This paper is developed upon a conference presentation in Copenhagen
(Eriksson, 2004a) and a note on it in a WPA newsletter (Eriksson,
2004b). The topic is the tentative diagnosis IRF (Impaired Recovery
Function) that is based on “four parameters of health” (Eriksson, 2003).
The four parameters of health are results of an attempt to
conceptualise health-related conditions out of an understanding of
recovery from stressful events. IRF is a theoretically defined
condition where the general level of function of the organism no longer
is enough to handle the accumulated level of need of recovery (see fig
1). It is postulated that general level of stress upon the organism is
positively correlated with need of recovery and at the same time
negatively correlated with the ability to perceive signals of need of
recovery. At a crucial point, therefore, the inability to perceive the
signals of need of recovery, and the drive to keep those signals
unnoticed, explains the tendency to sustain or even raise, the level of
stress (see fig 2 right). Since the need of recovery is not manageable
the level of stress is destructive.
The IRF-project permits an integrative view on health-related matters.
One concerns a definition of health: “health is an intact recovery
function (balance among needs)”. Since the recovery function (RF) is
the system that enables the individual to recover, it is related to
culture as well as tradition; the RF is contextual. In health care, it
is also possible to define preventive health care as interventions
maintaining the RF. Medical care in turn could be defined as
interventions restoring the RF (see fig 2 left).
The IRF-diagnosis perhaps can be used to tie theory to operational
definitions. One aim could be to construct an operational definition of
the very IRF-diagnosis. Theoretically, within the model, IRF is a risk
factor for prolonged negative health developments resulting in
conditions as panic disorder, obesity, chronic fatigue syndrome,
diabetes, pain syndromes and burnout (with its classical finding of
impaired cognitive function).
On the issue of nosology further developments of the theory have been
made regarding personality-related matters. Steps have been taken
towards theoretical integration of personality disorders, melancholia
and the effect of SSRI (Eriksson, 2005).
The IRF-project put emphasis on the assessment and the categorization
of the individuals’ ability to restore their systems of the recovery
function. Rehabilitation, then, should be guided by the aim of the
restoration. This has some clinical implications. Coping, for instance,
is an easy thing when the stress-level is low enough. In the model that
equals a high level of function or a decent buffer zone. When the level
of stress is too high, coping is more complex. The earlier strategy to
raise the level of stress to raise the level of function no longer
works. Instead the clinician has to persuade the patient that less is
more. In the model a lower level of stress, as seen on the right hand
of figure 1, leads to a higher level of function. In fact the medicine
is very bitter. In early phases of too high levels of stress the sense
of well-being is raised at the cost of level of function. In
rehabilitation, the thing is turned up side down: the level of function
is raised at the cost of a lowered sense of well-being.
Of course this is all familiar for practitioners. The suggested model
offers a conceptual structure for these experiences and hopefully can
be used to support the implementation of rehabilitation programs that
build upon the same ideas.