I suppose it makes for a better movie when the changes are both abrupt and dramatic, like in the Robin Williams' adaptation of Oliver Saks' book. In psychiatry, the only time we've had anything close to that was when Chlorpromazine was introduced in the 1950s and then again when Clozaril reached the U.S. in the 1990s. But, really, even then that was more the hype, the PR, than the reality. Yes, the medications quieted the voices, for some people, and that was a good thing. But being relieved of one symptom-even a formidable and distressing one like harsh, critical voices-does not in and of itself constitute ‘recovery'. There remained the other symptoms of the illness to contend with, and then there was the ground left to make up after having spent three or thirteen or thirty years living the tortured life of a ‘mental patient'. There was no pill that could help the person pick back up the pieces of his or her disrupted and derailed life. No wonder so many people, early on in the introduction of Clozaril, committed suicide.
Real life is not nearly so dramatic, most of the time. This point was driven home to me, in a fairly awkward way, during an early morning live radio interview I was obliged to do when in a foreign city to give a fund-raising presentation. Half asleep, I at first was somewhat taken aback by the interviewer's question when she asked if I had ever (really) seen anyone (really) recover from a serious mental illness. "Yes, sure," I replied, "I see it happening everyday." But then came her follow-up: "Can you give us an example?" "An example?" I finally muttered, after an uncomfortably long pause during which I was trying to collect my murky thoughts. "You mean like John Nash in A Beautiful Mind or someone like that?" "Yes," she said, "who have you seen recover?"
Had I not been half asleep and in my pajamas, I might have had the presence of mind to use this question as an object lesson for the audience. As it was, I tried half-heartedly to give her an example or two of people, ordinary people, I knew who had experienced significant improvements over time. I don't think I did a very good job. People who heard the interview told me later that they thought I had done the best I could with the questions I was asked, and commiserated with me over the fact that the radio host knew so little about the subject. But, then again, was she any different from most people whose knowledge of mental illness comes from the movies, or television, or the local news? And if that's not recovery, then what is?
In a study we did involving people taking Clozaril, one man described the most significant effect of the medication to be that he could now sit through an entire movie without having to leave the theatre. Not only was he no longer as restless sitting in the dark, but he also could actually follow the narrative from start to finish. In another study we conducted around the same time, in which we saw similar improvements in people who were offered friends (as well as medication), one woman described the pleasure she took in finally being able to get through a grocery store without, in her words, "freaking out." Neither of these people will ever receive a Nobel Prize, I suppose. Neither is even likely to make the local news as an exemplar of recovery. But that's because real life, and therefore recovery, are not nearly so dramatic, most of the time.
For me, recovery is captured very adequately in the story of the man and his omelet. I had been working for several months in psychotherapy with a forty-something year old man with schizophrenia who was having difficulty identifying goals for himself when he reluctantly, sheepishly, divulged something to me that he treated as almost a deep and perhaps dark secret. What would give him pleasure, what he would like to be able to do, would be to make himself a cheese omelet for dinner. Not just any cheese omelet, but an omelet made just so, with the eggs stirred in the plan until set and then the cheddar cheese laid gently down on top and melted ever so quickly under the broiler. This was a way to make omelets that he had discovered, and only he knew. His mother's omelets never came out so well, because she folded the cheese into the omelet rather than melting it on top. But he wasn't able to make his own omelets as long as he was living in his mother's house, as he had been for the previous 15 years, since he had had to drop out of college. That was one thing he really would like to do, now that I had asked.
Further discussion generated a list of reasons why it had not been possible for him to make himself a cheese omelet for the last 15 years. But many of these reasons could now be checked off the list. The eggs were in the refrigerator, his mother would be willing to buy the type of cheddar he liked, and there was a working oven, with a broiler, in her kitchen. There were only two things remaining that held him back. His mother would not let him use the oven, and even if she were to do so, he would be reluctant anyway because of the electricity it would require for him to fire up the broiler, adding unnecessarily to her monthly utility bill. One session with the man's mother was sufficient for him to be assured that she would allow, and even encourage, him to make his own omelet, and that he need not be concerned over the cost of the electricity involved. While initially worried that her son might burn the house down by forgetting to turn off the broiler, his mother eventually agreed to his making himself an omelet as long as she was home to make sure that everything was turned off when he was done.
A couple of weeks later, the man proudly announced to me that he had made himself a cheese omelet for dinner the night before, and that it had tasted as good as he had remembered, maybe even better. While not particularly newsworthy, he had taken a significant step forward, embarking on a meandering quest to see what else he now could do, emboldened by his sense of accomplishment. Making a cheese omelet had not cured him of schizophrenia, but it had ‘awakened' in him an appreciation that life still had more to offer him, even with schizophrenia. That kind of awakening can and does happen every day, and, really, what else is there?