Interaction between the person who is or has been psychotic and others

Psychosis is not only a burden for the person, but also for people around, resulting in interactions that can make suffering worse for all people involved. On this page problems in family interaction will be described and social stigma. The best way to fight stigma is when people suffering from psychosis present themselves as human beings. 

Expressed Emotions

Living with a family member with a psychiatric diagnosis can lead to anger and worrying. This anger and worry can be measured and is called Expressed Emotions. More expressed Emotions is correlated with more relapses. By the way high EE can also be measured on staff of wards. Families who are assisted with structured family work develop less EE. See page on family work. Some people critisized the editor for putting Expressed Emotions under the heading interaction with a person who is or has been psychotic. They say family adverstity is a cause, yes that can be, see under: epidemiological findings, childhood adversities, but EE is typically a mixture of anger and worrying that can be induced by living with a person of whom you think is dependent on you and has also upsetting behaviour. So people are catched in a dilemma: distancing the relatonship but than you are afraid the person gets into trouble or caring but then you think you have to endure upsetting behaviour. Supporting the family to find a way of coping and also preserving their own interests works very well.

Some films on family burden and what to do about it

Caring for someone with schizophrenia

Nneka and Linda discuss how schizophrenia effected their family

Family Psychoeducation -- Introductory Video


Some overview articles 

Expressed Emotion in Schizophrenia: An Overview, Anekal C. Amaresha and Ganesan Venkatasubramanian 


An overview of expressed emotion, Carl V. Rabstejnek. P.E., M.B.A., Ph.D.


Ria Lenior from Amsterdam University made a thesis on the course of Expressed Emotions: The social and symptomatic course of early-onset schizophrenia. Five year follow-up of a psychosocial intervention, A very relevant finding was that after 2 years there was no difference in psychosis relapse between a group of adolescents with psychosis with only a family friendly treatment and a group who received also a structured family intervention according to the method of Falloon. But after 5 years there was a big difference. The experimental group was less hospitalized and lived less in protected housing, while families did not differ in time spending on supporting their offspring (personal communication). There was not much difference in relapse so it could be that people could manage their psychosis vulnerability better and could survive better in society.


Latest information from IEPA conference Dr Juliana Umniware: identifying moderators and predictors of treatment outcome in caregivers, an RCT, go to 43,28 minutes.



Henry Gale the maker of Psychosis is nothing like a badger, writes: Talking is what I want to come out of this and talking is the only way that we can see a permanent change in the social climate surrounding mental health. Having recovered from years of continuous, debilitating mental health issues to a point where they’re still present but very much under control, I can safely say that talking is the best thing for anyone living with a mental health problem and for their friends and family. That stigma can stop this is unacceptable. It needs to be stamped out. If you are interested in watching this video,  I hope that it’s of some help to you and that, more importantly, it gets you talking! 


Stigma worse than psychosis, chipmunka publishing 


Schizophrenia: defying the odds and breaking the stigma. You tube mental health advocate Miguel shares his reflections on what it fundamentally means to live with schizophrenia / schizoaffective disorder 


A website from King’s college, institute of psychiatry, psychology and neuroscience on stigma 


Many anti-stigma campaigns about “the illness schizophrenia is an illness like diabetes” don’t work, the authors of this article argue: Read J, Haslam N, Sayce L, Davies E. Prejudice and schizophrenia: a review of the mental illness is an illness like any other approach. 


Stigma is a burden: Stigma: the feelings and experiences of 46 people with mental illness, Qualitative study, Sokratis Dinos, Scott Stevens, Marc Serfaty, Scott Weich, Michael King The British Journal of Psychiatry Jan 2004, 184 (2) 176-181; DOI: 10.1192/bjp.184.2.176 


Stigma in families of individuals in early stages of psychotic illness: family stigma and early psychosis, Celine Wong, Larry Davidson, Deirdre Anglin, Bruce Link, Ruth Gerson, Dolores Malaspina, Thomas McGlashan, and Cheryl Corcoran This is an exploratory study of both generalized and associative stigma in families of young people in early stages of psychotic illness. Overall, the level of stigma was low, though families of patients with recent-onset psychosis endorsed more associative stigma than families of young people identified as prodromal to psychosis. 


Social anxiety and the shame of psychosis: A study in first episode psychosis, Max Birchwood, Peter Trower, Kat Brunet, , Paul Gilbert,Zaffer Iqbal, Chris Jackson 

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ISPS Journal


The ISPS Journal Psychosis accepts personal and institutional subscriptions. All Individual Members of ISPS and members of regional ISPS groups receive quarterly issues of the journal as a membership benefit.

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