So, do family members cause mental illness? I'm going to give you my short answer. No, family members do not cause mental illness. And, as somebody who has worked with families for a very long time in the mental health care system, I have seen that idea cause so much pain for people, that I really had no intention of addressing that in this course at all. But I'm going to tell you why we are going to talk about it. The first reason we're going to talk about it is, because when I have gone through your discussion forums, I've seen that there are a number of people who have shared their belief. That experiences they had in their families or, or that people they know had in their families, have had an impact on their mental health as adults. And I feel like I want to respect that perspective by discussing it in some way in the course. The other thing, on the other side of that is, I know that there are a lot of family members in this course, and as I said, I know that this is an idea that has caused and can cause a great deal of pain for people. And in your reading that is titled, Stop blaming me for my daughter's illness, that woman talks about the fact that people are very open and pointing the finger at family members, and thinking that it must be their fault somehow. And so I also want to respect their experience by putting this issue on the table and trying to put down some ideas. That give you a sense of how I feel about this issue. So that's why we are going to tackle the question, do families cause mental illness? Why do families get blamed for the mental illnesses of their family members? Well let me fill you in on some of the things that have contributed to that. First, as I've said many times, psychodynamic theories have had a huge influence on mental health and psychiatry. That group of theories places a great deal of emphasis on early relationships and points to those early childhood interactions as sowing the seeds of mental health and mental disorder. Following this line of thinking, families were heavily implicated in creating psychopathology. And since mothers spent the most time with children, they got it especially bad. You may remember in the parody that I did of an intake interview in lecture three, I asked the question how many times a day do think about how much you hate your mother. I've never seen anyone actually ask that question that way, but there's definitely a lot of interest in what that poor mother did or didn't do that may have contributed to psychological damage. We continue to believe that early childhood experiences influence adult development but you will see that we do not put all the blame on mothers and families the way people once did. Then you hopefully remember R D Laing, one of the most prominent members of the anti-psychiatry movement. He had some ideas about familes causing mental illness. He put out a theory that schizophrenia was not an illness but a logical response to being in a pathological family context. These are ideas that are given a lot of credibility now, but they had a huge impact at the time. And because R D Laing was so popular, remember he had an international best seller in that book, it left a, a residue of a lot of family blaming behind. Later, when we started being able to talk more openly about issues of family violence and especially child abuse, the family was again seen as the source of mental damage that turned into later mental illness. There's unquestionably a literature that links childhood abuse, especially childhood sexual abuse, to adult psychopathology. It's important to emphasis that there are many children who survive such experiences and do not go on to experience mental illness as adults. But one of the reasons why we are so concerned to identify and intervene in situations of child abuse is because we know that it can have very long-term effects on the mental health and well being of its victims. So that's a situation which families can be blamed for causing mental illness. Although we know, unfortunately, that many children are abused by people outside of their family as well. Another addition to an environment of family blaming is research that has linked family dynamics to relapse in mental illness. This is research that's been done mostly in the context of schizophrenia. Where they've been able to demonstrate associations between negative family dynamics and individuals diagnosed with schizophrenia becoming more ill. I'll be saying more about that literature later. Outside of psychiatry, there is also widespread public conciousness around the idea of so called dysfunctional families. I'm locating that in the 1980s, because it seems like this is when the idea came to be part of every day discourse and knowledge. I can't help thinking that it might have had something to do with that also being an era when there was an explosion of these talk shows where families would come on stage to share their stories of anger and betrayal, usually exploding into flying fists and throwing furniture and all that sort of thing. I, that may have been just a North American phenomenon but there is no question that what happened was suddenly, dysfunctional family seemed to be everywhere. And it was actually entertainment on TV. And part of what that left behind was a public that got an idea about what a dysfunctional family was, feeling like it was something that they could identify. In its most basic form, a dysfunctional family is a family that's not able to carry out its functions, the functions that we described as being the reasons for its existence. The dysfunction in that family, is indicated by its failure or difficulty in promoting the health and well-being of its families, sorry, of its family members. So, what makes families dysfunctional? Why does it happen? Well one of the common reasons, is that we may have parents that are unwell and unable to take on the higher level of responsibility, that is necessary to make the family system run well. I'm focusing on parents here, because in the North American context, we generally expect that parents have the higher responsibility in families and other family members are, are dependent on them. These other family members are dependent both because they are usually younger and also because we're in a social context in which only adults have the authority and privileges that make it possible to act in the interest of the family. If the parents are unwell for example, if they're dealing with mental illness or substance abuse or other types of illness, and there's no one else available to step in and support hea-, healthy family functioning, then the family can fall into disarray or dysfunction. For these reasons and others, parents may have limitations or may not be competent to take care of their families, and the family becomes what we might call, dysfunctional. Another part that we have to admit, however, is that we also look to parents when we want someone to blame for the behavior of their children. There's a basic type of common sense belief that if you've got dysfunctional children, then it must be because their parents are dysfunctional. To give you an example of this type of thinking, this is a quotation from an article that I found in the American Journal of Community Psychology when I was trying to find the origin of the term dysfunctional family. This author says, parents who do not show a reasonable amount of love, respect, and discipline for their children should be identified and be made to assume some of the consequences of their children's behaviors. If a manufacturer produces a shoddy product that hurts or injures someone, he or she is held legally liable. That's pretty harsh stuff. It's pretty harsh to refer to children as shoddy products, and pretty harsh to suggest that parents are completely to blame for them being shoddy products. So try to imagine, if this is the kind of stuff that could be said in a professional journal about families, then can we be surprised that many children anticipated being blamed if there was any kind of problem with their children. Even going back as far as the Victorian asylums, family's were thought to part of the problem rather than part of the solution. You may remember that patients were to be kept away from these people who would undermine their recovery. So with a history that includes that, and all of the things I've mentioned, it's no surprise that families feel like they're being blamed by mental health professionals. And no surprise that so many people in the public also think they may be, be to blame for whatever problems their relatives are experiencing. But because you're taking a course called The Social Context of Mental Health, and you know about something called the biopsychosocial perspective on mental health, you know it can't be that simple. Remember, that the family definitely figures into what promotes and undermines mental health. When we addressed this in lecture two, we focused on how positive dynamics in the family promoted mental health, and negative things like family disruption and family violence undermined mental health. Now we can add that to the extent to which families are able to fulfill these functions that we have said are the basic functions of families, this will also have an effect on mental health. But we can't forget that although families play a huge role, they do not play an exclusive role in determining the mental health in any individual. We still have to take into account biological, psychological, social, and environmental factors that have an influence. And it is this combination of the biological, psychological, social, familial, and environmental, and don't forget, we also spoke about spiritual and cultural in our last lecture. All of these things together have an influence on mental health. So, if we're going to blame families, we should be, we shouldn't be forgetting to blame these other things as well. The biopsychosocial perspective reminds us that families don't dysfunction all by themselves, too. Family functioning has a context. Things like the social determinants of health are also social determinants of family health. It's much harder to be a functional family system if you're deveal-, if you're dealing with severe challenges in areas like social support, poverty et cetera. Another thing to consider is that we tend to focus on the nuclear family in North America. But families are multi-generational, and family dynamics are multi-generational too. Family dysfunction may be something that has been going on for many years or many generations in a family. It may have to do with the inheritance of problems that affect parenting. It may also have to do with the inter-generational transmission of traumas, an issue that has had a tremendous effect on Canada's indigenous people. And that is directly connected to the inter-generational effects of the colonialism they have experienced. For many reasons, some families are well-equipped to promote mental health in their members and other families are very poorly equipped to promote mental health in their members. There are some special considerations to take into account when we talk about families who are in contact with the mental health care system. First, I've already dis-, already discussed that service providers have blamed families and, as Susan Ingram suggests in her article, some still do. Second, families have been put into a very difficult place by the mental health care system. After deinstitutionalization, families were compelled to take on roles as extensions of the treatment team. And this meant they had to be involved in things like monitoring medication, making treatment decisions, et cetera, that could put them at odds with their loved ones. I'm not sure that we do enough to prepare families for what that can do to their relationships. Because sometimes they get put in the position of having to do things that are not consistent with the wishes of people they love. And that can be a very hard thing on a family. And then, another issue is the focus we've had on family dynamics as a possible trigger of relapse in mental illness. This is the research literature I mentioned before. There's a body of research about what is called the expressed emotion of families. That tracks how family dynamics like being critical of a diagnosed family member or being emotionally over-involved with them, can make their symptoms get worse. This research came from what I think was a very positive place of trying to figure out if there are ways to alter family environments to help promote the health of people diagnosed with serious mental illnesses. But it turned in, into another way of making families feel like they were being blamed for making their family member sick. Now we understand more that what we've been calling high expressed emotion may just be a reaction to a family's member's symptoms getting worse, rather than the cause of them getting worse. But even without knowing which comes first, it's clearer that this expression of either high criticism or emotional involvement, bearing in mind that defining that is culturally defined as well. Well, these things may just be an indication of the overall level of stress in the family and the need to do something to reduce stress for everyone in it. A final thought on why families get blamed for mental illness. We've talked many times about stigma against mental illness, and stigma affects families as well as individuals who are diagnosed with mental illnesses. Families are viewed with suspicion for all the reasons we've described, and part of the way that they just, they experience stigma against mental illness, is by being on the receiving end of those suspicions. And having people assume that the presence of mental illness in their families is an indicator of their failure to perform competently as parents, or spouses, or children, et cetera. Another thing is that we learn more about, as we learn more about the biological basis of mental illness, many people assume that a family members are to blame, because they passed on the bad genes that caused a mental illness. As we've discussed, genetics is only part of understanding what causes mental illness, but many people don't understand that. And will think of people with ill family members as people who must be carrying defective genes. Family members are affected by these attitudes, and may even internalize these attitudes. Some of the consequences you can see of that, is that people may isolate themselves because they fear being blamed by others. At the same time, stigma may mean that people are avoiding them too. And as several of you indicated in your discussion forum, it's not necessarily safe to talk about having a mental illness or having a family member who has one. So secrecy can become quite a burden for families living with mental illness. So, in conclusion. I still say families don't cause mental illness. But I hope that this discussion gives you some food for thought, in terms of thinking about what it is that can happen in families. That can undermine the mental health of their, of it's, of family members, and how also this is not just about what happens within those families but also about what happens beyond those families. And I think it returns us to this very old idea you know, it takes a village to raise a child. It actually takes the entire village to protect and raise all of us. And so you know, in, in the spirit of thinking about the social context, part of what I hope this leaves with you is some thoughts about how, not just family members, but people beyond the family, can also promote mental health for people within families. So with that we're going to move on to the next segment which is about what happens with families and mental illness.
