Schizophrenia , Genetics, and the Double Bind

Oy, there seems to be some confusion:

If ANY of you get the impression from this blog that schizophrenia is caused by family behavior, think again! That erroneous thinking was common in the sixties, family therapists, believe it or not, had perpetrated such nonsense with talk of the "double bind." Even I, who trained in the early 80's heard this kind of misinformation at the Family Institute of Chicago.

A double bind is a situation in which a person has to make a decision, but no matter what the choice, he loses. In a family context that person is the kid. The kid will either upset one parent or the other, or will somehow sacrifice himself. That behavior, that self-sacrifice, is the "schizophrenia."

For example, let's say, one parent says, I really, really want you to visit grandma after school. But the other says, Don't even think of visiting your grandmother after school. That's a double bind.

Family therapists, especially the Italian school in the sixties and seventies, proposed that double binds made children behave in ways that seemed "psychotic." The word they used, and it's a marvelous word, is


Schizophrenia, according to these docs, was caused by family dynamics.

NO, NO, NO. We're a lot smarter now. We're sure it's from a genetic predisposition. Pretty sure, that is. Schizophrenia often presents for the first time when a person with a genetic predisposition is under social stress or in an unusually stressful context, like academia, being away at college.

Sorry for the confusion if there was any.

copyright 2007, therapydoc


frumhouse said…
I suppose as long as misunderstanding about mental illness abound - acceptance for those who suffer will not happen. Thankfully, it seems that with more scientific research and compassion, those with mental illness will no longer be the outcasts they once were.

Nothing like blaming the family or the victim for a genetic condition!
frumhouse said…
Nothing like blaming the victim or the victim's family for a genetic condition! I am glad that modern science, and perhaps a bit of compassion is making the stigma of mental illness less in today's society.
therapydoc said…
Exactly. It seems so obvious that what docs should do is USE the family to help, rather than go on the offensive.
TAG said…
Thanks for your helpful words on forgetting things I wish I didn't know. I totally understand about not wanting to get into giving professional advice with less than a good clear understanding of the facts.

I too am a professional in a very technical field. Like you there seem to be endless questions from people wanting advice when I do not have all the needed information to provide a good advice.

More than anything else I guess my goal in sending the question was to prompt you to do a more general post on forgetting things you wish you didn't know.

Love the blog.

Keep up the good work.

therapydoc said…
Okay, TAG, I'll get on it. It might take a few weeks, though.
Anonymous said…
a double bind is a no win situation involving two people not three, mother says to son in angry voice "don't you know i love you?"
or "can't you do anything right?"
i am sure it contributes to mental illness.
therapydoc said…
That's true, but it's not an all or none situation. In other words, we're both right, as we say in this postmodern world. Thanks for your thought.
Anonymous said…
If you wish to make INFORMED comments on the double bind, you need to research it alot better than you have. The Double Bind Theory- still crazy Making After all these Years by Paul Gibney (2006) is a good place to start. Your explanation of the concept was totally incorrect and the truth of the matter is a hypothesis that has assisted in veiwing 'mental illness' in a less pathologising way. It doesnt exactly blame the family for a childs 'so called' dysfunction, it actually informs us that it is the way that we communicate (double bind being such a communication) can affect behaviour.
therapydoc said…
Sheesh, Anna, say it nice, and don't spleen someone on their own blog. I shouldn't have even published your comment. Such a tone.

And I never said the theory didn't inform us.

And we don't go by absolutes in the social sciences.
therapydoc said…
If you read the stuff I've posted about expressed emotion, primarily anger, then you see that I tell people to keep it down, keep all strong emotions under control around people who suffer from schizophrenia.

Expressed emotion triggers the anxiety that is the stuff of schizophrenic episodes.

A double bind triggers anxiety. So it may be related to episodes of schizophrenia.

This is not to say that the double bind is the cause of schizophrenia. There's a difference.
Anonymous said…
Apparently you share the views on schizophrenia likewise as the brain medication corporations do. Let me take a single example for you, there are over 20 diferent anti psychotic medications in the US alone. Still "brain researchers" appointed by the billion dollar brain medication firms still seems to not find a "cure". However- they seem to claim that there are disturbances in brain chemistry among for example schizophrenics. Examples of this are "dopamine" and "serotonin". If the key to curing/helping schizophrenia lies in the brain chemistry, then why are there as mentioned above- over 20 diferent anti-psychotics in the US alone....? And why do over 1/3 of those that are claimed schizophrenic on anti-psychotics experiencing no relief of symptoms? Many of them also get WORSE. There are also horrible side effects included in the anti psychotic medications. Do your homework, doc.
therapydoc said…
Dear Anonymous,
This wasn't a comprehensive treatment of the subject. Sorry if you didn't read me right. I don't always assume pharma will cure anything, nor do I believe we have a cure or are anywhere near a cure for schizophrenia.

And I'm quite aware of the horrible side-effects of medication, but thanks for reminding others.

If I were a betting person, I would bet that within the next ten years there will be more elegant treatments, maybe pharmacological, maybe lasers, or stem cells. Who knows?

All I'm saying is that the family interaction doesn't cause it, but stress, what we call expressed emotion, certainly can exacerbate symptom presentation. It does for everyone else, too.
Anonymous said…
The real question is how can they possibly prove that it is genetic? Have they found the schizophrenia gene yet? Beware big pharma propaganda. It is very double-binding. If I were a betting person I would bet on all the geniuses like Bateson and their wonderful emperical and scientific evidence that the family environment is virtually the sole source of the very healthy environment-adaptation that results in schizophrenia and many other so-called mental illnesses. Of course, if you drug a patient into a stupor the symptoms will go away (along with the symptoms of being a living organism).
therapydoc said…
If I recall, the brain imaging studies found differences in the brains of people with schizophrenia.No doubt you are correct, "crazy" family systems make people act "crazy." But just because it looks like schizophrenia, doesn't mean it is, and I think any good doc would know the difference. And you are right again, drug up folks and they quiet down. Very unethical, depending upon the disquiet.
cj said…

I was the last anonyomous only. By your comments, including your example which is not exemplar of the theory, it appears you never took the time to really look into the double bind theory. There has always been a tendency to grab a superficial concept of it and run off into wild permutations that are not it, even among researchers. The archetype Bateson-double-bind is very specific involving infant or toddler and mother (but often does involve other family members). Your example would never fulfill the criteria even if it were repeated every day for years.

I'm just saying we shouldn't abandon such a promising theory (or hypothesis) just because it is difficult to test and thus a rumour has got about that there is no evidence in its favour. To my knowledge there has been no definitive statement that schizophrenia is not caused by family behaviour. Actually a lot of work was done on it, volumes of data backing up the concept before Bateson et al. felt warranted in issuing a paper about it. A good place to start is the book by Sluzki and Ransom, Double Bind The Foundation.... contains what they considered the 22 most significant papers on the subject over a twenty-year period. I think my impulse to post was in the hopes that I might prevent anyone just beginning to look into the theory from being turned away from it by your comments. I encourage people to really delve into it. It is very mind-expanding consciousness-expanding and it may even lead to enlightenment. Alan Watts was involved with the research and has a paper in that book. It is much more interesting and inspiring than Dr. Spock and age-old, still unproved genetic theories of mental illness.

As one who has lived inside one of those double-bound, schizo-like minds for all of my sixty years of totally ruined life, I have always known for certain that it was never anything genetic nor psysiological. I am just a hermit now living in the remote bush with no plumbing or electricity, so I cannot do the research to continue a comprehensive discussion. I do see the world as in danger of being led astray by convincing but specious arguments in favour of the most profit-driven influences, who also have the clout to completely flood a respectible field with propaganda. I only discovered the double bind theory this year, and following its progress over its years, I can see a sort of insidious insertion of doubts and misdirection hounding it.

A theory like the double bind theory by its nature is very difficult to grasp. Any therapy based on it would require a lot of therapist skill and talent and insight. So people are prone to go for a much easier pseudo-'germ theory' sort of linear logic presented by the geneticists and pharmacists. The theory does not claim to identify such a completely isolable 'thing' that causes another 'thing' (schizophrenia). It is a far more systems-oriented, multidimensional, multi-level, and very interactive two-way or more-way phenomenon over time.

Anthropologist Gregory Bateson, whose father was the geneticist who coined the term 'genetics', himself admited the possibility of genetic disposition as possibly even an equally contributing factor, so we cannot say he was ignorant of it nor averse to the idea.
cj said…
In reply to your comments, it would be bad science to conclude that the observed brain differences may have caused schizophrenia and not give equal possibility that schizophrenia caused the brain changes. There is evidence, according to Bruce Lipton, for example, that DNA does not actively determine anything. Our cells do the selecting of which DNA to utilise. And they do this in response to their environment, which is influcenced (via peptides for one) by our habitual thoughts such as beliefs [or our thought-responses to consistently repeated double-bind situations]. He says our thoughts and beliefs therefore can change our DNA.

I did think of one body of data that may give you pause for thought: the Romanian Orphanage situation. Just a few tidbits from a study, not supporting the double bind theory, but supporting the concept that social factors far outweigh genetic predisposition, and maybe indeed "schizophrenia is caused by family behavior" which you refuted at the top of this page. A few excerpts from:

"...the team scanned the brains of 74 of the Bucharest children, now ages 8 to 11, using magnetic resonance imaging. What they found was striking: Brains of children who had remained in institutions had less white matter — the type of tissue that connects different regions of the brain — than orphans who were placed in foster care or children living with their own families. Reductions in white matter have been found in numerous neurological and psychiatric conditions, including autism, schizophrenia and ... ADHD.

The article concludes with: "Geschwind said. ... 'There's oodles and oodles of information and data that points to really clear and obvious policy implications: [The] kind of environment a child has from zero to 3 and 3 to 5 is fundamental to their[sic] future.' "

Sorry for the length, but my point is that these orphanages represent a sort of general-population genetic sample yet the observed effects were so widespread, or even universal as to preclude or overshadow any genetics.

It is now known that the brain is making up to a million synaptic connections per day from birth through third year, connecting and then disconnecting some, all according to the child's experiences and his responses and the responses to his responses, in a sort of trial-and-error transactive continuum. Double binds lock up the mind the way a computer locks up when given opposing commands. It follows that if the experience of the child is habituated to mind-locking, the synapses and neural circuits will reflect that. Eventually the activity and neuroplasticity lessens and the pattern becomes set for life. It becomes one's way of thinking about everything, or rather not being able to think about anything.

There are some absolutely brilliant articles and work still being done on double bind theory, such as an article in Scholar and Feminist magazine:


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