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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
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
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