Procovery
The Procovery model provides a clear vision and set of principles for overcoming mental illness using a set of concrete, practical, and learnable everyday skills. Because its principles and strategies apply to all stakeholders—clients, families, clinicians, case managers, etc.—we believe we can improve the continuity of care within our system and improve access to care by building bridges to community services and supports.
– Diane McFarland, Director of the Division of Comprehensive Psychiatric Services, Missouri Department of Mental Health
Let's ... start anywhere and everywhere in applying hope and practical strategies in making procovery a reality for everyone in our service systems!
– Sinikka McCabe, Administrator, Division of Support Living, Wisconsin Department of Health and Family Services
Procovery is remarkable and unique, a concept and a tool that brings together in a meaningful way three groups of people who in our current healthcare system are often at odds with one another -- consumers, family members and staff. Drawn from experience as well as a staggeringly complete review of the recovery literature, Crowley has created an approach that has clear applicability to all chronic illnesses as well as substance abuse.
– William Flynn, M.D., Geriatric Psychiatrist
Procovery seems to be everything in the middle. I know where I am and where I want to be but never knew how to get there. Procovery seems to be that!
– Angela Ward
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The word procovery means "attaining a productive and fulfilling life regardless of the level of health assumed attainable (vs. recovery, returning to a prior state of health)". The principles and strategies of the model of Procovery define a forward-focused, hope-centered, and practical approach for finding healing and building life with serious and chronic illnesses, injuries and trauma. The word "procovery" was invented by writer Kathleen Crowley in 1996 and her model of procovery principles and strategies resulted from years of research and interviews of individuals who found resilience, and those who supported and cared for them.
The material below, excerpted from Kathleen Crowley's first book on Procovery, The Power of Procovery, provides a more in-depth feel for what every person can do, today, to move forward to procovery and help others do so.
1. Introduction
2. Opening the Door to Procovery
3. What is Procovery?
4. Roadblocks to Procovery
5. Setting Favorable Conditions to Procovery
6. Procovery Strategies
7. Nurturing Procovery
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Introduction
The voyage of discovery lies not in finding new landscapes but in having new eyes. —Marcel Proust
The concept of procovery is so simple, so available, and so rooted in common sense it’s almost funny that it took me years to get a glimpse of it, years to grasp the fundamentals. Namely: Sometimes healing has little to do with health; sometimes recovery in the traditional sense is not an option; and often we need to rewrite the scripts of our lives and reach forward to the largely unknown rather than backward to the familiar.
The fundamental focus of procovery is one of moving forward when you can no longer move back, of letting go of what was and rebuilding new dreams. Of accepting the realities of illness while focusing on life. Procovery offers individuals diagnosed with serious or chronic disorders an approach to attaining a productive and fulfilling life, regardless of the level of health assumed attainable.
[*] While the book focuses on mental illness, the procovery concepts, strategies and ideas are broadly applicable to all serious and chronic illnesses, and chronic pain.
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Opening the Door to Procovery
One cannot get through life without pain. . . . What we can do is choose how to use the pain life presents to us. —Bernie Siegel, M.D.
I learned about the power of procovery personally years ago, through a slew of hit-and-miss propositions, that only in hindsight did I recognize as a path forward.
For years I was convinced that my problem—clinical depression accompanying chronic pain—was medical. I thought that once “they” diagnosed the problem and treated the problem, “they” would cure the problem. I felt that nothing short of returning to life as I’d known it was acceptable. I thought that I needed a simple three-step program: 1) find the right doctor; 2) have him run the right tests; 3) be prescribed the right treatment.
Then one day at UCLA (where I was being treated at the time), I was told that they probably would not be able to reduce the physical pain I was experiencing, which they likened to that of someone with terminal cancer. And that as chronic pain and depression so often go hand in hand, I would likely be battling both for life.
But then, “We do have some good news, though,” I heard someone say. I remember trying to reach through the fog, the busy stream of thoughts running through my mind. They have good news, I thought. Thank God.
“We feel that while we may be unable to affect the actual level of pain you are experiencing, Kathleen, we may be able to teach you to reduce the bothersomeness of it.” I was then abruptly sent back to the psychiatric ward, in a daze, trying to fathom this.
It struck me as inconceivable that I could live every day in pain, physical and emotional, and learn to function again. No one had even suggested at that point that I would learn to be productive or happy again. Just that I might learn to survive.
The escort assigned to walk me back was one I’d been assigned several times before, a nice guy, a student at UCLA. I decided I would run all of this by him. The suicidal depression . . . the pain comparable to that of someone with terminal cancer . . . nothing they could do . . . battling both for life . . . good news . . . possibility I can learn to reduce the bothersomeness of it?
He stopped dead in his tracks as we were walking. “They said that to you?” he asked. And then after a long pause, and somewhat under his breath, he said, “Wow, and you’re the one locked in the psychiatric ward.”
My sentiments exactly, I thought.
How could I survive in constant physical and emotional pain? How could I care for my two precious daughters? How could my husband continue to love me when all he really wanted was for me to “be the way you used to be”? How, at the age of 27, could I make a life for myself that resembled nothing of the life I’d dreamed of and mapped out? How, when all my dreams were now impossible, could I go on?
But here I am, over 15 years later, writing this book, to tell you what I ultimately found absolutely shocking. They were right. I have been able to reduce the bothersomeness of both my pain and my depression. I am today not cured but healed.
We all have enormous power to help ourselves and others procover.
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What is Procovery?
Procovery / n: attaining a productive and fulfilling life regardless of the level of health assumed attainable [vs. recovery, returning to a prior state of health]
The focus is not to do remarkable things but to do ordinary things with the conviction of their immense importance. —Teilhard de Chardin
Procovery is an approach to healing based on hope and grounded in practical everyday steps that individuals can take to move forward.
More specifically, procovery addresses the question, “When I can’t move backward, in the traditional sense of recovery, what can I do?” with the answer that individuals can:
• Move forward
• Through individual actions
• That are ordinary,
• Regardless of the limitations of systems and symptoms, and
• With faith in the possibilities, even though the path may be difficult and indirect.
Changing the focus from reaching backward to moving forward can rebalance the scale by which we measure our lives. Focusing on defeating chronic illness often will result in losses that appear to vastly exceed gains—where life without illness will not be regained, and a hellish life of striving to cope remains.
This has to do with what Erich Fromm describes in The Sane Society as “the whole ‘balance’ concept of life as an enterprise which can fail. Many cases of suicide are caused by the feeling that ‘life has been a failure,’ that ‘it is not worthwhile living any more’; one commits suicide just as a businessman declares his bankruptcy when losses exceed gains, and when there is no more hope of recuperating the losses.”
In an essay called “Lessons from the Art of Surgery,” Richard Selzer, a surgeon, writes eloquently of the meaning of letting go of what was and embracing what can be:
“The young woman speaks. ‘Will my mouth always be like this?’ she asks.
‘Yes,’ I say, ‘it will. It is because the nerve was cut.’
She nods, and is silent. But the young man smiles.
‘I like it,’ he says. ‘It is kind of cute.’
All at once I know who he is. I understand, and I lower my gaze. One is not bold in an encounter with a god. Unmindful, he bends to kiss her crooked mouth, and I so close I can see how he twists his own lips to accommodate to hers, to show her that their kiss still works. I remember that the gods appeared in ancient Greece as mortals, and I hold my breath and let the wonder in.”
Focusing on overcoming chronic illness, on integrating illness into life, shifts the balance—although illness is one specific loss, it no longer dominates the equation, and the future holds potential.
This essential individuality of procovery has two important consequences. First, different individuals start procovering in different places and along entirely unique paths, so procovery utilizes a “just start anywhere” philosophy— individuals can begin anywhere in any increment. Item 4 on the task list need not necessarily be completed before item 5. For each of us, as Rachel Naomi Remen, M.D., writes, there are “conditions of healing that are as unique as a fingerprint.”
Second, because procovery is an individual path it will not “look” the same for any two individuals—or even for the same individual over time. As C.B. Keogh notes in one of the GROW handbooks, “The line between sickness and health must be drawn through the center of each person rather than be used by one group to separate itself from another.”
Procovery is also built upon the ordinary. Jay Neugeboren, whose brother Robert has spent most of his life, since the age of 19, in hospitals and psychiatric wards around New York City, writes of the time and money spent searching for organic causes and cures, “while back on the ward patients languish and die for the simple lack of human attention to their ordinary, daily needs.” It is often thought that big problems need big solutions. In fact, small steps can carry great distances.
Procovery is an end and a means, a destination and a process of getting there. It is not a model of medicine or rehabilitation, not a replacement for pharmaceutical treatments and rehabilitative services. It instead describes an orientation, an approach that can be adopted by any model, or any individual, today.
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Roadblocks to Procovery
I remember asking around frantically about shock therapy and hypnosis, and anything under the sun short of lobotomies and suicide—always short of suicide—to relieve this unbelievable pressure, which I report now, not in the interest of laying on the agony, but simply to demonstrate how dark it can get just before total dawn, and how hard the last minutes of labor can seem when you’re delivering a devil. —Wilfrid Sheed
It would be hellish enough if the only roadblock to procovery were the experience of illness and the limited resources available to most individuals and systems for treatment. Therefore, we must look closely at the unnecessary roadblocks that result from our misperceptions and misunderstanding of what is possible for individuals diagnosed with serious and chronic illness.
Consumers and professionals alike often measure success against an ultimate goal of recovery, defined by Taber’s Medical Dictionary as the process of “regaining a former state of health.” But recovery in this sense is often not an option, any more than one can undo a car wreck or the death of a loved one.
Pending this unavailable “recovery,” treating professionals often have an extremely limited vision of what is possible, and therefore offer a limited vision of the future—at best one of maintenance, one of surviving.
Low expectations lead to health care and support systems operating in such a way as to treat individuals as passive recipients rather than active participants. Consumers are often overlooked as a valuable resource in their own care and have little impact on their own treatment choices, resulting in decreased self-efficacy and increased non-compliance.
This situation is exacerbated by economic disincentives for individuals to rebuild their lives. For example, a distinct show of capability and increase in health could result in a loss of benefits such as Supplemental Security Income or Medicaid coverage and a discontinuation of the very service that may have substantially contributed to an individual’s success.
Stigma and prejudice further toughen the path of healing, creating an additional barrier against which overburdened and often underfunded health systems struggle to provide services.
Individuals diagnosed with severe or chronic illnesses, and the people aiding them, may justifiably see a crisis not only in the disorder itself but also in society and the healing systems available to them.
Keep in mind, however, that the Chinese symbol for crisis connotes danger and opportunity.
“In the middle of difficulty lies opportunity.” —Albert Einstein
What can each of us do despite the system of which, in fact, each one of us is a part? We can do more with less by doing differently.
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Setting Favorable Conditions for Procovery
I am not interested in the past. I am interested in the future, for that is where I expect to spend the rest of my life. –Charles F. Kettering
Like gardening, procovery can best be initiated by setting up favorable conditions, planting more seeds than you expect to sprout, and nurturing the ones that do.
Favorable conditions are those that singly or together can significantly ease the path to healing. Like procovery itself, the conditions that are most favorable will differ among individuals. Here are eight conditions that I have seen to be important:
1. Believe that procovery is possible, that an individual diagnosed with serious or chronic illness can overcome it, integrating illness into a productive and fulfilling life.
2. Recognize the power of the individual. As William Anthony, Ph.D., has said, “recovery can be facilitated by any one person.” Because procovery can be initiated or contributed to by any individual, at any time, procovery is most easily reached in a climate that fosters individual initiative—whether that of consumer, family, or staff.
3. Focus forward, not backward. Much can be accomplished when we let go of who we were and get to know who we are now and who we can become. Instead of trying to figure out, “Why did this happen to me?” “What could I have done to prevent it?” “What did I do to deserve it?” it is often more productive to ask, “What can I do about it?” and to move forward. This is not intended in any way to downplay the role of therapy and analyzing one's past, which can be a critical factor in procovery; it is intended only to suggest that focusing backward, looking at all one has lost, can be an overwhelming barrier to procovery.
In the final analysis, the question of why bad things happen to good people translates itself into some very different questions, no longer asking why something happened, but asking how we will respond, what we intend to do now that it has happened. —Harold S. Kushner
4. Focus on life rather than illness, and strengths rather than weaknesses, identifying and building on what is available. It has been said that teaching to draw is teaching to see; teaching procovery is teaching to recognize what is available in life.
5. Recognize that big problems don’t necessarily need big solutions. It would be nice if there were one answer to feeling better, one exercise to do or one pill to take. But procovery is generally reached by an accumulation of helpful things. Small changes can have big impact.
“I am done with great things and big plans, great institutions and big success. I am for those tiny, invisible loving human forces that work from individual to individual, creeping through the crannies of the world like so many rootlets, or like the capillary oozing of water, yet which, if given time, will rend the hardest monuments of human pride.” —William James
6. Just start anywhere. There are as many paths to healing as there are paths to illness. The process of procovery begins by moving forward in any area, in any increment. Often our lives are so fragmented; just the thought of repair seems overwhelming. “Where do we start?” we wonder. Whether it’s No. 1 or No. 5 or No. 30 on the task list, whether it’s getting a goldfish or getting a job, just start anywhere.
Streams pour into creeks, creeks into rivers, and suddenly you have a Mississippi. —Carol Flinders, Ph.D.
7. Accept backsliding. The process of procovery is often two steps forward and one backward—or sometimes one step forward and two back. If we don’t expect someone to make a perfect soufflé the first time, or win a marathon, or play a song on the piano, how can we expect an individual to procover from serious illness without setbacks or relapses? Backsliding is to be expected in any really difficult matter; it can be an indication of the difficulty of the task. Society applauds a persistent person who succeeds after repeated failure “against all odds,” but beats the heck out of people while they are “failing.”
The real challenge of rehabilitation programs is to create fail-proof program models. A program is fail-proof when participants are always able to come back, pick up where they left off, and try again. —Patricia Deegan, Ph.D.
8. Keep hope alive. Positive emotions create positive reactions in the body, and negative emotions create negative reactions. While the biology of this is in dispute, the fact of it is not: hope is an enormous factor in healing. There is always reason to hope, and it is a central factor in successful procovery—both as a broadly underlying condition and as an active strategy.
Clearly, hope is a life force in and of itself. A little hope —a remote chance for survival or a small improvement in one’s condition—can give the strength to carry on.—Ernest H. Rosenbaum, M.D. and Isadora R. Rosenbaum, M.A.
Being able to affect your procovery doesn’t mean you caused your illness. It doesn’t mean that you were never ill in the first place. It doesn’t necessarily mean you’re symptom free.
While procovery may result in the elimination of illness, this is not the focus. The focus of procovery is instead on the broader and more critical process of healing, of building life. That is, to master symptoms without necessarily eliminating them, and overcome illness without necessarily curing it.
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Procovery Strategies
What we have to learn to do, we learn by doing.—Aristotle
So what strategies can individuals specifically take to bring about procovery? The procovery strategies briefly discussed below are discussed in detail in The Power of Procovery:
Detoxifying the diagnosis. Use diagnosis only to the extent helpful. Individuals are not defined by their diagnoses. A diagnosis can be helpful, for example, to provide a starting point for treatments, can help put individuals in touch with each other for support, and can provide a label for further research. But at a certain point, a diagnosis becomes tremendously self-limiting.
Practical partnering in health care. Bernie Siegel, M.D., notes, “the most important kind of assertiveness a patient can demonstrate is in the formation of a participatory relationship with the doctor. Most patients don’t talk to their doctors or ask a lot of questions for fear of angering this person who is going to ‘make’ them well.” In health care, compliance and choice are often mirror images, and active partnering steps by professionals, consumers, and family members, within current systems, can radically improve the procovery process.
Medication management. Medication management is a two-way street. Although the physician has the power to “order” or write a prescription, the consumer (other than in the case of forced medication) has the ultimate power to take it or not. Yet in large part, consumers are left out of medication planning—choices, dosage, and timing—and frequently have their reported side effects invalidated or downplayed. Developing a collaborative medication management approach can increase compliance and greatly support the path to procovery.
Uncovering hope. The intangibility of hope is in its measurement and not its effect. Hope can be found in what a person can do and what is available. Growing hope involves having faith in what is possible; recognizing and building on seeds of hope when they appear; and—most critically—not extinguishing it.
Creating change. Sometimes in the face of illness our dreams blow up in our face. It is important to dream a new dream, and once you’ve done this to pick some aspect of it and begin working toward it in any increment.
Dissolving stigma. There is a great deal of talk about stigma, meaning negative judgments and discrimination by others. But the most powerful and destructive stigma of all is inner stigma. People diagnosed with severe or chronic illness often come to see themselves as damaged merchandise, not as strong, or deserving, or likely to succeed as others. Individuals can significantly move toward procovery by addressing inner stigma first. It is often easier to have an impact on yourself than on others, and helping yourself strengthens you to impact others.
Using feelings as fuel. The anger, guilt, frustration, and other feelings experienced along the path to procovery are too often seen as symptoms, rather than consequences of illness and/or the procovery process. Taking a procovery-oriented approach of moving forward through ordinary, individual actions, much can be done not only to cope with feelings but also to use feelings as fuel for procovery.
Gathering support. Procovery may or may not involve a health "system", but it is generally not done alone. Finding ways to effectively invite and accept support, as well as match the support to the supporter, can make an enormous difference. William Anthony, Ph.D., writes, “A common denominator of recovery is the presence of people who believe in and stand by the person in need of recovery.”
Sticking with procovery when the going gets rough. Sometimes in the midst of crisis, all procovery efforts are abandoned or forgotten. But procovery efforts during crisis can greatly determine whether this particular crisis will be just part of the procovery process, a detour on the way to procovery, a turning point toward procovery, or a loss of will in getting there at all.
Self-care actions to take and choices to make. Illness can loom so deadening, so debilitating, so destructive that we assume it requires something strong, powerful, and exceptional to beat it. Self-care may seem too “anecdotal,” too incidental to have an impact. But in fact self-care makes use of the most powerful medicine of all—the active participation of the individual.
Living intentionally through work and activities. Most simply stated, what we do all day matters. Although diagnosis may be specific, healing is holistic —involving medical, psychological, legal, family, spiritual, and financial components, many of which are impacted by one’s approach to work and activities. Choices about work and activities can be made reactively or intentionally, and as a result, can increase the barriers or smooth the path to procovery.
Retaining procovery: the benefit of the bargain. Despite all the effort put into procovery, it can be easy, once feeling better, to take improvement for granted and to downplay or simply forget the importance of all the actions that made it possible. Fortunately, the meaning and insight that results from the process can provide individuals their unique road map to retaining it.
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Nurturing Procovery
There is no medicine like hope
No incentive so great
And no tonic so powerful
As the expectation
Of something better tomorrow.
—Orison Swett Marden
If you want to work and send out one resume, you will hope that one resume lands you a job. If you send out 50 resumes, you not only increase the odds but your faith in the possibility of a positive outcome. This “upward spiral” applies to procovery: If you take a procovery-oriented step, no matter how small, you not only create a new possibility of a positive outcome but—because that new possibility exists—you build hope. And this hope, in turn, tends to spur more positive action.
This is not to say that procovery is easy; it can be the greatest challenge of a life. As Fyodor Dostoyevsky wrote, “A new philosophy, a way of life is not given for nothing. It has to be paid dearly for, and only acquired with much patience and effort.”
The difficulty of procovery is all the more reason to celebrate successes along the way, and to recognize that what might appear to be backsliding or “failure” can instead be an integral part of the process (and may in hindsight be seen as critical to having moved forward).
The voyage of the best ship is a zigzag line of a hundred tacks. See the line from a sufficient distance, and it straightens itself to the average tendency. —Ralph Waldo Emerson
In fact, procovery is often understood best in hindsight. Just as you can drive from Miami to Los Angeles and not see a sign that you are on the way to California for more than 1,500 miles, the signs of procovery aren’t always early or obvious.
The more we learn to seek out procovery the more obvious it becomes, the more subtle are the signposts that we can read, and the more available it begins to strike us. I am reminded of an anecdote by Kermit Long:
Two men were walking along a crowded sidewalk in a downtown business area. Suddenly one exclaimed: “listen to the lovely sound of that cricket.” But the other could not hear. He asked his companion how he could detect the sound of a cricket amid the din of people and traffic. The first man, who was a zoologist, had trained himself to listen to the voices of nature. But he didn’t explain. He simply took a coin out of his pocket and dropped it on the sidewalk, whereupon a dozen people began to look about them. “We hear,” he said, “what we listen for.”
Adapted from The Power of Procovery in Healing Mental Illness: Just Start Anywhere, by Kathleen Crowley (c) Copyright 2000.
http://www.procovery.com/procoveryprimer.htm