Friday, May 04, 2007

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.

anna 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.