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Week 2: History of The System and Its Perception of the Family

Week 2: History of The System and Its Perception of the Family. PSRT 4271: The Family role in rehabilitation. Navigating the Maelstrom. Family Burden. The Schizophrenogenic Mother. How It Seemed in the 1950s. Fred Clanton arrives at the mental hospital.

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Week 2: History of The System and Its Perception of the Family

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  1. Week 2: History of The System and Its Perception of the Family PSRT 4271: The Family role in rehabilitation

  2. Navigating the Maelstrom

  3. Family Burden

  4. The Schizophrenogenic Mother

  5. How It Seemed in the 1950s Fred Clanton arrives at the mental hospital. http://www.youtube.com/watch?v=fs10ow-_2u8

  6. The Schizophrenogenic Mother • 1845: SMI as brain pathology (Griesinger) • 1896: Dementia praecox: organic (Kraepplin) • 1911: SZ as autism (Bleuer) • 1913: SZ as hereditary (Freud) • 1931: American psychiatrics break away • Despite flawed research, other forces at work… • Harry Stack Sullivan: SZ: from painful early relationships • Maternal behavior causality • Contrary to Freud’s biological basis

  7. Mother of the Schizophrenogenic Mother • Frieda Fromm-Reichmanm • Influenced by Horkeimer • Socialization: a dynamic process done within “constant influence of domestic relationships” • Able to establish rapport with those with SZ • Sought acceptance of insight therapy for SZ • The SZ pathogen: “environmental” “…sought to advance psychotherapeutic treatment by substituting the thesis behind it.” --Hartwell

  8. Evolution “Mom types” “Smother love” “Pseudolove” “Ambitious” mothers “Perverted maternal instinct” “Symbiotic relatedness” Yale Psychiatric Institute NIMH Palo Alto VA Hospital

  9. Double Bind Theory

  10. Common Link? All theory! No evidence!

  11. Coming to the light… • 1960s: Rise of biopsychiatry • Neuroleptic medications • Changes in ideas about “balance of power” and families • Women’s liberation movement • Civil Rights movement • 1967: Transmission of SZ Conference • Hereditary basis • 1977: Beyond the Double Bind Conference

  12. Community Mental Health History: Overview • Symbols vs. Synapses • From Psychosocial… • Parental influences • Internal forces and impulses • …to Biopsychosocial • Biology + Psychology • Research  biological • Rehabilitation  psychosocial

  13. Treatments: 3 Domains Pharmacological Psychosocial Rehabilitative

  14. Pharmacological 1950s: chlorpromazine (Thorazine) 1980s: clozaril 1990s: “atypicals” Positive symptoms addressed Fewer side effects Expectations change Aggressive dosing begins Marketing intensifies

  15. Psychosocial • Psychoanalysis emphasized, then discredited • Transference out; collaboration in • Trust; therapeutic alliance • Skills development emerges • Psychoeducation • Behavior tailoring • Relapse prevention • Coping skill training

  16. Psychosocial, 2 • Family work • Education, support, coping • Evidence-based results: • Reduced anxiety, less stress, fewer relapses, less hospitalization • Comorbidities • Integrated modalities • Outreaches

  17. Psychosocial, 3 • 1990s: Psychiatric Rehabilitation • Out: training, treating, changing • In: inclusion, integration, normalization, resilience, strengths- based, recovery, hope Patient-centered services Skills and supports development Research: increasing “specificity” Early engagement Integration with clinical services (One goal: Better relationships with families)

  18. Rehabilitative • Building skills • Establishing supports • Fostering independence • From… • Training, treating, changing • …To • Including, integrating, normalizing, recovering • 1940s: Fountain House • 1970s: Assertive Community Treatment

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