Learn how social factors promote mental health, influence the onset and course of mental illness, and affect how mental illnesses are diagnosed and treated. This course explores how our understanding of mental health and illness has been influenced by social attitudes and social developments in North America and around the world. The course begins by situating our contemporary mental health practices in historical context, then looks at different aspects of mental health, mental illness and mental health services and their connections to what’s going on in our social environment.
1.7 Recovery and mental health
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来自 University of Toronto 的课程
The Social Context of Mental Health and Illness
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从本节课中
Welcome and A Brief History of Madness
We begin with a quick orientation to the course and continue with our first lecture topic: A brief history of madness.
与讲师见面
Charmaine WilliamsAssociate Professor
Faculty of Social Work
Okay. I'm just going to provide a brief
introduction to the concept of recovery as a lead in to the next segment.
About ten years ago, mental health professionals started discussing recovery
as a process in which, to quote the Substance Abuse and Mental Health Service
Administration in the US, was a journey of healing and transformation.
The full definition says recovery is a process of change through which
individuals improve their health and wellness, live a self directed life.
And strive to reach their full potential. SAMHSA also introduced the dimensions of
recovery that you see here. Housing and social support are certainly
things that we have seen as part of the definitions of psychiatric and
psychosocial rehabilitation that we've already discussed.
The introduction of health is significant here because it signals the importance of
seeing people who are diagnosed with mental illness holistically.
So that we're concerned, not only about the possibilities of symptoms of mental
illness, but also their overall experience of physical, mental and
emotional health. I think another important addition here
is the concept of purpose. In defining purpose as part of recovery,
we recognize that people who have mental health problems, are valued members of
our communities and desire to be treated as valued members.
It, in our history of dealing with madness,
it's been clear we've not always recognized people who are affected by
mental illness as people who should participate in society or deserve to
participate in society. I would go further to suggest that part
of one of the effects of stigma against mental illness is that once people are
diagnosed with one, we start to forget they are whole people with other things
going on with their lives, and so that gets in the way of things like
participation, and independence, and self determination.
So, as I said, since recovery is a concept that really originated with
clients of the mental health care system, I wanted you to hear about it from
somebody who has lived experiences being a client of the mental health care
system. So I'll be introducing an interview with
somebody who has that experience next. So it was real pleasure for me to
interview the person that you are going to see next Caroline Fei-Yeng Kwok.
Caroline is the author of this book Free To Fly, which is a memoir about her
experience of living with bipolar disorder,
and is her second book on that topic. And I thought she would be a wonderful
person to invite in for an interview, because she can speak so well on so many
of the issues that we touched on in this course.
She is an advocate, she is an educator, she has spoken in different parts of the
world about reform in the mental health care system, as well as her own
experience of mental illness, and is an eloquent speaker on all of these topics.
I wanted to read a little bit from the foreword to this book, which was written
by a Dr. Mary Seeman.
She is a psychiatrist and professor at the University of Toronto, and I thought
she, her words just spoke so well to Caroline.
I couldn't think of a better introduction.
So, Dr. Seeman says she's developed a strong
sense of who she is, what her purpose is on Earth and what the future holds.
She demonstrates that recovery is there to be seized and cherished, that healing
is possible even after several bouts of serious illness.
Her story of self determination will empower others and bring them comfort.
She has suffered, as this book makes clear, but has transformed her suffering
into hope. And with that, I'll pass this on to the
interview with Caroline. So you've mentioned recovery.
And that's, that's one of the things I really want to talk to you about.
Could you tell me a bit about recovery and like, what your understanding of it
is, and why you started talking about recovery?
Well re, recovery, there are three models of recovery as you may know.
There's a clinical model of recovery in which first of all, like a, if the
symptoms are reduced, and if a person could function well, and.
You are recovered. huh.
But then the self esteem of the client is still very low and the anxieties of the
clients are very low. That is what my understanding of the
clinical model of recovery. The second model that I understand is
psycho-social rehabilitation model of recovery.
huh. In which, well, you still have to take
medications and there's lots of case managers and then come employment are
there to reduce hopefully. Depression and social integration.
And our, and the, well the last model, is called the mod, the, the empowerment
model recovery which is something, that I find very useful, for myself.
Mm-hm, so could you tell me more about that last model, then?
The last model, it is, they have, the principles of recovery is based on
hope, in the sense of hope for the clients,
right. And then also the sense of inclusion, the
social inclusion, not exclusion, but social inclusion.
Hm. And also, it also has to do with the the
self determination of the clients, the resilience of the clients, the self
control of the clients. And then also it has to do with the fact
that, to have someone to believe in you. And then to believe in yourself.
And to, and to live a life. And to have a life that is to your
fullest potential. Mm hm Mm hm.
Then, according to these three models of
recovery, right? Mm hm.
Well, for, actually, these days. I've seen that a lot those mental health
professionals, Still like to use a clinical model which is another word for
the medical model of recovery. Mm-hm.
And their job especially in the inpatient units.
And the second model is the psycho-social rehabilitation model is immediately used
by these psycho-social rehabilitation centers.
Such as at the Cross Boundaries where I'm teaching at the moment.
But I would love to see the... Okay.
For clients who can not respond to the clinical model, maybe psychosocial
rehabilitation model would have them and then for clients who can not repsond to
both the clinical model and psychosocial rehabilitation model, well.
The empower model would help them. You've talked about how it's possible
that somebody can experience that, that final type of empowerment recovery.
Yeah. even if they haven't necessarily been
able to be completely free of symptoms. Yeah.
Could you say more about how you think that's possible?
Well it is possible if the President has hope.
Mm. Okay.
And as you see the hope is very important right even when you have cancer you have
to hope right and the cancer cells won't go away.
And unless with chemotherapy and whatever,
but during the process of recovery of cancer problems.
Mm-hm. Then you have to hope.
Mm-hm. So by the same token, I think that for a
person with similar problems, say mental illness, that person has to hope.
Mm-hm. So its partly about being able to have
that hopeful state even though other things are going on that might be getting
in the way of you feeling completely well.
Yeah right and also I feel that another thing that will light your stress will be
self determination. Oh could you say more about that.
I find that some of my clients in at cross boundaries they don't.
They said I couldn't do this, but I ended up not doing it.
So the, I'd see the case managers would have to push them a little bit,
or to encourage them. Mm-hm.
To do a little bit of this, you know, self determined.
Mm-hm. And so it's the goals in life.
Right, right. So you don't.
Even if I'm, even if I'm depressed.
You have to implement this goal. Oh, you can do it, you know, it's just a
small step, you know. Not a big step.
A small step, you know, at one time. And then, you know,
implement the sense of goal. Is that something that makes people feel
like. Achieved.
Yeah. The sense of achievement, you know.
Say for example if I was sick, right, and I was.
If I were depressed and I didn't feel like getting up then, then you have to
have someone there to tell you okay, now don't worry.
Just get up and have a cup of coffee. And, then if that person is interested in
a cup of coffee, then okay, and then, afterwards you can tell the person, okay
after your cup of coffee, oh you did a good job.
That is a small encouragement for a small task.
Mm-hmm. Step by step.
So part of recovery, if I understand you correctly, it's, it's not just what the
person themselves is feeling, but it's also about being surrounded by people.
Who understands you, and encourage you, and believe in you.
It's just like in my case. Mm-hm.
You know, like, in the past, as I was telling you.
Under the con, under the clinical model. I was considered recovered.
I mean, I could go back to school, you know, but I did not feel that I was
recovered. Mm-hm.
Because the confidence was lost. I was, I was so dependent on my aging
parents, as I had indicated in my book Free To Fly.
And I wasn't myself. And also, right now,
under the empowering model, I know the kind of medications that I've have,
because as I mentioned to you earlier I suffered from a coma.
Mm-hm. Because of wrong over, overdose of
medication by the psychiatrist. And ever since then, I've been going to,
know full information about the different kinds of medications that I am taking.
Hm, hm. And with that I discuss it with my
psychiatrist or with my family physician. But at least I would, have a better
understanding, of what the kind of medications I am having.
Hm, hm. So this is another way for me to
overcome.. Mm-hm.
So I'm, I'm struck by, your, your defining recovery as partly also about
being an informed service user. Yeah.
An informed consumer Consumer survivor. Recovery is an individual process.
Mm-hm. It various from one person to another.
Mm-hm. You know.
So the way that you recover is not the same as the way somebody else with a.
Yeah, yeah right, right. And sometimes some people recover a bit
slower, and some people can recover a bit faster.
And some people maybe they can react to this clinical model, some of them can't
and just like me, I react to the same problem and powerment model.
