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.

The Courage to Survive, Thrive, and Tell About It: Marsha Linehan’s Journey

Marsha Linehan, Ph.D. is easily one of the most influential psychologists of the past thirty years. She is a giant in the field. I remember the first time I met her — she seemed  to eclipse the other, also very prominent psychologists who were sitting next to her. Her presence is powerful and imposing. And she has suffered greatly.

Dr. Linehan is the creator of Dialectical Behavior Therapy, a cognitive-behavioral therapy that is closely related to Acceptance and Commitment Therapy (ACT), and which is often focused on helping people who are chronically suicidal and self-harming, behaviors with which that many clinicians are often uncomfortable working. I have always had a great deal of respect for her contributions and for her committed service to those who others often shun.  

And yet, while she has dedicated her entire professional life to working with people who are among the most stigmatized in our society, that stigma also silenced Dr. Linehan…until now. For the first time in her life, Dr. Linehan, at age 68, has come out publically (very publically—the front page of the New York Times!)  to talk about her own psychological suffering, including her struggles with suicide and her psychiatric hospitalization.  In this bold and courageous move, Dr. Linehan honors those individuals she has spent her career serving saying, “I have to do this. I owe it to them [the people she serves]. I cannot die a coward”.

Here is a link to the New York Times interview with Dr. Linehan. It is a compelling account of how suffering effects us all, even those like Dr. Linehan who can appear so invincible and larger-than-life.

A personal caveat to the tone of the article:

While I was humbled and moved by Dr. Linehan’s courage to speak out about her struggles in this article, I was also disappointed with some of the tone of the article, which I feel compelled to comment upon. Unfortunately, with statements like “…borderline patients can be terrors” and “…many people with severe mental illness live what appear [italics mine] to be normal, successful lives” the author of the article promotes some of the same stigmatizing stereotypes that have silenced so many, including Dr. Linehan. Instead of implying that people who are severely suffering are abnormal and can only appear to be living a good life, I would argue that suffering, in whatever form it may take, is normal life. People can suffer immensely and live well, as Dr. Linehan has proven. The more that we continue to speak about psychological suffering in ways that imply an “us against them” or “sick versus well” stance, we continue to promote that same stigma that Dr. Linehan has spent her life working against, and living with.

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