Recovery from the perspective of individuals with bipolar disorder undergoing treatment at community mental health centres: a multicentre metaphor study

Abstract

Background

This study aimed to examine the experiences, meanings, and perceptions regarding recovery of individuals with bipolar disorder undergoing treatment at four different Community Mental Health Centres (CMHCs) in Türkiye, using metaphor analysis.

Methods

A descriptive phenomenological design, a qualitative research approach, was used. Between August 2024 and January 2025, The study sample consisted of 149 individuals diagnosed with bipolar disorder who received outpatient care at community mental health centres across four provinces of Türkiye. Data were collected using a nine-item ‘Metaphorical Perceptions Data Collection Form’ prepared by the researchers. Descriptive statistical methods (percentages, means, and standard deviations) and content analysis techniques were used to analyse the data. Ethics committee approval and participant consent were obtained for this study.

Results

According to the findings, 54.74% of the participants were female, 57.2% were single, and the mean age was 40.61 ± 12.88. 30.9% of the participants were university graduates, and 65.8% were unemployed. 24.8% of participants had received treatment for more than 20 years, while 46.3% had been hospitalised one to three times. One hundred and twelve metaphors related to recovery were identified in the data. These were grouped into six categories: ‘Recovery as the Regaining of Independence’, ‘Recovery as the Reconstruction of Life’, ‘Recovery as a Pathway to Inner Serenity’, ‘Recovery as an Element of Personal Development’, ‘Recovery as an Element of Social Acceptance’, and ‘Recovery as an Elusive Goal’.

Conclusions

These findings reveal that psychiatric care should guide the individual’s subjective recovery process, considering not only the clinical but also the psychosocial and personal aspects of care. Mental health professionals, particularly psychiatric nurses, should develop personalised and recovery-focused interventions that consider the metaphors used by patients.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12888-026-08183-x.

Introduction

At the beginning of the 21st century, structural transformations in mental health services in countries such as the United States, Canada, New Zealand, Australia, Ireland, and the United Kingdom led to the reshaping of the mental health field in accordance with the humanistic paradigm [1]. This transformation shifted the focus of the approach to mental health from psychopathology and dysfunction to an individual’s skills, strengths, and capacity for optimal functioning [1, 2]. The mental healthcare model has shifted from the traditional medical model, which focuses on illness, to recovery-based models that focus on the individual [3]. Accordingly, the fundamental aim of mental health services is to go beyond ensuring an individual’s clinical recovery and to enable their reintegration into social life to restore meaning to their lives, to increase their social functioning, and to improve their quality of life [4]. Community Mental Health Centres (CMHCs) have become important structures supporting a community-based, holistic recovery process by offering individuals with chronic mental illness opportunities for psychosocial support and social skills training, in addition to medication treatment [5].

Recovery in bipolar disorder presents distinct challenges compared to other chronic mental illnesses due to its episodic course, fluctuating mood states, and variable levels of functioning over time [6, 7]. Individuals with bipolar disorder often experience alternating periods of remission and relapse, which may lead to discontinuities in personal, social, and occupational functioning [8]. These fluctuations can complicate individuals’ perceptions of recovery, as recovery may not be experienced as a stable or linear process, but rather as a fragile and dynamic state shaped by recurrent mood episodes.

Psychosocial interventions carried out in CMHCs offer individuals the opportunity to create and live a meaningful life beyond the limitations of their diagnoses [2]. These psychosocial interventions encompass not only clinical recovery but also the subjective dimensions of personal recovery, such as hope, meaning, identity, empowerment, and reacquisition of social roles [9]. The recovery process involves an ongoing struggle with setbacks and whether it is sustained is a personal choice [10]. How individuals interpret the recovery process plays an important role in determining their participation in, and attitudes toward, treatment [11]. In this context, recovery can be viewed not as a linear goal to be achieved, but as a journey that also involves constructing a new meaning for the individual’s life. These journeys inevitably contain experiences unique to the individual [12].

A subjective and holistic perspective is fundamental to recovery [13], and recovery takes on a unique meaning for each individual in their own words [14]. Therefore, addressing recovery experiences from the patients’ perspectives is crucial for reflecting the dynamics of recovery and revealing its patient-specific meaning. This will guide the provision of a subjective recovery experience for individuals and enable psychiatric nurses to effectively support patients on their recovery journeys [15]. It will also contribute to the implementation of individualised, effective nursing care by enabling planning of care that meets patients’ expectations for recovery [12].

Metaphors play a significant role in defining our daily realities, experiences, emotions, and actions [16] and emerge as concepts that enable individuals to transform abstract and complex experiences into concrete, meaningful, and shareable language [17]. In this regard, metaphors can serve as important tools, particularly for expressing subjective processes such as mental recovery. Patients can use metaphors to express their highly personal and unique experiences, the processes they have undergone, and their thoughts on recovery. Metaphors are likely to provide powerful clues, especially when expressing subjective processes, such as mental recovery. The literature indicates that studies using metaphors to explore recovery in individuals with chronic mental disorders are limited [18–20]. To our knowledge, no published study has examined recovery through metaphors among individuals with bipolar disorder. From a psychiatric nursing perspective, exploring recovery through metaphors offers a valuable means of understanding patients’ subjective experiences, unmet needs, and expectations beyond clinical symptom reduction. Metaphors can guide nurses to tailor recovery-oriented, person-centred interventions, enhance therapeutic communication, and support autonomy, hope, and social reintegration among individuals with bipolar disorder. This study provides an important theoretical basis for future studies by directly reflecting patients’ perspectives on recovery in bipolar disorder. Accordingly, this study aims to examine, using metaphor analysis, the experiences, meanings, and perceptions of recovery among individuals with bipolar disorder undergoing treatment at four CMHCs in Türkiye. To this end, the following questions were addressed:

1. What metaphors do individuals with bipolar disorder develop regarding recovery?

2. What are the perceptions of individuals with bipolar disorder about recovery?

3. What categories do the metaphors developed by individuals with bipolar disorder about recovery fall under, based on their common characteristics?

Method

Type of research

The use of qualitative methods in health research is considered the most humane and person-centred way to elicit people’s thoughts and actions [21]. Therefore, a descriptive phenomenological design, which is a qualitative research approach, was adopted in this study. A descriptive phenomenological design aims to reveal the meanings that individuals with experience of a phenomenon attach to that phenomenon and to conceptualise these meanings [22]. Metaphors are among the most commonly used tools in this conceptualisation. Metaphors are useful figurative forms of expression that concretise individuals’ complex and abstract feelings, thoughts, and meanings [23]. Metaphors play an important role in defining and describing our daily realities, experiences, emotions, and actions beyond their existence in language [16]. This study aimed to reveal the perceptions of patients undergoing treatment at a community mental health centre regarding recovery, as expressed through metaphors.

The convenience sampling method a type of purposive sampling was used to select the study group. The study group comprised 149 individuals with bipolar disorder who were receiving outpatient treatment at Community Mental Health Centres in four provinces across Türkiye between August 2024 and January 2025. Patients who were over the age of 18 years, literate, and diagnosed with bipolar disorder were included in the study. Acute psychiatric symptoms can impair abstract thinking, insight, and expressive abilities, which are critical for metaphor formation. Furthermore, comorbid psychiatric conditions may affect the validity of metaphor analysis by producing misleading interpretations that are unrelated to bipolar disorder. Therefore, patients in the acute phase of psychiatric illness and those with secondary psychiatric illness were excluded from the study, as they could influence the results. It has been suggested that, in qualitative research, the number of participants can be determined by data saturation and by groups’ ability to meet research objectives and provide detailed data [24]. Patients were included until data saturation was reached, and none withdrew. Saturation was assessed at the levels of metaphor generation and thematic categorization, consistent with qualitative methodological principles. Data saturation was considered achieved when no new metaphors, meanings, or conceptual categories related to improvement emerged in subsequent interviews. Metaphorical expressions were analyzed throughout the data collection and analysis process. In later interviews, metaphor production largely converged on established patterns, notably metaphors related to independence (e.g., “bird”, “freedom”, “wing”), reconstruction and renewal (e.g., “flower”, “rebirth”, “sun”, “tree”), and inner serenity (e.g., “happiness”, “peace”, “well-being”, “fresh air”) (Table 2). Although fewer metaphors were coded under ‘Recovery as an Elusive Goal’, subsequent interviews did not introduce additional metaphor types or extend the thematic framework. After repeated analyses of the data, it was observed that the newly collected metaphors replicated previously identified meanings and categories but did not add conceptual depth; therefore, the data collection process was terminated.

Table 2.

Categories created from the metaphors the individuals with bipolar disorder developed for the concept of recovery

Categories	Metaphors	n
1. Recovery as the Regaining of Independence	Bird (10); Freedom (7); Wing (2); Car (1)	20
2. Recovery as the Reconstruction of Life	Flower (6); Rebirth (4); Sky (3); Tree (2); Sun (2); Spring (1); Re-engagement with life (1); Return to life (1); Finding my former self (1); Newborn baby (1)	22
3. Recovery as a Pathway to Inner Serenity	Happiness (17); Peace (7); Fresh air (4); Well-being (4); Feeling at ease (3); Breathing (2); Hope (1); Calmness (1); Living in paradise (1); Rest (1)	41
4. Recovery as an Element of Personal Development	Maturation (2); Growth (1); Butterfly (1); Tree (1); Self-confidence (1); Spring (1); Exercising personal agency (1)	8
5. Recovery as an Element of Social Acceptance	Being accepted (5); Happiness (3); Rose (2); Well-being (1); Breathing (1); Not being ignored (1)	13
6. Recovery as an Elusive Goal	Happiness (4); Scaling a mountain (1); Something impossible (1); Meaningless (1); Miracle (1)	8

Note. Metaphor labels may recur across themes; placement reflects participants’ attributed meanings in the “because” statements

Participants

The mean age of patients in the study was 40.61 ± 12.88 years (range: 17–74 years). Of the participants, 54.4% (n = 81) were female; 53.7% (n = 80) were single; 30.9% (n = 46) had a university degree or higher; and 65.8% (n = 98) were not working. Twenty-four point 8% (n = 37) of patients have been receiving treatment for 20 years or more. 46.3% (n = 69) of patients were hospitalized 1–3 times, while 27.5% (n = 41) were hospitalized more than three times (Table 1).

Table 1.

Sociodemographic characteristics of the individuals with bipolar disorder

Characteristics	n	%
Gender
Female Male	81 68	54.4 45.6
Marital Status
Single Married	80 69	53.7 46.3
Educational Level
Elementary School Middle School High School University and above	39 22 42 46	26.1 14.8 28.2 30.9
Working Status
Not working Working	98 51	65.8 34.2
Duration of treatment
Less than 1 year 1–5 6–10 10–15 15–20 20 years and above	9 29 23 27 24 37	6 19.5 15.4 18.1 16.1 24.8
Number of hospital admissions
None 1–3 More than three	39 69 41	26.2 46.3 27.5
Age	40.61 ± 12.88 (Range:17–74)

Instrument

Data for the study were collected using metaphors, a commonly used data collection method for eliciting individuals’ experiences and perceptions and obtaining detailed information about how they perceive events. The ‘metaphorical perceptions data collection form’, prepared by the researchers in accordance with the literature, was used to elicit the metaphors patients used to describe their recovery. The form consisted of two sections. The first section included eight questions covering the patients’ demographic characteristics and information about bipolar disorder. The second section contained a fill-in-the-blank item designed to elicit patients’ metaphors about bipolar disorder: “Recovery is like _______ because ________ (What do you think recovery is like? Why?) The patients were asked to complete the sentence using a metaphor and explain their reasoning.

The metaphor question was selected to obtain dense yet meaningful expressions that reflect participants’ lived experiences, perceptions, and meaning-making processes. The explanatory “because” component added to the question enabled participants to articulate the underlying meanings of their metaphors, thereby facilitating the collection of rich qualitative data suitable for thematic and interpretive analysis.

The Metaphorical Perceptions Data Collection Form is a qualitative data collection tool rather than a psychometric measurement instrument. Therefore, formal psychometric validation procedures are not applicable. Prior to data collection, expert opinions were obtained from three faculty members experienced in qualitative research— one psychiatrist, one psychologist, and one psychiatric nurse—to enhance the clarity and appropriateness of the form.

Psychiatric nurses working at the community mental health centres where the study was conducted collected data through individual, face-to-face interviews using an interview form in a room where patients could express themselves comfortably. The purpose of the study was explained to the patients by nurses, and written and verbal consent was obtained from those who agreed to participate. The concept of metaphor was then explained to the patients, who were asked to think about their concept of recovery and to create a single metaphor reflecting their thoughts. Each interview lasted 15–20 min, and the patients were given sufficient time to generate their metaphors.

Data analysis

The analysis of data obtained from the metaphor question was conducted in accordance with Moser’s methodological principles [25], recognized in the international literature as ‘metaphor analysis’ within qualitative data analysis approaches, and comprised several systematic steps. First, all participants’ responses were read repeatedly to enable an in-depth examination of the data. During this process, metaphorical expressions were identified in statements in which participants explicitly compared recovery to another concept or phenomenon (e.g., “Recovery is like … because …”). At this stage, data from nine patients with incomplete data collection forms (n = 9), including forms left entirely blank, and 28 forms containing expressions not considered metaphors (n = 28) were excluded from the study. Responses were considered non-metaphorical and excluded when they (1) described recovery literally (e.g., focusing only on symptom reduction, medication use, or clinical improvement without a figurative comparison), (2) consisted solely of general evaluative statements without an identifiable metaphorical source image or mapping (for example, “Recovery is good or important” with no interpretable metaphor), or (3) provided a definition or explanation rather than a metaphor. Only responses containing an explicit or clearly interpretable metaphor (i.e. a source image linked to recovery and justified in the “because” clause) were retained for analysis. A total of 112 patients provided valid metaphors. Subsequently, the identified metaphors were coded by extracting the source domain (metaphorical image) and the target domain (the recovery experience). Similar metaphors were grouped not based on literal similarity, but according to shared underlying meanings. For example, metaphors related to freedom, movement, or independence were clustered. Third, these metaphor clusters were examined and categorized into broader themes representing the essence of participants’ perceptions of recovery. The themes were refined through iterative comparisons among the raw data, metaphor groups, and emerging interpretations. Metaphors were coded and assigned to themes based on the interpretive meaning provided in participants’ “because” explanations, not on the metaphor term itself. Therefore, the same metaphor label could appear under different themes when it conveyed different meanings. These categories are listed in Table 2. SPSS was used to analyze descriptive statistics (frequency, percentage, mean, and standard deviation) for patients’ demographic characteristics, recovery-related features, and themes and metaphor categories. SPSS was employed solely for descriptive analyses summarize participants’ sociodemographic characteristics and present the distribution of metaphor categories. These numerical summaries were prepared to provide contextual clarity rather than to guide interpretation. Consistent with phenomenological principles, the primary focus of the analysis was on the content and meanings of the metaphors.

Researcher reflexivity

The study was designed and conducted using an inductive qualitative approach. No predefined theoretical recovery framework was applied during data collection or the initial stages of analysis. Participants were not introduced to any recovery models during data collection. The metaphors and themes emerged directly from the participants’ narratives.

The researchers acknowledged their familiarity with recovery-oriented frameworks and critically examined their potential influence during the analysis to ensure that the themes were data-driven rather than theory-driven. The CHIME and POETIC frameworks were subsequently used at the interpretation stage to contextualize and discuss the findings within the established recovery literature. This retrospective alignment was intended to enhance theoretical understanding rather than to guide or constrain data generation. Researcher reflexivity was maintained throughout the analysis to minimize the influence of pre-existing theoretical assumptions.

Validity and reliability of the research

A detailed description was provided to ensure the validity of the research [26]. Accordingly, the analysis of the data is explained in detail, a sample metaphorical image is provided, and quotations from the patients’ statements are included in the findings section. An expert review was conducted to increase the reliability of this study [26]. The data were analysed separately by the first and second authors of the study, and their analyses were compared. Any differences in opinion regarding the analysis were resolved by consensus. For the sample metaphor list generated during data analysis, expert opinions were obtained from three faculty members specializing in mental health and disorders: one psychiatrist, one psychologist, and one psychiatric nurse. The final forms of the metaphors and categories were determined based on expert opinions. Following the analysis of the data, Miles and Huberman’s [27] reliability formula was used, and the inter-coder agreement rate for this study was found to be 93%. Because the calculated value exceeded 70%, the study’s reliability was considered adequate.

Ethic

Ethical approval for the conduct of the study was obtained from the Gaziantep University Non-Interventional Clinical Research Ethics Committee (Ethics Committee No. 2024/430). Participants were informed about the study, and voluntary participation was ensured by obtaining both written and verbal informed consent. The study was conducted in accordance with the principles of the Declaration of Helsinki.

In the study, the potential for emotional distress was carefully considered due to the possibility that discussions of recovery might evoke distressing topics (e.g., disappointment, loss). To minimize the risk of emotional discomfort, data collection was conducted by researchers who were specialist psychiatric nurses in community mental health center settings, where clinical support was readily accessible. Participants were informed that they could pause or terminate the interview at any time without providing a reason. Emotional responses were monitored throughout the data collection process, and no participant chose to withdraw or request additional support. These ethical precautions were implemented to prevent potential ethical dilemmas that could arise when discussing sensitive recovery experiences.

Results

The mean age of the patients participating in the study was 40.61 ± 12.88 years (Table 1). The socio-demographic characteristics of the 149 patients who participated in the study are presented. The metaphors produced by patients regarding recovery and the categories derived from these metaphors are presented in tabular form. The metaphors produced by the patients were examined in terms of their common characteristics and grouped into six themes (Table 2). Within the framework of the identified categories, metaphors were evaluated using patients’ quotations.

Theme 1: Recovery as the regaining of independence

This theme highlights that recovery means regaining freedom, autonomy, and capacity for independent movement. Participants expressed recovery through symbols of freedom and movement, including birds, wings, and cars. Patients emphasised independent living skills, such as making their own decisions, being free from restrictions, being independent of others, and going wherever they wanted. The metaphor most frequently used by patients within this theme was the ‘bird’ metaphor. Patients associated recovery with freedom, independence, and liberation from restrictions using bird metaphors. Recovery is described as a state of ‘freedom from captivity’ and of ‘free existence’. It is understood as a process of transformation into an unrestricted existence, in which the individual has complete control over his or her life. Examples of metaphorical expressions in this category are as follows:

• It resembles a bird because when you recover, you are free. (P44)

• Recovery is like wings because I can only fly when I have wings. (P47)

• Recovery is like freedom because you can make your own decisions. (P136)

• Recovery is like a car because when you recover, you can go anywhere you want on your own. (P144)

• Recovery is like freedom because I feel like a prisoner of my illness. (P149)

Theme 2. Recovery as the reconstruction of life

This theme reveals that recovery is not merely a process of physical and mental restoration for the individual, but also signifies a reconnection with the full range of colours, emotions, and meanings of life. Participants described recovery using symbols of vitality, renewal, and freshness, such as flowers, trees, the sun, and the skies. They emphasised transformative changes such as a sense of rebirth, restoration of one’s former self, overcoming difficult times, and reintegration into life after a stroke. Within this theme, patients described recovery as a process that restores vitality and encompasses a multifaceted existence. Examples of metaphorical expressions in this category are as follows:

• Recovery resembles a flower because when you recover, life becomes colourful and multifaceted, like a flower. (P6)

• Recovery resembles rising from the ashes because you are reborn and reconnect with life. (P16)

• Recovery resembles the sun because it is like being reborn. (P30)

• Recovery resembles spring because you feels renewed. (P84)

• Recovery resembles being reborn because when I recover, I can previous life. (P92)

• Recovery resembles being reborn because the difficult times are behind the individual. (P95)

• Recovery resembles finding my old self because I can return to being socially active. (P109)

• Recovery resembles a newborn baby because when I recover, everything will be beautiful again, and I believe I will get along well with my family. (P132)

• Recovery resembles a tree because trees shed their leaves in winter and blossom in summer, just like recovery itself. (P139)

• Recovery resembles returning to life because I can feel everything—every emotion. (P145)

Theme 3: Recovery as a pathway to inner serenity

This theme emphasises that recovery is a holistic experience, manifested as inner peace, happiness, and tranquillity. The metaphor most frequently used by patients in this theme was ‘happiness’. Patients associate recovery with feelings such as peace, happiness, calmness, and relaxation. Patients perceive recovery as relief from the debilitating effects of illness and as a means of achieving inner calm and a balanced state of mind. Recovery is defined as a transformational process whereby individuals rediscover the meaning of life and attain inner peace. Examples of metaphorical expressions related to the metaphors in this category are as follows:

• Recovery is like breathing because if you cannot breathe, you cannot live. (P18)

• Recovery is like feeling at ease because I recover, I can comfortably perform my daily tasks. (P19)

• Recovery is like sleeping in a soft bed because it is just as peaceful. (P64)

• Recovery is like living in heaven because when you recover, you have a happy life, like in heaven. (P77)

• Recovery is like resting because being ill is very tiring. (P79)

• Recovery is like happiness because when you recover, the pain ends. (P96)

• Recovery is like being calm because when I am ill, I sometimes get very irritable. (P127)

• Recovery is like breathing fresh air because when you recovery, you feel refreshed and well. (P140)

Theme 4: Recovery as an element of personal development

This theme emphasises that recovery is a process of personal transformation and empowerment. Patients associated recovery with gaining self-confidence, regaining control over their willpower, maturing, and learning from life experiences. Recovery has been expressed through metaphors symbolising development, strengthening, and self-realisation over time, such as the growth of a tree or the emergence of a butterfly from a cocoon. Participants’ statements indicate that recovery is perceived as a developmental journey that enables the individual to gain a stronger, more conscious, and more resilient stance in life. Examples of metaphorical statements in this category include:

• Recovering is like self-confidence because it represents my confidence returning (P42).

• Recovery is like regaining your own will because you do not have that when you are ill. (P82)

• Recovery is like growing up because it matured me. (P90)

• Recovery is like maturing because when you recover, you become aware of changes in your ideas, responsibilities. (P94)

• Recovery resembles a tree because, just as a tree grows and develops, when you recover, you become better. (P99)

• Recovery resembles a butterfly because a person emerges from their cocoon, develops, and grows. (P119)

Theme 5: Recovery as an element of social acceptance

This theme demonstrates that recovery is a process of reconnecting with society and gaining social acceptance from the individual’s perspective. Participants’ statements revealed that the experience of mental illness often leaves individuals facing labelling, exclusion, and marginalisation. Participants equated recovery with positive relationships such as people approaching them more warmly, chatting with them, hiring them, and including them in their social lives. Patients described recovery as a symbol of the transition from social exclusion to social acceptance and recognition, and as an element that allows individuals to feel equal, valued and visible within society.

• Recovery is like happiness because people seeing you as a psychiatric patient is an unhappy thing. (P58)

• Recovery is like being accepted, because then people chat with you, you go to work, and you do not get fired. Everyone loves you. (P67)

• Recovery is like breathing because when I recover, then I will be equal to everyone else. I will not be labelled. (P76)

• Recovery is like not being ignored because then they can notice me. (P86)

• Recovery is like being accepted because if you get better, people will like you and not exclude you. (P121)

• Recovery is like a rose, because like recovery, a rose looks beautiful and smells nice. (P148)

Theme 6: Recovery as an elusive goal

This theme reveals that recovery is perceived as a difficult, sometimes even impossible, goal for some individuals. Participants likened recovery to a miracle, a climb up a high mountain, or the achievement of impossible personal goals. This perception is reinforced by the failure to achieve the expected outcome despite long-term treatment and by the losses experienced in life. While recovery is sometimes symbolised by rare moments of peace and happiness for patients, it can also be associated with deep disappointment and feelings of hopelessness. In this context, it emerges as a difficult and uncertain goal, shaped by personal life experiences. This theme elicited the fewest metaphors from the patients.

• Recovery is like a miracle because it is difficult to recover. (P20)

• Recovery is like being happiness and peaceful because, that, unfortunately, not everyone achieves. (P55)

• Recovery resembles overcoming pain because recovery is very difficult for me. (P133)

• Recovery seems impossible to me because recovering is like my dog Cesur coming back my dog died, and he will not return. (P112)

• Recovering seems meaningless to me because I have been going to the doctor for years and have taken a lot of medication, but I still have not yet recovered. My husband left me, and I have not seen my children. (P122)

Discussion

Considering that metaphors are powerful mental tools for understanding and explaining abstract, complex, or theoretical phenomena, the patients in this study produced 112 valid metaphors. The 149 patients produced 42 different metaphors. The large number of metaphors generated by patients demonstrates that perceptions of recovery are multifaceted. This diversity was also reflected in the themes derived from the participants’ expressions. Of the themes identified, five were positive and one was negative. The coexistence of positive and negative themes highlights the subjectivity of recovery and reveals its multidimensional and complex nature as experienced by individuals. From a recovery-oriented perspective, such contrasts were interpreted not as inconsistencies, but as expressions of the non-linear and dynamic nature of recovery.

The findings of the study reveal that recovery is conceptualised as encompassing six main themes: regaining independence, reconstructing life, achieving inner serenity, personal development, social acceptance, and an elusive goal. Participants’ statements indicated that recovery is a multidimensional, subjective, and dynamic process. These findings align with the CHIME (connectedness, hope/optimism, identity, meaning/purpose, empowerment) and POETIC (purpose, optimism/hope, empowerment, tensions, identity, connectedness) models, which are frequently referenced in the recovery literature [28, 29]. When themes derived from individuals’ metaphors of recovery are mapped onto the CHIME framework, the theme “Recovery as Regaining Independence” aligns most closely with Empowerment, emphasising autonomy and control over one’s life. “Recovery as the Reconstruction of Life” corresponds to meaning, reflecting a focus on making sense of life, enhancing quality of life, and pursuing a meaningful existence. “Recovery as a Pathway to Inner Serenity” embodies hope and optimism, which are grounded in beliefs about the possibility of future recovery and the maintenance of well-being over time. “Recovery as an Element of Personal Development” primarily maps onto Identity by redefining and rebuilding a positive self-concept, and supports Empowerment by highlighting self-awareness and agency in the change process. “Recovery as an Element of Social Acceptance” is consistent with Connectedness, emphasising relationships, social support, and reintegration into society. However, “Recovery as an Elusive Goal” falls outside the CHIME framework [28].

Metaphors facilitate individuals’ ability to describe their experiences while also contributing to the development of a common language regarding mental disorders. The literature reports that journey and war metaphors are particularly prevalent in expressing and making sense of experiences of mental illness [30]. For example, metaphors such as ‘Depression is darkness,’ ‘Bipolar disorder is a speeding train,’ and ‘Traumatic experiences are wounds that never heal’ are powerful narrative tools for explaining the profound effects of mental illness on individuals [31]. In a study by Durgu and Dülgerler [19], recovery was conceptualised using a “journey” metaphor grounded in the experiences of individuals with bipolar disorder. Within this theoretical framework, the journey has a beginning; the ‘things carried along’ when setting out (resources such as living with bipolar disorder, family, the social environment, and endurance) support the process; the ticket for the journey represents medications; and there are stops along the way, such as hospitals, health professionals, and companions. It was further emphasised that each journey possesses its own distinct route and meaning. The theme of ‘Recovery as the Regaining of Independence’ that emerged in the current study indicates that recovery is closely associated with regaining autonomy and personal control. Furthermore, the importance that patients place on autonomy may reflect the restrictions they perceive during acute periods and inpatient treatment. Participants’ descriptions of recovery, expressed through symbols of freedom such as ‘bird’, ‘wing’, and ‘car’, reflect individuals’ desire to direct their own lives. Schoeneman et al. [32] similarly reported that recovery from bipolar disorder was articulated through metaphors such as “return to freedom” and “control/responsibility,” highlighting the centrality of autonomy and personal agency in recovery narratives. In this context, Warwick et al. [33] defined recovery as “the path to living the life you want,” while Guerrero et al. [34] emphasised personal decision-making, non-interventional living, and autonomy as dimensions of recovery for individuals with psychiatric conditions. Similarly, Chirio-Espitalier et al. [35] drew attention to the concept of self-determination in personal recovery among individuals with bipolar disorder. Durgu and Dülgerler [19] also support this approach, stating that individuals with bipolar disorder conceptualise recovery as a process in which they set life goals, chart their course, and strengthen their control over their lives. This finding also aligns with the ‘empowerment’ dimension of the POETIC model, which is grounded in personal recovery experiences of bipolar disorder [29]. Therefore, the results of our study support the notion that personal recovery is a process whereby the individual ceases to be a passive object of recovery and becomes the subject of his or her life.

The theme of ‘Recovery as the Reconstruction of Life’ has been defined as the process of reconnecting with the colours, emotions, and meaning of life. This experience has been expressed through metaphors symbolising vitality, renewal, and freshness, such as flowers, butterflies, trees, the sun, and clean air. In the participants’ narratives, recovery was associated with transformative changes, such as rebirth, leaving difficult times behind, and returning to one’s former self and to life. In Miranda-Ruche [36], a participant described the recovery experience using a “football match” metaphor, noting that, when you play poorly, you are taken off the field and sit on the bench to observe the other players, and rejoin the game when you are able to play well again. In this context, recovery is portrayed less as an outcome and more as a process of re-engagement with everyday life and valued roles. Similarly, Guerrero et al. [34] noted that developing a fulfilling life, rebuilding life after a mental health crisis (e.g., relationships and work-life), and having a purpose in life were fundamental elements in definitions of recovery among individuals with psychiatric experience. Within the POETIC model, Jagfeld et al. [29] explain the difficulties and losses that individuals with bipolar disorder experience as a result of extreme mood episodes (such as the loss of the ability to fulfil work, career, or parenting roles) in the ‘Purpose and Meaning’ component. This component emphasises that developing a renewed sense of meaning and purpose in life provides powerful internal motivation that guides the recovery process. In this context, evaluation of the study’s findings indicates that recovery is not merely a reduction in disease symptoms; it is a process of restoring meaning to one’s life, repairing lost functions and relationships, and rebuilding one’s life.

The theme of ‘Recovery as a Pathway to Inner Serenity’ revealed that individuals equate recovery with inner peace, tranquillity, and happiness. The prominence of concepts such as ‘happiness,’ ‘peace,’ and ‘relaxation’ indicates that individuals evaluate recovery in the context of emotional well-being rather than solely in terms of functional improvement. Schoeneman et al. [32] similarly conceptualized recovery using metaphors such as peace, safety, and health. Guerrero et al. [34] emphasise the link between recovery, well-being, and quality of life, while Hancock and Perich [37] note that recovery-focused interventions contribute to this process by increasing feelings of hope and self-efficacy. A study conducted by Kraiss et al. [38] revealed that personal recovery is significantly related to positive thinking. Positive thinking has been noted to contribute to the recovery process by supporting psychological balance, particularly in individuals experiencing mood swings, such as those with bipolar disorder. The findings of the present study indicate that individuals view inner calm and positive emotional states as goals in recovery and that these goals reflect a recovery experience intertwined with hope, positive thinking, self-efficacy, and emotional well-being.

The theme of ‘Recovery as an Element of Personal Development’ reveals that, from an individual perspective, recovery is not merely the disappearance of symptoms but also a process of empowerment, self-awareness, and transformation. Participants described their inner journeys and processes of change using development-focused metaphors, such as butterflies and trees. This finding aligns with the “Identity” component of the POETIC model [29]. In this model, identity is defined as an individual’s reconstruction of a positive sense of self [29]. Guerrero et al. [34] similarly noted that individuals view recovery as a process of developing resilience, making sense of their experiences, and constructing a positive self-identity. Recovery is essentially a maturation process; it is shaped by experiences that are sometimes challenging and sometimes empowering, and in all cases it involves the transformation of the individual [19]. These findings clearly demonstrate that personal recovery is not merely the absence of psychiatric symptoms; rather, it is a process of rebuilding one’s self-perception, discovering inner resources, and giving new meaning to one’s life.

The theme of ‘Recovery as an Element of Social Acceptance’ demonstrates that individuals define the recovery process not only as an individual transformation but also as the desire for social acceptance and reintegration into society. Participants’ metaphorical narratives revealed that social expectations, such as not being labelled or excluded, being visible, and being valued, are central to recovery. This finding aligns with the “Connection” component of the POETIC model, indicating that recovery is shaped within a social context [29]. In Miranda-Ruche [36], a participant compared the stigma encountered during recovery to a seemingly insurmountable “high wall”, noting that persistence may eventually reveal a “crack” through which a “ray of light” can pass, thereby creating an opening that allows the wall to be dismantled. This metaphor underscores how stigma can act as a barrier to social inclusion and acceptance, and it closely mirrors our participants’ emphasis on not being labelled or excluded and on being visible and valued as part of recovery. Jupille et al. [39] emphasised that social support and belonging play a critical role in the personal recovery process, while Durgu and Dülgerler [19] stated that support from family and social circles enhances recovery by increasing an individual’s self-worth. Similarly, Kraiss et al. [38] found that social participation is an important psychosocial determinant of personal recovery, whereas Leamy et al. [28] found that the recovery process is facilitated by a supportive and restorative environment. Furthermore, some participants in the present study directly associated recovery with employment and defined being hired or having work experience as important indicators of recovery. The literature also emphasises that being able to work, earn an income, and contribute to the family plays a fundamental role in recovery. For individuals with bipolar disorder, employment is critical not only for productivity but also for reintegration into society, for feeling useful, for gaining a valuable social identity, and for socialising [12, 19, 39, 40]. These findings indicate that employment opportunities for individuals with bipolar disorder and other mental illnesses should be created or enhanced to support their personal recovery.

The theme of ‘Recovery as an Elusive Goal’ reveals that some individuals perceive recovery as a difficult, even impossible, goal. Participants described recovery using metaphors such as “a miracle”, “climbing a mountain”, or “an irretrievable loss”. This reflects emotional fragility, hopelessness, and conflicts arising from deficient expectations about the recovery process. Ponticiello et al. [41], using a ‘magic wand’ thought experiment, revealed that individuals with bipolar disorder have different relationships with their illness. Some participants did not want to recover, perceiving the productivity and creativity resulting from the illness as part of their identity, whereas others preferred full recovery, motivated by a desire to be free of symptoms. Similarly, in our current study, some participants viewed recovery as a hopeful process, whereas others described it as distant or even meaningless. Similarly, Jönsson et al. [42] reported that some individuals experienced hopelessness about full recovery and that past losses, in particular, made the recovery process more difficult. In contrast, Guerrero et al. [34] found that individuals with psychiatric experience developed more hopeful, functional, and coping-oriented definitions of recovery than professionals. This contrast demonstrates that recovery is a subjective process that varies among individuals and is shaped by experience, context, and relationships with illness.

This study has certain limitations. First, regarding sampling limitations, the study was conducted only among individuals receiving treatment at four Community Mental Health Centres (CMHCs) in Türkiye and does not reflect the perceptions of recovery in other cultural, regional, or institutional contexts. This limits the generalisability of the findings. From a methodological perspective, the research used a descriptive phenomenological design and relied solely on participants’ metaphorical narratives collected at a single point in time. In this context, the variability and multidimensional nature of the recovery process over time can only be partially represented. The use of a metaphor-based data collection approach may have limited the data to participants’ expressed perceptions, rather than eliciting lengthy narratives or broader, more elaborate claims. However, the data obtained through this approach reflected the shared essence of the recovery experience, rather than a lack of depth or an overreliance on repetitive metaphors. Another limitation is that the data were restricted to the metaphors expressed by the participants and to their explanations. The findings were shaped by the individuals’ perceptions and expressive abilities. It should be borne in mind that individuals who experience difficulties in abstract thinking or in expressing themselves in writing or verbally may face challenges in the metaphor-forming process. This may limit the diversity and depth of the metaphors obtained.

Conclusions and recommendations

This study revealed the personal, social, and emotional dimensions of recovery by examining how individuals with bipolar disorder interpret their recovery processes using metaphors. Recovery, as expressed through the participants’ metaphors, was conceptualised as six main themes: regaining independence, reconstructing life, achieving inner peace, personal development, social acceptance, and an elusive goal. The findings show that recovery is not limited to the reduction of symptoms but is experienced within a broader framework, including giving new meaning to one’s life, connecting with one’s social environment, and rebuilding one’s sense of self. The research reveals that psychiatric care should guide the individual’s subjective recovery process, considering not only clinical aspects but also psychosocial and personal aspects. Mental health professionals, particularly psychiatric nurses, should develop personalised and recovery-focused interventions by considering the metaphors used by patients. In clinical practice, metaphors can be used as a communication tool to facilitate therapeutic dialogue, enabling nurses to explore patients’ perceptions of recovery, autonomy, and control over their lives. At the community level, these findings highlight the importance of recovery-oriented services that support individuals’ independence and social participation, rather than focusing solely on clinical stability. Regarding psychiatric nursing practice and policy in community mental health settings, the findings support integrating metaphor-informed communication into routine assessment and recovery planning to better identify service users’ priorities (e.g., autonomy, meaning, and social inclusion) and tailor recovery-oriented interventions accordingly. This will ensure that individuals are supported not only in terms of disease symptoms but also in achieving multidimensional goals, such as the meaning of life, identity construction, social bonds, and emotional balance.

Supplementary Information

Below is the link to the electronic supplementary material.

Author contributions

The authors contributed equally to the manuscript.

Funding

The authors declare that they received no institutional or external support for the funding of this research.

Data availability

The datasets generated and/or analysed during the current study are not publicly available due [Reason Why Data Are Not Public] but are available from the corresponding author on reasonable request.

Declarations

Ethics approval and consent to participate

Permission to conduct the research was obtained from the Gaziantep University Non-Interventional Clinical Research Ethics Committee (Ethics Committee No. 2024/430). Participants were informed about the study, and both written and verbal informed consent was obtained to ensure their voluntary participation. This study was conducted in accordance with the principles of the Declaration of Helsinki.

Consent for publication

Written consent for publication was obtained from all individuals who agreed to participate in the study.

Competing interests

The authors declare no competing interests.