My first IMHO, or In My Humble Opinion, SharePost was titled IMHO: Who Decides What Normal Is? I'll link to it at the bottom of this blog entry. Here now, I offer my opinions about recovery.
I've been researching recovery rates for SZ: the reality is most people recover. Courtenay Harding's Vermont study tracked people who had psychosocial treatment and support in the community; those in her Maine study received only medication and had recovered. The recovery rate skyrockets when studies include people taking medication who have support services in place.
All five of the famous long-term studies list favorable recovery rates, some as high as 68 percent.
A UCLA study lists 10 key factors in recovery: 1) family relationships, 2) substance abuse, 3) duration of untreated psychosis, 4) initial response to medication, 5) adherence to treatment, 6) supportive therapeutic relationships, 7) cognitive abilities, 8) social skills, 9) personal history and 10) access to care.
Harding tracked the ex-patients of a Vermont state hospital over a period of 32 years. The anti-psychiatry contingent uses her study to prove medication isn't necessary in order to recover because a large number of the former patients were no longer on the meds. What the people who nix drugs fail to realize is that initially the Vermont participants were on medication so their duration of untreated psychosis was minimal. Most studies indicate the majority of people require SZ meds.
Does the brain recalibrate itself in our forties and fifties as Harding's research suggests? She is coy on the subject of the seemingly spontaneous remission of some of the patients she studied. I'm 44 years old, smack dab in the middle of my life. I hope to have 40 more years on this earth. That would be like living two lifetimes in one life. I doubt I would be able to function well or live that long if I kept going off the medication and was paranoid and delusional.
A 2006 New York Times article, "Revisiting Schizophrenia: Are Drugs Always Needed?" offered this controversial viewpoint: "When some people first develop psychosis they can function without medication-or with far less than is typically prescribed-as well as they can with the drugs." It quoted doctors who believe patients could manage with significantly less medication possibly because they have a mild form of SZ.
This presumes excessive dosing is the norm, which is not always true. For 16 years, I was on such a low dose of Stelazine that it was barely a maintenance dose. I was on a mere 5 mg ever since coming out of the hospital the first time. When Dr. Altman, my current psychiatrist, raised this drug to 10 mg in 2003, my Seasonal Affective Disorder stopped cold. Now I'm on a higher dose of an atypical which has been like a miracle drug. So a low dose isn't always the way to go.
Holding everyone with a mild form to a different standard of care could be risky. Right now there is no test or diagnostic criteria that can determine who among us will be able to live without SZ meds after having a psychotic break and who won't. Prevailing wisdom has been that early treatment with some form of drug protects the brain from further damage. It is precisely because I was given the right drug right away that the SZ didn't progress. I'm glad the staff at the hospital didn't leave my recovery to chance.
See an earlier SharePost of mine that covers a meta-analysis of 43 studies that indicates early intervention is the best course of action. It was published in the November 2008 Harvard Mental Health Letter.
Out "in the field"-in real life-you hear hell-and-heartache stories. A friend's brother discontinued his meds to disastrous effect. Another person's voices returned. A 52-year old woman had to be re-hospitalized after a drug holiday. The problem is no professional can predict who will do well after stopping the drugs and who won't. It's like playing Russian Roulette.
Recovery from schizophrenia comes down to two things: research and education. You need to educate yourself about your illness and research and develop strategies for living well.
People without SZ should also be aware of the signs and symptoms of this medical condition, and incorporate some of the 10 key factors of recovery in their lives. Parents should get their children involved in the world; teenagers should work at a part-time job or even do volunteer work, as volunteer work is often used on college applications when high school students apply to the university. Post-secondary education can only be of benefit too. I would also recommend travel. This falls under the personal history factor as the best defense.
Substance abuse [refraining from street drugs and alcohol] is a no-brainer to me. Supportive therapy and access to care also can and should be improved. Relying solely on medication isn't the solution. The worst scenario is no meds and no psychosocial rehabilitation: that is a powder keg.
We need more dedicated professionals entering the field who believe people can recover and who will be creative and proactive in addressing their patients' treatment needs. Dare I say we need more peers entering the field who are living proof that people can recover.
IMHO: People can and do recover every day. Not only is recovery possible, today it is probable that someone will recover.
I'd love to hear from you about this. As always your comments are welcome.
Published On: July 05, 2009