Recovery from Schizophrenia: An International Perspective Edited by Kim Hooper, Glyn Harrison, Aleksander Janca & Norman Sartorius. Oxford University Press. 2007. 392 pp. £49.00 (hb). ISBN 9780195313673

This book is a long overdue account of a research tour de force led by the World Health Organization (WHO) between 1991 and 1996, which made a crucial addition to the contemporaneous research challenging the early Kraeplinian view that the long-term prognosis for schizophrenia was almost uniformly poor. Enormous difficulties arise when comparisons are made across multiple studies in different countries, using different sample frames, sampling criteria, periods of follow up and assessment measures, and this provided the rationale for a series of well-designed WHO multi-country studies using uniform methodology. However, such studies raise enormous problems of their own, not least the difficulties in negotiation, coordination, implementation to attain their goal and, especially in this case, publication, since this particular book had to face unprecedented challenges in finally reaching the light of day.

The International Study of Schizophrenia was a transcultural investigation coordinated by WHO in 18 centres in 14 countries, and was designed to examine patterns of long-term course and outcome of severe mental disorders in different cultures, develop better methods for studying characteristics of mental disorders in different settings and to strengthen the scientific base for future international research on schizophrenia from a public health perspective. Cohorts or participants assessed in a number of earlier WHO studies, and also local studies at three other centres, were followed up for between 12 and 26 years.

Recovery from Schizophrenia reports the combined findings and the separate findings from each centre. The central message from the study is that schizophrenia is largely an episodic disorder, with rather favourable outcome for a significant proportion of those afflicted, and that the long-term outcome for over half was quite good. Prognosis for these cohorts was better in low- and middle-income countries. Poor early course of illness was the best predictor of subsequent poor outcome, but even so a fifth with poor early course subsequently recovered. The linkage of the data to differences in local cultures, kinship networks, social support systems, local family and community beliefs, expectations and practices, health systems, and rapidly changing economies and urbanisation has raised more questions than have yet been answered. A key concern for the reader is how comparable were the original participants, given that they were drawn from a variety of studies of treatment populations 15–30 years ago rather than from community samples. (Certainly people with chronic schizophrenia are commonly seen in low- and middle-income countries, finally abandoned by exhausted and impoverished families, and they are the one patient group with which the traditional healers I have met make no claim to have any success, in contrast to first-episode illness. The comparable effect of early and sustained support to the families of people with severe schizophrenia would seem to be well worth investigating.)

This book is a fascinating read for researchers and mental health professionals containing much to interest, educate and intrigue, and is a classic for the library bookshelf.