Recovery and Realism

To the Editor: We read with dismay the Taking Issue editorial by Robert A. Rosenheck, M.D., in the October 2000 issue. We believe he speaks for many in the field who simply don't believe that persons with serious and persistent mental illness can get better and recover. Hope and belief are the foundation of medicine and the first step toward recovery from any illness. Once again the psychiatric world is guilty of taking away such hope for recovery when it expresses such fatalistic positions in an editorial in one of the more widely read journals.

Schizophrenia and related disorders are not synonymous with total disability. Even before the advent of atypical antipsychotic medications, recovery was a concept that was embraced and lived in places like Fountain House and other rehabilitation programs around the country. We believe there are compelling data to prove that the new medications are superior in many domains, especially in improving negative symptoms and cognition. Symptoms in these two domains are often as problematic as positive symptoms and may be even more responsible for holding people back from success in areas such as employment.

Furthermore, to assert, as Dr. Rosenheck does, that the new medications cause diabetes and hyperlipidemia without any solid data is irresponsible. The treatment of serious and persistent mental illness has not received much positive press, and our patients even less so. Dr. Rosenheck states that "we must not be swayed by hype, glitz, or flawed research." If by "glitz" he means persuading corporate America to hire persons with serious and persistent mental illness, so be it. We have come to see that a little glitz and glamour can go a long way toward attracting more and better people into mental health care fields and may change the mindset of many Americans who see serious and persistent mental illness as a world of hopelessness, violence, and disability.

If you talk to the people who are struggling with recovery today, they will tell you they feel better and are doing more than before thanks to many factors, but the newer medications are certainly one important reason.