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Who Is Most Likely to Recover From Psychosis?

Adversity, socioeconomic status, and education all play a role.

Key points

  • Despite the cultural myth of the "hopeless schizophrenic," many people not only live with a schizophrenia spectrum disorder, but thrive.
  • People who recover from psychosis are not necessarily lucky. A few factors determine recovery, including socioeconomic status.
  • However, those factors of psychosis recovery make up only a third of afflicted individuals, making recovery outcomes difficult to study.
Dan Meyers/Unsplash
Source: Dan Meyers/Unsplash

Given the very few public models of successful people living with a psychotic disorder, there is a cultural assumption that once a person develops psychosis, this person has no hope of recovering. Media portrayals of people with schizophrenia don’t help normalize a satisfying picture of a thriving person with schizophrenia, despite many of us who live and work normally among the rest of the world.

False recovery models are not really true. There are many people who thrive with a schizophrenia spectrum disorder (SSD) aside from our very public advocates like Dr. Elyn Saks, a professor and memoirist at the University of Southern California, Esmé Weijun Wang, author of The Collected Schizophrenias, and people like John Nash, the renowned mathematician whose story was told in the book and film, A Beautiful Mind. There exists an entire database devoted to people thriving with a schizophrenia disorder at the Curesz Foundation website, an organization helping people with SSDs recover.

But who exactly are these “lucky” people? And are their stories indeed based on luck? Or are there factors, when applied en masse someday, that could help many (if not the majority) of people with schizophrenia recover?

Predictors of Recovery From Psychosis

A comprehensive study published earlier this year in Schizophrenia Bulletin followed up with 243 patients over a 20-year period exhibiting a disorder with psychotic symptoms including schizophrenia, schizoaffective disorder, schizophreniform disorder, and bipolar disorder with psychotic symptoms.

Researchers assessed three definitions of recovery: symptomatic, functional, and personal. Symptomatic recovery indicated reduced symptoms overall, while functional recovery described the quality to which an individual can participate in daily life uninterrupted by their disorder. Personal recovery referred to the ability to forge one’s own identity, find meaning in life, have a sense of purpose, and take responsibility for their recovery and disorder.

They found that across symptomatic, functional, and personal recovery, 51.9 percent, 52.7 percent, and 51.9 percent of participants showed significant recovery across the three domains, respectively; 74.2 percent of participants showed improvement in at least one area of recovery, while 44 percent met both criteria of symptomatic and functional recovery. Ultimately, 32.5 percent of participants displayed active recovery in all three definitions, which are consistent with previous research findings.

Notable significant predictors that determined who exactly recovered from psychosis across all three domains included parental socioeconomic status, family history of an SSD, childhood adversity, developmental delay at age 3, and completion of high school.

Does that mean if you’re not born into a wealthy family with no trauma or relatives with an SSD you’re doomed? Not necessarily.

The nature of psychosis makes it so that prominent predictors of recovery are more difficult to obtain. Psychosis can appear differently between each individual. In psychology, you might hear psychosis referred to as a disorder of heterogeneous makeup, meaning there are many reasons why people develop psychosis and don’t recover. Due to the heterogeneity of these predictors, they only explained 33.7 percent, 34.3 percent, and 27.5 percent of the participants respectively in each recovery model.

It is important to remember that studies that show predictors of poor or positive outcomes do not necessarily indicate fate. The data reveal to educators, policymakers, and mental health teams what is lacking in an individual’s life that can potentially later be remedied by nonprofit aid, social support, or any future possibility that professionals can come up with. Even if you’re not born into a family of financial status, gaining education and resources can be obtained through other ways.

As Thomas Insel, previous director of the National Institute of Mental Health, detailed in his book Healing, recovery from serious mental illness involves people, place, and purpose. If you have housing, a community where you feel like you belong and contribute to daily life, and a sense of hope and purpose, you’re more likely to recover.

Still, a third of all cases exhibit full signs of recovery, and that’s enough to discredit the myth of the “hopeless schizophrenic." Perhaps we can learn from these findings to make recovery a real future for many more.

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Peralta, V., García de Jalón, E., Moreno-Izco, L., Peralta, D., Janda, L., Sánchez-Torres, A. M., ... & SEGPEPs Group Ballesteros A Gil-Berrozpe G Hernández R Lorente R Fañanás L Papiol S Ribeiro M Rosero A Zandio M. (2022). Long-Term Outcomes of First-Admission Psychosis: A Naturalistic 21-Year Follow-Up Study of Symptomatic, Functional and Personal Recovery and Their Baseline Predictors. Schizophrenia Bulletin, 48(3), 631-642.