Abstract
The importance of good communication in medicine is often overlooked by professionals. Certainly, a large proportion of the complaints received by the health complaints commissioners (health ombudsman) throughout Australia, and internationally, indicates that more effective communication between health service providers and consumers of those services would considerably reduce, if not eliminate, health complaints and, in some cases, litigation. It is therefore, encouraging to see books being published by medical practitioners which make a genuine effort to explain psychiatry to a lay audience. In the opinion of this reviewer, however, this book is useful but falls short of achieving all its stated objectives.
The importance of the role of carers of people with mental illness has often been either underestimated or simply taken for granted. Carer groups are now beginning to be better organised and are endeavouring to have their views taken into account. At a recent launch of a report for Sane Australia, T h e Honourable John McGrath (MLA, Victoria) predicted that the voice of carers will become increasingly strong. One of the many problems that families and carers face is obtaining understandable and accurate information about mental illnesses.
Many feel isolated because of the requirements of patient confidentiality. In Victoria, in 1996 an amendment to section 120 of the Mental Health Act 1986, acknowledged this by allowing some information, which would otherwise be confidential, to be given to primary carers if the information is necessary for the ongoing care of that person. This sensible amendment has the potential to assist health service providers in working with carers and families in the public system in a way that is practical and in the interests of all parties. It is, however, too soon to assess how well it is working and whether providers are interpreting it in ways that will realise the intentions of the legislature.
The author of What Every Patient, Family, Friend and Caregiver Needs to Know About Psychiatry, is Richard W. Roukema, a physician and Clinical Associate Professor at the University of Medicine and Dentistry in New Jersey. Roukema recognises that consumers, whether patients, family members, friends or others giving care to those in distress, need information and he endeavours to provide them with this in an informative and interesting way. He acknowledges that consumers are becoming much better informed about their own health than was the case in the past but he writes, somewhat gratuitously, ‘no longer is the physician the sole authority on health’.
Roukema notes that while there have been several books written for the lay person about specific disorders, there are very few which give ‘an overview of all adult emotional and mental illnesses’. His text, however, is far from comprehensive. He focuses on ‘today's consumers, whether patients, family members, friends, or others giving care to those in distress’ who need information about their disorders. He also includes helpful ‘hints’ on how to care for and help those people. His attempt to do this is useful but is less informative than, for example, Sidney Bloch and Bruce S. Singh's Understanding Troubled Minds (which was published in 1997 by Melbourne University Press and reviewed in the Journal earlier this year). If I was asked to choose between Understanding Troubled Minds and the book under review I would choose the former. It is far better organised than Roukema's book, which tends to ramble because of the overuse of ‘a number of observations on various subjects based on my personal reflections’.
Roukema's work uses a series of commonly asked questions to explain various illnesses, ‘losses’, disorders and problems. Unfortunately, the questions are often bunched together with no clear answer given. For example in chapter 9 ‘Sexual problems in our culture’ he writes:
How could a couple be married for 15 years and never have sexual contact? Why does a man desire to expose himself to young women in public? Why do men rape and kill? Why is there so much cruel and sadistic sexual behaviour? Why are we so curious about sex? The answers to these questions are not readily available to us as yet, and the mystery surrounding sexuality is still greater than our knowledge about the subject. But some things are known.
Those things that are known remain unclear. Roukema tells us that along with wealth and power sex is ‘much discussed’. Some individuals are obsessively driven, others more tempered. Isn't it surprising, he muses, that some individuals risk sexually transmitted diseases and, in humans (and, according to Roukema, probably animals although he concedes this would be difficult to prove) sexual needs are connected with psychological needs which may be normal or not so normal.
While there is much information in this book, the musings make some sections difficult to follow. The arrangement is puzzling because ideas such as ‘problems’ and ‘losses’ are intermingled with concepts like psychoses (in chapter 1). Roukema's frequent references to his personal experiences were, for me, barriers to gaining information. Somewhat superfluously, the author acknowledges that his personal observations ‘are not to be regarded as absolute fact’ because ‘changes that have occurred in the treatment of various disorders are acknowledged’. Statements like, ‘The youth of today think that they have invented drugs’ add little and smack of paternalism in a work that purports to be supportive of people in distress. I acknowledge, however, that some readers may respond well to this style and will relate to the personal accounts. Ultimately, this is a matter of taste and personal preference.