Schrank & Slade's article on recovery in psychiatry (Psychiatric Bulletin, September 31, 321–325) is important for three reasons. First, it provides an exhaustive coverage. Second, many components contributing to recovery are also non-specific therapeutic factors, like: (a) accepting the illness; (b) hope; (c) self-confidence; (d) courage, including an attitudinal readiness to experiment with tolerable risks; (e) responsibility and control, encompassing ‘internal locus of control’; (f) recognising one's values, strengths and limitations, which includes self-monitoring and evaluation. Similar factors also constitute desirable therapist qualities. Third, and the most important, is that the authors have resurrected the age-old concept of ‘determination’.
I believe that this concept is closely related to that of ‘will’, which is probably even more fundamental as regards mental health recovery. Determination also shares some common components with psychological phenomena – placebo effect, motivation and expectation, and it plays an important role in clinical outcomes, for example in cancer survival.
The concept of will (as in ‘will power’) on the other hand, is deeply embedded in all human cultures. A ‘will to survive’ has appeared in war and heroic anecdotes throughout centuries and a ‘will-to-win’ has been the mantra in competitive sports. Even though this concept is difficult to operationally define, it is unquestionably worthy of investigation by the mental health profession.
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