In medicine and psychiatry, we plan treatment around principles such as “achieving remission” and “improving functioning and quality of life.” One of the goals of psychiatric treatment is to have few or no psychiatric symptoms (i.e., symptomatic remission), which then creates a foundation that supports an individual’s innate capacity to study, work, and be a friend, parent, or partner (i.e., functional remission). In combination, symptomatic and functional remission allows for an enriched and fulfilling life (i.e., good quality of life). Symptomatic remission, functional remission, and quality of life are concrete outcomes that can be defined and tracked over time. One of the strengths of this approach (which I would call an enlightened or recovery-informed medical model) is that it provides clear recommendations about which treatment to use (e.g., medications, specific psychotherapy) in order to help a person move from being distressed, preoccupied, and feeling badly about themselves, to a state of being less bothered by symptoms and more invested in the roles and activities that they value in life.

While people frequently “recover” from acute and serious medical illnesses, medical providers and patients themselves are unlikely to use the term “recovery” for chronic conditions in which symptoms persist to some degree with a clear and direct impact on functioning. It is often the case, however, that we see people doing psychologically well despite extreme objective adversity. As a result, I prefer “being in recovery” over “recovered” as it emphasizes the journey and process, not the endpoint. In a broader sense, people could then be considered in recovery if they: 1) have “good enough” symptom control, 2) take an active role in managing their own condition (with the help of a physician and medicine if needed), 3) have a good quality of life and, perhaps most importantly, 4) have a positive attitude about living with an illness, enjoying the life they have, despite hardships from illness. I had already introduced Frankl’s idea about the importance of the attitude towards the situation in the beginning. Acceptance and Commitment Therapy are examples of a psychotherapy that is grounded in some of Frankl’s insights.

I consider many of the individuals for whom I am a care provider to be in recovery, despite their struggle with serious mental health conditions such as schizophrenia. Despite some ongoing symptoms and in the context of taking medications, they live a good life as they define it, and have carved out valued roles as members of their families and society. For most, it was a long, winding and stony road, – per aspera ad astra as the Latin saying goes (through hardship to the stars).

The role of medications in recovery deserves specific mention. I suggest considering medication not as an end in and of itself, but rather as a tool to first achieve symptomatic and then functional remission. With this accomplished, a person is in a much better position to make subsequent gains in cultivating hope and achieving life goals (e.g., finishing school, maintaining or obtaining work), all of which serve to contribute to a positive attitude towards the self and one’s recovery.