"This is my admonition [to psychiatrists]," one person wrote to advice columnist Abigail van Buren, better known as "Dear Abby." "Make it known to your patients that you really care. As schizophrenics, we need all the caring that we can get."

This advice came from one of more than 500 letters sent to Dear Abby several years ago by people with schizophrenia and is now part of a booklet titled "Now That We Are Listening."

"We need to be told we are valuable human beings, lovable people with a capacity for love and giving of ourselves," wrote another person with schizophrenia. "Our own nightmarish thoughts drive our self-respect, self-love, and self-trust right out of us."

The project began several years ago, when the Group for the Advancement of Psychiatry’s (GAP) Committee on Psychiatry and the Community approached Van Buren. They inquired if she would ask her readers with schizophrenia to write to her describing their experiences with psychiatrists and psychiatric treatment.

"When GAP asked me to help with the project, I was thrilled," said Van Buren’s daughter, Jeanne Phillips, who now writes the column under the well-known pseudonym. In 1956 her mother, Pauline Phillips, wrote to the editor of the San Francisco Chronicle and told him that she could write a better advice column than the one that had been appearing in his newspaper. So began the career of Dear Abby. Phillips began helping her mother answer the onslaught of mail at the age of 14 to earn her allowance.

"Anything that I can do to demystify and destigmatize mental illnesses and the attitudes that the public has about them is a boon to everybody," said Phillips, who was not surprised by the candid nature of many of the letters. "People are willing to tell Dear Abby things they wouldn’t tell their doctor, and often do."

After the letters flooded in, GAP members compiled them in a 47-page booklet aimed at helping psychiatrists, mental health professionals, and policymakers be more attuned to the needs of people with schizophrenia. According to GAP member Stephen Goldfinger, M.D., the Committee on Psychiatry and the Community "wanted to give back to the consumers who were so willing to share their stories with us" and gain access to groups that normally do not think about community psychiatry issues.

Janssen Pharmaceutica funded the production and distribution of the booklet.

GAP committee member Richard Lamb, M.D., said that the letters were enlightening. "Many [people] described their experiences with treatment in graphic and meaningful ways. Some found that their psychiatrists were not so helpful, so they got help from other areas including the spiritual community, families, and friends."

For example, one person wrote, "The psychiatrists in the program engaged in the worst sort of mystification. I asked how, why, and will it happen again? No information was offered, no guidance, and no questions were encouraged. . . .The most pompous of the many pompous assured me that ‘a little knowledge is a dangerous thing.’ "

Another person wrote, "After my first breakdown I saw Dr. X. . . . He cared little about me. He told me all about his family and patients and even answered his messages during my appointment."

Said Lamb in response to these and other letters, "We learned that we really must be sensitive to the feelings and concerns of people with schizophrenia."

Some of the letters showed that psychiatrists were, in fact, invaluable to their patients with schizophrenia. "I hooked up with a doctor who prescribed my medicines. She is my lifeline, a very, very, long rope," wrote one respondent. "Our work together has saved my life and turned it around altogether."

Last August, Dear Abby printed another letter, this time from the Committee on Psychiatry and the Community, responding to the many letters it had received and informing readers that the lessons learned were summarized in "Now That We Are Listening."

The committee said that although there were many inspirational letters about lifesaving care, "we physicians were appalled at how often the treatment was perceived as impersonal, fragmented, and dehumanizing."

Since the August column appeared, almost 10,000 copies of the booklet have been distributed.

Copies of "Now That We Are Listening" can be obtained by writing to McKassen, Attn: Maria Harryn, 800 Business Center Drive, Suite 100, Horsham, Pa. 19044. ▪