Recovery as a medical myth

Sir: I would like to comment on the responses to my paper (Psychiatric Bulletin, October 1999, 23, 621-622). Prior (Psychiatric Bulletin, January 2000, 24, 30) states that I was using a medical concept of recovery; I agree. However, I did not define recovery, and it was the patients who thought that they had not recovered. I think that this concept of recovery is part of a medical model in which people suffer from clearly defined episodes of illness, from which they can hope to make an equally clearly defined recovery, provided they get the right treatment.

Psychiatry has tended to operate with these oversimplified concepts. My conclusion is that recovery from mental illness is part of a medical view of things, and as such is largely a myth. It is an unexamined idea that people believe, but which does not reflect reality. It also seems that this unhelpful myth is shared by our patients. One reason for the hold that this myth has is that it fits quite well with the situations that we face in acute psychiatry. It justifies interventions that may be urgent and difficult. It is in the longer term that the model fails.

Hope and optimism are essential in mental health services, as Sayce and Perkins comment (Psychiatric Bulletin, February 2000, 23, 74). That is why the medical concept of recovery — by which so many are likely to be disappointed — is an unhelpful myth. They mention a different process of recovery — which is slow, and very personal: a rebuilding of a life, which may take a life time.

We are only now beginning to understand this process and how to help people with it. It is an exciting and growing field. What is clear is that medical treatments by themselves do not achieve this. Too often in the past the traditional medical focus on diagnosis, medication and coercion have been seen by service users as standing in the way of personal recovery. There is a problem concerning words here. Recovery is a very positive and uplifting word. It has been linked into a limited medical model where it does not fit. ‘Personal recovery’ may be a better term as it stresses the individual, and gets away from the idea that this is something that we can do to people.