Critical Values Based Practice Network

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Families and Psychosis

Written by Sarah Keenan on . Posted in Clinical Psychology Bite-Size

Families and Psychosis

Issue 10 – January 2009

Author: Sarah Keenan (sarah.keenan@nottshc.nhs.uk)

Key points

  • There have been different understandings relating to the causes of psychosis, and these have been echoed in therapeutic approaches to working with families.
  • Families are one amongst many complex factors that influence well-being (positively and negatively). Therefore we need to consider family influences when thinking about the cause and maintenance of distress.
  • A family’s social context and access to material and social resources is likely to influence the distress of each family member.

Implications for practice

  • Services should try to understand families by considering how all members interact and influence each other rather than focus on helping families cope with an ‘ill’ individual
  • Services should aim to increase a family’s social, financial and emotional resources, which is likely to reduce distress in all family members, including users of mental health services.

 From one extreme to the other: setting the scene

Since the early 1930’s there has been a drive within medical and psychotherapy professions to explain the cause of “mental illness”. Early causal explanations emphasised the family environment, and more specifically difficulties in the relationship between mother and child. This led to many families feeling blamed and stigmatised and has left a lasting mark when speaking to families, who are often understandably very sensitive to the legacy of the term “schizophrenogenic mother”1. Latterly we have seen the emphasis on biogenetic explanations of “mental illness”, which has resulted in neglect of a person’s social and personal context in causing distress 2. The combined influence of rightly not wishing to blame families and the emphasis on biogenetic explanations has made it taboo to even start to consider the potential role of families in the causation and maintenance of mental health problems3. As systemic writers have noted the reasons for someone developing mental health problems (including psychosis) are likely to be complicated and involve a range of different and interacting factors in a person’s life and social context 4. However, families are one amongst many positive and negative influences on well-being.

Why is this important?

Families often find the behaviours of their relative who is labelled as “psychotic” as bizarre or challenging and as interrupting their future hopes and dreams, and those of the person they support5. Therefore it is important that families are supported with these experiences. What this support should look like is less clear.   Many family support packages (see Rethink Carers Education Programme) emphasise educating families about how to cope with someone with a diagnosis of a mental illness. This is in keeping with much research which emphasises “carer burden” in terms of the pressures that carers feel in terms of time, social and financial support 6. These packages often emphasise the negative impact of caring for someone who uses mental health services. This depiction of the relationship neglects the mutually beneficial aspects 7, and assumes a uniformity of caring experience. Further, focusing on a diagnosis or “illness” is problematic because of issues relating to the utility of diagnosis8.

Social Understandings of Distress

We know that many people and families live within poorly resourced social contexts, such as communities with high levels of unemployment and poverty. People who have few resources are more likely to experience mental health difficulties 9. Family units are also influenced by these factors. Limited access to support and social resources is likely to negatively impact on the whole family unit, its level of stress and the nature of their interactions. Therefore it is important to understand family interactions and distress within a wider social and cultural context.

Summary

It is generally acknowledged that service users can effect their family, however, the influence that families can have on services users in terms of levels of distress is less emphasised (perhaps due to the historical influences previously mentioned). It is important that mental health professionals ask about family history and support and that this is done without placing “blame” for difficulties with any component of the family system. Instead the complexity of interactions and broader context of each family should be acknowledged. Families who live within contexts identified as having fewer social support resources are likely to have fewer resources to support people who use mental health services. The distress of all family members is likely to be decreased if they have access to more social resources10.  

REFERENCES

  1. Fromm-Reichmann, F. (1948). Notes on the development of treatment of schizophrenics by psychoanalysis and psychotherapy. Psychiatry, 11, 263 – 273.
  2. Bentall, R. (2004). Madness explained: Psychosis and human nature. London: Penguin.
  3. Johnstone, L. (1999). Do families cause “schizophrenia”? Revisiting a taboo subject. In C. Newnes, G. Holmes, G. and C. Dunn (Eds.), This is Madness. Herefordshire: PCCS Books.
  4. Stanbridge, R., Burbach, F., Lucas, A. & Carterd, K. (2003). A study of families’ satisfaction with a family interventions in psychosis service in Somerset. Journal of Family Therapy, 25, 181 – 204.
  5. Knudson, B. & Coyle, A. (2002). Parents’ experiences of caring for sons and daughters with schizophrenia: A qualitative analysis of coping. European Journal of Psychotherapy, 5, 169 – 183.
  6. Gutierrez-Maldonado, J., Caqueo-Urizar, A. & Kavanagh, D. J. (2005). Burden of care and general health in families of patients with schizophrenia. Social Psychiatry and Psychiatric Epidemiology, 40, 899 – 904.
  7. Wooff, D., Schneider, J., Carpenter, J. & Brandon, T. (2003). Correlates of Stress in Carers. Journal of Mental Health, 12, 29 – 40.
  8. Coles, S. (2008). Difficulties with diagnosis. Clinical Psychology Bite-size, Issue 6.
  9. Houghton, P. (2008). Understanding Psychosis. Clinical Psychology Bite-Size, Issue 1.
  10. Hagan, T. & Smail, D. (1998). Power mapping – I. Background and basic methodology. Journal of Community and Applied Social Psychology, 7, 257 – 267.

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