The self-help movement, American in origin, has expanded exponentially to become an international phenomenon. However, few may know the important role Chicago psychiatrist and neurologist Abraham A. Low, M.D., (1891-1954) played in the history of the self-help movement when he founded Recovery Inc.

Dr. Low, born in Poland in 1891, attended school in Austria and received his medical training at the University of Vienna. He arrived in the United States in 1921 and practiced general medicine, first in New York City and later, in 1923, in Chicago. In 1925, he was appointed Instructor in neurology at the University of Illinois Medical School. Subsequently, he became Associate Professor of Psychiatry as well as Acting Director of the University of Illinois Psychiatric Institute. He remained on the faculty of the University of Illinois until his death in 1954.

Dr. Low, who believed that psychiatric patients could take an active role in maintaining their mental health through control of their responses to recurrent symptoms, was a pioneer in developing the basic principles of self-help.

In 1937, Recovery Inc. was founded by Dr. Low to provide mental health aftercare for psychiatric patients, many of whom had received treatment at the Psychiatric Institute of the University of Illinois Hospital.

Recovery soon became an independent organization. As more members joined and formed new groups, Recovery expanded throughout the Chicago area. It subsequently grew to a national, and now international, organization with more than 600 chapters.

In addition, his ideas contained much that anticipated later developments in group, cognitive, and behavioral therapies. The characteristics outlined by Dr. Low for Recovery Inc. provided a model for successful support-group intervention in psychiatry. Among the characteristics of self-help groups discovered by Dr. Low were: the necessity of personal participation, importance of face-to-face personal interactions, need to define a purpose with agreed-upon actions directed toward that end, opposition to some entrenched and orthodox practices, and use of a reference group for individual members that provides a point of connection and identification with others

Dr. Low believed and taught that in the face of increasing anxiety, patients were prone to use alarmist and defeatist language with fatalistic implications. These features were understood by Dr. Low as components of a danger signal, which he summarized as the symptomatic idiom. Dr. Low believed the patient had the will, which could be trained to accept or reject the suggestions of the symptomatic idiom. The implications of the symptomatic idiom were impending physical/mental collapse and resignation to permanent handicap.

Dr. Low's interest in developing a theory of the will places him among many of the historic psychologists, though the concept of the will has been given relatively little attention in modern psychiatry by both biological and psychoanalytic theorists.

Spotting technique

Although the authority of the physician to make medical diagnoses is a central tenet of Recovery, the self-help program was developed to function independently of the physician-patient relationship. Dr. Low developed a technique called "spotting", whereby a patient looks for signs of defeatist thinking and brings them to the attention of the group for help in applying the Recovery principles. Within the meetings, a highly structured panel interview occurs. Individual patients present their case vignettes and testimonials, called "examples", always following a prescribed, four-part formula designed to illustrate Recovery principles. These examples begin with a description of the event or situation and how it escalated to become a source of acute anxiety or crisis for the patient. The second step is identification of the specific physical and behavioral symptoms generated by the situation. Then, in the third step, the patient "spots" the Recovery principles that he/she applied to help lessen the symptoms. The fourth step focuses on a summary statement comparing the current reaction and resolution to how the patient would have handled the situation before his/her Recovery training. After the patient completes his/her "example", the group members provide further spotting, which reinforces additional Recovery tools the patient could have used in that specific situation.

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