Recovery from schizophrenia: a challenge for the 21st century

While much professional interest, public advocacy and media attention accompanied the neuroscientific research advances of the Decade of the Brain, much less prominence was accorded to the very considerable progress in psychiatric treatment, rehabilitation and community-based services for persons with schizophrenia. The increasing availability of evidence-based practices and more optimistic views of optimal outcomes possible in schizophrenia are of much practical importance to consumers and practitioners alike. Expectations for substantial improvements in a larger proportion of individuals with schizophrenia than heretofore are emerging on psychiatry's radar screen, especially in symptom control, psychosocial functioning and quality of life. We believe that it is now realistic to set as a goal for professionals and consumers the feasibility of recovery from schizophrenia for half or more of individuals with the first episode of schizophrenia. In this issue of the International Review of Psychiatry, we aim to clarify the rationale for this ambitious clinical objective and stimulate research that will bring it to fruition within a decade. Five domains of advocacy, clinical and empirical work, have converged to bring recovery from schizophrenia to the fore and make it a realistic aim for practitioners and consumers. These include (a) a conceptual framework to guide research and understanding of recovery as a process leading to a defined outcome; (b) new modes of measurement that can permit recovery from schizophrenia to be operationally defined and empirical studies of recovery to proceed; (c) the arrival of a critical mass of evidence-based treatments that can support the progress of consumers to recovery; (d) an emphasis on positive and normative role functioning for treatment and rehabilitation; and (e) empowerment of consumers and their families that has made recovery their personally meaningful goal. The vulnerability-stress-protective factors model of schizophrenia can help researchers to organize data that are heuristic regarding factors that affect recovery or, at the other end of the spectrum, poor outcome. Recovery can be operationally defined by dimensions related to symptom remission and functioning in family, work, friendship, residential and recreational arenas. Considerable evidence-based treatments are available to promote improved functioning of consumers in the domains relevant to recovery. The current state of research on recovery has generated ample hypotheses for planning hypothesis-testing studies and for evaluating quality of care and clinical outcomes that will move the important goal of recovery forward.