Schizophrenia and family situations

Press, 26 November 1977, Page 17

Schizophrenia and family situations

The Origin and Treatment of Schizophrenic Disorders. By Theodore Lidz. Hutchinson. 137 pp. $7.35. (Reviewed by Ralf Unger) The constant search for the cause of an illness such as schizophrenia in some sort of structural pathology or physiological imbalance has become part of the definition of the disorder in some circles. However, Lidz sees the appearance of schizophrenia as one of the potential fates that man is subject to in his efforts to find a way of life as an independent being among the hazards that beset his life from infancy to maturity. Since 1949, Lidz has been one of the most respected names in psychiatry. In particular, he has drawn attention to the importance of the family milieu for the understanding of schizophrenic disorders and their treatment. The function of the therapist is to “become involved in learning from and with the patient, rather than treating him, to carry out a study of life together with him.” , , In this summary of Lidz’s writings over the last 25 years, he propounds that there is a close connection between schizophrenic disorganisation and thinking disturbances which result from the parental style of communication — as, for instance, the famous “double-bind” situation where parents give a child alternative possibilities of acting, both of which lead to a loss of love or punishment of some sort. In the confusion of interpreting this communication the child falls apart in his own thinking and his distortions of reasoning lead to gross, bizarre behaviour and an attempt to handle situations by the early childhood type of magical thinking. The schizophrenic patient does not lose intelligence, but starts to believe that he is the focal point of all events, no matter how unrelated or coincidental they are. The capacity to use language and to think develops slowly up to adolescence like other aspects of personality growth. Through this stage of life, the child moves through a world filled with such things as animism: the bringing to life of inert objects. Similarly there are ideas of influencing inanimate nature as well as the behaviour of others. The adolescent who becomes schizophrenic feels that he can influence his environment by his thinking and if there is a later

precipitant in a crucial development hurdle — such as separation from the family, going to university, an attempt to become intimate sexually, the isolation of the housewife — then because of the many developmental deficiencies and distortions, the previously laid ground for schizophrenia comes to the surface. The patient ceases to test the logic and validity of his thinking and is buffeted by a distorted world. Two particular family types which seem to cause schizophrenia are defined by Lidz. The first, “skewed,” provides a profoundly distorted and distorting developmental milieu because one spouse passively accedes to the strange and even bizarre concepts of the more dominant spouse concerning child-rearing and how families should live together. The other is labelled “schismatic” where there is extreme parental discord with the family divided into opposing factions which create a most unfavourable environment. In both these types of families the patient’s emergence as an individual becomes thwarted by his subservience to the completion of the parents’ life, or to salvaging the parents’ marriage. It is often considered that persons suffering from true schizophrenia cannot be influenced by various types

of psychotherapy. In fact, in decades gone by, if an illness improved it was decided that a misdiagnosis had been made and it. had not been schizophrenia. The new understanding of the nature and origins of these disorders, however, has lead to an approach in which a patient is taught to trust his own feelings and ideas while questioning those that are essentially his parents’ feelings and perception. Finally, Lidz gently criticises views of such people as Laing who argue that no-one in the world can remain sane and schizophrenic episodes have a beneficial effect. Although highly creative individuals sometimes become schizophrenic, being schizophrenic is rarely creative and the despair of these patients does not concern the state of the world, but comes about from feelings surrounding a few highly significant persons in their life. The search is to cultivate deep and meaningful relationships and this book, like others of Lidz’s writings, although occasionally lapsing into complex jargon, is a major contibution in moving schizophrenia away from the Jekyll and Hyde mythology, to a discussion of confused children becoming terrified adults who create their own world of fantasy security.