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How Families Respond
Family member responses to a loved one's mental illness seem to form a
pattern of phases. Everyone's response is unique, but there are phases common to
many families. Understanding the phases of family response to a member's illness
is important to the timing and type of treatment and support offered by
outsiders.
Dr Connie Ragiel presented on this topic to the NAMI-HC general membership
meeting in September, 1999. The following material, taken from a publication by
Hatfield and Lefley, "Families of the Mentally Ill: Coping and Adaptation,"
describes typical features at each stage.
1. Ignoring what is coming
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minimizing early changes in the individual
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viewing symptoms as normal in development
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intermittent anxiety and unrest
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conflict between family members
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members functioning as they always have
2. The first shock of recognition
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a family member identifying a problem
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realizing that the condition is old and now finally heard
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family becomes mobilized to a course of action
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an activity flurry occurs in seeking help for the individual
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anxiety increases and people begin to dread the future
3. Stalemate
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usually things don't go well
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the individual becomes unwilling to get involved in care
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professionals minimize the illness and what is happening to the family
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family focuses on dynamics of the family rather than interventions aimed at
helping to understand and work on best behavior
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anxiety reverts to panic for some while some members retreat and others
focus totally
4. Containing the implications of the illness
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Members try to find reasons for the illness
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focus on avoiding accepting the decline in family functioning
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the family cannot comprehend an enduring infirmity for the individual
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members still remain optimistic and hopeful
5. Transformation to official parenthood
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The illness becomes worse and reality cannot be denied
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the family puts a label on the individual
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the impact of the diagnosis and all of its implications is finally felt
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anxiety remains high as the family attempts to ward off implications
6. The search for causes
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Finding a cause (and blame) for problems is critically important in our
society
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families seek treatment to understand what they did wrong
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blame is placed on others and the family's collective sense of competence
and health is destroyed
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the family members become divided
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conflicting information bombards the members
7. The search for treatment
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Treatment is influenced by family's level of acceptance, family member
perception of cause, and what treatment services are available
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confusion about biological vs. interpersonal beliefs
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health care system barricades are raised (confidentiality, insurance, etc)
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sometimes families are welcomed into treatment and other times shunned
8. The collapse of optimism
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Symptoms may decrease, but individual not the same
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individual makes progress - then backslides - then progresses
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the hope of cure begins to depart
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family members may retreat from the outside world
9. Surrendering the dream
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The family mourns what the client could have been
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not understanding fully the prolonged nature of the illness
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fluctuations occur causing alternating hope and despair
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expectations for the individual change
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health care provider and family view of improvement may not agree, causing
family despair even when individual improves
10. Picking up the pieces
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As the situation settles the family comes into perspective
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compartmentalization occurs with family member care responsibilities
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one person assumes primary role of caregiver
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other members disassociate from the care role and continue to live their
normal life
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other members feel helpless and underplay the illness impact
Source: Jan-Feb 2000 Telegraph
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