Recovery model: the person in the center of the intervention.

Ricardo Guinea, Chair, Organising Committee.

Placing the person at the center of the intervention is perhaps the simplest way to describe the paradigm shift that the recovery model is introducing on a large scale in contemporary care systems for people with severe mental illness. That the person is in the center, has implications of great importance that are worth highlighting.

What does it consist to be a person? It is a question more for a philosopher than for a scientist. For Adela Cortina ("The frontiers of the person", Taurus Ed 2009, pp.185), "we recognize as a person who has the capacities required for self-consciousness, for the mutual recognition of dignity, to act from freedom and assume responsibilities".

That this idea may be important is underlined by the fact that for many years it was not the person but the disease that occupied the center of the intervention of the models of attention. This is consistent with the way in which reality presents the biomedical paradigm. Under the biomedical perspective, there are things like schizophrenia or bipolar disorder, which are -or should be- medical illnesses; then you have to treat them as such. From this perspective, certain priorities are followed. If this is the case, to face the problem it is necessary the person to be aware of the disease, it is necessary to treat acute situations and do whatever possible to avoid relapses. And for this, a systematic psychopharmacological treatment has shown to be the most effective tool.

However, when studying the testimonies of the people actually recovered, it was found that this idea did not meet the expectations of many of them. In those testimonies, the idea frequently appears that the biomedical approach tends to produce poor life experiences that are often empty of content.

That the person occupies the center, as the model of recovery preaches, takes a different perspective. Recovering, according to one of the most cited definitions, is a highly personal process to overcome and find a new meaning in life, beyond the catastrophic effects of suffering from mental illness - whatever that may be. To recover is to live a meaningful life, a life that is worth living, a life in which the person has opportunities, in which personal projects and preferences and personal choices really account.

Thomas Kuhn ("The Structure of the Scientific Revolutions", 1962) would emphasize that between the two versions there is the typical change of theme proper to the paradigm changes in science. In this case it would be to say that we have reached a certain point in which to work scientifically on the idea of ​​how to cure mental illness is a stalemate where we cannot see where progress might continue. Then the typical turnaround of the paradigmatic change occurs: since we do not progress on the idea of ​​how to cure the sick, we consider instead the idea of ​​how to help them live a dignified life, a person's life.

Although sometimes presented as such, these two visions here outlined are not completely antagonistic. The possibility of reducing the symptoms, even partially, is very valuable so that they do not invade the whole life of the person. Alleviating pain with drugs as much as possible is part of the best of medical deontology, and is a tool that the medical art makes available to people. The key, as is the case with any tool, is in how it is used. A drug can be - and often is - a liberating element for the person who suffers, to the extent that it facilitates being him or her and not the symptoms, the agent takes control of life. Or otherwise it can be a mental anesthetic, that buries the person after a semblance of serenity, as also often happens.

What is clear is that recovery is beyond the mere question of whether or not to follow a certain procedure, be it pharmacological or other treatment. Recovering is in connection with having real opportunities to get a job as a way to participate in the community, with a decent accommodation, with not being segregated or stigmatized by their mental diversity. And also, and this is very important, with the responsibility of the person to use - and how to use - those opportunities in their own and inalienable recovery process.

 What is critical is whether the person is in the center or not, if the help is offered in a way that empowers the person and not the other way around. That is, in my opinion, a central point of the debates around the notion of recovery that we will celebrate at the XIII World Congress. How each actor is able to understand that framework of help from his singular contribution - the professional, the family or the supportive network, peer supporter, the person himself. How to foster collaboration frameworks from the mutual recognition of capabilities, and manage the demands of control that, we should not ignore, emerge frequently.

Adela Cortina, Professor of Ethics and Political Philosophy at the University of Valencia, Spain.

To help us situate the notion of person, which today is at the core of the transformations of the care systems in most countries, we have invited Adela Cortina, Professor of Ethics and Political Philosophy at the University of Valencia, who has Kindly accepted to deliver the inaugural lecture.