Contact: Johan R A Eriksson
Psychologist
Brandbergens vårdcentral
Jungfruns gata 416-419
SE-136 60 Haninge
SWEDEN

E-mail: johan.eriksson@sll.se

Abstract
The paper describes the theoretical context of the tentative diagnosis IRF (Impaired Recovery Function). 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, the point of  IRF, 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. Since the need of recovery is not manageable the level of stress is destructive. Within the IRF-project health is defined as an intact recovery function (balance among needs). Preventive health care is defined as interventions maintaining the recovery function (RF) whereas medical care is defined as interventions restoring the RF.

Keywords: recovery function, need of recovery, health

Introduction
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.

Figure 1                                                                                           Figure 2

                                        

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.

References

Eriksson , J. (2003) ”A Psycho-Pedagogical Model for Rehabilitation in Exhaustion Syndrome – a Cognitive Tool” (Psykopedagogisk Modell för Rehabilitering vid Utmattningssyndrom – ett Kognitivt Verktyg). Svensk Rehabilitering 1.

Eriksson, J (2004a) ”Pain, Fatigue and Anxiety - Exploring Prolonged Negative Health Development I: A Theoretical Structure – On Impaired Recovery Function”. Nordisk Psykolog Kongres (Nordic psychologist conference) 2004. Copenhagen 18-20/8.

Eriksson, J. (2004b) A note on a project of tying operational definitions of psychiatry to theory: On the tentative IRF-diagnosis. World Psychiatric Association. Section on Classification, Diagnostic Assessment and Nomenclature. Newsletter. December 20.

Eriksson, J. (2005) Psychiatric Care After One’s Need? – A New Theoretical Perspective. 8th International Conference on Philosophy and Psychiatry, Philosophies for Community Psychiatry: Recovery-Oriented, Evidence Based, and Beyond. New Haven, Conneticut, USA September.