Being ill and getting better: recovery and accounts of disorder

Abstract

The aim of psychiatric treatment is to help patients to get better, but working out what getting better should be taken to mean can be problematic. This chapter explores how one's view of what counts as recovery will depend on the account of disorder that one adopts. Accounts of disorder can be split into two main categories. Biologically based accounts (paradigmatically those of Christopher Boorse) claim that disorder is purely a matter of biological dysfunctioning. According to such accounts the aim of treatment will be to restore functioning such that ultimately the patient's psychological subsystems will function in the same way as those of other humans of the same age and gender. Accordingly, whether a patient is getting better will be seen as the sort of thing that can be fairly assessed by standardized rating scales. In contrast, accounts which hold that disorder is a value-laden concept will lead one to view recovery differently. According to such accounts, for a condition to count as a disorder it must be bad. It will be argued that whether a condition is bad or not will vary with factors such as the social environment, and also with the aims, desires, and self-understanding of the individual patient. One consequence of this is that a condition that was once bad for the patient can be rendered neutral or good for them not only by altering the functioning of their psychological subsystems, but also by altering the patient's social environment or their own assessment of the situation. This means that measuring “recovery” will not be a straightforward matter. The chapter ends by considering how treatment efficacy might best be assessed according to such a view of recovery.

“Clinician Knows Best”? Injustices in the Medicalization of Mental Illness

“…The medicalization of schizophrenia and bipolar disorder, in which these disorders are viewed primarily as problems of individual biology, supports a clinical model of recovery. In this model, the goal of recovery is the alleviation or remission of symptoms and the regaining of functioning, enabling a person to live relatively independently and to be integrated into the community (Adenponle, Whitley, and Kirmayer 2012, 109;Cooper 2007Cooper , 2012Gill 2012, 95;Schrank, Wally, and Schmidt 2012, 133;Slade 2012, 78). Recovery is evidenced by measurable outcomes in areas such as employment, education, housing, and independence in activities like personal hygiene and self-care.…”