The origins of schizophrenia

  This controversy has raged most fiercely over the origins of schizophrenia. Schizophrenia had always been known to run in families and it had been observed that these families could seem ‘odd’ (eccentric or withdrawn), often with strained or intensely over-involved relationships. As schizophrenia is a disorder expressed in thinking and relating there is an obvious possible link between it and early upbringing. Family life is, after all, conducted through thinking and relating and aims to equip the growing child with skills in these areas. As psychoanalytical thinking was applied to schizophrenia (something that Freud explicitly avoided) a number of theories were proposed, some of which had enormous influence and have entered the language.

The ‘schizophrenogenic mother’

  The most notorious (and probably the most damaging) of these was that of the cold, hostile, and yet controlling parent – the ‘schizophrenogenic mother’ (literally ‘schizophrenia-causing mother’). This was proposed by the analyst Frieda FrommReichmann who, along with Harry Stack Sullivan, engaged in long-term intensive psychoanalysis with hospitalized schizophrenia patients in the USA. Her most famous patient, Joanna Greenberg, later described her experiences in her best-selling autobiographical novel I Never Promised You a Rose-Garden.

  Fromm-Reichmann described a powerful, but cold and rejecting mother figure who bound the patient close to her, preventing the growth of healthy independence and sense of self. Schizophrenia was then understood as a disorder of ‘ego-development’ resulting in weak personal boundaries (hence the confusion of internal and external experiences in hallucinations). Fromm-Reichmann’s conclusions are preposterous by current standards. She based them entirely on her patients’ reports in analysis and never actually bothered to meet or interview the mothers. It is reputed that her ideas derived from the analysis of only 11 patients. Despite its early rejection within the profession, the conviction lives on that families can ‘cause’ schizophrenia. This has led to endless self-blame by parents and, in some circumstances, their rejection and exclusion by mental health staff.

The ‘double-bind’

  The anthropologist Gregory Bateson proposed that persistent, logically faulty, and contradictory communication with a child prevented it forming a proper sense of itself and its relationships to the external world. Bateson was influenced by Bertrand Russell and A. N. Whitehead’s mathematical writings. One of their proposals was that the number which designated a series of numbers could not itself be a member of that series – as the designating number was of a ‘logically different order’. Bateson said that there were similarly logically different levels of communication and that we sent messages to each other (often in an oblique manner) where one part of the message indicated how the main part should be understood. He called these oblique messages ‘meta-communications’ (i.e. communications about communication). Typically meta-communications were emotional and non-verbal and became family assumptions (e.g. ‘mother can only love her children and always feel positive about them’).

  Bateson called it a double-bind when the non-verbal message and verbal message contradicted each other (e.g. an obviously angry mother saying she didn’t mind at all that the child had broken a glass and holding her arms out for an embrace). A double-bind required three components: a clear simple message, a contradictory meta-communication, and an absolute ban on the contradiction being acknowledged. All three were necessary but it was probably the family culture of denying the contradiction that was most pathological. After all, all families give contradictory and confusing messages. The term ‘double-bind’ is now used loosely to imply any contradictory communication but Bateson’s theory was much more precise.

  These theories have all been conclusively demolished by careful scientific examination. One approach was to get independent researchers to listen to tapes of families with and without schizophrenia and rate the occurrence of double-binds, or to interview families and rate them for coldness, hostility, overinvolvement, etc. Reliable differences were simply not found. Adoption studies, however, delivered the coup de grace. Very rigorous studies of children adopted away at birth to healthy families found rates of schizophrenia when they grew up just as high as if they had been brought up with their schizophrenic mother. Similarly twins adopted away at birth to different families demonstrated the same difference in rates between identical and non-identical twins found in those brought up in their natural families. None of these risks are 100 per cent and clearly upbringing and environment have quite a lot of influence.

  While family influence as the cause of schizophrenia has been conclusively dismissed it remains implicated in the course of the illness. Individuals with schizophrenia in highly emotionally charged families are likely to break down more often. This could, of course, be because families with more severely ill members are more stressful (see Chapter 4). However, training families to respond less emotionally does reduce the rate of breakdown, so high expressed emotion probably does have an effect.