CLEVELAND -- For families coping with mental illness, the belief that people are the cause of the illness may be toxic to the family itself, poisoning relationships and intensifying the stress of caregiving, according to a researcher at Case Western Reserve University.
In two studies, Elizabeth Robinson, an assistant professor of social work at CWRU's Mandel School of Applied Social Sciences, found that blaming a person for the illness was associated with poor family functioning, whether blame was cast upon the mentally ill family member, another family member or someone outside the family.
"Those who blamed people for the illness saw their families as less caring, cohesive, or able to solve problems or communicate," Robinson explains.
Robinson's studies are among the first to focus on the relationship between family functioning and causal attributions about mental illness -- that is, what family members believe is responsible for their relative's illness.
Such research is useful to mental health professionals in their work with clients and families, because the meanings and interpretations people ascribe to situations are significant coping strategies, according to Robinson. Identifying and changing interpretations or beliefs that may be harmful is widespread in therapeutic practice, she notes.
Robinson's initial study focused on 39 mentally ill clients and their families, mostly white, who were participating in a long-term program of education, support and medication management. She later performed similar research with 38 minority family members who were the primary support of a relative with severe mental illness. Only 13 had been in a long-term educational program.
In both studies, Robinson assessed family functioning based on the family's degree of cohesiveness, communication, expressiveness, conflict, organization and problem-solving ability.
Participants were asked to state their own explanation of the cause of the mental illness and to rate the degree to which each of the following was responsible: themselves, the ill relative, other family members, people outside the family, biology, heredity, God, and chance.
When Robinson aligned the causal agents into three groups -- people, biology/heredity, and God/chance -- she found a significant correlation between the people group and family functioning. "Blaming people, whether oneself, the client or others inside or outside the family, was strongly and significantly associated with perceptions of poor family functioning among mothers, fathers, siblings, and the family as a whole," Robinson reports. This proved true for study participants regardless of ethnicity.
While the exact causes of mental illnesses such as schizophrenia, bipolar disorder and major depression are still imprecisely understood, Robinson notes, "There is general agreement that these illnesses are due to a biologically based vulnerability to environmental stressors."
Helping mentally ill patients and their families understand and, more importantly, believe this may be one of the most significant functions of long-term psychoeducational programs, Robinson observes. "It takes more time to change cognitive coping strategies such as causal attribution," she points out, "than it does to simply provide information."
Her paper, "Causal Attributions about Mental Illness: Relationship
to Family Functioning," was published in the April l996 issue of the
American Journal of Orthopsychiatry.