Feb 25, 2020
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Mental-Health Researchers Ask: What Is ‘Recovery’?

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In the other paper, an editorial, Larry Davidson, a psychiatric researcher at Yale, pointed out that the results were not surprising. The researchers had intentionally left out a subset of R.A.S. queries that probably mattered most, involving how well respondents were managing their symptoms — statements like “Coping with mental illness is no longer the main focus of my life” and “My symptoms interfere less and less with my life.”

By taking out these questions, Dr. Davidson said, the study demonstrated only that, in the absence of mental distress, “the everyday lives of people with a mental diagnosis are just like everyone else’s.” The authors, however, noted that those questions were excluded because, by definition, the comparison groups had no symptoms.

In effect, both parties agree: The R.A.S., and many similar scales, amount to little more than symptom checklists, in the end not much different from those used to track the short-term effects of a drug. The field could use different, and better, means of assessing how people shake off or learn to manage a mental-health diagnosis.

The scales originated decades ago with mental-health consumers, or “survivors,” who saw the usual clinical definitions of symptoms relief, like the Hamilton Depression Scale, as unable to capture the fullness of personal recovery.

The scale analyzed in the Dutch study, for instance, asks people to rate, on a scale of 1 to 5, how strongly they agree with various statements like, “If people knew me, they would like me,” “If I keep trying, I will continue to get better” and “It’s important to have healthy habits.” Researchers rely on scales like this to gauge the longer-term, real-world effects of all variety of mental-health programs, like group therapy for rape victims in the Democratic Republic of Congo or community outreach for psychosis in Wisconsin.

But as the new study finds, questions like these are applicable to anyone, with a diagnosis or not; not to mention that responses can vary by the day, or even the hour, depending on what insults or encouragements hold sway in the moment.

People who find a way to move on with their lives after receiving a psychiatric diagnosis — depression, anxiety, bipolar disorder, schizophrenia — generally must do so the hard way: gradually, by fine-tuning some combination of personal rituals, social connections, work demands, therapy and, when necessary, medications. And these idiosyncratic regimens of self-care are not easily captured by the measures currently available to researchers.

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