What Do We Mean When We Say “Recovery”?
Kenneth Minkoff, M.D., a member of the National Council Medical Director Institute, is a board-certified community psychiatrist and addiction psychiatrist, part-time assistant professor of psychiatry at Harvard Medical School, and the COO and senior systems consultant at ZiaPartners, Inc. Dr. Minkoff also provides consultation to large systems on developing welcoming, integrated, recovery-oriented services to individuals and families with complex needs.
Dr. Minkoff’s insights are especially relevant as we recognize the importance of recovery:
On the definition of recovery:
Recovery – when applied to mental illness, substance use disorder or other persistent illnesses or conditions – is a term that reflects a hopeful journey toward what can be an amazing outcome. It’s a process that people go through in relationship to one or more chronic conditions in their lives – it’s not an event. When we say “recovery,” we’re talking about recovery of the person who’s struggling, not recovery from the disease or condition.
Even though the condition, symptoms, risk of relapse and need for treatment may persist, the person recovers over time and continues to improve in ways that may lead to a better life outcome than as if nothing had happened to them. Once you understand recovery at the core, you’ll understand it’s not defined by what you’re recovering from – it’s a personal process.
On the nuances of the recovery journey:
People are frequently not recovering from only one thing – one condition, disorder or issue – they’re commonly recovering from many things at the same time. Along this journey of recovery, the following are foundational principles: the importance of self-acceptance, of building a hopeful vision that you could have a happy and meaningful life, of building on your strengths and of understanding the importance of developing a set of skills for managing all of your issues in an integrated way, both by yourself and through support.
Recovery is a deeply meaningful and personal experience in the face of one or more chronic conditions. It’s a spiritual process that can help you reposition your understanding of yourself in very fundamental ways.
On the evolution of the recovery concept:
The concept of recovery in the face of a chronic disease originated in the field of addiction more than 70 years ago, started being applied to mental illness about 35 years ago and is steadily and increasingly being applied in a lot of other areas. In the medical field, for example, there’s been progressive language around people recovering from chronic physical conditions, such as cancer or injuries that cause significant physical disabilities.
There’s an increasing understanding of the importance of recovery from trauma of all kinds. And then there’s recovery from the experience of having been incarcerated, from having been homeless, from divorce, bankruptcy and so on. And yet, even as our understanding of the recovery process has grown and more people with serious mental illness have shared the hope of their own lived experience with recovery, the concept of recovery for people who have serious mental illness is still not well-known to the general public. This is something that is important to change.
On rethinking our approach to recovery:
In many cases, people in recovery have experienced treatment that was impersonal and mechanical; where the doctor only saw them as the disease. We’re trying to move away from these adverse practices and recognize the importance of different relationship models when it comes to recovery. We need to recognize terms like person-centered care, shared decision-making and trauma-informed care and we must have the humility that as practitioners, we are joining them on their ongoing journey and connecting with them as human beings.
On supporting someone’s recovery journey:
There are those who think no one can understand recovery unless they have lived it; however, while there are different types of recovery, everyone has their own experience. When supporting someone in their recovery journey, it’s important that we embrace humility and be respectful of what they’re doing. We should let them teach us. And we should acknowledge that while we are not an expert in other people’s recovery, we can be an expert learner about anyone’s recovery.
For more thought leadership from Dr. Minkoff, register for NatCon20. Dr. Minkoff will co-lead a preconference university – “Welcoming Integrated Services for People with Co-Occurring MH/SUD: Practical Steps for Implementation in Your Program” – on Saturday, April 4.