Dr. Courtenay Harding, Ph.D.
Institute for the Study of Human Resilience
Dr. William Anthony, Ph.D.
Center for Psychiatric Rehabiliation
Senior Consultant on Survivor Perspectives
Center for Psychiatric Rehabilitation
Senior Association, National Empowerment Center
Dr. Marianne Farkas, Sc.D.
World Health Organization Collaborating Center
Hello. I have entitled this presentation, "Long Term Outcome for Rehabiliated Psychiatric Patients: Reasons for Optimism". The plan this morning is to look at recovery and the evidence for it among people with very serious mental illness. Let us look at some things that we've learned about rehabilitation and also a little bit about resilience. I'm going to present seven of the ten world studies this morning.
Now, when we talk about subjects who are recovered, we're talking about no medications, no symptoms, being able to work, relating to other people well, living in the community, and behaving in a way that you would never know that they had had a serious psychiatric disorder. And if you have heard of that old belief that one third get better, one third get worse, and one third stay the same, we found that it was not true. In the Vermont Longtitudinal Study, we took the bottom third of this population and found that two-thirds of them also turned around. So that our old views of schizophrenia are considerably different than they have been for the last hundred years. What I'd like to do is go through this table a little bit and talk about these studies and then tell you what exactly these investigators had to say when they got through.
When we talk about subjects who are recovered, we're talking about no medications, no symptoms, being able to work, relating to other people well, living in the community, and behaving in a way that you would never know that they had had a serious psychiatric disorder.
The first study was done by Manfred Bleuler, whose father Eugene Bleuler renamed dementia praecox and studied schizophrenia. And his son, Manfred took over the hospital at Burgholzi in Zurich, Switzerland and he did what his father did not. He followed 208 people for 23 years and found that 53-68% of his subjects significantly improved or recovered.
Gerd Huber and colleagues in Germany followed 502 for 22 years after their episode of schizophrenia and found 57% significantly improved or recovered.
Luc Ciompi and Christian Muller in a medium-sized city in Lausanne followed 289 people for 37 years ... they found 53% significantly improved or recovered.
Ming Tsuang and the Iowa 500 study had the strictest criteria for schizophrenia but found 46% improved. Using the DSM III diagnosis, we found 62-68%. Dr. Ogawa et al. in Japan found 57% and Michael DeSisto in Maine found 49%.
Let me tell you what these gentlemen had to say about the long-term course of schizophrenia.
Manfred Bleuler: "I have found the prognosis of schizophrenia to be more hopeful than it has long considered to be."
Luc Ciompi and Christian Muller: "The long-term evolution of schizophrenia is much more variable and considerably better than heretofore admitted."
Courtenay Harding and John Strauss: "We have gathered some evidence that the course of schizophrenia is a more complex dynamic and heterogeneous process than has heretofore been appreciated or predicted by diagnostic specificity."
Gerd Huber: "Schizophrenia does not seem to be a disease of slow progressive deterioration. Even in the second and third decades of illness, there is still the potential for full or partial recovery."
So that, ladies and gentlemen, is substantial evidence for recovery. There are also many myths about schizophrenia, which have been challenged by all of these studies. "Once a schizophrenic, always a schizophrenic," has been significantly challenged now. The reality is improvement and recovery for most patients.
Source: The Recovery Vision [PDF file]
[Ed. Note: After reviewing the data offered by Dr. Harding, psychiatrist #1 had this to offer: "... she is a psychologist with a vested interest in seeing recovery. Just check out her “Center for Rehabilitation and Recovery” website." [Source]
Since when are physicians not supposed to have "a vested interest in recovery"?]
Schizophrenia, Psychosis, Recovery, The Recovery Based Model, Hope for Schizophrenia Sufferers