10 Chapter 1 GENERAL INTRODUCTION Definition of recovery Recovery is a broad term with a wide range of meanings. The Oxford dictionary states: ‘senses relating to gaining or regaining possession’ and ‘senses related to the regaining of a state or position.’ Regarding the last category, one of the sub definitions is: ‘restoration or return to health from illness’ (1). In medicine, recovery generally means this ‘returning to a pre-existing state of health.’ In psychiatry and mental healthcare diverging descriptions of recovery have emerged, coming from different backgrounds. Usually, two types of recovery are defined: clinical and personal recovery (2). Clinical recovery Clinical recovery entails a medical point of view, in which symptoms of an illness need to be reduced by treatment, for instance by medication. This meaning corresponds with ‘cure’ of a disease and definitions come from professionals. According to Slade, clinical recovery usually has four key features: 1. it is an outcome, 2. it is objective, 3. it is rated by a clinician and 4. it is invariant across individuals (3). Usually, for research purposes, clinical remission is at the basis of the definition of recovery (4). The Remission in Schizophrenia Working Group (RSWG) defines remission as improvements in core signs and symptoms to the extent that they are of such low intensity that they no longer interfere significantly with behavior or cause suffering. Operational criteria include a score of mild or less on specific items of a symptom scale over a 6-month period, e.g. the Positive and Negative Syndrome Scale (PANSS) or the Brief Psychiatric Rating Scale (BPRS). The RSWG states that recovery is a more demanding and longer-term phenomenon than remission and that remission is a necessary but not sufficient step toward recovery. Recovery implies, besides being relatively free of disease-related psychopathology, the ability to function in the community, socially and vocationally (5). Some authors indeed include functional improvement in their definition of clinical recovery, e.g. having work, having friends, living independently (6), or a score of >65 on the Global Assessment of Functioning (GAF) (7). Others define these factors as an additional type of recovery: functional or social/societal recovery is about interpersonal relationships, work or study, daily living and self-care (8-11). Some limit functional recovery to regaining psychological functions, such as executive functions and self-regulation (12, 13). Usually, though, the abovementioned dichotomy of clinical and personal recovery is used in research. Personal recovery The definition of personal recovery has been developed by the patient movement and has been based on narratives of individuals who have experienced mental illness. The most cited definition is the one from William Anthony: “a deeply personal, unique
RkJQdWJsaXNoZXIy MTk4NDMw