The idea for this book originated at a 1991 conference entitled ‘Mental Illness in the Family,’ hosted by the Department of Social Work at the Clarke Institute of Psychiatry. Since the conference was held to commemorate the Clarke’s twenty-fifth anniversary, it seemed appropriate to reflect on clinical practice and to examine how approaches to families affected by mental illness have evolved over the past twenty-five years.

There have been significant changes in the delivery of mental health services and in the treatment of mental illness in the past three decades. The deinstitutionalization movement of the late 1950s and early 1960s,...

Persons who are or have been patients in the mental health system have for some years been writing about their experiences as service recipients. They are perforce experts in the field of mental health program planning, and their contributions are often frank, articulate, and exceedingly sensitive. These writings contain important clues and information from which mental health program planners might take direction. Yet surprisingly little note has been taken of the patient-authored literature in the development of program initiatives for mentally ill individuals.

This essay examines the patient-authored literature and seeks to establish points of agreement between patient-authors and professionals...

Clinical views of and approaches with families of the mentally ill have undergone important transformations over the past two decades. This essay focuses on two major paradigmatic shifts that have occurred in our thinking and practice – namely, a shift towards a biopsychosocial orientation and a shift from viewing families as pathogenic influences to involving them as valued resources and collaborators in the treatment process. These changes in our perspective are examined here as they concern the role of the family in the development, course, and treatment of serious mental illness. As well, the promising new approaches for effective longterm adaptation...

In the past twenty years, few areas in mental health have undergone the kind of dramatic change that has occurred in the relationship among families, mental illness, and the mental health system. The change has been complex and multidimensional. Professional attitudes have shifted from an emphasis on the negative role played by families in the etiology and maintenance of pathology to a more supportive and respectful recognition of the burdens carried by families as they care for relatives with mental illness (Atkinson, 1986). Families themselves have emerged as major players in the mental health arena by virtue of the powerful...

The role of family therapy has gradually been eroded in the treatment understanding of families dealing with an adult member who has a serious mental illness. It has been replaced by educational programs offered by professionals (Anderson, Hogarty, & Reiss, 1980) and peerled family groups, usually under the auspices of a family association, such as Ontario Friends of Schizophrenics. This development is viewed in the main as a positive step towards reframing the roles and needs of families and removing the stigma associated with mental illness in the family. It is linked with a non-blaming stance on the part of...

Considerable attention has been given in the past decade to helping professionals in the field of mental health care to better understand the family dilemma that emerges when mental illness strikes a loved one (Hatfield & Lefley, 1987; Lefley & Johnson, 1990; Marsh, 1992; Walsh, 1985; Wasow, 1982; Vine, 1982). Numerous programs have been developed to help families cope with a great array of daily problems (see, for example, Anderson, Reiss, & Hogarty, 1986; Bernheim & Lehman, 1985; Falloon, Boyd, & McGill, 1984; Hatfield, 1990; Woolis, 1992).

Educational programs for families are now widespread across the country, and most families...

When Tom S. refused to continue taking his medication, his parents feared the outcome. Sure enough, within several days his behaviour began to change. He accused his parents of trying to poison him, and eventually attacked his father with a baseball bat. Frantic – and not knowing where else to turn – his parents reluctantly called the police, expecting that Tom would be taken for psychiatric treatment. At the hospital, the attending psychiatrist decided there were insufficient grounds for involuntary committal; the police, in turn, charged Tom with assault and incarcerated him, pending a psychiatric assessment.

Thus began one family’s experience with...

The loss of a child to a schizophrenic illness is a painful reality for one in one hundred families (Sarason & Sarason, 1980). Fantasies that the bizarre, unpredictable behaviour is temporary must be abandoned and replaced with the reality that the illness, for most, will be controlled, not cured (Breier et al., 1991; Carone, Harrow, & Westermeyer, 1991). Schizophrenia, in spite of being the focus of research for decades, remains one of the most enigmatic and devastating of the psychiatric disorders (Kay, 1990). It is a disease that manifests itself during adolescence or early adulthood and is usually associated with...

Sibling relationships have received little attention in the study and treatment of serious psychiatric disorders. With few exceptions, most clinical literature refers either globally to ‘the family’ or specifically to ‘parents.’ A handful of authors differentiate the experience and needs of well siblings, and fewer still (often themselves siblings of a mentally ill brother or sister) have written about the sibling experience.

Why has this topic received so little attention in the literature? There are many possible explanations. Clearly contributory is the relative invisibility of siblings and the infrequency of their involvement in the consultation process or in family conferences....

Affective disorders (major depression, bipolar affective disorder, and dysthymic disorders) are common conditions in the general population with a point prevalence of 9 to 20 per cent at any given time (Boyd & Weissman, 1981). They are recurrent and pervasive, and affect the overall functioning of the person and the family (Keller et al., 1983; Keller, 1988). These disorders are chronic in approximately 25 per cent of depressed patients, and 20 per cent fail to recover from an episode (Depue & Munroe, 1986). Affective disorders often affect women of child-bearing age and therefore potentially have a significant impact on early...

The field of child protection is challenging, given the difficult situations facing mental health professionals. In recent years, the law has shifted to provide parents every opportunity to care for their children before the termination of these rights is considered. This legal stipulation can present a particular dilemma to mental health professionals in situations where parents’ functioning is marginal and it is unclear whether they can provide for their children’s physical and emotional needs. Parents suffering from a mental illness present a unique challenge for clinicians. While a diagnosis in itself does not determine parenting capacity, the symptoms can affect...

When parental mental illness impairs the ability to provide adequate basic care for a child, and when the support of family members or community services cannot remedy this situation, it is necessary for parental custodial rights to be terminated. Though many mentally ill parents can provide adequate care for their children, others cannot. This essay discusses the unfortunate circumstances in which parental mental illness causes children to be permanently separated from their parents and describes the treatment of one young boy who has suffered this loss. Many of the presenting features of this case are typical of child welfare referrals...

Infants are preprogrammed with a high capacity for perceptual discernment in interaction with their environment (Stern, 1985). The mother can also learn about her infant before birth by tracking the biological rhythms of the baby’s activity and rest in the womb. Ideally, she does this naturally as a part of her necessary and increasing preoccupation with her infant (Winnicott, 1965). This dynamic primary relationship constitutes the first biopsychosocial ecology of the infant. In a way, the passage of the baby through the birth canal is a metaphor for the emergence of that relationship into the world, where it is influenced...