Abstract
Although there is a clear statistical association between expressed emotion (EE) and schizophrenic relapse, our understanding of the mechanisms underlying this relationship is underdeveloped. This study tested a theoretical model in which caregivers’ perceptions of their ill relative’s agency underlie the EE-relapse association. To evaluate this model, we completed qualitative and quantitative analyses of narratives provided by individuals caring for a relative with schizophrenia. The results indicate that high-EE caregivers perceive the expression of symptoms as stemming from their ill relative’s agency more frequently than low-EE caregivers. This was true for both high-EE-criticism and high-EE-emotional overinvolvement caregivers. High-EE and low-EE caregivers did not differ in their perceptions of the role of their ill relative’s agency with regard to the control of symptoms. The findings suggest that EE may be a proxy risk factor for caregivers’ perceptions of their ill relative’s agency.
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Notes
It is important to note that reviews of Schneider’s first-rank symptoms have failed to confirm that these symptoms are unique to schizophrenia (e.g., Nordgaard et al. 2008).
We were first introduced to this quote by Ahern (2001b).
Identifying information in these narratives has been changed or removed in order to protect the confidentiality of the participants.
Although not specifically examining the use of the agentive case, Estroff (1993; Estroff et al. 1991) has noted the importance of semantic case with regard the experience of mental illness. Specifically, in examining narratives of individuals with schizophrenia, Estroff has argued that semantic case can provide insight into how individuals position themselves versus their illness. Estroff identifies two types of positioning: (a) “I am” illnesses, where there is little to no differentiation between self and illness or where the self may even be replaced by the illness (e.g., I am schizophrenic); and (b) “I have illnesses,” where illnesses are referred to as possessions of the self and there is greater separation between self and illness (e.g., I have cancer).
The verb “to have” can be interpreted in several ways. In some instances, the verb “to have” can be used idiomatically, where the subject of the verb is assigned to the agentive case (e.g., I had breakfast = I ate breakfast [Quirk et al. 1985]). In the narrative from the high-EE key relative, the key relative appears to use the verb “to have” in the phrase “he had a beer” as if it were synonymous with the verb “to drink.” Given that the subject in the phrase “he drank a beer” would be considered the agent, we considered the subject in the phrase “he had a beer” to be the agent as well.
One key relative did not describe any instances of the control of symptoms in his/her narrative. As such, this analysis was based on 20 participants only.
One key relative did not describe any instances of the control of symptoms in his or her narrative. As such, this analysis was based on 20 participants only.
We would like to thank an anonymous reviewer who noted the relevancy of this paper to our study.
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Breitborde, N.J.K., López, S.R. & Nuechterlein, K.H. Expressed Emotion, Human Agency, and Schizophrenia: Toward a New Model for the EE-Relapse Association. Cult Med Psychiatry 33, 41–60 (2009). https://doi.org/10.1007/s11013-008-9119-x
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DOI: https://doi.org/10.1007/s11013-008-9119-x