Family Identity Disrupted by Mental Illness and Violence: An Application of Relational Dialectics Theory

ABSTRACT

This research examines how family discourse or talk about severe mental illness (SMI) creates and animates familial identity. More specifically, we sought to understand the interplay of competing discourses present in family members’ talk about their experiences of living with and caring for a family member with SMI. We gathered data through ethnographic interviews with 20 family members of persons with SMI and a history of violent behavior. Our analysis revealed two primary discursive struggles: a normal yet abnormal family and physically/emotionally close yet distant family relationships. Our findings highlight how participants use various discourses to co-create a sense of who they are and what it means to be part of a family defined by SMI and violence.

KEYWORDS:

• Family communication
• mental illness
• relational dialectics theory
• violence

Notes

1. Psychiatric diagnoses and disorders were identified by the participants and not from official medical records. Mental illness was conceptualized as any Diagnostic and Statistical Manual, fourth edition (DSM-IV; American Psychiatric Association, 2000) diagnosis or other traits consistent with a diagnosable serious or severe mental illness (as reported by the participant). The federal definition of serious mental illness has shifted in name from chronic mental illness to severe and persistent mental illness and, as it stands currently, to serious mental illness (National Registry of Evidence-based Programs and Practices, 2016). Severe mental illness generally included adults aged 18 or older who are diagnosed with schizophrenia, schizoaffective disorder, psychotic disorders, major depressive disorders, bipolar disorders, borderline personality disorders, and/or anxiety disorders. The shift from severe to serious expanded diagnosable criteria to include children (National Registry of Evidence-based Programs and Practices, 2016). Mental disorders vary in degree of impairment and duration; serious mental illness includes those disorders that substantially interfere with or limits one or more major life activities (Center for Behavioral Health Statistics and Quality, 2016). Our current sample represents persons with reported serious mental illness and a history of violent behavior.

2. All participants reported that a diagnosis did not come immediately after the onset of aggressive behavior or symptoms of mental illness. This delay was the result of various forces, such as denial by family members and/or treatment providers, or by fear of stigma associated with a potential diagnosis. Despite the delay, their experiences prior to diagnosis are significant in how they each perceived their family dynamics, identity, and experiences. Likewise, some family members, especially siblings, lived outside of the house (e.g., away at college) when the diagnosis was made; however, their sense of family identity was still greatly impacted by their earlier experiences and the diagnosis more broadly.

3. Contact the first author to request the interview protocol/questionnaire.