A decade ago psychologist Ronald Levant, then at Nova Southeastern University, was telling some of his colleagues at a conference about patients with schizophrenia whom he had seen recover. One of them asked rhetorically, “Recovery from schizophrenia? Have you lost your mind, too?”
Until recently, virtually all experts agreed that schizophrenia is always, or almost always, marked by a steady downhill progression. But is this bleak forecast warranted? Certainly schizophrenia is a severe condition. Its victims, who make up about 1 percent of the population, experience a loss of contact with reality that puts them at a heightened risk of suicide, unemployment, relationship problems, physical ailments and even early death. Those who abuse substances are also at risk for committing violent acts against others. Contrary to popular belief, people with schizophrenia do not have multiple personalities, nor are they all essentially alike—or victims of poor parenting.
Nevertheless, research has shown that with proper treatment, many people with schizophrenia can experience significant, albeit rarely complete, recovery from their illness. Many can, for example, live relatively normal lives outside a hospital, holding down a job and socializing periodically with family and friends. As psychiatrist Thomas McGlashan of Yale University concluded in a prescient 1988 publication, “The certainty of negative prognosis in schizophrenia is a myth.”
From Desperation to Hope
Around 1900 the great German psychiatrist Emil Kraepelin wrote that schizophrenia, then called dementia praecox (meaning “early dementia”), was characterized by an inexorable downward slide. In 1912 another doctor, A. Warren Stearns, wrote of the “apparent hopelessness of the disease.” Some treatments of the day, which included vasectomy and inducement of intense fever using infected blood, reflected this sense of desperation. An attitude of gloom pervaded the field of schizophrenia research for decades, with many scholars insisting that improvement was exceedingly rare, if not unheard of.
Yet experts have lately come to understand that the prognosis for patients with schizophrenia is not uniformly dire. Careful studies tracking patients over time—most of whom receive at least some treatment—suggest that about 20 to 30 percent of people recover substantially over years or decades. Although mild symptoms such as social withdrawal or confused thinking may persist, these individuals can hold down jobs and function independently without being institutionalized.
In one study published in 2005 psychologist Martin Harrow of the University of Illinois College of Medicine and his colleagues followed patients over 15 years and found that about 40 percent experienced at least periods of considerable recovery, as measured by the absence of significant symptoms as well as the capacity to work, engage in social activities and live outside a hospital for a year or more. Although most patients do not go into long remissions and may even decline over time, some 20 to 30 percent of this majority experience only moderate symptoms that interfere with—but do not devastate—their ability to perform in the workplace or maintain friendships.
Improved Treatments
Contributing to this less fatalistic view of schizophrenia are the effective treatments that have become available over the past two decades. Such atypical antipsychotic medications as Clozaril (clozapine), Risperdal (risperidone) and Zyprexa (olanzapine), most of which were introduced in the 1990s, appear to ameliorate schizophrenia symptoms by affecting the function of neurotransmitters such as dopamine and serotonin, which relay chemical messages between neurons.
In addition, certain psychological interventions developed over the past few decades can often attenuate symptoms such as delusions and hallucinations. For example, cognitive-behavior therapy aims to remedy the paranoid ideas or other maladaptive thinking associated with the disorder by helping patients challenge these beliefs. Family therapies focus on educating family members about the disorder and on reducing the criticism and hostility they direct toward patients. Though not panaceas by any means, these and several other remedies have helped many patients with schizophrenia to delay relapse and, in some cases, operate more effectively in everyday life.
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15 Comments
Add CommentWhy was this article printed in the March 2010 issue of Scientific American? There seems to be nothing new here. A rehash of old information seems odd for this magazine. The picture on the cover to bring attention to this article is awful!
Reply | Report Abuse | Link to thisi hadn't heard most of this personally and I'd like to know what the original sources are. would the authors please site some references?
Reply | Report Abuse | Link to thisI agree, the related image sucks. However, my spouse was diagnosed with this disorder about 5 years ago, after drowning and being electrocuted simultaneously in a lake on the 4th of July. At times, he will experience severe auditory hallucinations that will cause all of the other symptoms, described, to domino. I have read my fair share, plus his, on the subject but have never come across the bleak downhill future from which this article is now reporting that some sufferers may recover from.
Reply | Report Abuse | Link to thisI try to motivate him and discuss how much his family needs him and loves him, hoping to get us through the tough times. But...I, for some reason, always thought he would return to his old self some day. I assumed, like depression for some, it could be over someday and we would move on. Half way through the reading, my heart crushed and I broke down in shock. Again at 3/4 and by the end I felt as if my heart was ripped from my chest and my life's future stopped in limbo. Now everything seems questionable, whereas before, I thought there was a destination in sight that we were journeying toward. My husband is only 33 yrs in age and I love him immensely, as do our children.
He was on meds a few years ago, which was a great relief from the symptoms, then he was off them for a couple of years. It became a severe nightmare as he relapsed. I finally got him back to a doctor, a year ago, and things started off well, Until, the first med stopped helping. He has tried a few different ones since then but none of them are quite cutting it (only some relief) and his doctor seems to be irritated with the unsuccessful results. She says that she can't follow him around all day to see what's making him sad and that he needs to try to figure it out. He is also bipolar and I was not with him, at her office, that day. Otherwise, it might not have been said. I deem her comment inappropriate and felt it was obvious that he would be sad because he has irritating voices screaming at him, in his head, all day. I'm going to imagine that it sucks!, can't she? Thought that link was pretty cut and dry as far as 'obvious' goes.
He has never been hospitalized for this and he maintains p/t employment, never missing a day. After the first visit or two, to the current doctor, his blood pressure has gone up and remains high.
Even though it wasn't the intent, the new information I have learned from this article is not good news to me. I know this is great news for some. I can't help but to hope of a better recovery than the one that's described here.
WHAT?! My uncle was schizophrenic. I can tell you it does exist.
Reply | Report Abuse | Link to thisHere is a link to a detailed bibliography of recovery as a key concept and practice in preventing relapse and promoting work socialization and normalcy from serious persistent mental illnesses:
Reply | Report Abuse | Link to thishttp://www.yale.edu/PRCH/pdf/ProgramReferences.pdf
Here is a bibliography from Yale's recovery initaive:
Reply | Report Abuse | Link to thishttp://www.yale.edu/PRCH/pdf/ProgramReferences.pdf
thanks for the bibliography
Reply | Report Abuse | Link to thisYour story truly gripped my heart. What your husband needs most is your continued love and support -- and certainly a different physician. I really hope for the best recovery possible for your husband.
Reply | Report Abuse | Link to thisI am curious as to what state you live in b/c I *might* be able to give you some valuable info regarding poor communication and 'bedside manner' by the physician in question. Can you email me directly? I'd like to help, plus, I think I might have some info that will help you get back that feeling of hope that you think you've lost.
Reply | Report Abuse | Link to thisLet me help if I can, Please.
Thanks,
S
I welcome any source of hope and helpful information. We are in Texas and my email is nunyabeezwax@att.net. Thank you both!
Reply | Report Abuse | Link to thislol i be all like talking to myself sometimes do that me im all like tarded?
Reply | Report Abuse | Link to thisI am a female of European descent and I was diagnosed with the disease in my teens. Although I take medication and participate in therapy, I struggled with the symptoms associated with breaks from reality well into my thirties.
Reply | Report Abuse | Link to thisIn 1992 I was alone and contemplating the visual and auditory hallucinations that routinely disrupt my thinking and behavior when, in a moment of perceptual clarity, I said out loud "They don't qualify as hallucinations unless I respond to them." As soon as I heard myself say it out loud I knew that I had just had a mind-altering realization.
From that point on, I would get reality checks from my animals - if they didn't confirm it - I didn't react. Whenever possible I would enter into a meditative state and focus on the light that shone through my eyelids. I'm not sure what I was thinking about as I stared into my eyelids, but after a time my symptoms became less intrusive and it became easier to not respond.
Since that stellar realization, I have enjoyed a relatively content and secure life. Although I still experience the hallucinations, my thinking patterns have become more consistent and I am functioning at an ever-higher level with each passing year.
Within ten years my diagnosis was down-graded from Paranoid schizophrenia to schizo-affective disorder. I still experience a higher level of paranoia than most people, but it's not producing the delusional thoughts and alternate realities that it has in the past.
While it is true that my disorder has improved significantly, during times of extreme stress - emotional and/or physical - I can't override the erratic thought processes and I experience confusion and extreme sensitivity to sound and tactile stimulation. For this reason I continue taking medications so that I'm always at therapeutic levels.
Although my disorder is disabling (I've never held a job for more than a year), in the last decade I have completed more projects and endeavors than in the entire forty years prior. I'm happier and more productive because I am no longer compelled to respond to aberrant perceptions or delusional thoughts.
I find it interesting that there are those among us who would complain about an ugly picture or call the information in the article common knowledge, when only 1 percent of the population experiences reality breaks (which are much uglier than the picture, by the way ...). There are many common misconceptions and myths about the disorder, and I appreciate any attempts to dispel them.
My Dad was a psychiatrist specializing in treatment of schizophrenic patients. Once I remember him calling a former patient of his about 15-20 years after he'd treated her (that'd have been back in the late fifties, when the only drugs available were the first-generation antipsychotics; but his work was always based on establishing a therapeutic bond, with drugs when helpful, but secondary). She was doing fine.
Reply | Report Abuse | Link to thisNo recovery? I don't believe it.
My Dad believed that the insurance industry and the pharmaceuticals had largely killed off not just serious treatment of patients with major mental illness, but even much of clinical training in psychiatry, since the 30 day limit on payment for hospitalization and the overblown claims for new (and more profitable) medications were deeply harmful to the entire enterprise of helping people with the most serious problems, skewing treatment and research alike toward purely neurophysiological concerns and away from treatment of the patient as a human being in the world...
This article accords very closely with my mother's experience of schizophrenia. I'm glad to see more rational examination of schizophrenia, and less hype/mythology.
Reply | Report Abuse | Link to thisWhat page was the article "Living with Schizophrenia"
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