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by Virginia Lafond
University of Toronto Press, 2002
Review by Tony O'Brien, M Phil. on Dec 17th 2004

Grieving Mental Illness

The first edition of Grieving Mental Illness was published in 1994, and according to the Introduction to his edition, has produced a stream of mail to author Virginia Lafond. Grieving Mental Illness is described as a self-help book, but more than that, as a guide for those with mental illness and their caregivers in "ways and means of coming to terms with – indeed, recovering from - the effects of mental illness on your life, and particularly on you as a person" (p. xx). In response to letters from readers the second edition includes two new sections, a guide for practitioners, and responses to questions.

The model for the book is grief, the stages of the grieving process and means of bringing experiences of grief into conscious awareness so that they can inform and guide recovery rather than hinder it. Lafond adroitly avoids any polarized argument between grief and trauma as a model of mental illness, arguing that both experiences may be relevant. The techniques and tasks scattered throughout the book have much in common with the rationalism of cognitive therapy, especially in identifying beliefs, and examining possible alternative views. Chapter One introduces the grieving process, and the subsequent chapters cover different stages and aspects of the grieving process: denial, sadness, anger, fear and acceptance. Grieving Mental Illness is highly readable and practical; each chapter has headings to highlight specific topics, and exercises aimed at helping people with mental illness and their caregivers in recognizing and consciously using the many aspects of grief as they cope with mental illness.

Lafond's book is one more step in the process of normalizing mental illness. As she points out in the early chapters, we have no difficulty in talking about grief in relation to physical illness, so why not in relation to mental illness? Grief as a process of adjustment has become part of mainstream thinking, so it seems odd that the idea of using grief as a model for understanding mental illness needs to be argued for. Yet it does. We may be enlightened in the need for least restrictive care; we may regard 'mental illness' as a properly neutral term with which to understand human distress; we may regard mental illness, at least in our finer moments, as common in our communities, and not something to fear. But Lafond argues that we have not sufficiently considered mental illness as a process of loss, and one requiring the same attention to the grief involved as other losses.

There are many positive messages. A recurring refrain is 'name and claim'; a phrase that suggests that the person with illness needs to place themselves at the center of the experience, and in so doing can exert more influence in determining the course of their lives. In discussing denial, Lafond argues for its importance, citing the protective role of denial in dealing with overwhelming loss. In Chapter seven Lafond deals with the problematic concepts of insight and acceptance. Here she follows fairly conventional thinking in her references to disagreement with clinicians as resulting in lack of insight. Those who take a more critical view may feel that insight is not defined by agreement with clinicians. To some extent Lafond acknowledges this, but there is a sense in which deference to clinical authority is seen as an important aspect of recovery.

Throughout, the book is informed by Lafond's experience of mental illness and as a user of mental health services. She is generous in sharing some quite personal incidents from her own life, but never insists that these will be the same for everyone. In fact Lafond emphasizes the individual nature of the experience of mental illness, and the need for individuals to find solutions that work for them.

Mental illness, or the experience of psychic distress, is a many-roomed house. Alongside the traditional medical theory, rights theory, recovery discourse and anti-psychiatry philosophy there is room for those who might benefit from Lafond's amalgam of 12 steps programs, grief theory and cognitive therapy. The book is aimed at consumers and caregivers, but professionals will find many practical techniques that could provide a new approach or perspective when other approaches don't work. For those who are looking for an accessible guide to using grief as a model for coping with mental illness are likely to find Lafond's book helpful and inspiring.

 

© 2004 Tony O'Brien

  

Tony O'Brien M Phil., Lecturer, Mental Health Nursing, University of Auckland