Prognosis

What is the prognosis?

"Even for the person facing great psychiatric disabilities, our souls can flower with hope. Hope is an essential ingredient for recovery" (Simon, a person who has experienced schizophrenia).

A diagnosis of schizophrenia does not necessarily mean that a life long illness is inevitable. People do improve and recover. The assumption that people with schizophrenia are likely to experience a progressively worsening course of illness is not supported. Research reports a range of outcomes varying from full recovery to severe and continuous incapacity. A significant proportion of people are able to achieve favourable outcomes. Indeed, favourable outcomes (varying from having mild impairment to experiencing full recovery) have been estimated for 21% to 57% of people with schizophrenia.

Recovery will mean different things for different people. It may mean 'complete' recovery in the sense of being symptom-free, or it may mean learning to live well with some residual symptoms of schizophrenia.

"I believe real recovery is far from a simple matter of accepting diagnosis and learning facts about schizophrenia and medication. Rather, it is a deep searching and questioning, a journey through unfamiliar feelings to embrace new concepts and a wider view of oneself. Recovery is not an event but a process that is, for myself and many others, a life-long journey" (Champ 1998, p.59).

As many people with schizophrenia do move in the direction of improvement, consigning a person to early negative prognosis must be avoided. Harding (1988) argues that every person with schizophrenia has the right to rehabilitation, no matter how 'chronic' they appear.

Nevertheless, it should be acknowledged that schizophrenia is a potentially a severe disorder. A significant number of people with schizophrenia experience negative outcomes. These include employment difficulties, social isolation, poverty, repeated hospitalisation, imprisonment, insecure and transient accommodation, homelessness, poor physical health and an increased mortality.

Suicide, accidents and disease are prevalent among people with schizophrenia. Research indicates the average person with schizophrenia dies 15 years younger that the general population. The largest single contributor to this excess in mortality is suicide with a rate of suicide nearly 13 times that of the general community.

However people with schizophrenia are far more likley to die of a range of physical illnesses such as heart disease, the complications of diabetes mellitus or infection. It is evident that care is provided less often, later in the course of an illness and less aggressively than in the rest of the community.