Dr. Moller: When I started working in the field of mental illness in 1978, patients' were not even told the name of their illness. They were treated like robots. Take your medicine. Keep them quiet. I knew just by the look in patient’s eyes that there was a person there who was suffering tremendously. And I knew then that that was going to be the focus of my research—it would be on the lived experience of schizophrenia. What’s it really like to be trapped inside a brain that is playing all these tricks on you? It’s horrible. It’s frightening. And as patients learned that it was okay and safe to talk about really scary things, and that I wasn’t going to get all freaked out about it, they started opening up.
So, as a result of studying young people who are recovering from schizophrenia, I was wanting to discover milestones that would indicate recovery so I could share these with patients and families. Just like you do if you have a heart attack—“Okay, after a month we can put you on the treadmill and you should be able to do this”—there are recovery milestones for all other illnesses. There were no recovery milestones for schizophrenia. So, the model that emerged out of the qualitative data from my dissertation I named the MAPP recovery model: “M-A-P-P,” which stands for milestones of adjustment post-psychosis.
There are 50 milestones that are divided into 4 distinct phases of recovery. The 4 phases are named “from the couch to the bus depot to the mall to work.” That’s the layman’s terms, that everyone can relate to. In research terms the 4 phases are cognitive dissonance, which is the acute psychotic phase. Insight, which is when the patient begins to question, “Hm, maybe there really aren’t ghosts trying to follow me—maybe that’s my brain playing tricks on me.” The third phase is cognitive constancy, which is when the person is able to reengage with the world in an interactive way. And the fourth phase is ordinariness, and that phase was named with the help of the participants in the research. When I said, “What’s the ultimate goal that you hope to achieve at the end of this program?” and they said, “I just want to be ordinary, like everybody else.”
In understanding the MAPP trajectory, it’s important to know that these phases are not linear. They overlap. So, when a patient is in the throes of the psychosis and they’re on the couch, they’ll be questioning, they’ll be trying to get some insight. Eventually this person will say, “I’m tired of being isolated“ and they’ll go somewhere rather remote where there is not a lot of people they have to talk to. So typically, that’s a bus depot, and we see a lot of our patients hanging out at the bus depot because at the bus depot you’re sort of a non-entity but yet the person with schizophrenia is craving to be around other people but afraid to speak or still unable to speak. That phase can be another 9 months or so. Then the individual will say “you know I was ready to go to the mall.” And what’s different about the mall is its light, the patient is seen, and they interact, and they purchase things. To make a purchase like everyone else, it’s a huge milestone. Then they’re ready for ordinariness. Then they’re ready to think about going to school, getting some kind of a job, and getting on with it.