Siblings of schizophrenic patients--a review.

The families of patients with schizophrenia carry an enormous emotional and social burden. This article is a historical review of the study of the well siblings of schizophrenic individuals. The early investigations (1950s-1970s) were based on the theory of familial transmission of schizophrenia and focused on siblings from the aspect of their susceptibility to the disease. Many claimed that even siblings who did not develop full blown schizophrenia still suffered from considerable psychiatric disorders that were attributable to pathological familial psychodynamics. Case control studies were used to explain how some well siblings "escaped" the pathological family network. With the introduction of the concept of family burden in the late 1960s, research shifted to the emotional impact of growing up with a schizophrenic brother or sister. This was accompanied by the emergence of self-help groups and published case histories of siblings themselves. In the early 1980s, the data were essentially descriptive. Investigators studied sibling shame, poor self-esteem and feelings of stigmatization. Different patterns of coping with the subjective burden were distinguished. More recently, greater efforts have been made to systematically define the variables associated with the burden experienced by siblings. To answer the many still outstanding questions, further studies are needed based on a longitudinal design and homogeneous samples. For example: Are sibling's personal relationships outside the family affected? Does the sibling place within the family affect his or her reaction to the sick brother or sister? Does guilt play a role? What type of intervention is needed? With the increasing role of the community in the management of the mentally ill, such research has become very important.