Picturing Recovery: A Photovoice Exploration of Recovery Dimensions Among People with Serious Mental Illness

Background.  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” (SAMSHA, 2012).   Despite the increasing attention recovery has in mental health services research, practice, and policy, the concept remains elusive and difficult to operationalize and measure. This limits its use in informing the development and implementation of recovery-oriented services. To address this gap, Whitley and Drake (2010) developed a dimensional model of recovery composed of five interrelated dimensions including: clinical, existential, functional, physical, and social elements of recovery.  In this study, we used photovoice, a participatory action research method, to explore how people with serious mental illness (e.g., schizophrenia) and a history of substance abuse and homelessness discussed their recovery through narrative and visual representations.  We applied Whitley’s dimensional model to explore how these recovery dimensions interacted to influence people’s recovery.  

Methods.  Photovoice is a participatory research method that empowers people with cameras to document their lived experiences and inform social action.  Sixteen consumers recruited from two supportive housing agencies participated in six weekly sessions in which they took photographs about their physical health and wellness and then discussed the meaning of these photographs in individual interviews and group discussions.  All interviews and groups discussions were audio taped and transcribed.  Pile-sorting techniques and grounded theory were used to analyze narrative and visual data. We then coded photographs and stories related to participants’ recovery using Whitley’s dimensional model of recovery.

Results. Participants were mostly male (56%) and either African American or Hispanic (87%). The majority (88%) had a diagnosis of schizophrenia, major depression or bipolar disorder, and more than half reported a history of substance abuse (56%). Our analysis shows that the five dimensions were present in participants’ photographs and stories of recovery and were intertwined in several important ways.  Participants talked about how they used existential dimensions of recovery, particularly their religious beliefs and practices (e.g., “God makes me stronger”; “I pray to forget drugs, for peace of mind”), to support and sustain clinical aspects (e.g., achieving sobriety, adherence to medications) of their recovery.  Functional achievements, such as participating in employment and peer specialist training programs, represented for many a validation  of their own agency, thus enhancing existential elements of recovery and combating self-stigma (e.g., “Society says the we can’t function in society. This certificate proves that’s a myth”).  Lastly, the social dimensions of recovery, such as receiving and giving support to friends, peers, and family members, rippled through as person’s life and supported many aspects of recovery, such as reducing relapse and isolation (e..g., “having that support system prevents depression and relapse”), and enhancing a person’s self-worth (e.g., “being a peer specialist allows me to help others . . . that gives me strength”).

Conclusions.  Study findings illustrate the value of using a dimensional recovery model and point towards important interrelationships between recovery dimensions.  Implications for using participatory methods and a dimensional model of recovery to inform recovery-oriented services will be discussed.