The number of people with chronic conditions is soaring. Are we less healthy than we used to be – or overdiagnosing illness? (Suzanne O'Sullivan, The Guardian, March 1 2025)
"Johnstone prefers to conceptualise mental health problems as survival strategies rather than brain disorders.
In this theory, experiences that are described as “symptoms” are actually a reaction to threats and a manifestation of what a person needs to do to overcome that threat.
Humans are essentially social beings. Troubled behaviour and low mood are inseparable from their social environment and relationships.
As Johnstone says, what is classed as mental illness can be a person’s attempt to be protected, valued or to find their place.
For Anna, this might mean examining how events such as the need to change schools in the middle of an academic year affected her.
Her subsequent feelings and actions might be better regarded as a survival strategy rather than as a brain disorder.
“Our behaviour is an intelligible response to our circumstance, history, belief systems and bodily capacities,” Johnstone says.
When mental health problems are viewed in this way, recovery starts to seem far more possible.
The importance of this is illustrated by the story of Prof Paul Garner, a UK-based senior medical doctor and researcher.
In March 2020, Garner caught Covid-19 and was shocked to find himself severely fatigued weeks after the acute infection seemed to have passed.
His initial infection had been mild but the aftermath left him feeling as if he had been hit “around the head with a cricket bat”.
At points, he felt he was dying. He had a new symptom every day: muggy head, upset stomach, tinnitus, pins and needles, breathlessness, dizziness.
In a blog for the British Medical Journal, he described his illness as like “an Advent calendar, every day there was something new”.
Garner is an infectious disease specialist. He expected that he, of all people, should be able to explain what was happening to his own body, but found he couldn’t.
He wondered if the virus had triggered some novel immunological disorder that did not exist in medical textbooks.
So he turned to the internet for answers and found he was not alone. In long Covid support groups, there were lots of people who shared his exact experience. Marathon runners who could no longer walk after mild Covid.
Through the long Covid groups, he found his way to communities of people who had developed chronic fatigue syndromes after other infections. Many of these people had been ill for decades.
His original expectation, based on his medical knowledge, was that he should get steadily better with time, recuperation and gentle increases in activity.
But that was not marrying with his unfolding reality. A 10-minute bike ride taken on a good day had provoked a three-day relapse.
So Garner decided to learn from the narratives of those who had been dealing with non-recovery for much longer than him.
They recommended pacing: working within the limits of his energy levels rather than trying to exercise his way out of the situation.
He took advice from a friend: “Stop trying to dominate the virus … accommodate it.” He learned to do less.
That brought him to a baseline in which he was not getting worse – but he was not getting better, either.
That could have been where Garner’s story ended. By September 2020, he had improved but he was no longer recovering further.
So he started searching beyond the non-recovery stories, for those with more positive outcomes.
That was how he found Recovery Norway, a group of people who once had chronic fatigue syndrome but had beaten it.
The group gave him a recovery mentor as well as another perspective and, crucially, a recovery identity.
He realised that while pacing had helped him at the start, he had then become obsessed with it.
As he described in his blog, he had started to unconsciously monitor signals from his body until he became paralysed with fear.
He believed long Covid was a metabolic disease that had damaged his mitochondria, but the Norway group made him think differently.
He didn’t doubt the virus had triggered the fatigue but felt he had later become caught in a vicious cycle of illness driven by his fear.
Viruses cause fatigue in order to make people rest, which promotes recovery.
But, in Garner’s case, his recovery had gone awry because he inadvertently conditioned his body to stay tired.
Garner realised he had to retrain his brain to react differently to the fatigue if he was to get better.
“I suddenly believed I would recover completely,” he writes. “I stopped my constant monitoring of symptoms. I avoided reading stories about illness and discussing symptoms, research or treatments by dropping off the Facebook groups with other patients. I spent time seeking joy, happiness … and overcame my fear of exercise.”
By the end of 2020 he had made a full recovery.
ADHD used to have a recovery identity. In the 1960s and 70s, the DSM described it as condition that went away in adolescence.
By the 90s, it was recognised that the symptoms did not always disappear completely but did lessen as people got older. Some studies found remission in up to 60% of people.
Severe ADHD lessened but often persisted, while people with mild ADHD could expect a chance of full recovery.
But ADHD is slowly being incorporated into the identities of many young people. Some support groups discourage the attempt to overcome ADHD traits.
People are told to unmask and to share their ADHD selves with others.
But learning to control our moods, behaviour and impulses is part of growing up, whether one has ADHD or not.
We all become more socially competent, gain focus and are better able to cope through practice.
Encouraging young people to do otherwise may be well-intentioned but potentially sets them up for non-recovery.
The rise in subtler ADHD presentations in adults may also undermine a young person’s expectation that their difficulties will disappear in time.
A growing population of adults have incorporated ADHD into their self-concept. When a medical problem is part of a person’s identity, it becomes inescapable."
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