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New BU institute to study schizophrenia rehabilitation and recovery

By David J. Craig

When 75 Tewksbury State Hospital patients gathered outside the hospital for a press conference on February 14, the stories they told evoked images of the nightmarish state institutions of the past, not of a modern public health-care facility.

Incidences of patients being showered once a week with a garden hose while lying on a gurney, and of feces and vomit left uncleaned in common areas for hours, were particularly disturbing to Courtenay Harding because they were evidence, she says, of a common misconception about serious mental disorders such as schizophrenia -- that patients with such conditions are hopeless and need to be controlled and tolerated, not rehabilitated.

Courtenay Harding, a SAR professor of rehabilitation counseling and director of BU's new Institute for the Study of Human Resilience, says that given the proper care, people suffering from schizophrenia can reclaim their lives. Photo by Kalman Zabarsky

But Harding, a SAR professor of rehabilitation counseling and director of BU's new Institute for the Study of Human Resilience (ISHR), says that people suffering from schizophrenia can reclaim their lives -- and in fact, given the proper care, are likely to do so.

"Poor treatment such as what those patients described is very debilitating," she says. "If people are treated as if they aren't going to get better, they lose hope and feel like they have no control in their life. Basically, they're stripped of the things that will help them get better.

"Research has shown that schizophrenia is a prolonged, but not a chronic disorder," she continues. "People tend to be very sick at the onset, but the symptoms taper off gradually."

For the past 15 years, Harding has been challenging entrenched professional attitudes about schizophrenia. She is among a small but growing number of researchers whose long-term studies have shown that schizophrenia is not a strictly degenerative disorder -- as "about 75 percent of American psychiatry still believes," she says -- and that patients who have access to rehabilitation resources and are treated sensitively can improve.

As director of ISHR, which was launched upon her arrival at BU on January 1, Harding plans to oversee a series of research projects aimed at identifying what she believes is "a natural healing process" that helps schizophrenia patients to recover.

"We're going to build a theoretical model that explains what underpins the recovery process, based on our interviews with consumers of mental health-care services and on literature about human resilience in fields such as psychoneuroimmunology, cardiology, and oncology," says Harding. "Basically, we want to discover what empowers patients and what happens during recovery. We'll then use that information to build training programs for mental health-care providers."

Harding, who previously taught psychiatry at the University of Colorado for 12 years, says that because the prevailing attitude among American psychiatrists, psychologists, social workers, and nurses is that recovery from schizophrenia is rare or impossible, there has been little research on the recovery process.

But evidence exists, she says, that rehabilitation programs that teach schizophrenia patients how to manage their own symptoms and medications and teach job skills, social skills, and simple tasks such as balancing a checkbook all raise patients' self-esteem and help reduce symptoms.

A study she published in 1987, for instance, found that 30 percent of patients in a progressive rehabilitation program for schizophrenia patients in a Vermont hospital in the 1950s had fully recovered 32 years later, and another 32 percent showed significant improvement. In contrast, only 49 percent of matched patients in a Maine hospital with no rehabilitation program significantly improved during the same time.

"The people we studied were the ones who had languished in the back corridors of hospitals for a long time and had been considered hopeless," she says. "But we found some really amazing lives being lived. When we interviewed former patients about what had made the biggest difference in their recovery, we would hear things like, 'Somebody told me I had a chance to get better. Somebody believed in me.'

"Of course, what shocked us in Maine was that a lot of the patients got better despite the system," says Harding, who is working on funding for the institute. "So that, in addition to eight other studies from around the same time that found similar results, led us to think that there was a natural healing process going on."

She says tapping into a patient's resilience promotes that healing process and is integral to recovery. "Resilience is part of the human spirit," she says. "It's that natural urge people have toward health, and it's what people use when they dig deep to overcome a real crisis. It's a process of taking back control of your life and reinventing yourself."

Harding is currently conducting a five-year study about coping strategies used by 2,400 schizophrenia patients at six different locations in the United States.

For more information, contact Courtenay Harding at 353-3549.

16 March 2001
Boston University
Office of University Relations