Schizophrenia

After reading Schizophrenia: A Sibling’s Tale, write a paper of 600-750 words in which you address the following questions:

1. What did you think of the article?

2. How did the article relate to topics presented in the textbook?

3. What interesting questions did the article raise for you?

4. Identify the positive and negative symptoms of schizophrenia and give an example of each.

5. Describe the types of therapy discussed in Schizophrenia: A Sibling’s Tale.

Use the Library databases and include two to four scholarly sources from the library to support your claims, in addition of the article you are critiquing. In addition to the scholarly resources from the library, you can include past classroom materials as well as your textbook as additional reference material.

Prepare this assignment according to the guidelines found in the APA Style Guide. An abstract is not required.
SCHIZOPHRENIA: A SIBLING’S TALE Kirby, Stephan . Mental Health Practice (through 2013) ; London Vol. 13, Iss. 1, (Sep 2009): 18-22.

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FULL TEXT

Headnote

A diagnosis of psychosis can have a devastating effect on close family members of the person concerned.

Stephan Kirby introduces Leanne Bowman’s account of living with a brother who was diagnosed with

schizophrenia five years ago

Summary

Stephan Kirby suggests that mental health professionals need a greater insight into the effects a diagnosis of

serious mental illness has on family members. Leanne Bowman’s account explains how her brother’s diagnosis

was received and how living with him since then has introduced new challenges to her life.

Keywords

Serious mental illness, schizophrenia, siblings, advocacy

As an occasional user of mental health services, and a mental health nurse of many years’ standing, I have some

insight into the needs, requirements and problems facing mental health professionals and the users and carers we

come into contact with. But the one thing I have never given much thought to over the years, apart from as an

academic or professional requirement, was how my own mental health issues were affecting and had affected

loved ones around me.

As professionals, we know it makes sense to foster relationships with service users, based on listening and

understanding. But from political and common-sense points of view it is vital to remember to listen to our patients’

carers, their parents, siblings, children and other loved ones, and understand what the experience of mental illness

is like for them, as well as for the patient in our care.

I met Leanne, a mental health nursing student, when she was embarking on her final year of study. When preparing

some work for me, Leanne was open and honest when discussing her brother’s major mental illness and the effect

it had and was having on her family life and her training.

We hope this paper offers readers an insight into the trials and tribulations faced when a close family member has

a serious mental illness. We hope readers will gain an understanding of what it is like to have a sibling diagnosed

with schizophrenia.

In what follows there is a discussion about the feelings, isolation and stigma encountered by Leanne when she

learnt that her brother ‘was schizophrenic’, a term we accept is not politically correct. It shows the importance of

appropriate support from mental health services and professionals to enable families to cope effectively with the

situation.

Leanne Bowman’s story

‘I am a third-year mental health nursing student and by no means an expert on schizophrenia. But I can explain

how the condition affects the family because my brother Jamie (not his real name) was diagnosed with this severe

and enduring mental illness when he was 18 years old. Our mother is his primary caregiver and I am the secondary,

but no less involved, carer.

‘When Jamie was diagnosed in 2003 I experienced a mixture of feelings and emotions. First, I felt a great sense of

loss, almost like a bereavement. In a sense it was a bereavement because, while Jamie looked the same, he acted

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very differently from the brother I knew. This process is described by Kuipers et al (2002) who identify two types of

loss: the loss of the person we knew and the loss of the hopes and aspirations we had for them. I also experienced

“survivor’s guilt” (Kuipers et al 2002) because I was the “normal one” and had managed to escape the suffering of

being mentally ill. I felt that because I was the older sibling I had a responsibility to protect my brother from

suffering, but I had somehow failed him. I also felt frustrated because my mother and I seemed to be doing

everything we possibly could to help Jamie, but it was never enough.’

Stigmatisation ‘I had a basic understanding of the term schizophrenia, but probably like many others I had

misconceptions and was even scared of the term and its connotations. In society in general there is a stereotyped

view of people with mental health problems, especially in the case of schizophrenia. The common misperception is

that these people are violent, exhibit sexually inappropriate behaviour and have a split personality (Kuipers et al

2002). Corrigan and Watson (2002) refer to this stigmatisation as “the double misfortune of the mentally ill”. It

occurs because of discrimination in areas such as work and independent living and, second, due to the effect of a

culture steeped in stigmatising images that are exacerbated by headlines in the national media, such as

“Schizophrenic man chops off his mother’s head” (Anon 2004) or “Schizo cabbie knifed six” (Moult 2005).

‘In the five years since my brother was diagnosed we have encountered our share of stigmatisation and isolation.

When Jamie first came out of hospital the positive symptoms of his illness (Box 1) appeared to be under control

but he was suffering with the negative symptoms and often stated that he felt depressed. As a result, he would

often use socially inappropriate coping strategies to lift his depressive state, which more often than not involved

taking illicit substances.

‘When Jamie was taking them he became violent and aggressive towards our mother, towards me and his friends.

At first, we turned a blind eye and tried to deal with it ourselves because we wanted to protect him and did not

want him to get into trouble. But the violence and aggression escalated until it reached the point where we had to

call outside help every week to have him removed from the house.

‘This sort of behaviour does nothing to promote a positive image of people with schizophrenia, but I understand

that Jamie acted this way because of the substances he was taking. When he is not taking anything, he is a gentle

and loving human being, but I do not think our neighbours understood that.

‘Schizophrenia can be devastating not only for the person who is ill, but also the entire family. Among the most

vulnerable and most affected are siblings (Friedrich et al 2008), as the unremitting stress affects many aspects of

their lives, including relationships, roles and health. I can relate to this because my life has changed dramatically

since Jamie’s diagnosis. As a result of his changeable moods and unpredictable behaviour, I stopped inviting

friends over because I often felt embarrassed because I did not know what sort of mood he would be in from one

minute to the next.

‘I was lucky because my friends understood when I had to cancel plans or if I was late. They knew it was because

Jamie’s needs had to come first. On the rare occasions when I managed to meet friends it was hard to focus on

the conversation because I was worried something might be happening at home. At times my friends’ problems,

such as boyfriend troubles, seemed unimportant compared with what was happening to our family. Chapman

(2004), a carer herself, says she was reluctant to mix socially because her son’s illness was always uppermost in

her mind.’

Carer experience ‘The relationship with my mother also changed. We had always been close and in some ways we

became even closer. But there were times when we would disagree about the best way to deal with a situation. For

example, if my mother and I had arranged to go shopping, but Jamie wanted to go somewhere different, his needs

came first. If I disagreed with my mother and said we should do as we had planned, neither of us would have been

able to enjoy the shopping because we would have worried about how Jamie had reacted to taking second place,

so we would cancel our arrangements.

‘The National Service Framework (NSF) for Mental Health Standard 6 states that “carers play a vital role in helping

to look after service users of mental health services particularly those with severe mental illness” (Department of

Health (DH) 1999).

‘The National Institute for Health and Clinical Excellence (NICE) (2002) also acknowledges that “carers of someone

suffering with schizophrenia have an integral role in community mental health care”. Their experiences need to be

taken into account for their own wellbeing and to ensure they can give their loved ones relevant community

support. NICE makes it clear that intelligible information about schizophrenia and the possible role families can

have in promoting recovery and preventing relapse should be made available to service users and their families.

‘But as a carer I feel let down by mental health services. After Jamie was first admitted to a psychiatric unit under

the Mental Health Act 1983, where he spent 28 days, I kept asking to speak to the mental health nurses on the

ward to find out how he had been or if they were any closer to a diagnosis, but they always seemed to be too busy

to talk to us. On the last day of Jamie’s detention, my mother and I were to our surprise invited to the ward to

discuss Jamie’s progress and plans. But…