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Some Family Operations and Schizophrenia: A Study of Five Hospitalized Families Each with a Schizophrenic Member

Some Family Operations and Schizophrenia: A Study of Five Hospitalized Families Each with a... Abstract The Family Study Project This paper arises out of the work of the Family Study Project. This project is unique in bringing family units into the hospital for study and treatment. Five families have lived in the hospital for periods of six months to two and one-half years. The two initial families each consisted of a mother and her daughter, the father having left the home. Two later families have included the mother, father, and two siblings, and one has consisted of the father, mother, and one sibling.†Efforts have been made to allow the families as much privacy as possible. Each family has one or two hotel-like rooms for sleeping and private quarters. Recording has been limited to the therapy hours, family interactions in the common rooms—the halls, dining rooms, kitchen, occupational therapy room, and TV room—and such interactions in the families’ private quarters References 1. The shift in focus can be distressing. A similar shift would be from a focus on automobiles to a focus on traffic. 2. The term “stand-in” is used in terms of the staff members overinvolved but is considered usable to describe others involved in the way described. 3. Physical battle among family members has at times ensued, with staff members joining to prevent injury. 4. Visitors and staff alike frequently respond profoundly, though their intent is to remain objective. 5. There are, of course, multiple sources of this tension. The manifest aspects of some will be described. 6. Jack, too, related to his parents in terms of this conflict. 7. Further described in the section “Abandonment and the Loss of Contact.” 8. During one family therapy meeting, the normal sibling of the Baker family told of confiding her heartaches to father during their “father-daughter conferences.” “Jack was only close to mother,” she went on, “Mother told Jack of all her difficulties with father.” Mother replied defensively: “I had to tell someone.” The sister concluded: “Jack is sick because he had no one to relate to.” 9. As previously noted, it is observed that these restrictions need not apply to individual relationships outside the family. 10. Mrs. Crompton was aware that her baby did not burp as she expected. She concluded “logically” then that the baby “must be full of gas.” It was this lack of symmetry with mother’s expectation that became the focus of mother’s own hypochondriacal fears for “the baby’s welfare.” This lack of symmetry was also the basis of Mrs. Crompton’s diagnosis that the child was sick. 11. Mrs. Baker had successfully maintained her amorphous and helpless position, which was noted in the earlier example. 12. It can be seen that the symptomatology is not confined to this member. 13. The family members are aware of these maneuverings only as being to help the other. The parental dispute is couched in terms of disagreement as to the best way of helping the son (cf. the Ellicot family). 14. That one needs to operate so exclusively in terms of one’s own uniqueness is considered an important part of the fiction induced through the countertransference response. 15. When the family mythology is threatened, Mrs. Baker acts quickly to reinforce its preservation. 16. The term child is used to refer to the person in the “child” role. The term mother as well refers to the person in the “mother” role. The father is considered to share in the mechanisms highlighted in the mother-child model. His special position is discussed in other papers of the study.5 17. The development of the crisis noted is analogous to the scream in an electronic system which the public speaker learns to avoid. This occurs when the microphone and the loud speaker, both set for the same frequency, face each other and pick up and reproduce each other’s sounds in phase. 18. This issue is expressed by the pediatrician, who “wishes he could give the sedative to the mother instead of the child.” 19. It is considered that salient features of the families studied are to be observed through the determination of what is absent, as well as the examination of what is present. 20. The network of pseudorationalisms accepted in awareness by the family as reality has been called the family mythology. This mythology comes to have reality if one accepts the omissions (for example, of time). The structural aspects of this mythology are considered to convey a message in accord with the actual behavior.2 21. The term anxiety is used to refer to bound, as well as free-floating, anxiety. 22. It has been observed that the mother’s effort to retreat from overcloseness is usually accomplished by encasing herself in isolating distance. There seems to be no middle ground. 23. In each of the family members the omission from awareness of relationships is striking. This seems to be related to a difficulty in obtaining distance and regarding self. It is noted that during the phase of distance mother’s thoughts remain explicitly attached to ruminations about this distance and the other person’s part in it. This lack of self-awareness is in marked contrast to the capacity to comprehend the intimate (though not the surface) workings of others. 24. No effort is made in this presentation to discuss the new situations that work to reduce the predicament, though these are equally significant. 25. This type of experience is reported with regularity. 26. It is noteworthy that in the family one of the impinging realities commonly omitted is a sense of developing time. The sickly child remains the sickly one, even though the illness is long past. It is often difficult to realize that the strapping son is the sickly one. On the other hand, the incidence of appropriate illness at the psychologically appropriate time is equally remarkable. One son’s Eustachian tube was treated with many insufflations and probings and became, indeed, closed and infected. One could, with equal accuracy state: This son’s Eustachian tube became infected and closed and was then treated with many insufflations and probings. Hearing was prior to his birth, and subsequently remained, a major theme in whole family predicament. 27. It has been noted that the parents, in their denial of inner self, deny in consciousness an inner motivation. I have never heard one of the parents state: “I did this for me because I wanted to.” An inner self which, without thinking, determines preference is omitted from consciousness. There must always be an external rational reason. The kind of statement epitomized in the words, “I did it, I don’t know why, but I wanted to; it caused no difficulty,” is ego-alien. Socially acceptable irrationality and inner-determind preference are denied self and considered psychotic. 28. The term pseudoidentity is used to refer to primitive oral incorporation of projected aspects of the parents, which, remaining unfused and unintegrated, may later be disgorged to be embodied in the voices of a hallucination. 29. This symbiotic stage is considered normally to be in the foreground until the second to the fifth month of the first year.1 30. This helplessness-omnipotence is considered significant, not by its qualitative presence but by its quantitative pervasiveness within the character structure of the parents, as revealed in the observed family interactions. 31. The parents’ lack of recognition of the symptomatology is not surprising within the framework presented. 32. The use of a word as a magical entity is observed as common defense measure, which is significantly used in the structure of the family mythology. 33. One of the mothers whose daughter had always taken the infantile role did become psychotic. Her daughter then joined with her in her symptomatology and in demanding the staff to take stand-in roles. 34. At one point she took on the helpless role but managed this in terms of proceeding with an elective operation. 35. For example, the parents’ fantasies about loosing control of self are being reinforced by the active loosing of control by the symptomatic member. Their energy and attention then are turned toward the now necessary controlling of the symptomatic one. 36. Ackerman, N. W., and Behrens, M. L.: A Study of Family Diagnosis , Am. J. Orthopsychiat. 26:66-78 ( (Jan.) ) 1956.Crossref 37. Bateson, G.; Jackson, D.; Haley, J., and Weakland, J.: Toward a Theory of Schizophrenia , Behavioral Sc. 1:251-264 ( (Oct.) ) 1956.Crossref 38. Bowen, M.; Dysinger, R. H., and Brodey, W. M.. and Basamania, B.: Study and Treatment of 5 Hospitalized Family Groups Each with a Psychotic Member, read in the sessions in Current Familial Studies at the annual meeting of the American Orthopsychiatric Association, Chicago, March 8, 1957. 39. Bowen, M.: Family Participation in Schizophrenia, presented at the annual meeting of the American Psychiatric Association, Chicago, May 15, 1957. 40. Bowen, M.; Dysinger, R. H., and Basamania, B.: Role of the Father in Families with a Schizophrenic Patient , Am. J. Psychiat. 115:1017-1021 ( (May) ) 1959. 41. Bowen, M.: A Family Concept of Schizophrenia, in Studies in Schizophrenia, edited by Don Jackson, New York, Basic Books, Inc., to be published. 42. Brodey, W., and Hayden, M.: Intrateam Reactions: Their Relation to the Conflicts of the Family in Treatment , Am. J. Orthopsychiat. 27:349-355 ( (April) ) 1957.Crossref 43. Dysinger, R. H.: The “Action Dialogue” in an Intense Relationship: A Study of a Schizophrenic Girl and Her Mother, presented at the annual meeting of the American Psychiatric Association, Chicago, May 15, 1957. 44. Dysinger, R.: A Study of Relationship Changes Before Onset of Abruptly Beginning Schizophrenic Psychosis, unpublished material. 45. Fleck, S.; Cornelison, A. R.; Norton, N., and Lidz, T.: Intrafamilial Environment of Schizophrenic Patient: Interaction Between Hospital Staff and Families , Psychiatry 20:343-350 ( (Nov.) ) 1957. 46. Freud, S.: On Narcissism: An Introduction , in Collected Papers , Vol. IV, London, International Psycho-Analytical Press, 1925. 47. Fleck, S.; Freedman, D. X.; Cornelison, A.; Terry, D., and Lidz, T.: Intrafamilial Environment of the Schizophrenic Patient: V. The Understanding of Symptomatology Through the Study of Family Interaction, read at the annual meeting of the American Psychiatric Association, May, 1957. 48. Heisenberg, W.: Philosophic Problems of Nuclear Science , New York, Pantheon Books, 1952. 49. Jones, M.: The Therapeutic Community: A New Treatment Method in Psychiatry , New York, Basic Books, Inc., 1953. 50. Lidz, R. W., and Lidz, T.: The Family Environment of Schizophrenic Patients , Am. J. Psychiat. 106:332-345 (Nov.) 1949. 51. Lidz, T.; Parker, B., and Cornelison, A.: The Role of the Father in the Family Environment of the Schizophrenic Patient , Am. J. Psychiat. 113:126-132 ( (Aug.) ) 1956. 52. Parker, S.: Role Theory and the Treatment of the Anti-Social Acting Out Disorders , Brit. J. Delinquency 8:285-300, 1957. 53. Saint-Exupéry, A.: The Little Prince , New York, Harcourt, Brace & Company, Inc., 1943. 54. Wynne, L.; Ryckoff, I.; Day, J., and Hirsch, S.: Pseudo-Mutuality in the Family Relations of Schizophrenics , Psychiatry 21:205-220 ( (May) ) 1958. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png A.M.A. Archives of General Psychiatry American Medical Association

Some Family Operations and Schizophrenia: A Study of Five Hospitalized Families Each with a Schizophrenic Member

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References (15)

Publisher
American Medical Association
Copyright
Copyright © 1959 American Medical Association. All Rights Reserved.
ISSN
0375-8532
DOI
10.1001/archpsyc.1959.03590040049005
Publisher site
See Article on Publisher Site

Abstract

Abstract The Family Study Project This paper arises out of the work of the Family Study Project. This project is unique in bringing family units into the hospital for study and treatment. Five families have lived in the hospital for periods of six months to two and one-half years. The two initial families each consisted of a mother and her daughter, the father having left the home. Two later families have included the mother, father, and two siblings, and one has consisted of the father, mother, and one sibling.†Efforts have been made to allow the families as much privacy as possible. Each family has one or two hotel-like rooms for sleeping and private quarters. Recording has been limited to the therapy hours, family interactions in the common rooms—the halls, dining rooms, kitchen, occupational therapy room, and TV room—and such interactions in the families’ private quarters References 1. The shift in focus can be distressing. A similar shift would be from a focus on automobiles to a focus on traffic. 2. The term “stand-in” is used in terms of the staff members overinvolved but is considered usable to describe others involved in the way described. 3. Physical battle among family members has at times ensued, with staff members joining to prevent injury. 4. Visitors and staff alike frequently respond profoundly, though their intent is to remain objective. 5. There are, of course, multiple sources of this tension. The manifest aspects of some will be described. 6. Jack, too, related to his parents in terms of this conflict. 7. Further described in the section “Abandonment and the Loss of Contact.” 8. During one family therapy meeting, the normal sibling of the Baker family told of confiding her heartaches to father during their “father-daughter conferences.” “Jack was only close to mother,” she went on, “Mother told Jack of all her difficulties with father.” Mother replied defensively: “I had to tell someone.” The sister concluded: “Jack is sick because he had no one to relate to.” 9. As previously noted, it is observed that these restrictions need not apply to individual relationships outside the family. 10. Mrs. Crompton was aware that her baby did not burp as she expected. She concluded “logically” then that the baby “must be full of gas.” It was this lack of symmetry with mother’s expectation that became the focus of mother’s own hypochondriacal fears for “the baby’s welfare.” This lack of symmetry was also the basis of Mrs. Crompton’s diagnosis that the child was sick. 11. Mrs. Baker had successfully maintained her amorphous and helpless position, which was noted in the earlier example. 12. It can be seen that the symptomatology is not confined to this member. 13. The family members are aware of these maneuverings only as being to help the other. The parental dispute is couched in terms of disagreement as to the best way of helping the son (cf. the Ellicot family). 14. That one needs to operate so exclusively in terms of one’s own uniqueness is considered an important part of the fiction induced through the countertransference response. 15. When the family mythology is threatened, Mrs. Baker acts quickly to reinforce its preservation. 16. The term child is used to refer to the person in the “child” role. The term mother as well refers to the person in the “mother” role. The father is considered to share in the mechanisms highlighted in the mother-child model. His special position is discussed in other papers of the study.5 17. The development of the crisis noted is analogous to the scream in an electronic system which the public speaker learns to avoid. This occurs when the microphone and the loud speaker, both set for the same frequency, face each other and pick up and reproduce each other’s sounds in phase. 18. This issue is expressed by the pediatrician, who “wishes he could give the sedative to the mother instead of the child.” 19. It is considered that salient features of the families studied are to be observed through the determination of what is absent, as well as the examination of what is present. 20. The network of pseudorationalisms accepted in awareness by the family as reality has been called the family mythology. This mythology comes to have reality if one accepts the omissions (for example, of time). The structural aspects of this mythology are considered to convey a message in accord with the actual behavior.2 21. The term anxiety is used to refer to bound, as well as free-floating, anxiety. 22. It has been observed that the mother’s effort to retreat from overcloseness is usually accomplished by encasing herself in isolating distance. There seems to be no middle ground. 23. In each of the family members the omission from awareness of relationships is striking. This seems to be related to a difficulty in obtaining distance and regarding self. It is noted that during the phase of distance mother’s thoughts remain explicitly attached to ruminations about this distance and the other person’s part in it. This lack of self-awareness is in marked contrast to the capacity to comprehend the intimate (though not the surface) workings of others. 24. No effort is made in this presentation to discuss the new situations that work to reduce the predicament, though these are equally significant. 25. This type of experience is reported with regularity. 26. It is noteworthy that in the family one of the impinging realities commonly omitted is a sense of developing time. The sickly child remains the sickly one, even though the illness is long past. It is often difficult to realize that the strapping son is the sickly one. On the other hand, the incidence of appropriate illness at the psychologically appropriate time is equally remarkable. One son’s Eustachian tube was treated with many insufflations and probings and became, indeed, closed and infected. One could, with equal accuracy state: This son’s Eustachian tube became infected and closed and was then treated with many insufflations and probings. Hearing was prior to his birth, and subsequently remained, a major theme in whole family predicament. 27. It has been noted that the parents, in their denial of inner self, deny in consciousness an inner motivation. I have never heard one of the parents state: “I did this for me because I wanted to.” An inner self which, without thinking, determines preference is omitted from consciousness. There must always be an external rational reason. The kind of statement epitomized in the words, “I did it, I don’t know why, but I wanted to; it caused no difficulty,” is ego-alien. Socially acceptable irrationality and inner-determind preference are denied self and considered psychotic. 28. The term pseudoidentity is used to refer to primitive oral incorporation of projected aspects of the parents, which, remaining unfused and unintegrated, may later be disgorged to be embodied in the voices of a hallucination. 29. This symbiotic stage is considered normally to be in the foreground until the second to the fifth month of the first year.1 30. This helplessness-omnipotence is considered significant, not by its qualitative presence but by its quantitative pervasiveness within the character structure of the parents, as revealed in the observed family interactions. 31. The parents’ lack of recognition of the symptomatology is not surprising within the framework presented. 32. The use of a word as a magical entity is observed as common defense measure, which is significantly used in the structure of the family mythology. 33. One of the mothers whose daughter had always taken the infantile role did become psychotic. Her daughter then joined with her in her symptomatology and in demanding the staff to take stand-in roles. 34. At one point she took on the helpless role but managed this in terms of proceeding with an elective operation. 35. For example, the parents’ fantasies about loosing control of self are being reinforced by the active loosing of control by the symptomatic member. Their energy and attention then are turned toward the now necessary controlling of the symptomatic one. 36. Ackerman, N. W., and Behrens, M. L.: A Study of Family Diagnosis , Am. J. Orthopsychiat. 26:66-78 ( (Jan.) ) 1956.Crossref 37. Bateson, G.; Jackson, D.; Haley, J., and Weakland, J.: Toward a Theory of Schizophrenia , Behavioral Sc. 1:251-264 ( (Oct.) ) 1956.Crossref 38. Bowen, M.; Dysinger, R. H., and Brodey, W. M.. and Basamania, B.: Study and Treatment of 5 Hospitalized Family Groups Each with a Psychotic Member, read in the sessions in Current Familial Studies at the annual meeting of the American Orthopsychiatric Association, Chicago, March 8, 1957. 39. Bowen, M.: Family Participation in Schizophrenia, presented at the annual meeting of the American Psychiatric Association, Chicago, May 15, 1957. 40. Bowen, M.; Dysinger, R. H., and Basamania, B.: Role of the Father in Families with a Schizophrenic Patient , Am. J. Psychiat. 115:1017-1021 ( (May) ) 1959. 41. Bowen, M.: A Family Concept of Schizophrenia, in Studies in Schizophrenia, edited by Don Jackson, New York, Basic Books, Inc., to be published. 42. Brodey, W., and Hayden, M.: Intrateam Reactions: Their Relation to the Conflicts of the Family in Treatment , Am. J. Orthopsychiat. 27:349-355 ( (April) ) 1957.Crossref 43. Dysinger, R. H.: The “Action Dialogue” in an Intense Relationship: A Study of a Schizophrenic Girl and Her Mother, presented at the annual meeting of the American Psychiatric Association, Chicago, May 15, 1957. 44. Dysinger, R.: A Study of Relationship Changes Before Onset of Abruptly Beginning Schizophrenic Psychosis, unpublished material. 45. Fleck, S.; Cornelison, A. R.; Norton, N., and Lidz, T.: Intrafamilial Environment of Schizophrenic Patient: Interaction Between Hospital Staff and Families , Psychiatry 20:343-350 ( (Nov.) ) 1957. 46. Freud, S.: On Narcissism: An Introduction , in Collected Papers , Vol. IV, London, International Psycho-Analytical Press, 1925. 47. Fleck, S.; Freedman, D. X.; Cornelison, A.; Terry, D., and Lidz, T.: Intrafamilial Environment of the Schizophrenic Patient: V. The Understanding of Symptomatology Through the Study of Family Interaction, read at the annual meeting of the American Psychiatric Association, May, 1957. 48. Heisenberg, W.: Philosophic Problems of Nuclear Science , New York, Pantheon Books, 1952. 49. Jones, M.: The Therapeutic Community: A New Treatment Method in Psychiatry , New York, Basic Books, Inc., 1953. 50. Lidz, R. W., and Lidz, T.: The Family Environment of Schizophrenic Patients , Am. J. Psychiat. 106:332-345 (Nov.) 1949. 51. Lidz, T.; Parker, B., and Cornelison, A.: The Role of the Father in the Family Environment of the Schizophrenic Patient , Am. J. Psychiat. 113:126-132 ( (Aug.) ) 1956. 52. Parker, S.: Role Theory and the Treatment of the Anti-Social Acting Out Disorders , Brit. J. Delinquency 8:285-300, 1957. 53. Saint-Exupéry, A.: The Little Prince , New York, Harcourt, Brace & Company, Inc., 1943. 54. Wynne, L.; Ryckoff, I.; Day, J., and Hirsch, S.: Pseudo-Mutuality in the Family Relations of Schizophrenics , Psychiatry 21:205-220 ( (May) ) 1958.

Journal

A.M.A. Archives of General PsychiatryAmerican Medical Association

Published: Oct 1, 1959

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