The Recovery Protocol- Part 1

Introduction
Citizen Psychiatry was formed to represent the unheard survivor voices of adults over my 40-year career in community mental health who are tired of limping along in life due to poor medication response. This comes after countless drug trials from a psychiatric provider. For those living with long-standing anxiety disorders and chronic depression, ineffective medication response can halt a person’s capacity to believe it is possible to make a personal recovery when in a weakened state. Sadly, ongoing medication failure where one is languishing can, over time, lead people to suspend their lives and dreams, as witnessed with the multitudes of people I have served. For many, this has led to cycles of being on disability, repeat hospitalizations, constant work disruption, loss of family relationships and friendships, loss of earnings, to the giving up on passions, dreams, and goals.

The response from mainstream psychiatry to ineffective medication has been to continue with more medication trials in hopes of lucking into an effective drug or combination of them. This revolving door consumers have experienced has left many dismayed and feeling defeated. While more medication trials are one route to address this condition, like psychotherapy as adjunctive support to medications, for many witnessed in my career, where these approaches have not been adequate, this has led to defeatist thinking with the consumer believing that making a recovery is not possible. However, for some, Electro-Convulsive Therapy (ECT), as the last mainstream option, is placed on the table to consider. However, this procedure is seen from the consumers eyes, in my experience, as too invasive and too frightening of a prospect to consider. When ECT is presented as the last option, consumers have often voiced to me that their internal conclusion by that time is that they feel too complex or broken and are now left with an ECT procedure of distaste. Regardless of the route, medication failure’s impact by that time is a demoralizing experience, and the anguish has been palpable for those I have served.  Though there are novel treatments on the horizon, like psychedelic therapy, consumers are clamoring to know what other options can be employed other than what the mainstream public system continues to offer. Being stuck in an illness cycle with anxiety and depression conditions is not how they envisioned their lives when the institution of psychiatry leads consumers to believe these conditions can be treated effectively with medications. People in this medication non-responsiveness loop in my career have reported themes of feeling trapped on a treadmill with no exit.

The Recovery Protocol Breakthrough is a novel program that answers what to do next when medications are not enough. By applying this protocol with one’s psychiatric or mental health service provider, people can empower themselves to experience making a recovery from a weakened mental health position to living from a position of strength compared to what they currently endure. When recovery is in motion, a “person-led life” can be realized instead of living with the grief of an illness-centered life.  Click here to view charts. This recovery program allows consumers to partner with their service providers, who would lead this practice during regular “meeting room” appointments. The journey to recovery commences in this relational space, where owning one’s life again can be realized.

The aim of this recovery protocol is not just to build a person’s capacity to break free from the chains of the mental illness hold on one’s life but to transition out of an Illness-led Living to a new orbital position where Person-Centered (led) Living dominates, a freeing experience (See, The Fable). Hence, mental illness conditions like depression or anxiety disorders are no longer experienced as the center of one’s life.

This protocol accomplishes this by showing each person how to carry the weight and stress of their mental health condition, not in a weakened state, as currently experienced, but in a state of strength, agency, and empowerment. Held in this way, a person experiences,

a) a diminishing influence of mental illness hold on their life       
b) the weakening strength of the mental condition in their life
c) the loosening of the mental illness grip on their life

In listening to the consumer constituency over the decade of service, a stream of sentiments about living under the reign of poor medication response has been expressed. Here is a summary of these sentiments:

1. a) I am at my wit’s end. I feel more hopeless than ever before.
2. b) I would rather suffer the symptoms than take these drugs that numb and make my body feel weird.
3. c) I feel like I am limping along in life with no way out.d) I have gained weight, lost my sexual appetite, and barely any energy for my children and work.e) I feel undervalued when the discussions are primarily about the diagnosis-symptoms-medication as if I am the diagnosis needing fixing. There is more to me than this.

Such sentiments expressed and others outlined resulting from failed medications tend to erode an individual’s recovery psychology (recovery mindset) of “Agency” and “Hopefulness” (AH), the core belief set driving a “personal recovery” (recovery). Here, the term “recovery psychology” has been defined as,

… representing a belief set of formed attitudes that determine the degree to which a person can conceive of having the capacity to make recovery possible utilizing their personal resources, exercised for this purpose.

With poor medication returns, the longer a person cycles in this form of treatment non-responsiveness, the greater the erosion of one’s recovery mindset. In effect, due to the non-effectiveness of medications, the software code written into their recovery psychology by this time has become corrupted with a negative sense of self and life. This corrosive impact tends to piggyback on the internalized stigma of accepting a psychiatric label as core to their identity, making their recovery mindset ill-prepared to pursue a recovery.

Consider this statement from “The Psychiatrist” regarding empowerment in the article: Does the Scientific Evidence Support the Recovery Model? Volume 34, Issue 1, January 2010, pp. 3 – 5,

…People who accept that they have mental illness may feel driven to conform to an image of incapacity and worthlessness, becoming more socially withdrawn and adopting a disabled role. As a result, their symptoms may persist, and they may become dependent on treatment providers and others…This view is supported by an early study of people with serious mental illness, which found that those who accept that they have a mental illness *(not the label) and have a sense of mastery over their lives *(an internal locus of control) have the best outcomes. However, those who accept the label of mental illness, i.e., *identify with it, tend to have lower self-esteem and an external locus of control, and those who find the mental illness label to be most stigmatizing have the weakest sense of mastery. Thus, internalised stigma undermines the possibility that insight *(accepting the label) will lead to good outcomes. (* This mark denotes inserted text for clarification purposes).

Another significant source for degrading an individual’s recovery psychology relates to the hardware components of the person’s body and brain. It is well known now that consumers suffering from various mental health illnesses, like depression and anxiety conditions, eat poorly, and the degree of low movement and sleep impairment can, for many, be very lacking. For example, for people who live a sedentary lifestyle and suffer from depression, this issue can result in poor oxygen supply and low blood flow to the brain, which in turn can mean a lack of nutrients and oxygen reaching the brain cells to function well and this, in turn, can make the depression worse than it ought to be. These maladaptive lifestyle patterns, among others like poor diets and sleep disturbances, have unequivocally been shown by research to corrode the hardware of Soul, body and brain, making these mental health conditions more acute.

When you couple this corrosion with that of the software code degradation of one’s recovery psychology (recovery mindset), these layers further weaken a person’s mental health state for the worse. This combination further clouds the recovery climate of an individual, making recovery seem like an elusive dream that is not worth holding.  In this corrosive state, mental health conditions are perceived as greater in weight and stress than they were originally at the beginning, leading to an increasingly distressing impact on the person’s life. The static created in the hardware transmissions and operations, along with the software code corruptions, greatly weakens the person’s recovery psychology and increases the felt weight and stress of carrying the mental illnesses. The strain of holding this perceived weight and stress in a weakened recovery state is similar to what is outlined in The Fable. To answer this hardware deficit, the second half of the protocol breakthrough looks to the up-and-coming field of Function Medicine in psychiatry that addresses these issues where medication can’t without enduring more toxicity and poor efficacy. More on this subject matter later on.

What “The Recovery Protocol Breakthrough” injects for the first time is a regenerative practice that counters the erosion of an individual’s recovery psychology (recovery mindset) tied to medication failure by leveraging the resource capacity of a person through,

1) focusing on what is going right in a person’s life
2) exposing their inner and external strengths and exercising them
3) addressing the hurdles to recovery to diminish their felt stress and weight
4) weakening and distancing one’s attachment to the mental illness
5) addressing the hardware of Soul (body & brain) to strengthen their operations.

Our regenerative approach contradicts the traditional problem-driven deficit approach of mainstream helping disciplines that asks, “What is wrong that needs fixing?”. With this protocol’s strength-based approach, elevating “Agency” with “Hopefulness” is integral to building a strong recovery psychology, allowing people to move forward in their lives on purpose. When the program is applied, consumers feel visible in the service provider’s meeting room. They can start acknowledging that they, too, are the holders of power to change (empowerment) rather than be seen through the prism of a diagnosis where the “Pill” is considered the locus of power, psychiatrically.

What is Recovery?
To start, read the chapter What is a Recovery? (link insert) listed under the menu title Recovery Explained for a fuller account from Citizen Psychiatry perspective. In short, a recovery can be described as follows,

A “Personal Recovery” can be defined as a transformative personal shift in mindset where the individual transitions from “Illness-Centered Living,” an unrecovered position, towards “Person-Centered Living,” where the individual, and not the illness, is at the “Helm” of one’s life.

With this definition in mind, recovery frees up personal space in a person’s life, resulting from the shrinking of space The Illness (mental illness) presently occupies within their personal sphere of living. As such, the objective is not to be curative. Just like living with asthma, for example, at first, it takes up most of the personal space in a centralized position within the person’s life that infects every aspect of it. However, with favorable responses to treatment and lifestyle adjustments, the asthma condition can take on a new de-centralized orbit as its occupancy of personal space shrinks. In turn, the gains of personal space within the person are realized as the individual slides into a person-centered stance in their life. In this recovery position, the person experiences owning their life again. Here, we find that, in a strong recovery position, the asthma is not allowed to diminish the quality of one’s life, nor does it affect how empowered a person feels.  Either the asthma dominates the person’s life, or the person does. This is the aim of the Recovery Protocol Breakthrough to provide the steps that allow one to dominate and lead their life rather than their mental health conditions.  For many people, making a recovery is freeing and liberating, whether medications are involved or not, compared to what is currently experienced.

For individuals feeling pinned under the weight and stress of their mental illness, like depression and anxiety disorders, this is debilitating enough, but when “medication non-responsiveness” is enduring, the light of hope can dim greatly. This recovery protocol can breathe life into treatment and recovery, transforming “psychiatric surviving” into “personal thriving.”

-The quality of one’s recovery mindset or psychology can either hinder or enhance recovery outcomes.

Unlike the “Pill” used in making a psychiatric recovery, a “personal recovery” requires leveraging personal resources, such as skills, abilities, hopes, purposes, talents, interests, passions, roles, foods, movement, sleep, and values connected to elevating “Agency” (A) and “Hopefulness” (H). This focus produces a regenerative impact on one’s mental health. In addition, the strength-based approach, being the opposite of the traditional problem-driven, deficit-fixing approach, includes the relevance of nutrients, foods, movement, and sleep to further build a stronger sense of self for the person with the individual’s hardware of the Soul.

–Pill taking alone cannot cultivate a recovery when poor medication returns exist.

To date, the chemical route (medications), as the first line of treatment, is leaving people with protracted (without relief) depression and anxiety disorders in a state of “treatment suspension” until a new “Pill” or combination thereof comes on board. Without building a stronger recovery capacity, the opportunity to shift from living an illness-centered position towards a person-led position, for many, becomes an elusive dream as they await a magic pill. However, by applying the program, a window in a person’s life can open where recovery can begin to take flight.

– The “Pill” addresses the chemistry of the psychiatric illness and not the psychology of recovery-

Citizen Psychiatry advocates for including a “recovery first policy” in the Meeting Room of a provider, acting as a co-partner to their services. For consumers, the medical community in psychiatry looks at poor medication response as “medication resistance.” Unfortunately, people languishing with this form of treatment resistance, as stated, tend to find their recovery psychology degraded over time the longer this condition is in existence. For many consumers, the adverse impact tends to produce an increasing sense of powerlessness, worthlessness, hopelessness, and helplessness to effect change in their lives, the opposite of empowerment where a strong sense of “Agency” with “Hopefulness” (AH) is held. This program’s purpose is geared towards building a stronger sense of “Agency” and “Hopefulness,” leading to greater self-empowerment.

The mission of Citizen Psychiatry is to champion the consumer to introduce and implement the recovery program as a practice to complement not just psychiatric treatment but other service professionals in mental health who are working with people languishing with “medication failure.”

Continue to The Recovery Protocol Part 2 – Click Here