The healthcare community is moving from the traditional mental health model towards a new paradigm that values collaboration between patients and health professionals, as well as individual abilities and strengths. This is aimed at helping service users become experts in their own recovery instead of passive receivers of care as espoused in the traditional biomedical model. The new approach is based on the principle that all people involved in recovery, including health professionals, patients, and loved ones, are equally valued in the caring process. This paper reviews the new recovery philosophy with reference to adults with depression. It underscores the possibility that the new model could yield better outcomes for depression patients by offering them a sense of purpose and meaningful life.
Personal Recovery Philosophy
The personal recovery philosophy emphasizes the capacity of people to recover from psychiatric conditions based on a consumer-directed, family-centered approach. It encourages integration, independence, and productive roles for all individuals involved in care, including family, friends, community resources, and support groups. In this paradigm, recovery is depicted as a process in which individuals with mental health issues gain and maintain hope, recognize one abilities and weaknesses, engage in active life, enjoy personal autonomy, hold a unique social identity, live a meaningful life, and realize a positive sense of self. The divergence between ‘recovery’ and ‘cure’ is the foundation of the personal recovery philosophy. Kidd, Kenny, & McKinstry (2015) define recovery as internal conditions that people experience when recovering from an illness or circumstance along with external conditions that enable recovery. Cure is characterized as a means of restoring health and reducing symptoms. Hence, recovery-oriented mental health is directed by an individual rather than the practitioner and requires identification of mental health consumers by their personal characteristics and aspirations instead of their symptoms or diagnosis.
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The dominant psychiatric model claims that mental disorders are physical brain diseases that require pharmacological treatment. The basic premise is that mental health conditions are associated with the structure and function of the brain with anomalies in neurotransmitters, genetics, neuroanatomy, and neurophysiology playing key roles in pathology. Conditions like depression, schizophrenia, attention deficit/hyperactivity disorder (ADHD), and substance use are, thus, seen as biologically-based brain illnesses. Proponents of the biomedical model argue that there is no meaningful difference between mental and physical diseases and that the main cause of psychiatric disorders is biological abnormality. Widespread acceptance of this theory in the medical community has led to a sharp increase in the use of psychiatric medications, especially in the recent decades due to increasing diagnoses of mental illnesses. Psychiatrists who practice under the biomedical model are trained to diagnose, treat, and prevent mental illnesses based on standards acquired from the diagnostic and Statistical Manual of Mental Disorders (DSM). They use medications to treat physical abnormality just as regular medical doctors. Scientific evidence shows that psychiatric medications can restore chemical balances. Common categories of medications include antidepressants, antipsychotics, anti-anxiety disorders, and mood stabilizers. In the biomedical paradigm, the primary goal of research is to uncover biological causes of mental disorders whereas treatment research focuses on the development of somatic therapies based on underlying biological dysfunction. The ultimate goal is to create precise therapeutic agents that target the diseases without inflicting harm to the individual.
While the traditional biomedical model is effective in symptom reduction, it is subject to scrutiny in scientific circles. One of the earliest challengers, George Engel (1977), questioned the model’s disregard for psychological, social, and behavioral dimensions of disorders and reliance on somatic measurements. He specifically pointed at the acceptance of disordered somatic as an underlying factor of behavioral aberrations. Engel’s skepticism for the biomedical model sparked discussions about the rationality of the theory. Other challengers point at the lack of reliable biomarkers of mental disorders. To date, scientists have not identified consistent biomarkers for mood, thought, behavior, and mental conditions, and although psychiatric drugs are effective in restoring neurotransmitter imbalances that are thought to underlie mental disorders, there is no credible evidence that chemical imbalances are solely responsible for the development of mental disorders or that drugs work by correcting somatic imbalances (Deacon, 2013). In the last decade, the healthcare community has embraced advances in neuroscience, leading to the development of safer and more effective pharmacological treatment. Even so, mental disorders are becoming more severe and chronic, and the number of diagnoses is increasing significantly by the day. Modern psychiatric medications are no more effective than those developed or discovered accidentally over half-a-century ago. Above all, the pharmaceutical industry is focusing less on the development of new psychiatric drugs because of the lack of promising molecular targets for mental health issues and the lacking evidence that new mental compounds are superior to placebo.
The personal recovery philosophy attempts to work where the dominant biomedical model fails. Rather than focusing on the somatic domain, it revolves around a multitude of factors such as individual uniqueness, personal choices, attitudes, rights, dignity, and partnership between all people involved in care. In particular, personal recovery relies on the concept of co-production, which means that caregivers should desire to create a collaborative environment that accommodates service users and mental health professionals. A collaborative environment that includes professionals at all stages of recovery and loved ones is the optimal solution to creating services that truly meet the needs of service users. Each member of the collaborating team plays a productive role in the care process, ranging from citizen power to therapy and manipulation (Arnstein, 2015). The role of health professionals is to provide specialized guidance and therapy while the role of the patient and their kin is to provide the value of lived experience. The aspect of lived experience denotes various ways that individuals with lived experiences of mental health illness, recovery, and service use participate in the creation and delivery of health services. Proponents of personal philosophy claims that the model treats the whole person as opposed to focusing on the physical roots of the problem. Key components of personal recovery include appreciation and modification of contributing emotions, behaviors, and ideas; identification of life events and problems that influence symptoms; realization of a sense of control of individuals’ lives; and the knowledge of coping techniques and problem-solving strategies.
In spite of significant advancement in neuroscience, the biomedical model has failed to improve outcomes in mental health partly due to lack of clinical innovation and inclination toward somatic measurements and drug trial methodology. Although the approach has contributed considerably to the development of empirically-supported treatment, it has ignored the treatment process and set the profession apart along practitioner-and-scientist lines. Personal recovery philosophy represents an interesting alternative to the long-dominating biomedical model. The new model not only helps individuals with mental health disorders to recover but also to work through their problems and social connections.
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Application of Personal Recovery Philosophy in Treatment and Management of Depression in Adults
With standard primary care proving less effective in the treatment and management of depression, the personal recovery model seems like a plausible alternative. It perceives an individual’s potential recovery from depression as a personal journey that embroils hope, supportive relationships, secure sense of self, coping skills, social inclusion, empowerment, and meaning.
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