Book Review
Rehabilitation 
Treatment and Rehabilitation of
Severe Mental Illness. W Spaulding, M Sullivan, J Poland. New York: The Guilford Press; 2003. US$45.00.
Reviewer
rating*: Excellent
Review by:Raymond Tempier, MD, MSc, FRCPC
Saskatoon, Saskatchewan
Psychiatric rehabilitation is in dire need of a comprehensive framework to expand its field. This book, in my opinion, is fulfilling these needs. It presents an up-to-date and detailed overview of the rehabilitation and treatment of people with severe mental disorders. This comprehensive framework is especially geared for those of us who plan to implement innovative and effective clinical services for these unfortunate individuals. This book provides a detailed account of theories and techniques related to this field. The authors wisely advocate for the integration of rehabilitation with other approaches, namely, psychopharmacology, skills training techniques, and cognitive-behavioural psychotherapies. Because more than 450 references are cited, the reader will have a complete and accurate review of what is currently the best in terms of treatment and rehabilitation for schizophrenia. This material is included in 12 chapters and 3 appendices. One appendix is on functioning, problems, and definitions; the second is on how to write a rehabilitation plan; and the third provides a simple but useful algorithm for the treatment and rehabilitation of schizophrenia.
The book is divided into 3 parts: key concepts, assessment and treatment techniques, and the organizational context of rehabilitation. The key concepts section puts psychiatric rehabilitation into a historic perspective, as it emerged from the 1970s deinstitutionalization movement. In Chapter 1, the authors position psychiatric rehabilitation as an integrated paradigm within the medical and therapeutic community, and social learning models. Chapter 2 deals with the evolution of the psychopathology of mental illness from the early psychodynamic explanations of mental illness to the latest neurobiologic developments. Chapter 3 presents the structure of clinical assessment, as well as the formulation and planning of rehabilitation interventions. The authors wisely insist on the importance of acknowledging clients’ values and goals before engaging any rehabilitation or recovery process. The core notion of a clinical problem critical to the development of a rehabilitation plan is also developed in this chapter.
Chapter 4 details models of neurophysiological dysregulation in mental illness. In Chapters 5 and 6, the attractive concept of neurocognitive recovery is presented. It was also fascinating to learn about the interaction between neurobiologic parameters and psychosocial interventions, for example, the normalization of cortisol levels in individuals involved in psychiatric rehabilitation (1). Chapter 7 summarizes the different approaches to neurocognitive interventions. The benefit of the milieu as therapeutic environment per se is also acknowledged. The authors confirm that nonspecific rehabilitation factors, such as attendance and participation, can be conducive to neurocognitive recovery and exert beneficial effects on the course of the illness at any time. Two tables give readers practical clues on how to facilitate attention, learning, and memory in group skills training. Chapter 8 deals with social cognition or complex neurocognitive functions that are “social” (for example, perception of facial cues and voice tone). Is a skill only an ability to perform specific tasks? According to Spaulding and others, it has many other meanings, which they describe in Chapter 9. The next chapter focuses on person–environment interactions, especially the milieu that can be a support and a social learning tool. The authors reaffirm that human values, scientific understanding, and technical solutions should all contribute to the development of effective rehabilitation plans.
The last part of the book focuses on the implementation and management of a rehabilitation program. Chapter 11 explains the diverse roles that rehabilitation team members (that is, case managers, skills trainers, milieu coordinators, and psychopharmacotherapists) have to play. Changes in functioning and environment demands call for periodic medication reevaluations, and the authors clearly see the physician in a central role requiring highly coordinated efforts to deliver effective pharmacologic treatments. The last chapter discusses how to practically run a rehabilitation program and is based on Spaulding’s 20 years of rehabilitation practice. It especially underlines the role and duties of the program director. The issue of a program drift (that is, the gradual deviation from basic principles and procedures and how to remedy it) is also addressed here. Finally, the authors, being Americans, stress the importance of adapting the managed care model to rehabilitation interventions that benefit patients at the stable phase of their illness. In managed care, this is the time when the discontinuation of services for “medical stability” is achieved.
This book is a major work and clearly presents what psychiatric rehabilitation has to offer at its best. The authors have much experience and tremendous expertise in the field of rehabilitation. This book will serve as a core text for courses in psychiatric treatment and rehabilitation of those with severe mental illness. It summarizes the actual state of knowledge regarding this relatively new field of psychiatry. The text is well written in clear and practical language. Numerous footnotes define many concepts or semantic nuances, such as the difference between psychiatric and psychosocial rehabilitation.
The price is reasonable for the amount of knowledge it provides, and the text represents a good investment for those who treat patients with severe disabilities or who are interested in developing more rehabilitation interventions.
Reference
1. Spaulding W, Wyss H, Littrell R. Training psychophysiological self-regulation skills in psychiatric rehabilitation. Psychosocial Rehabilitation Journal 1990;13:37–9.
*Reviewer
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Excellent / Excellent
Very Good / Très bon
Good / Bon
Fair / Passable
Not recommended / Pas recommandé
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