Mental Illness and The Family
(Broadcast starting week of May 12th)

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In this hour, we explore Mental Illness in the Family. Anger. Frustration. Resentment. Helplessness. If someone in your family has mental illness, may be feeling all of these things. What can you do to help yourself, and by doing so your loved one as well? Guests include: Dr. David Miklowitz, a professor of psychology at The University of Colorado-Boulder and author of The Bipolar Disorder Survival Guide: What You and Your Family Need to Know; Dr. Lisa Dixon, an associate professor of medicine and psychiatry at The University of Maryland, where her research focuses on schizophrenia and family treatment; Dr. William Beardslee, a professor of child psychiatry at Harvard Medical school, Psychiatrist-in-Chief at Boston's Children's Hospital, and author of Out of the Darkened Room: When a Parent is Depressed: Protecting the Children and Strengthening the Family. Julie Totten, founder of Families for Depression Awareness; and Rose Styron, wife of writer William Styron, who suffers from major depression. Sharon Lerner with a special report on parents that have had to give up custody of their ill children to foster care when their mental health insurance runs out. And commentary by John Hockenberry.

Host Dr. Fred Goodwin begins with an essay in which he describes the history of family therapy. In the mid-1960s, when he started his psychiatric training, it was popular because therapists believed families caused mental illness. With the discovery of effective medications and the results of twin studies which showed genes were involved in mental illness, these family theories were discredited. However, in time, therapists began to realize that, as powerful as the medications were, their effects were not always lasting. When doctors observed people in the hospitals, they got better on the medications, but when they went home, they'd often deteriorate. Either they were not taking their medications, or the level of stress in the family was too high, with leftover anger or guilt hanging in the air, negatively impacting recovery. Thus began the rebirth of family psychotherapy for the seriously mentally ill, this time in combination with medications, rather than as an alternative to them. In recent years, new kinds of family therapies -- pioneered by some of the very people on this show -- have become critically important in maintaining wellness and preventing relapses. Although they never would have guessed it in the mid-1960s, as it turns out, medications allow family therapy to work, and families allow medications to work.

Then, we hear from poet Rose Styron, the wife of William Styron, the Pulitzer prize-winning writer whose books include Sophie's Choice and The Confessions of Nat Turner. Mr. Styron suffers from major depression, which he wrote about in Darkness Visible: A Memoir of Madness. Mrs. Styron shares her thoughts on living with her husband and his illness.

Rose Styron's most recent work is By Vineyard Light, a collection of her poems.

Next, Dr. Goodwin is joined by Dr. William Beardslee, a professor of child psychiatry at Harvard Medical school, Psychiatrist-in-Chief at Boston's Children's Hospital, and author of Out of the Darkened Room: When a Parent is Depressed: Protecting the Children and Strengthening the Family and Julie Totten, founder of the education and advocacy group Families for Depression Awareness.

Dr. Beardslee begins by saying that depression is a family illness because it affects emotions, communications, and relationships. Ms. Totten describes her own experience growing up with a father and brother with undiagnosed depression. Although she did not have a name for their illness, it still affected her. Because of their unpredictability, she felt anxious, overwhelmed, and out of control, and she tried to exert control in her own life, for example by running five miles every day, watching her weight, and getting good grades -- i.e. by trying to be "the good daughter.".

They then discuss strategies for building resilience in children when a parent is depressed, thus lessening the chances that the children will, themselves, suffer from depression or other mental illnesses. Dr. Beardslee's focus has been on allying himself with parents' very strong desire to do well by their children. He's found that even when parents are depressed, they want to do things that are best for their children. He suggests three things to help children be resilient -- make sure they are able to do the appropriate developmental tasks (attend school, play sports, etc.); let them develop strong relationships with other children (often depressed parents do not make the extra effort to bring their children to friends' houses or invite other children over to play); and encourage self-reflection and self-understanding, which begins with helping them to understand the illness as a treatable medical problem.

To contact Dr. Beardslee, please write to: Dr. William Beardslee, Psychiatrist-in-Chief, Children's Hospital Department of Psychiatry, 300 Longwood Avenue Boston, MA 02115. Or visit: http://www.harvard.edu/.

To contact Ms. Totten, please write to: Ms. Julie Totten, Families for Depression Awareness, 118 Waltham Street, Second Floor, Watertown, MA 02472-4808. Or visit: http://www.familyaware.org/.

Next, reporter Sharon Lerner describes the heartbreaking step some parents have to take to get care for their mentally ill children -- they have to relinquish custody to the state. Insurance companies often have caps on mental health services or do not cover care for serious mental illness. In some cases, even Medicaid does not cover the full cost of treatment. Under these circumstances, parents in at least twenty-five states have been encouraged to give up their children to the state in exchange for treatment. Ms. Lerner covers state laws in Oregon and Missouri that were enacted to try to prevent this from happening. In addition, a federal law to stop this practice may be on the distant horizon, but any bill addressing custody relinquishment will have to wait at least until next March, when the General Accounting Office will release its report on the scope and causes of the problem.

For more information, please contact the Bazelon Center for Mental Health Law at www.bazelon.org.

After a short break, Dr. Goodwin is joined by Dr. David Miklowitz, a professor of psychology at The University of Colorado-Boulder and author of The Bipolar Disorder Survival Guide: What You and Your Family Need to Know and Dr. Lisa Dixon, an associate professor of medicine and psychiatry at The University of Maryland, where her research focuses on schizophrenia and family treatment. She, herself, has a brother with schizophrenia, and is active with the National Alliance for the Mentally Ill.

They discuss family treatment therapies for people with serious mental illnesses such as bipolar disorder and schizophrenia. Dr. Miklowitz describes treatment programs which he has started for people suffering from bipolar illness and their families. The treatment involves educating the whole family about the illness, improving communication skills, and teaching problem-solving techniques. Studies show that these family-focused therapy programs, whether for schizophrenia or bipolar illness, can double the effectiveness of medications in preventing relapses and lessening symptoms.

Dr. Dixon then describes a family-based program she's been evaluating. The Family-to-Family program, which is run by the National Alliance for the Mentally Ill, focuses on similar elements -- education, communication, and problem-solving -- but it is run by families, not by clinicians. In addition, families can join the program even if the person with the mental illness is not in treatment. She says that, unfortunately, the very effective type of program Dr. Miklowitz describes is rarely available at community clinics. Therefore, families have tried to come up with some sort of solution on their own. She's found these family interventions to be very effective in reducing family burden and improving communication and relationships among all family members. More research still needs to be done on how effective they are in preventing relapses and lessening symptoms.

To contact Dr. Miklowitz, please write to: Dr. David Miklowitz, Department of Psychology, University of Colorado, Muenzinger D244, 345 UCB, Boulder, CO 80309-0345. Or visit: http://psych.colorado.edu/.

To contact Dr. Dixon, please write to Dr. Lisa Dixon, Department of Psychiatry, University of Maryland Medicine, 22 South Greene Street, Baltimore, MD 21201. Or visit: http://www.umm.edu/.

Finally, commentator John Hockenberry offers his thoughts on the changing nature of families, from large, multigenerational, extended clans to our current "immediate family" units. He says, "Families were once the archive of a body of experiences of people who had gone through it before you, made mistakes you could see, coped with disease, accident, mental illness. Solutions were imperfect… but the experiences were real, alive, close-by."

 

For more information about mental illness, contact:

The National Alliance for the Mentally Ill 1-800-950-NAMI [6264]

The National Institute of Mental Health NIMH Public Inquiries, 301-443-4513

The National Mental Health Association 1-800-969-NMHA [6642]

National Depressive and Manic-Depressive Association 1-800-826-3632

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