Madness, the family and psychiatry

Abstract

It is argued that an important factor behind the lack of direction in current policies towards serious mental illness has been the failure to critique properly the highly entwined relationship between the discourses of psychiatry and `the family'. Interviews carried out with an ethnically diverse group of Londoners, who had a relative diagnosed as suffering from serious mental illness, suggest that while the families have an allegiance to a medical model, they are also actively and critically appropriating psychiatric discourse. Closer examination suggests that concerns about sexuality and people's apparent ability to engage successfully with intimate relationships are prominent among the criteria that family members use to judge sanity. A certain amount of historical explication is necessary to put these observations into context, since there has been so little critical analysis of the role that families play in psychiatry. A number of points can be made from the known histories of asylums and psychiatry that suggest that families and familial ideologies were significantly involved in defining ideas of insanity during both the rise and demise of asylum. On the one hand, idealizations of familial and emotional life came to be seen as connected to the causes and treatments of sanity. On the other hand, families were themselves actively involved in the construction of the asylums since they were choosing to commit relatives they deemed to be mad. These historical observations can help illuminate material from contemporary interviews with families. It is argued that our contemporary understandings of mental illnesses are immanent to ideas of family and emotional life.