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Three articles originally published in the Deccan Herald, Panaji, Goa (8/11/2018) by Anil Vartek, Vice-president of the Schizophrenia Awareness Association.

Dr Low’s enduring fight for the mentally ill 

Keeping symptoms of mental illness in check and ensuring continuous improvements in the condition of the mentally ill is a long process. Psychiatric treatment helps improve conditions to a certain extent. But many find it difficult to sustain this improvement later. Based on his experience with patients, American psychiatrist Dr. Abraham Low developed a method to help maintain improvements. Known as the Recovery Method, it continues to be used globally.

Dr. Low emigrated from Europe to the United States and started practising psychiatry in a hospital in Illinois. Along with medicine, he was well-versed with subjects as diverse as philosophy, psychology, linguistics and literature. This gave him insights into a person’s upbringing, psychology, personality, inspiration and possibility of change which all helped him in his work with Recovery self-help groups. 

In the 1930s available medicines on mental illnesses were not very effective. Treatments were also limited; with shock treatment being a major course of treatment in emergencies. While practicing psychiatry, Dr. Low realized that the shock treatment brought symptoms under control, and patients could resume their daily life. Patients got discharged from the hospital. However, the effects of the treatment could not be sustained in the long run. Symptoms increased as patients struggled with their daily lives, ultimately leading to re-hospitalization of the patient. 

Dr. Low was ill at ease with the patients’ suffering and their ups and downs.  He began experiments on how to maintain the patients’ symptom-free condition achieved after the hospitalization. Minute observations led him to believe that the patient is never completely helpless. Most patients can control their symptoms at least to some extent. Patients can regulate their own thoughts, control unstable thoughts and purposefully recall stabilizing thoughts and in the process help themselves. By recalling the Recovery Tools such as "Maintaining my internal peace is my supreme goal" and "I can only control my internal environment, not my external environment," extreme manifestations of rage, anger, and emotional outbursts can be controlled by oneself. Chances of relapse reduce substantially with the habitual use of Recovery tools. In this way, Dr. Low through his observations and experiments developed Recovery tools which help patients achieve stability and peace.

Following these fundamental principles of Recovery, meetings in the early stages used to take place under Dr. Low’s own supervision. In these meetings the patient used to first share the experience of mental instability. Then Dr. Low would analyse it piece by piece. He would explain to everyone what mistake the patient did and what would be the correct behaviour in the given circumstances. The impact of these early sessions was so profound that patients in large numbers started attending these meetings. 

These techniques were light-years ahead of their time. It was a time when people were fascinated by Sigmund Freud’s theories. Increasing popularity of the Recovery techniques was bound to make some psychiatrists uneasy. They started opposing Dr. Low’s techniques and began pressuring him to leave the hospital. They even threatened to revoke his medical license. In the face of growing opposition, Dr. Low felt dejected and decided to shut down the Recovery group. But as the patients were benefiting from this group, Dr. Low reconsidered his decision.

One day Dr. Low was late in attending the Recovery meeting. When he arrived, he saw that the patients had already begun the meeting and were running it quite well. He was extremely pleased to see the meeting run smoothly in his absence. He then thought of a new idea: to let the patients run the group by themselves. This would reduce the load on him. Bringing in improvements in their health and running the group by themselves would lead to more groups and spread of recovery ideas. To structure his thoughts on the method better, Dr. Low wrote down the Recovery principles, rules to start and also run the groups.  Dr. Low’s concern of who will run the Recovery group meetings, in his absence, thus ended with great optimism and faith.

In spite of being comfortably well off with his own private practice, Dr. Low was incessantly driven by the need to find ways to bring peace, stability and balance to patients through self-help. In 1954, after a lifelong struggle and inspiring struggle to devise self-help, Dr. Low, who called patients "my dear ones," passed away. He left behind him a legacy of the worldwide self-help method that is Recovery. More than 600 groups, including SAA’s Eklavya SHG, continue to hold weekly Recovery meetings even today. Dr. Abraham Low can rightly be considered a pioneering professional who believed in promoting a reliable self-help method in restoring the well-being, dignity and a rightful place in the community for those who are misunderstood and misrepresented for the mental illness that is not any fault of theirs.

Next week’s article will focus on the nitty-gritty of the Recovery Method and how it benefits not only persons diagnosed with mental illness but also others experiencing stressful circumstances.

Understanding Recovery Method (part one)

In the last article we got to know Dr. Low and his struggle to develop and establish the Recovery Method. The present article will focus on how this method is used in the case of mentally ill persons, or shubharthis, as we call them in SAA. 

In these meetings shubharthis sit on the floor or in chairs in a circle.  There is no hierarchy in these meetings.  Even the group leader shares his or her experiences in the structured format as any other group member. Thus, at these meetings no one gives advice but only shares one’s response in the pre-determined format. Each one shares his or her experiences and narrates how the Recovery tools were used to cope up with their disturbing events. 

How are the Recovery meetings conducted?

At the beginning of each meeting new members are introduced. Invariably, there is some light hearted banter followed by an overview of the work done so far. This takes about 15 minutes.  Then the actual meeting starts.  In the beginning a few paragraphs from Dr. Low's books are read. Then the structured sharing with the help of Recovery techniques begins.  Anyone from the group can share.  However there is no obligation to share. Group members share the recent incident that they can remember in detail. Sharing takes place in the following four steps: 

What was the specific event that caused the distress?

In this first step a shubharthi describes any incidence which caused him or her distress.  The disturbing event then could be as ordinary as having to converse with someone, feeling anxious about performance in examination, to attending social gatherings, etc. 

Which physical and mental symptoms were experienced on that occasion?

In this second step, the shubharthi describes the different forms in which stress was expressed like sweating profusely, tremors in voice, butterflies-in-the-stomach, an intense desire to flee from that place, rage, a feeling of hopelessness or helplessness, etc. All persons suffering from mental illness or emotional turmoil, experience these feelings at some point in time in varying intensities.

Which Recovery tools were used to cope up at that time?

The third step in group meetings is one of the important and critical ones. Here, one narrates one or more spottings or Recovery tools that came to one’s mind and helped to cope with the disturbing situation. For example, it could be ‘Maintaining my inner peace is my supreme goal’ or ‘I am an average person’ or ‘Excuse rather than accuse.’ If we are troubled because of others’ behaviour, say, lack of understanding or arrogance, the Recovery tool, ‘I cannot control my external but only internal environment’ can be useful.  Sometimes when one is pushed into a state of inaction the Recovery tool, ‘Command your muscles’; can be very useful. Or, this spotting can also be of great support and safety in situation like : when I imagine some risk and feel like running away in the middle of a street full of traffic, I can command my muscles not to panic but stay calm and safe.

Recovery has many such helpful tools available to us through Dr. Low's writings. In his writing Doctor Abraham Low clearly elaborates why these tools are important, the thought behind these tools and the manner in which they help the patient. This is an important step in Recovery practice. Remembering Recovery tools in stressful situations is a matter of habit.  This habit can be cultivated by repeated use of Recovery tools and sharing of such incidences in Recovery groups.  The intensity of symptoms can be reduced through this method. Repeated use of these four steps becomes Recovery Method a part of the patients’ behaviour. Recalling Recovery tools becomes a natural process.

Small improvements are a major component of the recovery process. It will be unrealistic to expect that big changes will take place in a short span of time. Giving appropriate responses to everyday challenges first deliberately and then naturally is the soul of Recovery Method.

What changes were observed after the use of Recovery tools?

In this fourth step the person sharing his or her experience of mental restlessness describe how their state would have been without using Recovery tools. 

For example, ‘I screamed as a reaction to others behaviour and left that place only to repent later’, ‘I wasted time and I did not work’, I started feeling inferior, I was restless - such feelings of failure are shared by the shubharthis.  Constant emotional ups and downs becomes a pattern for many shubharthis.  In Recovery meetings shubharthis share how by using Recovery tools they were able to maintain their inner peace, control their anger, realise that they are not responsible for the situation, and do their work quietly.

I endorse myself for using Recovery Method:

After the fourth step comes the important component, i.e the person sharing the experience endorses himself/herself.  This step is very important because during the illness patients begin to think that there is nothing worthwhile leading to low self esteem. It is therefore important to endorse even the minute improvements that take place in their behaviour using Recovery tools. This gives hope to the patients and accelerates their recovery. This is important for changes to be sustainable. After the patients sharing other group members pinpoint the other tools used by the patient. This process fortifies the patient’s confidence and prepares him/her to face new challenges. Changes however small, lay the foundation of future life. In India and USA, I have seen how the Recovery Method benefits even those who have been extensively hospitalized, given shock treatment or are under other long term treatment.

Understanding Recovery Method (part two)

What does Recovery Method teach us?

In the last articles we learnt about the different steps of using the Recovery Method.  On the face of it these steps seem very simple but each step offers different advantages. The first two steps help the patient understand the incident, one’s own symptoms, and increases self awareness regarding factors that trigger restlessness. 

Remembering Recovery tools while facing day to day challenges becomes a habit for the patient through the third step.' Distressing but not dangerous', 'Failure is a part of life', ‘Old habits can be changed through practice', 'It takes courage to commit mistakes', ‘People don't irritate you, you get irritated', 'Endorse your efforts not just the outcome', and many such simple principles are suitable to cope up with day to day challenges. The ease and effectiveness of the Recovery Method lies in its simplicity.

These tools try to reduce the intensity of restlessness for the patient. Truth be told, these tools are effective for any persons who wish to improve themselves irrespective of their mental state.The fourth step allows the user to reflect on his or her behaviour before and after using Recovery Method and realise how their efforts contribute to positive changes.  This inspires one to use the Recovery tools again and again which reinforces pro-recovery behaviour.

What are the special features of the Recovery process?

Recovery Method encourages one to reflect on small situations in daily life, situations that one can manage by oneself.  Patients are usually in the habit of worrying about their life at large. They are naturally inclined to compare themselves with their peers, worry about their future and wonder when their lives would be like others’.  This kind of thinking is an integral part of most of the families. This kind of thought process is not seen as problematic when patients are working towards improving their mental health.  This leads to unrealistic expectations regarding the patients’ progress.  These expectations then create an undue pressure on the patient leading to a relapse.

Major issues and legal aspects such as marriage and employment are not discussed in the Recovery meetings.  The meetings focus on day to day situations and how the tools can be used to deal with them.  Patients tend to worry and overthink about the past and the future.  Thinking about all questions at once, especially when in a fragile mental state, is of no use.  It only increases the patients negativity through thoughts such as ' I can't do this, I won't be able to do it at all'.   Years pass and bringing normalcy to life becomes impossible.  Recovery Method changes this very thought pattern.It is important to understand what we can do in day to day seemingly minor situations.  Small steps can be taken by any of us. For example,  stepping out of the house when feeling depressed,  cleaning the cupboard or a section of it when feeling restless,  controlling  rage and the urge to shout at others,  by remembering ' my internal peace is my Supreme goal'.  Recovery Method reminds one that it is possible to do small actions even when feeling restless and remain quiet when experiencing extreme anger.

While the usual thinking focuses on the incapacity of the persons to work, Recovery Method emphasizes on thoughts such as 'I can do it, I am capable, I can control my behaviour, and situation'. Recovery Method helps one to move from feelings of failure, helplessness and insecurity towards hope and security.  Small improvements become visible in all aspects of life, and like drops which form the ocean, the patients enthusiasm grows in leaps and bounds. Recovery Method changes the patients’ way of thinking and behaviour. From ‘I can’t do it’ Recovery helps patients move towards ‘I can do it, I can at least try’. Patient’s thinking patterns gradually change. Recovery Method is a way of thinking and a way of living. 

Recovery Method training through SAA:

India has a human resource deficit in the field of mental health. Along with psychiatrists, there is a shortage of psychologists and mental health social workers. If self-help methods like Recovery Methods become available, many patients will be able to make progress towards good mental health. Operational Recovery groups at the district level could be helpful to many people. Some SAA volunteers are trained in Recovery method in USA. Persons interested in learning the Recovery self-help techniques can approach SAA.

English Translation by Ms. Kalyani Vartak