After reading Schizophrenia: A Sibling’s Tale, write a paper of 600-750 words in which you address the following questions:
1. What did you think of the article?
2. How did the article relate to topics presented in the textbook?
3. What interesting questions did the article raise for you?
4. Identify the positive and negative symptoms of schizophrenia and give an example of each.
5. Describe the types of therapy discussed in Schizophrenia: A Sibling’s Tale.
Use the Library databases and include two to four scholarly sources from the library to support your claims, in addition of the article you are critiquing. In addition to the scholarly resources from the library, you can include past classroom materials as well as your textbook as additional reference material.
Prepare this assignment according to the guidelines found in the APA Style Guide. An abstract is not required.
SCHIZOPHRENIA: A SIBLING’S TALE Kirby, Stephan . Mental Health Practice (through 2013) ; London Vol. 13, Iss. 1, (Sep 2009): 18-22.
ProQuest document link
A diagnosis of psychosis can have a devastating effect on close family members of the person concerned.
Stephan Kirby introduces Leanne Bowman’s account of living with a brother who was diagnosed with
schizophrenia five years ago
Stephan Kirby suggests that mental health professionals need a greater insight into the effects a diagnosis of
serious mental illness has on family members. Leanne Bowman’s account explains how her brother’s diagnosis
was received and how living with him since then has introduced new challenges to her life.
Serious mental illness, schizophrenia, siblings, advocacy
As an occasional user of mental health services, and a mental health nurse of many years’ standing, I have some
insight into the needs, requirements and problems facing mental health professionals and the users and carers we
come into contact with. But the one thing I have never given much thought to over the years, apart from as an
academic or professional requirement, was how my own mental health issues were affecting and had affected
loved ones around me.
As professionals, we know it makes sense to foster relationships with service users, based on listening and
understanding. But from political and common-sense points of view it is vital to remember to listen to our patients’
carers, their parents, siblings, children and other loved ones, and understand what the experience of mental illness
is like for them, as well as for the patient in our care.
I met Leanne, a mental health nursing student, when she was embarking on her final year of study. When preparing
some work for me, Leanne was open and honest when discussing her brother’s major mental illness and the effect
it had and was having on her family life and her training.
We hope this paper offers readers an insight into the trials and tribulations faced when a close family member has
a serious mental illness. We hope readers will gain an understanding of what it is like to have a sibling diagnosed
In what follows there is a discussion about the feelings, isolation and stigma encountered by Leanne when she
learnt that her brother ‘was schizophrenic’, a term we accept is not politically correct. It shows the importance of
appropriate support from mental health services and professionals to enable families to cope effectively with the
Leanne Bowman’s story
‘I am a third-year mental health nursing student and by no means an expert on schizophrenia. But I can explain
how the condition affects the family because my brother Jamie (not his real name) was diagnosed with this severe
and enduring mental illness when he was 18 years old. Our mother is his primary caregiver and I am the secondary,
but no less involved, carer.
‘When Jamie was diagnosed in 2003 I experienced a mixture of feelings and emotions. First, I felt a great sense of
loss, almost like a bereavement. In a sense it was a bereavement because, while Jamie looked the same, he acted
very differently from the brother I knew. This process is described by Kuipers et al (2002) who identify two types of
loss: the loss of the person we knew and the loss of the hopes and aspirations we had for them. I also experienced
“survivor’s guilt” (Kuipers et al 2002) because I was the “normal one” and had managed to escape the suffering of
being mentally ill. I felt that because I was the older sibling I had a responsibility to protect my brother from
suffering, but I had somehow failed him. I also felt frustrated because my mother and I seemed to be doing
everything we possibly could to help Jamie, but it was never enough.’
Stigmatisation ‘I had a basic understanding of the term schizophrenia, but probably like many others I had
misconceptions and was even scared of the term and its connotations. In society in general there is a stereotyped
view of people with mental health problems, especially in the case of schizophrenia. The common misperception is
that these people are violent, exhibit sexually inappropriate behaviour and have a split personality (Kuipers et al
2002). Corrigan and Watson (2002) refer to this stigmatisation as “the double misfortune of the mentally ill”. It
occurs because of discrimination in areas such as work and independent living and, second, due to the effect of a
culture steeped in stigmatising images that are exacerbated by headlines in the national media, such as
“Schizophrenic man chops off his mother’s head” (Anon 2004) or “Schizo cabbie knifed six” (Moult 2005).
‘In the five years since my brother was diagnosed we have encountered our share of stigmatisation and isolation.
When Jamie first came out of hospital the positive symptoms of his illness (Box 1) appeared to be under control
but he was suffering with the negative symptoms and often stated that he felt depressed. As a result, he would
often use socially inappropriate coping strategies to lift his depressive state, which more often than not involved
taking illicit substances.
‘When Jamie was taking them he became violent and aggressive towards our mother, towards me and his friends.
At first, we turned a blind eye and tried to deal with it ourselves because we wanted to protect him and did not
want him to get into trouble. But the violence and aggression escalated until it reached the point where we had to
call outside help every week to have him removed from the house.
‘This sort of behaviour does nothing to promote a positive image of people with schizophrenia, but I understand
that Jamie acted this way because of the substances he was taking. When he is not taking anything, he is a gentle
and loving human being, but I do not think our neighbours understood that.
‘Schizophrenia can be devastating not only for the person who is ill, but also the entire family. Among the most
vulnerable and most affected are siblings (Friedrich et al 2008), as the unremitting stress affects many aspects of
their lives, including relationships, roles and health. I can relate to this because my life has changed dramatically
since Jamie’s diagnosis. As a result of his changeable moods and unpredictable behaviour, I stopped inviting
friends over because I often felt embarrassed because I did not know what sort of mood he would be in from one
minute to the next.
‘I was lucky because my friends understood when I had to cancel plans or if I was late. They knew it was because
Jamie’s needs had to come first. On the rare occasions when I managed to meet friends it was hard to focus on
the conversation because I was worried something might be happening at home. At times my friends’ problems,
such as boyfriend troubles, seemed unimportant compared with what was happening to our family. Chapman
(2004), a carer herself, says she was reluctant to mix socially because her son’s illness was always uppermost in
Carer experience ‘The relationship with my mother also changed. We had always been close and in some ways we
became even closer. But there were times when we would disagree about the best way to deal with a situation. For
example, if my mother and I had arranged to go shopping, but Jamie wanted to go somewhere different, his needs
came first. If I disagreed with my mother and said we should do as we had planned, neither of us would have been
able to enjoy the shopping because we would have worried about how Jamie had reacted to taking second place,
so we would cancel our arrangements.
‘The National Service Framework (NSF) for Mental Health Standard 6 states that “carers play a vital role in helping
to look after service users of mental health services particularly those with severe mental illness” (Department of
Health (DH) 1999).
‘The National Institute for Health and Clinical Excellence (NICE) (2002) also acknowledges that “carers of someone
suffering with schizophrenia have an integral role in community mental health care”. Their experiences need to be
taken into account for their own wellbeing and to ensure they can give their loved ones relevant community
support. NICE makes it clear that intelligible information about schizophrenia and the possible role families can
have in promoting recovery and preventing relapse should be made available to service users and their families.
‘But as a carer I feel let down by mental health services. After Jamie was first admitted to a psychiatric unit under
the Mental Health Act 1983, where he spent 28 days, I kept asking to speak to the mental health nurses on the
ward to find out how he had been or if they were any closer to a diagnosis, but they always seemed to be too busy
to talk to us. On the last day of Jamie’s detention, my mother and I were to our surprise invited to the ward to
discuss Jamie’s progress and plans. But the mental health professionals seemed to be talking among themselves
and the only time they made eye contact or paid us any attention was when they told us that Jamie’s diagnosis
was schizophrenia, that we could take him home and that we would get some support from a mental health team
specialising in psychosis.
‘I wanted to shout: “What does that mean?”, “Why did this happen?”, “What can we do to help?” But we were not
given the opportunity to ask any questions.
‘The Mental Health Policy and Implementation Guide (DH 2001) states that early intervention in psychosis teams
(EIP) are there to support people aged 14-35 years with a first presentation of psychosis and to offer support for
the first three years. The guidelines also state that EIP teams should involve families and carers in the assessment
and treatment process, as well as offering family therapy and maintaining regular contact with carers.
‘The EIP team did give us some useful information about schizophrenia and had regular contact with Jamie. But I
felt that I was disregarded as a carer because I was not the parent or the primary carer. It is important to recognise
that the bond between siblings is distinct and can be the longest lasting relationship in some families (Barnable et
al 2006). Even if they are not involved in care, siblings can still experience stress by being part of the same
household and because of the chronicity of the illness.’
Expressed emotion ‘Despite initial promises, my mother and I were not offered any family therapy. There were
times when my brother and I were constantly arguing and being hostile towards one another, due to his
unpredictable behaviour. At these points, it would have been useful to have had some knowledge of the stress-
vulnerability model (Zubin and Spring 1977), which the EIP teams use to underpin care. But I had not heard of it – or
the concept of expressed emotion (EE) (Brewin et al 1991) – until I started nurse training.
‘The theory of EE (Thomas et al 2004) correlates certain family communication patterns with an increase in
symptoms and relapse in patients with schizophrenia. I support the idea of EE, but in practice, it is difficult not to
make negative comments and to be critical when your sibling is constantly being demanding, and is hostile and
aggressive towards you, especially when there has been no offer of support or family interventions to help deal
with the situation more positively.
‘My brother too received little help, and was offered only antipsychotic medication. We were told by the mental
health professionals that as long as he continued to take his medication he would be “under control”. The drug
Jamie was prescribed, amisulpride, is an atypical antipsychotic drug that is a first-line treatment in people newly
diagnosed with schizophrenia (NICE 2002). I do not dispute its effectiveness in alleviating some of the positive
symptoms of his illness, but he still has auditory hallucinations – even though he will deny this to his mental health
worker – and he continues to suffer with the negative symptoms of schizophrenia, particularly a lack of motivation.
‘Jamie’s lack of motivation has a major impact on the family because we constantly have to prompt him to attend
to even simple things such as self-care, or to make doctor’s appointments to get his prescriptions, and then remind
him to take his medication twice a day, every day. I feel that badgering him to take his medication takes away his
freedom of choice. When I am at home my role as a sister is over-ridden by a nursing role, so it feels that I never
get a break from mental health and mental illness and the professional caring role I am training for.
‘I think it would have been beneficial for Jamie to have tried interventions such as cognitive behaviour therapy
(CBT), which can work in conjunction with medication to try to normalise his experiences of hallucinations.
Evidence suggests that therapies such as CBT can be part of treatment to reduce the impact of the positive
symptoms of schizophrenia (Turkington et al 2006).
‘Another thing never mentioned by the professionals who have worked with us is the word “recovery”, which the US
National Institute of Mental Health (NIMH) (Darton 2002) defines as the “act of claiming and gaining the capacity
to take control of life that is personally meaningful and satisfying” despite “the limitations and challenges invited
and imposed by distress, its treatment and the personal and environmental understandings made of them”.
‘But, despite the lack of support from services, Jamie has always had and will always have our support. It is almost
five years since his diagnosis. He has not been hostile or aggressive for at least a year since he gave up taking
illicit substances. He is demanding at times and does not always understand that I cannot drop everything
because he says so.
‘Jamie has a long-term girlfriend with whom he is very happy and he feels mentally well enough to find
employment. He is an intelligent, thoughtful, insightful and creative young man. And he has had recognition for his
talents as a budding DJ.
‘At times I lost sight of what it must be like for Jamie. He still hears voices when he is particularly stressed; he has
lost friends and being labelled “a schizophrenic” has affected his self-confidence. But no matter how difficult it is
for his carers, it is worth to reminding ourselves now and again that we are not the ones with schizophrenia.
‘My mother has been a tower of strength and she has kept me strong. I have the utmost respect for her: she is a
fantastic role model. I am not sure what the future holds for me as a carer and I think there are likely to be more
difficult times ahead, but we will face them as a family.’
Nurse training ‘Three years ago, I started my mental health nurse training because I wanted to help other people
with mental illnesses and to be able to pass on my negative and positive experiences to other professionals,
academics, carers, fellow students and, most importantly, service users. During clinical placements I have had the
opportunity to work with people with a variety of mental health problems.
‘I find myself drawn to working with young men: I find in them the qualities I see in my brother. They do not usually
open up immediately about their fears and it takes time to build a therapeutic relationship and gain their trust,
whereas the women I have worked with generally find it easier to express their feelings and are more willing to
‘One thing I find difficult about being a nursing student is how my experiences and viewpoints are frequently
challenged, albeit unconsciously. I often hear staff nurses saying things such as “there is so much high EE in that
family, no wonder he is back in hospital”. But I don’t think I am judgemental and I will always make time to speak to
service users’ families, offering as much support, information and, perhaps more importantly, hope for the future,
which I believe is an integral part of the nursing role. We need to walk a mile in their shoes to appreciate fully what
it is like to have a family member with a serious mental illness.
‘Now that I work in mental health services I am more positive about the future. Services have improved since 2003,
with more nurses being trained in psychosocial interventions and putting them into practice. I hear the word
“recovery” a lot more than I did five years ago. I have worked with some excellent nurses during my training. I hope
that when I am qualified I will never to be too busy to talk to a carer as I know only too well the unrelenting stress
of being a carer of someone with a mental illness.’
I felt that because I was the older sibling I had the responsibility to protect my brother from suffering, but I had
somehow failed him’
Box 1 Positive and negative symptoms
As a general rule, positive symptoms are an additional experience, whereas negative symptoms are a reduction in
* Thought disorder.
* Lack of volition.
* Lack of excitement.
* Poverty of thought.
* Poverty of speech.
(Brennan G (2009))
I wanted to shout: ‘What does that mean?’, ‘What can we do to help?’ But we were not given the opportunity to ask
Implications for practice
* Staff caring for a person with schizophrenia must be aware not only of the patient experiences but also that of
family members, who have to live with the crisis phase of the illness.
* Staff should seek and acknowledge family members accounts, recognising that they are as much experts on the
illness as the patient, especially in terms of relapse triggers and coping strategies.
* It should be remembered that true collaborative working necessitates the involvement and experience of the
Anon (2004) Man decapitated mum. The Sun March 26 2004. London.
Barnable A, Gaudine A, Bennett L et al (2006) Having a sibling with schizophrenia: a phenomenological Study.
Research and Theory for Nursing Practice. 20, 3, 247-265.
Brennan G (2009) The person with a perceptual disorder. In Norman I, Ryrie I (Eds) The Art and Science of Mental
Health Nursing. Second Edition. Open University Press, Milton Keynes.
Brewin C R, MacCarthy B, Duda K et al (1991) Attribution and expressed emotion in the relatives of the patients
with schizophrenia. Journal of Abnormal Psychology. 100, 546-554.
Chapman V (2004) Carer issues in mental health. In Kirby S, Cross D, Hart D (Eds) Mental Health Nursing:
Competencies for Practice. Palgrave Macmillan, Hampshire.
Corrigan P, Watson A (2002) The paradox of self-stigma and mental illness. Clinical Psychology: Science and
Practice. 9, 1, 35-53.
Darton K (2002) Recovery. Openmind. 115, May/ June. www.mind.org.uk/Shopping/Openmind/
Extracts/ExtractfromOpenmindIssue115 Recovery.htm (Last accessed: April 29 2009.)
Department of Health (1999) The National Service Framework for Mental Health: Modern Standards and Service
Models. The Stationery Office, London.
Department of Health (2001) The Mental Health Policy Implementation Guide. The Stationery Office, London.
Friedrich R, Lively S, Rubenstein L (2008) Sibling’s coping strategies and mental health services: a national study
of siblings of persons with schizophrenia. Psychiatric Services. 59, 3, 261-267.
Kuipers E, Leff J, Lam D (2002) Family Work in schizophrenia: A Practical Guide. Second edition. Gaskell Press,
Moult J (2005) Schizo cabbie knifed six. The Sun. October 5 2005.
National Institute for Health and Clinical Excellence (2002) Schizophrenia: Core Interventions into Treatment and
Management of Schizophrenia in Primary and Secondary Care. NICE, London.
Thomas B, Hardy S, Cutting P (2004) (Eds) Stuart and Sundeen’s Mental Health Nursing: Principles and Practice:
UK Version. Mosby, London.
Turkington D, Kingdon D, Weiden PJ (2006) Cognitive Behaviour Therapy for schizophrenia. The American Journal
of Psychiatry. 163, 3, 365-373.
Zubin J, Spring B (1977) Vulnerability – a new view of schizophrenia. Journal of Abnormal Psychology. 86, 2, 103-
This article has been subject to double-blind review. For author guidelines visit the Mental Health Practice home
page at www. mentalhealthpractice.co.uk. For related articles visit our online archive and search using the
Leanne Bowman was a nursing student at the University of Teesside at the time of writing this article. She is now a
staff nurse working on an acute inpatient unit at Tees, Esk and Wear Valley’s NHS Trust
Stephan Kirby is a senior lecturer in forensic mental health at the University of Teesside
Ms Bowman’s brother has consented to this article being published DETAILS
Publication title: Mental Health Practice (through 2013); London
Number of pages: 5
Publication year: 2009
Publication date: Sep 2009
Publisher: BMJ Publishing Group LTD
Place of publication: London
Country of publication: United Kingdom, London
Publication subject: Medical Sciences–Nurses And Nursing, Medical Sciences–Psychiatry And Neurology
Source type: Scholarly Journals
Language of publication: English
Document type: General Information
ProQuest document ID: 217209814
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Copyright: Copyright RCN Publishing Company Sep 2009
Last updated: 2016-04-09
Database: ProQuest Central
- SCHIZOPHRENIA: A SIBLING’S TALE