CLINICAL HANDBOOK OF SCHIZOPHRENIA

CHAPTER 55RECOVERYDAVID ROELARRY DAVIDSONFor over 20 years, the notion of recovery in schizophrenia was cherished by only asmall—but energetic—group on the fringe of the field of mental health. However, recentlythis concept has taken center stage in major policy documents and initiatives in theUnited States and around the world. This chapter includes a review of some of the centraldevelopments that led to this “era of recovery” for persons with schizophrenia, grappleswith some of the complex and confusing elements of the concept, and discusses differenttheoretical approaches to and definitions of recovery. Finally, a consideration of the mainimplications of such notions for the treatment and rehabilitation of persons with schizophreniaand related disorders is discussed.HISTORY AND BACKGROUND OF THE CONCEPTToward the end of the 19th century, Émil Kraepelin identified a disease entity that hetermed dementia praecox and described as having a characteristic downward and deterioratingcourse beginning in adolescence, leading irreversibly to severe, persistent impairment,and ending in a premature death. Although his observations were based primarilyon long-term residents of institutions, his basic idea that dementia praecox, later referredto as schizophrenia, inevitably leads to progressive deterioration still reigns dominant todayin the field and in society in general, leading to frequent lifelong pessimistic pronouncementsabout persons with the disorder. This view justified—as well as grew outof—the custodial care of people with schizophrenia, who, as a result, were perceived aschronic and “maintained” for long periods of times in large state hospitals, with littlecare or hope for a better future. This static, grim picture went on for years. However, towardthe middle of the 20th century, a number of developments changed the conceptualizationof the course and outcome of schizophrenia. Recovery is central to these new566