January 28, 2005

Daniel B. Fisher and his "Empowerment Model"

Medscape.com recently ran an interview with Dr. Daniel B. Fisher, MD, PhD, Executive Director of the National Empowerment Center in Lawrence, Massachusetts. Dr. Fisher described his theory of Empowerment Model recovery, how it fits in with the medical model and medication treatment of mental illness, and how he believes it helps people with severe mental illness recover. Although this is just one person's opinion, some ideas could certainly be integrated into long-term care. Below is a paraphrase of some key points:

An integral part of the Empowerment Model is a distinct definition for mental illness. According to Dr. Fisher, mental illness "is a combination of severe emotional distress and an interruption of a person's place in the community and social role -- being a worker, parent, student, a participant in overall community life -- which is not dissimilar from what is considered a mental disorder in DSM-IV.[2]." This is a functional view of what mental illness is, although it doesn't rule out the possibility (a strong possibility, given scientific research findings) that such "severe emotional distress" and an "interrupted role in community and society" could stem from biological causes as well as environmental and social ones.

Another key part of the Empowerment Model is hope. Dr. Fisher states that in his research experience, the most important aspects of recovery from schizophrenia and bipolar disorder was a person's hope for their own future, a belief that their condition was not permanent, and a supportive environment that helped reestablish them to a role in the community. He also cites as evidence two studies from the World Health Organization, showing that the rate of recovery from severe mental illness is twice as high in developing countries than in industrialized countries. In these developing countries, Dr. Fisher says, the approach to healing is "...very socially oriented, and they instinctively recognize the importance of keeping people connected to the community."

When asked how his empowerment model contrasts to the medical model of mental illness, Dr. Fisher replied that an empowerment model emphasizes that severe mental illness is not permanent, and that people have recovered. He stresses the importance of reestablishing social connections, and having peers as guides and mentors in the recovery process. He tells people that medication is to be used as a tool in their recovery process, as a way to help them control their symptoms enough that they can begin re-establishing relationships and re-entering the community. With the help of medication, a person can begin the process of learning to be with others, make friends, find a job, go to school, and take care of themselves.

Cognitive Therapy is also part of Dr. Fisher's 10 Principles of Recovery, to help people manage and control their thoughts during the stresses of everyday life.

To read the whole interview, see "An Empowerment Model of Recovery From Severe Mental Illness: An Expert Interview With Daniel B. Fisher, MD, PhD" (Jan 20, 2005) on www.medscape.com. Requires free registration for viewing.


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