When an individual is diagnosed with a mental disorder, that person’s family begins what is often a lifetime of decisions about treatment and care affecting everyone. “Finding the balance between the sometimes conflicting needs of the patient and his or her loved ones lays the foundation for a lifelong partnership in health – the most effective treatment of all.”
This then is at the core of Talking to Families about Mental Illness: What Clinicians Need to Know. Written by the founder of the Family Center for Bipolar Disorder in New York, author Igor Galynker, M.D., Ph.D. brings to clinicians and families alike the opportunity to find that balance. A specialist in mood and anxiety disorders, Dr. Galynker is a Professor of Clinical Psychiatry at the Albert Einstein College of Medicine of Yeshiva University.
The book is divided into four parts: General Rules and Approaches, Diagnosis and Treatment, Common Disorders, and Real-Life Issues. In the first seven chapters, Dr. Galynker provides skills the clinician can use regardless of diagnosis, while issues specific to common psychiatric disorders are presented in the remaining chapters. Seasoned clinicians may feel they are back in the classroom as they read information about mental illness with which they have long been familiar. However, this aspect of the book may be welcomed by the newly licensed clinician and it is organized in a way that makes it a valuable resource for both to use in their own practices.
The information directed to the clinician can also be extremely helpful to families in further understanding mental illness, how disorders manifest, and their treatments and medications. Indeed, the author recommends families should be treated as colleagues and partners in caring for their family member, especially families he refers to as “consumer experts,” those who possess a large fund of knowledge about the disease from personal research and experience. “Typical families,” those with little knowledge of mental illness, should be provided with “supportive education and guidance” as it is likely their first exposure to anyone from the mental health profession. Regardless of the family’s knowledge base, Dr. Galynker believes the genetic component of the illness should be emphasized and the family structure supported.
Dr. Galynker helps families to understand the need for medication via an analogy with a medical illness, illustrating the symptoms and needs that can exist in both cases. For instance, bipolar mood disorder is analogous to type 1 diabetes, and major depressive disorder, type 2. Other analogies include congestive heart failure and schizophrenia, hypertension and generalized anxiety disorder, asthma and panic disorder, and allergies and phobias. In each case, both the mentally ill person and the person with a medical condition need to take their medications and maintain healthy lifestyles so that their conditions can be managed effectively.
One thing that I felt needed clarification is the advice given in the chapter on generalized anxiety disorder and panic disorder. A symptom associated with a panic disorder that causes many individuals to go to an ER is “crushing chest pain that feels like a heart attack.” Dr. Galynker suggests that these individuals may not yet be diagnosed with mental illness and “may also have mild to moderate coronary artery disease and may get unnecessary invasive procedures, including stents, before they are properly diagnosed.”
In one portion of the conversation example Dr. Galynker says, “I strongly recommend that he see a psychiatrist to rule out panic attacks before a cardiologist who is a stent specialist.” What needs clarification is whether that psychiatric consultation should occur after the first visit or after several visits to the ER. While it is probable he did not mean that one should skip the ER entirely when having chest pains, personally speaking, this reviewer would never take a chance that chest pain was not a heart attack regardless of whether I had been diagnosed with panic disorder.
What may be most helpful to clinicians is the abundance of conversation examples Dr. Galynker provides for reference or to modify for use in their own conversations with families. After having similar conversations countless times in the past, the clinician may be able to glean from the examples new ways to deliver the facts about a diagnosis, treatment, and medications to families and the mentally ill themselves. While any one example will not fit exactly the clinician’s own patient situations, the message needing to be conveyed frequently contains the same necessary information.
In addition, many of the questions families have are answered in terms that are readily understood without the need for specialized medical knowledge. I wouldn’t rule out the possibility that a family who takes the time to read Talking to Families about Mental Illness will use it as a guide to gauge the quality of meetings with their own mental health providers.
Dr. Galynker also illustrates how the family of a mentally ill person can “compartmentalize their brains into two fairly independent parts: that of a relative and that of a nurse or doctor.” In this way, they can function as a relative when things are going well and take appropriate action as necessary when the nurse/doctor part of their brain observes early warning signs of an impending episode. If families gain nothing else but this one skill from reading the book, they will have a very powerful tool in their possession to be proactive in helping manage their loved one’s disease, not with fear but with confidence.
The gist of the book’s main goal, as detailed in the epilogue, is to help doctors, help families, reduce the stigma of mental illness, and to save families. To this end, Dr. Galynker successfully provides a very good resource in Talking to Families about Mental Illness that can help clinicians and families achieve their common goal of caring for the mentally ill.
Talking to Families about Mental Illness: What Clinicians Need to Know
By Igor Galynker, MD, PhD
W. W. Norton & Company: November 1, 2010
Hardcover, 288 pages