Your Mental Health

Library Journal

Hilary Liftin

There's a child's game called 20 questions in which one person thinks of an animal, vegetable, or mineral, and the other person is permitted 20 questions to figure out what it is. The beauty of the game is how often the questioner succeeds -- we are often only 20 questions away from understanding what is in another person's head. Now two of the foremost experts in establishing psychiatric guidelines have joined forces to help laypeople recognize when a psychiatric problem might benefit from treatment, and their approach is an equally elegant -- though far more sophisticated -- 20 questions.

When the DSM-IV, the fourth edition of the diagnostic manual of mental health, was published, in 1994, with Allen Frances as chairman of its task force and Michael First as editor, this manual became internationally established as the standard reference for mental-health workers. With Your Mental Health, the authors have presented the information in the DSM-IV in clear language that isn't the least bit technical. In doing so they have made a historic contribution to how people who need help can figure that out.

According to the authors, one in five individuals at any given time has a psychiatric problem that might benefit from treatment. The reader is given 20 questions to ask him or herself about his or her mental state -- a diagnostic screening questionnaire. These 20 questions correspond to 20 chapters that cover just about all of the psychiatric problems a person might have, from "The 'Blues'" to "Abnormal Eating" to "Sleep-Related Problems." Each chapter gives descriptions of disorders, specific diagnostic criteria, treatment options, additional reading, and places to go for help (including web sites).

The authors could not have done a better job in writing this material. It is simple and direct without being condescending. Unlike the doctors' reference, Your Mental Health is written in the second person ("You feel that the things strangers do or say may in some way refer to you...." "You have beliefs that other people find unusual or off-the-mark...." "You often have unusual perceptual experiences...."); the result is that the self-diagnoser may feel, finally, that he or she has been understood. One can't help believing that the doctors expect this and intend it as a beginning to the recovery process. Your Mental Health provides the nonprofessional with an unprecedented tool to understanding how serious our problems and those of our friends and family may be. Beyond this achievement, Your Mental Health will certainly serve clinicians, providing them with excellent language with which to describe diagnoses to their patients. Your Mental Health covers all of the sections in DSM-IV except those problems that are mostly discovered in hospitals, such as those that result from medical conditions.

It is quite a brave feat for doctors to communicate some of what they have learned to their would-be patients. In their introduction, which is as eloquently crafted as this task merits, the authors caution readers not to use mental problems as excuses for bad behavior, not to use what they learn for name-calling, not to overdiagnose, and not to think diagnosis solves any problems. All psychiatric problems, they point out, are "usually an exaggeration or a distortion of a basic human tendency that has fundamental adaptive value when it works well. Many phobias are inborn adaptive fears that have become wildly exaggerated. Binge eating was a great way to store calories when the getting was good in a world without refrigerators and haunted by possible starvation...." What this means is that many of the problems described in the book are familiar to all people; it is only when they are so out of proportion as to affect the way someone functions in the world that they require treatment. An anxiety-ridden person might simply turn to the chapter "Anxiety, Fear and Avoidance." But the authors' assertion of the value of the book rings poetic and true: "The psychiatric disorders in aggregate present a wonderful museum of humanity displayed in all of its unusual variety."--Hilary Liftin, barnesandnoble.com