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Monday, November 19, 2007

2 Myths that Haunt Me From the Past about Mental Illness and Schizophrenia

When I started to study Medicine to become a psychiatrist, yes I am one of those, at the end of the seventies I still witnessed the remains of the antipsychiatry. I remember how the books by Thomas Sasz were still read by some psychiatrists.

More alarming is the realization that when I started to work in psychiatry the nonsense of double bind relationships between mother and the child with Schizophrenia as a cause of the illness was still at it's peak. I tell this to my students in order to place our modern hypothesis into perspective.

Even I at this young age have witnessed a huge transformation in psychiatry. I look back a little ashamed because I think that looking back at these two "myths", as I would call them now, they were not that harmless.
Other developments of the past are still usable no matter how you think about them, they didn't cause that much harm, such as psychoanalysis.

1. The Myth of Mental Illness. Thomas Szasz, a seminal text from 1960, prior to the publication of his well-known book with the same name.

The notion of mental illness thus serves mainly to obscure the everyday fact that life for most people is a continuous struggle, not for biological survival, but for a "place in the sun," "peace of mind," or some other human value.

This text and his following book The Myth of Mental Illness: Foundations of a Theory of Personal Conduct was highly influential in the anti-psychiatry movement. In it, Szasz argues that mental illness is a social construct created by doctors, and the term can only be used as a metaphor given that an illness must be an objectively demonstrable biological pathology, whereas psychiatric disorders meet none of these criteria.

2. Double Bind as cause for Schizophrenia
In 1967 a team of researchers published the results of their further investigation of the double bind. They proposed that the operational component of the double bind is its pattern of disqualification -- the means by which one person's experience is invalidated as a result of the imposed bind. They cited five methods for disqualifying the previous communication. Evasion or a change of subject is the first method of disqualification. If the previous statement (a) does not clearly end a topic of discussion, and the next statement (b) does not acknowledge the switch in topic, then the second statement disqualifies the first statement:

a. Son: Can we go to the park and play soccer?

b. Father: What a beautiful day for working in the garden.

The second method of disqualification is sleight-of-hand. Sleight-of-hand occurs when the second response (b) answers the first (a) but changes the content of the previous statement:

a. Daughter: We have always gotten along well.

b. Mother: Yes, I've always loved you. . .

In the above example, the mother has responded to her daughter but has switched the issue from getting along well to love.

Literalization, the third type of disqualification, occurs when the content of the previous statement (a) is switched to a literal level in the second statement (b) with no acknowledgment of the change of frame:

a. Son: You treat me like a child.

b. Father: But you are my child.

The fourth method, status disqualification, happens when a person uses either personal status or superior knowledge to imply that the previous message is not valid:

a. Mother: I have observed that he doesn't play very well with the other children.

b. Son: But I do, Mama!

a. Mother: He doesn't realize because he is so little . . .

Redundant questions are used to imply doubt or disagreement without openly stating it:

a. Daughter: I get along well with everybody.

b. Mother: With everybody, Cathy?


therapydoc said...

Oh, oh, oh. WHAT A GREAT POST! Thanks, well done. Bottom line is parents like these don't "get" parenting at all, and they're probably not all that nice to people their own age, either.

Dr. Shock said...

Yes, and they really did think it caused Schizophrenia.

Lara said...

Knowing this post is practically a year old, I'm not sure if you can still respond, but here goes:

Why did they believe that? Was it because they observed that MOST schizophrenics had relationships with their primary caregivers which involved these kinds of conflicts, or was it because when they observed schizophrenics experiencing these kinds of conflicting messages they observed more psychosis in the patient as a result of the anxiety and felt the anxiety that the double bind created was a causal factor?

Dr. Shock said...

What they observed were anxious parents. They mistook this for the origin of the problem while it was just a consequence of having to care for a severe ill child.
Every parent with a psychotic child is scared, worried. They mixed up cause and effect.
Regards Dr Shock

Lara said...

Thanks so much for responding!

I'm sorry that I'm still not clear on how they inferred anxious parents caused the psychosis their children were experiencing, and how they connected it to 'double bind' communication. I'm trying to understand how they made this link from dysfunctional communication patterns to manifest psychosis as it seems rather a large stretch. Was it that the anixiety ridden parents send more 'double bind' signals, or was it based on one simple observation of conflicting signals between a mother and her schizophrenic son?

I'm curious as searches on 'double bind' communication bring up more references to schizophrenia than to models of family dysfunction.

Thanks again for your response and the clarity you have on the many issues you discuss in your blog.

PS - Great blog!