Recovery from Schizophrenia? Yes, it’s Possible!

If you live in a major city you have probably encountered a person who is dressed strangely, mumbling to himself, not making eye contact, and perhaps pacing back and forth or engaging in some other repetitive behavior. You may have sighed and felt a twinge of sympathy mixed with a sense of resignation, “this person is never going to get better” you think as you move quickly to the next place you need to be. Although the person in this example may not be diagnosed with Schizophrenia, a mental illness characterized by unusual perceptual experiences and strong beliefs that seem strange to others (e.g., being under surveillance), this person is likely suffering from some sort of serious mental illness.

While our media is often filled with stigmatizing and inaccurate portrayals of people with mental illness, I’ve been happy to see that there has also been some recent press showing a more realistic and non-stigmatizing viewpoint. For example, the New York Times is currently running a series on living with serious mental illness. The first article in the series, the revelation of Dr. Marsha Linehan’s personal struggles with serious mental illness as child and young adult, was covered in our blog in July. The second article in the series was released in early August and shares the story of Joe Holt, a computer programmer and entrepreneur, who is living with the diagnosis of Schizophrenia.

What I like about this story

Part of what I like about the NY Times story is that it nicely illustrates an idea that is increasingly being acknowledged in the treatment community — that people with serious mental illness can and do recover.  The NY Times’ story of Joe Holt also shows us that the path of recovery is not straight, that it is filled with bumps, detours, and unexpected side trips; yet, people with serious mental illness do lead productive, enriching, and fulfilling lives.

It may be shocking for you to hear that people with illnesses like Schizophrenia can recover. For the early part of my career, I was under the impression that most people diagnosed with serious mental illness had a pretty hopeless future.  I only learned that this impression is false in 2006, when I stumbled across two studies on people released from the long-term units of two New England state hospitals. One state implemented programs based on a recovery model (more on that below) and the other received more standard treatment, typically a combination of medication and supportive therapy. The results were astounding! I remember sitting there shocked as I read the results from the study over and over again. In the study that just examined the outcomes of the people who received the recovery-oriented services, the majority (68%) of people did not show symptoms of schizophrenia at the 20-year follow-up, and nearly 50% did not show any symptoms of mental illness (Harding et al., 1987)! In the study that compared the people who received recovery-oriented services vs. those who received care as usual, people who received recovery-oriented care were more likely to live on their own (over 45% were living independently, i.e., not in boarding houses or half-way homes), were more likely to be/have been employed, and had fewer mental health symptoms (DeSisto et al., 1995). Results from groundbreaking studies like these provided the momentum to create a new approach to treatment called the recovery movement or recovery model.

What is the Recovery Model?

The principles of the recovery model can be grouped into four themes: 

  1. Mental health care should be person-centered and directed
  2. Mental health and recovery exist on a continuum (i.e., mental health and recovery are more than just “you’re well” or “you’re ill”)
  3. The person is more than his/her mental illness and thus, treatment is more than just management of symptoms
  4. Cultural and social identities and experiences should be incorporated into treatment (e.g., helping the person overcome stigma attached to mental illness).

The 12 principles of recovery listed by the Substance Abuse and Mental Health Services Administration (SAMHSA) are:

•There are many pathways to recovery.

•Recovery is self-directed and empowering.

•Recovery involves a personal recognition of the need for change and transformation.

•Recovery is holistic.

•Recovery has cultural dimensions.

•Recovery exists on a continuum of improved health and wellness.

•Recovery is supported by peers and allies.

•Recovery emerges from hope and gratitude.

•Recovery involves a process of healing and self-redefinition.

•Recovery involves addressing discrimination and transcending shame and stigma.

•Recovery involves (re)joining and (re)building a life in the community.

•Recovery is a reality. It can, will, and does happen.

While it may seem obvious that the 12 principles of recovery should be a part of every mental health treatment a person receives, I am glad to be part of a mental health movement and system that are  actively working to incorporate recovery principles into their treatments. I am also delighted to see that the media is starting to promote recovery (even if it is not explicitly acknowledged as such) with positive and inspiring stories about people with serious mental health conditions living with and beyond their diagnoses. If you’d like to learn more about recovery (September is Recovery Awareness Month), here are some resources:

Substance Abuse and Mental Health Services Administration

Recovery Month Website

United States Psychiatric Rehabilitation Association

National Alliance on Mental Illness (NAMI)

Oregon division of NAMI

Portland Hearing Voices (from their website:  “a community group to promote mental diversity”)

References

DeSisto, M. et al. (19xx). The Maine and Vermont three decade studies of serious mental illness. II.
     Longitudinal course comparisons. British Medical Journal of Psychiatry, 167, 338 – 342.

Harding, C. M., Brooks, G. W., Ashikaga, T., Strauss, J. S., & Breier, A. (1987). The Vermont longitudinal study of persons with severe mental illness, I:  Methodology, study sample, and overall status 32 years later. American Journal of Psychiatry, 144, 718 – 726.

Spoiler Alert: Spoilers Don’t Spoil

Have you ever had the experience of learning the ending of a book, movie, or TV show that you had really wanted to read/watch and saying to yourself, “AARGH—it’s ruined for me!”?

In college, I tried to be very careful about reading the introductions to classic literature. I found out the hard way that the people who write the introductions often presume the reader is already familiar with the work. Inadvertently, I’d learn key plots points—sometimes the ending—before I had even started the book.

At the time, I figured that knowing the ending would detract from my enjoyment of the book.

It turns out, I was wrong.

Researchers Find That Knowing Key Plot Twists Enhances Enjoyment of Respected Books

According to Science Daily, two researchers at the University of California – San Diego ran a series of experiments looking at how knowing the ending of a story in advance effects how much people enjoy it. The researchers used short stories by well-known authors such as Agatha Christie, John Updike, and Raymond Carver. Everyone was given a story to read in one of three ways: 1.) Some people simply read the story; 2.) Others were given a paragraph to read that gave away the ending (the spoiler) prior to reading the story; 3.) and for others, the ending was given away during the story rather than before.

People for whom the story was “spoiled” reported enjoying the story more. Not only did knowing the ending in advance not ruin enjoyment of the story, but spoiling the story appeared to enhance it! It didn’t matter whether the story was a literary work, a mystery, or something with an ironic-twist (e.g., surprise) ending.

Why?

The researchers suggest that well-written stories are enjoyable regardless of what we know about them. When we know the ending, we can pay more attention to other elements. Given that the stories were by respected authors, it would be interesting to know if the same results are true for less skilled writers.

Next time a work of fiction is “spoiled” for me, rather than respond with “AARGH!” perhaps I ought to say, “Thank you—now I’ll enjoy it even more.”

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