Influence of the family on the course of disease

The family may play different roles - either beneficial, supportive, motivating or unfavourable - inducing relapses.  It is good to think about your own influence and responsibility for the further course of the illness and the treatment of a family member.
Stock photo. Posed by model.

Schizophrenia is a disease associated with numerous myths and burdened with considerable stigmatisation. In order to effectively help not only the patient, who is our close relative, but also ourselves, caregivers should gain as broad knowledge about the disease and the methods of its treatment as possible and also closely collaborate with professional therapists. Sometimes, symptoms of the disease suggest emotional withdrawal of the schizophrenic patient, however, as in each of us, also the patient feels deep nostalgia for human closeness and emotional support of the closest family.


Family members have real and significant influence on what will happen with the ill person over the years of life with schizophrenia. Family can do a lot of good for the future of the ill relative.

Members of families of schizophrenics should not feel guilty because of the fact that someone in the family became ill with schizophrenia. Blaming oneself or someone else in the family for causing the illness does not lead to anything good. Neither for the patient nor for his or her family. But this does not mean that indifference is the right way to respond to the illness. Support of the family and friends may be invaluable for the ill person.


You should think about responsibility instead of guilt. About the future instead of the past.

It is worth knowing that...

A schizophrenic remains a family member.

Family is important to such a person, often even more important than in the case of healthy people who are drawn to the world with friends, fun, work or interests. For many schizophrenic people family is particularly important in part because they do not have too many friends and activities outside the family circle. And the process of ill people's return to increasingly better life in the society often starts in the family.

It is worth knowing that...

There is no sense to deny the fact of the disease by saying, for example,"nothing happened, it's a coincidence, no problem"), but, on the other hand, it makes no sense fall into extreme pessimism ("this is the end, it's a sentence, nothing good will ever happen to us").

Such an extreme approach to the illness does not have a positive influence on the practical ways of life with the patient or the course of his or her treatment. If a family member has already fallen ill, it is good to find out as much as possible about the illness and its treatment from reliable sources. Then it is good to apply this knowledge in everyday life, taking it into account in one's own behaviour.

Theories about family impacts on disease progression

Do you know that...

From the scientific point of view, the first reports about family effects on the development of the disease were published in the 40s and 50s of the previous age.

The theory of "schizophrenic mother" was created, whose overprotection and rejection were to be one the factors to induce psychosis. After the theory was rebutted, another theory became popular, assuming the influence of family, especially of parents, on the risk of schizophrenia relapses, namely, the theory of expressed emotions (EE).

These emotions are manifested, first of all, in excessive criticism and hostility to ill persons. The observation of patients with worse prognosis, returning from hospital in a situation, when the level of emotional functioning in the family was not much different from emotions of the patient, was at the base of the EE theory development. At present, expressed emotions (EE) include:

  • generalised criticism,
  • rejecting attitude,
  • self-sacrifice,
  • excessive identification with the patient,
  • overreactivity to stimuli.
The are arranged in three domains: hostility, criticism and excessive emotional involvement.


A high level of expressed emotions (EE) is associated with a considerably higher risk of disease relapse (50-65%) vs. low EE level (25-35%).

The EE level is a predictor not only of schizophrenia relapses but also of chronic mental disorders, such as bipolar affective disease and alcohol addiction syndrome, and of chronic somatic diseases. A high level of criticism and hostility reveals higher predictive significance than excessive emotional involvement. High EE levels, observed not only in the patient's family members but also in formal caregivers, were also found to have been responsible for worse prognosis for the patient's condition.
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