ABSTRACT
The robust results of the “expressed emotion” (EE) research, conducted in several countries in the developed and developing worlds, reveal that people with schizophrenia living with relatives (by birth or marriage) who are critical or over-involved (referred to in the research as high EE) have a much higher relapse rate than those living with relatives who are less critical or intrusive (low EE) (Leff and Vaughn, 1985; Parker and Hadzi-Pavlovic, 1990). High EE relatives also have a higher sense of burden from caregiving (Scazufca and Kuipers, 1996). In conducting this research, the family member’s level of expressed emotion is measured by tape-recording a structured interview with the family member in which he or she discusses the person with schizophrenia, and by having a researcher count the number of remarks expressed which indicate criticism, hostility, over-involvement, warmth or positive attributions. A metaanalysis of twenty-six expressed emotion studies of schizophrenia conducted in eleven countries indicates that the relapse rate over a two-year follow-up period was more than twice as high, at 66 per cent, for patients in families which included a high EE relative than in low EE households (29 per cent) (Kavanagh, 1992). Other studies have shown that relatives who are less critical and over-involved exert a positive therapeutic effect on the person with schizophrenia, their presence leading to a reduction in the patient’s level of arousal (Tarrier et al., 1979; Sturgeon et al., 1981). In the same vein, people with schizophrenia who see their parents as being affectionate and undemanding have a low relapse rate if they are in contact with their parents, but tend to do poorly and relapse more often if they are not (Warner and Atkinson, 1988).
