An Interview with Clifton Nees

What is recovery psychology?

It is the scientific study of behaviors and mental processes which bring about or represent that recovery from a psychological disorder is occurring.  It would not only challenge clinical and abnormal psychology but seek to abolish them, not as an opponent but an ally, recovery psychology would be the fulfillment of the very notion of clinical psychology as a science that is meant to help people.

What does the term recovery mean?

I estimate that there are about 43 different definitions of recovery from various sources.  Once the psychiatrist Dan Fisher said it was a process in which we become ourselves, in psychiatric rehabilitation it would be the replacement of artificial supports, meaning the mental health system, with natural supports, such as family and friends.  The psychological definition however, as I would put it is: The establishment or return of a person’s chosen “normal” behaviors, which directly alters the presence of abnormal behaviors. 

Is this like Alcoholics Anonymous or something like that?

Well, with regard to the person saying that they are in recovery, it is.  If we were to observe the practice of working a 12-step program and document changes in observable behavior under the scrutiny of the scientific method.

So what you are saying is that psychology does not recognize this concept of recovery?

The Journal of Humanistic Psychology has printed the writings of Dan Fisher, Patricia Deegan and others who write about recovery have seeped in here and there.  However, it is not greatly recognized the way it should be.  The presidents’ column of the APA Monitor in October 2005, said psychology was uniquely qualified to lead the recovery movement.   The article cites the 2001 Commission on Mental Health as being something legitimate, and this is then APA president Ron Levant saying this, and if he had read any of the material of the 2001 commission he would have known about the endorsement that peer support being a legitimate concept of recovery.

What is peer support and what do you mean by that statement?

 Peer support is natural thing a person has in their life by having peers.  When a person is cut off from their natural cohort due to a psychological disorder, the thing that has been found beneficial is the hiring of peer support workers in the profession that is designed to serve them.  The idea stems from the concept that there is a personal dynamic at work that a person who knows what it is like first hand is involved in a person’s treatment.  If the president of the APA believed in these recovery ideals, then the question to ask where is the peer support department of the APA?

So recovery psychology is a science?

All science begins with a philosophical notion; psychology has its roots in philosophy.  Psychology is the science of behaviors and mental processes.  Recovery from psychological disorders occurs whether or not psychologists recognize it.  So far I am doing second hand research, second hand meaning that I am not using actual test subjects to watch and record their recovery; although I would love to pursue that endeavor with some of the already existing applications that could give recovery psychology an application basis.  This second hand research is more philosophical; it is the interpretation of already published mental health recovery literature and psychology literature.  Basically, it is the philosophy that the science of psychology needs to study something more proactive than problematic with regards to psychological disorders.

In what way have you interpreted this mental health recovery literature?

Over and over again the literature will say that “people do recover from mental illness” and anybody who has studied psychology and has a good understanding of grammar would say that “do” is an action verb.  Behavioristic psychology defines behavior as anything a living organism does.  People are living organisms.  In the mental health recovery literature over and over again is the assertion that recovery is a process.  If a mental illness is set of abnormal or disordered processes to warrant there being an abnormal psychology, then recovery as a process can also be studied in a psychological context. 

You said recovery from mental illness, then recovery from psychological disorders what is the difference?

Recovery is recovery, there is no difference there.  I think where you are getting confused is the difference between psychiatry and psychology; which is mostly a divergence of academic terminologies.  Mental illness, mental disorder and psychological disorder are all synonyms. What is the difference between psychiatry and psychology?

Psychiatry is medical treatment of mental disorders and illnesses.  It differs from psychology greatly because it only focuses on treating disorders.  However if you purchase an Introductory Textbook on Psychiatry by Nancy Andreasen and compare the content to Abnormal Psychology: Clinical Prespectives on Psychological Disorders by Robert Halgin and Susan Kruase-Whitbourne, you wouldn't see much of difference on diagnostic information on the various types of disorders.  In fact each chapter of the latter qoutes Nancy Andreasen.  So there is an obvious deifference between psychiatry and psychology, but more obvious than that is the big blur between the two.

You mentioned psychiatric rehabilitation earlier, is this a part of psychiatric medical treatment?

No, but it should be!  If a person is hospitalized for a medical condition such as a broken leg, might need rehabilitative services after leaving the hospital to expedite their recovery.  If a person is released from a psychiatric unit, often they are categorized as being stabilized and that is that…if you were sent home with a broken leg being stabilized, who knows if it will heal properly or you will be wearing the cast forever.  Rehabilitation and recovery are fundamental concepts serving as markers that determine if the treatment was even worth doing to a person.

How does psychiatric rehabilitation relate to recovery psychology?

The same way a professional welder relates to a PhD in thermodynamics; they both might know something about heat, fire and molten metals…but to say they have the same knowledge background would be incorrect. 

Thanks for clarifying that, Now what were you saying about psychology?

There is an obvious connection between psychology and psychiatry.  Psychology is a behavior science, which studies mental processes and behaviors. Clinical psychology is an application based science of treating psychological disorders; while Abnormal psychology is a research based science of pathology or abnormal behavior.  The two of which, I would say constitute a remission psychology.  Remission would be like just being stabilized, it differs greatly from having recovery.

How do recovery and remission differ?

In psychological disorders there is what is called positive symptoms and negative symptoms.  Positive symptoms are the abnormal behaviors resulting from a disorder, such as hallucinations and delusions. Negative symptoms are missing normal behaviors like smiling, starting conversations or having initiative.  Remission only implies that abnormal behaviors have ceased or lessened in intensity, frequency, duration or latency.  Psychology and psychiatry mostly focus on remission, often through medication.  The medication often has adverse side effects which look like more novel types of abnormal behavior or exhibition of even more positive symptoms, and as I told you earlier this in the health industry is considered as a fair trade off.  So just because a person has their abnormal behavior altered it does not mean they have developed any sense of “normal.”

Who defines this sense of normal?

It would be the persons in recovery themselves; after all it is the person in recovery that needs their own norms.  Recovery is described as a personal journey and why not?  The major diagnostic criterion for a disorder is personal distress.  Now how can we say to a person “you have a lot of personal distress, we have measured your subjective and qualitative self concept and determined that you are sick” and turn around and say “We can not empirically and objectively measure your coping and adaptation skills so therefore you are hopeless and there is no recovery.”  That would not only be an absurd fallacy of logic but quite unscientific.  Recovery is very scientific.  Recovery does not mean cure, but if we were to scientifically scrutinize the concept of cure we would find that cure does not mean cure.  Scientifically we can not determine what is normal other than to determine what a majority of people feel is normal.  But if a person is having the criterion of personal distress and we introduce this person to a hundred others with the same personal distress and perhaps the same disorder, we are likely to find no abnormality or personal distress. If these hundred persons are experiencing some degree of life satisfaction in which they did not experience prior, we would not tell them what normal is or deny them the right to identify themselves as being in recovery.  Although they might be in recovery together, each one experiences their own personal recovery.

Would there be any similarity of recovery psychology to positive psychology?

Yes, there would but positive psychology does not address psychological disorders with the same fervor that the recovery model does…from what I read on positive psychology it almost denies the concept of recovery.

So what work have you done on this?

I have printed a sample textbook of recovery psychology entitled “Recovery Psychology” as an example of what could be.  I have it buried in disclaimers, because it is not in any way a finished work, but then again it should not have to be for people to get the message.  I have been to seminars and conferences and I meet all these people who spew out the same ol’ rhetoric about recovery and the agenda of transforming the mental health system or public education campaigns, but I see nothing in the most important area, being psychology as an academic discipline taught at colleges and universities. Anybody who has ever enrolled in course on abnormal psychology or clinical psychology and bought the course textbook with the same name should easily understand the idea, especially if psychological disorders have effected their lives on a personal level.  When I discuss the idea with a person they seem to think I am talking about a “book,” which is kind of belittling to the concept of recovery in a psychological context.  I started working on the idea on Wikiversity, as well as I have printed a blank edition of the textbook as another model for the concept.  I thought of the expression “If a tree falls on the internet and nobody hears it…”  Really, I could put just about anything on this web page and it would not matter, it seems as though the "information highway" is fairly intellectually brankrupt.  I created a workbook for persons in recovery who are students of clinical psychology to work on the concept and come to their own conclusions about recovery and psychology.  In the fall of 2008 I plan on working on working on the “Manisfesto on a Science of Recovery Psychology” in a collegiate setting.  This would be my philosophical thesis that recovery should be in clinical psychology.

You said that there are already existing applications out there, what are these applications and are they being practiced by psychologists?

Two big ones that can be seen right here in the valley are Mary Ellen Copeland’s Wellness Recovery Action Plan and a Recovery Education program offered by a behavioral health company.  The prior was written by a person in recovery who designed a tool that a person can use to identify their symptoms and their problems and work out what works for them, it has a lot to do with mental processes and behaviors.  It does not forever linger on what a person does that is abnormal, but it perpetuates what a person can do that helps them establish goals, hope and empowerment.  The latter program is another active behavior regime, which starts as a therapeutic intervention and ends up with the person being educated with an associate’s degree.  These applications only fall short of being science because it not being quantified empirically; otherwise they represent what would be called recovery psychology as an applied science.

Now to wrap this up, your final words how is what you are saying different from what others are saying?

After the 2001 Commission on Mental Health, the U.S. President signed an executive order that led the way to this agenda about “transforming the mental health system.”  Like I said earlier there is an undeniable association between clinical psychology and psychiatry, an obvious connection between psychology and the mental health system.  So this agenda is left in the hands of social workers, and the recovery model is always clashing heads with the medical model.  I say if you want to transform the mental health system toward a recovery oriented system, you need to transform the sciences and the academic disciplines that educate the public.  There is a lot of talk about the recovery concept but all the trainings and academic materials come in forms discussing service provision, recovery is a thing in itself (Das Ding Ina Sinch.)

To see this image more click here