The Classification and Assessment of Intellectual and Other Psychological Impairments in the Mentally Disabled

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Psychiatric rehabilitation of the chronically mentally ill requires conceptual distinction among psychological abnormalities of the nervous system, representing active pathology or a disease state; impairment of functions by means of which those abnormalities can be inferred; disabilities, i.e., losses of functional ability consequent upon an impairment; and handicaps, which are the social disadvantages resulting from disability [1-3]. These various levels of functioning cannot be separated from the environment. Socioenvironmental stressors, defined by Mechanic [4] as a discrepancy between demands presented to a person and his or her capacity to deal with them, influence the appearance of impairments, disabilities, and handicaps. Wing [5] lists three factors that can cause and exacerbate social disablement in cases of frequent relapse or chronic impairment: environmental overstimulation or understimulation, social disadvantage, and adverse personal reactions (secondary disablement) caused by acceptance by the handicapped person of limitations that are not actually necessary. It is clear that assessment and evaluation of impairments are important in avoiding understimulation and overstimulation and preventing or correcting adverse personal reactions. Although premorbid and environmental factors play an important role, we can expect the more severely impaired also to be the more severely disabled. Patients with schizophrenia are especially subject to