11.7c Social environment: Families & culture  

i) social environment

Families

Families have an important role in terms of helping us with managing the patients. They often have the most significant burden of care.

Families also influence diagnosis in a number of other ways.

Relationships as clues to pre-morbid status

If the family is absent or distancing that might provide us with a clue to what the person's pre-morbid status was like, but it also may produce a significant challenge in diagnosis because we do not have anyone who is with that person for hours in a day who can tell us what they are doing, how they are different, what they are like most of the time. Their absence will provide a real problem for management.

In the case of Sam, the family was there all the time, but their threshold of abnormality before they complained was very, very high. So it was not until their father's behaviour was grossly disturbed that they called for help.

Family dynamics will also influence the ability to make an adequate assessment

Pre-existing family dynamics will also influence the ability to make an adequate assessment. In some cultures and communities the male has a very particular role . If there are only female members in the family there can be a real issue for those female members feeling comfortable talking about their husband's or father's behaviour. These pre-existing dynamics will have a strong influence in relation to what they report or do not report.

In the case of Sam this was not an issue but in some cases it is, particularly when Middle Eastern men have traumatic brain injuries, the wives are often very reluctant to talk about their husband's aggressiveness and irritability for fear that this will be viewed inappropriately within their community.

Families can have hidden agendas

Families can have significant hidden agendas. Particularly in the case of anxiety disorders a spouse or family member may not want to talk about their relative's agoraphobia because the agoraphobia serves a purpose, it reduces their independence and autonomy. The family might like the fact that this person is now much more home bound and more containable in relation to their behaviour.

Shame

While those of us who work in the area of traumatic brain injury or in the area of mental health recognise that brain injury and mental health causes changes in behaviour, that they are illnesses that warrant and deserve treatment, often a family member will be very ashamed of how their loved one is behaving and therefore not disclose or reveal what is going on. This is often the case with wives who are ashamed of how their partner may be behaving and limit the amount of information that they give.

ii) Questions

Answer these questions:
Are the following true or false:
If the family is absent or distancing that could provide us with a clue to what the person's pre-morbid status was like.
If a person with mental illness and TBI is living by themselves that fact will create a significant problem for management.

Check your answers here
If the family is absent or distancing that could provide us with a clue to what the person's pre-morbid status was like.
True
False
If a person with mental illness and TBI is living by themselves that fact will create a significant problem for management.
True
False

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