The three books I will be referring to here are variations from single insider accounts by people with schizophrenia. “Two Accounts of a Journey through Madness” (1971) combines Mary Barnes’s reflections on her schizophrenia and her therapist, Joe Burke’s account of his experience with Mary. “A Mingled Yarn” (1972) is Psychiatrist Beulah Parker’s reporting of a family with a person with schizophrenia, based largely on one of the family member’s account. “Is There No Place on Earth for Me” (1982) is reporter, Susan Sheehan’s account of the life of Maxine Mason (pseudonym Sylvia Frumpkin) and her struggles with schizophrenia.
In “Two Accounts”, Mary Barnes describes her “madness” in one of the clearest and most insightful reflections I’ve encountered:
“Much of me was twisted and buried, and turned in upon itself, as a tangled skein of wool, to which the end had been lost. The big muddle started before I was born. It went on, getting worse. My mother and I battled with feelings. My father was in it; then my brother barged in. My two sisters came and the mess got bigger. When I was grown up in years, I got a vague idea there was a big split in me between my head and my heart. I seemed to go around thinking big thoughts in my head quite cut off from the life in my heart.” (p.3)
She later describes some the family dynamics which may have played a role in her illness:
“Life was like ice, brittle ice. The whole family wanted this ice to melt, wanted to be loved. But we feared if the ice broke we would all be drowned. Violence and anger lurked beneath the pleasantries. On the surface we were a kind family. Physically we were well cared for, good food, lots of milk, fruit and ages, clean clothes and a big enough house. Deep down we were torn up with hatered and strife, destroying, killing each other” (p.5)
Mary survived multiple hospital stays and treatments of the era in Britain, but her long association with Kingsley Hall, which R.D. Laing inaugurated and with psychiatrist Joe Berke, who worked at Kingley Hall, an alternative communal living treatment center for people with schizophrenia in London, helped to transform her. She later became a famous artist.
Joe Berke describes when he first met Mary:
“Although trained as a nurse and later as a teacher of nurses, Mary eventually took up a second career as a hospitalized schizophrenic. Specifically because she wished to give up both professions, and come to terms with herself as a woman, she eventually created the situation by which we met, and I assisted her project of emotional disruption and resurrection.” (p.75) In a subtle way this statement illustrates the shift in approach toward a person with mental illness from a psychiatrist. Joe expresses his support for Mary’s “project” of healing herself.
Joe Berke later comments on his experience with families of schizophrenics and double binding: “In all cases where one or more family members had been labelled schizophrenic a unique pattern of communication could be made out. People did not talk to each other, but at each other, and tangentially, not directly. There was a continual shifting of position. Parents seemed impervious to the point of view of their children and vice-versa. One particular feature of such families and an essential weapon in the hands of parents bent on destroying the autonomy of their kids (and later vice versa) is known as double binding. Double binding is a means of putting another in a strait jacket of guilt and anxiety in order to prevent him from doing something you have already told him it is OK to do. It is a marvellous tool for driving someone mad.”(84).
I interviewed Joe Berke in 1993 in London and went with him to one of his Arbors Centers to interview some of the “guests” – patients with schizophrenia who live in a home community with ongoing therapist presence. Both Joe and the guests I interviewed claimed that the supportive and non-judgmental home community environment of Arbors, which was modeled after some of R.D. Laing’s ideas and Kinglsley Hall, was critical in their overcoming the symptoms of schizophrenia and the effects of their previous hospitalizations and medications.
Psychiatrist Bulah Parker chronicled a California family, the Carpenters, in “A Mingled Yarn, published in 1972, a year after “Two Accounts”. Eliot Carpenter had schizophrenia and his sister, Amy, who became a psychologist, acted as the insider for Parker’s account. Dr. Parker was influenced, as was Joe Berke, by the current double bind interpretations of family dynamics.
“The conflicting directives of his parents placed Eliot Junior in a double bind; pleasing one parent would lead to rejection by the other. Conflicting directives caused him to develop a split personality.” (xii) “There is now considerable evidence that persons will not become schizophrenic unless communication within the family is disturbed or distorted, though they may suffer from other serious psychopathological conditions. We have already noted how Eliot Junior was placed in a double bind that led to a divided self.”(xiv). I suspect that Dr. Parker was influenced by both Bateson and Laing.
Susan Sheehan’s book about “Sylvia Frumpkin” (Maxine Mason) is a great example of a reporter-cum-ethnographer capturing the internal and external life of a woman with schizophrenia. From the book jacket of “Is There No Place for Me?”(1982):
“Sylvia Frumpkin was born in 1948 and began showing signs of schizophrenia in her teens. She spent the next seventeen years in and out of mental institutions.In 1978, reporter Susan Sheehan took an interest her and for more than two years, became immersed in her life: talking with her, listening to her monologues, sitting in on consultations with doctors – even , for a period, sleeping in the bed next to her in a psychiatric center. With Sheehan, we become witness to Sylvia’s plight: her psychotic episodes, the medical struggle to control her symptoms, and the overburdened hospitals that, more often than not, she was obliged to call home.”
By the 1980s some thinking within the psychiatric world may have begun moving more toward a genetic and bio-chemical understanding and away from a strictly family dynamic explanation for possible causes of schizophrenia. Robert Coles wrote the Introduction to Sheehan’s book and has this to say:
“No one knows how it comes about that Sylvia Frumpkin has the kind of life we find chronicled in this book. Genes matter, some scientists say. Family life is important, others insist. Early childhood experiences count heavily, a number of doctors emphasize. But there is still plenty of room, one suspects, for speculation and research, room even for words such as ‘luck’,’chance’,’destiny’. Why, one wonders, this person and not that one? It is clear that many who seem to have everything against them genetically and environmentally seem to come out reasonably well psychologically, while others, with everything seemingly going in their favor, end up with exceedingly vulnerable, even fragile minds.” (p.xiii).
I believe that Coles’s statement may sum up my own current view and it may highlight the difficulty with coming to any conclusions about the etiology and management of schizophrenia. It is instructive, however, to review the available “insider” accounts over time. We may still hope for some breakthroughs in understanding this illness and in how to treat the debilitating symptoms.