Recovery Process of Participants with DSM Diagnoses of Schizophrenia, Bipolar or Depressive Disorders

Background and Purpose: The concept of recovery from mental illness represents a paradigm shift from the view of mental health diagnoses as permanent and disabling conditions.  Guiding principles of the recovery movement emphasize that recovery occurs through a variety of pathways, and existing research on the lived experience of mental illness has indicated that recovery is best defined by the person in recovery.  To support improvements in recovery-oriented mental health services, further research is needed on the factors and processes of sustained recovery from serious mental illness.  This study adds to the literature on the lived experience of the recovery process among persons with major mental health conditions—specifically schizophrenia, bipolar disorder, and major depression—who have been successful in a sustained recovery process without ongoing medication use.

Methods: This qualitative study employed a grounded theory approach to explore internal and external processes and factors that contributed to a sustained recovery process among participants with mental health diagnoses of schizophrenia, bipolar disorder, or major depression.  Purposive sampling was used to recruit participants who were in recovery and who had not been taking psychiatric medications for at least twelve months prior to the interviews.  In-depth, semi-structured interviews were conducted with 19 participants who met the study’s inclusion criteria.  The majority of the participants were White (89.5%), had at least some college education, and were married or living with partners (84.2%), but participants were evenly split among men and women (47.4% male, 52.6% female) and represented a wide variety of age groups (age 27-70).  Data analysis used the constant comparative method with open and selective coding using “recovery” as a sensitizing concept.  Three researchers participated in coding, recoding, and making connections among codes until theoretical saturation was reached.

Results: Participant narratives revealed the importance of perspective change during the recovery process, with participants describing key changes in how they viewed themselves and their relationship with their mental health conditions and symptoms.  This perspective change of viewing oneself as a “recovered,” “resilient,” “better,” or “whole” person and the illness experience as a learning or growth process was supported by both internal and external processes and factors.  Internal factors included cognitive processes (an increased sense of ownership to take control of life, determination to get better, positive thinking, and being hopeful), emotional processes (increased awareness, understanding, and acceptance of emotions, particularly negative emotions), and self-care activities to meet physical and spiritual needs.  External factors included social support, social roles, social giving, and having a meaningful external focus.  Notably, participants identified that taking on roles of social giving provided even greater benefits than receiving support from others.

Conclusions and Implications: Consistent with SAMSHA’s Recovery Principles, study findings highlighted the importance of hope, client-centered and respectful treatment, and the central role of the individual in a multifaceted recovery process.  Rather than a passive “patient” mindset, recovery-oriented mental health treatment should encourage the development of self-efficacy to direct one’s own recovery process, effectively manage emotions, and even take on active roles of social giving.