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Guide for families


This is a guide for families who have a member suffering from a major mental disturbance, such as schizophrenia, bi-polar disorder or severe depression. The basic text was written by Constance Packard, M.S.W. She is the mother of a son with a diagnosis of schizophrenia, a family therapist and a member of the Windhorse Board of Directors. Windhorse is a coalition of professional, consumers, and family members and we consider it very important that these three groups work together in a way which informs the whole. The clinical staff, therefore, went through a process of revising and refining the Guide, with special input from Sally Clay and Harold Raush. Sally is a consumer/survivor activist who was, at the time, both on the staff and a member of the Board of Directors. Harold is the father of a Windhorse graduate, a clinical psychologist and co-leads the family program. We offer the Guide as an introduction to the way we at Windhorse Associates work with the families of our clients. We also offer it to other families anywhere who may find it helpful.

Mental health professionals used to tell us that parents caused mental disturbance in their children. Students of psychiatry, clinical psychology and social work learned about “shizophrenogenic mothers” and distant fathers. Fortunately, that belief concerning the cause of mental illness no longer holds sway. At present, the predominant view in the field is that mental disturbance is a physical illness in which thoughts and behaviors are symptoms of an imbalance in the brain. Mental illness is compared to a disease such as diabetes. We are told that something is defective and can only be “fixed” through medical technology such as drugs. This view is often called the “medical model”.

The implication of this view is that if there is a defect in the brain, then there is no hope of recovery, and the best we can do is manage symptoms. The medical model requires a constant vigilance for the reappearance of symptoms, and encourages a tendency to find something “wrong” in the slightest change in attitude or behavior. In addition, if families and professionals rely solely on the medical model, we tend to give messages that dis-empower those who suffer from these conditions.

The Windhorse approach is quite different. We view mental affliction as essentially a human problem that can best be addressed through human means. While there are many factors involved in mental disturbances, including brain function and heredity, we do not regard the person as an illness, or a bundle of symptoms. Instead we deal with the problems at hand with common sense – with respect, discipline, kindness and lifestyle choices. We work to create a physical and psychological environment that benefits everyone who lives within it – both the person in difficulty and his or her family and friends.

We believe that recovery is possible, and that we can emerge from the suffering and confusion of mental disturbances with a depth of understanding that will stand us in good stead for the rest of our lives. We believe that it is possible to have a meaningful life, in spite of disability, all along the path of recovery and whether or not full recovery occurs.
We include families in our work because family dynamics, attitudes and communication do affect the recovery process, either giving impetus to recovery as part of creating a “sane environment” or impeding it. Family members are deeply and powerfully interconnected. If one member of a family is in an extreme state, all members of the family will most likely find that they are also in an extreme state of some kind in response to the difficult situation and the intense emotions associated with it. The on-going disruption, grief and anxiety experienced by families, combined with negative cultural attitudes towards mental illness and a fragmented mental health system, constitute major and continuous stresses of many kinds on many fronts. We know that it is a difficult journey, and that all of you at times have been stretched to the limits of your endurance. We know that families, as well as clients, commonly find themselves in a dark labyrinth of grief, fear, conflict and confusion – and that it is hard to know where to turn for guidance.

No matter how great the stress or turmoil, in our experience there are two basic concerns closest to the hearts of most family members: 1) How can I give my son or daughter, sister or brother, husband or wife what he or she needs from me? 2) How can I and the other members of our family survive and flourish in the midst of all this chaos and heartbreak? These are the two basic concerns to be addressed in thinking about the family situation and how to help. They are completely interrelated and interdependent and cannot really be addressed separately, because the ability of family members to give their mentally disturbed relative what he or she needs from them will be greatly enhanced if they themselves have attained a degree of equanimity and are leading satisfying lives.

In fact, the interconnectedness of these two concerns is an important principle underlying all our work and also extends to the network of professionals and team members involved in the client’s treatment. Stated in another way, the first principle guiding our work is that the client, the professionals and significant family members are all inextricably and closely linked in the recovery process and that everything affects everything else, for better of for worse. Consequently, it is of great importance that we all work together with a common purpose and a common vision of what promotes recovery.

Through our combined experience as professionals, family members and recovered consumers, we have learned some guiding principles for families that lead toward healing and recovery. It is these five principles that we present here and which we believe enable us to give our family member the support and nurturing he or she needs, to set boundaries and limits to protect everybody in the family and to find the space to nurture ourselves – all necessary requirements if the family is going to function for the benefit of all its members.