Family reactions to psychosis

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There are no typical family reactions to the family member's disease, most often a child, but transcultural studies define the spectrum of such reactions - regardless of the fact if it is the first manifestation of disease or its chronic course.

The first psychosis is usually preceded by a prodromal period, i.e., a period when the early signs of the disease become visible. Unfortunately, it is rather difficult to associate the first prodromes with the disease and their analysis is easier when full psychosis develops. Prodromal symptoms may include:

  • significant social isolation or total withdrawal (it comes to "withdrawal into oneself", weakening of contacts with the environment, difficulty to start friendly talk - a number of teenagers manifest such symptoms, these features are really integrated into the natural development of man, thus the identification of disease symptoms is not easy),
  • strange convictions or magic thinking,
  • clearly odd behaviours,
  • clear negligence of personal hygiene,
  • digressions, empty words, depletion of the speech with regards to its contents and frequency of use (it sometimes comes to breaks in the train of thought, making the entire statement incomprehensible),
  • disturbed emotional life (one may get the impression that the affected person has become indifferent to the surroundings or that his/her emotions have become inadequate to situations - cheerfulness in situations which raise sadness in others, sometimes a mood full of vulgar odd jokes; the loss of ability to experience pleasures may also be the cause of arguments in the family),
  • the loss of initiative, interest or energy - apathy, which - understood as laziness - becomes a source of conflicts in the family,
  • deteriorated functioning in various social roles, difficulties with learning,
  • unusual perceptive experiences.
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Stock photo. Posed by model.

It happens that such a prodromal state is maintained fairly long and the patient isolates more and more from the environment. With another course, psychotic symptoms are rapidly manifested and it comes to the outburst of psychosis, what in the majority of cases, ends up with hospitalisation of the patient.

The family responds to such symptoms in various ways. Transcultural studies define the spectrum of these reactions, mentioning, first of all, a life in uncertainty and misunderstanding, devotion (of mother), the sense of loss, increasing deterioration at the area of leisure, the feeling of discrimination of social disintegration, identification of psychiatrists as the source of stigmatisation, worse functioning of the parents of ill children in marriage, in addition, a higher level of anxiety and depression in mothers.

It is worth knowing that...

The sense of shame caused by being diagnosed with schizophrenia is as common as it is unreasonable. It is probably a consequence of asylum psychiatry and isolation of chronically ill people. Still 100 years ago, the majority of patients were chronically hospitalised.

Even today, many of the patients face social stigma and people are ashamed or frightened to reveal that their son or daughter suffers from schizophrenia. Nowadays, members of the families of schizophrenics – largely due to psychoeducation – complain mainly of the transparency of their child's condition; also, they are aware it takes a long time to achieve remission, but they take pride in every small victory over the disease.

The table below demonstrates the most common reactions of the patient's relatives to schizophrenia during the first episode of psychosis, confronted with the real picture of the disease.

Reaction Typical phrase What is it really like?
sadness, anxiety „We feel we have lost our child”
„We are afraid we shall lose or hurt him/her”
The first episode of psychosis is certainly not "emotional death", the ill son or daughter will be the same person, which was loved and is still loved by the parents, siblings and the partner. At the same time, the first episode of psychosis is not always a symptom of schizophrenia. It may be an affective disorder or a schizophrenia-like disorder, or a mental disorder resulting from a somatic condition or resulting from psychoactive substances - following an effective therapy, it may be the only psychotic episode in the life of that person.
fear „Are we safe, staying with him/her under one roof?” Persons with psychosis are much less aggressive than normal, healthy persons. Simultaneously, in a situation of "double diagnosis" - i.e. schizophrenia and symptoms of psychoactive substance abuse (most often alcohol) - the risk of aggressive behaviours in the patients increases.
shame, guilt, blaming oneself „Are we guilty of that?"
„What will the people think of us?”
„Were you a better mother...”
The problem with the sense of guilt is a typical reaction of the parents to the onset of psychosis in heir children, especially in the mother-son relationship. It should clearly be stated that psychosis is not any punishment for any guilt, nor is it any proof of educational errors.
the sense of isolation „No one is able to understand it” The more knowledge is acquired on the causes of psychosis, its course and possibilities of its therapy, especially when the knowledge and emotions are exchanged with members of other affected families, the lower is the feeling of isolation
bitterness, denial of the disease, denial of the severity of disease „Why should it happen to us?”
„It could not happen in our family”
„It is only an episode which will pass without leaving a trace.”
Every hundredth person suffers from schizophrenia and this epidemiology is maintained, therefore, the case of schizophrenia is in line with the constant trend of incidence and not an ominous twist of fate.
ambivalence „We loved him/her so much, and he/she is now so cruel that we want him/her to go away” The problem of revealed emotions, demonstrated in excessive criticism, hostility to patients and excessive emotional involvement.
depression „We are no more able to speak without crying” A depressive reaction is in such a situation fairly understandable, while its continuation will only deteriorate the ability to help and stay with the ill person.
anger „We are aware that now his/her siblings need help and we devote the whole time to him/her ” An involvement into the therapy of siblings is difficult for the fears of the parents, as well as of the siblings themselves, of the risk of contracting schizophrenia by other family members. One should, however, remember that a help of the brother or the sister - provided in the first episode of psychosis - may be the only chance for help by peers.
inability to break away from the subject „There is no a more important problem for us than his/her disease, and it will always be” During the first psychotic episode, similarly as during particular exacerbation episodes, the issue of disease will dominate in the family but it may gradually be replaced by the issues of therapy, recovery and prevention of disease relapses.
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