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Book Review   |    
Serious Mental Illness and the Family: The Practitioner's Guide
Jay Neugeboren
Psychiatric Services 1999; doi:
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by Diane T. Marsh, Ph.D.; New York City, John Wiley & Sons, 1998, 374 pages, $55

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"My objective," Dr. Diane T. Marsh writes in chapter 1 of Serious Mental Illness and the Family, "is to provide a practical guide that can be translated into clinical practice."

The need for such a guide is great, and Diane Marsh performs a large service for us by addressing this need in a sensible, humane, lucid, and comprehensive manner. Serious Mental Illness and the Family provides information about care and treatment that will prove invaluable to practitioners, and it does so by placing information and guidelines in large, well-researched contexts: it gives us both historical background and developmental frameworks—relying, for example, on the work of John Rolland and others—that will better enable us to understand most situations in which we may find ourselves.

Dr. Marsh relies not only on recent and helpful developments in research but on relevant anecdotal material both from families and from clinical practice. She makes important distinctions—for example, between family consultation and family therapy—and each chapter ends with a section entitled "From Theory to Practice." The book also contains a goodly number of vignettes, although the degree to which these vignettes are fictionalized—and idealized—is not always apparent.

Dr. Marsh is a professor of psychology at the University of Pittsburgh at Greensburg and a clinician who has worked for many years with patients and families affected by serious mental illness; she is also on the American Psychological Association's task force on serious mental illness-serious emotional disturbance. The author is especially good at delineating ways in which practitioners can make use of recent developments. "Treatment outcomes for serious mental illness," she points out, "compare favorably with those of general medical problems," and this welcome news, happily, informs much of her book.

"Thus," she writes in a telling passage, "in contrast to the message of hopelessness that was so often conveyed to patients and their families in the past, current practitioners are able to offer genuine assistance and hope." Dr. Marsh provides readers the sources of this hope—the skills, competencies, and approaches, whether clinical, anecdotal, or developmental—in chapter after chapter of sensible, data-filled, fascinating detail.

She gives us strategies for intervention (psychological, educational, informational, and medical), personal and family action plans, and specific models that can aid us in working with all possible familial configurations: with parents, spouses, siblings, and offspring. In a final chapter, she also offers specific examples of model programs such as the MESA model of family education, and the TEC (Training and Education Center) Network.

Serious Mental Illness and the Family succeeds admirably in its "quest for a more humane and responsive system of mental health care" because its author is herself a most humane, responsive researcher and practitioner. It is wonderfully thorough about the kinds of comprehensive modes of care that are essential to dealing skillfully and compassionately with serious mental illness, and it should serve as a standard resource for all those who live and work with serious mental illness.

Mr. Neugeboren is writer-in-residence at the University of Massachusetts at Amherst and is the author of 13 books, including Imagining Robert: My Brother, Madness, and Survival.

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