Expressed emotions: Why are they relevant for caregivers?

Psychiatric illnesses are believed to be caused by a variety of factors. The biopsychosocial model of illness focuses on three main factors- biological, psychological and social. It emphasizes that psychiatric illness is a result of the interplay among these factors. Let us understand how social factors contribute towards mental illness.

Man is a social animal and cannot exist in isolation. Consequently, mental health and mental illness are also influenced by external factors like the social environment, attitudes and beliefs of people around. Expressed Emotion (EE) is a concept that emerged in the 1960s and has changed the way the role of family factors is viewed in mental illness. The term expressed emotion refers to the feelings that relatives display about a psychiatric client. In a series of studies conducted around the 1960s in London, researchers found that patients were more likely to experience a relapse of symptoms of schizophrenia if they returned to live with parents or wives than if they went to live in lodgings or elsewhere. Three specific types of expressed emotions were identified which were associated with post discharge relapse.

Types of Expressed Emotions

1. Critical Comments– indicate that the family member dislikes something specific about the mentally ill person or their behavior. It can also get reflected through non verbal behavior like the tone of voice or gestures. For example, “He is so annoying that I can’t take him anywhere”.

• Hostility– the mentally ill member of the family is rejected as a person. For example, “he is crazy”.

• Emotional over-involvement – represents a combination of factors such as an exaggerated emotional response, over-intrusive or self-sacrificing behavior and marked over-protectiveness. For example, giving up all personal interests to watch over the ill person.

• Warmth– is judged mainly from tone of voice of the family member when talking about the ill person.

• Positive Remarks– when the family member says something positive about the ill person.

Research has indicated that high hostility, critical comments and emotional over involvement correlates with a higher relapse rate in persons diagnosed with schizophrenia and several other mental illnesses. In such family environment, care should be taken to put in place protective factors like regular medication, reduced contact with high EE relatives and increased warmth.

What can be done in such a family environment?

Such family environment warrants a four-pronged approach which includes:

1. Psychoeducation- Educating the family about the illness, its course, possible causative factors, and prognosis is the first step that would help in relapse prevention.
2. Family Intervention- Family therapy under the guidance of a trained mental health professional would help in improving the family dynamics and fostering better relationships amongst family members.
3. Communication Skill Building- Helping the family identify dysfunctional patterns of communication and replacing them with healthier communication styles would lead to a reduction in the expressed emotions in the family.
4. Reduction in Face to Face contact- In case the above interventions are difficult to implement, reducing face-to-face contact between the high EE person and ill individual is often helpful.

Getting diagnosed with a mental illness is not equal to the end of life. A person with mental illness can also live a fulfilling and meaningful life. Medications are helpful but we also need to appreciate the role of the family caregivers in the overall treatment process. They are the ones who can help enrich the lives of the mentally ill.

Samvedna Care understands your needs well. We believe in holistic care not only for the ill individual but also for their families. Evidence shows that family counselling helps in significantly improving interpersonal relationships and reduce the risk of relapse in people with mental illness. Our trained experts through family-based interventions can help you sail through difficult times while maintaining your own mental health.