Why Are We So Bad at Getting Better?

Four and a half years ago, in the heat of an N.B.A. playoff game against the Houston Rockets, Kevin Durant, the superstar forward of the Golden State Warriors, dodged a defender, dribbled once, and sank a two-point jump shot. When he turned to run upcourt, however, he bounced off his right foot and felt something tear. He managed to hop to mid-court, clutching his leg, but then doubled over in pain. After Durant limped out of the game, an MRI showed that he had ripped the muscle fibres in his calf; a prior injury, along with a sharp increase in playing time, probably placed him at increased risk. For the next few weeks, as the Warriors advanced to the N.B.A. Finals, Durant tried to recover. But when his teammates found themselves down three games to one, facing elimination, some of them reportedly complained about his absence.

Durant decided to return for Game Five against the Toronto Raptors. Fifteen minutes into the game, he dribbled across half-court, crossed over between his legs, and stopped abruptly, letting the ball roll away. This time, he limped to the sideline, fell to the ground, and grabbed his right leg with a resigned look on his face. He left the arena in a gray walking boot, crutches under both armpits, with a ruptured Achilles tendon.

The Warriors ultimately lost the series, and Durant lost a full season of play in the prime of his career. In the years that followed, he counselled other players not to rush their recoveries. “I wish I had made a different decision,” he has said.

Kevin Durant is one-of-a-kind, but almost all of us have, at some point, done what he did. Some ninety per cent of Americans report going to work while feeling unwell. Eighty per cent of cardiac patients skip rehabilitation programs that are proven to aid in their recoveries. Whether by choice, obligation, or necessity, many of us rush back to daily life at half strength, neglecting the sleep, downtime, or follow-up care that could help us recover. Often, our jobs and families and responsibilities feel as high stakes as any playoff game, and we either can’t afford to take a break or are conditioned not to.

This is a perilous mistake, according to Gavin Francis, the author of the recent book “Recovery: The Lost Art of Convalescence.” Francis, a general practitioner in the U.K., writes that illness “is not simply a matter of biology, but one of psychology and sociology.” He argues that setting aside time to recover may feel antithetical to modern life, but failing to do so can seriously undermine our ability to return to good health. After an infection, a surgery, or a panic attack, patients increasingly feel that they need “permission to recover,” and treat convalescence less as a chance to heal than as something to get over with. And, when we prize efficiency over recovery, we risk ending up with less of both.

Convalescence is as old as medicine, and has, at times, been practically synonymous with it. When Hippocrates wrote about the components of a healthy life, twenty-five hundred years ago, he treated recovery from illness as an essential step, emphasizing vis medicatrix naturae—the healing power of nature. His commandment to “do no harm” reflected, in part, a humble approach to medicine that kept patients comfortable, clean, and rested while the body healed itself. Later, his ideas influenced the restorative baths of the Romans, which were considered essential for maintaining health and treating weakened soldiers. Galen, the personal doctor to Marcus Aurelius and the era’s most famous medic, argued that the physician is only nature’s assistant. The ideal of convalescence echoed through the centuries, perhaps finding its fullest expression in Victorian England.

By the mid-eighteen-hundreds, the Industrial Revolution had transformed British life to the point that society itself could seem to make people sick: too much work and too little sleep; destructive diets and polluted streets; crowded housing and a dizzying pace of technological change. Reformers argued that pills and procedures were insufficient for restoring health and that the sick deserved healing environments and time off, even if they weren’t wealthy. A prominent Scottish surgeon, John Roberton, wrote in a medical journal, “I cannot conceal from myself the fact, that medicine, in a variety of cases, comes merely in aid of other means, and deservedly ranks as secondary and inferior to these.”

Convalescence came to be understood as a necessary stop on the journey from illness to health, one that shouldn’t be cut short by the “great struggle of life,” as one Victorian writer put it. In “Convalescence in the Nineteenth-Century Novel,” the literary scholar Hosanna Krienke argues that convalescent time, with its “uncertain progress, ambiguous outcomes, and an emphasis on daily pleasures,” was such a big part of the era that it shaped the plots of popular novels, including Charles Dickens’s “Bleak House” and Samuel Butler’s “Erewhon.” “Victorians embraced the temporality of convalescence as a prized experience, one particularly precious in an age of technological and industrial change,” Krienke writes.

Brits cared enough about getting better that they helped to invent the convalescent home. According to Krienke, in 1841, Theodore Monroe, a medical trainee at London’s St. Bartholomew’s Hospital, treated a woman who lived in a nearby slum, and someone told her to escape to the country to get better. “The words sounded an utter mockery,” an article in All the Year Round, the weekly periodical founded by Dickens, recounted. When Monroe asked a local bookseller to advertise a request for a room in rural England, the bookseller reasoned that others might benefit from the same, and together they arranged for hospital patients to be discharged to an old workhouse in South London. They eventually raised enough money to erect a large yellow-brick building near the Thames called the Metropolitan Convalescent Institution. Within a few decades, hundreds of convalescent homes were serving tens of thousands of people each year; before Dickens died, he called them “among the most valuable of modern charitable institutions.”

Across the ocean, a young American physician named Silas Weir Mitchell learned similar lessons while tending to soldiers who were injured in the Civil War. After the war ended, he wrote that rest and nutrition were vital for rehabilitation, and started prescribing civilians an escape from daily drudgery. Mitchell believed that many of his patients suffered from neurasthenia, a something’s-not-quite-right diagnosis that encompassed such symptoms as weakness, lethargy, insomnia, anxiety, depression, and headaches. Some psychologists called the condition Americanitis, blaming it on the relentless U.S. work ethic; one doctor estimated that the condition caused a quarter-million deaths a year.

Some people thought Mitchell was a quack. His “rest cure,” primarily for women—isolation, bed rest, and high-fat foods, plus electrotherapy and massage to prevent muscle atrophy—earned him the nickname Dr. Diet and Dr. Quiet, and Virginia Woolf skewered the treatment in “Mrs. Dalloway.” Charlotte Perkins Gilman, a patient of Mitchell’s who suffered postpartum depression, wrote a short story in which the rest cure drives the narrator insane. Mitchell’s recommendations for men, however, were celebrated by those who could afford them: travel, fresh air, hunting, hiking, and companionship, sometimes called the West cure. A young Theodore Roosevelt followed Mitchell’s guidance, in 1884, after his wife and mother died within hours of each other; he spent two years rough-riding in the Dakotas and returned revitalized. (His excursions are one reason the U.S. has national parks.) After Walt Whitman suffered two strokes, Mitchell made several house calls to the ailing poet, inspiring Whitman to make a trip West and find “days full of sunbeams and oxygen.” Of his time there, Whitman wrote, “How it all nourishes, lulls me, in the way most needed; the open air, the rye-fields, the apple orchards.”

We don’t talk about convalescence anymore. The word plummeted in twentieth-century usage, and the concept has largely faded from public discourse. During the First World War, officials developed new protocols to rehabilitate soldiers, and recovery became more about practicality than tranquility. Krienke argues that “emerging ideals of efficient, economical recuperations” turned the era into a “cultural cleaving point for conceptualizing the recuperating body.” When the U.K. created the National Health Service, in 1948, convalescent homes, with their emphasis on lengthy and holistic recovery, were largely excluded from the program. And, during my own medical training, I received countless hours of instruction on the epidemiology of disease and the physiology of illness, but only a handful of lectures on how to help patients recover. Yet we may need convalescence more than ever. Americanitis has arguably become worse: modern life has delivered endemic loneliness, social-media anxiety, workism as a religion, and deaths of despair.

One evening last summer, on my way home from a busy shift in the hospital, I felt a sudden chill, followed a few minutes later by a feverish warmth. By the end of my commute, my muscles had started to ache. I tested negative for COVID, but woke in the middle of the night with a dry mouth and throbbing head. A strange knot of pain in my back was getting worse. I took a Tylenol and sipped some water, only to throw it back up. At dawn, I apologetically asked a colleague to cover my patients, hoping to take a day to recover. It wasn’t a hunting-and-hiking trip out West, but it would have to do.

That week, I requested one sick day after another, always hoping that I was on the verge of feeling better. When my illness proved me wrong, I showed up at my hospital’s emergency department, not as a doctor but as a patient. I watched an I.V. drip fluids into my arm as a battery of tests and scans ruled out the usual infectious diseases. Back home, my fevers receded, but I was still struggling to eat and taking painkillers constantly for my back. In the mirror, I saw a gaunt face staring back.

I thought about taking the week to recuperate, as the Victorians might have done. A colleague even offered to take my upcoming shifts. “Take your time,” he texted me. “I’m happy to cover.” But the mere suggestion made me feel guilty. Every day I rested was a day that someone else would have to work; I worried that my illness would become a burden not only to myself but to those around me. In the end, the logistics of putting in sick requests and rearranging my call schedules made the hard option—just going to work—seem like the easier one.

That week, I gingerly made my way around the medical wards. One afternoon, while rushing to see a patient who was having trouble breathing, I turned a corner and dropped my stethoscope. When I bent over to pick it up, a searing spasm shot through my body. I gasped with pain, unable to move. Eventually, I hobbled on through gritted teeth—a less athletic rendition of Durant’s limp to the sideline.

In the end, what fought off my mystery illness was my own body, not any drug. Medicine helped me through that time, but it didn’t heal me—and my rush to return to work could be considered a sickness of its own. I often wonder whether my recovery might have been more complete if I had made the choice to rest. A year later, my back still hurts.

The decline of convalescence may be rooted, in part, in the immense progress we’ve made in treating disease. This is a sad irony: as medicine has gained new tools, it seems to have forgotten the value of old ones. Hippocrates is said to have argued that the “healing force within each of us is the greatest force in getting well.” These days, when doctors can prescribe antibiotics or antidepressants or chemotherapy, it might seem strange for them to recommend bed rest, fresh air, or a sanatorium in the mountains.

Yet research increasingly suggests that the Victorians had a point. Sleep empowers us to fight infection; good nutrition allows us to repair wounds; time in nature has been shown to lift moods, alleviate pain, and lower blood pressure. Companionship can reduce the lethality of disease. Even many antibiotics don’t kill bacteria; they simply inhibit bacterial growth while our immune systems do the rest. Perhaps we give medicine too much credit. “A doctor who sets out to ‘heal’ is in truth more like a gardener who sets out to ‘grow,’ ” Francis writes in his book about recovery. “Actually, nature does almost all of the work.”

Restoring convalescence to a place of importance will require structural change: political movements should fight for guaranteed sick time and paid family leave; medical education should teach the art and science of recovery. But it will also require a cultural change. Today, when we think of convalescence at all, we tend to think of it as a kind of lost time that we try to minimize, rather than a meaningful part of our lives that we should try to make the most of. We have to learn to see it as an opportunity, not an inconvenience.

At some point in life, we all experience something that we can’t recover from. In these moments, we may learn what convalescence really means. In a chapter called “The (Occasional) Advantages of Illness,” Francis quotes the writer Anatole Broyard, who was diagnosed with prostate cancer in his sixties. “I felt galvanized. I was a new person. All my old trivial selves fell away,” Broyard wrote. “As I look ahead, I feel like a man who has awakened from a long afternoon nap to find the evening stretched out before me.”

When I spend time with seriously ill patients, I’m often struck by their equanimity. For them, recovery is about living the fullest lives they can—physically, emotionally, spiritually—given the inescapable limitations. It’s an attempt to make peace with a new state of being. Reading Francis’s book, I thought of a man I cared for long ago. He was in early middle age, with young children and a high-powered career. For weeks, he’d braved a punishing treatment for a life-threatening condition, and now faced a protracted and uncertain recovery. On the morning he was set to leave the hospital, I wished him well and asked him how he felt. “I’m a fish discovering water,” he told me. “Getting sick made me realize that I’m alive.” ♦

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