Week 2: History of The System and Its Perception of the Family
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PSRT 4271 : THE FAMILY ROLE IN REHABILITATION
Week 2: History of The System and Its
Perception of the Family1
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Navigating the Maelstrom2
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Family Burden3
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The Schizophrenogenic Mother4
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How It Seemed in the 1950s5
Fred Clanton arrives at the mental hospital.http://www.youtube.com/watch?v=fs10ow-_2u8
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The Schizophrenogenic Mother6
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
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Mother of the Schizophrenogenic Mother7
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
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Evolution8
“Mom types”“Smother love”“Pseudolove”“Ambitious” mothers“Perverted maternal
instinct”“Symbiotic
relatedness”
Yale Psychiatric Institute
NIMHPalo Alto VA Hospital
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Double Bind Theory9
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Common Link?10
All theory!No evidence!
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Coming to the light…11
1960s: Rise of biopsychiatry Neuroleptic medications Changes in ideas about “balance of power” and
familiesWomen’s liberation movementCivil Rights movement1967: Transmission of SZ Conference
Hereditary basis
1977: Beyond the Double Bind Conference
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Community Mental Health History: Overview12
Symbols vs. Synapses
From Psychosocial… Parental influences Internal forces and impulses
…to Biopsychosocial Biology + Psychology
Research biologicalRehabilitation psychosocial
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Treatments: 3 Domains13
PharmacologicalPsychosocialRehabilitative
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Pharmacological14
1950s: chlorpromazine (Thorazine) 1980s: clozaril 1990s: “atypicals”
Positive symptoms addressedFewer side effectsExpectations changeAggressive dosing beginsMarketing intensifies
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Psychosocial15
Psychoanalysis emphasized, then discredited Transference out; collaboration in Trust; therapeutic alliance Skills development emerges
PsychoeducationBehavior tailoringRelapse preventionCoping skill training
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Psychosocial, 216
Family work Education, support, coping Evidence-based results:
Reduced anxiety, less stress, fewer relapses, less hospitalization
ComorbiditiesIntegrated modalitiesOutreaches
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Psychosocial, 317
1990s: Psychiatric Rehabilitation Out: training, treating, changing In: inclusion, integration, normalization, resilience,
strengths- based, recovery, hope
Patient-centered servicesSkills and supports developmentResearch: increasing “specificity” Early engagementIntegration with clinical services(One goal: Better relationships with families)
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Rehabilitative18
Building skillsEstablishing supportsFostering independence
From… Training, treating, changing
…To Including, integrating, normalizing, recovering
1940s: Fountain House1970s: Assertive Community Treatment