Tag Archives: Edward Shorter

The Unintended Consequences of Focusing on Recovery in Schizophrenia

By Marvin Ross

Much has been said in this blog by my colleague Dr David Laing Dawson and myself on the concept of recovery. Wouldn’t it be wonderful if full recovery was possible but it isn’t. However, I really should clarify that somewhat. Schizophrenia should probably be referred to as a spectrum disorder like autism.

When Bleuler first coined the term in 1908, he referred to it as the schizophrenias and said that it was a physical disease process characterized by exacerbations and remissions. No one was ever completely “cured” of schizophrenia — there was always some sort of lasting cognitive weakness or defect that was manifest in behavior. Unfortunately, over the years, it began to be considered to be one disease only.

In a recent article in Psychology Today, University of Toronto medical historian, Edward Shorter, had this to say. In adolescent-onset schizophrenia, some don’t recover at all; others make only a “social recovery,” and some maybe go on to have a normal life or “Maybe not”. Shorter then adds that “The field has made virtually no progress in unpacking chronic severe illness and differentiating out several distinct entities. In no other field of medicine would this be conceivable!” and “Some involve loss of brain tissue, others don’t. Some have to stay on meds, others don’t. Some get well, others don’t. These are not all the same illness!”

In fact, it has long been recognized that there are three outcomes to schizophrenia. Roughly a third are treatment resistant and remain very ill, a third can be helped with meds and other treatment modalities to improve sufficiently to lead a reasonable but disabled life, and a third will have one psychotic episode, receive treatment and never have another or any long term deficits.

According to the Treatment Advocacy Center, 10 years after diagnosis, “one-fourth of those with schizophrenia have recovered completely, one-fourth have improved considerably, and one-fourth have improved modestly. Fifteen percent have not improved, and 10 percent are dead.”

How do you think the families of the majority of those with non recoverable schizophrenia or the individuals themselves will feel when we hold up to them what is achievable by only 25%? And, we tell them that it is achievable. Why can’t I (or my son or daughter) achieve that. Have I done something wrong? Cancer is an interesting analogy. There is not one cancer but many. And each cancer has its own unique characteristics and prognosis.

Non melanoma skin cancer (basal cell and squamous cell) have 5 year survivals of 95% and 90%. In contrast, the 5 year survival for pancreatic cancer ranges from 1% for stage IV to 14% from stage 1A. Imagine if we told those with stage IV pancreatic cancer not to worry because 5 year survival is 95%. Ridiculous isn’t it but that is what we tell people with schizophrenia. Don’t worry, you should be able to recover because 25% do.

Now, I’m not saying to abandon hope but rather to be realistic and pushing recovery is not realistic if it is not qualified.

The second problem was mentioned to me by my friend Kathy Mochnacki of Home on the Hill in Richmond Hill Ontario. She pointed out that if you claim that recovery is possible, then why continue doing research. People can recover so no need for it. Of course, scientists know better but they are dependent on funding from governments and other agencies.

So, let’s all inject some scientific reality into a very troubling and serious disease.

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