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.