Recovery is not only a destination but it is the entire evolution of steps along the pathway to this destination. In administrative terms, Recovery is successful integration into the community. Whereas in the CT-R clinician’s and individual’s terms, it is fulfillment and culmination of the aspirations. Clinically, Recovery involves a series of milestones which not only constitute one’s goals towards achieving their aspirations but also as a measure of one’s generalized progress. There generally is a progression from one milestone to the next with occasional setbacks. It should be noted that some individuals progress more rapidly along the Recovery pathway and others take much longer. It is our impression that the institution of the CT-R program and given sufficient time, that all individuals can achieve varying degrees of Recovery. This is an empirical question to be resolved by future research.
These milestones include but are not exclusive to (not necessarily in temporal order):
-Activation of the adaptive mode
-Selection of aspiration(s)
-Preparation of the Recovery Map
Attitudes, Beliefs, and the Three Systems
The machinery involved in moving the individual along the pathway starts with the activation of the adaptive attitudes such as “ I can do it…. It is worth a try….It is a way of getting to my aspirations …etc.” As the adaptive attitudes are activated ,there is a subsequent activation of the three major systems: the cognitive, affective, and behavioral systems.
-The cognitive system consists of basic functions such as attention, memory, flexibility, emotion recognition and discrimination, etc.
-The affective system consists of feelings of satisfaction, pleasure and exaltation on the one hand and dysphoria, anxiety and apathy on the other. These affects in themselves have stimulus properties.
-The behavioral system consists of the patterns of behavior that are utilized to implement a particular goal.
In the regressive mode, the patterns of behavior have degenerative or dysfunctional quality which hinders progression on the pathway to recovery. Conversely, in the adaptive mode, the behaviors are adaptive in aiding in fulfillment of aspirations and achieving recovery. When the attitudes, beliefs and the three major systems are activated, these combine to produce the motivation towards adaptive or regressive behavior.
Types of Learning in the Recovery Process
From the standpoint of mechanisms, individuals participating in the program have demonstrated three types of learning: unlearning of maladaptive patterns such as walking around naked, renewing old adaptive patterns of behavior that have been buried and learning new patterns of behavior. The first type, unlearning, refers to the attenuation or extinction of those attitudes and behaviors that were bizarre or grossly inappropriate. These include permission giving attitudes such as “ If I walk around nude, people will admire me” or “ If I reach out and touch people they will be friendly.” These inappropriate attitudes and their relevant bizarre behaviors, such as playing with feces, tend to be automatically attenuated or extinguished as the individual progresses along the road to Recovery. The phenomenon of relearning was of significant surprise to me. It appears that these individuals’’ basic personality is still intact and accessible despite many years of hospitalization. This basic personality has been disguised by the positive and negative symptoms but returns to its premorbid level when the individual reaches their destination. A new learning occurs in these individuals just as it does in normal individuals. As they encounter new situations, they apply their previous learning to develop new attitudes and patterns of behavior. Sometimes this can be accelerated through special programs dedicated to skill development.