Description

Disability associated with mental disorders is and will remain one of the most significant problems in the public health domain in the last decades of the twentieth century, consuming a disproportion- ate amount of societal resources and severely testing the coping capacity of the affected individuals, their families, and communi- ties. In spite of impressive advances in the development of pharma- cological means of controlling symptoms and, in some notable instances, of intervening into the clinical course of major psychiat- ric disorders, such as schizophrenia, the insidious loss of adaptive skills and motivation and the progressive restriction of the social field are still the lot of a sizable proportion of people who have suffered psychotic illnesses. Pioneering research into the effects of institutionalism (Barton 1959; Wing and Brown 1970), the "social breakdown syndrome" (Gruenberg 1967), and the predictors of the outcome of rehabil- itation (Wing 1960) have highlighted the complex, multifactorial causation of the disabilities which previously had been regarded either as part of the "natural history" or as inexorable sequelae of the "disease process," and pointed to the crucial significance of the premorbid personality and the social environment. These land- mark studies, however, had left many issues unresolved and raised new research questions.