differences between treatment and rehabilitation, point out that treatment attempts are directed more toward minimizing sickness, whereas rehabilitation aims more toward maximizing health. Eliminating or suppressing impairments does not lead automatically to more functional behaviors. Likewise, a decrease in disability does not always lead to reductions in impairment. Note that a chronic or severe impairment (e.g., diabetes, schizophrenia, and stroke) does not always result in chronic disability or handicap. What the impairment does is increase the risk of chronic disability and handicap. Conclusion With an emerging consensus that major psychiatric disorders are stress-linked biomedical disorders, rehabilitation approaches have grown out of eclectic and empirical traditions emphasizing the development of patients' skills or supportive environments for coping with the enduring disabilities and handicaps of illnesses Downloaded from by guest on 23 November 2021 554 SCHIZOPHRENIA BULLETIN such as schizophrenia and affective disorders. Psychiatric rehabilitation uses assessment and intervention techniques based on such orientations as social learning and behavior therapy (Paul and Lentz 1977; Liberman and Foy 1983; Liberman and Evans 1985); client-centered therapy and human resource development (Rogers 1957, Carkhuff 1972, 1983; Carkhuff and Berenson 1976); and lifespan developmental psychology (Strauss and Carpenter 1981; Pepper 1985). The psychiatrically disabled person must be involved as much as possible in setting rehabilitation goals—a process that necessitates the development of a trusting, mutually respectful, and empathic relationship with service providers. The preferred mode of intervention combines judicious and rational psychopharmacology with an educational approach that trains patients directly in the knowledge and skills they need to function in society. "Teaching as treatment" (Carkhuff and Berenson 1976) is supplemented by interventions at the level of the person's immediate environment, as well as at the community support system and societal level. An operational philosophy defining the scope of psychiatric rehabilitation has recently been issued by the National Institute of Mental Health (Stockdill 1985). Psychosocial rehabilitation refers to a spectrum of programs for persons with long-term, severe psychiatric disabilities. The goal is to improve the quality of life for these individuals by assisting them to assume responsibility over their lives and to function as actively and independently in society as possible. The programs are designed to both strengthen the individual's skills and to develop the environmental supports necessary to sustain the individual in the community. Major services, which may be offered on a continuum, should be coordinated with those offered by other agencies providing psychiatric, as well as the broad array of human services. The specific services include opportunities to meet social/recreational needs, vocational training and job placement rehabilitative residential services, training in the skills of daily and community living, and case management services. In addition, some psychosocial rehabilitation programs include client assessment and goal-planning activities, educational programs and family support activities. The services, which the individual may need to use on a short-term basis or indefinitely to achieve or maintain community adjustment, are provided in the context of a supportive, normalizing environment in the community. They are offered in a manner that emphasizes the "personhood" rather than the "patienthood" of the individual, that maximizes the individual's responsibility, control and feelings of self-worth, and that encourages ownership in the rehabilitation process, [p. 2] The rehabilitation process encompasses three overlapping stages that recur for as long as the patient requires professional services (Anthony, Cohen, and Cohen 1983). Assessment at the symptomatic, functional, and resource levels initiates the patient and professional in a collaborative planning phase. Through diagnostic and assessment interviews, inventories, informants, historical data,