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Sir: I read with interest Dr Whitewell's comments about the myth of recovery from mental illness (Psychiatric Bulletin, October 1999, 23, 621-622). The topic, particularly resonated with me as the institution where I work is being featured in a television series entitled ‘The Talking Cure’ (my italics). I would agree with Dr Whitewell's premise that we live in an age where expectations are high and there is a pressure on psychiatrists to provide ‘solutions’ or ‘cures’ through whatever treatment they offer be it psychotherapy, pharmacotherapy or some combination of the two.

It seems to me that the current emphasis on clinical governance and evidence-based medicine as well as the need for randomised-controlled trials to prove that our treatments are effective is part of this culture. While I would not argue against the value of quality assurance and evidence-based medicine, perhaps a more realistic appraisal, in broader terms, of the likely outcome of our treatment is needed.

The most up to date antipsychotics do not ‘cure’ schizophrenia in the same way that psychodynamic psychotherapy does not cure people with borderline personality disorders. In child psychiatry there is a pressure for clinicians to provide a cure for conditions such as Attention-Deficit Hyperactivity Disorder (ADHD), with medication such as methylphenidate. ADHD is increasingly regarded as a ‘thing’ that can be ‘cured’ whereas it is actually more of a conceptual tool which may help us to address a complicated area of child psychiatry. Of course, we often do offer valuable therapeutic interventions, otherwise what would be the point of us existing, but let us be realistic about what we can achieve. In this way too, patients may feel more empowered to find their own ways of alleviating their difficulties without relying excessively on clinicians.

Essentially, I would agree with Dr Whitewell that the desire for complete or absolute cure is a primitive one. Sometimes after a session with a particular family or child I wonder what help I have offered them. It may well be that they have found their contact with psychiatric services useful, but I find that I need to let go of the desire to solve all their problems or offer them a way of escaping all their difficulties. This is how it is with mental illness generally. I believe we need to be more realistic about what we can offer our patients in terms of ‘recovery’ while at the same time always working with them to alleviate their difficulties in the hope that things will improve.