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Menninger questions the concept of a natural course of mental illness comparable to that seen in many physical illnesses. Rather, he sees the process of mental illness fluctuating with the ebb and flow of life, depending upon the interplay of internal and external forces which favor and oppose recovery. Recovery is an ambiguous term referring sometimes to process and at other times to the end state of process. In either instance mental illness is a cumulative failure of function; recovery is a reconstitution of function. In the face of disintegration, the individual uses different orders of emergency devices to insure survival. When the processes of recovery begin, more extreme defense measures are abandoned or compromises become established. Opposing recovery are internal and external factors such as resistance (which may be the psychological equivalent of inertia), primary and secondary gains from illness, persistence of the precipitating stresses, ignorance, age and infirmity, entanglement with diverse social complications. Facts and forces working for recovery include pain and suffering, positive human relationships, adequate work and play. The physician influences the course of illness to the extent that he can mobilize or alter various forces so as to change the balance in the direction he seeks.