a chance of recovery and those who do not. (Blikshavn, Husum, & Magelssen, 2017; Burnside, 1998; Kelly & McLoughlin, 2002; Olié & Courtet, 2016; Schoevers, Asmus, & Tilburg, 1998; Vandenberghe, 2011) Two reasons are often mentioned for questioning irremediability: the nature of psychiatric illness and the nature of psychiatric treatment. The nature of psychiatric illness In the discussion on the irremediability of psychiatric suffering, often a comparison is made with cancer. Several authors argue that the distinction between remediable and irremediable forms of cancer is fairly straightforward for two reasons. First, cancer has a clear biological basis. Secondly, for most forms of cancer it can be predicted whether and, within certain boundaries, when they will lead to death. (Appel, 2007; Appelbaum, 2016; Miller, 2015; Schoevers et al., 1998) Various authors point out that psychiatric suffering differs in both aspects. First, the current psychiatric diagnostic model is said to describe syndromes and therefore offers no insight in the underlying biological, psychodynamic or social factors, hampering the possibility of accurate prediction of disease progression. (Blikshavn et al., 2017; Demyttenaere & Van Duppen, 2018; Naudts, Ducatelle, Kovacs, & Laurens, 2006; Schoevers et al., 1998; Yarascavitch, 2017) Second, psychiatric disorders themselves are said not to be lethal, except maybe for severe eating disorders. (Lopez, Yager, & Feinstein, 2010) Therefore patients may have a life expectancy of decades. (Kissane & Kelly, 2000; Steinbock, 2017) Various authors argue that it may be possible that in this period new treatments are discovered, which can eventually help relieve suffering. (Broome & de Cates, 2015; Burnside, 1998) However, when asked about the possibility of future new treatments, 56% of 248 Dutch psychiatrists thought that this should not be taken into account when deciding about PAD, 22% thought it should be taken into account, 22% were neutral. (Onwuteaka-Philipsen et al., 2017) The nature of psychiatric treatment The second reason for questioning irremediability is the nature of psychiatric treatment. First, it is argued that the broad range of biomedical and psychotherapeutic approaches offers so many (combined) treatment options that a claim about irremediability is practically impossible. (Kirby, 2017) Secondly, authors argue that psychiatrists apply all these therapies dynamically, which can make it hard to determine when and why specific psychiatric treatments work and also when and why they stop working. (Schoevers et al., 1998) Thirdly, authors mention that sometimes when therapists and patients stop trying to control symptoms, paradoxically, the chances of recovery improve. This is said to happen when a switch is made from a symptom-reduction to an acceptance based therapy. (Blikshavn et al., 2017; Hodel & Trachsel, 2016; Olié & Courtet, 2016) It is also argued that a certain risk of self-harm may have to be accepted in order for the patient to recover. (Chabot, 2000) 58 | PART II - CHAPTER 4 4