As I was preparing my presentation (titled “Living Successfully with Depression and Suicidal Thoughts”) to be given at NAMI Wisconsin’s Family Programs Summit this November, I ran into the term “personal medicine,” meaning an activity that a person does to obtain wellness, rather than something a person takes. The term was introduced by Patricia Deegan, PhD, in early 2003 as a result of qualitative research she did through the University of Kansas – School of Social Welfare [The Importance of Personal Medicine: A Qualitative Study].  Upon interviewing individuals who were taking psychiatric medication, Deegan found that “When describing their use of psychiatric pharmaceuticals or ‘pill medicine’, research participants also described a variety of personal wellness strategies and activities that I have called ‘personal medicine’. Personal medicines were non-pharmaceutical activities and strategies that served to decrease symptoms and increase personal wellness.”

Pat Deegan writes: “Personal medicine is what we do to be well. It’s the things that put a smile on our face and that make life meaningful.” She continues “Many of us have learned that finding the right balance between Personal Medicine and psychiatric medicine is the road to recovery.” [Common Ground Toolkit and Recovery Library]

She cited three examples of personal medicine that work for her: playing with her dog, taking care of her daughter, and reading scripture. I jotted down six examples to begin with: parenting and grand-parenting, cooking and baking, singing, texting and emailing Rebecca and Benjamin, sending notecards to people, and writing. Oh -and reading is a ready seventh activity; it’s the way I start every morning! Listening to music, often at the end of the day, is an easy eighth.

Reading Pat Deegan’s research closely, I see she identified personal medicines as falling into two broad categories: those activities that give life meaning and purpose, and self-care strategies. Both types increase feelings of wellness and help keep psychiatric symptoms and/or undesirable outcomes such as hospitalization at bay.

Necessary personal medicine is sometimes serious work. There was a year in my life when I was moderately depressed. I felt I had to bake five days a week: I had to bake every day I was home alone, at the time between jobs, every day that my husband Jim was away at his work. I baked for three hours every day, minimum. Why? I needed to structure my time, to accomplish something and to knead and stir down pain and numbing thoughts. It was always a batch of chocolate chip cookies one day and bread the next day. This period occurred after the children were grown, so what we didn’t or couldn’t eat ourselves, which was a lot, we gave away.

I learned this lesson [Partners in Recovery – PIR, June 2010] from Ms Deegan:  “It is so easy to get lost in thinking that we are not good enough or that we are irrevocably flawed because we have a diagnosis of mental illness. But healing does not come from outside us; healing comes from within.”

Now I realize that at that time in my life I was using baking as a self-care strategy, without being alert to my decision to do so. Baking simply kept me on my feet, kept me “productive,” and stopped the grinding negative thoughts. The joy and creativity I normally found in cooking and baking was absent. No lofty thoughts occurred while the warm dough was molded under my hands. No images of Grandma or my Mother – my bread-baking teachers – formed in my brain that I can remember. No smell of yeast permeated my mind. I simply did the tasks and came out with good home-baked items.

Good home-baked items. And I did not deteriorate in my mental status. I improved with time, never needing hospitalization or respite care. There is something good and healthy in people with a diagnosis of mental illness. Medicine doesn’t only come from a doctor or a mental health provider team. “Discovering personal medicine is powerful medicine and connects us to the resilient, healing parts of ourselves.” [PIR]

Today, much of the time I spend cooking and baking takes the form of personal medicine that makes my (recovered) life sing with purpose and meaning. I love the seasonal foods and the celebrations that each represent. In our family, every spring, there is homemade cream of asparagus soup with a twist of lemon on the side. Summer brings ruby red strawberry shortcake with berries from the field and real whip cream, plus new leaf lettuce for many simple tasty salads. Then late summer taught me to appreciate warm peach cobbler. Fall is chili and beef stew and the first cinnamon apple pie. The December holidays are hot chocolate from scratch, my delectable Mustard Apricot Glazed Ham, baked sweet potatoes, and pecan pie. All this is done with flow and calm that brings a great deal of satisfaction and attention to detail. My mind and senses are stimulated and utilized in a very positive and reinforcing way. And my family eats well too!

May each of you find the personal medicine that connects you to the resilient healing part of yourself.

One doesn’t recover from a mental illness in the same way one recovers from a broken arm. Yet recovery and healing is possible, and life can be enriched. We refer to that healing as a personal recovery.

Reading more of Professor Mike Slade’s work on personal recovery I found that my journey rediscovered something essential for the recovery to succeed: a sense of personal agency. This is the belief and assurance that one has the power to positively impact one’s own life; the power to act in one’s best interest. He writes that developing a sense of agency can be a difficult process precisely because mental illness often takes away that assurance and belief. He urges professionals, staff and family to show support which recognizes the importance of renewing the individual’s sense of self agency.

Finding and supporting that sense of agency – the ability to act in your own best interest – in yourself and for those you love is a crucial part of personal recovery.

I developed a great deal of authority over my life when I successfully quit smoking, a task I once thought was impossible for me. You see, when I quit I’d found I could make a difference in my health care, a truly enormous difference; perhaps a life-saving one. And I learned people would support me in this difficult but worthwhile goal!

Now I hopefully approached a new goal, to learn tools and techniques to help counter the persistent negative thoughts common to major depression. The experience of power over my life I’d had when I successfully quit smoking taught me to seek new tools which I could use to achieve new goals: It was time to learn Cognitive Behavior Therapy, and I had no problem learning and practicing its techniques. I continue to be an agent in my own life: Here in my 67^th year I set out to find a Personal Trainer so the physical work-outs I desired would be effective and fun. I found one through a good friend; hired her, and have lost weight and body fat while building muscle, etc. I think more clearly and can concentrate more fully since I have been on a regular exercise schedule.

The symptoms of depression and bipolar II persist but weaken; the sense of authority over my own life increases; I’m healing.

Touching my own experience, I saw in it each of the four recovery tasks listed in the previous post.

Recovery task 1: “The first task of recovery is developing a positive identity outside of being a person with a mental illness.” The person identifies elements that are vitally important to him or her, which will differ in significance from what another person identifies. “…only the individual can decide what constitutes a personally valued identity for them. “

I was lucky. In the midst of serious depression, I was married, a mother, and pregnant with our second child. . I did not lose those identities completely, but they were shaky. The years passed and I started my recovery journey: about 10 years later, the roles of wife and partner, mother to a child and mother to a teenager crystallized and doubt had been replaced often with enjoyment and wonder.

Recovery task 2: “The second recovery task involves developing a personally satisfactory meaning to frame the experience which professionals would understand as mental illness. This involves making sense of the experience, putting it in a box, and framing it as part of the person, but not as the whole person.”

The frame in which I understand my mental illness experience keeps evolving as the mental illness does not cease. But as the illness fades and my recovery grows, the frame gets more refined with the passing years.

I realize that again, I was lucky. I was married to Jim and he knew mental illness to be a no-fault biopsychosocial medical illness. So did I: I had inherited the tendency to depression, but was able to frame this as bad luck, not personal or family fault. Also, I lived near Madison, WI which had good services and I could afford good medical care. Again, I was fortunate.

I also had training in a health care field. I was a registered dietitian, (and still am) and proud that I was on the academic staff at the University of Wisconsin-Madison for 16 years (as a clinical instructor in the Department of Nutritional Sciences). So I was comfortable in various in and out-patient settings. I also knew appropriate levels of anatomy and physiology – and even biochemistry-lite. So I could follow the medical model of mental illness.

So I framed my experience of mental illness as an illness and as time went by, I was more and more able to put the illness in a box and frame it as only part of me but Not ME.

Recovery task 3: “Self-managing the mental illness.” Mental illness becomes ONE of life’s challenges. As people develop personal responsibility, self- management skills develop. This doesn’t mean managing the mental illness completely on one’s own but rather, knowing when to seek help and support.

I was desperate to “get better”. I cooperated in every way I could, even in the long decade of my body failing to respond to any of many anti-depressants. I never skipped a medication or an appointment. I ate well and got enough exercise at that time of my life.

As I began to recover in the 1990’s I took an even more active role in managing my illness. I learned cognitive behavior therapy (CBT) and carried out the exercises on paper, as assigned and in session with a psychology doctoral student. It helped me greatly, the CBT, so that I keep it up today as needed. Nothing has been as effective as CBT for minimizing negative thinking.

Now I’ve taken further steps to guard my health. In January of 2014 I hired a personal trainer(!), adding hour-long work-outs six days every week, three of them with my trainer.

Recovery task 4: “Developing valued social roles.” The key word here is valued. Valued by the individual with mental illness and by the greater social circle/setting/society. The person undergoing recovery, in this last task, must find a niche for himself or herself in their community. It could be a position/role modified from previous times or a new experience altogether . The role may or may not have anything to do with mental illness.

A huge change in my life occurred when I began to volunteer in a big way in the mental health organization NAMI, at the local and state level. You can read about my development in the About Me section of this website.

With this change I gained a tremendous amount of confidence and poise. I also had conviction in the value of what I was doing (teaching and, later, directing the Family to Family Education Program for NAMI WI). I felt education to be a liberating factor in living with mental illness in myself and in the family. I was fortunate in that the work fit me like a glove; teaching small groups of college age adults in the application of didactic material to the clinical setting gave me experience for teaching small groups of adults. My history as an adult child of someone with a mental illness and my own history of depression and after 2002, bipolar II illness, helped me understand families and persons with mental illness and all the dilemmas and controversies that entails.

So I definitely found a position in the community where I was valued and I felt valued.  I carried out my responsibilities with confidence and skill and compassion. I blossomed. I had developed something essential for self-management: a sense of personal agency .… I was the author of my own work.

Dear readers: To talk together about recovery for those struggling with mental illness we need a definition of recovery that does justice to the magnitude of the journey. Here is one such definition –

“…..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, and contributing life even within the limitations caused 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.”

Recovery from Mental Illness: The Guiding Vision of the Mental Health Service System in the 1990s. William A. Anthony, Ph.D Psychosocial Rehabilitation Journal, 1993, 16(4), 11–23.

I encourage you to read the entire article from which the definition above was taken. What the article has to say about recovery was ground-breaking when first published in 1993. It is a fine resource as well today.

If the definition above is the vision, we need guide to follow it: 100 Ways to support recovery. A guide for mental health professionals, Second Edition, 2012.

The guide’s author is Mike Slade – Professor Mike Slade – Clinical Psychologist and Professor of Health Services Research at the Institute of Psychiatry, Kings College, London. I found plenty of material in the report helpful to anyone wanting to learn about recovery and eager to help a family member or friend.

Professor Slade clarifies that recovery is a word with two meanings. Clinical recovery “is an idea that has emerged from the expertise of mental health professionals, and involves getting rid of symptoms, restoring social functioning, and in other ways ‘getting back to normal’”. “[Personal recovery] … is an idea that has emerged from the expertise of people with the lived experience of mental illness and means something different to clinical recovery.”

Most mental health services, Mike Slade acknowledges, are currently organized around meeting the goal of clinical recovery. Yet most mental health policy around the world increasingly emphasizes support for personal recovery. His guide aims to support the transition to ongoing personal recovery, framing the process by identifying common tasks undertaken by persons in recovery:

Recovery task 1: “The first task of recovery is developing a positive identity outside of being a person with a mental illness.”
Recovery task 2: “The second recovery task involves developing a personally satisfactory meaning to frame the experience which professionals would understand as mental illness.”
Recovery task 3: “Self-managing the mental illness.” Mental illness becomes ONE of life’s challenges.
Recovery task 4: “Developing valued social roles.” Roles valued by the individual with mental illness and by the greater social circle/setting/society.

I was able to see each of those four tasks in the flow of my own recovery ……………….

Here is a favorite explanation of mine about recovery:

“Recovery is a process, a way of life, an attitude, and a way of approaching the day’s challenges. It is not a perfectly linear process. At times our course is erratic and we falter, slide back, regroup and start again……The need is to meet the challenge of the disability and to re-establish a new and valued sense of integrity and purpose within and beyond the limits of the disability; the aspiration is to live, work, love in a community in which one makes a significant contribution.” –Pat Deegan, PhD, quoted in Recovery Now “What is Recovery “

I first read Pat back in 1993 and I cried because she understood the ill person’s experience as it is, burdened by symptoms and then the relief, when well again.  No one has ever expressed this empathy since with more insight and delicacy for me:

Courage and fear was my main diet as I began my recovery journey . Always fear. Fear when I went to my first psycho-education meeting sponsored by UW Hospitals in early 1990’s. I didn’t know how I would be received, who the other people would be in the class —would I be able to talk to them and what would I say?  Courage too, but it always took second place. It is definitely easier to stay home than expose oneself to the risks of rejection and dreadful anxiety that accompanied me whenever I went forward.

Fear when I quit smoking.  Afraid the anxiety of not having cigarettes would cause me to lose my temper around people I loved and lose control of myself.

Fear when I tried out for University of Wisconsin –Madison Choral Union. It was something I wanted so badly to do: To sing within a large group of men and women forming an impressive choir. I had wanted to be part of this since I’d been a college student.  And now in my 40’s I had my voice back (A polyp was removed from my vocal cord and I’d quit smoking)!  Deeply anxious, I simply couldn’t allow myself to speak spontaneously to the Choral Director and I couldn’t think of what to say……..so I went to the audition reading my information and questions from an index card.  Nice; I was selected to be part of the alto section!

For the mentally ill, struggling with symptoms that strike to the heart of whom they think they are or could be, Recovery is hard, lonely, lonely work. And so important. I’ve been reading anew a number of documents and articles on recovery and have found some helpful resources to pass on to you.

Another season has come to pass in south central Wisconsin. Summer is here; indeed today is July 4th. I feel blessed as I reflect upon the year that has passed. I have good health and I am very thankful.  Oh I work at it, daily, maintaining good mental and physical health. But we know that striving for good health and working towards it, even faithfully, doesn’t promise we will be healthy.

I’m especially thinking of mental health recovery. I am in recovery and have found, to my deep satisfaction, that healing has come to me.  Recovery is complex to talk about. What does it mean, as applied to people with mental illness and psychiatric disorders and why is their recovery is SO important?

Here is a working definition of recovery:  A process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential.

Further, it is something worked towards and experienced by the person with the mental illness.  Mental health professionals and family cannot “do” recovery to the person. The essential contribution of professionals and family is to support the person in their journey of recovery.  As the recovery journey is individual so the best way to support it will vary person by person.

In reality the support that is needed goes beyond individual providers, friends and family. It extends to accessible community services also.

Note that there is nothing mentioned here about a medical recovery or cure for mental illness. But it is real, and this recovery is a new sense of self and of purpose. As health and wellness is regained, people once again take pride in themselves and ….get a life! But gaining recovery is hard work!

Stay with me; I will be returning to the topic of Recovery within Mental Illness often during the next posts.