Discussion of Pauls Story

Paul's story raises a number of important issues about mental illness that you will learn more about as you read this book. Many of these issues are controversial. Throughout this text you will see that, depending on training and orientation, theorists, researchers, and mental health professionals often have very different answers to these questions.

One important issue involves questions of etiology, or the cause(s) of such illnesses. What caused Paul's illness? Could someone have predicted that Paul would become ill by observing his development, and could the illness have been prevented? Partly because there is still a great deal we do not know about the etiology of the severe mental illnesses, this is an area of great controversy and heated debate. Some professionals believe that aspects of Paul's personal history, environment, and family life may help us to understand the cause of his illness. Others feel that these issues have little or no bearing on the disease because its cause is essentially biological rather than environmental. Most importantly, the different etiological beliefs held by professionals, family members, and people like Paul lead to choices of specific treatment strategies.

Another important issue that is raised is the question of prognosis or the probable course or outcome of the disease. Will he recover with medication and treatment? Or, will he become progressively more confused, alienated, and withdrawn over time? Can the prognosis of such a disease even be established? Although there is increasing agreement among professionals on the prognosis of these diseases given correct medication and services, there is still great variability between people with the same illness.

The final and most important issue remains: What is the best way to help Paul and other people like him? As you will see, there are many aspects to the care of mental illness. Specific beliefs about the etiology of these diseases lead to specific treatment strategies. Treatment is usually considered to be any action designed to cure a disease or reduce its symptoms. Rehabilitation, on the other hand, is usually defined as any action intended to reduce the negative effects of the disease on the person's everyday life.

To help explain this difference, let's consider a woman who has had a stroke and has lost her ability to walk. A doctor might prescribe anticoagulants, blood pressure medication, change in diet, and regular exercise to help reduce the probability of future strokes. These prescriptions would be considered treatment. The doctor might also prescribe physical therapy to help return the patient to the highest level of physical mobility after the deficits caused by the stroke. This therapy aimed at returning the patient to normal or near-normal functioning would be considered rehabilitation. Finally, a rehabilitation professional making a home visit might recommend that a ramp be built to the front door, that doorknobs be changed to levers, and that the bathroom be fitted with hand bars. These modifications to the patient's environment would also be considered part of the rehabilitation process.

The differences between treatment and rehabilitation seem clear for the woman who had a stroke. But for the person with mental illness, like Paul, the difference between treatment and rehabilitation is not always clear. Indeed, some professionals believe that it is a mistake to make a distinction between the treatment of mental illness and a process of rehabilitation. In fact, researchers have found evidence that the rehabilitation process itself has a direct and positive effect on the disease (Bond et al., 2001; Lysaker et al., 2001). Most PsyR professionals believe that treatment and rehabilitation are complementary processes.

The importance of the differences and similarities between treatment and rehabilitation will become evident as you move through this text. This issue is vital when considering questions such as "Who provides treatment? Who provides rehabilitation? What is the role of the psychiatric rehabilitation practitioner? What kinds of services should be provided?"

This textbook will provide you with answers to many of these questions. Real people, like Paul, and his loved ones are dependent on the answers. You will also learn about new, challenging, and complicated issues that address the best ways to help persons with severe mental illness.

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