Functional Recovery in Schizophrenia: Raising the Bar for Outcomes in People with Schizophrenia

Abstract

This special issue focuses on the issue of functional recovery in schizophrenia. In line with the recent understanding that clinical remission can be defined, measured, and in some cases consistently achieved, attention has been focused on the fact that functional recovery may be possible as well. In contrast to the older Kraepelinian views of schizophrenia as having almost uniformly poor outcome, many current treatment strategies are aimed at reducing disability and improving functional outcomes. These treatments target disability directly with behavioral interventions and target its determinants with cognitive enhancement approaches. While documentation of efficacy is in early stages, these approaches include both pharmacological and remediation strategies. With the interest in promoting functional recovery comes the need to define and understand what functional recovery actually is. In some sense, we lack a basic terminology of functional recovery, a well-defined measurement strategy, evidence of milestones in improvements, and treatment strategies that are targeted at meaningful elements of recovery. This special issue provides some first steps in these areas. As we note in our article, Alan Bellack and I start by providing some tentative and heuristic definitions of functional remission and functional recovery. Other articles cover the assessment of functional disability and recovery, contributors to disability in the domains of awareness of illness and comorbidities, treatments aimed at functional recovery, and evidence from the treatment of first-episode patients that suggests that recovery is possible. Finally, we close with an opinion piece. Three highly educated and accomplished people with severe mental illness provide their perspectives on the different steps, stages, and features of different definitions of functional recovery. We hope that at the end of this issue, we have learned something new about recovery as a medical concept and recovery as a personal process. More importantly, I hope that we will promote discussion and stimulate research in the important area of functional recovery in schizophrenia. People with schizophrenia deserve a chance to recover; it is our goal and responsibility to get as close to that goal for as many people with schizophrenia as possible.