The relationships between the types of inner-family communication and the development of renewed psychoses have frequently been investigated scientifically. Statistical relationships were to be found between a tense family climate ("high expressed emotion" or HEE) and an increased number of relapses of the illness. This has often been used to bring the blame to the families. It was maintained that the family was to blame for such a relapse either through hostile conduct or through over-protective behaviour. Based on these considerations, one encouraged the persons affected to separate themselves from the "family which makes them sick" and to become independent. The family itself was widely encountered with unconcealed rejection.
In the meantime, one knows that this one-sided interpretation is not correct. A tense domestic climate is by no means alone the responsibility of the relatives. The reasons for such a tense climate are generally to be seen in the inter-relationships between the behaviour of the person who has fallen ill and the reactions of those who are closely related to him/her. Nevertheless, these relatives frequently get the feeling that the outdated manner of thinking, of the "family which makes them sick", is still present in the heads of many therapists.
It is entirely natural that the severe illness of a family member cannot remain without consequences for the remaining members of the family. Relatives would have to be fully insensible if they themselves would not demonstrate occasional times of nervousness, despair, exhaustion, discouragement, uncertainty and perhaps sometimes also injustice. This makes everything simply topsy-turvy if the relatives are reproached by the therapists citing that these natural and normal human sensations are negligent conduct. If families are blamed and inner-family tensions are solely held to be the responsibility of these relatives, marriages will break apart, parents-child relationships will be destroyed and inter-sibling bonds will be severely burdened. As a consequence, the future family care is destroyed, thereby further intensifying the isolation and loneliness of the person who has fallen ill. It must be remembered that the help system offered by the family is still the largest, if is not the strongest social help system for persons who have become psychologically ill.
Naturally, no relative will contest the fact that a quiet and relaxed domestic atmosphere is profitable for all partners involved.
As such a relative, I see an obligation for therapists, in the interest of their patients, to work towards achieving a domestic climate which reflects less emotional tension. It is the responsibility of therapists to work towards maintaining a family help system as far as possible. The relatives should demand this of the therapists! Without the trustworthy cooperation in a trialogue, this goal cannot be achieved!
These relatives are not sick, but in trouble. They are awaiting support. They expect help through a supportive relationship with the member of the family who has fallen ill, they expect support and help in the interest of the person who is ill. They expect support in their efforts to normalize the inner-family relationships, which might possibly be burdened, they expect support and recognition for themselves personally, they expect trustworthy conversations with the therapist and they demand respect.
My request of therapists: please do not see relatives as being enemies or as troublemakers, or as co-patients who must be treated along with the person who is ill. Consider that relatives generally try hard to restore the sense of well-being in family members who have fallen ill; in the interest of your patients, look for the cooperation with their relatives. Of course, this may mean additional work for you first of all, but I am fully convinced that this trouble will pay for itself in the long-term, also for you - through a better working climate, through fewer complaints from relatives and, perhaps, also through better results in your therapeutic work.