“Families are the compass that guides us. They are the inspiration to reach great heights, and our comfort when we occasionally falter”(Brad henry). Families are our support system in any time and in any way. When a person comes across through any problem he goes to his family to solve the issue because he trusts them more. But what if a person’s family themselves avoid him due to his diseases? Were they supposed to do it or they should support him? Humans have a fundamental need to belong. Just as we have needs for food and water, we also have needs for positive and lasting relationships,” says C. Nathan DeWall,PhD, a psychologist at the University of Kentucky (Kristen weir,2012).If we go to the literal meaning of rejection it means to refuse to accept something and family rejection means being refused by family members due to mental illness or bizarre acts that are not acceptable to the family. Other synonym used for family rejection is “family estrangement”-it is the unsatisfactory distance between at least two family members which may be physical or emotional (kylie Agllias,2013).
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The pain of perceived rejection is real. Brain imaging (fMRI) have shown that some specific parts of the brain(anterior cingulated cortex & right prefrontal cortex)are activated when a person feel rejected (Eisenberger, Liberman & Williams,2003). Beyond the USA, England, Australia, Japan and South Africa, the preference for psychosocial explanations over biogenetic causes for schizophrenia has been found in Ireland, India, Malaysia, China, Italy,Ethiopia, Greece, Russia and Mongolia (Read, Haslam, Sayce & Davies,2006).Every society have their own norms and values which must be fulfilled by an individual if he want to survive within the society or community, if due to any cause he didn’t followed the norms, other people starts to avoid that person. Even, his family members do that because they have their own cultural beliefs and values due to which a person can end up with isolation.
On my clinical rotation in Karachi Psychiatric Hospital I came across through a scenario of 40 year old female patient diagnosed with Schezopernoid. She was admitted to the hospital on 21 July 2012.On taking history of the patient I came to know that before hospitalization she was living with her brother family, due her severity of disease she had tried to harm her nieces two times. Due to her bizarre acts her brother has admitted her to the hospital. Its almost three years, that patient is still in KPH. Although, with the help of medications and staff therapeutic support she is doing very well, almost she is back to her normal life and doing her work by herself, she is no more dependable on others. But still she is in the hospital because of her family rejection, her family thinks that if we take her back to home she will start behaving the same as she was doing before. Just because family think that she will harm them they are not taking her home.
Rejection can cause emotional, and cognitive consequences (Kristen weir,2012).It causes depression, anger, anxiety and sadness. It affects person’s thought process, as he will be not able to perform difficult tasks. It affects moods, sleep pattern and immune system as well. The longer the rejection, an individual’s resources of coping is depleted and the more likely he/she will experience hopelessness, helplessness and worthless (Williams & Nida,2011).Perceived rejection in any time throughout the life span can also compromise the socio-emotional functioning. According to PAR Theory a rejected person will have negative thoughts about this world, his life, inter personnel relationships and nature of human existence, he thinks that these all are are untrustworthy, dangerous, and uncareful. ( Rohner, Khaleque & Cournoyer 2012).
According to PAR Theory (Parental Acceptance Rejection theory) it is stated that a person is facing rejection if he/she is experiencing combination of any of these four expressions.(1) Cold or unaffectionate, (2) Unsympathetic and violent,(3) Uncaring and neglecting,(4) Undifferentiated neglecting ( Rohner.et al,2012).If I relate the above case scenario with PAR Theory my client’s family were neglecting her, she has told them many times to take her home but they didn’t. Family members were uncaring, they were not thinking about her emotions and feelings rather they were more focused on her disease and her past.
Is family rejection one of the causes of mental illness or due to mental illness family reject an individual? Evidences have shown that mental health issues has been related with perceived rejection i.e depression, behavioral problems like conduct disorder and substance (drug & alcohol)abuse. (Rohner et al 2012).But in contrary, most of the mental illness clients are not being accepted due to the stigma and stereotypes attached to their disease and their bizarre acts which can harm the family members, as the above scenario I have explained. A recent German study shows increasing stigmatization toward people with schizophrenia (Rusch, Angermeryer & Corrigan,2004).
For the recommendations or treatment, In Canada, over 90% support work/ recreation opportunities and involvement of family/friends. Only 49% support drug treatment and 42%support psychiatric hospitals .Similar results have been found in Britain( Read et al,2006).To promote mental health we have to go step by step ahead, we need to start with the patient/client herself. In the above case scenario in hospital setting we can work more on treatment, try to involve her in different recreational activities and make sure that she is improving. We must discuss the current situation of the patient with the family, ensure them about her progress and encourage them to take her home. We can also arrange family counseling sessions and face to face meeting of client and family. Families must take time for the client and play their role to recover the client. In only 40 percent of countries are families associations routinely involved in formulation or implementation of mental health policies at the national level(WHO,2011). As a community worker we can form an organization within our community which can initiate population based preventive interventions, integrate mental health in primary health care settings, promote positive and fully contribution of the people having mental health problems, understanding and addressing their issues by involving media, anti stigma, stereotypes and violence programs or campaigns for the community. To implement and to make these interventions effective government need to make clear policies, develop systemic plans and allocation of budget and time regarding these measures. According to WHO (2011), integration of mental health into the public health is needed, public thinking must be more involve in mental health planning. We must not look into care only but also on promotion and prevention.
Family rejection means not accepting any family member .There may be many causes, one of the main cause is mental illness. The pain of rejection can not only cause emotional or cognitive consequences but it can also affect a person’s biological perspective as well. Rejection and mental illness are inter linked relationship i.e. a person who is rejected by family, friends and society can end up in mental illness. On contrary, due mental illness a person is not accepted by the family due to stigma or societal norms. We can overcome this issue by prevention and promotion of mental health through sectors with the help of government.
Ronald P, R,Abdul , David E. C (2012). introduction to Parental acceptance-rejection theory,methods,evidences and implications. retrieved from http://csiar.uconn.edu/wp-content/uploads/sites/494/2014/02/INTRODUCTION-TO-PARENTAL-ACCEPTANCE-3-27-12.pdf
Agllias,K. (2013). Family Estrangement.Encyclopedia of social work. Retrieved from http://socialwork.oxfordre.com/view/10.1093/acrefore/9780199975839.001.0001/acrefore-9780199975839-e-919?rskey=asyLi8&result=2
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Read,J., Haslam,N., Sayce,L., & Davies,E. (2006). Prejudice and schizophrenia: a review of the !mental illness is an illness like any other” approach.Acta Psychiatr Scand,114, 303-318. Retrieved from http://www.freedom-center.org/pdf/read_prejudice_schizophrenia_biol_stigma.pdf
Weir,K. (2012). The pain of social rejection.American psychological association,43(4), 50. Retrieved from http://www.apa.org/monitor/2012/04/rejection.aspx
Who. (2007).Community mental health services will lessen social exclusion, says WHO. Retrieved from Who website: http://www.who.int/mediacentre/news/notes/2007/np25/en/
Williams,K., & Nida,S. (2011). Ostracism: Consequences and Coping.Association for psychological Science,20(2), 71-75. Retrieved from http://cdp.sagepub.com/content/20/2/71.full.pdf+html
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