Month: May 2019

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.

Gregory Bateson’s idea about double binds began with the work he, Don Jackson, Jay Haley, and John Weakland ( the “Palo Alto” group) did from 1952 to 1954, and published as an essay, “Toward a Theory of Schizophrenia” (p.201) in Bateson’s “Steps to an Ecology of Mind” (1972). His later thinking about the notion of double binds went well beyond the early research focus on family relations with schizophrenic patients. For the purposes of this blog, I will comment only on the application of the double bind theory to the family dynamics of schizophrenic patients as represented in the original Palo Alto group research and a follow-up paper given by Bateson in 1969 at a Symposium on the Double Bind and included as an essay, “Double Bind 1969″(p.271) in “Steps”.

An example from the original research, which has been most often cited, and which best describes the double bind conflict for a schizophrenic patient is given on page 217 in “Steps”:

“An analysis of an incident occurring between a schizophrenic patient and his mother illustrates the double bind situation. A young man who had fairly well recovered from an acute schizophrenic episode was visited in the hospital by his mother. He was glad to see her and impulsively put his arm around her shoulders, whereupon she stiffened. He withdrew his arm and she asked, ‘don’t you love me anymore?’. He then blushed, and she said. ‘Dear, you must not be so easily embarrassed and afraid of your feelings.’ The patient was able to stay with her only a few minutes more and following her departure he assaulted an aide and was put in the tubs.”

This example illustrates the bind that the patient has been put into by his mother’s contradictory messages. She both invites his emotional expression and rejects it. He is caught and does not have an obvious way out of the conflict. Bateson and the rest of the Palo Alto group found similar conflicting messages among other families of schizophrenic patients and their research helped inform the family therapy and family systems movement about communications within families which may be a contributory cause of mental illness.

While we still know very little about schizophrenia and its possible causes, there was far less known in the 1950s/1960s. We need to keep this in mind when judging the assumptions made from the research findings of the Palo Alto group. One assumption Bateson and others made was that the dynamic of the double bind could almost by itself ( though they did acknowledge possible genetic and bio-chemical influences) set up the conditions for a schizophrenic break. We now know there are some genetic and biochemical components to any schizophrenic syndrome. I believe that most psychiatrists do not acknowledge the possibility that double bind conflicts could also contribute to schizophrenic episodes. Double bind conflicts can also contribute to other mental and emotional disturbances and family therapists know this. It is likely that schizophrenia is caused by some aspects of social-interpersonal dynamics along with genetic tendencies. The posts I made on the memoirs of Esme Weijun Wang and Elyn Saks would support this point. Both women have managed their schizophrenia with a combination of anti-psychotic medications and psychotherapy. Another assumption made by Bateson and others was that the essential conflict in a double bind familial situation was between a mother and her son or daughter. This was also part of a period of blaming the mother for all sorts of deficiencies and illnesses. Leo Kanner’s notion of the “refrigerator mother” which implied that a cold and rigid mother may have caused children to become autistic was part of this period. Kanner asserted this in a 1949 paper, “Problems of Nosology and Psychodynamics of Early Infantile Autism” and Bruno Bettelheim, an influential child psychiatrist, later reinforced this idea in his 1967 book, “The Empty Fortress: Infantile Autisim and the Birth of the Self”. By 1969, however, the refrigerator mother notion was already being discredited. Kanner, himself, stated at a conference at the National Society for Autistic Children, that the condition of autism was innate.

Mary Catherine Bateson, Gregory’s daughter, has a chapter, “The Double Bind: Pathology and Creativity” in “Cybernetics and Human Knowing”, Volume 12, No. 1-2, 2005, in which she explains how the double bind theory goes beyond the focus on pathology that marked the original research with schizophrenics, but she also comments on Gregory’s original insights about the “language” of schizophrenics:

“I can remember listening with Gregory to tapes of ‘schizophrenic word salad’ as he commented that there was a structure to this seemingly chaotic rant. Not to put too fine a point on it, he said, ‘there’s a method in his madness’. Gregory came to the conclusion that at the root of schizophrenia there was a logical incoherence, a disruption in thought and communication, that could be seen as either caused or exacerbated by patterns of relationship in the families of schizophrenics. These patterns were referred to as the double bind.” (p.12)

Whether family dynamics or other external influences play a role in the etiology of schizophrenia or not, the double bind theory has influenced family therapists, psychotherapists and psychiatrists to some extent until the present. And while we are currently in a biomedical period, it may be worth considering how family dynamics may contribute to various mental and emotional issues.