Biomedical subjects
Publications and source records attributed to A B Hatfield.
Challenges to the next generation of family researchers are enormous as they move beyond the more global concept of family and begin to address the great diversity among families with mentally ill relatives. Since most mental illnesses are chronic conditions, families must also be understood from the long-term perspective of the family life cycle.
Research studies indicate that significant tension characterizes the relationships between providers and families whose relative is being treated in the mental health system. The author recommends that genuinely collaborative relationships be developed in order that people receiving treatment receive optimal care. Collaboration is defined, barriers identified, and ways to overcome these barriers suggested.
OBJECTIVE: Data from a 1993 survey of families in the National Alliance for the Mentally Ill (NAMI) were analyzed to examine services used by consumers and families' perceptions of the services' value. Data from 1993 and 1976 were compared to document changes. METHODS: A total of 3,099 families responded to a mailed questionnaire that was first used in a 1976 local survey of 89 NAMI members. Respondents indicated which of 11 services had been used by their ill relative in the past two years and rated the services as having "no," "some," or "considerable" value. Chi square tests examined relationships between service use and value and key variables. RESULTS: In 1993 families reported nearly universal use of medications and rated them highest in value. More than 60 percent of the ill relatives had been hospitalized in the past two years, and hospitalization was rated second highest in value. Individual therapy, used by two-thirds of the consumers, also received high ratings. Community services were used by about a third of the consumers; these services were valued less highly than office-based services and medications. Respondents in 1976 reported less use of medication and residential services, more hospitalization, and more use of individual, group, and family therapies. In 1993 all services were valued more highly than in 1976. CONCLUSIONS: The 1993 survey findings showed that more consumers used office-based services and hospitalization than community-based alternatives, and that families rated the former services more highly. Value ratings of community services rose significantly between 1976 and 1993.
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This chapter examines family-provider relationships that occur outside of planned educational programs and how they impinge on family wellbeing. It discusses and recommends collaborative approaches in work with families.
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The National Alliance for the Mentally Ill (NAMI) was conceived a decade ago in the tradition of self-organized parents' groups for handicapped and chronically ill children. The character of the organization and its rapid growth are thought to be due to its clear identity as a "mental illness" group, its control and direction by parents and relatives of people suffering from mental illness, and its relationships with staff and professionals. The author believes that the NAMI movement is at an important juncture in its development and identifies factors that could influence its character in the next decade.
Many current approaches to the management of schizophrenia emphasize the influence of environmental stress on the course of the illness. Relatively neglected is the internal experience of schizophrenic patients as a source of stress and anxiety. The author draws on a wide range of first-person accounts by patients with schizophrenia to identify four internal sources of stress--altered perceptions, cognitive confusion, attentional deficit, and impaired identity--and to reveal the wisdom and creativity with which patients have come to terms with their illness.
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Although mental health professionals have shown much enthusiasm for the concept "expressed emotion (EE)," little critical analysis of the concept has appeared in the literature. Placing families in dichotomous categories of high EE and low EE amounts to stereotyping; such an approach does little to help professionals in understanding the complexities of family life with a mentally ill relative. High EE is seen as a factor that maintains mental illness in a relative. Once more, families feel hurt and alienated. Once more, families feel negatively labeled, but not empathically understood.
Mental health professionals have begun to show interest in working collaboratively with families of mentally ill people in the interest of the patient's well-being. Many professionals are aware, however, that considerable alienation exists. One source of difficulty may be the language used to describe families. Drawing from the field of general semantics, the author examines recent writings for examples of language that may appear confusing or offensive to families. It was found that difficulties result from professionals' tendencies to confuse fact with inference, to stereotype families by placing them in either/or categories, to use judgmental language, and to use language of control that contradicts their goals of collaboration or partnership.
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To meet the exigencies of coping with the onset of schizophrenia in the family, caregivers sought out an array of professional and nonprofessional supports. The respondents to a questionnaire, all members of a self-help group, reported considerable merit to the help of friends, relatives, and group members. In contrast, the various forms of therapy were valued little; nearly half found no value at all. These findings are better understood when needs of families are expressed. Of highest priority are understanding of the illness, practical guidance in patient management, and community resources such as housing. These are not typical functions of therapy. Self-help groups may serve these needs better.
Believing that families are a valuable yet virtually untapped resource in treating and rehabilitating the mentally ill, the author surveyed 89 people to find out how they coped with their relative's long-term illness. Through trial and error, such families have developed a wealth of information about how to live with and manage chronic patients. The author also investiaged the types of service and supports families need. She urges professionals to begin dealing with relatives as allies instead of adversaries and to devise new modalities that make them collaborators in the treatment process.