The Positive Ways approach to good Mental Health means weaving together the Medical (or Illness) Model and the Recovery Model to advocate the ‘Purposefulness Model’.
The main difference between the three models of wellbeing concerns the degree of optimism each has toward how a person can engage with their future in a positive way. For me this means having an optimistically, future orientated, purposeful and growth outlook on life. It advocates building and sustaining mutually supportive relationships and in holding personal view in which life simply ‘makes good sense’.
The Purposeful Model sets out to meet that for me by; treating people as responsible, capable, active and being able to both learn and to influence their environment, especially in co-operation with others. Purposefulness includes holding the expectation that we can a lead a rich and vibrant life, and be capable of suitably overcoming or incorporating illness, and accommodating any other limitations in order to be contented. To that extent positiveness and optimism are not ‘Pollyanna’ like attitudes but are rather about aclimatisation and Adeption in the face of challenges.
Alongside Purposefulness, the model values mutuality. People often struggle to find the balance in their relationships, with others and with organiations, which results in power struggles and conflict, which can cause illness. The Purposefulness Model places importance on mutuality for good mental health.
The Recovery Model focuses on inspiring the person to take responsibility for their goals, to become well. This is a worthy objective, but seems to isolate the person, not necessarily deliberately, but seemingly. The recovery model suggests that individuals need to find their way simply because they have been assigned ‘self-determination’. This might overly imply isolation. This appears a healthy step towards empowering individuals but may not take account of the individuals current depleted motivations and or their current developmental needs.
Because these individual aspects can exist in individuals, the medical profession has traditional taken a paternalistic approach to overcoming illness. In the Medical or Illness Model, the medical professional consults with and listens to the patient. Information is gathered, a diagnosis is made, and the expert delivers the healing advice, which the compliant patient is expected to dutifully follow.
The difficulty with the Illness model, is that it is less empathetic and fails to fully take account of the patient’s perspective, and thereby undermines the personal responsibility that the patient should take for their own recovery. The patients can become disempowered and may not be proactive in their own health. Very often patients are left feeling that they are their illness (or diagnosis) rather than a person. In some cases, the illness/diagnosis becomes a label and some people may research and even adopt the behaviour and even feelings, and symptoms described in the model. To that extent the Illness Model may become self-sustaining in that the person may feel that they are and will continue to remain helpless.
The argument for paternalism, on the other hand, just sometimes some people need to accept help, support and care of others, because they simply cannot cope for themselves. For example, very recently I suffered a series of small strokes. Because I consider myself to be independent, I initially refused to be taken into hospital. In hindsight, I now accept that was a step too far and what I needed, and eventually after I finally passed out, was to be taken into care and administered to by people who simply knew more. This suggests, that there are times when we should all ask for and receive help.
However, the Illness Model treats the disease and unwittingly can thereby exclude the individual needs, treating the person as if they were the disease. The Illness Model position then becomes ‘that the best the person can do is stabilise their situation, moods and behaviour by simply being compliant. This may sometimes mean that (in the UK it is called ‘sectioning’), some suffering persons may be subjected to custodial health care, enforced medication and imposed talking therapies.
In the process, those dispensing the ‘care’ may consider themselves superior to the person, which can lead to conflict, disempowerment and in some cases neglect and abuse. This is may be made worse if the professional carer is not well trained, lacks empathy or is unable to build appropriate rapport with the person. This is compounded when approaches relied on in the Illness Model, like diagnostic tools (such as DSMV) and the use of pharmacology (drugs), are criticized as being about ‘maintaining’ the individual ‘in the system’, that is are serving profit before recovery.
The Recovery Model, in contrast, favors a focus on the patient/client having an influence or control over their mental health, which it assumes is possible. This becomes achievable because, the person is treated with respect and is presumed to be self-determining (I say presumed, because there may be times where a person has become so instituationalised or dependent on the system that they are simply not confident in making decisions, they then need support to become self-determining).
What I appreciate about the Recovery Model is that it accepts mental health challenges, as normal and does not disempower the person or need to assign those challenges to any diagnosis or illness.
The Recovery Model advocates a process through which a person with mental health challenges can co-operate with the ‘system’ in a way which leaves them responsible for their own health. The ambitions of the Recovery Model seem to be to; remove the stigma of mental health suffering; make interventions more individually sensitive; and to enable collaboration between all stakeholders in the individuals caring process.
In the UK this became a model known as ‘Care in the Community’, which whilst professing that principle, seemed to be more like an economic cost saving approach, which simply left unprepared sufferers and their familial carers struggling to cope. This persisted for some time, but then seem to improve with the introduction of professional carers with ‘lived experience’ into the system. This means caregivers can be more empathic, because they may have had and experienced the system and their own challenges. In this sense, introducing empathetic and experienced carers into its approach, the Recovery Model starts to address elements of any unnecessary power imbalance that may have existed under the Illness Model.
For me, it seems that the Recovery Model was helpful in encouraging a sense of ‘shared decision making’. i.e. that individuals (like me and my stroke), still need interventions, but they should and could be treated as self-determining, that is in deciding what action should be taken (unless they are incapacitated). The proviso is that this is wholly dependent on the individual being discerning enough to know when they need help. Given that, I can understand and appreciate that there are times where ‘the system’ needs to behave in a paternalistic manner. None-the -less, the recovery model sets out for a degree of personalisation in the care delivered and should lead to more empowered and engaged persons.
My main concern with the Recovery Model is that it could still allow a person who had not acquired enough knowledge of, or adopted suitable attitudes towards their challenges and options, to be disenfranchised. The Purposefulness Model attempts to overcome this by arguing that care should be delivered in a manner that encourages shared responsibility and a greater sense of community and togetherness. That is through mutuality.
Even more validly in my view, more importantly, the Recovery Model encourages the bigger picture for a person’s life in that they are more than just their challenges or illness. The Purposefulness Model encourages the individual to live a life of meaning and purpose.
The Purposefulness model focusses on support, hope, accountability, personal responsibility and education as guiding principles, for a holistic approach to the client/individual recovery or healing ‘journey’. The individual is encouraged to move beyond just health and is treated as person, who can develop a sense of being able to bounce back from any setbacks on the path to recovery, which is termed hardiness (and more they can live a productive and full life in community).
The word ‘journey’ is used, because the individual may experience setbacks as they ‘travel’ move on in their lives. In the process, professionals, friends and the community collaborate to ensure that everyone’s needs are met, including to move to an even bigger and brighter future.
The ‘Purposefulness’ model encourages individuals to move even further on through their journey, focusing on their hopes, wishes and dreams, by encouraging them to develop their gifts, strengths and talents. Wellness and Purposefulness can be a voyage of self-discovery and of personal growth; whereby experiences of mental illness can provide opportunities for change, reflection and discovery of new values, skills and interests, not just alone, but in deep collaboration, or mutuality, with others termed peers. In this process the individual becomes a supportive peer.
My sense is that the three models can and should work in some form of symbiosis. This is because persons are not always competent (me with my stroke, others with the psychosis or schizophrenia), who may not understand their illness or diagnosis and want, out of fear (or in my case sheer bloody-mindedness), to escape the system. They may even refuse to accept that they are unwell. This could leave them and other stakeholders at risk.
One of the areas that I find of interest, is the consideration of medication. The Illness Model has been accused of over-prescribing and may have been attacked by some in the Recovery Model, and even if it was not attacked, may have been a necessary evil. Under the Purposefulness model, my view is that, medicine is seen as a choice and is imbued or taken with knowledge and as a welcome addition to the overall health of the person. This likely to enhance the efficacy of the drugs through placebo effect. I found this when I started to take my heart medicine, it was more effective when I knew about it and took it as part of my overall movement towards health, not as a resigned attitude of dependence.
This is even more effective under the Purposefulness Model, because those who have experienced recovery and movement towards wellness, become the peers for those still suffering and struggling through the uncertainty of healing. My sense and anecdotal evidence are, that taking responsibility for an optimistic future often needs the negotiated support from those who have travelled the journey already, like a Sherpa. They are called Peers.
The beauty of peering is that we all take primary care for ourselves and then equal responsibility for the care of each other.