Influence of Family Life on the Course of Schizophrenic Illness

Abstract

Much of the literature on the family of the schizophrenic patient has suggested that a number of common features are present in the personalities of the parents, and that these are significant in the aetiology of the illness. Most studies have been con cerned with the parent-child relationship and only a few with the adult patient and his parents. Tietze's description of mothers as generally over-anxious, obsessional, and domineering is typical (Tietze, 1949); and Fromm-Reichmann (1948) coined the term schizophrenogenic to describe such women. The more systematic work has indicated a high frequency of domineering and over-solicitous be haviour among mothers (Mark, 1953; Freeman and Grayson, 1955; Gerard and Siegel, 1950; Kohn and Clausen, 1956). Two studies, however, have pro duced negative evidence (Neilsen, 1954; Hotchkiss, Carmen, Ogilby, and Wiesenfeld, 1955) and the second of these was the only one in which the behaviour of the mother and patient was directly observed. Even if differences exist between the mothers of schizophrenics and other mothers, this need not be of aetiological importance. The possibility must first be excluded that behaviour such as over protectiveness may be the result of the patient's unusual behaviour influencing the parents (Kasanin, Knight, and Sage, 1934). Once an illness has developed in one member of a family, a heightened level of tension is probably common. Once estab lished, tense relationships in turn may have an important effect on the later stages of the illness. Some evidence that family relationships can in fluence the course of schizophrenia was provided by a previous study, which showed that re-admission of long-stay patients was related to the type of living group to which they returned (Brown, Carstairs, and Topping, 1958; Brown, 1959). Patients who lived with wives and parents showed a higher re-admission rate than those going to brothers, sisters, or more distant kin, or in lodgings. There was evidence that the risk of deterioration in clinical condition was increased when prolonged contact with close rela tiv s in the house was unavoidable?when, for example, both patient and mother were unemployed. Results could not be explained entirely by the length or past severity of illness or by differences in clinical condition at the time of discharge; and it was concluded that it might not always be best for the schizophrenic patient to return to the close emo tional ties of affection or hostility often found in parental and marital homes. These close emotional ties are not, of course, confi ed to households of any particular kinship, c tegory. It was therefore decided to continue the work by studying the relationships within each home to which discharged patients returned. The majority of patients in this second study were short-stay schizophrenics, and a different survey method was used. Patients and their families were interviewed at the time of discharge and during the year, if the patient was re-admitted, as well as at the end of the follow-up period. In this way the difficulties inherent in the previous exploratory survey, which relied on one interview at the time of follow-up, were avoided. In particular, since patients and families were seen at discharge, predictions could be made about outcome which were not influenced by knowledge of the later course of the illness; and the clinical condition of patients (assessed at the time of discharge) could be controlled in testing the pre dictions. The two hypotheses were: