What Every Patient, Family, Friend, and Caregiver Needs to Know About Psychiatry

A great deal has been learned in the last 45 years about the brain disorders called mental illnesses. Unfortunately, this book written by psychiatrist Richard Roukema seems to have not quite caught up with the new information.

The book has much to say about the ideas of Freud, but I am not convinced that "every patient, family, friend, and caregiver" needs to know anything about Freud. There are other things we do need to know, many of which are not mentioned, or are touched on only briefly, in this book. We need to know how to evaluate and gain access to hospital and community care; how to deal with managed care; how to judge whether the psychiatrist is prescribing appropriate medications in appropriate dosages; and how to communicate with a person who is psychotic or depressed.

Dr. Roukema questions whether it is influences of today's media, genes, or parenting styles that have the greatest effect on a child's chances of becoming mentally ill. He concludes that there is "little doubt that all the factors mentioned are important." He recognizes that "evidence is accumulating that schizophrenia is biologically based, has a large hereditary component, and is not produced primarily by poor parenting." Then he goes on to say, "There are probably psychosocial factors that weigh heavily on individuals who are prone to schizophrenia, but the hereditary base needs to be present to produce the chemical changes in the brain found in schizophrenia."

Dr. Roukema seems not to understand the significance of recent brain research. He does not mention Fuller Torrey's twin studies, which provide strong evidence for the neurodevelopmental theory of schizophrenia. Speaking of genes, he says: "In bipolar disorder there is a dominant gene that carries the illness from one generation to another." This statement is probably based on research among the Amish people, published in 1987, which appeared to implicate a single dominant gene. That conclusion did not hold up when additional data became available and were published in 1989. Genes for bipolar illness are still being sought through studies of other large families.

The 79 suggested readings at the end of the book include 35 that are at least 20 years old, and only 20 that are under ten years old. Considering the rapid pace at which research is revealing new ideas and overturning old ones, the age of the readings seems a shame. Many good, up-to-date books that are helpful to families have been published in this decade, but none of them are listed here.

This book is helpful in listing conditions that should lead a person to see a psychiatrist. They include the onset of psychotic, manic, or depressive behavior, in which case it is necessary to rule out other causes of these symptoms, such as a brain tumor, hypertension, and hyperthyroidism; alcoholism or drug abuse with concomitant psychosis, depression, or severe anxiety; and thoughts of or attempts at suicide.

One piece of good advice given by Dr. Roukema is to make contact with a local chapter of the National Alliance for the Mentally Ill (NAMI). NAMI support groups and family-to-family education classes can help with finding the answers to many questions. Also, many NAMI affiliates have office staff who can supply information about local services for mentally ill persons.

Ms. Bouricius, who lives in Amherst, Massachusetts, is a family member of the Alliance for the Mentally Ill of Western Massachusetts and a family support group leader.