I had the good fortune to be working at a dynamic Recovery program for adults beginning in 1990. I passionately believed that not only does recovery happen – but that we would be able to demonstrate it by reporting significant improvements in quality of life outcomes such as employment, housing and social supports. The program’s commitment to Supported Employment, for instance, was emphatic and we took pride in doing “whatever it takes” to support our members’ integration into the community. The Recovery movement was just taking root in California and throughout the U.S.
When I look back on the following 19 years, I can’t help but feel some sense of disappointment about the overall outcomes — especially employment. Maybe I was overly optimistic, but the average rate of competitive employment (full and part-time) reported by the program has hovered between 10 and 20 percent. I had always expected it to be much higher. Many other newly established recovery programs reported similar, underwhelming results.
In the early years, Courtenay Harding joined us to share results from her Vermont study debunking the myths of schizophrenia as a progressively deteriorating, hopeless disease. She reported that a full 34% of the 269 discharged patients from the hospital’s back wards were in recovery, working in the community and off psychotropic medications. Whitaker called attention to Martin Harrow’s long term study that revealed 39% of the participants were off meds and in recovery (compared to 5% on meds) and 60% were working.
The phrase that stands out to me from these studies is “symptom remission without functional remission”. In other words, people experiencing hearing disturbing voices, feeling overwhelming anxiety or black moods reported a lessening of symptom severity – but were still not rejoining our work-forces and communities. I recall several people that I worked with closely, who indicated that much of their emotional distress had faded along with their future goals and passions.
Now, don’t get me wrong. This innovative program never fixated on diagnoses, nor on insisting upon pharmacological treatments of them. Choice, empowerment and shared decision making were bedrock values, so you wouldn’t hear many conversations about non-compliance. Still, multiple prescriptions for psychotropics were more common than not. This was the case for virtually all of the other psychosocial rehabilitation programs I was familiar with as well. Each of them offered the same biologically based standard of care for people diagnosed with bipolar disorders, schizophrenia and depression.
The discomfiting thrust of Whitaker’s books and the research literature suggests that psychotropic medications have played a major role in undermining the long-term outcomes of consumers. It appears that if someone is experiencing psychiatric problems, they might have a better chance of finding a meaningful role and recovery by avoiding or escaping the mental health system altogether. Has the Recovery movement been compromised by the continued reliance on pharma-centric approaches? It may be a gross oversimplification to attribute anemic employment results to just the use of psychotropics — Crushing poverty, a difficult economy and stigma come to mind — But the evidence points to medications being more of a stumbling block than a step up. The Recovery movement is overdue for a new road map.
Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.