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Abstract. This paper explores Maude Abbott's internationally significant career in medicine and her parallel commitment to caring for her sister, Mice Abbott. An examination of Abbott's life reveals the difficulties [...]

Parents with psychiatric disabilities face many challenges, especially if their children are placed in foster care--the cards are stacked against them regaining custody. To help reunite families, the Urban Justice [...]

In this article, ethical issues related to the treatment of families with a member with mental retardation are discussed. The history of psychotherapeutically treating the community with mental retardation and accompanying concerns, such as dual diagnosis and diagnostic overshadowing, are discussed. Ethical considerations of the informed consent and assent process are discussed and applied to more modern areas of confidentiality, treatment goals, and individual sexuality. Marriage and family therapists are encouraged to bring clarity and balance to the process of informed consent and assent when working systemically with the population with mental retardation and their families.

This study identifies how persons with dementia and their caregiving spouses individually perceive their own, their spouse's and their mutual engagements in everyday activities. Fifty-two cohabiting spouses, half of whom were diagnosed with dementia, were interviewed. A qualitative constant comparative analysis was performed, identifying four major themes: perceived changes in activity engagements; consequences of experienced changes; dilemmas experienced by the caregivers; and management approaches to handle a changed everyday life. Each individual described their activities to include loss of social engagements and changes in the relationship. Dilemmas experienced by the caregivers included 'interfering with the spouse's engagement or not' and 'placing the spouse's or one's own needs first'. The caregiver management approaches identified included 'taking over' or 'encouraging initiative'; 'lowering demands or avoiding problematic engagements'; and 'managing through collaboration'. Findings provide insight into everyday engagements for persons with dementia and their caregivers, important to healthcare support providers., Keywords: daily activities; dementia; caregivers; engagement; home intervention 251 ArticleEngagement in activitiesExperiences of persons with dementia and their caregiving spouses SAGE Publications, Inc.200810.1177/1471301208091164 SofiaVikstrom Karolinska Institute, Sweden, sofia.vikstrom@ki.se StaffanJosephsson Karolinska [...]

Background: Spouses of people with mental disorder experience various forms of objective and subjective burden. This should negatively affect their quality of life. However, until now no single study has addressed this question. Aims: To investigate the quality of life of spouses of people with schizophrenia, depression or anxiety disorders. Method: Spouses of patients suffering from schizophrenia (n = 45), depression (n = 49) and anxiety disorders (n = 39) were consecutively recruited from outpatient services in the city of Leipzig. Quality of life was assessed by means of the WHOQOL-BREF, a self-administered questionnaire developed by the World Health Organisation. Results: Compared with the general population, the quality of life of the spouses of mentally ill people was lower in the domains 'psychological well-being' and 'social relationships'. There was a significant association between the patient's functional level and the spouse's quality of life. Conclusions: Better treatment, professional support and participation in self-help and advocacy groups may help to improve the quality of life of spouses of mentally ill people.

Children who live with a mentally ill parent are viewed primarily as being 'at risk' of developing a mental illness themselves and those who remain well are considered extraordinarily resilient. This particular risk/resilience discourse is embedded within larger contemporary discourses about risk and childhood. Childhood is seen as a critical period of development during which children need protection due to their physical and psychological vulnerabilities. In this paper, the implications of this dominant casting of children are explored and it is argued that the conceptual repertoire about those living with a mentally ill parent should be expanded. A critique of the literature that established the risk/resilience discourse is followed by a discussion of research about parenting with a mental illness within which children are surprisingly absent. Recent thinking about children arising out of the 'new' social studies of childhood is summarized to illustrate its resistance to the hegemonic image of children as passive, developing, 'unfinished' persons. A recasting of children as complex young persons who have competencies as well as vulnerabilities linked to their developmental stages, would lead to different lines of inquiry about children's experiences of mental illness in a parent. Keywords: Sociology of childhood: Risk: Parental mental illness

The current study examined whether excessive reassurance seeking serves as a vulnerability factor to depression in a sample of high-risk youth using a multiwave longitudinal design. At Time 1, 140 children (aged 6-14) of affectively disordered parents completed measures assessing reassurance seeking and depressive symptoms. In addition, every 6 weeks during the following year, children and parents completed measures assessing depressive symptoms and the occurrence of hassles. In line with hypotheses, the results of contemporaneous analyses indicated that children with high levels of reassurance seeking reported greater elevations in depressive symptoms following elevations in either hassles or parental depressive symptoms than children with low levels. At the same time, the results of time-lagged analyses indicated that both these relationships were moderated by age with excessive reassurance seeking being associated with greater elevations in depressive symptoms following elevations in either hassles or parental depressive symptoms in older but not younger children. KEYWORDS: excessive reassurance seeking; depression; contagious depression; high-risk.

Siblings are considered logical replacements for aging parental caregivers of persons with severe mental illness. For workshops on future planning conducted with 400 elderly parents, 60 siblings answered a survey regarding their future caregiving expectations, anticipated difficulties, and need for help. Nearly all expected to be involved, but were more likely to provide social and emotional support than the instrumental support offered by their parents. Nearly half indicated that the consumer's hostility and lack of cooperation were major barriers to effective care. It was suggested that siblings need education and help from professionals in assessing behaviors, interacting appropriately, and conferring control of their own lives to their ill relatives. For consumers, social skills and self-esteem training in psychiatric rehabilitation programs should address the area of sibling relationships and reciprocity. Such issues should be dealt with early, rather than later in the course of illness KEY WORDS: mental illness; siblings; families; caregiving.

This study describes the effects of a psychoeducational multiple-family group program for families of people with severe mental illness in post-war Kosovo that was developed by a Kosovar-American professional collaborative. The subjects were 30 families of people with severe mental illnesses living in two cities in Kosovo. All subjects participated in multiple-family groups and received family home visits. The program documented medication compliance, number of psychiatric hospitalizations, family mental health services use, and several other characteristics, for the year prior to the groups and the first year of the groups. The families attended an average of 5.5 (out of 7) groups, and 93% of these families attended four or more meetings. The uncontrolled pre- to post-intervention comparison demonstrated decreases in medication non-compliance and hospitalizations, and increases in family mental health service use. The program provided training for mental health professionals, led to policy change in the Ministry of Health, and resulted in dissemination to other community mental health centers. This study provides preliminary evidence that a collaboratively designed and implemented psychoeducational, multiple-family program is a feasible and beneficial intervention for families of people with severe mental illness in impoverished post-war settings.

Despite decades of research documenting family burden related to mental illness of a relative, little is known about families' responses over time. A grounded theory study was designed to describe families' responses to these severe mental illnesses. Twenty-nine participants representing 17 families were interviewed 3 times over 2 years. Interviews were analyzed using constant comparison. Living with ambiguity of mental illness was the central concern. The basic social process was pursuing normalcy and included confronting the ambiguity of mental illness, seeking to control impact of the illness, and seeing possibilities for the future. Goals were managing crises, containing and controlling symptoms, and crafting a notion of 'normal.' Strategies were being vigilant, setting limits on patients, invoking logic, dealing with sense of loss, seeing patients' strengths, and taking on roles. The study revealed that families were profoundly affected by the social contexts of mental illness.

Family caregivers for relatives with Alzheimer's Disease (AD) often experience significant stress-related problems in mental and physical health. Patients with AD often survive for protracted periods of time, placing an extensive burden of care on the caregiver prior to the patient's death. The present study addresses ethnic differences in the experience of AD caregivers around the time of their loved one's death, including life-sustaining treatment decisions and reactions to death. The results showed that, in our sample, more patients died in their homes than has been reported for deaths in the United States. African-American and White caregivers differed substantially in their reports of end of life care and subjective reactions to the death. Compared with White caregivers, African-American caregivers were less likely to make a decision to withhold treatment at the time of death, less likely to have their relative die in a nursing home, and reported less acceptance of the relative's death and greater perceived loss. Results suggest that death after AD caregiving deserves further study, and that ethnic differences in end of life care and bereavement may be of particular importance.

Mental health professionals working at three rural public community mental health agencies were asked for their views on the families of mental health patients. Findings revealed themes that included families as supportive caregivers, as unsupportive agitators, as in pain, as uninformed, and as unequal partners. Implications for clinical intervention, education, and research are discussed.

This article examines the relatives of outpatients suffering from obsessive-compulsive disorder and agoraphobia and their expressed emotion. Employing a structural equation model the authors maintain they found the relatives demonstrating hostility toward the outpatient, as well as low rates of problem-solving ability.

When families cannot serve as full-time caregivers for severely, mentally ill family members, agency-supported caregivers provide an alternative to chronic hospitalization. Caregivers who provide 24 hour per day care experience caregiver burden; they also find rewards and meaning in their work. The purpose of this study is to observe positive experiences of paid caregivers for seriously, mentally ill individuals, especially the meaning or purpose it gives their lives and the self-fulfillment or self-actualization that caregiving provides. The caregivers in this study possessed a high purpose in life suggesting that caregiving may give meaning to life. Also, the caregivers of these individuals with severe, mental illness tend to be highly other-oriented (altruistic), an external focus that may decrease their own self-awareness. Thus, caregivers who provide continuous residential care may benefit from therapeutic interventions designed to reinforce self-care skills.

This article describes a pilot project in which eight Community Mental Health Centre staff were trained in a cognitive-behavioral intervention for families of 37 mentally ill clients. After involvement in training, the staff demonstrated more regular inclusion of family members in routine clinical practice, and a trend towards an increase in relevant knowledge. After involvement in the program, the families experienced a decrease in burden (Family Burden Interview Schedule) even though the primary clients' functioning (Global Assessment of Functioning) did not change. The results are encouraging, indicating that it is possible to train staff in ordinary clinical settings in effective cognitive-behavioral family interventions. The findings need to be replicated in a controlled study with larger samples.

The article examines insanity and dysfunctional domesticity among England's poor from the 1830s to the 1840s. Research shows that poor women endured significant pressures attributing to a dysfunctional home life, and it is posited that insanity may have been a means of escape.

In the past few decades, deinstitutionalization and community-based rehabilitation and support programs have increased the likelihood that women with serious mental disorders will be parents and will raise their children. This review describes what is known about the parenting of these women, focusing on diagnosis, child characteristics, and other contextual effects.

Families of 180 people with serious mental illness, representing various socioeconomic and ethnic groups, were interviewed about their understanding of their family member's illness, coping with problems caused by the illness, sources of support, effects of medication and substance abuse, and dealing with mental health professionals. Several significant areas of concern emerged, and are explored with attention to differences based on gender, ethnic group, socioeconomic status, and role of the family member.

Family psychoeducational programs are efficacious adjuncts to pharmacotherapy for patients with schizophrenic and bipolar disorders, but little is known about what these programs change about families. The authors assessed changes in face-to-face interactional behavior over 1 year among families of bipolar patients who received a 9-month family-focused psychoeducational therapy (FFT; n = 22) or crisis management with naturalistic follow-up (CMNF; n = 22), both administered with maintenance pharmacotherapy. Members of families who received FFT showed more positive nonverbal interactional behavior during a 1-year posttreatment problem-solving assessment than families who received CMNF, although no corresponding decreases were seen in negative interactional behaviors. The positive effect of family treatment on patients' symptom trajectories over 1 year was partially mediated by increases in patients' positive nonverbal interactional behaviors during this same interval.

A personal narrative is presented that describes living with a brother dying from AIDS and a mother who becomes mentally ill. Subjects include emotional trauma and self-actualization.

The purpose of this study was to determine whether parents participating in 14 National Alliance for the Mentally Ill-affiliated support groups in Illinois had significantly lower caregiver burden than a comparison group of parents not participating in support groups. Respondents included 120 parents: 86 participants and 34 nonparticipants. Ordinary least squares regression analysis revealed that caregiver burden was significantly lower among support group participants, those with lower depression, and those whose offspring had fewer unmet needs and days hospitalized.

This study describes and analyzes the first stages of the care trajectory of psychiatric patients from the standpoint of family perceptions and actions. Six types of trajectories were identified based on three variables: patient's condition and situation, response from health and social services, and family network configuration. Families are central players at the first stage of the care trajectory and long-term preventive intervention conducted by school services or general practitioners have proven beneficial and have permitted a progressive and harmonious entry into specialized mental health care.

The scientific literature on family caregiving in aging and mental illness is discussed. Topics include the extent and nature of family caregiving, conceptual models of the caregiving experience, caregiving demands and effects in aging and mental illness, intervention studies in aging and mental illness, and implications for further research.

In a prior study of 54 relatives of patients with schizophrenia and 72 control participants, 3 neuropsychological functions met the criteria for risk indicators of the schizophrenia genotype: executive functioning, memory, and auditory attention. In an assessment of the stability of these findings, the sample was reexamined 4 years after the initial assessment. Three test scores were found to differ between groups (Immediate Verbal Memory, Delayed Verbal Memory, and Dichotic Listening Digits Detected) or to show a significant Group x Gender interaction (immediate and delayed verbal and visual memories). None of the test scores showed Group x Time interactions, suggesting that the discriminating power of the tests was stable over time. Evidence for deficits in working memory and role learning on the object alternation test was also found. These results support the idea that neuropsychological dysfunction among relatives of patients with schizophrenia is a stable trait caused by the familial predisposition to schizophrenia.

A study was conducted to investigate the factors that influence the quality of life of families with clinically referred children. Results show that family achievement of quality life is dependent on parent and family contextual factors and child psychosocial functioning. It was also observed that socioeconomic disadvantage, parent stress and psychopathology, unhealthy interpersonal relations and limited social support negatively affect the attainment of quality family life.

Fifty-five patients who met criteria for serious mental illness nominated a relative with whom they had lived for at least the previous 6 months to be sent a questionnaire that included a scale for rating patients' contribution to family life in 10 specific areas. Thirty-six relatives returned completed questionnaires. Patients rated their own contributions using the same scale. Overall, relatives rated patients' contributions as positive, and their ratings of patients when well generally agreed with patients' self-ratings. For women only, relatives rated contributions as significantly less when the patient was ill. Patients' self-rated level of psychological symptoms was the best predictor of relatives' overall satisfaction with them. Ratings of patients' contributions mirrored sex-role stereotypes.

Using a sample of 40 Anglo American family members of schizophrenic patients, the present study replicates and lends cross-cultural support for an attribution-affect model of expressed emotion (EE). Consistent with attribution theory, the authors found that highly critical relatives (high-EE) viewed the illness and associated symptoms as residing more within the patient's personal control as compared with less critical relatives (low-EE). A content analysis classified the types of behaviors and symptoms most frequently criticized by relatives. Symptoms reflecting behavioral deficits (e.g., poor hygiene) were found to be criticized more often than symptoms reflecting behavioral excesses (e.g., hallucinations). In line with an attribution-affect framework, relatives may be less tolerant of behavioral deficits because they are viewed as intentional, whereas behavioral excesses are easily recognized as core symptoms of mental illness.

A professionally led multifamily psychoeducation program for families with a schizophrenic member was designed according to participating families' reported concerns. The families provided information on their problems, needs, coping, and requirements from the program. They expressed more concern about 'negative' symptoms of schizophrenia (e.g., social withdrawal) than about positive ones (e.g., hallucinations). Participants' overall positive response to the program is discussed in terms of further development of a multifamily psychoeducation model with family-generated content.

Families of older adults with neurological impairments present exciting opportunities for the integration of the fields of family therapy and neuropsychology. This article examines the impact that an older adult's neurological impairment can have on family structure and functioning. A short-term model for psychotherapeutic intervention with families is presented. The model addresses cognitive, affective, and behavioral aspects of family functioning in light of the neurological impairment.

The consultative group approach to working with relatives of psychiatric patients proposed by Mannion, Draine, Solomon and Meisel (1997) recommends the use of knowledge gained from previous interventions to improve the techniques employed in the following programming. This approach is innovative and has many strengths, but also has a number of weaknesses. These include its very short intervention period (four weeks) and its assumption that group therapy is less expensive than individual treatment.

Results from a random field trial of family education interventions were applied to create a new model of family education programs. This paper reviews the family education literature, the random field trial results, and the pre-piloting of an adapted service model called group consultation. The new model emphasizes a more interactive approach to the conventional group workshop model as opposed to adherence to a pre-planned curriculum. Pre-pilot group participants were all past members of group workshops. In a process evaluation these group members were questioned about their reactions to the new group format and its usefulness.

Siblings of adults with mental retardation are considerably more likely than siblings of adults with mental illness to believe that the brother or sister has a significant impact on their lifestyle. They generally regard their sibling experience as mostly positive, and tend to be quite close to their brother or sister. Siblings of adults with serious mental illness are less likely than siblings of adults with mental retardation to identify a broad pattern of impacts on their life. In most cases, they regard the sibling experience rather negatively.

This article discusses the family experience of serious mental illness, including subjective and objective burden, potential for family resilience, family roles, and personal and family variables that can mediate the impact of the illness. Following a specification of essential family needs, a number of effective family interventions are presented, including family support and advocacy groups, family consultation, family education, family psychoeducation, and psychotherapy. Finally, the authors examine ways of resolving potential conflicts related to confidentiality and offer suggestions that can enhance the effectiveness of psychologists who work with these families.

Interviews with parents of adult children with mental retardation were conducted to identify differences in caregiver burdens and gratifications, based on in-home and out-of-home placement. Parental responses indicate that caretakers of adult children with mental retardation are worried and feel responsibility for their care regardless of residential placement of the adult child.

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.

The point of view of a mental health researcher who was diagnosed with bipolar disorder when her four children were young is applied to several of the other articles in this section. She comments on various aspects of work with families in which one member has a serious mental illness, raising and discussing issues relevant to consumers, as well as to family members.

A sibling of a person with severe mental illness who is also a psychiatrist and a researcher responds to the next generation of research proposed in the articles in this special section. Four issues are emphasized: benefit vs. burden; association, causation, and statistical modeling; strengths and limitations of study samples; and interventions.

Comparison of 222 parents of an adult child who had a psychiatric disability and 434 parents with a nondisabled adult child revealed that parents' positive appraisals of their relationship with the target child was significantly predicted by their perceived caregiving burden, but not by their child's psychiatric status. Implications for interventions that enhance parent/adult child relationships are discussed.

Research on families of people with severe mental illness has identified significant caregiving burden. Although professional interventions generally assume that families have a major role in the client's progress, the focus of the consumer movement on recovery through empowerment, peer supports, and consumer-run services may have important, as yet unquantified, effects. Keeping in mind the functional heterogeneity of individuals with mental illness, it is suggested that consumer emphasis on autonomy may provide the major relief for family burden.

Experiences of subjective burden were analyzed in a sample of 164 siblings of persons with serious mental illness. Findings indicated that the well sibling's experience of burden was consistently related to the symptomatology of the ill sibling. In addition, those who viewed the ill sibling's behavior as outside his or control exhibited lower levels of subjective burden than did those who viewed the behavior as within the sibling's control. Implications for research and clinical intervention are discussed.

Differences in perceived burden were investigated among black, Hispanic, and white groups of caregivers of adults with serious mental illness. Controlling for sociodemographic characteristics and caregiving-related stressors, black caregivers tended to report less burden than whites, a result not explained by protective mechanisms (social support, religious involvement, illness attributions). No statistically significant differences were found in perceived burden between Hispanic and white caregivers.

Predictors of benefits derived from participating in support groups for families of persons with mental illness were examined A survey of 131 families indicated that social support resources outside the group, as well as support received from and provided by the group, were associated with information acquired by the participant. Improved relationships with family and the ill relative were predicted by the participant's health and provision of support in the group.