Evidence That People Recover from Schizophrenia

Long-term research by Harding, Ciompi, Bleuler and others has shown that a majority of people hospitalized for lengthy periods have recovered significantly or completely from schizophrenia. The researchers defined consumers as completely recovered being without symptoms, off of psychotropic medication, living independently in the community, working, and relating well to others with no behaviors considered odd or unusual. The researchers defined consumers as significantly improved when the consumers fulfilled all but one of the domains. Their findings are summarized in the following table:

Long-term Studies Showing People Recover from Schizophrenia

Study	Sample Size	Follow Up in years)	% Recovered and Significantly improved
Bleuler (1974)	208	23	68%
Huber et al (1979)	502	22	57%
Ciompi (1988)	289	37	53%
Tsuang et al. (1979)	186	35	46%
Harding et al. (1987)	269	32	68%
Total	1,454		Average= 58%

To answer the question of the influence of state mental health policy on recovery, Harding and colleagues compared the rates in Vermont with those in Maine (DeSisto, et al, 1995). These two states had distinctly different mental health policies in the 1950’s and 1960’s. Vermont had a very innovative approach that emphasized rehabilitation, community integration, and self-help. Maine focused on symptom reduction and maintenance. The recovery rates were strikingly different. In all dimensions, Vermont had a significantly higher recovery rate. The authors had carefully matched the sample of subjects in the two states. They concluded that the major reason for the higher recovery rate in Vermont was the result of a social policy that emphasized hope, rehabilitation, and a belief that each person, regardless of the severity of their condition, was capable of living a full and independent life in the community.

By today’s criteria (see NEC’s 7 characteristics of a person who has recovered), these numbers would be considerably higher because absence of symptoms and being off medication are no longer considered major criteria for recovery. In addition, all these studies were done following people who had been hospitalized for lengthy periods. There is growing evidence that when people can be assisted in a non-hospital environment, closer to home, with lower doses of medication, that a person’s recovery is even higher (Mosher, 1999). Additional support for believing that everyone, under optimal conditions, can recover from schizophrenia, derives from cross cultural studies done by the World Health Organization showing that the recovery rate from schizophrenia is much higher in developing than in industrial countries (Jablensky, et al, 1992).

References:

Long-term Epidemiological Studies of Schizophrenia

Bleuler, Manfred (1974). The long-term course of the schizophrenic psychoses. Psychological Medicine, 4, 244-254

Huber, G., Gross,G., Schuttler,R.. (1975). Long-term follow-up study of schizophrenia. Acta Psychiatrica Scandinavica, 53, 49-57.

Ciompi, L. (1988). Psyche and Schizophrenia. Harvard U. Press, Cambridge,MA.

Tsuang,M., Woolson, R., and Fleming, J. (1979). Long-term outcome of major psychosis. Archives of General Psychiatry, 36: 1295-1301.

Harding, C. et al. (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, 144:718-728.

DeSisto, et al. (1995). The Maine and Vermont three decade studies of serious mental illness. British Medical Journal of Psychiatry 167: 338-342.

Alternatives to Hospitalization

Mosher, L. R. (1999). "Soteria and Other Alternatives to Acute Psychiatric Hospitalization: A Personal and Professional Review." Journal of Nervous and Mental Disease, 187, 142-149.

Cross Cultural Studies:

Jablensky, A., Sartorius, N., Ernberg, G., Anker, M., Korten, A., Cooper, J. E.,Day, R., and Bertelsen, A. (1992). "Schizophrenia: Manifestations, Incidence and Course in Different Cultures. A World Health Organization Ten-Country Study." Psychological Medicine Monograph Supplement 20. Cambridge: Cambridge University Press.

These and additional references available in the Recovery Reader. Complete listing of contents

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