PSRT 4271 : THE FAMILY ROLE IN REHABILITATION

Week 2: History of The System and Its

Perception of the Family1

Navigating the Maelstrom2

Family Burden3

The Schizophrenogenic Mother4

How It Seemed in the 1950s5

Fred Clanton arrives at the mental hospital.http://www.youtube.com/watch?v=fs10ow-_2u8

The Schizophrenogenic Mother6

1845: SMI as brain pathology (Griesinger)1896: Dementia praecox: organic (Kraepplin)1911: SZ as autism (Bleuer)1913: SZ as hereditary (Freud)

1931: American psychiatrics break away Despite flawed research, other forces at work… Harry Stack Sullivan: SZ: from painful early

relationships Maternal behavior causality Contrary to Freud’s biological basis

Mother of the Schizophrenogenic Mother7

Frieda Fromm-Reichmanm Influenced by Horkeimer

Socialization: a dynamic process done within “constant influence of domestic relationships”

Able to establish rapport with those with SZ Sought acceptance of insight therapy for SZ The SZ pathogen: “environmental”

“…sought to advance psychotherapeutic treatment by substituting the thesis behind it.” --Hartwell

Evolution8

“Mom types”“Smother love”“Pseudolove”“Ambitious” mothers“Perverted maternal

instinct”“Symbiotic

relatedness”

Yale Psychiatric Institute

NIMHPalo Alto VA Hospital

Double Bind Theory9

Common Link?10

All theory!No evidence!

Coming to the light…11

1960s: Rise of biopsychiatry Neuroleptic medications Changes in ideas about “balance of power” and

familiesWomen’s liberation movementCivil Rights movement1967: Transmission of SZ Conference

Hereditary basis

1977: Beyond the Double Bind Conference

Community Mental Health History: Overview12

Symbols vs. Synapses

From Psychosocial… Parental influences Internal forces and impulses

…to Biopsychosocial Biology + Psychology

Research biologicalRehabilitation psychosocial

Treatments: 3 Domains13

PharmacologicalPsychosocialRehabilitative

Pharmacological14

1950s: chlorpromazine (Thorazine) 1980s: clozaril 1990s: “atypicals”

Positive symptoms addressedFewer side effectsExpectations changeAggressive dosing beginsMarketing intensifies

Psychosocial15

Psychoanalysis emphasized, then discredited Transference out; collaboration in Trust; therapeutic alliance Skills development emerges

PsychoeducationBehavior tailoringRelapse preventionCoping skill training

Psychosocial, 216

Family work Education, support, coping Evidence-based results:

Reduced anxiety, less stress, fewer relapses, less hospitalization

ComorbiditiesIntegrated modalitiesOutreaches

Psychosocial, 317

1990s: Psychiatric Rehabilitation Out: training, treating, changing In: inclusion, integration, normalization, resilience,

strengths- based, recovery, hope

Patient-centered servicesSkills and supports developmentResearch: increasing “specificity” Early engagementIntegration with clinical services(One goal: Better relationships with families)

Rehabilitative18

Building skillsEstablishing supportsFostering independence

From… Training, treating, changing

…To Including, integrating, normalizing, recovering

1940s: Fountain House1970s: Assertive Community Treatment