How Vermont Discovered the Possibility of Recovery

About this course

Courtney Harding lays out the empirical base for the recovery movement with this first module on the Vermont Long-Term Outcome Study. She explains how a combination of social support, hope, and modest use of medications produce far better outcomes than have generally understood to be possible in the field.

Note: This lecture does not currently provide continuing education.

Course fee

This course is for free. If you find this course useful, please consider making a donation to help support our work.

Your Instructor

Courtenay Harding was trained at the University of Vermont and Yale and has been a professor of psychiatry for more than 3 decades. Currently, she is a Visiting Professor in the Department of Psychiatry at Eastern Virginia Medical School. Her research has included lead participation in two three-decade NIMH studies of schizophrenia and other serious disorders. Her work on redesigning systems of care has taken her to 30 states and as many countries. Prof. Harding received the Alexander Gralnick Research Investigator Award from the American Psychological Association’s foundation for “exceptional contributions to the study of schizophrenia and other serious mental illness and for mentoring a new generation of researchers.”

Class Curriculum

  How Vermont Discovered the Possibility of Recovery
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Learning objectives

Module 1: Changes in Schizophrenia Across Time: Paradoxes, Patterns, and Predictors of Outcome

  • To understand the paradox between clinical everyday experience and the findings from the 11 very long-term studies 2 to 3 decades in length from across the world of serious and persistent problems known currently as schizophrenia.
  • To demonstrate that results have consistently shown that at least 1/2 to 2/3 of every cohort studied found significant improvement and even full recovery against all odds and the expectations of most clinicians and systems of care.
  • To review findings from long-term studies and show that many clinical assumptions we have made do not hold up over time.
  • To outline the ingredients that help or impede the recovery process.
  • To describe predictors and patterns of outcome and other lessons learned from these studies.

Module 2: How Vermont Discovered the Possibility of Recovery in People Meeting the Contemporary Criteria for Schizophrenia

  • To provide intimate details of one of the very longest studies of schizophrenia from Vermont, USA.
  • To show how Dr. George Brooks, as a young psychiatrist and pharmacologist, shifted from his narrow biomedical approach to much wider collaborative biopsychosocial strategies.
  • To describe how this model demonstration project resulted in taking the absolute worst cases from the back wards of Vermont’s only state hospital to success in the real community when everyone else thought it was impossible task.
  • To provide specific examples of this program and how they have profound implications for today’s treatment modalities.

Module 3: Does Rehabilitation Really Make a Difference in the Long-term Outcome for Schizophrenia and other important implications for care?

  • To describe the world’s only matched comparison very long-term project called The Maine-Vermont Study which showed the impact of rehabilitation versus no rehabilitation for very long stay and deinstitutionalized patients.
  • To show how the data from this comparison provide significant support for the importance of rehabilitation to help people reclaim their lives.
  • To provide a rationale for making rehabilitation a first-line insurance-covered approach because finding a job, a home, friends, an intimate other and social justice can often reduce symptoms, get people back on their feet, and back into society.
  • To discuss evidence-based, practice-based, and peer-based approaches which, if tailor-made to each individual, may help people reclaim their lives much quicker and better than long-term medication and maintenance-based strategies which keep most people at only modest levels of functioning and on the edges of society.

Module 4: What Does Recovery Mean?

  • To provide different definitions of the words: recovery and recovering. To elucidate the conceptual differences between remission and recovery.
  • To show the interaction between biopsychosocial factors, the person, and the impact of time on the course.
  • To describe factors such as symptom and diagnostic fluidity, reconstitution of vocational and social functioning, continuities and discontinuities of personality and adult developmental tasks, coping strategies, gender effects, and the impact of environmental engineering.
  • To show the importance of hope, resilience, neural plasticity, self-efficacy and healing.
  • To provide ideas to transform psychiatric, social and psychological work into more joyous and rewarding relationships and experiences for all parties.

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