Early Psychosis Intervention: A Culturally Adaptive Clinical Guide

31. Experiential Aspects of Recovery in Early Psychosis: Focus Group Findings

31 Experiential Aspects of Recovery in Early Psychosis: Focus Group Findings May Mei-ling Lam Importance of Subjective Experience Young people who have suffered from a first episode of psychosis have high rates of remission if treated adequately and comprehensively. Despite this, more than 33% of clients are readmitted to the hospital within six months, 55% within two years and 80% within five years following the treatment of their first episode of psychosis. Given these alarming relapse rates, it is important to develop ways of intervention during the initial recovery period in order to reduce the risk of recurrence. This cannot be achieved without understanding the complex issues associated with increased risk of relapse. These include poor adherence to medication (see Chapter 24, “Medication Adherence: Specific Issues in Early Psychosis in Asia”), increased substance use (see Chapter 27, “Comorbid Substance Abuse in Early Psychosis”), impaired insight and understanding of the illness, emotional stress, and the subjective recovery experience . The current clinical focus observes a client’s behaviour and interpreting it in terms of clinical models, instead of adopting an approach that starts from valuing and respectfully understanding the person’s experience from his or her perspective. Not much research has looked into what recovery is and what it means to people with first episode of psychosis. Qualitative studies on the subjective perspective of recovery experience with individuals with a first episode of psychosis are few. Early psychosis services recognized some of the shortfalls of traditional services and endeavour to provide a comprehensive and individually focused approach that tailors treatment to the needs of young people. This chapter will look at the subjective experience of these young people in making sense of the psychotic experiences and recovery as promoted by early psychosis services. The concept of recovery is briefly discussed, followed by the young person’s 346 May Mei-ling Lam subjective perspective on what is “good” service that helps the individual to recover from psychotic disorders, so as to shed light on therapeutic strategies and actions that are likely to aid the recovery process. What Is Recovery? Recovery is a concept unique to each individual and may have different meanings for different people. It is also not static; as the person grows and achieves his or her goals and dreams, he or she may feel that a greater level of recovery is reached. Recovery is essentially a transitional state of mind where people feel at ease with themselves so that they can respect, love, and appreciate themselves and others, as well as the world they live in. The recovery concept was originally used in the physical disability movement in America. Since then, it has been widely used by mental health professionals. Anthony (1993) suggests that the concept of recovery for severe mental health problems is multidimensional. In this model, social and psychological recovery processes are as important as clinical recovery. Clinical recovery is defined by a reduction of symptoms, such as auditory hallucinations and delusions. On the other hand, social recovery includes development of meaningful social roles and relationships, involvement in vocational activities, and access to safe and clean housing, while psychological recovery is the process of developing ways to understand and manage psychotic experiences and to regain the maximum sense of life structure. These distinctions are important as current services and research focus too heavily on clinical recovery. However, if a person can recover socially and psychologically , clinical recovery may be less relevant to the person’s quality of life. Definition of recovery includes dimensions of self-esteem, adjustment to disability , empowerment, and self-determination. “For some of us, recovery means learning to cope with our difficulties, gaining control of our lives, achieving our goals, developing our skills and fulfilling our dreams.” The eight principles listed in Table 31.1 are adapted by Anthony (1993), who describes them as important in understanding a recovery-based approach to serious mental health problems. Experience of Early Psychosis Clients Psychosis is often, although not always, experienced as a personal disaster with a potentially damaging mix of secondary trauma and loss. This is particularly Experiential Aspects of Recovery in Early Psychosis 347 important in young adolescents recovering from their first-episode of psychosis at an early psychosis service. As it is, young individuals are going through their golden developmental stage in life, yet at the same time, they are facing specific challenges and complex issues related to their illness and treatment...