Post by Admin on Dec 14, 2015 14:20:51 GMT
www.madinamerica.com/2015/12/madness-and-the-family-part-one-the-history-and-research-of-family-dynamics-and-psychosis/
[Rest of text & active Links in Above Text]
There are very few things considered more taboo in the world of mental health than the suggestion that problematic family dynamics can lead to a child developing a psychotic disorder. And yet, when we look honestly at the history and research of psychosis and the broader concept of “mental illness,” it becomes apparent that there are few subjects in the mental health field that are more important. I’d like to invite you, then, to join me on a journey into this taboo territory, dividing our trip into three legs. In the first leg (Part One), we’ll go back in time to explore how such a crucial topic has become so vilified, and then embark upon a flight for an aerial view of some of the most essential findings of the last 60 plus years of research that look at the links between problematic family dynamics and psychosis. In the second leg of the journey (Part Two), we’ll explore a framework that offers us the potential to unify the research on the various problematic family dynamics, trauma, and other factors associated with psychosis, locating the roots of psychosis within two core existential and relational dilemmas that I believe we all struggle with to greater or lesser degrees. Finally, in the third and last leg of our journey (Part Three), we will reap the fruits of our exploration, and consider how what we have learned may guide us as parents, as family members, and as society as a whole in offering genuine support to those who continue to grapple with these extreme states of mind.
A Brief History of a Serious Taboo
Between the late 1940s and the 1980s, we saw a steady flow of exploration and research on the links between certain kinds of parent/child dynamics (and general family systems dynamics) and the subsequent development of psychosis within the child. Among those leading the charge on this research were pioneering psychologists and family systems theorists such as Freida Fromm-Reichmann, Gregory Bateson, R.D. Laing, Murray Bowen and Carl Whitaker. Based upon the fruits of this exploration, there was a period of time in which tremendous hope existed that certain kinds of family therapies and parent education could lead to a significant reduction in the amount of adolescents and young adults who went on to experience psychosis and other distressing states of mind, or that such interventions could at least foster recovery for those who had already gone down this path. One book from that era that I find particularly illuminating and accessible to the layperson, highlighting the hopeful family-oriented movement of this time, is The Family Crucible, which documents a successful family therapy process that leads to the reversal of an adolescent girl going down the path of a schizophrenia diagnosis (Napier & Whitaker, 1978).
Fast forward to today, however, and we find that any quick surf across the internet will pull up a plethora of mainstream mental health organizations that are very quick to denounce the possibility that problematic family dynamics has anything at all to do with a young person developing a psychotic condition. So what happened? It appears that the general assumption within mainstream society today is that somehow the entire 60+ years of research finding links between problematic family dynamics and psychosis must have been thoroughly debunked; and in fact you will find explicit statements to this effect throughout the mainstream mental health field today. And yet, after years of poring over the literature on the etiology and recovery of psychosis, I have yet to find any substantial research that directly contradicts the essential premise that problematic family dynamics can lead to extreme psychological breakdown. So again, what happened?
Let’s rewind to the early 1950s, when the development of the first psychiatric drug, the “antipsychotic” drug Chlorpromazine, led to one of the most powerful industries the world has ever known—that formed by a coalition between the pharmaceutical and the psychiatric industries (which I’ll just refer to as the psychopharm industry for short). This industry was founded on a single ideology—the “mental illness” theory, or “medical model” (which I’ll refer to simply as the medical model)—an ideology that gave this industry tremendous power and influence. The medical model essentially states that distressing states of mind can, for the most part, be categorized into discrete “mental illnesses,” and that although these mental illnesses continue to the present day to be rampant and even growing within our society, we must rest assured that the great medical advances of this industry have already developed powerful drugs that can generally contain them, and that it is just a matter of time before our medical technology will eliminate these illnesses altogether (see my book, Rethinking Madness, or my article here for a more thorough critique on the medical model).
The medical model had already been in existence with varying degrees of power for many decades prior to the development of psychiatric drugs, having been particularly fostered within the field of psychiatry. However, up until this point, the medical model had not been able to fully overcome the popularity of the more psychosocially oriented models and methods when it came to making sense of and dealing with human distress, and this presented a particularly challenging dilemma for the psychopharm industry. How could this industry convince the public that much of human distress could be conceived of as discrete “mental illnesses” arising from diseases of the brain and requiring “medical treatment” with psychiatric drugs at a time when psychosocial interventions were showing so much promise? In the 1970s, the answer to this dilemma came in a somewhat surprising form—the parents of those diagnosed with schizophrenia.
As mentioned earlier, beginning in the late 1940s, we find this very dynamic period of time in the field of psychosis theory and treatment/recovery models in the West, in which a series of studies and projects emerged that offered considerable hope for the prospect that for many young people who were experiencing psychosis, their recovery could be greatly facilitated by addressing the problematic relationships within their life. These included various family and social systems models that supported the entire family or social system, seeing the “identified patient” as essentially a canary in a troubled coal mine; residential facilities such as Soteria, Diabasis and I-Ward, which fostered the development of healthy relationships in away-from-family environments; and transpersonal approaches that viewed such crises from within a spiritual context (i.e., as “spiritual emergencies”), and supported the development of healthy relationship between the “self” and the entire web of interdependence that extends beyond simply one’s immediate social network.
But as this psychosocial movement entered the 1970s, just as it was reaching a point of truly game-changing momentum, a tremendous backlash occurred. Many parents, understandably not feeling comfortable with so many fingers being pointed at them, resisted the idea that they played any role in their children’s development of psychotic conditions, and they began to push back, hard. And it just so happened that the psychopharm industry was more than happy to take full advantage of the situation, providing these parents with the perfect remedy to their dilemma—the medical model. For these parents, this model offered them an alternative narrative that relieved them of any burden of responsibility—their children simply have brain diseases, which is terribly tragic but has nothing to do with family and social dynamics; and for the psychopharm industry, these parents provided the ideal platform with which to spread this model so crucial to increasing their power and their profit margin—what could possibly be a more persuasive “grass roots movement” than an army of concerned parents willing to offer their complete devotion?
The power of this coalition between defensive parents and the psychopharm industry rapidly escalated, leading to a kind of perfect storm that essentially obliterated the movement towards family therapy and general relationship support as a means to addressing psychosis and other extreme states. The flagship organization of this coalition, which still maintains extraordinary power and influence within the mental health field today, is the National Alliance for the Mentally Ill (NAMI). As an indication of just how successful this coalition has been, in spite of over 60 years of very robust research showing strong correlations between problematic family dynamics and psychosis, and in spite of robust research showing the great benefits of fostering healthy interpersonal relationships as a means to support recovery from psychotic conditions (discussed in more detail below), it has become one of the most serious of taboos within the mental health field to suggest that problematic family dynamics can precipitate psychosis and other extreme states of distress.
In short, then, we find ourselves living in a society in which disability due to psychological breakdown has been continuing to grow at nearly exponential rates in spite of (or perhaps partially because of, as documented so well in Robert Whitaker’s Anatomy of an Epidemic; 2010) a psychopharm industry whose scope and power has likewise grown at a nearly exponential rate. And all the while, we find that the very hopeful and well established premise that so much of this psychological breakdown is rooted in problematic family dynamics has been discarded like so much outdated and worthless trash.
I and others have come to believe, however, that this has been a colossal mistake—that if we take the time to pick up this “trash” and carefully reconsider it, we will find that we have thrown away some truly valuable gems, gems that have the potential to offer real peace of mind to so many troubled individuals and families within our troubled society. So let’s take the time now to look more closely at some of the key findings of the links between family/relational dynamics and psychosis, and explore some of the implications of these with regard to avoiding the onset of psychosis in youth, and in supporting the recovery of those who have already experienced such a breakdown. But before we do, let’s first take a closer look at what we mean by the term “psychosis.”
What Exactly Is Psychosis?
We typically throw the word “psychosis” around freely as if we’re pointing to a condition or illness that is well established, but I’ve come to feel that the term “psychosis” is far overused and abused in our society. Essentially, whenever someone has beliefs, perceptions or behaviors that don’t line up with the generally accepted norms of one’s society (i.e., consensus reality), they’re at risk of being diagnosed with a “psychotic disorder,” typically “schizophrenia,” “schizoaffective disorder” or “bipolar disorder.” However, just because certain beliefs, perceptions or behaviors are considered “abnormal” does not automatically imply that they are “unhealthy,” and vice versa. To the contrary, contemporary society as a whole is extremely violent and destructive—indeed, multiple indicators suggest that we as a species will be quite fortunate if we survive the 21st century; so we need to rein in any tendency we may have to automatically assume that “abnormal” beliefs, perceptions and behaviors are problematic or represent “mental illness,” and that “normal” beliefs, perceptions and behaviors are necessarily “healthy.”
As I’ve discussed extensively elsewhere (and as summarized in my article here), I think it’s helpful to first make the distinction between those anomalous experiences (shorthand for “nonconsensus beliefs, perceptions and behaviors”) that are harmful/distressing and those that are not. If they’re not harming anyone or distressing the individual, then what’s the problem? Why give them any kind of label at all? And in those cases where they are harmful or distressing, this still does not necessarily mean that they are qualitatively any different than other harmful or distressing beliefs and behaviors that are considered more “normal,” such as burning fossil fuels, eating meat, getting drunk or believing in the special entitlement of one’s nation, race or religious group.
There clearly are, however, certain states of mind that are more than simply the existence of certain anomalous beliefs, perceptions and behaviors, or experiencing particularly intense states of emotions. Many people clearly do develop a condition in which these kinds of extreme experiences become significantly unstable and overwhelming, and it is this condition to which I think it can be helpful to refer to as “psychosis.” I have come to see this condition as generally representing an unconscious attempt of a desperate psyche to radically transform one’s deepest experience and understanding of the self and the world—a condition that occurs when one’s current experience and understanding of the self and the world has reached a point where it is simply no longer tolerable, for whatever reason. And considering that our capacity to relate to self and other is so profoundly shaped by our relationships with our parents and other close family members, it stands to reason (and to the research, as discussed below) that these most primary of our relationships can profoundly affect our vulnerability or resilience to such psychological breakdown.
[Rest of text & active Links in Above Text]
There are very few things considered more taboo in the world of mental health than the suggestion that problematic family dynamics can lead to a child developing a psychotic disorder. And yet, when we look honestly at the history and research of psychosis and the broader concept of “mental illness,” it becomes apparent that there are few subjects in the mental health field that are more important. I’d like to invite you, then, to join me on a journey into this taboo territory, dividing our trip into three legs. In the first leg (Part One), we’ll go back in time to explore how such a crucial topic has become so vilified, and then embark upon a flight for an aerial view of some of the most essential findings of the last 60 plus years of research that look at the links between problematic family dynamics and psychosis. In the second leg of the journey (Part Two), we’ll explore a framework that offers us the potential to unify the research on the various problematic family dynamics, trauma, and other factors associated with psychosis, locating the roots of psychosis within two core existential and relational dilemmas that I believe we all struggle with to greater or lesser degrees. Finally, in the third and last leg of our journey (Part Three), we will reap the fruits of our exploration, and consider how what we have learned may guide us as parents, as family members, and as society as a whole in offering genuine support to those who continue to grapple with these extreme states of mind.
A Brief History of a Serious Taboo
Between the late 1940s and the 1980s, we saw a steady flow of exploration and research on the links between certain kinds of parent/child dynamics (and general family systems dynamics) and the subsequent development of psychosis within the child. Among those leading the charge on this research were pioneering psychologists and family systems theorists such as Freida Fromm-Reichmann, Gregory Bateson, R.D. Laing, Murray Bowen and Carl Whitaker. Based upon the fruits of this exploration, there was a period of time in which tremendous hope existed that certain kinds of family therapies and parent education could lead to a significant reduction in the amount of adolescents and young adults who went on to experience psychosis and other distressing states of mind, or that such interventions could at least foster recovery for those who had already gone down this path. One book from that era that I find particularly illuminating and accessible to the layperson, highlighting the hopeful family-oriented movement of this time, is The Family Crucible, which documents a successful family therapy process that leads to the reversal of an adolescent girl going down the path of a schizophrenia diagnosis (Napier & Whitaker, 1978).
Fast forward to today, however, and we find that any quick surf across the internet will pull up a plethora of mainstream mental health organizations that are very quick to denounce the possibility that problematic family dynamics has anything at all to do with a young person developing a psychotic condition. So what happened? It appears that the general assumption within mainstream society today is that somehow the entire 60+ years of research finding links between problematic family dynamics and psychosis must have been thoroughly debunked; and in fact you will find explicit statements to this effect throughout the mainstream mental health field today. And yet, after years of poring over the literature on the etiology and recovery of psychosis, I have yet to find any substantial research that directly contradicts the essential premise that problematic family dynamics can lead to extreme psychological breakdown. So again, what happened?
Let’s rewind to the early 1950s, when the development of the first psychiatric drug, the “antipsychotic” drug Chlorpromazine, led to one of the most powerful industries the world has ever known—that formed by a coalition between the pharmaceutical and the psychiatric industries (which I’ll just refer to as the psychopharm industry for short). This industry was founded on a single ideology—the “mental illness” theory, or “medical model” (which I’ll refer to simply as the medical model)—an ideology that gave this industry tremendous power and influence. The medical model essentially states that distressing states of mind can, for the most part, be categorized into discrete “mental illnesses,” and that although these mental illnesses continue to the present day to be rampant and even growing within our society, we must rest assured that the great medical advances of this industry have already developed powerful drugs that can generally contain them, and that it is just a matter of time before our medical technology will eliminate these illnesses altogether (see my book, Rethinking Madness, or my article here for a more thorough critique on the medical model).
The medical model had already been in existence with varying degrees of power for many decades prior to the development of psychiatric drugs, having been particularly fostered within the field of psychiatry. However, up until this point, the medical model had not been able to fully overcome the popularity of the more psychosocially oriented models and methods when it came to making sense of and dealing with human distress, and this presented a particularly challenging dilemma for the psychopharm industry. How could this industry convince the public that much of human distress could be conceived of as discrete “mental illnesses” arising from diseases of the brain and requiring “medical treatment” with psychiatric drugs at a time when psychosocial interventions were showing so much promise? In the 1970s, the answer to this dilemma came in a somewhat surprising form—the parents of those diagnosed with schizophrenia.
As mentioned earlier, beginning in the late 1940s, we find this very dynamic period of time in the field of psychosis theory and treatment/recovery models in the West, in which a series of studies and projects emerged that offered considerable hope for the prospect that for many young people who were experiencing psychosis, their recovery could be greatly facilitated by addressing the problematic relationships within their life. These included various family and social systems models that supported the entire family or social system, seeing the “identified patient” as essentially a canary in a troubled coal mine; residential facilities such as Soteria, Diabasis and I-Ward, which fostered the development of healthy relationships in away-from-family environments; and transpersonal approaches that viewed such crises from within a spiritual context (i.e., as “spiritual emergencies”), and supported the development of healthy relationship between the “self” and the entire web of interdependence that extends beyond simply one’s immediate social network.
But as this psychosocial movement entered the 1970s, just as it was reaching a point of truly game-changing momentum, a tremendous backlash occurred. Many parents, understandably not feeling comfortable with so many fingers being pointed at them, resisted the idea that they played any role in their children’s development of psychotic conditions, and they began to push back, hard. And it just so happened that the psychopharm industry was more than happy to take full advantage of the situation, providing these parents with the perfect remedy to their dilemma—the medical model. For these parents, this model offered them an alternative narrative that relieved them of any burden of responsibility—their children simply have brain diseases, which is terribly tragic but has nothing to do with family and social dynamics; and for the psychopharm industry, these parents provided the ideal platform with which to spread this model so crucial to increasing their power and their profit margin—what could possibly be a more persuasive “grass roots movement” than an army of concerned parents willing to offer their complete devotion?
The power of this coalition between defensive parents and the psychopharm industry rapidly escalated, leading to a kind of perfect storm that essentially obliterated the movement towards family therapy and general relationship support as a means to addressing psychosis and other extreme states. The flagship organization of this coalition, which still maintains extraordinary power and influence within the mental health field today, is the National Alliance for the Mentally Ill (NAMI). As an indication of just how successful this coalition has been, in spite of over 60 years of very robust research showing strong correlations between problematic family dynamics and psychosis, and in spite of robust research showing the great benefits of fostering healthy interpersonal relationships as a means to support recovery from psychotic conditions (discussed in more detail below), it has become one of the most serious of taboos within the mental health field to suggest that problematic family dynamics can precipitate psychosis and other extreme states of distress.
In short, then, we find ourselves living in a society in which disability due to psychological breakdown has been continuing to grow at nearly exponential rates in spite of (or perhaps partially because of, as documented so well in Robert Whitaker’s Anatomy of an Epidemic; 2010) a psychopharm industry whose scope and power has likewise grown at a nearly exponential rate. And all the while, we find that the very hopeful and well established premise that so much of this psychological breakdown is rooted in problematic family dynamics has been discarded like so much outdated and worthless trash.
I and others have come to believe, however, that this has been a colossal mistake—that if we take the time to pick up this “trash” and carefully reconsider it, we will find that we have thrown away some truly valuable gems, gems that have the potential to offer real peace of mind to so many troubled individuals and families within our troubled society. So let’s take the time now to look more closely at some of the key findings of the links between family/relational dynamics and psychosis, and explore some of the implications of these with regard to avoiding the onset of psychosis in youth, and in supporting the recovery of those who have already experienced such a breakdown. But before we do, let’s first take a closer look at what we mean by the term “psychosis.”
What Exactly Is Psychosis?
We typically throw the word “psychosis” around freely as if we’re pointing to a condition or illness that is well established, but I’ve come to feel that the term “psychosis” is far overused and abused in our society. Essentially, whenever someone has beliefs, perceptions or behaviors that don’t line up with the generally accepted norms of one’s society (i.e., consensus reality), they’re at risk of being diagnosed with a “psychotic disorder,” typically “schizophrenia,” “schizoaffective disorder” or “bipolar disorder.” However, just because certain beliefs, perceptions or behaviors are considered “abnormal” does not automatically imply that they are “unhealthy,” and vice versa. To the contrary, contemporary society as a whole is extremely violent and destructive—indeed, multiple indicators suggest that we as a species will be quite fortunate if we survive the 21st century; so we need to rein in any tendency we may have to automatically assume that “abnormal” beliefs, perceptions and behaviors are problematic or represent “mental illness,” and that “normal” beliefs, perceptions and behaviors are necessarily “healthy.”
As I’ve discussed extensively elsewhere (and as summarized in my article here), I think it’s helpful to first make the distinction between those anomalous experiences (shorthand for “nonconsensus beliefs, perceptions and behaviors”) that are harmful/distressing and those that are not. If they’re not harming anyone or distressing the individual, then what’s the problem? Why give them any kind of label at all? And in those cases where they are harmful or distressing, this still does not necessarily mean that they are qualitatively any different than other harmful or distressing beliefs and behaviors that are considered more “normal,” such as burning fossil fuels, eating meat, getting drunk or believing in the special entitlement of one’s nation, race or religious group.
There clearly are, however, certain states of mind that are more than simply the existence of certain anomalous beliefs, perceptions and behaviors, or experiencing particularly intense states of emotions. Many people clearly do develop a condition in which these kinds of extreme experiences become significantly unstable and overwhelming, and it is this condition to which I think it can be helpful to refer to as “psychosis.” I have come to see this condition as generally representing an unconscious attempt of a desperate psyche to radically transform one’s deepest experience and understanding of the self and the world—a condition that occurs when one’s current experience and understanding of the self and the world has reached a point where it is simply no longer tolerable, for whatever reason. And considering that our capacity to relate to self and other is so profoundly shaped by our relationships with our parents and other close family members, it stands to reason (and to the research, as discussed below) that these most primary of our relationships can profoundly affect our vulnerability or resilience to such psychological breakdown.