David W. Jones

Stepfamilies and older people: evaluating the implications of family change for an ageing population

The changing nature of family life has become a major issue in contemporary Britain. Concerns that change will bring moral decline and social fragmentation are countered by a more optimistic view which focuses on a future of more equitable and flexible family ties. Research drawing on area-based data in Luton amongst older, middle-aged and younger people with experience of family change suggests that so far as inter-generational relations, caring, and transfers of family wealth are concerned, traditional attitudes towards blood ties, household independence and care and support survive alongside new step relationships. The research also suggests that although several respondents had more than one generation of experience of family change, the language of step relationships is still one which is not yet completely accepted, or one with which people feel completely at ease.

Myths, Madness and the Family: The Impact of Mental Illness on Families

This book fills a gap in our knowledge about the experiences of families of people suffering from severe mental illness. Original research material is used to support claims that families are struggling with complex feelings such as loss, anger and shame.

Introducing Psychosocial Studies of Emotion

This chapter provides an introduction to the papers that make up this book. The psychosocial contributors represented here all share an interest in affect, the emotions and emotional life. Some recent writers (e.g. Blackman and Cromby, 2007) make clear distinctions between ‘emotion’ and ‘affect’, with, for example, ‘emotion’ being used to refer to conscious experience, and ‘affect’ to a more basic drive — or bodily based phenomenon. We agree with Greco and Stenner’s (2008) suggestion that such distinctions are not always fruitful, partly because the terms are used highly inconsistently. Emotions exist partly in the body, but they are also in our minds, in our language and in the cultures that surround us. They can be understood as a crucial bridge between the individual and the social, and are quintessentially psychosocial phenomena. They have a mercurial status, not existing without an individual to experience the emotion, but often having little significance without a socio-cultural framework that imbues feelings with meaning.

Conclusions: Psychosocial Studies – A Therapeutic Project?

The essays in this book show in different ways and in a wide range of contexts how emotion is implicated in every area of our personal and public lives, relationships and institutions. Various psychosocial theories and per spectives have been deployed by the contributors to examine the different ways in which emotion provides a psychosocial bridge between the inner and outer worlds, binding them together, through the shifting processes of history, discourse and unconscious phantasy.1 Clearly there are many ‘psy- chosocial’ approaches. They vary in the kind of psychology being deployed, as illustrated by the various forms of psychoanalytic psychology, identity theory and biographic narrative approaches to be found here, and the wider range to be found elsewhere. Along with this diversity in their models of the ‘psycho’, psychosocial approaches also vary in the ways that the ‘social’ can be theoretically and/or empirically present, with sociological theory (Rustin, Chapter 2), politics (Evans, Chapter 6; Yates, Chapter 7) and history (Jones, Chapter 16), cultural forms and artefacts (Powell, Chapter 8), policy studies (Cooper, Chapter 13), criminology (Gelsthorpe, Chapter 14) and education policy (Price, Chapter 15) being among the ways in which the ‘social’ has been presented to readers of this book.

Moral insanity and psychological disorder: the hybrid roots of psychiatry

This paper traces the significance of the diagnosis of ‘moral insanity’ (and the related diagnoses of ‘monomania’ and ‘manie sans délire’) to the development of psychiatry as a profession in the nineteenth century. The pioneers of psychiatric thought were motivated to explore such diagnoses because they promised public recognition in the high status surroundings of the criminal court. Some success was achieved in presenting a form of expertise that centred on the ability of the experts to detect quite subtle, ‘psychological’ forms of dangerous madness within the minds of offenders in France and more extensively in England. Significant backlash in the press against these new ideas pushed the profession away from such psychological exploration and back towards its medical roots that located criminal insanity simply within the organic constitution of its sufferers.

A Psychosocial Understanding of Personality Disorder: The Historical Problem of Moral Insanity

Various terms such as ‘psychopath’ and ‘antisocial personality disorder’ have been used at different times to describe individuals who act, with no apparent remorse, with great callousness causing disruption and distress around them. Despite being formally described within medical texts for many years the status of these diagnoses remains highly contested both within and outside of psychiatry. It will be argued that a psychosocial perspective can firstly help us to understand why this and related categories of mental disorder have been so contentious and secondly may also point us towards more useful ways of understanding the phenomena. Two points about a psychosocial perspective are raised in this chapter. Firstly, consistent with the premise this book there is the engagement with the social and cultural significance of emotion. Secondly there is the need to cross disciplinary fissures; not only trying to bridge the most obvious gaps between the psychological and the sociological, between the individual and the cultural, but also most notably in this case the analysis benefits from historical context.

The Family, the Asylum and Community Care

This chapter will spell out why consideration of the world of the ‘family’ is so important to our understanding of serious mental illness. It will be argued that families, for various reasons, have been a significant factor in the lives of those who have come to be seen as suffering from serious mental illness. It is not only the actual behaviour of families but, perhaps even more importantly, it is also the ideas and assumptions about ‘the family’ that have been such critical features of the environment which has shaped not just the policies and practices that are aimed at mental illness, but our very definitions of sanity and madness.

The Myth of the Family: ‘Love and all that business’

This chapter introduces the metaphor of myth, that is, a story whose premises are not questioned (Barthes 1973; Levi-Strauss 1968), as a way of exploring and explaining the significance of family relationships. Previous chapters have suggested that relatives of people suffering from mental illness are coping with a range of intense feelings that are often difficult to acknowledge and manage. They are frequently experiencing grief, which is complicated by feelings of ambivalence and anger. Feelings of shame, as discussed in the last chapter, may also be present. Shame impacts on people’s feelings of identity and taps into highly sensitive aspects of experience. It will be argued that the notion of family can usefully be regarded as a myth, which brings a degree of order to relationships that are often beset with troubling feelings that are sometimes, although by no means solely, connected to ‘sexuality’. The association of the constructs of insanity and deviant sexuality has been drawn attention to by many, particularly in relation to ideals of femininity (Chesler 1972; Skultans 1979). Whilst there is, no doubt, some truth in these observations, it will be argued here that there is a highly complex relationship between families, sexuality and sanity. It is not just that aberrant sexuality is sometimes seen as a mark of insanity, but that behaving within the ideals of family is seen as a crucial component of sanity.

Concluding Discussion: Living with Ambivalence

This book began by referring, in the Introduction, to Carol Peters’ questions, which she raised during an interview about how she feels about her brother’s difficulties: How can we deal with this? How are we meant to react? What do you want us to do? … [C]an you explain to us what is going on in his brain that he is suddenly screaming and shouting at us, and abusing us and everything else, do you know why? Previous chapters have highlighted the importance of the active ‘struggle’ for meaning that is going on underneath that questioning and the importance of dialogue in reaching resolution. As Chapters 1 and 2 emphasized, professionals have often approached families with their own rather strong, ideologically informed views that have made dialogue unlikely. For example one reading, or one hearing, of Carol’s questions could lead someone to provide answers in terms of practical action. The ‘expressed emotion’ specialist might suggest the families take a non-critical accepting stance. Leaflets and information might be provided by a psychoeducationalist, outlining the status of current knowledge of neurology, biochemistry or twin studies.

Coping with Stigma: the Significance of Shame and Identity

The study of the association of stigma and mental illness has a long and distinguished history. To some, the very existence of the concept of mental illness can be understood in terms of stigmatization. There has been an impressive literature on the impact of the label of mental illness on people’s behaviour and on the perceptions of others (Goffman 1961; Scheff 1975). Goffman (1963) has noted that the effects of stigma are not confined to those who are directly marked by difference, but reach those associated with that person, referring to this as ‘courtesy stigma’. It is very likely that families involved in mental illness will experience stigma (Wahl and Harman 1989). This is a potentially important issue since stigma may well restrict people’s willingness to seek help and support (Wasow 1995; Yarrow et al. 1954). In fact, whilst this concern is undoubtedly highly relevant, further exploration of the experience of stigma offers useful insight into the nature of identity and family relationships.