This paper discussed various philosophical and ethical perspectives on how to know recovery from schizophrenia. According to the empirical approach, recovery can be measured by objective and standardized tools which evaluate the severity of psychiatric symptoms or levels of social and vocational functioning. These measurements have minimum scores or sets of criteria of what recovery looks like, so this approach may be useful to evaluate patient’s treatment outcomes by healthcare providers. On the contrary, phenomenological approach stands qualitative research methods to understand an individual’s subjective, lived, or unique experiences while he or she lives with schizophrenia. Historical perspective holds that a point of view on recovery has been changed from negative to positive as our social perspectives for schizophrenia changes. Feminist perspective suggests that recovery can be understood by exploring female’s subjective experiences like successful marriage life or having responsibility for children. Ethical perspectives regarding the meaning of recovery were also addressed. Each philosophical and ethical perspective guides different research methodology and methods. Therefore, to employ appropriate methodology and methods, understanding philosophical and ethical backgrounds would be important.
Schizophrenia is one of the most serious and chronic mental disorders characterized by positive and negative symptoms, which leads to a functional deterioration. Lifetime prevalence of schizophrenia is about 1% of the general population of the world [
This changed view about the course of schizophrenia can be accounted by not only the introduction of antipsychotic drugs, but many other factors such as a landmark study on the prognosis of schizophrenia conducted by Harding, Brooks, Ashikaga, Strauss, & Breier [
Many studies have been conducted to understand what recovery from mental disorders means and to measure its features or characteristics. There are two different conceptualizations of recovery, so called, scientific vs. consumer perspectives, outsider vs. insider views, and outcome-oriented vs. process-oriented views [
Therefore, this paper: 1) reviewed philosophical and ethical backgrounds on how we could know a person with schizophrenia has recovered or is recovering, and 2) discussed how these perspectives could affect the knowledge development on recovery from schizophrenia.
Empiricism holds that knowledge is acquired by experience. Experience is defined as sensory data or information particularly about the objects of the world derived by using the senses. Empiricists focus on observable which is measurable by sense. In order to develop knowledge, empiricists must gain clear and accurate representations of the world by focusing on the physical world. This approach sees science as an act of discovery, rather than of invention [
From this empirical approach, recovery from schizophrenia can be understood in terms of symptom relief or functional outcomes on an individual level. People with schizophrenia have positive and negative symptoms. These symptoms can be measured using observational tools by health care providers. Liberman, Kopelowicz, Ventura, & Gutkind [
There is no doubt that empiricism has played a significant role in knowing the meaning of recovery of persons with schizophrenia. Empiricism emphasizes the development of a general theory or rule. This theory or rule can help us with manipulation and control over our lives looking at recovery from schizophrenia. Through the empirical perspective, the symptom remission and vocational and social functional improvements can be utilized to advance the science of knowledge about recovery. In terms of the perspective of health care providers, the empirical approach seems useful for evaluating whether or not a person with schizophrenia has recovered one’s function. This judgment requires objective descriptions including objective data. However, this empirical approach has several limitations. It views recovery as objective and observable. It does not consider the subjective and personal experiences of humans. Moreover, this approach views recovery on an individual level, not on a family level. Therefore, the understanding of recovery can be expanded by recognizing the individual’s subjective and social aspects. The examination of different philosophical tradition such as phenomenology is needed to understand the meaning of recovery better.
Hermeneutics is a process of interpretation, and is to understand fully something behind the phenomena, not just fragments [
From phenomenological perspective, recovery is understood in terms of the subjective and unique experience of an individual or family. Anthony [
From numerous qualitative studies on what recovery looks like, several common themes were explored: overcoming stuckness, redefining their identity, self-empower- ment, hope, understanding mental illness and preventing relapse, returning to basic functioning, improving quality of life, reintegration with context, and finding acceptance and ways to advocate [
Phenomenological approach generates forms of explanation and predictions that offer understanding and choice. This perspective allows us to broaden our views and to provide the opportunity to get to something behind objective and measurable recovery [
However, this phenomenological approach has its limitations. With this approach, living with schizophrenia includes diverse and multiple aspects of the daily lives of patients and families. This makes it hard to determine what recovery is and how it can be explained by a generalized rule. This indicates that the recovery from mental illness cannot be understood only by empirical or phenomenological perspectives. Although we can understand the subjective aspects of recovery better using the RAS or the MHRM, these tools are still problematic in terms of inconsistent domains and variables.
Historicism holds an adequate understanding of the nature and value of anything which requires consideration of its place and role within a process of historical development. Scientific development must be examined in regard to the context in which they occurred. In contrast with logical positivism, historicism takes the position that science is to be understood and evaluated by the process, not by a product. This approach provides both a methodological principle regarding how to understand situations and a philosophy about how situation came to exist [
With a historical approach, the recovery from schizophrenia can be understood in terms of the change in social perspectives for the disease, resulting in the change of health situations. The point of view for recovery from schizophrenia in the past was not the same as that of the present. For example, just a few decades ago, schizophrenia was perceived as being crazy or captured with an evil spirit. Thus, schizophrenia was recognized as being not cured or recovered. Human rights of the patients were also not respected. However, with the liberation movement by patients with mental disorders, perspectives on the recovery has been changing from the negative to the positive belief that schizophrenia can be recovered and human rights for the patients should be respected like that of lay people. Therefore, self-help, empowerment, and advocacy of patients with mental disorders have been developed [
Feminist perspective’s key tenets are that the major source of knowledge can be drawn from contextually-oriented women’s subjective experiences [
In order to discover what recovery from schizophrenia means with feministic view, women’s subjective experiences about recovery from schizophrenia should be asked and contexts of the phenomena should be considered across the study. Research questions should be for women. Interpretations of findings should be validated with study participants [
As one of the consequentialism, utilitarianism determines whether the action is right or wrong according to its consequences, rather than reason or process. This approach focuses on the value of well-being, such as happiness, freedom, and health, strictly according to the principle of utility. This means that we should produce the maximum value for the greatest number. This view is based on the idea that individuals have an equal weight for the interests [
Kantianism poses the opposite perspective from utilitarianism. Action can be judged by reasons, so called rational powers, rather than the consequences of actions. It means that the moral reason can justify one’s action, which is provided by the objective rule. Everyone in a similar situation must follow the moral rule. Treating person with respect and moral dignity is another important tenet of Kantianism. Therefore, we always should treat person as an end, not as a means [
Communitarianism holds that a commitment to a community which shares communal values, social goals, and cooperative virtues, is elementary in ethnics. This approach suggests that an individual is influenced by one’s society. It is only social roles that can determine what people ought to do, not the individual’s value [
Right theory underscores liberty, expression, and protection of life against oppression and unequal treatment raised by communitarianism or utilitarianism. These rights are the basis of moral judgment. From the rights, rules and obligations are derived [
As presented, what a person recovering from schizophrenia looks like is somewhat different. Some people see recovery as relieved positive and negative symptoms or functional improvement of a patient with schizophrenia, however, others regard the phenomena of recovery as having hope and responsibility, enhancing quality of life, and healing process. Although women’s experiences have been rarely seen in these concepts, it is evident that these are major points when considering definitions of recovery from schizophrenia.
Employing different methodology in studies usually produces different methods and results. Methodology guides research studies at a theory level, and method is a technical way to gather data [
Ethical perspectives also can influence methodology in research studies. At a glance, ethical perspectives are regarded as a guiding principle to decide whether what a person or a group did is right or wrong. When you look inside ethical perspectives, such as utilitarianism vs. Kantianism, and communitarianism vs. rights theory, some methodological thoughts that ethical perspectives can guide studies can be raised. Common interest of both utilitarianism and Kantianism is about result vs. motivation of a person’s behaviors. This could be applied to whether recovery from schizophrenia can be known as a result or a process or motivation of the person. A shared or an individual’s point of view is the main interest of communitarianism and rights theory. Therefore, when recruiting study participants, it is important to decide who the informant should be, who can tell the phenomena of recovery.
Kim, M. (2017) Philosophical and Ethical Perspectives on How We Could Know Recovery from Schi- zophrenia and Their Impact on Knowledge Development. Open Journal of Psychiatry, 7, 31-39. http://dx.doi.org/10.4236/ojpsych.2017.71003