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Influence of Family Life on the Course of Schizophrenic Disorders: A Replication

Published online by Cambridge University Press:  29 January 2018

G. W. Brown
Affiliation:
Bedford College, University of London, Regent's Park, N.W.1
J. L. T. Birley
Affiliation:
Institute of Psychiatry, De Crespigny Park, London, S.E.5
J. K. Wing
Affiliation:
Institute of Psychiatry and London School of Hygiene; M.R.C. Social Psychiatry Unit, Institute of Psychiatry, De Crespigny Park, London, S.E.5

Extract

In spite of the new methods of treatment and care introduced during the past fifteen years, schizophrenic patients are still liable to relapse with a recurrence of florid symptoms such as delusions, hallucinations and disturbed behaviour, and great suffering can be caused to all concerned (Brown et al., 1966). It has been shown that the onset of florid symptoms is often preceded during the previous three weeks by a significant change in the patient's social environment (Brown and Birley, 1968; Birley and Brown, 1970). Other studies have focused on the influence of more persistent environmental factors, such as the emotion expressed towards the patients by relatives with whom they were living. In an exploratory survey of discharged long-stay men it was found that close emotional ties with parents or wives indicated a poor prognosis (Brown, Carstairs and Topping, 1958; Brown, 1959). In a further study, patients were seen in hospital just before discharge, and their relatives were interviewed at home at the same time, and both were seen together at a joint interview shortly after discharge. It was found that those patients who returned home to live with relatives who were highly emotionally involved with them (as judged by ratings of the relatives' behaviour) were more likely to suffer a relapse of florid symptoms, even when the severity of psychiatric disturbance at the time of discharge was taken into account (Brown et al., 1962). Ratings of the patient's own expressed emotion showed much less involvement, and were much less highly associated with subsequent relapse. There was also a suggestion that short-term and long-term influences might have a cumulative effect; for example, that a raised level of tension in the home made relapse more likely in the event of a critical change in the patient's social environment (Brown and Birley, 1968). These facts, together with the contrasting but just as handicapping reaction of schizophrenic patients to an under-stimulating social milieu, were brought together in a more general theory of environmental influences on the course of schizophrenia (Wing and Brown, 1970). This also took account of the high physiological arousal which had been found in the most withdrawn schizophrenic patients (Venables, 1968; Venables and Wing, 1962). It was argued that in a socially intrusive environment acting upon a patient whose thought disorder was in any case liable to become manifest whenever circumstances became too complicated, a patient would tend to attempt to protect himself by social withdrawal; but this process might easily go too far, both in hospital and outside it, leading to complete social isolation and inability to care for himself. The optimum social environment, for those who remained handicapped, was seen as a structured and neutrally stimulating one with little necessity for complex decision making.

Type
Research Article
Copyright
Copyright © Royal College of Psychiatrists, 1972 

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References

Atchley, R. C. (1970). “A qualification of test factor standardization: a methodological note.” Social Forces, 49, 8485.Google Scholar
Birley, J. L. T., and Brown, G. W. (1970). “Crisis and life changes preceding the onset or relapse of acute schizophrenia: clinical aspects.” Brit. J. Psychiat., 116, 327333.CrossRefGoogle Scholar
Blalock, H. M. (1960). Social Statistics. New York: McGraw Hill.Google Scholar
Blalock, H. M. (1964). “Controlling for background factors: spuriousness versus developmental sequences.” Social Enquiry, 34, 2840.CrossRefGoogle Scholar
Brown, G. W. (1959). “Experiences of discharged chronic schizophrenic mental hospital patients in various types of living group.” Milbank Mem. Fund Quart., 37, 105.CrossRefGoogle Scholar
Brown, G. W., Carstairs, G. M., and Topping, G. G. (1958). “The post-hospital adjustment of chronic mental patients.” Lancet. ii, 685.CrossRefGoogle Scholar
Brown, G. W., Monck, E. M., Carstairs, G. M., and Wing, J. K. (1962). “The influence of family life on the course of schizophrenic illness.” Brit. J. prev. soc. Med., 16, 55.Google Scholar
Brown, G. W., Bone, M., Dalison, D., and Wing, J. K. (1966). Schizophrenia and Social Care. Maudsley Monograph No. 17. London: Oxford University Press.Google Scholar
Brown, G. W. and Rutter, M. L. (1966). “The measurement of family activities and relationships.” Human Relations, 19, 241.Google Scholar
Brown, G. W. and Birley, J. L. T. (1968). “Crisis and life changes and the onset of schizophrenia”. J. of Health and Social Behaviour, 9, 203214.CrossRefGoogle Scholar
Cooper, J. E. (1970). “The use of a procedure for standardizing psychiatric diagnosis,” in Psychiatric Epidemiology (eds. Hare, E. H., and Wing, J. K.). London: Oxford University Press.Google Scholar
Epstein, S., and Coleman, M. (1970). “Drive theory of schizophrenia.” Psychosomatic Med., 32, 113140.CrossRefGoogle Scholar
Goodman, L. A., and Kruskal, W. H. (1954). “Measures of association for cross classification.” J. Amer. stat. Assoc., 49, 732764.Google Scholar
Hirsch, S. R., and Leff, J. P. (1971). “Parental abnormalities of verbal communication in the transmission of schizophrenia.” Psychol. Med., 1, 118127.CrossRefGoogle Scholar
Kendell, R. E., Cooper, J. E., Copeland, J. R. M. et al. (1972). Psychiatric Diagnosis in New York and London. Maudsley Monograph No. 20 (to be published by Oxford University Press).Google Scholar
Leff, J. P., and Wing, J. K. (1971). “Trial of maintenance therapy in schizophrenia.” Brit. med. J., 3, 599604.Google Scholar
Mueller, J. H., and Schuessler, K. F. (1961). Statistical Reasoning in Sociology. Boston: Houghton and Mifflin.Google Scholar
Rosenberg, M. (1962). “Test factor standardization as a method of interpretation.” Social Forces, 41, 5361.Google Scholar
Rosenberg, M. (1968). The Logic of Survey Analysis. New York: Basic Books.Google Scholar
Rutter, M. L., and Brown, G. W. (1966). “The reliability and validity of measures of family life and relationships in families containing a psychiatric patient.” Soc. Psychiat., 1, 38.CrossRefGoogle Scholar
Venables, P. H. (1964). “Performance and level of activation in schizophrenics and normals.” Brit. J. Psychol., 55, 207218.CrossRefGoogle Scholar
Venables, P. H. (1968). “Experimental psychological studies of chronic schizophrenia,” in Studies in Psychiatry (eds. Shepherd, M., and Davies, D. L.). London: Oxford University Press.Google Scholar
Venables, P. H. and Wing, J. L. (1962). “Level of arousal and the subclassification of schizophrenia.” Archives of gen. Psychiat., 7, 114119.CrossRefGoogle Scholar
Wing, J. K. (1970). “A standard form of psychiatric Present State Examination and a method of standardizing and classification of symptoms,” in Psychiatric Epidemiology (eds. Hare, E. H., and Wing, J. K.). London: Oxford University Press.Google Scholar
Venables, P. H. and Freudenberg, P. K. (1961). “The response of severely ill chronic schizophrenic patients to social stimulation.” Amer. J. Psychiat., 118, 311322.Google Scholar
Wing, J. K., Bennett, D. H., and Denham, J. (1964). The Industrial Rehabilitation of Long-stay Schizophrenic Patients. Medical Research Council Memo No. 42. London: H.M.S.O. Google Scholar
Wing, J. K. Birley, J. L. T., Cooper, J. E., Graham, P., and Isaacs, A. D. (1967). ‘Reliability of procedure for measuring and classifying “Present Psychiatric State.”’ Brit. J. Psychiat., 113, 499515.CrossRefGoogle ScholarPubMed
Isaacs, A. D. and Brown, G. W. (1970). Institutionalism and Schizophrenia. Cambridge: Cambridge University Press.Google Scholar
Wing, J. K., Cooper, J. E., and Sartorius, N. (1972). Measurement and Classification of Psychiatric Symptomatology (Instruction Manual to P.S.E. and CATEGO) (To be published).Google Scholar
Wynne, L. C. (1968). “Methodologic and conceptual issues in the study of schizophrenics and their familes,” in The Transmission of Schizophrenia (eds. Rosenthal, D., and Kety, S. London and New York: Pergamon.Google Scholar
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