This chapter briefly discusses the history of the notion of "cure" in relation to serious mental illnesses from Pinel to the present day, including both theories on the nature of the illnesses and the nature of presumed therapeutic agents and mechanisms. The chapter then gives a brief overview of the notion of "recovery" in relation to serious mental illnesses, also from Pinel to the present day, and describes various definitions and forms of recovery as they have emerged over time. With this historical and conceptual background in place, the chapter then takes up the present state-of-the-art in psychiatry in relation to both concepts of cure and recovery, considers the empirical and neuroscientific evidence available relative to each concept, and then suggests several directions for research and philosophical reflection as the field continues to evolve. Two guiding principles that shape this discussion are that mental illnesses are not one-dimensional phenomena, but may be made up of several loosely related components which each have their own natural course, and that mental illnesses do not typically take over the entirety of a person's functioning, but also leave other aspects of functioning relatively intact. The combination of these principles suggests that cure and recovery are not likely to be binary functions in relation to serious mental illnesses (i.e., yes or no), but will more likely be more a matter of degree across multiple domains.
Julian C. Hughes
Dementia is dead, long live aging! This chapter sets out the philosophical sources for understanding working with "dementia." The concept, "dementia," serves no useful purpose. Even "Alzheimer's disease" turns out to be problematic. This is because there is a lack of precision around the boundaries of these notions. The messiness that surrounds these notions, in terms of facts and values, is made obvious when we consider mild cognitive impairment, which is said to be a pre-dementia state. It makes more biological sense to think in terms of the ageing brain, rather than to search for discrete disease entities. We need to think in terms of dementia-in-the-world. Ageing is not something that we do solely at the end of our lives: it is a part of our lives, to be celebrated. We must look more broadly at dementia-in-the-world as a (biological, psychological, social, and spiritual) feature of our ageing lives.