Schizophrenia and family caregiving


  Book Club Discussion Guide

This story can impact the reader at several levels. However you approach it - as personal memoir, a family memoir
or as a demonstration of the care given to people with serious mental illness,  I hope these questions will help 
to stimulate some good discussions.

1.    Some of the scenes in Shot in the Head take place more than fifty years ago.  Others involve emotionally-
charged situations.  The author states that the book’s dialogue and sequence of events are her
"best efforts to present what really took place.” How is its accuracy important to your experience
of the book?  What do you expect when you read a book classified as memoir?
     
2.    The author describes her lack of involvement in Paul’s care in the first few years of his 
hospitalization.  
What factors contributed to that distance?    How does she change over the course of Paul's illness?

3.   As much as this book is about Paul and Katherine, it is also about the whole family, especially the other siblings - Monica, Ilene, Patrick, Sheila, etc.  Did you identify with any of the siblings? Which one?  How did their relationship with their brother change during the course of his illness?  Where do you see the changes?

4.     Paul’s care changes dramatically over his lifetime.  How do Federal and State legislation impact his care?  What role do you think public agencies, the medical community and insurance companies should play in the care of someone like Paul?  What role should be played by the family - parents, siblings, children? What help do family caregivers need?

5.    How is the care received by people who suffer from brain diseases different from the care received by people who suffer from malfunctions of other body organs such as the kidneys, heart or pancreas?  What factors have led to these differences?  Do you think a person with serious mental illness should be forced to accept treatment? 

6.    Society also deals with brain disease differently than other types of illness.  For example, if your neighbor has breast cancer or a heart attack, you bake the family a cake or offer to help get the patient to medical appointments.  How do you react if you find out a neighbor has bi-polar disorder or schizophrenia?  Why?  How can this change?  

7.    Which of the stories about Paul- things he did, things that happened to him - touched you the most?  

8.    When Paul begins to suffer pulmonary problems, he is diagnosed first with pneumonia.  How do you think his cognitive impairment impacted the level of care he received?  How did it impact his care from the oncologist?

9.    How did his care change when his sisters had him transferred to a nursing home?  How did his behavior change?  Why do you think it changed?

10.    The author uses several genres to put forward her story – narrative, emails, poetry, pictures.  How do these different genres impact the reader’s enjoyment and understanding of the issues and the characters?


11.    Do you believe Paul is better or worse off when he is released from the state hospital?  Give examples of how his life changes.  How do we balance the trade-offs between a person’s desire for freedom and the knowledge of the medical establishment that he or she needs supervision?  Where else in our lives do we see similar trade-offs?

12.  Has your perception of mental illness changed since reading Shot in the Head?  If so, how?


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