passerine: Picture of Sparrow from Dykes to Watch For (Default)
[personal profile] passerine
I actually like some of the writing I did for my Human Behavior class, so I'll be making a few posts based on it.



These are Dr. Courtney Harding's criteria for recovering from schizophrenia:

- having a social life indistinguishable from your neighbor
- holding a job for pay or volunteering
- being symptom-free
- being off medication

In Harding's study, about one-third of people considered the "least functional" with the diagnosis were considered to fully recover, meeting all four of these criteria. An additional third were able to meet three out of four of the criteria, with "off medication" generally being the one not met. Some of the credit for this is due to the "recovery-oriented" model in Vermont that Harding was studying. However, even in the "maintenance-oriented" model studied in Maine, recovery or significant improvement (3 out of 4 of the recovery criteria) occurred in almost half of the patient population. Knight credits the difference in Vermont to "the healing effects of meaningful activity, which the individual chooses to pursue".

I believe this particular list of "recovery" criteria is problematic in and of itself, although on the surface it sounds like a reasonable template.

First, "having a social life indistinguishable from your neighbor" places a value on conformity that I consider inappropriate and potentially dangerous. It assumes that the individual lives in a safe neighborhood with people who are similar to him/her, except (presumably) not diagnosed with schizophrenia. One of the case studies in my Human Behavior I involved a man with this diagnosis whose problems were aggravated by an unsafe neighborhood that had severe problems with gang-related criminal activity. In this case, I would hope that the gentleman's social life was distinguishable from his neighbors'! Other potential misuse of this criteria could involve an extroverted individual from a reserved culture (or vice-versa), an LGBT individual choosing to socialize primarily with other LGBT individuals, or a practitioner of a non-Christian faith (or no faith at all) for whom church is not an appropriate social outlet.

Next, "holding a job for pay or volunteering" says nothing about the quality of the job or volunteer experience. It also dismisses the roles of college student and homemaker/stay at home parent as less than the role of someone working a low-skill job for even a few hours each week. Another concern is that, for the sake of being seen as "recovered", an individual may pursue employment that is a bad fit or that is considerably below the individual's true skill level - and may in fact be encouraged to do so by clinicians.

[Personal edit that was not in original post: "Get a job, any job" has often been proposed by various clinicians as a cure-all for [personal profile] invisionary's depressive episodes. Somehow, abandoning his degree plan, working at the convenience store down the street for $8 or $9 an hour, and either cutting into our time together as a family or simply putting the girls in daycare - which would cost MORE than his take-home pay for a job like that - would be mentally healthier than being the full-time primary parent of our kids. Never mind that this would a) make our financial situation worse instead of better, b) create added stress and logistical problems, and c) be completely unrewarding as an occupation. Also never mind that there are jobs out there that destroy people's mental health, as both [personal profile] invisionary and I can attest to from personal experience.]

"Being symptom free" seems harder to argue with, but what exactly constitutes "symptom free"? Are non-mainstream or unfamiliar religious or cultural beliefs "symptoms"? A friend who used to work for her county's CPS nearly made a mental health referral for suspected schizophrenia for a mother who kept on talking about how "the black crow has taken [her] mother and sister away." Fortunately, before the referral could be made, a co-worker from the same culture as this mother was able to explain that "the black crow" was a cultural euphemism for death. The woman was bereaved, not psychotic.

Last, "being off medication" - as our readings noted, if three out of four criteria were met, this was generally the one that was not. Also, does "medication" refer to antipsychotics only, to all psychiatric medications, or to all medications including those for other medical conditions? What if someone is taking a medication that has both psychiatric and non-psychiatric uses for the non-psychiatric use, such as Depakote or Topamax for recurring migraines?

Mosher (1999), in describing the Soteria project, notes that "good outcomes" (defined as "no more than minimal symptoms" and EITHER living independently OR going to work or school) were more common in those individuals who had achieved a higher level of education, lived independently, and succesfully held a job before the episode that led to hospitalization. In other words, those who had been more "functional" before were better able to become "functional" again. Also, good outcomes were more likely if a clear precipitating event that triggered the psychotic episode could be identified.

This suggests to me that the notion of "recovery" especially from schizophrenia is tied into the ability to conform to social norms. To a point, this makes sense - many social norms exist to enable people to interact in productive rather than damaging ways. However, some social norms can, themselves, be damaging to society as a whole and to the individual who is being asked to conform. Holding up paid employment (no matter how menial or demeaning) as a hallmark of recovery is no more right than past beliefs that a woman's desire to work outside the home is a sign of insanity.

Date: 2009-05-20 02:18 pm (UTC)
delight: (Default)
From: [personal profile] delight
... as the adult child of a schizophrenic, I have a lot of things to say in response to this, but I am not really comfortable doing so in a public forum.

There may be a locked post, though.

Because I am very, very glad none of this came up in my Abnormal Psychology course; I would've flipped my lid and explained how none of these things would be good for her, and how she's much better now than she was when trying to do some of these things ...

Date: 2009-05-20 06:20 pm (UTC)
esteleth: (Default)
From: [personal profile] esteleth
It strikes me that the best way to talk about "recovery" from schizophrenia is the same (or very similar) way that one would talk about recovery from any other chronic condition. Namely: 1) Is the person able to have a day-to-day life that is stable and is affected minimally by the negatives of their condition? 2) Is the balance between helpful and unhelpful effects of their medication / other treatment balanced in favor of the helpful? 3) Is the person able to be a functional, contributing member of society at the level that they desire and are capable of?
These criteria can be used to discuss schizophrenia (and other mental disorders) as well as physical disorders and chronic illnesses equally well, I would think.
I agree very much that many of the criteria Harding cites for "recovery" are highly problematic. Like you said, if a person (hypothetically speaking) has a law degree and is highly intelligent, then telling them that working minimum wage at a fast-food restaurant is not helpful, especially if they are focused on living on unemployment / disability right now while they search for a job at a law firm while also getting their medications and treatments in order so that they are capable of holding down that job. Context is very important. There are many times where being unemployed is vastly preferable to being underemployed, and, like you point out, if someone is the caregiver of another, these things must be taken into account.

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