Families caring for people diagnosed as mentally ill : the literature re-examined / Christina Perring, Julia Twigg, and Karl Atkin.

  • Perring, Christina.
Date:
[1990], ©1990
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Licence: Attribution-NonCommercial 4.0 International (CC BY-NC 4.0)

Credit: Families caring for people diagnosed as mentally ill : the literature re-examined / Christina Perring, Julia Twigg, and Karl Atkin. Source: Wellcome Collection.

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    4 FAMILIES CARING FOR PEOPLE DLA.GNOSED AS MENTALLY ILL health refers to fflness, patient, relative or supporter. The different assumptions that underlie this choice of language, as well as the language itself, have hampered the process of interpretation. In addition to the barriers that arise in relating findings across different disciplines, there are perspectives within disciplines that pose barriers to understanding. Emphasis on the well-being of families in its own right is only a comparatively recent interest in the field. More usually, interest in the well-being of families has been only for its significance as a means to the greater end of helping the patient. This general lack of attention to family weU-being was highlighted as early as 1968 (Grad and Sainsbury, 1968). Some more recent reviews, such as that by Keisler (1982), include only a brief reference to families; the updated version (1984) of Talbott's influential book devotes only one of its 22 chapters to the families of chronic mental patients. This is despite the fact that 6o per cent of first-episode schizophrenic patients Hve with their families (MacCarthy, Kuipers, Hurry, Harper and LeSage, 1989a). Although Fadden, Bebbington and Kuipers (1987a) described this as a large body of literature, it remains unsatisfactory with regard to its coverage of, and relevance to, carers. That the literature is unsatisfactory comes, in part, from the fact that there are distinct themes in the literature on families and mental health. Gubman and Tessler (1987) have described three of these, all of which show bias in their interest towards favourable outcome for the patient. These themes are the role of the family in both the origins of mental distress and rehabilitation, and what has become known as 'family burden'. Much of the research on the first two themes has been influenced by a perception of the family as having a potentially pathogenic influence on mental illness (e.g. Laing and Esterson, 1964/1982; Vaughn and Leff, 1976). Although the influence of this perspective has waned, there is a risk that aspects of it may inappropriately have been carried over into the third theme, that of family burden. More recently, a change in orientation has taken place. This has occurred against the policy background of increased care in the community, as well as an increased interest in the carer generally. It is now more common to view the family as a source of support and care (Kreisman and Joy, 1974; Vaughn and Leff, 1981) and some attention has been paid to ways of enhancing this family role (Grotty and Kulys, 1986; Hawks, 1975). Some recent work has focused on families as coping with and adapting to the impact of mental illness (Hatfield and Lefley, 1987; Orford, 1987), though even this work is