Hospital and Community Psychiatry

Recovery, Inc., the Association of Nervous and Former Mental Patients, founded in 1937, is the oldest and perhaps the best known self-help organization for nervous and former mental patients. Like many other long-lived self-help groups, Recovery is nonprofit, nonsectarian, and completely member managed. Members learn a system of techniques of controlling their behavior and changing their attitudes and practice these techniques in their daily lives. They share their successes, setbacks, and insights at weekly meetings that follow a structured format.

The "self-leadership" techniques that members learn, as well as the structure of the meetings and other rules, were laid out more than half a century ago. Recovery does not offer diagnosis, treatment, advice, or counseling or attempt to supplant the physician or other mental health professionals. Members are urged to take responsibility for their own mental health while cooperating with professionals.

Recovery has been increasingly recognized in the mental health field as an important resource for current and former patients and their families. Since 1969 Recovery members have staffed a booth at the Ames Ivan Psychiatric Association's annual meeting.

Recovery was begun in Chicago by the late psychiatrist Abraham A. Low as a research project at the Psychiatric Research Institute, of the University of Illinois Medical School, where Low was associate director from 1931 to 1940. The purpose of the groups he started was to prevent relapse in former mental patients and chronic suffering in nervous patients. Dr. Low believed that no case was hopeless and that all patients could learn the techniques he developed for coping with dysfunctional emotional reactions. His book Mental Health Through Will Training published in 1950, describes the self-help techniques and is still required reading for every Recoveryite.

In 1941 Recovery left the Institute and became a nonprofit corporation under the laws of Illinois, with Dr Low continuing as medical director. By 1950 a handful of Recovery groups were operating in other cities in the Midwest, and Dr. Low, who had long believed that the organization should be operated by members without professional supervision, began training a small group of member leaders in his methods for organizing and running the weekly meetings.

Since Dr Low's death in 1954, Recovery has become an international organization. About 270,000 people now attend weekly Recovery meetings in the U.S., Canada, Puerto Rico, Ireland, England, Wales, and Israel. There are about 700 active Recovery groups in 55 organized geographic areas.

The Recovery method is based on the premise that most patients returning home from a psychiatric hospital experience some residual symptoms, including "restlessness, tenseness, and preoccupation," and are, according to Dr. Low, mostly afraid of "terrifying sensations, threatening impulses, obsessing thoughts and depressing feelings, that is, their own inner experiences." Dr. Low believed that the fears associated with these inner experiences often lead to relapse or to chronic nervous suffering. "Symptoms are distressing but not dangerous" was a maxim used by Dr. Low to reassure patients that their emotional states could not cause lasting damage. This maxim of Dr. Low's is one of many that Recoveryites use to overcome their fears and give support and encouragement to themselves and other members.

At the core of the Recovery method is the self-help technique called spotting, whereby members recognize an emotional disturbance when it occurs or is about to occur, give it a name, and identify the factors precipitating their dysfunctional response. Other techniques involve will training and muscle control to prevent the disturbance from disrupting functioning.

Self-endorsement is also an important technique. Members learn to give themselves credit for every effort that they make to practice the Recovery methods. The effort, not its success, is endorsed.

Meetings, which last from one and a half to two hours, are usually held weekly in a public nonprofessional setting such as a library or church. There is no charge for attendance, although a free-will offering is collected. Meetings are open to persons who are at least 18 years old. Members' families are welcome, and mental health professionals may observe or seek help themselves. However, only patients and former patients may become trained leaders. Members are encouraged to use what is called "Recovery language," a basic part of Dr. Low's self-help method. They avoid using abstract psychological terminology.

At a typical meeting, the leader welcomes new members. Then members read aloud a chapter from Dr. Low's book or listen to a tape of one of his lectures. The main part of the meeting is the panel. Panel members each spend about five minutes describing a recent event in their lives that caused symptoms of a dysfunctional emotional response. At Dr. Low's insistence, the example must be trivial. Recovery members have learned that if one can learn to cope with everyday events in an adaptive way, the same principles will carry over to more serious situations.

When presenting the example, the panel member describes how he or she spotted the emotional disturbance (or is having trouble with the spotting) and what Recovery methods could be used to gain control of the dysfunctional reaction. Finally, the panel member describes what his or her reaction would have been before Recovery training. The group is then given ten minutes to spot on the example and to offer additional insights. They may suggest that the panel member endorse him or herself. Each example requires about 15 minutes, and four to six examples are presented at each meeting.

At the end of each meeting, there is an informal period of "mutual aid," during which light refreshments are sometimes served. Dr. Low set a policy that holds social activity to a minimum because he felt that training in the techniques was very important and required a great deal of time. Most Recovery groups hold only one or two social events a year, since one objective of the program is to help members participate in the community outside of Recovery.

Between meetings, members may telephone each other for support, an important mutual aid procedure set up by Dr. Low. Calls are limited to five minutes, but the caller may call again later if necessary.

There are about 700 Recovery group leaders worldwide. Leaders demonstrate their own use of the method and remind members of the self-help meeting structure as developed by Dr. Low. Group leaders may eventually serve in district and area leadership positions on Recovery's board of directors.

All Recovery leaders receive annual authorization from the board of directors. Leaders from each of Recovery's 55 geographical areas hold monthly training meetings for leaders. Members of the leader training committee travel to each area regularly to conduct training conferences. An annual training conference for area leaders is held in Chicago in November, and additional training is available at Recovery's annual membership meeting in May.

Recovery's policies are set by an unpaid, 12-person board of directors. Directors, who are from widespread geographical locations, are elected by the membership to three-year terms. All board members are former patients and authorized group leaders. The board elects its own officers. In keeping with the principles of self management, the Recovery president represents the organization as its chief executive officer.

Shirley Sachs, executive director, supervises a staff of five full-time and three part-time employees, some of whom are Recovery members. Recovery's headquarters is in a modest brownstone near downtown Chicago. The staff provides services to Recovery's members and group leaders as well as to the board of directors and its committees

To fulfill its goal of making Dr. Low's self-help method available to those who may need it, the organization encourages use of its services as a valuable community mental health resource and an adjunct to professional care.