Physical Rehabilitation as a Model for Psychiatric Rehabilitation

Several authors have suggested that the rehabilitation of persons with physical disabilities provides an apt and instructive model or analogy for understanding the rehabilitation of persons with psychiatric disabilities (e.g., Anthony, Cohen, & Farkas, 2002; Deegan, 1988). An obvious benefit of this comparison is that rehabilitation from physical injury or disease is a relatively common and acceptable phenomenon in modern society. Sports figures recovering from injuries sustained on the playing field and aging public figures recovering from heart attacks or strokes are frequent subjects of media coverage. In addition, as medicine improves, life expectancy increases, making it more likely that a family member, friend, or acquaintance will develop a physical handicap.

The individual who has a disability due to a severe mental illness may experience difficulty with aspects of everyday life that require assistance, increased time and effort, or environmental modifications. As with the individual with a physical disability, one of the first steps in the rehabilitation process is acceptance of the disability and a willingness to work to overcome it. Unlike the individual with a physical disability, however, the reason for a person's disability due to mental illness may be less apparent to others.

Sadly, it is still true for many people that signs of a physical handicap (e.g., wheelchair) cause less negative stereotyping than indicators of a mental, cognitive, or emotional handicap (e.g., talking to oneself). These cues, which can be signals for stigma, may trigger stereotypic responses and discrimination (Corrigan, 2002). On the positive side, as our understanding of the brain and nervous system increased in the latter part of this century, so has our understanding of mental illness. Initially, the idea was that as public knowledge increased, the stigma associated with mental illness would be reduced. Recent studies suggest that as public understanding of mental illness increases, stigma about these diseases changes (Link, Phelan, Bresnhan, Stueve, & Pescosolido, 1999; Phelan, Cruz-Rojas, & Reiff, 2002). For example, as the public becomes more aware that severe mental illness has a genetic component, less blame is assigned to the ill individual. However, this new understanding suggests that other family members may be more likely to become ill

(Phelan et al., 2002). Still, as knowledge increases and medications and services improve, there is good reason to assume that stigma will decrease.

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