Wulf Rössler gives a comprehensive description of the state of psychiatric rehabilitation today. The shift of focus from an illness (in fact a medical) model to a model of functional disability in psychiatric rehabilitation is much welcome. Proper housing, education, work, satisfying relationships and participation in the community are basic conditions for people to recover and therefore goals of the client movement.
By using the adjective "psychiatric", rehabilitation is placed in the domain of psychiatry. Proper housing, education, access to work or other valued activity and full participation in the community fail to have consistent links with psychiatry on the level of planning, financial structures or political priorities. For this reason the implementation of the 22 United Nations (UN) standard rules on the equalization of opportunities for persons with disabilities (1) is essential. It is very important that national and local authorities implement these standard rules, although lack of financial resources is an obstacle for many countries.
Rössler claims that a psychiatrist should have a role in the process of rehabilitation. However, I would like to emphasize the role of the client movement. Local client organizations can help to organize peer support, which appears to be very successful (2). National and international client organizations (3; www.enusp.org; www.wnusp.org) can support the implementation of the UN standard rules. Another aspect that makes the client movement important is the range of methods for pursuing recovery developed by people who have been on the receiving end of mental health services (e.g., 4; www.basisberaad.nl; www.hearing-voices.org). Self-help groups, crisis card and psychiatric will are concepts that deserve much more attention. The idea of empowerment has been constructed with a lot of input from clients (5).
Rössler concludes his overview by observing there is still a long way to go from results we have collected by research to daily practice. The advancements are considerable although some modesty would not hurt. First of all, there is some controversy regarding the academic status of schizophrenia (6-8). Despite its ambiguous status, this diagnosis has an overwhelming impact on people's life. Secondly, medical science plays a dominant role in psychiatry, and therefore still is the academic domain of body and mind.
The beneficial effects on mind (and body) of the Ayurveda from India and of Chinese medical practice cannot be denied, but are difficult to fit in with the current paradigm of medical science. Thirdly, recently new challenging information has been gathered about the functioning of the brain. These findings call for an urgent need to redefine psychiatry. The famous book "Discours de la méthode", first published in 1637, was written by René Descartes (9) because he wanted to propose an academic framework in which the scientific developments of that time could be accommodated. We will be lucky if by 2037 we will have a similar framework for psychiatry.
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