Expressed emotion as precipitant of relapse in psychological disorder

Back in the day in England there was very little understanding about the nature of schizophrenia.  In some places people who suffered from schizophrenia were labelled as “lunatics” and locked away in an attic room  away from the main house and other members of the family.   During the early 20th century treatment for schizophrenia in hospitals was very draconian. Some patients were confined in a box and smoked , some were subjected to insulin therapy where they fall into a coma and  died or had frontal lobotomy which was a procedure where a sharp, long needle was inserted through the eye in order to get to the brain. Doctors then believed that these treatments worked.

In the 1950’s  the drug chlorpromazine was used. Patients became stable and were discharged back to their homes.  It wasn’t  long before these patients relapsed and  returned to hospital. To understand the reasons for these relapses George Brown studied over 200 men who were discharged back to their homes.  He found that those who were discharged to their parents and wives were more likely to relapse than those who were discharged to other relatives or lodgings. Brown found that there was a connection between the carers’ behaviour towards the person with mental illness and the relapses. He termed this as expressed emotion.  There’s high expressed emotion and low expressed emotion.

High expressed emotion denoted by HEE is emotion that is expressed by words, actions and attitudes by carers or relatives who live with the person with schizophrenia.  High expressed emotion is characterized by hostility, critical comments or emotional over involvement. Hostility can be conveyed by the person’s general attitude towards the illness and to the person with schizophrenia.  Hostility can be expressed by words that are harsh or critical towards the person suffering from mental illness, blaming the person for being sick or lazy, spoken in a loud and aggressive manner.  Emotional over involvement is when the carer or relative blames himself for the illness and showing regret and remorse.  Brown in his study discovered that his patients who returned to their wives or parents soon relapsed and returned to hospital. Other studies found that wives and parents are more likely to have HEE towards their ill relatives than siblings or informal carers.

Low expressed emotion donated by LEE is emotion that is conveyed by a compassionate, empathetic attitude towards the sufferer.  Exercising patience , giving the sufferer plenty of space, speaking in soft tones. Talking to and trying to understand the person suffering from schizophrenia – his hallucinations, delusions and exploring coping strategies so that the sufferer may have a fulfilling life play a major role in relapse prevention.  Patients who were discharged to lodgings or who lived with their siblings and who had very little interference from wardens or informal carers  in general fared better.

If you have a relative who is suffering from some form of schizophrenia , studying and understanding the nature of the illness will help you cope with your relative’s demeanor. Usually HEE manifests itself when the person is not yet ready to accept that his relative is unwell or lacks understanding of the nature of the illness. As health care professionals ,  informing carers about schizophrenia in terms of thought, feelings and behaviour to a carer would go a long way in preventing  your clients from relapsing.  If you are a  health care professional providing care for a person with schizophrenia should involve relatives who live with that person. Getting everyone on board should be standard practice as it is only then that the client will stand a better chance of remaining well for a long, long time.

If you are a person suffering from schizophrenia, a carer or a health care professional please share your  experiences.

#schizophrenia #low expressed emotion #high expressed emotion #relapse prevention


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