Deegan also developed innovative trainings and curriculums including an audio-taped simulation of hearing voices. The "voices curriculum" has received international acclaim and is used to train police officers, psychiatrists, mental health workers and family members to work more compassionately with people diagnosed with mental illness. Pat has given keynote addresses, lectures, and workshops across the United States, Canada, Europe, Scandinavia, Australia, New Zealand and Israel. She has 27 published papers on topics related to recovery and empowerment as well as many articles that have been featured in newsletters and on websites. Pat's papers have been have been translated into Spanish, Hebrew, French, Portuguese, Dutch, Norwegian, Swedish and German. If you are using PowerPoint, when you go the next slide, the “Pat Deegan” video will play automatically. If using overheads, play the video on the DVD.