Recovery as perceived by people with schizophrenia, family members and health professionals: a grounded theory.

BACKGROUND: Advances in knowledge in the biomedical and psychosocial sciences have expanded our understanding of schizophrenia and of how it evolves in people living with it. These individuals are no longer viewed as being 'ill' and requiring long-term hospitalisation. We have come instead to have a much more positive view of them and of the role they can play in coming to terms both with their health condition and with society. In the majority of cases, schizophrenia sufferers have the potential to recover.

AIMS: The purpose of this study is to propose a theoretical explanation of recovery based on the concept of human responses put forward by the American Nurses' Association.

PARTICIPANTS: Data were collected from 41 participants (16 people living with schizophrenia, 5 family members, 20 health professionals). Selection criteria required the people living with schizophrenia to be in stable health, see themselves as being in the process of recovery, and be able to speak about it. Family members were expected to have displayed a strong bond with their relative living with schizophrenia, and the health professionals to have had at least 3 years experience dealing with schizophrenia patients.

METHOD: The Grounded Theory approach was selected because it allows for diversified data sources to be used in the empirical study of a phenomenon. It is an appropriate approach for the conceptualization of complex phenomena and the development of middle-range theory. To ensure a variety of subjects were involved, semi-structured interviews were conducted in three different settings: a specialised psychiatric hospital, a self-help group, and a community setting.

FINDINGS: Seven categories emerged from the analysis and conceptualization: perceiving schizophrenia as a 'descent into hell'; igniting a spark of hope; developing insight; activating the instinct to fight back; discovering keys to well-being; maintaining a constant equilibrium between internal and external forces; and, finally, seeing light at the end of the tunnel. Comparison of these categories led to their being consolidated into a core category in which recovery is defined as a 'process involving intrinsic, non-linear progress that is primarily generated by the role as actor that the individual adopts to rebuild his or her sense of self and to manage the imbalance between internal and external forces with the objective of charting a path through the social world and regaining a sense of well-being on all biopsychosocial levels.'

CONCLUSION: This study of recovery from schizophrenia is conceptualised from the nursing perspective: the concept of 'Human Responses' [American Nurses Association (ANA), 1980. Nursing: A Social Policy Statement. ANA, Kansas City, MO; American Association of Neuroscience Nurses (AANN's), 2001. AANN's Neuroscience Nursing: Human Responses to Neurologic Dysfunction, second ed. W. B. Saunders Company, Philadelphia]. It was possible to go beyond a descriptive analysis and bring out the dynamics of the process through a detailed, in-depth presentation of the recovery process. The theoretical explanation we have postulated is based on the inner resources of individuals diagnosed with schizophrenia and their potential to make a recovery.