An Optimistic Twist for Schizophrenics

Article excerpt

In the mid-1950s, a group of patients in a Vermont state mental hospital were diagnosed as schizophrenic and their families were told that they would probably never lead productive lives. After all, their doctors noted, they were middle-aged, poorly educated inviduals whose social withdrawal, inappropriate emotions, hallucinations and other symptoms had resisted years of attempted treatment.

By the early 1980s, however, the same patients had punched holes in the pessimistic predictions of their psychiatrists. A majority were living in the community and leading much fuller lives than anyone had expected, according to several Yale University researchers whose surprising findings were presented last week in Dallas at the annual meeting of the American Psychiatric Association.

"These were bottom-of-the-barrel patients," says study director Courtenay M. Harding. "Some of them were not expected to ever leave the hospital. But it appears that in many cases schizophrenia may take 10 to 20 years to turn around. Still, we can't predict who will eventually improve and who won't."

About 1 percent of the U.S. population has schizophrenia. The latest manual of psychiatric diagnoses, published in 1980, states that patients with repeated bouts of schizophrenia are likely to get worse, while recovery is rare. Yet the Vermont patients, whose original conditions were re-diagnosed using current psychiatric criteria, do not fit this picture, contend Harding and her co-workers.

They located nearly all 269 patients originally labeled as schizophrenic or suffering from some other severe mental disorder. Case records, minus diagnoses, were analyzed and assigned up-to-date psychiatric labels. The investigators selected 118 subjects as having met modern criteria for schizophrenia. Interviews were conducted with 82 of them who were still alive over 20 years after receiving intensive job and psychological rehabilitation upon release from the hospital. (At the time, a national effort to get patients out of state mental hospitals had just begun.) Friends and families of 28 deceased patients were also interviewed. Eight patients refused interviews or could not be located.

One-half to two-thirds of these once "chronic" schizophrenics showed -- or had shown before their deaths -- varied degrees of productivity and social involvement, says Harding. Most displayed slight or no schizophrenic symptoms, had one or more moderately to very close friendS, required little or no help meeting basic needs and led relatively full lives. Only 40 percent of the subjects reported full-time employment in the previous year, but this may have been due primarily to their age, which averaged 61 years at follow-up, points out Harding.

She says that significant improvement on most outcome measures was found for almost 80 percent of the living subjects in the study. …