What appears to be missing from the proposed definition is a statement that "recovery" (as opposed to the process of recovery) means living like people without a mental illness live, the core elements of which are having your own place to live, a job, and a partner and/or family. The proposed definition should be revised to make clear that people will be able to achieve "recovery" in this sense, which is readily feasible with current technologies promoted by SAMHSA, including scattered site supported housing, supported employment, assertive community treatment (ACT) and peer support. In addition, the proposed definition must include the explicit expectation that service systems will be re-oriented to enable individuals to live in their own place, have a job, and have a partner and/or family.

These elements are critical to make recovery a meaningful concept rooted in concrete expectations about what is needed to afford individuals with mental illnesses the opportunity to live full lives as members of their communities, consistent with the ADA's integration mandate and the Olmstead decision. Without these elements, the proposed definition of recovery would enable service systems to continue treating individuals with mental illnesses living much as they have in the past, without providing the chance to live the same way that the rest of us do. The definition of recovery cannot be one that permits these individuals to remain dependent while "working on" a recovery that public service systems can and should put in their reach. Recovery must encompass more than a set of slogans about hope, respect, relationships and purpose. It must include the specific expectations above that are necessary to make these concepts meaningful.

Robert Bernstein, PhD
President and CEO
Bazelon Center for Mental Health Law
www.bazelon.org

This definition misleadingly focuses only on the individual mental health disordered or addicted person, and thus omits those affected by the illness of another.
Because we have the knowledge now, it would be preferable to state directly that mental health and addictive disorders are almost always individually and inter-personally determined and experienced.
All people, children and adults, exposed to others with these disorders are at high risk to suffer from the traumas of living with mental illness and active addiction. Thus, they require attention to their own individual recoveries and are entitled to the designation of "identified patient."
It is anti-recovery for all individuals involved to assign responsibility for recovery to anyone besides the identified individual, whether that person is the mentally ill or addicted person, or someone affected by that individual. Everyone has the right and the responsibility for their own personal recoveries. They may then be better able to offer the kinds of support to others that will not reinforce pathology.
Currently, clinicians can identify and treat individuals affected by the mental illness or addiction of another through the diagnoses of trauma or the adjustment disorder categories. This mechanism for providing insurance coverage does not address, and thus fails to validate, the familial aspects of addiction, thereby reinforcing denial of interpersonal causation and influence.
While DSM still limits clinicians to individual diagnoses, clinicians can and do pay attention to both the individual and the interpersonal environmental and systemic factors that are actually involved. In our Family Recovery Research Project (Brown and Lewis, 1999; Brown, Lewis, and Liotta, 2000), we outlined three domains of experience that operate simultaneously in the process of active addiction and recovery. These include the environment, the family system, and the individuals within. Tracking the process of recovery within these three domains offers the researcher, the clinician, and family members the opportunity to understand and address elements of environmental trauma, interpersonal, systemic pathology and recovery, and individual development, including pathology and healthy recovery for all individuals involved.
Ideally, the new definition of recovery, with its four dimensions and the guiding principles, could include a direct statement incorporating the individual and the interpersonal elements I've noted.

Dr. Karl Mennninger proposed seven criteria of emotional maturity that nicely parallel a good definition of recovery. They are as follows: 1)
The ability to deal constructively with reality.2) The capacity to adapt to change. 3) A relative freedom from symptoms that are produced by tensions and anxiety 4) The capacity to find more satisfaction in giving than receiving 5) The capacity to relate to others in a consistent manner with mutual satisfaction and helpfulness 6) The capacity to direct one's instinctive hostile energy into creative and constructive outlets. and 7) The capacity to love. Three of these seven criteria are about relatedness to others. Internal growth is essential but is manifested in how we relate to others. Any definition of recovery should emphazise this and I don't see it in the above definition.

Recovery principle 1 is only accurate so
long as it excludes persons who suffer from anasognosia, the inability to know
they are ill, hence lacking the ability to
drive their own person in the direction of
recovery. Also, schizoaffective people
may have a succession of cyclical crisis
due to their inability to know they are ill,
and only when they are stable can be
reasoned with. This takes a lot of patience, perseverance and compassion
by all those in contact with the ill person,
to help them to a beginning of a life free
from their devastating, crippling and mind
robbing disease. It involves finding the right medication leading to compliance and
offering HOPE, and the tools that go along
with that hope.