
Psychiatr News March 17, 2006
Volume 41, Number 6, page 49
© 2006 American Psychiatric Association
Developmental Stages Important in Recovery
John L. Bulette, M.D.
Nassawadox, Va.
There is much to commend in the suggested change in paradigm outlined by
APA President Steven Sharfstein, M.D., in his column in the November 4, 2005,
issue. It should be noted that recovery is a concept that has been widely
accepted in substance abuse/addiction circles and is integral in the trauma
literature, for example, Judith Herman's book Trauma and Recovery is
some 20 years old. Perhaps the change in paradigm is overdue.
In my experience a major element in working with patients afflicted with a
major mental illness is that for various reasons they have dropped off the
developmental trail, most notably in the area of maturation of affects. Not
identifying affect signals correctly and not developing language to be able to
talk about these signals retard or distort the process of desomatizing affect
signals. When children evolve into the preadolescent and adolescent stages and
are threatened by affect signaling, their capacity to function in important
roles, especially with peers, is curtailed and thus their maturations delayed
or arrested. The concept of recovery should include recovering one's capacity
to grow and develop in relationshipssomething that requires an
increasing maturing of affects. I'm hopeful that our colleagues will join this
debate to refine and integrate the concept of recovery into psychiatric
practice.
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