Myth Busting: Schizophrenia is Incurable

The Recovery Vision: New paradigm, new questions, new answers.

Presenters:
Dr. Courtenay Harding, Ph.D.
Director
Institute for the Study of Human Resilience

Dr. William Anthony, Ph.D.
Executive Director
Center for Psychiatric Rehabiliation

Judi Chamberlain
Senior Consultant on Survivor Perspectives
Center for Psychiatric Rehabilitation
Senior Association, National Empowerment Center

Dr. Marianne Farkas, Sc.D.
Director
World Health Organization Collaborating Center

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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.

"The same treatment for all" is a myth. We've found that individualized treatment is much more successful because there's wide heterogeneity of function, interest, and capacities within each person.

There's a myth that says, "You only do rehab afterwards..." after the symptoms settle down. It turns out you need to do rehab starting on day one. Rehab is actually treatment. Rehab can reduce symptoms. Getting someone a job can reduce symptoms. Getting them stable housing can reduce symptoms. So why wait until the symptoms subside with medications when we have strategies to do something about it?

There's a myth that says, "No psychotherapy for these patients". But our patients tell us they need supportive psychotherapy and they need somebody to talk with about the process that they're going through.

There's another myth that says, "We need to be on medications all our life." There's absolutely no evidence in the world literature that says that's true. There may be a few people who need it all their lives, but certainly most people do not. Over time, most patients begin to titrate off their medication.

There's a myth that "people can only do low levels of work" and in reality, people can do all levels of work. It depends on their education. I got telephone calls from all over the country when I was on National Public Radio a while ago. People who were physicians, professors, high school teachers, nurses, engineers who called called to say thank you for telling our story because we don't tell anyone because of the stigma.

And the last myth, and one of the most insidious, is that "families are the cause of it all". When you work with families, they can be collaborators and very helpful.

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"?]

See also:

The Recovery Model

Examples of Human Resiliance

A conversation with a "psychiatrist"

Unlike The Murphy's

Misrepresentations of Schizophrenia

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Schizophrenia, Psychosis, Recovery, The Recovery Based Model, Hope for Schizophrenia Sufferers