By David A Karp.
Oxford University Press
ISBN: 0 19 512315 8
“The hardest part of caregiving is not knowing whether what you
are doing is right or wrong”. So says one of the many caregivers
quoted in this book, giving a flavour of the difficulties
David Karp is an American professor of sociology who has turned
his attention to the dilemmas of family caregivers where there is
mental illness in the family, especially schizophrenia and manic or
The core questions in this book concern the moral obligations
that family members may feel, including what we may owe each other;
what the moral boundaries of family relationships are; and what are
the limits of sympathy. Through a series of interviews he addresses
the issue of how people come to understand the nature of their
obligations, and the responses provide a very moving account of the
Through reading this work it became clearer than ever how
care-givers are faced with the task of constructing their own
understanding of mental illness, and formulate an understanding of
how it comes about. This includes that most difficult of
quandaries: “Am I in some way responsible for this person’s mental
Karp classifies family responses into four sections which he
calls “the four Cs” namely cause, cure, control and coping. In each
section we see how the affect of mental illness on a family is a
process that has deep ramifications all round.
The last two chapters are called “Surviving the System” and
“Caring in Post Modern America”. These reveal how very American
this book is, but the themes are applicable to a British
The way in which Karp combines analysis with empathy makes this
a difficult story told with great respect. This is a compassionate
book and should be read by all those touched by mental illness
within the family.
Ged Smith is senior mental health practitioner, Royal
Liverpool NHS Trust.