Family relationships
The evidence is now fairly clear, and has been repeated on many occasions, that family members' attitudes can affect the outcome for people diagnosed with schizophrenia or bipolar disorder. There are two important aspects to this.

The first is that friends and relatives occasionally find dealing with some of the problems that can be associated with psychotic experiences (particularly embarrassing , socially disruptive or socially withdrawn behaviour ) frustrating and difficult, and sometimes become critical or actively hostile towards the individual.

The second reaction is to find the changes very upsetting and to try to look after the person rather as if they were a child again. While this ' emotionally over- involved' reaction is understandable and can be helpful in the short term, during recovery it can lead to dependence in the individual and exhaustion in the carer.

Either or both of these attitudes in carers (i.e. criticism or over- involvement) have been described as ' High Expressed Emotion'. If they become extreme, they have been found to lead to poorer outcome and an increased likelihood of a return of psychotic experiences. In contrast, people living in more supportive, tolerant, low Expressed Emotion environments tend to have a lower likelihood of a return of psychotic experiences, better social functioning, and better outcome.

Perhaps unsurprisingly, relatives who find caring particularly stressful also tend to have high levels of Expressed Emotion. The way someone's psychotic experiences are understood and explained by their friends, relatives and other people helping them is very important, and can help determine the extent to which they are able to recover.

Staff relationships
Not all caregivers are relatives; some individuals live in hostels, for example, and have important relationships with staff and other caregivers. It has been found that both relatives and staff caregivers find the same problems difficult (disruptive behaviour and social withdrawal). Up to 40 per cent demonstrate high levels of Expressed Emotion, mainly criticism. Clearly any relationship, whether with family or staff, can be problematic. It is important to remember that this is true not only for psychotic experiences but also in a wide range of other long term and ongoing difficulties, such as depression, epilepsy, and even obesity.

This article is an edited extract from the followind pdf report (available for download, but it may take a few minutes depending upon your Internet link):

Understanding mental illness - Recent advances in understanding mental illness and psychotic experiences.
A report by The British Psychological Society Division of Clinical Psychology. 2002.
Published by BPS Division of Clinical Psychology.
ISBN:1 85433 333 X

Hard copies of the full document are available from the BPS office at a cost of £10 DCP members, £15 non-members. Free copies can be downloaded from the British Psychological Society web site