High Emotional Expressiveness (EE)

Emotional Expressiveness or EE is the level of expressed criticism, worry or emotional involvment on a scale of low to high by the family members towards the patient and has been linked with increased risk of relapse when the emotional involvement is too high. Here is some background information that you will find useful. I notice that many studies of emotional expressiveness were undertaken decades ago in the 1960s and 1970s. Very likely the increased use of medication beginning in the 1970s to treat mental illness as a biochemical imbalance unrelated to the patient's environment has a lot to do with why we haven't learned more about this since.

Parents and spouses are not the only people coping with the demands of the patient, yet they seem to be the people researchers single out when studying emotional involvement, overlooking hospital staff, psychiatrists and intervention programs.

The very nature of a program means that you are turning the spotlight on the individual and, with all good intentions, of course, may be making that person uncomfortable about their prospects in recovery. Medication that the patient is often told must be taken for the rest of their life also conveys an emotional message of defeat. The doctor's mere presence may reinforce that something is wrong with the patient. The use of the word "patient" is loaded with meaning.

People with schizophrenia in under-resourced countries where EE is low, by that I take it to mean where rehabilitation programs and medicine are scarce, tend to have better outcomes. They don't have access to all the resources to "fix" things, so maybe it works because they just leave their relative to his own devices, supported by the belief system of the family and reinforced by the community that the person is a temporarily invaded by evil spirits. They know they can do something about evil spirits.

In contrast, the Western world prides itself on individualism. The individual is often at odds with the community. The community itself doesn't have a fixed belief sytem because it is made up of individualists. All values are now relative in the West. We give off mixed messages because there are so few fixed ones.

The complexities of what goes into sustaining a recovery are many. The good news is that you can learn to reduce high EE in order to avoid relapse. We could start by looking at the social constructs surrounding our current treatment of mental illness.

Maybe it's time to just stop worrying about it. Shall we all just take a valium?