Why do families blame themselves?
If so many of the family theories have been discredited why spend so much time on the issue here? Family theories in mental illness continue to exercise a remarkably powerful hold over us despite the evidence. And not just in schizophrenia but in depression, anorexia nervosa, personality disorder, drug and alcohol abuse, etc. Parents seem to have an endless capacity to blame themselves for what happens to their children (and perhaps children to blame their parents). This is probably because we need to believe it. Just as we need to believe in free will and our influence on the outside world, family members need to believe that they influence each other. If we didn’t why would we bother? The evolutionary psychologists would say that parents need to believe it to invest years and years bringing up their children. We’re biologically programmed to look after our children so we need some belief system to support it (just as they might say we’re biologically programmed to mate and need to believe in love to support it). It is proposed that such a belief is a mechanism for sustaining our attention to our biological task.
The downside is, of course, guilt and blame. If we believe we have an influence we feel we have failed if things do not work out well. It is inescapable. Even in expressed emotion work where therapists insist emphatically that no one is to blame and that the aim is solely to find more effective coping strategies, families do feel blamed. ‘If only we weren’t so over-involved he would not have so many relapses.’ ‘Other families must have dealt with it better otherwise how would the therapist know what to advise?’ For some families feeling responsible, despite the guilt, is preferable. It implies the logical consequence that there must be something they can do to influence the outcome. Cultures which value resignation are less likely to blame themselves (high expressed emotion is less common in India than in Europe).
The anti-psychiatry movement
Arguments over mind and brain and nature and nurture have always been part of psychiatry and are likely to remain so. They supported the most sustained and celebrated ‘external’ onslaught on psychiatry. This occurred during the 1960s and 1970s in what came to be called the ‘anti-psychiatry movement’. The mental hospital scandals of the early 1960s and publication of Erving Goffman’s Asylums had prepared the ground for a devastating attack. This was not to be a criticism of some of psychiatry’s practices or of failures in the system; this was to be an assault on the very legitimacy of psychiatry.
The anti-psychiatry message was that psychiatry did not so much need improving as scrapping. At its best it was confused and confusing and at its worst a truly evil instrument of oppression masquerading as a benign medical practice. Three charismatic authors came to personify the movement. Two were practising psychiatrists. Their books became campus bibles in the late 1960s and the 1970s at a time of widespread student unrest and they were hugely influential in the Paris student revolt of 1968 and its international consequences.
Thomas Szasz, a Hungarian immigrant to the US, rose to fame with his book The Myth of Mental Illness in 1961. In this he argued that ‘mental illnesses’ were fabrications to deny socially deviant individuals their legal rights. He argued vigorously against involuntary treatment and for the separation of psychiatry and the state and the abolition of the insanity defence. He believed that those judged mentally ill should be treated equally and held accountable for their actions (i.e. psychotic individuals should have the right to refuse treatment and be sent to prison if they break the law, even when demonstrably unwell). He often drew on hysteria as his model of mental illness (probably reflecting his experience as a psychoanalyst in New York), which has limited the power of his case. It has been suggested that his extreme libertarian standpoint and opposition to compulsion stemmed from his experiences under Soviet occupation. He is regularly quoted by the Church of Scientology in their opposition to state run and coercive psychiatry.
Michel Foucault was a French philosopher who believed that the concept of mental illness was an aberration of the post-Enlightenment age. He objected to the classification of identities, arguing that the existence of madness did not entail the identity of madman. His book Madness and Civilisation challenged the very basis of psychiatric practice and cast it as repressive and controlling (rather than curing and liberating). His work had enormous influence in Continental Europe (most evident in Basaglia’s reforms in Italy). However, his writing is dense and difficult to absorb and he is more often quoted than read.
The most accessible and influential of the anti-psychiatrists was R. D. Laing. A Glaswegian psychoanalyst with a brilliant mind and lucid prose style, he turned the psychiatric world upside down with a series of best-selling books. An original and impulsive man, his views changed throughout his career and like Freud he didn’t feel the need to acknowledge these radical changes or explain them. His first, and most influential book, was The Divided Self: An Existential Study in Sanity and Madness (1960). He called his position ‘existential phenomenology’ (don’t ask!) and proposed that the delusional thinking of the schizophrenia patient was simply a different take on the world. He argued that this could be challenging but it was essentially creative and, with enough imagination and moral courage, could be understood. However, these different worldviews threaten our security so we seek to deny them by imposing a diagnosis and ‘pathologizing’ them.
