Mental Illness in the Family: Issues and Trends

Beverley Abosh s April Collins, eds. Buffalo, NY: University of Toronto Press

Reviewed by Jill Littrell

MENTAL ILLNESS IN the Family: Issues and Trends is a collection of papers originally presented at a conference hosted by the Clarke Institute of Psychiatry in 1991. Overall, the contributions are well written and generally informative.

The pieces by Bachrach, Walsh, Trainor, and Butterfiled and Patternson primarily focus on schizophrenia, and of these, three of the essays provide historical accounts of the professional mental health community's changing view of the family's role in schizophrenia. These chapters describe the field's movement away from the assumption that family dysfunction causes mental illness to the recognition that families can influence the course of mental disorders.

Trainor (p. 39) describes the earlier approaches as "excluding families to protect the patient or restructuring them to root out disturbance." Walsh (p. 31) expresses the more contemporary view of the goal in family therapy as being the "we need to emphasize the family's crucial role in caregiving and problem solving." Several of the essays note the relapse precipitating effect that the expression of resentment and criticism by family members can have on the outcomes of major depression and schizophrenia.

Barankin and Greenberg's contribution focuses on the impact that an affective illness in a parenthes on children. The authors (p. 111) appropriately point out that although the mental health outcomes of children whose parents are depressed are not as good as children of normal parents, 54% of these children are doing well. The literature on resilient children and the buffering impact that the presence of a nurturing adult can exert is reviewed (p. 111). Barankin and Greenberg conclude that the case for heritability is well established. Unfortunately, like most others in the field, the authors appear to have aggregated outcomes for manic depression and major depression. Although there is consensus on this issue for manic depression, in several of the studies cited by Barankin and Greenberg, the findings did not support the case for inheritance of major depression.

Several of the essays examine legal issues. Swirsky focuses on family members' interaction with the court system when pressing charges against a violent, mentally ill member of the family. She (p. 68) sensitively describes the anguish the process can bring to families who desire effective treatment but confront a system which offers two mutually exclusive tracks (punishment or treatment).

Many of the chapters offer case presentations. Unfortunately, these case presentations fail to provide specific description of the behavior patterns or offer subjective statements from the patient's perspective. Rather, they offer an interpretation of the dynamics in the case, consistent with the author's assumptions about the nature of mental illness presented in the beginning of the chapter. Instead of enriching the perspective of the reader, the case presentations simply reiterate the perspective the authors had advanced earlier.

On the whole, the book suffers from a problem often encountered in anthologies. The reader confronts diverse frames of reference whose contradictions are never confronted within the book. For example, the beginning chapters by Walsh and Trainor chronicle the field's evolving perspective away from the view of family dynamics exerting a causal role in the emergence of mental illness. By contrast, the Collins essay does a very good job, in the context of a case analysis, of conveying the (perhaps) previously assumed perspective in the family-therapy; that triangulation and the lack of a well-differentiated parental subsystem (p. 82-83) are factors in the family life of the schizophrenic.

Jill Littrell Georgia State University

Copyright Family Service America Jan/Feb 1999
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