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Before I responded further to the points
teejai had made, I thought I'd drag in this article excerpt that I came across the other day because I think it's relevant to the conversation.
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... Harding said that her findings, and the notion that people with schizophrenia recover, is greeted generally with skepticism. "People look at me like I am from another planet," she told Psychiatric News.
Harding is director of the Institute for the Study of Human Resilience and senior director of the Center for Psychiatric Rehabilitation at Boston University.
She added that the skepticism is not difficult to understand given that few studies on the course of schizophrenia have taken a longitudinal approach. "What happens in most research strategies is that the investigators follow a cohort of convenience for a short time while they are still in treatment," Harding said.
Consequently, the literature tends to corroborate what psychiatrists see on a day-to-day basis: chronic disease and recidivism. But Harding said that impression is a classic example of the "clinician’s illusion"—a misapprehension about the nature of disease, common to any number of chronic conditions, that is an artifact of a physician’s practice: The physician tends to see only those patients who are sickest and who do not respond to treatment, while those who are less infirm and respond are—naturally enough—seen less frequently or not at all. In time, the physician cannot help but form an impression of nearly incurable chronicity.
"Any clinician worth his salt will tell you it happens," Harding said. "You get inured to what the range is because you keep seeing these [chronic] people right in front of your nose."
And the short-term clinical reality of schizophrenia is frequently dismal. "The day-to-day experience is heavily crowded caseloads and shelters where it doesn’t look like anyone is getting better," she said. "The expectation is that you do stabilization and maintenance with medication and entitlements, and that’s the best you can do."
Yet Harding said that outside the range of the "clinician’s illusion" are uncounted patients who have passed through and out of systems of care, gotten married, and are holding jobs. "Most of them are not even known in the community as having mental illness," she said. "They have gone about their lives and are embedded in society."
Source: Skepticism & Recovery
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Three points strike me as particularly insightful. The first is that clinicians who provide care often see only a very small segment of that individual's life -- most often, when they are at their worst -- and this can shape their beliefs in regard to treatment and recovery. When we look over the long-range however, a different picture emerges that relates to recovery and different forms of treatment, including quite frequently, the abandonment of drug treatment.
The other point that is especially interesting is, there is a certain percentage of people who never enter into psychiatric treatment. They go through their experience, they put themselves back together, and they go on in their lives. As a result, their experiences are not included in published studies that help establish treatment guidelines and forms of care.
The important thing to remember is that whenever we're looking at a study, we have to pay attention to what has been seen but also to what has
not been seen. Only by allowing both can we begin to grasp the information the study has to offer and apply it in the best manner.