Textbooks of psychiatric rehabilitation are rather like the no. 37 bus of my years living in south London: first you wait a long time at the bus stop and then a whole bunch turn up at once. In the past 2 years I have acquired four substantial tomes on the topic: our own Enabling Recovery: The Principles and Practice of Rehabilitation Psychiatry (Gaskell, 2006); the soberly entitled Psychiatric Rehabilitation (Academic Press, 2007); the highly academic Principles and Practice of Psychiatric Rehabilitation: An Empirical Approach (Guilford, 2008) and now Recovery from Disability: Manual of Psychiatric Rehabilitation. All these texts draw on the same evidence base, although the last three are written by practitioners working in the USA, which of course has a radically different system of health and social care than the UK. Even within the USA there are varying rehabilitation traditions: what one might loosely call the Boston model of psychosocial rehabilitation pioneered by William Anthony; an eclectic tradition centred on the work of Robert Drake and Kim Mueser in Dartmouth, Patrick Corrigan in Chicago and Gary Bond in Indiana; and finally the UCLA model, of which Robert Liberman is the doyen.
Liberman began his journey as a young psychiatrist in the 1960s, exploring the exciting new world of behavioural treatments for mental illness. He has remained true to this tradition. The UCLA model consists of tightly operationalised therapeutic modules that involve a didactic approach to rehabilitation using principles of operant conditioning and social learning (Skinner and Bandura are acknowledged influences, and Wolpe was an early collaborator). Although not avoiding issues of theory and service management, the book attempts to be more a practical manual than a textbook. In this Liberman is at least partially successful. A particularly good chapter on working with families would give any practitioner a degree of competence in this oft-discussed but in reality oft-avoided aspect of mental healthcare. Where treatments are sketched in, the reader is directed to resources commercially available from Psychiatric Rehabilitation Consultants, according to the website ‘the dissemination site for the UCLA Psych REHAB program’ (www.psychrehab.com).
Liberman's book stands out from the crowd in a number of ways. He is the only author to attempt to tackle the subject on his own, which allows his humanistic concern and deep commitment to alleviating the effects of mental illness on service users and carers to shine through, despite his occasional use of language that deviates from the politically correct. As the book's title indicates, Liberman is upfront about the ‘d-word’, disability: a word that has served in these socially inclusive and recovery-oriented times to make rehabilitation so very unfashionable. He has, uniquely among the fifty-odd contributors to the other recently published titles, the intellectual self-confidence to articulate concerns about the more glib formulations of the recovery movement, with the marvellously dismissive: ‘Catchwords trump dry logic, dull evidence and mere facts’. This book is in a very real sense a monumental achievement, fruit of 40 years of active research and practice in what was and remains an undeservedly unfashionable field.
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