This article was downloaded by: [University of Chicago Library]On: 02 October 2014, At: 23:10Publisher: RoutledgeInforma Ltd Registered in England and Wales Registered Number: 1072954Registered office: Mortimer House, 37-41 Mortimer Street, London W1T 3JH,UK

American Journal ofPsychiatric RehabilitationPublication details, including instructions forauthors and subscription information:http://www.tandfonline.com/loi/uapr20

Recovery from Schizophrenia:A Philosophical FrameworkABRAHAM RUDNICK aa Departments of Psychiatry and Philosophy ,University of Western Ontario , London, Ontario,CanadaPublished online: 25 Jul 2008.

To cite this article: ABRAHAM RUDNICK (2008) Recovery from Schizophrenia: APhilosophical Framework, American Journal of Psychiatric Rehabilitation, 11:3,267-278, DOI: 10.1080/15487760802186360

To link to this article: http://dx.doi.org/10.1080/15487760802186360

PLEASE SCROLL DOWN FOR ARTICLE

Taylor & Francis makes every effort to ensure the accuracy of all theinformation (the “Content”) contained in the publications on our platform.However, Taylor & Francis, our agents, and our licensors make norepresentations or warranties whatsoever as to the accuracy, completeness,or suitability for any purpose of the Content. Any opinions and viewsexpressed in this publication are the opinions and views of the authors, andare not the views of or endorsed by Taylor & Francis. The accuracy of theContent should not be relied upon and should be independently verified withprimary sources of information. Taylor and Francis shall not be liable for anylosses, actions, claims, proceedings, demands, costs, expenses, damages,and other liabilities whatsoever or howsoever caused arising directly orindirectly in connection with, in relation to or arising out of the use of theContent.

This article may be used for research, teaching, and private study purposes.Any substantial or systematic reproduction, redistribution, reselling, loan,sub-licensing, systematic supply, or distribution in any form to anyone isexpressly forbidden. Terms & Conditions of access and use can be found athttp://www.tandfonline.com/page/terms-and-conditions

Dow

nloa

ded

by [

Uni

vers

ity o

f C

hica

go L

ibra

ry]

at 2

3:10

02

Oct

ober

201

4

Recovery from Schizophrenia: APhilosophical Framework

Abraham Rudnick

Departments of Psychiatry and Philosophy, University ofWestern Ontario, London, Ontario, Canada

There is growing evidence and hope for considerable improvement in thelives of people with schizophrenia. Such improvement has been conceptua-lized lately as recovery, implying improvement beyond (or unrelated to)achieving remission of symptoms, and is characterized as the process and suc-cessful outcome of achieving personal life goals. Yet the characterization ofrecovery to date lacks a clear philosophical framework. This article proposesa philosophical framework for the notion of recovery. Specifically, the notionof self-organization is applied to the process of recovery from schizophrenia,using writings about other health-related notions, as well as literature fromtheoretical biology and process philosophy. The principal conclusionis that recovery can be generally characterized as a process of adaptive orcompensatory self-organization of the person as a whole and in relation tothe environment.

Keywords: Philosophy; Process; Recovery; Schizophrenia; Self-organization

Severe mental illness (SMI), particularly schizophrenia, can resultin psychiatric disability. Historically, the course of schizophreniawas thought to be a necessarily deteriorating one; hence, Kraepelin(1971) named it Dementia Praecox, i.e., early-onset dementia,implying an inevitable deterioration. Longitudinal studies havenow refuted that view, as long-term follow-up found that many—about half of—individuals with schizophrenia eventually do

Address correspondence to Abraham Rudnick, MD, PhD, CPRP, FRCPC, AssociateProfessor, Departments of Psychiatry and Philosophy, University of Western Ontario,Regional Mental Health Care, 850 Highbury Avenue, London, Ontario N6A4H1, Canada.E-mail: arudnic2@uwo.ca

267

American Journal of Psychiatric Rehabilitation, 11: 267–278

Taylor & Francis Group, LLC # 2008

ISSN: 1548-7768 print=1548-7776 online

DOI: 10.1080/15487760802186360

Dow

nloa

ded

by [

Uni

vers

ity o

f C

hica

go L

ibra

ry]

at 2

3:10

02

Oct

ober

201

4

relatively well, either on their own or with support from mentalhealth care services (Hopper, Harrison, Janca, & Sartorius, 2007).Manfred Bleuler demonstrated the heterogeneity of course inschizophrenia (Bleuler, 1978); his typology of illness course hassuccessfully stood up to the test of contemporary diagnostic cri-teria, and, hence, seems robust (Modestin, Huber, Satirli, Malti, &Hell, 2003). Admittedly, there is some controversy about how goodan outcome is achieved even in the better courses, as independent,high-paying employment has traditionally been reported to beachieved by only a small portion of people with schizophrenia;although, lately there is some more optimism in this regard (Ellison,Russinova, Massaro, & Lyass, 2005). Note that the lack ofaccomplishment of socially-valued roles among many individualswith schizophrenia could be explained by many factors, such associal stigma that disadvantages people with schizophrenia, result-ing in lack of employment opportunities. Thus, it is not necessarilythe course of schizophrenia itself, but perhaps the life course ofmany individuals with schizophrenia that impedes them fromachieving what are considered desired outcomes. As factors suchas social stigma can be improved (Sartorius, 2006), there is growinghope for considerable improvement in the lives of people withschizophrenia.

The notion of recovery from schizophrenia embodies thisgrowing hope. It is a relatively new concept that was put forwardin the late 1980s. Recovery in this context implies improvementbeyond (or unrelated to) achieving remission of symptoms, andcan be characterized as the process and successful outcome of set-ting, accomplishing, and maintaining personal life goals (Deegan,1988). Although recovery as a vision is currently being endorsedby many mental health care systems, particularly in the USA, thecharacterization of recovery in this context to date lacks a clearphilosophical framework. The grounding of a notion such as recov-ery in a clear philosophical framework is important, if not the leastbecause it may facilitate generation of theories and hypothesespertaining to recovery that can be empirically tested (Agassi, 1981).

This article proposes a philosophical framework for the notion ofrecovery. Specifically, the notion of self-organization is applied tothe process of recovery from schizophrenia, building on previousphilosophical writing about health-related notions, as well as onwritings from theoretical biology and process philosophy. But firsta more detailed definition and characterization of the notion of

268 A. Rudnick

Dow

nloa

ded

by [

Uni

vers

ity o

f C

hica

go L

ibra

ry]

at 2

3:10

02

Oct

ober

201

4

recovery from schizophrenia (and from severe mental illness ingeneral), as it appears in the recent literature, is in order.

THE NOTION OF RECOVERY FROM SCHIZOPHRENIA

Although the study of recovery from schizophrenia (and fromserious mental illness in general) is relatively new, it is rife withmany, sometimes competing, definitions and characterizations ofthe concept of recovery. Some of these definitions are grounded ina medical=objective model, others in a more grassroots=subjectiveapproach.

As an instance of a medical model approach, Liberman,Kopelowicz, Ventura, and Gutkind (2002) formulate an operationaldefinition of recovery from schizophrenia that is a multimodal,socially-normative inventory of personal assets and freedom frompsychotic symptoms, focusing on symptom remission, vocationalfunctioning, independent living, and peer relationship—they elab-orate that their criteria for recovery from schizophrenia pertain tothe past two years of an individual’s life and involve: (a) sustainedremission of psychotic symptoms as measured by the Brief Psychi-atric Rating Scale (Ventura, Green, Shaner, & Liberman, 1993)defined as a score of 4 (i.e., moderate) or less on key psychoticsymptoms of grandiosity, suspiciousness, unusual thought content,hallucinations, conceptual disorganization, bizarre behavior, self-neglect, blunted affect, and emotional withdrawal; (b) full or part-time engagement in an instrumental role activity (i.e., worker,student, volunteer) that is constructive and appropriate for cultureand age; (c) living independently of supervision by family or othercaregivers such that responsibility for day-to-day needs (e.g., self-administration of medication, money management) falls to theindividual; and (d) participating in an active friendship and=or peersocial relations or otherwise involved in recreational activities thatare age-appropriate and independent of professional supervision(Liberman et al., 2002).

These criteria are externally imposed and normative rather thandetermined by the person with schizophrenia; hence, they are moretraditionally medical in their approach. Liberman and colleagues(2002) admit that the specific choice of dimensions for the aboveoperational definition of recovery, as well as the quantitativethresholds selected, are arbitrary. A later article compared this

Recovery from Schizophrenia 269

Dow

nloa

ded

by [

Uni

vers

ity o

f C

hica

go L

ibra

ry]

at 2

3:10

02

Oct

ober

201

4

definition with other definitions of recovery; of most import is thatall four definitions that were compared listed both psychopath-ology and psychosocial functioning as criteria, and three of themalso listed duration (Liberman & Kopelowicz, 2005).

A prominent example of a grassroots approach is that ofDeegan (1988), who highlights recovery as a way of approachinglife so that one feels meaningful within one’s community, inspite of the psychiatric disability. To be precise, Deegan (1988)defines recovery as a process, a way of life, an attitude, and away of approaching the day’s challenges, and emphasizes that it isnot a perfectly linear process; furthermore, she argues that the needis to meet the challenge of the disability and to re-establish a newand valued sense of integrity and purpose within and beyondthe limits of the disability. This definition makes it possible forthe person with schizophrenia to determine what being in recoveryis because sense of purpose and integrity are, or at least can be,personal and individualized rather than externally imposed andnormative. There are also definitions that are in-between the medi-cal model and the grassroots one, such as that of Resnick, Fontana,Lehman, and Rosenheck (2005), who analyzed subjective compo-nents of recovery using preexisting data; they found four domainsof recovery orientation: empowerment, hope, knowledge, and lifesatisfaction.

Another—perhaps overlapping—way to classify characteriza-tions of recovery is to determine whether they address recoveryas an outcome or as a process. Corrigan and Ralph stress thedistinction of the lived experience of recovery as a process:

Viewed as an outcome, recovery represents a change from a previouslymaladaptive state to a position of ‘‘normal’’ living. . . Although recoverydoes not necessarily mean being symptom free or without disability,descriptions of recovery as an outcome typically include accomplishing lifegoals in important life domains such as work and housing, as well asreporting both psychological well-being and improved quality of life. . .Many consumers find the definition of recovery as outcome to be unsatis-factory. It suggests an evaluative component; the patient is only a person ifhe or she meets some arbitrary and externally imposed criterion. As analternative, this group proposes recovery as a process; namely, peoplewho are concerned about their psychological well-being, struggling withtheir symptoms, and attempting their life goals are ‘‘in recovery’’ regard-less of where they fall in terms of any outcome criteria. (Corrigan & Ralph,2005, p. 5)

270 A. Rudnick

Dow

nloa

ded

by [

Uni

vers

ity o

f C

hica

go L

ibra

ry]

at 2

3:10

02

Oct

ober

201

4

The characterization of recovery as a process has received lesssystematic attention than recovery as an outcome (Liberman &Kopelowicz, 2005). The rest of this article will discuss the character-ization of recovery as a process from a philosophical perspective,using conceptual analysis and building on writings from processphilosophy, philosophy of health care, and theoretical biology.

PROCESSES AND SELF-ORGANIZATION

The concept of a process has been systematically discussed inphilosophy. There is a school of thought, or rather a series of philo-sophers, who have based a large part of their philosophy on thenotion of a process. Such thinking is termed process philosophy.The most well known process philosopher is Whitehead, whoseclassic book on process philosophy is titled Process and Reality(1978). The first process philosopher is claimed to be the ancientGreek philosopher Heraclitus, who famously argued that the riveris never the same when one crosses it the next time; then Plato andAristotle, who did much to develop process philosophy; and thenLeibniz, Hegel, Peirce, James, Bergson, Dewey, Whitehead andSheldon, to name some of the most prominent contributors to thisintellectual tradition (Rescher, 1996).

If process is so basic to our construal of reality, at least accordingto this approach, then it is crucial to understand what a process is.So what is a process? A process can be characterized as ‘‘a coordi-nated group of changes in the complexion of reality, an organizedfamily of occurrences that are systematically linked to one anothereither causally or functionally . . . a process consists in an integratedseries of connected developments unfolding in conjoint coordi-nation in line with a definite program’’ (Rescher, 1996, p. 38).The central components of this characterization of a processare change=unfolding, connection=linkage, and coordination=integration. That is, a process necessarily—and perhaps suffi-ciently—involves difference of value(s) in some variable(s) overtime, a physical or other relation between entities and=or eventsthat manifests that difference, and a pattern of that difference,respectively. Thus, at least in principle, processes can be describedin mathematical form that reflects physical or other phenomena.

Indeed, process as a basic concept has been used in science. Inparticular, Ilya Prigogine, the Nobel laureate in physical chemistry,

Recovery from Schizophrenia 271

Dow

nloa

ded

by [

Uni

vers

ity o

f C

hica

go L

ibra

ry]

at 2

3:10

02

Oct

ober

201

4

has highlighted that some systems, particularly biological systems,are far from equilibrium, hence manifest irreversible processes,and therefore change from disorder to order, that is, manifestself-organization, at least temporarily (Prigogine & Stengers, 1984).One of Prigogine’s prime examples are chemical clocks, whichare chemical reactions where the concentration of one of thereactants exceeds a critical threshold, after which the chemicalsystem reaches a limit cycle, meaning that the concentrations ofthe products begin to oscillate with a well-defined periodicity; more-over, Prigogine argues that chemical clocks are more reliable astimekeepers than mechanical oscillators such as springs (Prigogine& Stengers, 1984).

The notion of self-organization processes has played a centralrole in the history of modern biology. Claude Bernard, the so-calledfather of modern physiology, pointed to the stability of ‘‘theinternal environment,’’ addressing the protective stability of theintra- and intercellular matrix resulting from continuousprocesses of regulation, which Cannon later termed homeostasis(Bernard, 1957; Cannon, 1939). According to this approach, it iswhen such regulation goes awry, that is, when such self-organiza-tion processes break down, that pathology—literally disorder—manifests itself.

The demarcation of order from disorder in the context of healthcare, that is, of health from disease, and more generally the charac-terization of health-related notions, has been approached in variousways. There are various health-related notions, some of which areassociated with particular demarcation problems: for instance,there is serious conceptual disagreement regarding the disability=handicap distinction (Edwards, 2005); similarly problematic notionsare disease, illness, and sickness (Hofmann, 2002). One way todemarcate health from unhealth is to characterize the healthy asthe common and the disordered as the uncommon; another wayis to characterize the healthy as the ideal and the disordered as lessthan that or as the unwanted (Rudnick, 2000). Both these character-izations involve difficulties. An alternative or complementaryway is to characterize the healthy as (preserved) self-organizationprocesses and the disordered as disrupted self-organizationprocesses (Rudnick, 2002a).

There are various types of self-organization processes in livingsystems. Perhaps most generally, there are self-creation and self-repair processes (Rudnick, 2000). Self-creation processes generate

272 A. Rudnick

Dow

nloa

ded

by [

Uni

vers

ity o

f C

hica

go L

ibra

ry]

at 2

3:10

02

Oct

ober

201

4

living systems, as manifest in the development of an embryo,whereas self-repair processes maintain living systems, as manifestin tissue inflammation in response to infection or injury. Bothself-creation and self-repair can be disrupted, which results indevelopmental abnormalities and nondevelopmental disorders,respectively, both leading at the extreme to premature death. Thischaracterization posits processes, particularly self-organizationprocesses, of which self-creation and self-repair appear to be themain types in biological systems, as key to our understandingand depiction of health-related phenomena.

What does self-organization mean in the context of mentalhealth? It could be argued that mental health self-organization isthe creation and repair of phenomena associated with mental con-structs, such as emotion, cognition, and behavior. Note that endors-ing reductionist assumptions, that is, reducing the mental to thebiological (if that is possible), would not fundamentally changethe question of what is self-organization in the mental health con-text, nor its answer(s); admittedly, reductionism is problematic ingeneral and particularly in mental health (Rudnick, 2002b), yeteven if we endorsed reductionism, we could characterize mentalhealth self-organization as neural self-creation and self-repair pro-cesses, thus preserving the notion of self-organization in mentalhealth. Assuming mental health self-organization consists of mentaland=or neural self-creation and self-repair processes, mental healthwould involve an ongoing process, as disruptions to emotion,cognition, and behavior are never ending; hence, there is a needfor their ongoing repair, if not (re)creation.

It has been argued that health in general involves an ongoingprocess, considering that we are persistently exposed to—somewould say bombarded with—potential threats, be they external,such as microorganisms, which are commonly neutralized, or inter-nal, such as micromalignancy, which is commonly eliminated(Antonovsky, 1987). This suggests that the process of mental health(self-organization) is more fundamental, and perhaps more impor-tant, than mental health as an outcome. It also suggests that recov-ery, viewed as an ongoing process that everyone goes through tosome extent (because everyone goes through some adversity intheir life), is not unique to people with schizophrenia. Still, whatcan the process of recovery from a psychiatric disability be, parti-cularly in relation to individuals with schizophrenia, whose livescan be seriously disrupted by many factors?

Recovery from Schizophrenia 273

Dow

nloa

ded

by [

Uni

vers

ity o

f C

hica

go L

ibra

ry]

at 2

3:10

02

Oct

ober

201

4

RECOVERY AS SELF-ORGANIZATION

It may be helpful for our purposes to use an analogy with physicaldisability such as paraplegia. Individuals afflicted with paraplegiaare seriously impaired and disabled, and have to learn to live withthis physical disability. If they do this successfully, which meansachieving their goals as much as possible in spite of the disability,they can be said to recover. What does their recovery consist of,particularly as pertaining to processes of self-organization? It seemsthat their recovery consists of compensating for the disability bygenerating, enhancing, utilizing and maintaining alternativeabilities that make up for the lost ability of walking. In a sense,this is a moving target, as goals change, and following that,sometimes the compensatory abilities have to be changed in orderto achieve the new goals (if so, outcome may be in flux, too, whichmakes the distinction between recovery as process and recovery asoutcome not fully clear-cut, albeit useful). Still, goals—particularlylife goals—do not commonly change frequently or considerably. Inorder for such alternative abilities to be in place, biopsychosocialprocesses have to occur. Such processes involve creating—and, ifneed be, repairing—compensatory structures and functions, someof which do not exist beforehand and some of which already existbut require enhancement. For instance, in order to ambulate, a per-son with paraplegia usually has to operate a wheelchair, whichrequires developing and maintaining above-average upper limbmuscle strength. This is not just a biological process, but may alsorequire psychosocial processes, for example, changing habits suchas performing anaerobic exercises for the arms regularly, as wellas asking for support in situations where it is difficult to ambulatewith a wheelchair, for example, staircases without elevators. Hence,recovery involves the whole person because it addresses goals, inparticular life goals, and more importantly for our purposes,because it involves biopsychosocial processes that compensate forthe disability and hence facilitate self-organization for the personas a whole.

Recovery from schizophrenia is similar to recovery from para-plegia, although there may be important differences. Note thatthe analogy with physical disability was one of the foundations ofpsychiatric rehabilitation, established systematically in the 1970swith explicit reference to lessons that can be learned from the fieldof physical disability and physical rehabilitation (Anthony, Cohen,

274 A. Rudnick

Dow

nloa

ded

by [

Uni

vers

ity o

f C

hica

go L

ibra

ry]

at 2

3:10

02

Oct

ober

201

4

Farkas, & Gagne, 2002). Schizophrenia is associated, like para-plegia, with disability, in part due to the many impairments itinvolves, that is, positive symptoms such as hallucinations anddelusions, negative symptoms such as impoverished motivationto act and restricted emotional expression, comorbidity such asdepression and anxiety, and cognitive impairments such as dis-rupted attention and memory (Pratt & Mueser, 2002). In order tocompensate for these impairments, some of which are persistent,and achieve desired goals such as employment or socialization,individuals with schizophrenia can possibly use and enhance abili-ties that are not disrupted, at least not irreversibly, by schizo-phrenia. Such abilities have not been sufficiently studied in thecontext of schizophrenia, but one such ability could involve seekingsocial support (Rudnick & Kravetz, 2001), as social support hasbeen shown to improve outcome for people with schizophrenia,e.g., vocational outcome (Rogers, Anthony, Cohen, & Davies,1997). The processes required for such an ability to be in place couldinclude (but not be limited to): social perception, which involvesperceiving social cues in the normative way, social reasoning,which involves processing information related to social perceptionand deciding what to do about it, and social behavior, whichinvolves social skills and their implementation—all leading to seek-ing social support when appropriate (admittedly, seeking socialsupport is not sufficient if a person is socially isolated, as happensto many individuals with schizophrenia due to stigma and otherfactors). Of course, if such processes are impaired themselves, asperhaps happens more in psychiatric disabilities than in manyphysical disabilities, and particularly in schizophrenia (Corrigan& Penn, 2001), then compensatory self-organization is compro-mised, and the disability persists and can impact considerably onthe person with schizophrenia.

Individuals with schizophrenia seem to vary in their disorder-related self-organization. For instance, a study that examinedpsychological processes constituting the experienced relationbetween the self and the disorder of individuals with schizophreniademonstrated that some individuals experienced the disorder asforeign to them, whereas others experienced the disorder aspart of themselves and their lives (Roe, Chopra, & Rudnick,2004). The experienced relation between self and disorder can beviewed as a set of psychological processes that regulate the senseof self, and thus may constitute an important part of psychological

Recovery from Schizophrenia 275

Dow

nloa

ded

by [

Uni

vers

ity o

f C

hica

go L

ibra

ry]

at 2

3:10

02

Oct

ober

201

4

self-organization. An interesting conjecture that has not yet beentested systematically is that when the self is experienced as relatedto the disorder and in control of it, this may constitute adaptiveself-organization in the long-term, and outcome may be improved.

Thus, it seems that the use of (uncompromised) processes ofcompensatory self-organization is central in recovery from schizo-phrenia. Recovery from schizophrenia can, therefore, be character-ized as the processes of adaptive self-organization of the person asa whole and in relation to the environment. Note that the self–biologically or psychologically defined-is always partly dependenton and interactive with the environment, so that recovery as self-organization can be seen to involve the environment as well asthe person, thus including external as well as internal compensa-tory mechanisms. Recovery from schizophrenia is viewed here asadaptive self-organization, because self-organization can be mala-daptive if it goes off-track (similar to bodily inflammation that goesoff-track, e.g., in autoimmune diseases), and recovery addresses theperson as a whole because it involves her goals as well as biopsycho-social processes that compensate for the impairments associatedwith the disorder.

CONCLUSION

Recovery from schizophrenia can be characterized as self-organization processes that compensate for the impairmentsand deficits involved in schizophrenia and thus reduce the dis-ability related to schizophrenia, whether or not the symptomsare alleviated. This proposal, as hopeful as it is, should be fol-lowed by hypothesizing and testing specific self-organizationprocesses involved in recovery from schizophrenia, as well asinterventions that facilitate these processes. This could beattempted on various—biological, psychological, and social—levels. For instance, caring for others could be explored as apossible self-organization process that may be compensatorybecause of its social and personal moral value (and the associa-ted high social-regard and self-esteem). And interventions thatfacilitate this, such as counseling and supports that encourageand facilitate voluntarism, may be examined for their effectson the individual with schizophrenia; indeed, there is some evi-dence to suggest that volunteering improves the well-being of

276 A. Rudnick

Dow

nloa

ded

by [

Uni

vers

ity o

f C

hica

go L

ibra

ry]

at 2

3:10

02

Oct

ober

201

4

individuals with SMIs (Li & Ferraro, 2005). Last, it is plausiblethat this approach can be successfully applied to SMIs otherthan schizophrenia, such as bipolar disorder, although thatrequires examination elsewhere.

REFERENCES

Agassi, J. (1981). Science and society: Studies in the sociology of science. Dordrecht,Netherlands: Reidel.

Anthony, W. A., Cohen, M., Farkas, M., & Gagne, C. (2002). Psychiatric rehabilitation(2nd ed.). Boston: Center for Psychiatric Rehabilitation.

Antonovsky, A. (1987). Unraveling the mystery of health: How people manage stress andstay well. San Francisco: Jossey-Bass.

Bernard, C. (1957 [1865]). An introduction to the study of experimental medicine.New York: Dover.

Bleuler, M. (1978 [1972]). The Schizophrenic disorders: Long-term patient and familystudies. London: Yale University Press.

Cannon, W. B. (1939). The wisdom of the body. New York: Norton.Corrigan, P. W., & Penn, D. L. (2001). Social cognition and schizophrenia. Washington,

DC: American Psychological Association.Corrigan, P. W., & Ralph, R. O. (2005). Introduction: Recovery as consumer vision

and research paradigm. In: R. O. Ralph & P. W. Corrigan (Eds.), Recovery inmental illness: Broadening our understanding of wellness (pp. 3–17). Washington,DC: American Psychological Association.

Deegan, P. E. (1988). Recovery: The lived experience of rehabilitation. PsychosocialRehabilitation Journal, 11, 11–19.

Edwards, S. D. (2005). Disability: Definitions, value, and identity. London: Radcliffe.Ellison, M. L., Russinova, Z., Massaro, J., & Lyass, A. (2005). People with schizo-

phrenia employed as professionals and managers: Initial evidence and explo-ration. Schizophrenia Research, 76, 123–125.

Hofmann, B. (2002). On the triad disease, illness, and sickness. Journal of Medicineand Philosophy, 27, 651–673.

Hopper, K., Harrison, G., Janca, A., & Sartorius, N. (Eds.). (2007). Recovery fromschizophrenia: An international perspective. Oxford, UK: Oxford University Press.

Kraepelin, E. (1971 [1919]). Dementia Praecox and Paraphrenia. Huntington, NY:Kreiger.

Li, Y., & Ferraro, K. F. (2005). Volunteering and depression in later life: Social benefitor selection processes? Journal of Health and Social Behavior, 46, 68–84.

Liberman, R. P., & Kopelowicz, A. (2005). Recovery from schizophrenia: A concept insearch of research. Psychiatric Services, 56, 735–742.

Liberman, R. P., Kopelowicz, A., Ventura, J., & Gutkind, D. (2002). Operationalcriteria and factors related to recovery from schizophrenia. International Review ofPsychiatry, 14, 256–272.

Modestin, J., Huber, A., Satirli, E., Malti, T., & Hell, D. (2003). Long-term courseof schizophrenic illness: Bleuler’s study reconsidered. American Journal of Psychiatry,160, 2202–2208.

Recovery from Schizophrenia 277

Dow

nloa

ded

by [

Uni

vers

ity o

f C

hica

go L

ibra

ry]

at 2

3:10

02

Oct

ober

201

4

Pratt, S. I., & Mueser, K. T. (2002). Schizophrenia. In M. M. Antony & D. H. Barlow(Eds.), Handbook of assessment and treatment planning for psychological disorders(pp. 375–414). New York: Guilford.

Prigogine, I., & Stengers, I. (1984). Order out of chaos. New York: Bantam.Rescher, N. (1996). Process metaphysics: An introduction to process philosophy. Albany:

State University of New York Press.Resnick, S. G., Fontana, A., Lehman, A. F., & Rosenheck, R. A. (2005). An empirical

conceptualization of the recovery orientation. Schizophrenia Research, 75, 119–128.Roe, D., Chopra, M., & Rudnick, A. (2004). Persons with psychosis as active agents

interacting with their disorder. Psychiatric Rehabilitation Journal, 28, 122–128.Rogers, E. S., Anthony, W. A., Cohen, M., & Davies, R. R. (1997). Prediction of

vocational outcome based on clinical and demographic indicators among vocation-ally ready clients. Community Mental Health Journal, 33, 99–112.

Rudnick, A. (2000). The ends of medical intervention and the demarcation of thenormal from the pathological. Journal of Medicine and Philosophy, 25, 569–580.

Rudnick, A. (2002a). The notion of health: A conceptual analysis. Israel MedicalAssociation Journal, 4, 83–85.

Rudnick, A. (2002b). The molecular turn in psychiatry: A philosophical analysis.Journal of Medicine and Philosophy, 27, 287–296.

Rudnick, A., & Kravetz, S. (2001). The relation of social support-seeking to quality oflife in schizophrenia. Journal of Nervous and Mental Disease, 189, 258–262.

Sartorius, N. (2006). Lessons from a 10-year global programme against stigma anddiscrimination because of an illness. Psychology, Health & Medicine, 11, 383–388.

Ventura, J., Green, M. F., Shaner, A., & Liberman, R. P. (1993). Training and qualityassurance in the use of the Expanded Brief Psychiatric Rating Scale: The ‘driftbusters.’ International Journal of Methods in Psychiatric Research, 3, 221–244.

Whitehead, A. N. (1978 [1927=8]). Process and reality. New York: Free Press.

278 A. Rudnick

Dow

nloa

ded

by [

Uni

vers

ity o

f C

hica

go L

ibra

ry]

at 2

3:10

02

Oct

ober

201

4