I EDITORIAL
Family Crisis is the theme chosen by the the focus for its activities in the coming year. This is something fundamental to the whole concept of mental health?both as cause and effect. Its implications are so wide as to include every aspect of the medical and social services, as well as raising some basic questions about the very nature of psychiatric illness. The family unit itself has been under attack ?for instance by Edmund Leach?as being no
family
NAMH
crisis as
longer appropriate or the likely source
to
present-day conditions,
of more harm than good. Further than that, a whole doctrine has emerged in the last few years which believes that the interactions of family members are actually the cause of severe mental illness. Mass media and the arts have eagerly taken up these ideas, which provide better scripts and story-lines than the patiently tested facts of scientific medicine. There is also the Generation-Gap problem, caused by ever-accelerating change in our general culture, which means that different family members will probably not share the same values and may scarcely even speak the same
language.
But in spite of all these attacks, the family is still the best social unit we've got and there seems little likelihood of any alternative to it. Theories that schizophrenics are 'driven mad' by their relatives are so far without proof (or even serious attempts at proof) though we do
know that all kinds of stress may sometimes be involved in starting illness. In spite of the tremendous development of public services, most chronic sickness and disability still has to be cared for within the family?Peter Townsend has found, for instance, that there are far more totally disabled old people at home than in institutions of all kinds. The trend towards community care has put more families into the position of acting as unpaid nurses, yet in terms of money, we pile every imaginable disincentive on the family which actually wants to keep a sick member at home. Wouldn't it be better
then to try and help the family?to encourage its healthy aspects and to add support where it is failing?rather than just to condemn, as some of our 'Telly-prophets' do. This sort of help is needed particularly at times of family crisis which may either be collective or stem from one particular member. Rehousing, sudden poverty, marital conflict or death of a parent will affect every member, though their reactions to this same stress will vary according to individual personality and circumstances. One particular person, who perhaps is specially vulnerable at that time, may appear to the outside world as 'the patient'. But this may be only the tip of an iceberg of emotional distress and conflict within the family group and treatment directed at a single member may not bs very effective. In other cases, the problem is mainly individual?a handicapped child, a disturbed adolescent, a wife with an unwanted pregnancy or a man retired unwillingly from lifelong work. Here, the presenting person needs the main emphasis of professional help, but reactions are likely to have spread throughout the family and if they are ignored, may largely undo the good effects of individual treatment. We have heard these
points made endlessly professional meetings and in written discussion. 'Family psychiatry' is much talked about, but scarcely exists in practice. Certainly we are not treating a family unit if its different memat
bers are all under the separate care of different It is particularly wasteful to act in this way when resources in general are so inadequate for the needs of our society. In his book, 'Neurosis in the Ordinary Family', Anthony Ryle has pointed out the need for an integrated family casework service, based on general practice, but with free access to specialised psychiatric help. Perhaps the coming Seebohm reorganisation of social work will give an opportunity for something like this to be created.
agencies.
Family Crisis is the theme chosen by the the focus for its activities in the coming year. This is something fundamental to the whole concept of mental health?both as cause and effect. Its implications are so wide as to include every aspect of the medical and social services, as well as raising some basic questions about the very nature of psychiatric illness. The family unit itself has been under attack ?for instance by Edmund Leach?as being no
family
NAMH
crisis as
longer appropriate or the likely source
to
present-day conditions,
of more harm than good. Further than that, a whole doctrine has emerged in the last few years which believes that the interactions of family members are actually the cause of severe mental illness. Mass media and the arts have eagerly taken up these ideas, which provide better scripts and story-lines than the patiently tested facts of scientific medicine. There is also the Generation-Gap problem, caused by ever-accelerating change in our general culture, which means that different family members will probably not share the same values and may scarcely even speak the same
language.
But in spite of all these attacks, the family is still the best social unit we've got and there seems little likelihood of any alternative to it. Theories that schizophrenics are 'driven mad' by their relatives are so far without proof (or even serious attempts at proof) though we do
know that all kinds of stress may sometimes be involved in starting illness. In spite of the tremendous development of public services, most chronic sickness and disability still has to be cared for within the family?Peter Townsend has found, for instance, that there are far more totally disabled old people at home than in institutions of all kinds. The trend towards community care has put more families into the position of acting as unpaid nurses, yet in terms of money, we pile every imaginable disincentive on the family which actually wants to keep a sick member at home. Wouldn't it be better
then to try and help the family?to encourage its healthy aspects and to add support where it is failing?rather than just to condemn, as some of our 'Telly-prophets' do. This sort of help is needed particularly at times of family crisis which may either be collective or stem from one particular member. Rehousing, sudden poverty, marital conflict or death of a parent will affect every member, though their reactions to this same stress will vary according to individual personality and circumstances. One particular person, who perhaps is specially vulnerable at that time, may appear to the outside world as 'the patient'. But this may be only the tip of an iceberg of emotional distress and conflict within the family group and treatment directed at a single member may not bs very effective. In other cases, the problem is mainly individual?a handicapped child, a disturbed adolescent, a wife with an unwanted pregnancy or a man retired unwillingly from lifelong work. Here, the presenting person needs the main emphasis of professional help, but reactions are likely to have spread throughout the family and if they are ignored, may largely undo the good effects of individual treatment. We have heard these
points made endlessly professional meetings and in written discussion. 'Family psychiatry' is much talked about, but scarcely exists in practice. Certainly we are not treating a family unit if its different memat
bers are all under the separate care of different It is particularly wasteful to act in this way when resources in general are so inadequate for the needs of our society. In his book, 'Neurosis in the Ordinary Family', Anthony Ryle has pointed out the need for an integrated family casework service, based on general practice, but with free access to specialised psychiatric help. Perhaps the coming Seebohm reorganisation of social work will give an opportunity for something like this to be created.
agencies.
