Book Review: David A. Karp’s The Burden of Sympathy

August 20, 2009 at 12:00 pm | Posted in Book Reviews | Leave a comment

If you’re bipolar, you may worry about feeling horrible shame and guilt while reading David A. Karp’s sociological study, The Burden of Sympathy: How Families Cope with Mental Illness. After all, this is a book that describes the feelings of fear, powerlessness, hatred, frustration and, yes, shame and guilt, that family members experience when they care for a family member who is seriously mentally ill. Oddly, the book did not have that effect. Instead, I gained insight into my family’s struggles, and it sparked a great discussion about how they have felt while caring for me.

The first chapter introduces the argument and theoretical frame that he drew from 60 interviews with family members of people with major depression, schizophrenia, and bipolar disorder. Before plunging in, I should point out that this is an academic book, and though it’s well-written, it’s written more for Karp’s fellow academics than it is for families or the mentally ill. I wasn’t put off by the theoretical discussion, which refers to numerous works with which the lay reader may not be familiar; however, some readers may be.

OK, having said that, Karp argues that the ethic of rugged individualism has eroded community to the point where the mentally ill often depend on just a few family members for the care that they need. This is, of course, exhausting for the caretaker, and, indeed, interviewees spoke again and again of feeling consumed by the loved one’s illness. As Karp puts it in his conclusion:

    In the absence of adequate public policies, the mentally ill and their families have largely been left to fend for themselves. Rather than finding sufficient community support, thousands of ex-patients live, socially isolated, in cheap single-room occupancy hotels or, worse, become part of America’s burgeoning homeless population. The remaining tens of thousands retreat behind the closed doors of family homes where they remain out of the public’s view and mind. The family has once again become the social institution of choice to provide care.

Karp argues that in an atomized “postmodern” culture like ours, families lack the support of a community and extended family. These may be available in other cultures, and may have been at other times in our, but here and now it most emphatically is not. The result creates misery for both caretaker and patient.

Each chapter contains a mini-argument organized around a theoretical issue or theme commonly found in his interviews. For instance, in chapter three he speaks about the emotional stages that family members go through, from confusion when the illness first erupts, to hope at a diagnosis, to resignation and sometimes despair when they realize that the illness and need for care are both lifelong. I found this section illuminating, because I went through similar phases myself from onset to the realization that bipolar illness cannot be “cured” with a pill or therapy — or even a pill and therapy.

Each chapter is fascinating in its own right — there are sections on the health care system and gendered expectations about care — and I haven’t got time to summarize them all here. Overall, though The Burden of Sympathy might be a difficult read for some, I think it’s well worth the effort for both mentally ill people and those who love them.

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