Measuring Recovery from Substance Use or Mental Disorders Workshop Summary (2016) / Chapter Skim
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5 Defining and Operationalizing Recovery from Mental Disorders
5 Defining and Operationalizing Recovery from Mental Disorders
Pages 41-56
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From page 41... ...
on the role of positive mental health in operationalizing recovery. DEFINITIONS OF RECOVERY FROM MENTAL DISORDERS AND IMPLICATIONS FOR MEASUREMENT Mueser discussed the definition and operationalization of recovery from mental disorders.
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One of the challenges for measuring recovery from mental disorders is being able to identify areas of convergence between the medical 1 Antony, W.A.
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From page 43... ...
Mueser said that although combining the objective and subjective definitions of recovery from mental disorders is challenging, one option is to define recovery in terms of psychosocial functioning, which is the area of greatest overlap in definitions. This in turn can lead to the development of models that integrate symptoms, objective functioning, and subjective experience.
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From page 44... ...
However, insight in the case of schizophrenia is also related to worse mood and worse subjective experience. The likely reason for this is that when people are asked to rate their own psychosocial functioning, they are really being asked to compare themselves to other people, and those who have a lot of reality distortion do not see the discrepancy, which could lead to negative emotions.
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The objective dimensions include various aspects of role functioning, mental and physical health, independent living, and social BOX 5-1 RECOVERY PROFILE: OBJECTIVE AND SUBJECTIVE DIMENSIONS OF RECOVERY Objective Dimensions Subjective Dimensions Role Functioning Well-Being • Work • Hope • School • Confidence • Parenting • Self-determination Health Sense of Purpose • Mental health (symptoms) • Physical health Internal Processes Related to Mental Illness Independent Living • Acceptance • Stable housing • Empowerment • Independence • Resiliency • Self-care • Self-stigma (absence of)
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From page 46... ...
A list of subjective dimensions he tentatively proposed include aspects of well-being, sense of purpose, and internal and external processes related to mental illness. He noted that the internal processes related to mental illness are the processes that a person goes through within themselves, while what he labeled external processes are in fact active strategies that a person may be using in order to manage the mental illness.
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From page 47... ...
The difference, Mueser said, is that there is a perception of greater control over substance use than mental health symptoms. In addition, in the area of mental illness, the emphasis of hope is partly aimed at countering the negative messages that psychiatry has communicated over the years about major mental illnesses, such as telling people with schizophrenia that they will never be able to work.
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From page 48... ...
Mueser replied that he would focus on people who have some prior indicator of severe and persistent mental illness. He argued that including everyone who has had a psychiatric illness would be too broad, in part because most of what researchers know about the subjective aspects of recovery from mental disorders is from working with people with severe and persistent mental illness.
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To measure happiness, operationalized as psychological well-being, Keyes and his colleagues asked study participants to think about the past month and answer such questions as whether they liked most parts of their personalities, had warm trusting relationships with other people, were being challenged to become a better person, felt that their lives had direction and meaning, were able to manage their lives, and were confident that they could express their own ideas and opinions. The social well-being operationalization of happiness includes social acceptance, social integration, social contribution, social coherence, and social growth.
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Another point of the two-continua model Keyes highlighted is that just because one has a mental disorder, or had a mental disorder in the recent past, does not mean that the person does not have some level of well-being. Of course flourishing with mental illness is quite rare, but it does happen.
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There were no differences observed in the model between men and women. The data also show that less than one-half of the genetic variance for mental disorders, such as depression, is shared with the genetic variance for flourishing.
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Data from the Midlife in the United States Study showed that in 1995, 18.5 percent of the adult population fit the criteria for one of those three mental disorders.6 When the sample members were reinterviewed in 2005, 17.5 percent fit the criteria. The overall percentages did not change, however: 4 Liselotte, N.D., Harper, W., Moutier, C., Durning, S.J., Power, D.V., Massie, F.S., Eacker, A., Thomas, M.R., Satele, D., Sloan, J.A., and Shanafelt, T.D.
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However, when one has a mental disorder, any improvement in good mental health is a sign of movement toward recovery, and several recent studies have underscored this point.9 He argued that measures of recovery should include some elements of flourishing. If flourishing can prevent the onset of mental illness, it is possible that it can also prevent relapse of mental disorders and substance use disorders; more studies would be needed to determine if this is so.
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From page 54... ...
He asked Keyes whether he thought that measuring flourishing could replace measuring recovery altogether. Keyes answered that he would like to think that the field can mature and perhaps grow out of the concept of recovery, because it would shift the focus to facing something positive, not something that was left behind.
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From page 55... ...
He wondered whether the functioning measures also fit into a continuum model. Mueser said that they do, and he clarified that he considers functioning measures especially important for people with serious mental illness because they are more changeable than the underlying subjective aspects of recovery.
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