Outdated practitioner views about family culpability and severe mental disorders.
Social Work › Vol. 43 Nbr. 5, September 1998
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Outdated practitioner views about family culpability and severe mental disorders.
Current theories and research about the etiology and treatment of psychotic disorders increasingly point to the importance of biological factors. Only about two decades ago these disorders were attributed by mental health professionals and the public at large to flaws in parenting and family interactions, whereas the scientific literature now emphasizes such things as genetics, early (perhaps prenatal) physical illnesses and brain traumas, and other physiological forces that produce neurochemical abnormalities in the brain (Gottesman, 1991, 1996; Maziade & Raymond, 1995; McFarlane, 1996; Torrey, 1994).
Accompanying this shift in the etiological literature has been an accumulation of evidence indicating the need to move away from treatment modalities that cause families of people with psychotic disorders to feel culpable for the causation or perpetuation of their relatives' disorders. Research has indicated that family systems therapies that tend to attribute psychotic disorders to parental or family dysfunction not only are ineffective in alleviating symptoms or preventing relapse but also may exacerbate both (Lefley, 1994; McFarlane, 1996). The latter can happen when the treatment intensifies the guilt and sense of blame felt by the family, which in turn increases family members' anxiety and preoccupation with their relative's problems. Increased anxiety and preoccupation are likely to intensify the level of expressed emotion in the family and the level of criticism and over-involvement by family members who, feeling blamed for causing the disorder, are less able to be supportive and philosophical in the face of its long-term persistence (Kuipers & Bebbington, 1990). Research has indicated that people with psychotic disorders are more vulnerable to relapse at higher levels of expressed emotion, anxiety, overinvolvement, and criticism. They are less vulnerable when family members can be more supportive...See the full content of this document
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