PersonalGrowth

The Strengths Perspective

gail louise Beyond Recovery to Healing, Chronic/SeriousMental_Illness ,

Here’s a statement that intentionally “turns around” our usual way of evaluating mental health outcomes: If we want a successful mentally ill person, we could create a group home and help the ill person thrive within it. But if we want, simply, a successful person with mental illness who thrives in the same community with everyone else, we should help them find persons and resources in the community that will empower their strengths and also help them persist and persevere in working to minimize the disabilities brought on by their mental illness.

You help them persist and persevere by engaging them in their areas of strength, not in focusing on their deficits and defeats.

This suggests we should use a strengths model, rather than the problem-based or deficit model for providing services to those suffering from mental illness or disorder.

 

I first heard of the Strengths Model back in 2000, when I was in graduate school studying community mental health from Professor Charles Rapp’s perspective. A recent text co-authored by Charles Rapp and Richard Goscha, The Strengths Model: A Recovery-Oriented Approach to Mental Health Services, Third Edition, 2012 simply reaffirms its importance in my thinking. I learned to focus on an individual’s strengths as building blocks to manage a situation or a life. I believe that people with mental illness would be >much< better served if all of mental health services had a strengths-based foundation rather than the traditional deficit- focused orientation.

“The strengths model posits that all people have goals, talents and confidence.” Furthermore, “All environments contain resources, people and opportunities.” (Link) But with the deficit-mindset, our perceptions of these are limited and modest and full of considerations of barriers and pathology. Strengths pale in comparison to the deficits.

“The strengths model then is about providing a new perception. It allows us to see possibilities rather than problems, options rather than constraints, wellness rather than sickness. And after being seen, achievement can occur.”

It is Rapp and Goscha’s belief that if those involved in mental health services and policy insist on the “muck and mire of deficits” perception, we cannot be of effective help to all of those affected with mental illness.

I learned that the Strengths Theory has nine key propositions. Several of the nine are block-busters that can explode our current ways of thinking about mental illness services.

Here is their first key proposition: The quality of the niches people inhabit determines their achievement, quality of life and success in living.

A niche is defined as the environmental habitat of a person or category of persons. There are two types of niches at the extreme: entrapping and enabling.

Here are four characteristics of entrapping niches (there are others):

  • Entrapping niches are highly stigmatized; people caught in them are commonly treated as outcasts.
  • People caught in an entrapping niche tend to “turn to their own kind” for association, so that their social world becomes restricted and limited.
  • People caught in an entrapping niche are totally defined by their social category. The possibility that they may have aspirations and attributes apart from their category is not ordinarily considered. To outsiders, the person is “just” a bag lady, a junkie, a schizophrenic….and nothing else.
  • In the entrapping niche, there are no graduations of reward and status. …… Thus, there are few expectations of personal progress within such niches.

Here are four describing enabling niches:

  • People in enabling niches are not stigmatized, not treated as outcasts.
  • People in enabling niches will tend to “turn to their own kind” for association, support, and self-validation. But often the niche gives then access to others who bring a different perspective, so that their social world becomes less restricted.
  • People in enabling niches are not totally defined by their social category; they are accepted as having valid aspirations and attributes apart from their category.
  • In the enabling niche, there are many incentives to set realistic longer term goals for oneself and to work toward such goals.

The strengths model proposes that finding, cobbling together or creating enabling niches should be the major focus of work for mental health services and professionals. The authors continue, “There is good reason to believe that the niches available to people with psychiatric disabilities influence the recovery process and their quality of life.” (pp. 37, The Strengths Model)

 

I am thunder-struck, when I think of my life and the quality of my life and its influence on my recovery process. A few thoughts:

I have been very fortunate, that the niches in my life have been enabling in my recovery journey with mental illness. I’ll look at a variety of life domains: home or living arrangement, work, education, recreation, and spiritual . Yes, I did a lot of work to gain recovery….but I had a stable set of niches or habitats. Read on:

I lived in a home all the years I have had an illness.   And since the very time of diagnosis and onset I had my own family …… a loving supportive husband and 5 year old daughter and I was pregnant with our second child. We still live in our own home, although it is a different house now, for after 30 years our children are grown. They are fine and healthy and love and care for us as do our two grandchildren. Jim and I continue to enjoy a rich relationship with each other and with our family.

I have had rewarding work. I was employed at St Mary’s Hospital Medical Center and at two nursing homes and one small alcohol and drug rehabilitation hospital as a Registered Dietitian (RD). For 15 years I also taught as a clinical instructor and later lecturer in Nutritional Sciences Department at the University of Wisconsin-Madison. After this career within dietetics, I turned to the mental health field.

I had been able to earn an undergraduate education without much trouble. But much later, when I returned for graduate school, I had a relapse and asked for accommodations. My request was met professionally and I was able to complete the work after some delay but with full effort. I am happy to say that I received my Masters Degree in 2003 from Southern New Hampshire University. In 1993 I had begun a 20 year career of volunteer work with NAMI. After 2007, I joined the staff of NAMI Wisconsin as their Coordinator of Family Programs.

All this work was challenging with a mental illness, but I certainly had roles I valued and that other people valued which were separate from the “role” of being a person with a mental illness. AND NOW, recovered and moved by my life experience I write about mental illness issues and affirm the lives of those who live with them. Today, this website is my vocation in more ways than one.

I’ve lived a whole, stimulating and enjoyable life in large part because the places and people – the niches – I lived in and among were consistently empowering. We must strive to have these empowering environments available in reality for all people with mental illnesses!

Part V – Why does all this recovery happen?

gail louise Beyond Recovery to Healing, Learning to Hope , , , ,

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 67th 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.

Part IV – The Tasks of Personal Recovery

gail louise Beyond Recovery to Healing, Learning to Hope , , , ,

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.

Part III – The Journey and Tasks of Recovery

gail louise Beyond Recovery to Healing, Learning to Hope , , , ,

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 ……………….

Part II – Hard; oftentimes Lonely Work

gail louise Beyond Recovery to Healing, Learning to Hope , , , ,

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.

Part I – On Recovery

gail louise Beyond Recovery to Healing, Learning to Hope , , , ,

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.

From Shame – Moving Toward Healing

gail louise Beyond Recovery to Healing, Brene Brown, PhD, MajorDepression, Real Life; Real Challenges, Shame , , , , , , , ,

During the recent half decade I have been so fortunate, as Brene Brown* describes, to have completed the journey from the “not being good enough” shame struggle to believing and knowing “who I am is enough.” Shame from having mental illness has left me. Shame from being related to other people with mental illness has left me also. I have been graced.

I only recently realized I had made this journey. I understand now how much shame – and my growing resilience in the face of shame – had influenced the course and depth of my mental illness through the years.

It didn’t happen, this journey to being shame-free, automatically. I happened to want to do what is recommended for building shame resilience for other reasons; I wanted to help others cope with mental illness. Often, as part of my work, I told my story of family and personal mental illness. I didn’t realize then, twenty five years ago, how much nurturance I would receive from assisting others.  My story of the power of shame and how I arrived at healing from shame follows …. [Read the Full Article]

 

*   Brene Brown, PhD, LMSW   Audio lecture, 2012: Men, Women & Worthiness, The experience of Shame and the Power of Being Enough.  Available on CD at Soundstrue.com  PO Box 8010/Boulder CO  80306.

On Healing…Learning to Hope despite Chronic Mental Illness

gail louise Chronic/SeriousMental_Illness, Learning to Hope , , , , , ,

Do you or someone you love have a chronic illness? The illness and the very real struggle to stand with the person suffering from the illness can be awfully hard to bear. What’s it like for you? I have written about my chronic illness experience. Go visit the menu option On Healing and scroll down. You’ll find my essay: Learning to Hope Despite Chronic Mental Illness. Learning to hope again and learning to believe that life will again have genuine promise were sweet rewards of my patient examination of what life had been and what life could be. I started with one small but tangible bit of “up” time. The time occurred “before my very eyes” as it were. It was what I most hoped for, so I built nurturing memories on it.  I hope yours will be also.

Please read on………………………….