19 - Resiliency in individuals with serious mental illness

Summary

Introduction

For many years the original term for schizophrenia, dementia praecox (or premature dementia) coined by Kraepelin in 1919 (1971) conveyed the assumption that the course of this disease and other serious mental disorders was invariably a chronic and deteriorating one. People with schizophrenia were informed that there was little they could do with their lives, that they should give up their hopes and dreams (Deegan, 1990), they should focus on following their treatment recommendations, but they had little role to play in actual decision making about their care. Over the past several decades there has been a sea change in the long-term perspective on schizophrenia, and more broadly on the concept of recovery from serious mental illness. These new perspectives have been largely brought about by the rise of the mental health consumer movement (Chamberlin, 1978; Davidson et al., 2009), and the development of new and more personally meaningful definitions of recovery that instill hope, empowerment, and responsibility in individuals with a psychiatric illness, and involve the individual as an active participant in his or her own treatment. As new perspectives on recovery have assumed an increasingly dominant role in the treatment of serious mental illness, the importance of resiliency has been recognized, both in terms of understanding how people meet and cope with the many challenges of their disorder and in terms of helping them to bolster their ability to learn and grow from their experiences in order to experience a full and rewarding life (Roe & Chopra, 2003).

This chapter begins with a brief review of the evolving concept of recovery, and its relevance for elevating considerations of resiliency to the understanding and improvement of outcomes in serious mental illness. Next, the role of resiliency as both an adaptive and a protective factor in serious mental illness is considered, followed by a description of strategies that specifically target resiliency skills for improving long-term outcomes. The chapter concludes with a discussion of how a resiliency-focused approach to treatment could further shift attention to important but neglected areas in serious mental illness, such as the experience of positive emotions, thereby improving quality of life in spite of the potential persistence of symptoms and impairments.