1 Psychology and human development1.10 Social psychology
1.10.4.3 Family life in relation to major mental illness
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Written by Resident Doctor Committee · Published
Discredited theories of family causation
These theories blamed parents and had no supporting evidence.
Theory | Proposer | Claim |
|---|---|---|
Double bind (1956) | Bateson | Contradictory messages at different levels, within a dependent relationship, with no permitted escape or comment, cause schizophrenia |
Schizophrenogenic mother | Fromm-Reichmann | A mother causes schizophrenia |
Refrigerator mother (mid-twentieth century) | Bettelheim | Emotionally cold, intellectual mothers cause autism |
Depression in families
A child of a mother with depression is most at risk of depression itself, and a family history is the strongest risk factor for depression.
Expressed emotion
Expressed emotion (EE) is how relatives talk about a patient. It describes the relationship at one time, not a fixed trait, and high EE in relatives predicts relapse in schizophrenia.
Component | What it is | Threshold for high EE |
|---|---|---|
Critical comments | Disapproval of behaviour, including tone | 6 or more |
Hostility | Rejection of the person as a whole | Any |
Emotional over-involvement | Overprotective self-sacrifice by the relative | Marked, usually 3 or more out of 5 |
Warmth and positive remarks are also rated but do not decide high EE.
The Camberwell Family Interview
The Camberwell Family Interview is the reference semi-structured interview of a key relative, not the patient, of a person with psychosis.
The interview lasts an hour or more and is recorded, and trained raters score the speech on five scales: critical comments, hostility, emotional over-involvement, warmth and positive remarks.
High expressed emotion and relapse
Brown, Birley and Wing (1972), then Vaughn and Leff, found nine-month relapse rates of about 50% with high EE versus 13% with low EE.
Relapse risk rose above about 35 hours a week of face-to-face contact with a high-EE relative, so less contact protects.
Severe symptoms can raise EE, but severity does not explain the whole association.
Family intervention
Family intervention combines education, communication and problem-solving to improve the home emotional climate, and it reduces relapse.
The National Institute for Health and Care Excellence recommends offering it to families who live with, or are in close contact with, a person with psychosis.