Posted on March 10, 2011
Education and Wellness Consultant, Fountain House
Before a person’s first psychotic break, their social support networks are normally large and interconnected. Social isolation is not a prominent feature of the early life of a person with schizophrenia, and only small changes in network strength are noticed immediately before his or her first break.
After the first hospitalization, the network starts to dissolve because of antagonistic attitudes and reactions of people close to the person and because of the person’s impaired social competence. At this stage of the illness, the person is in crisis, as is his or her social network.
Most of the dissolution in a person’s social network occurs soon after the first break. (He or she is being rejected.) At this same time, possibly in response to being rejected, the person’s emotional and social withdrawal from his network is observed. (He or she rejects.)
Relationships with close family remain but with fewer contacts - possibly because of the personal shame being projected onto close relationships. (Many clinicians have reported depression or depressed mood in people after a psychotic episode. Although there are many possible causes for this, feelings of shame, based on self stigma, seem to account for this in part.) At this stage, the person may feel more comfortable with people who didn’t know him or her before the break.
Therefore, the onset of schizophrenia, in the form of the first break, becomes a network crisis that affects the person’s sense of belonging. Active intervention with the network soon after the first break should be attempted to avoid collapse of the person’s social network and the resultant isolation.
We at Fountain House have the opportunity, not only to offer a new network of support through membership, but to help strengthen the person’s existing network of support. The therapeutic nihilism associated with the idea that social isolation is a product of the natural evolution of the schizophrenic process must be abandoned.