edited by Larry Davidson, Courtenay Harding, and LeRoy Spaniol; Boston, Center for Psychiatric Rehabilitation, 2005, 511 pages and 448 pages, $49.95 each, softcover
Dr. Jabbarpour is clinical assistant professor at the University of Virginia School of Medicine, Charlottesville, and chief of staff at Catawba Hospital, Catawba, Virginia.
Psychiatry is in an era of change not only in terms of new scientific models of mental health but also in values-based models of psychiatric service. Our nation's first two commissions on mental health were appointed by President Kennedy in 1963 and by President Carter in 1978. The third commission, the New Freedom Commission appointed by George W. Bush, sets a vision for recovery in its budget-neutral document, Achieving the Promise (1). "Recovery" is becoming more than a word. It is a possible juggernaut of hope and transformation. This two-volume set on recovery, published by Boston University's Center for Psychiatric Rehabilitation, was edited by three doctorate psychologists, Larry Davidson, Courtenay Harding, and LeRoy Spaniol, experts in the field of psychosocial rehabilitation with experience as researchers, authors, and speakers.
The volumes are organized into four main sections. The first is titled, "Recovery From Severe Mental Illness: Is it Possible?" The second section takes the next logical step with the title, "Then What Happens to People Over Time?" The third section, "What Helps People Improve?" is subdivided into a focus on fundamentals of community integration followed by attention to "treatment, case management, and advocacy." The last main section strives to answer the question, "How can mental health systems evolve into recovery-oriented systems of care?"
With only four of the scientific articles being new, nearly 80 % are previously published works, dating back to 1979. The volumes total nearly 1,000 pages, and the primary source of articles is the publisher's own Psychiatric Rehabilitation Journal. The editors provide seven additional articles, which are personal accounts and essays that are written mostly by persons with mental illness. These stories and editorials present the reader with a humanistic, subjective set of recitations to complement the previously published, peer-reviewed articles. The last formal chapter provides no personal accounts or articles but is a piece written by the editors on "an agenda for recovery and research."
If recovery is a scientific model, then more review could have been invested not only in those areas of the field where recovery easily informs our understanding of illness and outcome but also in areas where recovery has challenges in explaining service provision and certain other phenomena. If recovery is a values-based model, then additional attention to the ethics of recovery or the complex issues of how recovery is balanced by public and personal safety would have helped. Although the discussion addresses varying definitions of recovery, a clearer definition of "severe mental illnesses" in its association with recovery would have enhanced application of the model, as exemplified by the role of recovery in psychiatric illnesses affecting children, adolescents, and older adults. In an era when many persons with mental illness are not only homeless but are being transinstitutionalized into nursing homes, jails, and prisons, more discussion on recovery for persons in these situations would have helped. Historic perspectives would have complemented the model, including similarities of recovery with the efforts of Dorothea Dix and moral treatment of people with mental illness at the turn of the 19th century.
Recovery From Severe Mental Illnesses is more than a compilation of research evidence and implications for practice. Each article independently, whether initially published in the British Journal of Psychiatry or Psychiatric Services, might not have provided a full picture of recovery. However, the reader might view these volumes as a refitting of past works that compiles certain pieces of scientific literature from over three decades, cements them together with editorials and personal accounts, and provides a mosaic of a new image and new vision for mental health services. This text will be of interest not only to clinicians and consumers providing services but also to persons with mental illness, their family members, and their advocates.
1.Achieving the Promise: Transforming Mental Health Care in America. Pub no SMA-03-3832. Rockville, Md, Department of Health and Human Services, President's New Freedom Commission on Mental Health, 2003