Abstract

Any list of principles must be tentative and incomplete in the present state of knowledge. Nonetheless, it is possible to derive a number of principles from the work quoted. 1. (1) In the case of schizophrenic patients, one should aim at an optimal level of stimulation, since it has been shown that both extremes of stimulation are dangerous. This principle has a number of practical implications, an important one being that there has to be a graded series of steps, both within the rehabilitation workshop and in the kinds of living accommodations available to the patients. 2. (2) Staff must acknowledge the various levels at which disability occurs and plan rehabilitation programs in such a way that intervention occurs on as many levels as possible. 3. (3) The therapeutic milieu must be planned so that a patient's sense of social incompetence in minimized. Attention must be focused on recognizing a patient's assets and exploiting them, rather than on merely enumerating handicaps. Patients must also be given more responsibility and more independence, rather than being allowed to become passive and compliant. 4. (4) The work available should be varied and suitable in type. This point should not be overemphasized, however, since it is probable that the exact type of work is less important than the reestablishment of a regular work habit and a work personality. However, having a wide variety of work available will also enable staff to assess short-stay patients in various work settings; assessment is a valuable additional function for the workshop. 5. (5) One must acknowledge the limitations put on rehabilitation by the nature of the disease processes that are being treated. If rehabilitation workshops and living accommodations are each viewed as ladders with graded series of steps, then it must be realized that not everyone can reach the top of each ladder. If some alternative is to be found in the future to the back wards of the nineteenth-century mental hospitals, there must be long-stay hostels and sheltered workshops in the community to cater to patients who have improved as far as they are going to. It is discouraging for the staff of a rehabilitation workshop if it is allowed to fill up with patients who have stopped improving, and it is unhelpful for the therapeutic milieu.

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