Tuesday, May 6, 2008

Recovery, Hope, and Self-Esteem

This weekend I attended the annual scientific advisory board awards luncheon of the Depression and Bipolar Support Alliance, and also discussed with my son’s school mentor the impact of the lack of self-esteem has on his outlook and confidence.

The theme of the DBSA luncheon was to review recovery tools available online, 24-7. DBSA is increasingly using video to provide these tools. On their Web site, “Recovery Steps” is a major link. DBSA equates recovery with wellness.

The President’s New Freedom Report on Mental Health advocates the transformation of the nation’s mental health system to focus on recovery. The report and the DBSA link to the Substance Abuse and Mental Health Services Administration definition of recovery: “A journey of healing and transformation enabling a person with a mental health problem to live a meaningful life in a community of his or her choice while striving to achieve his or her full potential.” For two years I have been thinking off and on about how the mental health concept of recovery, the fundamental principle in reforming the nation’s mental health system, applies to AD/HD and to my 17-year-old son with special needs. The CHADD professional advisory board has not yet focused its concentration on this question, but we will over time.

The SAMHSA National Consensus Statement on Mental Health Recovery identifies ten components of recovery. I will only focus here on one aspect of recovery—hope.

Hope is a focus on a “better future–people can and do overcome the barriers and obstacles that confront them.” Hope is internalized but can be fostered by peers, families, friends, and others. To SAMHSA, “hope is the catalyst of the recovery process.” During the past two weeks my son has been upset with some peers’ criticism of him. He is highly sensitive; criticism takes a life of its own and becomes a focus on the negative, rather than a focus on the positive.

My son’s mentor believes that my son’s sensitivity is heightened by low self-esteem and low self-confidence. Robert Brooks, PhD, has emphasized at CHADD conferences over the years the need for each of us to have and use our "islands of competence." I have always used Brooks’ approach to emphasize with my son his strengths, while not exaggerating. My March 20, 2008 blog—“Self-esteem, Bonding, and Enjoyment”—focused on my son’s strengths. But offsetting strengths are the built-in doubts we all have, and that people with special needs may have even more of.

At the DBSA luncheon, consumers used the following words to describe their success in moving towards recovery—trusted, loved, depended on, understood, healthy, in control, and inspiring hope. My son’s mentor observed that self-esteem and confidence are “earned” through lived experiences. I wish to think that they are “developed” through life experiences. Within each of us is the memory conflict between positive experiences and negative experiences. Enhancing the positive experiences and reducing the frequency of the negative experiences is an objective. You can’t fake this—it is an internalized feeling. But hope and self-confidence can be fostered. It is much easier for me to stay focused on the positives, but life is this balancing act between the positive and the negative. The more negative experiences one has, the more difficult to have hope. (Not discussed here is the literature on resilience.)

CHADD will continue to brainstorm, think about, and examine the published science to conceptualize how the concept of recovery applies to a lifetime learning and living challenge called AD/HD. Using the SAMHSA definition, we know it is a journey of lifelong duration. We know that one has to “live a meaningful life.” Our role as parents, partners, and advocates is to assist our child or partner in achieving his or her own potential. (There are nine other interrelated components to recovery, according to SAMHSA, that will not be addressed here.)

Your thoughts, your experiences, and your approach can help CHADD more effectively think this through. Please share your ideas on how the mental health concept of recovery applies to living with AD/HD. Thanks for your time and sharing.



Anonymous said...

Dear Clarke,
I appreciate the topic of this blog entry.

I think the mental health concept of recovery can be a very helpful part of dealing with AD/HD. To me the word recovery denotes a process - it is an activity. When the word is used to describe a physical illness or injury, it is automatically perceived as a process that is going to take time and effort on the part of the person recovering. This is both good and bad. Good in that this is something a person with AD/HD will be actively and personally involved in. And, bad, in that most processes aren't quick and the effort can be tedius and difficult at times.

And with mental health and physical health being thought of in different ways, it adds an additional challenge. We wouldn't think of imposing on someone recovering from an illness or accident - they need time and space to heal. We are protective of them. The amazing part is that this occurs even if we don't like the person all that much. Think of how we treat our colleagues, neighbors, or relatives when they are dealing with a medical problem - most conflicts and hard feelings go out the window, even if it is only temporarily. It is naive to think that anyone would cut us the same slack if we are newly diagnosed or experiencing a change in our treatment plan for AD/HD. Most of us disclose the AD/HD in ourselves or in our family very selectively.

I like that SAMHSA recogizes the importance of hope. When I look back upon my family's AD/HD journey (which is apparently never going to end) it was messages of hope from those that truly understand AD/HD that carried me through the awful times. My involvement with CHADD has provided me with examples of those who conquered obstacles, given me hope by providing strategies to help with the negative side of this, and allowed me to meet friends who helped me arrive at a more realistic view by telling me when it was time to "get past it".

The hopes I had at the beginning of this journey are very different than where I am today - but the important thing is that my hope is still alive.

Marie Paxson
President-elect, CHADD

Anonymous said...

Tieing in the concepts of self-esteem and sports, which have appeared in a number of the blog entries, I encourage parents to explore non-team sports for their children.

My son never got into T-ball or soccer, or any of the other team sports. So we decided to let him try martial arts. That's a sport that emphasizes discipline and focus, yet allows each participant to proceed at his/her own pace. After 8 years, my son earned his fourth degree black belt. (There were other kids there with a variety of conditions, including Asperger's.)

Before he entered high school, I enrolled him in a 4-day day camp on wrestling. He'd never wrestled before, but he loved it and made varsity in 10th grade. It's great for physical fitness, and--maybe surprisingly--it's very good for participants with disabilities. One of the wrestlers on the team is deaf. And there's a kid on another team who doesn't have an arm. (That kid legitimately made varsity.) It's a tough, demanding sport, but they say that ADHD really involves "selective attention." If they focus on the sport, they can do very, very well. And what it does--unlike most team sports--is allows the individual to push him/herself to the limit--regardless of where that limit is.

More recently, he's continued with martial arts (Brazilian jiu-jitsu) and grappling...with some success. See: http://www.youtube.com/watch?v=3S6oOBw3Trc

Sports aren't for all kids. But if a kid is "turned off" by team sports, try a non-team sport. Start with martial arts and see what happens.