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by Julia Segal
Jessica Kingsley, 2017
Review by Christian Perring on Sep 12th 2017

The Trouble with Illness

The Trouble with Illness does a great job at exploring the many varied emotional issues that come with illness in the family. Segal's main message is that people have a great many ideas and fantasies about illness, not all of which are particularly rational or thought out, and they need exploring in order to manage the turmoil of long term illness and disability. There are losses involved with serious illness, and if they involve people's ability to do the activities that define them, involving work, relationships, or even treasured leisure activities, they have strong reactions. It can take a good deal of work to uncover the ideas people have that can make their lives more difficult. People behave strangely and even bizarrely, or can store up resentments because of their emotional reactions. The central assumption is that uncovering emotions and developing a better understanding of how people are thinking can help to make the situation better. With 35 years of experience Segal is confident that therapy can significantly improve the lives of families living with an ill or disabled family member.

Segal says that she uses a Kleinian psychoanalytic approach, and often uses the word "phantasy" which is a rather more technical term than "fantasy." While this is not an approach that has achieved any significant empirical support, it is best understood as an emphasis on the strangeness and extremity of ideas people have about the meaning of illness. But she explains that readers do not need to understand the technicalities of psychoanalytic theory in order to benefit from the book. That's good because many people would not want to have to buy into the often extravagant claims of Kleinian theory. The bulk of this book is not about supposedly deeply covered unconscious mental entities that influence behavior, but rather about problems that are easily understood with a little thought. For example, with discussion of illness and sexuality, she emphasizes that sometimes people refuse treatment or changes because they fear that it will make them less attractive to their partners. Some people are reluctant to use hospital beds to sleep in because it deprives them of the pleasure of sleeping with their partners in a larger bed. These are not hard emotions to comprehend.

The writing is clear and it fills and important gap in the literature. It should be useful both to therapists and people with chronic illnesses and disabilities who are dealing with emotional problems. The basic ideas are simple and are intuitively appealing.

The central problem of the book is that it ends up being a list of possibilities of how people can react with nothing ruled out, and there is not a lot of detail to the case studies. The longest ones are about half a page long, and some are described in a couple of sentences. The generalities of the descriptions end up being a bit banal and repetitive. After reading the first few chapters readers may want to dip into subsequent sections that are relevant to them. There's a useful final chapter on working with professionals although Segal may be overly optimistic about finding a therapist who is strong at working on these sorts of problems.


© 2017 Christian Perring


Christian Perring is Vice President of the Association for the Advancement of Philosophy and Psychiatry.