How to Talk with Families About Genetics and Psychiatric Illness

Patients who suffer with psychiatric illness often have questions about how the illness developed and the risks for other family members becoming affected. How to Talk with Families About Genetics and Psychiatric Illness responds to the increasing need for mental health clinicians to help families deal with these common questions, often based upon concepts from genetic medicine. The authors directly address the new psychiatric genetic research in an accessible manner and how, together with an individual's personal and family psychiatric history, genetics can provide information about likely causes of mental illness and the magnitude of risk. The book also provides guidance regarding how to initiate conversations when the clinician suspects that genetic information may address a patient's unspoken concern or help him or her cope or adapt to mental illness.

Peay and Austin do not claim to equip clinicians to become genetic counselors, but the book does provide a basic overview of genetics 101 that is a useful resource for clinicians. One example of a particularly helpful tool that they have developed for explaining the etiology of mental illness is the “jar model.” The jar is a simple visual analogy to explain the two factors—genetic and environmental—that contribute to mental illness. The picture of the jar depicts how mental illness can develop in a way that anyone can understand, especially for those who do not have a good grasp of numbers. Moreover, I expect that their model will be particularly useful in explaining vulnerability factors to participants in my current research on informed consent for psychiatric genetic research.

Following genetics 101, each chapter of the book is organized to provide examples of common questions and answers about psychiatric genetics. The earlier chapters are written for clinicians to use to discuss possible genetic contributions to the development and/or inheritance of mental illness. By way of example, Chapter 2 provides questions to assist the clinician who is not accustomed to talking about the genetics of mental illness while respecting a patient's right to not know as an option. Later chapters focus on common questions from the patient perspective. For example, one question that Chapter 6 addresses is “Why did you tell me that you think my risk to develop psychiatric illness is probably less than the 15% risk I found on the Internet?” In this example, the authors provide ways to explain to the patient about averaged risks and that in his or her case the clinician should also take into consideration the information provided that modifies risk for this unique situation.

In addition, each chapter includes pertinent cases from Peay's and Austin's experience in genetic counseling. The cases bring each chapter's discussion around a particular topic to a conclusion, often including family history and the graphic pedigree. In Chapter 8 and Chapter 9, the cases focus on the subject of pregnancy and parents of at-risk children and affected children. One case involves parents who are both physicians and have an autistic child; they are expecting a second child. The authors explain how the clinician could address the parents' questions about the etiology of autism and a conversation about how the parents might manage the uncertainty regarding the baby's condition for the remainder of the pregnancy and early in the baby's life. Other chapters include cases about unaffected family members, genetic susceptibility testing, and genetic testing to inform medication strategy.

While the consistent format of the book involves some redundancy for one who reads it from cover to cover, the layout increases its value as a resource on specific topics. How to Talk with Families About Genetics and Psychiatric Illness is a good source for mental health clinicians seeking assistance with common questions and also for unique situations that may arise in the course of practice. Genetic medicine is relatively new, and many clinicians self-report that they are uncomfortable with the coming onslaught of enormous amounts of data. For these reasons, the book's experienced-based discussions on a wide variety of topics can be extremely helpful in providing methods to clarify the issues.