You are on page 1of 4


(Or the reactions of the family system to a big problem: his loss of balance, fa
"There are things in themselves which should concern us, but the views that we f
orm them." (Epictetus) INTRODUCTION As a family counselor, I wanted to focus ext
ensive article on a subject that is of importance: The Family and psychosis. thi
s sum
This is not how to diagnose or treat psychotic (and there are other specialists
to do so), but to collaborate in the therapeutic approach of the environment in
which lives and grows sick person, because I am convinced that when an element t
he system becomes unstable or has been disrupted by the latter, the entire syste
m to be treated and adjusted to find, as far as possible, the homeostasis requir
ed to work best. There is no denying that the family, or should be, which will c
arry the burden of the disorder and ultimately will have to contend with the unp
redictability of it. It is therefore obvious to assert that the evolution of som
e psychosis will depend largely on the social, cultural and, above all, family m
embers, since, although the introduction of psicorrehabilitadores basic,
2 the love, understanding and support of family and friends, must be crucial. Du
e to the laborious nature of the subject and the challenging task therapeutic me
ans and moments associated with this operation, from here I advocate a multidisc
iplinary team that can cover each and every one of the specific work fields that
are accurate (Psychiatrists, Psychologists, Counsellors Family, Doctors, etc.).
. VITAL CHANGE. When a sick family member, is disturbed normal life and coexiste
nce are affected, so it is important information and understanding of the diseas
e, extremes will help to maintain harmony within the family. No doubt that comes
a huge impact because they generally do not want to accept the fact, creating t
he interrelations of verbal and nonverbal messages full of anguish. Appear mutua
l recriminations between family members, and do not sleep (insomnia), is left to
normal social activity that was done (it leaves less), and overall there is a d
eterioration of normal life. This situation causes a series of crisis to be tack
led in a practical way, because otherwise the family is doomed to plunge into wi
despread chaos. Most importantly, from the point of view of the family, is first
to recognize the symptoms of the disease at the beginning and after crisis (if
any) and how to act in such cases. There is a first maximum or idea to be taken
into account and then leave everything to be done: one is to blame, we should no
t feel ashamed. And the World Health Organization (WHO), addressing the issue of
schizophrenia and family says you should:
3 - To have the maximum possible information about the disease and they are neve
r left with any doubt, or the disease or the treatments. - Tune your doctor as m
uch as possible, ie to work between patient and family friendly atmosphere exist
s. - Avoid isolation, participating in meetings, group tours and how many are ev
eryday events, "the loneliness only increases anxiety and does not lead to anyth
ing positive." - Set yourself modest goals with the patient. It is better to ado
pt a symbol or type a page, do nothing. - Avoid direct confrontation with the pa
tient (except in case of gravity), and for this, if necessary, to resort to thir
d parties. The schizophrenic often listens more to siblings or friends as their
own parents. - Never avoid dialogue with the patient about what is concerned, ex
pressing at all times, in truth what it may seem that you have not understood. T
his is already important, but complements this series of things that the family
should have a good professional, enthusiastic, ready and willing to help, especi
ally in the problems "nonmedical" of the family, and his best advice, so I think
it is essential to include the family system in the therapeutic process, as exh
austed or stressed family do not think it a good environment for any patient. Th
ere is no doubt that when a family was "China plays", a mental patient, believed
to have entered a "bad dream", because we are in a society that still does not
understand it or understand it. If anyone is free to have an illness like this i
s for the leaders and health officials began to take other approaches
Four different than today's, as this type of patient requires a unique approach,
outside government offices and health centers. TO THE SYSTEM. Great authors of
this trend therapy, systemic€postulate what until now we have been pointing in
that one element of the "system" can be "sick" by the system itself. If this is
true, how to relate the condition of the parental couple with the disorder child
. Something similar can be read another quote from Framo, 1965, pp. 182: "when t
here are children with disorders is always a marriage disorders, although not al
l marriages produce children with disorders disorders." I believe there is the s
ecret of clinical treatment, in my opinion, the need to work in a context in whi
ch the identified patient is developing and maturing. It is not my intention to
leave the patient to one side, but simultaneously as therapeutic nuclear family
and, why not, with the family system of origin, which for sure has something to
say. Surely "variants of each family to help us reconstruct and understand the i
nteractive process, which culminates at a given moment in undesirable behavior o
f a son" (M. Selvini). Although it may seem that I am away from the job title (T
HE FAMILY TO THE PSYCHOSIS), it is not. My purpose is to make clear that psychos
is, to be a serious disease, does not come alone, does not appear by magic, even
if scientists and scholars of the subject mark the beginning for reasons as div
erse as genetic predisposition, viral infections, complications in childbirth, a
n imbalance of neurotransmitters, etc. I can not even deny any of these causes,
but provide many of the
May psychotic behaviors of children, adolescents can come for a counter-producti
ve and malicious behavior and the context is "matured" being, child, youth or ad
ult, presents some very symptomatic disorders. or adult, in which attitudes now
It is the family who can now say "I am not", is he / she / he who has the proble
m, without asking why reacts him / her that way. "We came because my son does no
t work well ..."¿ Safe? I have no doubt that in many disorders, "the fuse" that
appeared was placed, consciously or not, someone or something related to the fa
mily system. So I think it more appropriate to ask, what is inside the system th
at makes maintaining the problem? It was discussed what to do the family of the
patient identified face to face (for priority treatment of shock) that cause dis
ease and that begins to stabilize and feel better, but that does not end the rea
son for the family. If this were the end I think we would have tackled the probl
em from the standpoint of Change 1. We are interested in going beyond (if the fa
mily allows it), the origins of the problem that has developed between "here and
now." It is crucial, however, that the family take on the challenge and advice
to change attitudes. The loss of control would be impossible to establish the ru
les of the game, as the patient remains to the family as an element that is it.
In short, I think there may be "psychotic games" in an identified patient (IP) a
s a "provocation" aimed at promoting exchange reactions within the family enviro
nment, so our investigative work is hard, do not deny it has to go aimed at
6 to construct a scenario that highlights why the symptom in the family and its
relation to the context. Clearly, then, that delivery of the possibility of disr
upted relations between the family members had a negative impact on the IP. This
reasoning leads to the patient to the designated psychosis is not only the affe
cted, but we can speak of a psychotic tendency of the whole family. Just as ther
e are families anorexic, neurotic families, chaired by anguish, frightened famil
ies, will not be phobic families, families constantly threatened by something we
do not always get to make, thus constituting an obsessive family, etc., As I sa
y, there is also a psychotic family type in which the symptomatic member is, wha
t we might call the tip of the iceberg. For many problems should be traced back
to earlier generations looking for other "members symptomatic" because the trans
mission of dysfunctional patterns are verified through communication behaviors t
hat have been accepted as "normal" in some significant members of the family sys
tem, seen in several generations. I want, that the important thing, in my view,
leave the patient is not designated idle at home with a strong administration of
psychotropic drugs, but try to work with the rest of the family change behavior
s that will surely influence the behavior of IP€whether the requirements of the
family are still correct. The family is not alien to anything that happens and
how Selvini Mara Palazzoli argues in his book "The psychotic family games," if t
here are parents healthy, intelligent and motivated enough to faithfully perform
all steps of the requirements the therapist, it is possible that without treatm
ent the symptom in the IP, it able to change attitudes.
7 This is getting increasingly clear that individual therapy may be incomplete a
nd the trend is directed to prepare the way to learn about the relationships tha
t are consistent with the presence of a psychotic family member, watching carefu
lly , possibly different reactions of individual members. An occasional lack of
family reactions, or lack thereof, is anomalous and questionable, so the therapi
st has to take very careful and study the reason for the "no reaction." The fami
ly and their "dirty tricks." It is impossible, given today use the family as a p
natural, that which being
not human
mature forms and acquires all the essential elements to become adult. If these c
ycles for which we spent drinking from the feel and the culture within a family
"not healthy", you end up suffering the consequences at any given time of life (
especially if they lose the right resources to meet the "emotional perils" of da
ily life). It's easy to find families who, according to M. Selvini live in and t
heir environment by, most often unconsciously, "dirty tricks." For this term mea
ns all unfair means, "as subtle deceptions, lies, revenge, manipulation, ambiguo
us promises," double bind messages, perverse triangles, alliances between subsys
tems marked by ambiguity, etc. This shows that the psychotic behavior of the IP.
can be directly connected to this "dirty tricks." Is it difficult for one to fe
el betrayed by a member of the family system? In this context of manipulation is
easy to find someone symptomatic and perhaps less strong than others, the emoti
onal reactions that lead him to develop a full-blown psychosis. What is therefor
e in our therapy? I still insist that logically the IP and the family as
August smith context of the stimuli or conducive breeding ground for our patient
s designated to take root to life or is immersed in the mental chaos, completely
insane in that environment, pathogen. If the family does not become protective
of stress, it is useless to foresee an improvement in our patient and much less
if we did not see the goal not to create conditions that alter the actual balanc
e, that of that particular family, which need not be the same as another. It is
known that the "psychotic family are characterized by rigidity, lack of adaptati
on and acceptance to change, so we have to work all these aspects as they are de
tected, but, in my view, enclosed or limit to exclusive therapy, or afford to be
eclectic to take what suits us all therapy theories, the best go to our case an
d at the right time. These "games" that take place in the family is going to giv
e all behavior and therefore their levels of behavioral, emotional and thought,
so our work in the family must be comprehensive and, important in the future, no
t easy. All kinds of interactions that we have mentioned can be interposed betwe
en the members of the family system having high potential pathogen. The reconstr
uction of the primary objectives of the family must necessarily pass through a p
sychoeducation and restructuring of the bases, to return to the personal balance
and harmony. All this game, with strategic moves that make it up, they always f
rame analog level, non-verbal, as mentioned as part of "foul play" episodes of t
he double bond. Acts,
9 attitudes will be very different from the words to be issued, hence the observ
ation of all the guidelines in our interviews, is to pursue a single goal: to su
btly address the change 2. To do this properly at this level we capture analog p
rovocative aspects of certain behaviors that are likely to be some element of im
prisoning our family system in treatment, and have the appropriate strategy in o
rder to observe early, getting the best tool to preventing new situations that t
rigger emotional plot of the entire system. Since I do not see the possibility o
f living in a family and be oblivious to all the movements that are generated in
it,€in the evolutionary cycles of each member are new elements that are interr
elated with other elements of the system, adapting, falling, rising, alternating
in power, deciding, adding and removing rules, ... Living in the end. When all
this vital game hatches psychosis, which need not necessarily be available if, a
s I mentioned, adequate resources, it is because the balance is broken and has f
ailed to actively or passively. In our natural desire to always submit another a
nd create relevant and current partnerships vital when there arises or a "crack"
, a break unspoken disappointment, not shared verbally, not communicating (where
is the assertiveness?), is supported and, ultimately, it can be a burden one di
fficult to sustain. It appears, therefore, as a protest to events and situations
that the family has been planting over time. "However, whether we walk blindly
in the darkness of confusion or withdrawal from sinking into depression, or feel
possessed by a destructive rage, is, finally, to oscillate between these three
states of mind, patient does not loose his prey "(M. Selvini). The dam may be th
eir parents, or one of them, one who has disappointed those who want to sue some
subliminal way, that he has
10 altered the logical foundations of his world. " And all the "dirty tricks" th
at is set in the family system: some symptoms of child each family member to ado
pt its own strategy or position. It keeps playing and playing poorly. Given this
, there is no doubt that the game the whole family and parental attitude towards
making a psychosis, I see only two alternatives: to overcome or service. Only,
I think, an easy solution and not in the process, which is to frame the family i
n a "therapeutic setting" Setting also an appropriate therapeutic contract, in w
hich the conditions are given to share any abnormal situations, describing and d
iscovering, we get into their doubts and questions for answers. We are detective
s, nurses, mirrors and stones to listen, sometimes. Easy, right? Obviously, no.
A development with a win will always give us hope, "unfounded but not least aliv
e, that a saint in the future inspires us to know [where we have already learned
" everything "] a new strategy, perhaps asking for parents, the parental couple,
passing responsibility to the responsible pathogenic therapy.
Note .- Work and data extracted from the book "The psychotic family games" Selvi
ni Mara Palazzoli, Stefano Cirillo, Matteo and Anna Maria Sorrentino Selvini Edi
torial Paidós Family Therapy.