Schizophrenia is a debilitating disease that results in a loss of social functioning of affected individuals. The family where the schizophrenic belongs suffers the same kind of social dysfunction because it affects their interactions within the family. Some say that it is “one of the most elusive diseases known to man and unknown to medicine” because it leads to strains in relationships within the family. (Canavan). Some of the features of the disease that aggravate family relationships are hallucinations, delusions and formal thought disorder. Other negative manifestations of the disease on the affected individual are social withdrawal and distorted thinking. Naturally this affects the other members of the family because parents may exert an extra attention for the member of the family with schizophrenia to the detriment of the other members of the family. No matter how patient and tolerant other members of the family can be on their affected member, still there may be an abnormal relationship that ensues as the rest of the family members interact with him/her. (Canavan).
The schizophrenic disorders are a group of syndromes manifested by massive disruption of thinking, mood and overall behavior, as well as poor filtering of stimuli. According to DSM-III-R criteria, the onset of illness occurs before age 45. Signs must be continuous for at least 6 months; the illness is not preceded by a full depressive or manic syndrome; and symptoms are not due to mental retardation or organic mental disorder. The characterization and nomenclature of the disorders are quite arbitrary and are influenced by sociocultural factors and schools of psychiatric thought. It is currently believed that the schizophrenic disorders are of multifactorial cause, with genetic, environmental, neuroendocrine and path physiologic components. At present, there is no laboratory method to confirm the diagnosis of schizophrenia. There may or may not be a history of a major disruption in the individual’s life (failures, losses, physical illness) before gross psychotic deterioration is evident. Presenting a lifetime prevalence of 1%, in about 35,000 people in Ireland, it affects roughly 2 million people in the United States. This incurs a cost of $70 billion per annum. Genetic theories on the disease have existed since the turn of the century when this behavior was observed among the untreated relatives of schizophrenics (Jackson, 1991).
Sometimes it happens that patients with schizophrenia will need help from people in their family or community. However, it is but natural that there will be resistance in the offered treatment because he/she will not think that he/she needs any help. They always think that what they are seeing and thinking are concrete experiences. That is why there needs to be a complete understanding from the support systems. It is best that there is love and encouragement from the family members who take an active role in suggesting treatment and hospitalization as needed and which will all depend on how they are concerned with that member of the family. (Helpful Hints About Schizophrenia for Family Members and Others).
Patients with personality disorders tend to show anxiety and depression when pathologic techniques fail, and their symptoms can be similar to those occurring with anxiety disorders. Occasionally, the more severe cases may decompensate into psychosis under stress and mimic other psychotic disorders.
Treatment
1. Social
Social and therapeutic environments such as day hospitals, halfway houses and self-help communities utilize peer pressures to modify the self-destructive behavior. The patient with a personality disorder often has failed to profit from experience, and difficulties with authority impair the learning experience. The use of peer relationships and the repetition possible in a structured setting of a helpful community enhances the behavioral treatment opportunities and increases learning. When problems are detected early, both the school and the home can serve as foci of intensified social pressure to change the behavior, particularly with the use of behavioral techniques. Families adjust with difficulty as those close to the person with schizophrenia are often unsure of how to respond when their family member talks strangely. But to the person afflicted, what he/she says is all too real. They are not hallucinations or imaginary fantasies. Thus, instead of “going along with” a person’s delusions, family members can respond by saying that they do not see things the same way so that the person need not dwell on those delusions for a long time (Proshanky & Seidenberg, 1965).
2. Behavioral
The behavioral techniques used are principally operant and aversive conditioning. The former simply emphasizes the recognition of acceptable behavior and reinforcement of this with praise or other tangible rewards. Aversive responses usually mean punishment, although this can range from a mild rebuke to some specific punitive responses such as verbal abuse or deprivation of privileges. Extinction plays a role in that an attempt is made not to respond to inappropriate behavior, and the lack of response eventually causes the person to abandon that type of behavior. Pouting and tantrums, for example, diminish quickly when such behavior elicits no reaction.
3. Psychologic
Psychologic intervention is most usefully accomplished in group settings. Group therapy is helpful when specific interpersonal behavior needs to be improved (e.g. schizoid and inadequate types, in which involvement with people is markedly impaired). This mode of treatment also has a place with so-called acting-out patients, that is, those who frequently act in an impulsive and inappropriate way.
The high concentration of psychotics in the lower strata is probably the product of a very unequal distribution of psychotics in the total population. To test this idea, Hollingshead selected schizophrenics for special study. Because of the severity of this disease it is probable that very few schizophrenics fail to receive some kind of psychiatric care. This diagnostic group comprises 4.2 percent of all patients and 58.7 percent of the psychotics. Ninety-seven and six-tenths percent of these schizophrenic patients had been hospitalized at one time or another, and 94 percent were hospitalized at the time of our census. When we classify these patients by social class we find that there is a very significant inverse relationship between social class and schizophrenia. (Jackson, 1991).
It is often difficult when only people close to the family knows that one of their members is afflicted with schizophrenia. The family members must understand that the person must get the regular treatment after hospitalization. The person can stop medication which can even aggravate his/her condition. Family members must be aware that the patient needs to continue treatment so that there could be a positive influence on the recovery. If it happens that the treatment is not continued, the symptoms can continue for a long time and this can affect the members of the family because there will be disorganization and the person cannot even care for some of his basic needs. An aunt who had schizophrenia was quite a burden for her family because she had to be assisted in her daily needs since even her clothes remained wet as she developed a habit of often going to the refrigerator and drinking every now and then. She also would withdraw inside her room, not going out for a long time and not talking to anyone except herself. Some say that “All too often, people with severe mental illnesses such as schizophrenia end up on the streets or in jails, where they rarely receive the kinds of treatment they need.” (Helpful Hints About Schizophrenia for Family Members and Others).
Antisocial and borderline categories generally have a guarded prognosis. Those patients with poor outcomes are more likely to have a history of parental abuse and a family history of mood disorder, whereas persons with mild schizoid or passive-aggressive tendencies have a good prognosis with appropriate treatment. (Jackson, 1991, 83). Family members must somehow find the strength to face up to the challenge of having a family member with schizophrenia. They, too, face a multitude of emotions due to the behaviors presented to them on a daily basis. Author Long in “How Schizophrenia Affects the Family” mentions that some of the ways by schizophrenia affects the family members are: stress and anguish, guilt and shame, bitterness, sacrifice, limited financial resources, and diminished personal health and wellness (Long, “How Schizophrenia Affects the Family” as cited in Castagnaro, 2005).
Families can break apart if one member is schizophrenic since the family is in constant turmoil because of little understanding of the disease. Also there is a stigma that is often labeled on these families. Society must be compassionate towards those with this condition and find more ways for treating and funding programs on mental health disorders (Castagnaro, 2005).
