The Consequences of Social and Family Dysfunction: A Perspective from New Zealand

Introduction

In 1994, Anne told me that she was admitted to a mental hospital as a school girl. She was often medicated with a major psychotropic drug, Mellaril, and was also administered Electroconvulsive Therapy. This affected her memory and her education. She became a chronic psychiatric casualty who is still chemically dependent today. Her sister was placed in a Welfare institution and was subjected to harsh treatment from big girls of a different sexual orientation. Anne was raped in the mental hospital while her sister was bashed in the Welfare institution.

Many people have lived a life of chronic disadvantage arising from the system taking over and breaking families irreparably. In the fifties, sixties and seventies there was not much knowledge of the consequences and deep injuries done to members of dysfunctional families. Families that were cut adrift by the system had children and adolescents sent to foster homes, institutions or to mental hospitals. Sexual abuse occurred, probably frequently. One former female foster child told me in 1994 that she had been sexually abused in foster care. Two men, Adrian and Peter recently told me they had similar experiences in foster care.

Members of dysfunctional families have always been of interest to Welfare and Psychiatry. What is becoming apparent is that many of their issues are social problems that create burdens on the taxpayer, benefit dependency, and much ill health in the face of health fund cuts. Health cuts now ensure that only clearly diagnosed people and substance abusers are treated or hospitalized. The social problems now have to be worked out with people who are not interested, and often not knowledgeable about the issues. One way to address social and family dysfunction is through education - self-education for survivors and also for the professional people who assist survivors.

Some survivors, for example, may experience repeated abuse, isolation and witness threatening and intimidating behavior of others. Oftentimes, other family members' inappropriate behavior or reactions (e.g., they blame the survivor for the abuse) heightens traumatic reactions. The survivor may (if they are lucky) be referred for professional help. The casualties of families like this have been described in submissions to the 1996 Mental Health Inquiry. In the meantime, with limited resources, some psychiatric and/or mental health professionals will send the victims away and say "Go back to your family." There may be no family to return to! This is a social problem and there are too many casualties in New Zealand with issues still not properly resolved.

In the early 1990s, I addressed Social Workers of the Children and Young Persons Service. I told them that I often speculated over whether or not some foster children were being abused by their foster parents. A Social Worker gave me vigorous nods from a back seat. Children of abusive parents may be affected by family dysfunction from the extended family that became their foster family. As adults, they are prone to becoming ill and have more brushes with "the system." In many cases their sense of self worth may be severely knocked, and there are few reliable supportive people in their environment.

Every survivor has good attributes and qualities. They may have tremendous potential but in difficult financial times, survivors often do not have the money to develop that potential. An adjunct Professor in Colorado, Dr. Warner wrote that survivors of Schizophrenia could recover in prosperous times. The same is true of every other survivor in New Zealand.

In 1994, a Social Worker with Children and Young Persons Service suggested to me that long-term consequences of family dysfunction were not the problem of their department. An Income Support person told me both branches kept on "passing the buck." In 1995, I suggested to policy makers that they bring parents into the campaign on prevention of child abuse. The reply was that it "all depended upon the allocation of resources."

In 1998, the Children and Young Persons Service are now pushing to collaborate with Health personnel. Public Health and the Children and Young Persons Service in New Zealand are affected by funding cuts. So problems of dysfunction affect family members responsible for people who have gone through the system. Other victims are left to their own devices, often in conditions of chronic disadvantage and extreme poverty.

Posttraumatic Stress Disorder

More knowledge has emerged since the eighties in keeping with the policy of emptying the mental hospitals; it was then that Posttraumatic Stress Disorder (PTSD) entered the diagnostic manual. This is a useful way to understand the effects described above. A significant and deleterious aspect of PTSD is the train of thoughts associated with the violence experienced by survivors at the hands of abusive or hostile people. The traumatic thoughts may haunt the sufferers for two decades or more. The thoughts can also be accompanied by vivid pictures behind the eyes of violent or vicious people. These pictures are called "flashbacks." Some sufferers never lose their traumatic thoughts or the flashbacks. Pharmacology may aid in diminishing certain symptoms, but there is still sound evidence that mental health professionals often make serious diagnostic errors regarding PTSD. Survivors of PTSD may be misdiagnosed as Borderline Personality Disorder and may be pressured to change their behavior.

Some survivors, unable to stop the flashbacks, may create different pictures. Some may become sufficiently empowered to understand that flashbacks are a symptom of Posttraumatic Stress Disorder and effectively reduce or stop them all together. Toxic psychiatry or ill-prescribed drugs may exacerbate trauma reactions and at times, contribute toward the experience of flashbacks.

Flashbacks can cause terror and horror for survivors. It is comparable with (and often confused with) the hallucinations of Schizophrenia. Many women affected by PTSD died at the hands of their violent spouses before laws changed in the United States. Aphrodite Matsakis, Ph.D. a specialist in PTSD wrote about "Claudia" in Chapter Four of her book I Can't Get Over It. Claudia was a battered wife to whom the police said "There's nothing we can do about it. Call us after he actually starts beating or cutting you." In the United States in the 1960s, a wife needed consistent hospital reports for seven years before she could win divorce on "battered wife" grounds and a fair settlement. Claudia did not win her divorce, her spouse did. Evidence was given at the court that she had several (unspecified) psychiatric disorders. She was blamed for breaking up a happy home. Her spouse won the home and left her in poverty. His victory gave him authority to tell Claudia that he would get the children if she could not support them. Dr. Matsakis wondered whether Claudia's legal counsel was incompetent, or whether there were darker reasons that the personality of the abusive spouse was not brought up in the divorce proceedings.

Dr. Matsakis writes that professionals including doctors and nurses, at times, minimize grievous losses. For example, after a Hurricane, a concert violinist was taken to a makeshift hospital along with others who were injured. When she was told that three of her fingers would have to be amputated, she began to cry. Her nurse told her "Hush now, you big crybaby, bed number one lost his arm and bed two has to have both legs removed. Count your blessings and don't upset the others." It is this sort of indifference that must stop. If more people including professionals hear the cries, I believe that many of the tragedies (and potentially, revictimization) could be stopped by a change in direction from the policy makers.

Emotional Disorders and Denial

New Zealand has been in denial of the realities of social disadvantage for many years. The denial is possibly an artifact of people being frightened by what they can not face in themselves. Victims of social casualties, injustices, and massive losses are prevalent in New Zealand society and survivors can and will not go away.

One abused woman was told by her divorced spouse that she could "crawl off the face off the earth." This is indicative of the way many people regard abused people, who need to be heard and be assured that the injustices will be addressed. If society, social policy makers and the lawmakers do listen, the pain may be slightly alleviated. Unfortunately, many adhere to a "Just World" philosophy (see the work of Janoff-Bulman). The basic assumption of the "Just World" philosophy is that if you are sufficiently careful, intelligent, moral, or competent, you can avoid misfortune.

A Case Example from Aotearoa, New Zealand

New Moon, a newsletter put out by the Aotearoa Network of Psychiatric Survivors, published an account in 1992 of a woman, "Raelene," not being dealt with appropriately or compassionately after she was raped by an Island man in a mental hospital. She was later cruelly manhandled by nurses when she spoke about the rape at a group meeting. The hospital people told the family an alleged incident occurred. I met Raelene in 1994. She was repeatedly committed through the testimony of a nurse solely concerned with the behavior and the symptoms. Raelene was trying to restore the lost mobility of her left side. She had to have several smaller meals in the course of a day because of her stomach condition. Her stomach bled from the drugs she was made to take and the last time I saw her, she looked very ill indeed.

Deinstitutionalization: Human Rights or Financially Driven?

A few years ago, a nurse asked me what I thought was the driving force behind the emptying of the mental hospitals. I believe that the policy is driven monetarily. Dr. Jenkins, a United Kingdom doctor, attended the 1993 mental health conference in Auckland. He suggested that the proceeds from the sales of hospitals should be put back into providing services. This would ensure that deinstitutionalization would be successful. Unfortunately, proceeds of the sales of hospitals do not appear to have been injected into community services.

Conclusion

Although more care with psychiatric and abuse survivors is often taken today, not all cases are successfully helped. My research and experience in the first half of this decade appears to be about abused rather than mentally ill people, per se. Survivors' family status is not always addressed by support workers, although family status in the Human Rights legislation must be adhered to. The Human Rights Act covers situations such as employment, provision of services, and accommodations on the grounds of age, sexual status, health and family status.

Survivors are often held accountable for the wrongdoing in their family. We must remember that the problems of sexual abuse in children, adolescents and adults as well as the abuse sustained by the members of dysfunctional families are very serious. Theses difficulties are quite prevalent. The issues often appear to be swept under the carpet. Sadly, misdiagnosed survivors are often ridiculed or stigmatized by many people which perpetuates their social disadvantage.