Abstract complex than how they are portrayed


            This study aims to
figure out what the relationship and meaning of the ways that a family treats a
family member with a chronic mental or physical illness. The exploration of the
way those with a chronic illness are treated since their diagnosis is important
to understand the perceptions, behaviors, and communication that surrounds
illness. Chronic mental illness will be analyzed against chronic physical
illness to assess similarities and differences in family behaviors.
Participants included individuals selected from local support groups based on
their illness as well as family structure. An ethnographic study would be used
to compare both the verbal and nonverbal relationship between the ill family
member and the rest of the family.


















study aimed to focus on both physical chronic illnesses and mental chronic
illnesses and their effects on family communication, particularly surrounding
the diagnosis of the illnesses.

has a large impact on the perceptions of illness. In recent times, the publicity
around individuals with chronic illnesses, both mental and physical, has increased
dramatically in the media. From the production of films about those with
physical chronic illnesses to celebrity diagnosis of a mental illness, illness
is something our society is beginning to talk about more frequently. However
there are certain stigmas attached to these illnesses that make it harder for
patients and their families to cope with their situation. Most often because of
the portrayals of chronic illness that romanticize illnesses and do not
necessarily show all of the effects of these illnesses on the patient or their

mental and physical chronic illnesses are much more complex than how they are
portrayed in the media. These illnesses often produce copious amounts of side
effects that bring a whole new level of challenges to the patient’s struggle
through their daily life and readjustment after diagnosis. One effect that is
often not publicized as much as others is the relationships that exist between
the patient and their family. These family relationships may change drastically
with the diagnosis of and grappling with a chronic illness, changing how family
members perceive one another, how they act, and even how they communicate. All
of these things depend upon the nature of the family, and the illness and
produce different changes. However, through all different types of families and
illnesses, communication in situations like these is essential to understanding
one another. According to Rosland (2009), several interviews and focus groups
showed that family members lowered stress, and are central to patient success.
In most instances, the family is the primary caregiver to someone with a mental
or physical chronic illness, and the family relationship is important in the
healing process due to proximity and the support received from family members.
The diagnosis of a chronic illness has the potential to change the fabric of
the family dynamic to help accommodate to the family member who is ill.

it is clear that families often change to accommodate, it is unclear how family
members communication changes since the diagnosis of a chronic illness, if
change is present at all. Which begs the question: How are those with a chronic
illness treated by their families since their diagnosis? Little research exists
regarding the potential changes associated with the new found illness. Answering
this question will help to make those in a family with one or more person who
is chronically ill more aware of their own behavior, and will also shed light
on the patients perception of their illness, and how that has been influenced
by the family’s communication about the illness.

study is essential to the communication field, particularly health
communication, because it adds to the ongoing conversation about how to
understand people who are chronically ill and treat them in a world where in
2012, 117 million people had one or more chronic health issues (Ward et al.,
2014). This study will explore both chronic physical and mental illness in the
context of the family, focusing on marriage, parent-child relationships, and
the use of narratives. This will help assess the problems that come with
illness, and find out what happens to family communication when a family member
gets diagnosed with a chronic illness.

Literature Review

            Chronic physical illness and chronic mental illnesses are
reviewed separately here due to the tremendous differences in the two. In this
study they will be compared against one another to cross analyze the
differences and similarities in how the family member is treated depending upon
their type of illness.

Physical Illness

physical illnesses vary in types and intensity, but have one characteristic in
common: they recur throughout time, usually at random intervals. The
uncertainty that comes along with a diagnosis along these lines can greatly
effect family communication and relationships.

Marriage. Marriage
is the basis of most families in many cultures. Keeping the marital bond strong
could be very difficult in the face of a chronic physical illness. A chronic
physical illness could potentially change the daily lives and interactions of
the entire marital relationship. It is important to discuss the communication
that occurs around theses illnesses in order to understand how those who have one
have been treated since their diagnosis based on research already conducted
around similar communication processes. Badr and Acitelli (2005) found that in
couples that used relationship talk, or talking about the nature and direction
of the relationship, chronically ill couples had more benefit than a couple
that did not include someone who had a chronic physical illness did. This literature
proves that in a situation where a spouse is chronically ill, it is important
to use communication to make one another aware of certain things such as how
one felt about a situation, or what one needs or expects from their partners.
Talking about the state of the relationship can be helpful for chronically ill
people to express fears in relation to their illness and the marriage. Berg and
Upchurch (2007) suggested that collaborative talk is the type of communication
that is commonly correlated with positive results. This shows that it is
important for married couples to talk about their situation together to keep
their relationship strong since these tactics have been proven to be helpful
for the couple. Shuff and Sims (2013) add on to this by stating that couples
that are aware of their partner’s expectations of communication in the marriage
are more successful in supporting one another. Being aware of the partner’s
desires and being able to fill them is central to satisfaction in the
relationships’ functioning. Marital coping and sharing is not limited to
relationship talk though. Another powerful way of sharing within the family is
through narrative.

Narratives. Something
that is strongly recognized and praised throughout literature on chronic
physical illnesses is narratives. Several studies (Freeman & Couchonnal,
2006; Ott Anderson & Geist Martin, 2003; Walker & Dickson, 2004) stress
the importance of narratives for the family healing process. Narratives are
beneficial because they allow research to capture personal accounts of illness,
and let the ill person be a gatekeeper to their own information about their
illness. Ott Anderson and Geist Martin (2003) state that those with a chronic
physical illness are more likely to actively share if their feelings and
perceptions are confirmed by other people, especially friends and family. Some
chronic illnesses have a negative social stigma to them, and confirmation that
people will be respectful is important to getting the patient to open up about
their experiences. Narratives and storytelling help families to communicate
about changes that have taken place. Ott Anderson and Geist Martin (2003)
conclude that the ever changing identity in the face of illness never stops, it
is an endless development. Sharing through narrative in cases of chronic
physical illness has the potential to better family communication because the
patient is able to clearly and concisely explain what is happening to them from
their personal point of view. This can help the family identify what the
patient has gone through, as well as understand new emerging identities. However,
Lorde (1980) points out an important paradox where sometimes patients may be
empowered by giving a narrative account of their story, while others may feel
anxiety from reliving those moments of their life. According to Grotcher and
Edwards (1990), when participants used communication to reduce their fear of
their illness, they were likely to communicate about their illness more often. Walker
and Dickson (2004) show that narratives are important in understanding and meeting
the expectations of the family members when they are chronically ill. Often
times people will have expectations for their family members without verbally
expressing them, leaving family members more often than not confused about what
direction to take. However, a narrative or forms of storytelling in the case of
a chronic physical illness may reflect some of the patients unfulfilled needs,
and help family members to identify them.

Mental Illness

chronic mental illness can be extremely
hard for families to cope with given the negative social stigmas that exist
about the illness in most societies around the world today. A chronic mental
illness in a family member could lead to almost constant care and monitoring,
depending upon the illness and the intensity. Families may find it difficult to
cope with or come to terms with a family member’s diagnosis of a chronic mental
illness due to the many challenges it presents. Much of the literature
surrounding mental illness in the family is psychology based, and there is a
strong need for communication based studies to better understand these unique

Marriage. An
important aspect of the family dynamic is marriage. It is the foundation of
most families, and gives people feelings of stability. Communication is
essential to marriage, but little literature exists exploring the communication
around a diagnosis of a mental illness. However, much literature exists on its
effects on marriage. Perry (2014) focused on social networks and stigma in
relation to those with a serious mental illness. A spouse is a very prominent
and strong part of a married person’s social network. If someone is entering or
exiting a marriage, their social network changes in many different ways. Perry
(2014) found that the stigma of a mental illness had contact with the social
network and the relationship between the two works ambiguously together. Meaning
that the social network responded to the mental illness through their own
thinking, and proving that spouses typically control family conversations.
Spouses decide the climate of the family views and values towards different
topics as they raise their offspring, if they choose to have any. Segrin (2006)
shows that there is a strong call for communication scholars to explore the way
that families interact, especially about mental illness, and that a positive or
a negative attitude can set a precedent for what future family communication
will be like based off of how spouses interact. The different communication
processes that couples partake in set examples for children to interact based
on. Adding mental illness to the mixture, Schmaling and Jacobson (1990) show
that wives that are depressed are more likely to make an aggressive comment to
their husbands than wives that are not depressed would, and depressed wives
have less positive discussions than their counterparts. These aggressive
statements could likely become a stressor for the marriage or produce a negative
schemata of marriage for children or adolescents in the family. Segrin (2006)
offers that depression has a large impact on the family, and usually just
creates more problems that tends to result in fueling depression. However this
assertion could also be true of the communication patterns surrounding may
other types of mental illnesses in the family.

Parent-Child. Looking
at the parent-child relationship in reference to mental illnesses, it is known
that parents are the primary caregivers to children and adolescents with
chronic mental illnesses. Literature mainly focuses on the illness from the
parents’ perspective, rather than the child’s, suggesting that little is known
about children’s perceptions of their parents’ mental illnesses. Richardson,
Cobham, McDermott, and Murray (2013) explained that parent’s feelings of loss
about an adult child with a mental illness focuses on grieving about ambiguous
losses, like the child’s loss of self or identity. This loss and grieving
process has the potential to shape the families behaviors and patterns of
communications. Since there are usually no tangible effects of a mental
illness, parents may often find it hard to cope with a diagnosis and come to
terms with it. Even harder for families to process is the fact that in most
cultures and societies in the world, there is a negative social stigma to
having a mental illness. Richardson et al. (2013) also noted that parental
grief over the child’s mental illness was not socially acceptable. Several
studies (Richardson et al., 2013; Chadda, 2014) discussed this notion that
parents felt as though the illness or their own grief should be hidden because
it is not socially acceptable. Most of the struggles that parents in this
situation face are with the topics of self-concepts and identities, with
variance to whether it is their own, or their child’s’. Richardson et al.
(2013) found that the child’s illness changed the parents own identity. Since
the identity and self are such fluid concepts, it is important to understand
the self and different identities as well as the changes that occur with the
two in accordance to both the parents, and the children. There is little
literature in regards to mental health’s effects on self-concepts and
identities.  Aside from the self, another
important factor to contend when discussing mental illness between the parents
and children is parenting styles effects on these children with mental
illnesses. Hamond and Schrodt (2012) explored the effects of the different
parenting styles on children’s mental health and concluded that there was no
statistically significant evidence that the different styles had an effect on
mental health. However Hamond and Schrodt (2012) continued by noting that findings
indicated that acts of affection and authority make limited, but important,
improvements to the child’s mental health. When it is the parent in the
relationship who is mentally ill, the communication process is entirely
different. As found in Van Loon, Van de Ven, Van Doesum, Witteman, and Hosman (2014),
where adolescents internalizing and externalizing behaviors were correlated to parents
mental illness. Parents with mental illnesses were found to have a negative effect
on the adolescent or child, the whole family, and even the parent and child’s
interactions (Van Loon et al., 2014). This literature exemplifies that parental
mental illness controls more channels of communication than a child or adolescent’s
mental illness does. While much literature exists about families and mental
illness, unfortunately very few scholars focus on the talk that occurs about
the family member with the illness, and the communication around this topic.

the literature leads back to the question: how are those with a chronic illness
treated by their families since their diagnosis? Analyzing both mental and
physical illnesses and the family communication processes around them are
essential to furthering the conversation that communication scholars are
creating to understand these unique families.


            To answer the given research
question, qualitative methods would be most appropriate to find an answer.
Literature on related topics suggests that qualitative methods are most
appropriate (Badr & Acitelli, 2005; Berg & Upchurch, 2007; Chadda,
2014; Freeman & Couchonnal, 2006; Hamond & Schrodt, 2012; Ott
Anderson & Geist Martin, 2003; Richardson et al., 2013).  An ethnographic study should be used because
as Keyton (2011) states, it “…allows the researcher to observe and understand
how communication is generated and responded to in a particular context” (p.
300). This would aim to aid researchers’ in their quest to understand the
relationship of participants who are ill in relation to their family members.
This would involve a nonrandom sampling strategy to get the combination of
characteristics needed for the study. Specifically, purposive sampling, to be
able to get close and personal enough with the participants to have them share
details about their personal lives.

            This purposive sample depends upon
researchers knowing what is typical and atypical of the populations they are
studying. A sampling frame of an exhaustive list of chronic physical and mental
illnesses will be created, and participants will be selected based on whether
or not they, or someone in their immediate family, has one of the listed
illnesses. The sample will be selected by going to local support groups for individuals
with both mental and physical illnesses. A wide array of illnesses will be
selected, and age will be as varied as possible. Participants who are selected will
be contacted via e-mail or phone call to ask them to participate in the study.

            Once participants respond and
confirm their consent to take part in the study, the researcher will begin to
go into the family home and talk to family members. Since ethnography is
similar to a participant observation study, the researcher needs to build a
relationship with the families being studied, especially with those who have
the mental or physical illness, if possible, to assess the changes that have
occurred in behavior since the diagnosis. Once trust is established, the researcher
can come in and begin recording the conversations about the diagnosis time, and
how participants felt. This data will be compared to stories from before the diagnosis
period, for both mental and physical illness affected families. A list of operationalized
concepts such as: love, affirmation, avoidance, and fear, will be created to
classify the nonverbal actions towards the ill family member. Collecting both verbal
and nonverbal accounts can give a better representation of the true behaviors
of family members’ actions, both verbally and nonverbally towards the
chronically ill family member. An analysis of the responses in relation to the
stories around the diagnosis and before the diagnosis will be compared to the
observed actions of the families in relation to the ill family member. Once
this has been done for both chronic mental illness and chronic physical
illness, the results will be cross analyzed to compare and contrast the
different verbal and nonverbal communication styles. Using ethnography will
allow for an in depth and lengthy analysis of these different families, and the
effects of mental illnesses and physical illnesses on family communication.





















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