An Overview of Expressed Emotion

Purpose of This Review The intent of this piece is to gather together essential elements of Expressed Emotion (EE) — as preparation for articles expanding our knowledge of the emotional effects of family life — good and bad. I used an earlier version to prepare my editorial for Military Medicine, “Family’s Expressed Emotion to Returning Citizen Soldiers” (Rabstejnek, 2008). An impressive feature of this construct has been its survival for over a half century. EE has shown empirical consistency across studies of schizophrenia and then other mental health issues. Gestated in an era when families were considered instrumental in the etiology of schizophrenia, it has since survived the overwhelming biological and political movements that arose and prospered after introduction of Thorazine, as a treatment, in the mid-1950s — followed by the campaign, largely led by E. Fuller Torrey, to absolve parents of all blame. With the rise of biological theories, the academies essentially obliterated consideration of parents as a causative factor before the prodromal start of schizophrenia. EE advocates survived by judiciously making statements like: “Before we begin our discussion, one point warrants emphasis. Although this article describes a family variable that has been reliable linked to psychiatric relapse, there is no evidence that families cause disorders such as schizophrenia” (Hooley, 2007, p. 330). Survival of expressed emotion consistently emphasized relapse and not conditions before diagnosis.