FAMILY THERAPY AND
ONE REASON for the lack of theorizing about the family among psychoanalysts was their practice of individual therapy. Developed in the context of treating single patients, Freud's theory tended to follow from his practice, illuminating the intrapsychic dynamics of the individual. After World War II, however therapeutic practices began to change dramatically. During the war, psychiatrists were confronted with the task of treating large numbers of soldiers, and doing so quickly and cheaply. The psychological problems of these soldiers, furthermore, could hardly be considered private, personal or unique. All of them had similar traumatic experiences.[2 ] As a result the Freudian view of the psyche as a dark, hidden realm within the recesses of the individual lost some of its verisimilitude. Working with soldiers, Bion and others began to treat patients in groups and began to uncover emotional dynamics specific to people in groups. It became clear to these therapists that earlier theories were deficient in articulating the social nature of psychic life.
Parallel with but distinct from the origins of group therapy was the practice of treating an individual by including the entire family in the therapeutic sessions. The practice of family therapy, which did not begin until the late 1950s evoked the need to reconceptualize the nature of mental disorder on the basis not of individual fantasy
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but of interactional patterns. The therapist was compelled to see the family as a "system," avoiding at all costs the labeling of one member as "sick" since this was a tactic, in many cases, of the family itself. The practice of family therapy, which has become remarkably widespread since the early 1960s, is seemingly of great value for the development of a critical theory of the family.
The first important center of family therapy was at the Palo Alto Mental Research Institute. Gregory Bateson, along with Don Jackson, Jay Haley, John Weakland and others, began to treat schizophrenia, theoretically and practically, as a problem of the family system. Rejecting Freudian preconceptions, Bateson, by training an anthropologist, found theoretical support for family therapy in systems theory, cybernetics, information theory, ecology, communications theory---in short, in those postwar epistemologies that stressed the priority of the relationship over the individual. These theories, which were connected with the war, with the development of computers and with advanced capitalist society, led Bateson to emphasize communication patterns over private fantasies. The analysis of the message and the circuit required a set of concepts which made the individual intelligible only in the social matrix. All behavior could be viewed as communication, according to Bateson, but not in terms of the intentions of the individual. Communication was a question above all of interaction and rules for interaction; meaningful words and gestures implied both a sender and a receiver. In sum, communication was intelligible not from the point of view of the individual but only in the context of a relation.
To Bateson and the Palo Alto group, communication theory provided a new scientific basis for psychotherapy. Freud's theory, based on nineteenth-century physics and biology, had to be modernized. While Lacan, with the same general orientation of founding psychology on a new scientific basis, turned to Saussure, family therapy in the United States borrowed heavily from the latest technological and scientific advances. As early as 1951, Bateson redefined psychology in terms of
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communication jams, faulty processing of signals and informational deficiencies, and rejected completely Freud's energy model. Confronted by patients who were troubled not by hysterical symptoms but by a perplexing array of bizarre behaviors and profound withdrawals that were habitually labeled schizophrenia, Bateson replaced Freud's vertical theory, which probed genetically into the depths of the individual, by a horizontal theory that illuminated the surface expanse of the patient's family life. In applying communication theory to mental disorder, Bateson's great advance was to suggest that the fault lay not with the individual patient but with the logic of interactions in the family network. The question to face as we explore the theories of Bateson and other family therapists is whether they provide an adequate theory of the nature of family systems or whether they elaborate merely a dichotomy of normal/pathological family systems that does not take into account the structure of the nuclear family itself.
Bateson's application of communication theory to psychotherapy deals exclusively with problems of schizophrenia. Although as a diagnostic category schizophrenia goes back to Emil Kraepelin and Eugene Bleuler in the early twentieth century, it was used with increasing frequency only after World War II. Just as with Erikson's theory of the identity crisis, schizophrenia is a new form of pathology which suggests a new type of social crisis. The symptoms of schizophrenia are defined in extremely vague ways by the mental-health industry, but the following traits are normally mentioned: fragmentation of experience that splits feelings from ideas and acts from thoughts, and results in "bizarre" behavior; confusion of fantasy and reality, so that words become things and the person generates a private mental world; poor ego boundary, so that the person cannot discriminate between his own action or thoughts and those of others; reified perception of the self, so that the person feels dead or empty or manipulated by others; feelings of terror and isolation so that trust in others is impossible.
Two kinds of criticisms have been made of the category of schizophrenia: (1) that it
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is an empty label applied arbitrarily and which leads, as a consequence of treatment, to worse problems than it pretends to cure (this is the viewpoint of Laing and anti-psychiatry and will be dealt with below); (2) that these symptoms are specific to capitalist society and are found in the "normal" experience of all oppressed groups today (the Marxist position).
The Marxists argue that advanced capitalism leads to a general reification of experience, in which people are treated (by bosses, by advertisers, by the government) as objects to be manipulated. The market system has reached its logical conclusion separating concrete, intrinsic values completely from exchange values. Commodities are reinvested with the qualities of persons, while people are shorn of their human traits. Hence "schizophrenics" are only troubled a bit more deeply by what affects everyone. In the Marxist critique, the focus shifts from the family to the economy and the general culture. Whatever one thinks of the Marxist position, it does at least attempt to explain the sudden rise of schizophrenic symptoms in the contemporary period.
Schizophrenia to Bateson is the result of distorted communication in the family. Starting with Bertrand Russell's theory of logical types, in which a class cannot itself be a member of the class, Bateson goes on to show how certain communications embody logical errors which prevent a message from being perceived correctly. Bateson postulates that
in the psychology of real communications [the discontinuity between a class and its members] is continually and inevitably breached, and that a priori we must expect a pathology to occur in the human organism when certain formal patterns of the breaching occur in the communication between mother and child.These pathogenic "breaches" are called "double binds." A double bind is a message in which the receiver cannot distinguish the logical type or order of the message regardless of the interpretation he chooses to place on it. Bateson distinguishes three
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traits of the double-bind situation: (1) an intense, vitally important relationship exists; (2) the sender of the message expresses two orders of message in which one order denies the other; and (3) the receiver of the message cannot comment about it to correct the confusion or even point it out. The definition of the double bind becomes clear in an example Bateson gives. A schizophrenic patient, well on the way to recovery, was visited in the hospital by his mother. He greeted her with enthusiasm, putting his arms around her in an embrace. She stiffened in response and he withdrew his arms. Then she asked, "Don't you love me any more?" The patient blushed, and the mother responded: "Dear, you must not be so easily embarrassed and afraid of your feelings." The patient then relapsed into another schizophrenic episode.
In the example, the patient, if he interprets his mother's messages correctly, must conclude that to keep his mother's love he must not show that he loves her (by embracing her) but if he does not show that he loves her (withdrawing arms, blushing) he will lose her love. Either way he loses. Bateson claims that schizophrenia will develop in double-bind situations when the person has a "weak ego function" to begin with and therefore begins to lose the capacity to discriminate and interpret messages correctly. The schizophrenic will fail to assign the right communicational mode (1) to messages from others, (2) to his own messages to others, or (3) to his own thoughts or feelings. In such messages as the command "Be spontaneous!" the message content is simply to act with spontaneity, without foresight. But since the message is a command the second level of the message requires that the receiver follow an order initiated by someone else, or, in short act with foresight and at another's behest. If the receiver of the message is also not in a position to ask about the confusion any response he makes will be incorrect. In the example of the patient and his mother, for instance, there are numerous instances of the double bind. Bateson argues that when a person is confronted habitually by communications of this type his responses will be labeled "schizophrenic." The only way out of the double blind is to destroy completely
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ordinary rules of communication, and this is what the schizophrenic does.
If Bateson is correct, traditional Freudian psychology would at the very least require enormous revisions. The theory of the double bind assumes that pathological symptoms must be understood not as a return of repressed instincts as in Freudian theory, not on an energy model, but on a communicational model as the consequence of habitual confrontation with distorted messages. In other words, Bateson's theory leads to an examination of the structure of social interactions of the patient and it provides a means of comprehending a communicational system. Freudian theory is designed to interpret intra-psychic fantasies; Bateson's theory is designed to interpret social interactions. Freud's theory leads to individual therapy aimed at the patient's unconscious fantasy; Bateson's theory leads to family therapy aimed at the communicational patterns of the group.
As one might expect, Bateson has elaborated not only the communicational conditions of schizophrenia (the double bind) but also the family pattern in which schizophrenia is likely to occur. He distinguishes three common traits of the schizophrenic family system:
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turn to the family will often cause a crisis of the family system. Either the patient will resume his schizophrenia or some other member of the family will become ill. The stability of the family system, Bateson and the Palo Alto group contend, comes from its communicational structure which is based on the feedback loop. The family cannot be seen as a composite of discrete individuals, but as a set of relations. The ties between members are deeply rooted because these relations are composed of patterns of mutual expectation. Batseon notes, "We have to consider, not only A's reactions to B's behavior, but we must go on to consider how these affect B's later behavior and the effect of this on A." In the feedback loop such as this, the system is maintained not at discrete points of individual action, but through the resonating actions of all members. Thus if a father makes a dominance gesture about family finances most often this must be responded to by the mother and children with messages of submission and acceptance, and only then is the loop complete. Both sides of the communication must be considered in order to understand how the family works. In this sense, schizophrenia is not "caused" by the mother, nor is it a "deficiency" "contained within" the schizophrenic child; rather it is part of the family system as a whole. Feedback loops are vicious circles in which the husband blames the wife for nagging, while she blames him for withdrawing affection, each thinking the other is the cause of the family's problems. In fact they are both involved in a mutually confirming pattern.
Bateson gives a fifth criteria of the schizophrenic family: each member is continually undergoing the experience of "negation of self." In the double-bind situation, the receiver of the message tends to have his perception, interpretation or thought rejected and canceled. In the example given above, the patient's expression of love for his mother was negated by her. Bateson does not develop this trait of schizophrenic families in great detail. In fact, it appears to have more of an existential quality than a communicational quality. As we shall see, the characteristic of negation
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of self is developed at great length by Laing and his associates.
One frequent criticism of Bateson pertains just to this lack of an existential dimension to his position. Why, it is asked, should problems of communication lead to mental disturbance? Unlike Freud, Bateson does not seem to be able to explain the relation between miscommunication as a technical error and emotional disturbance. Why should the form of messages lead to emotional pain? Bateson's only response to this charge is again not at the communicational or behavioral level but at the existential:
Human beings have a commitment to the solutions which they discover, and it is this psychological commitment that makes it possible for them to be hurt in the way members of schizophrenic families are hurt.Interestingly enough, Bateson was unable to explain mental pathology purely through a systems approach to language. (His communication model also contains weaknesses as a theory of therapy, but we are not directly concerned with this.)
In large part due to his reliance on communication theory, Bateson's five indices of schizophrenic families tend to individualize and dehistoricize the understanding of the family. His criteria tend to discriminate between family systems without saying anything about contemporary family structure. For example, could a schizophrenic pattern develop in an aristocratic family in rural France in the fifteenth century? Bateson s criteria do not offer us a theory of what the contemporary family is or what its prospects are. His index that relations must be of vital importance to the schizophrenic pertains to all families and does not distinguish the peculiar emotional closeness of the nuclear family. Furthermore, unlike Marxist psychologists, he does not relate patterns of schizophrenia to the social structure, or even to the language patterns outside the family. Because of that there is no away of judging the extent to which schizophrenic families are autonomous in their communicational pattern or de-
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pendent upon circumstances in the wider society. Bateson's position
has the serious flaw--one which tends to characterize all of family therapy--of
isolating the understanding of the family from history and from society.
Nevertheless, the value of Bateson's theory must not be overlooked: he
has begun to develop a method to comprehend the family as an interactional
system, to make intelligible the emotional life of the family without individualizing
the problem. Family therapy begins with Bateson for just that reason.
His argument that one must understand the individual only within his social
context has enormous import for family theory in general. After Bateson,
family therapy spread very rapidly, because aspects of individual pathology
which had until then seemed unintelligible suddenly took on meaning when
viewed in a family context.
In the well-known book Pragmatics of Human Communication, Paul Watzlawick and his associates attempted to formalize more carefully Bateson's double-bind theory. They tried to expand the double-bind theory into a general theory of "pragmatic paradoxes." They begin with a fundamental distinction between symmetrical and complementary relationships, arguing that paradoxes may exist in numerous forms as confusions between the two. With great elegance and logical rigor they argue for the same general position as Bateson: that pathologies are products of distorted communication. They go on to develop a clever tactic for purposes of therapy. Since the patient is caught in a network of paradoxes which he cannot escape, the therapist should move one level up and make a paradox of the pathological paradoxes by ordering the person not to change at all. The patient can do nothing in this situation unless he steps outside the whole dilemma. While "paradoxical" therapy is certainly interesting and has achieved some acceptance professionally, the theory of Watz- lawick points up a danger that was not particularly pronounced in Bateson's writing, the danger of behaviorism. Unlike Lacan, the double-bind theorists base themselves on a behavioral understanding of reality. There are no gaps or breaches in family communications to them, no unconscious level of fantasy. Instead, the family group
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forms a neat system of interactional patterns, all of which exist on the surface level of perceptual reality. Hence, as Lacanians have complained, there is no symbolic level. in the analyses of the Palo Alto group, hence no tension, no depth to their theory. In the final analysis, the Palo Alto group's theory of undistorted communication cannot account for the problem of domination and freedom. From the viewpoint of the Lacanians, systems theory cannot save behaviorism from its determinist error.
Bateson and the Palo Alto group influenced family therapy in general by sensitizing practitioners to communication patterns and to the nature of the family as a system. But family therapy arose at about the same time in several centers without a single theoretical leader. The theory of family therapy thus reflects the broad continuum of diverse psychotherapies, from psychoanalysis to behaviorism, from gestalt to transactional analysis, including a good portion of plain eclecticism. Within this diversity, however, there seem to be some common themes shared by most, if not all, theories of family therapy.
Theorists of family therapy begin by defining their field through a critique of Freud's individualism: in order to comprehend the pattern of a family one must look at what goes on between individuals, not simply within them. They go on to argue that the pattern in each family is unique, that each family develops myths, rituals, a shared view of the outside world, mutual definitions of each other, and so forth, elements which effectively individualize the family. In this way the family defines itself as a coherent whole with more or less clear boundaries. In the words of one family therapist team,
However its life spreads into the wider community, there is a sense in which a family is a bounded universe. The members of a family ---parents and their young children---inhabit a world of their own making, a community of feeling and fantasy, action and precept.The effort throughout the literature is to focus on the individual family as a world unto itself. Theorists omit for the most part a historical understanding of the privatiza-
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tion of the family, and omit as well a sociological understanding of the structural requirements (such as sex roles) imposed on the family by the wider society. Instead their efforts are directed at the psychological level exclusively in an attempt to arrive at a concept of how families operate emotionally. Perhaps family therapy is unwilling to go further, since it is likely that when they call into question the normality and well-being of the family, family therapists will meet the resistance of society. To claim that families, even some of them, are disturbed goes against the general belief in the sanctity of the family. In a kind of reaction formation, family therapists may unconsciously be suppressing the important connections between family structure and family psychology. If this is correct, it would also explain their effort to separate disturbed families from "normal" ones. At least in this regard, Freud was more aware of what he was doing and of the resistance or opposition he faced than are family therapists.
A good example of the current state of family therapy is the work of Lyman Wynne at the National Institute of Mental Health. In a widely read article, Wynne and his associates define three types of families based on three types of relatedness: mutuality, non-mutuality and pseudo-mutuality. Each type is a different combination of two universal needs, that of personal identity and that of relationships with others. Families with pseudo-mutuality, which tend to develop a schizophrenic member, are defined by a pattern of emotional investment directed toward not perceiving accurately the changing needs and expectations of the family members but instead maintaining a sense of reciprocal stability, a rigid structure of relationships or a fixed family role structure. In families with schizophrenics, there is a great effort to maintain a fairly rigid pattern of attitudes against the inevitable changes undergone by family members. The theoretical pattern of Wynne's work is important to notice: the family therapist sets up an ideal of family functioning (mutuality) which is presented without much theoretical defense. The theory then tries to separate out sick
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families from healthy ones in order to isolate the group mechanisms which have elicited the disease. Hence the actual structure of "normal" families will not be called in question. Wynne enumerates, for example, several features of families based on pseudo-mutuality: they tend to suppress or reinterpret delusionally all deviations from the established family role structure; the schizophrenic perceives the structure as all-encompassing; an attitude of catastrophe surrounds the possibility of changes in the role structure; parents give indiscriminate approval to children;, there is much secrecy in the family; the family often relies on outside intermediaries; changes in family structure are met with scape-goating; the family role structures, not just the parental authorities are internalized; and so forth. When these mechanisms operate, Wynne contends, the family is in danger of producing a schizophrenic. These families have over-emphasized the human need for relations against the need for individual identity.
Implicit in family therapies such as Wynne's is the assumption that the general structure of the nuclear family is optimal and that deviations from it are (1) caused solely within the family and (2) need to be eliminated to bring the family back to the norm. As a whole, the family therapy industry, including not just individual therapists but private groups (like the Family Association of America), child guidance centers, community mental-health centers, hospitals, institutes, asylums, and numerous other therapeutic agencies, is devoted to the preservation of the current family form, as well as to the preservation of the general institutions of society (capitalism, representative democracy, etc.) which are seen as dependent upon healthy families but in no way damaging to them. In the past ten or fifteen years the United States has witnessed the birth and rapid expansion of this new form of social control and regulation.
The styles of therapy practiced on families varies to a. considerable extent. In general, however, the therapist tries, after diagnosing the troublesome family pattern, to alter the family system in some way. In a film called "A Modern Little Hans," from
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the Philadelphia Child Guidance Center, for example, a young boy's phobia of dogs was treated by the therapist by trying to change the authority pattern over the boy, which until then had been only the mother's responsibility, to include the father. Once the boy learned that his father, a postman, knew a great deal about fending off dogs which he could teach his son, the therapist was satisfied that a "normal" pattern of parental authority had been achieved or at least begun. He presumed that faulty authority patterns were the cause of the boy's fear. He then shifted the focus of conversation to the interaction between the parents, hoping to dissolve the barriers to their coalition of power. In "A Modern Little Hans," the boy's intra-psychic fantasies were ignored, and there was a strong presumption that family normality depended on a good working alliance between the parents to exercise authority over the children.
Among psychoanalysts, the same pattern of treating families is prevalent, although they do focus more on a genetic model of illness, concerning themselves with the transmission of super-ego problems through the generations. When there are "lacunae" in the super-egos of the parents, blind spots in their ethical codes, the children internalize them and act them out as symptoms. What was a problem of conscience in one generation becomes a problem of behavior in the next. Psychoanalysts applied their theory at first to delinquent children, avoiding the obvious social questions raised by this issue. Here again there is an assumption of a "normal" super-ego or "normal" authority structure which the sick family has not achieved.
Among family therapists the tendency is very strong to avoid the assumption of a continuity between "sick" and "healthy" families and therefore to avoid placing the family in a historical and social context. Even though researchers have shown that schizophrenia tends, with a statistically significant correlation, to be diagnosed in poor families as opposed to rich families, where neurosis predominates, the importance of class in differentiating family structure is often overlooked by theorists
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of family therapy. Moreover, family therapy, with its heavy reliance on communication theory, tends to have a parliamentary vision of reality in which all disagreements and antagonisms can be ironed out. The tendency in family therapy is to assume that there are no irreconcilable differences, no recalcitrant contradictions beyond the capacity of the family to handle. Because each family is seen as a microcosm closed unto itself, structural contradictions, of the nuclear family form do not impinge on communications within them. The inequities of sex roles, the dependence of children, the isolation of the family from a broader community in no way influence, in the writings of the family therapists, the ability of the family to attain a "normal, "healthy," "fulfilling" existence.
The work of Theodore Lidz and his associates at Yale on family therapy and schizophrenia is instructive. Lidz relies heavily on ego psychology and the theories of Talcott Parsons in his writing on the family. The normative, conservative role of the nuclear family is most explicit in Lidz: sick families are those quite simply where the "proper" differentiation of sex roles and the proper authority of the older generation over the younger have been violated. He states:
I propose that the essential dynamic structure of the family rests upon the parents' ability to form a coalition, maintain boundaries between the generations, and adhere to their appropriate sex-linked roles. Then I examine how failure to meet these few requisites leads to distortions in the ego structuring of their children.How is it possible, one might ask, for anyone to defend patriarchal sex roles as crucial to mental health and general well-being? How can such oppressive discrimination be psychically beneficial? Lidz borrows directly from Talcott Parsons the notion that men have instrumental roles and women have expressive roles in the family. When these are not fulfilled, Lidz warns, "weakness" in the man will lead to "coldness" in the
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woman, with disastrous consequences for the whole family. Lidz apparently wants us to believe that women turn cold When they are not dominated by men.
With his Parsonian theory, Lidz seems more aware of social and historical factors in family structure than most family therapists. But the effects of such awareness are deeply conservative: he uses Parsonian theory to show that the modern nuclear family is inevitable, unchangeable and in any case completely desirable. He proposes
the thesis that the isolated nuclear family, despite its paucity of stabilizing forces, is better suited for preparing its children to live in a society that is rapidly changing its adaptive techniques than are families with extended kinship systems.The marriage between the nuclear family and capitalism is a happy one because the former generates flexible egos which can go where the money is without ever questioning the social alternatives to new "adaptive techniques." Problems within the nuclear family itself call not for restructuring, according to Lidz, but for reinforcement of the norm. Family therapy thus plays a vital role in bolstering the established order:
The instability of the isolated nuclear family can, however, reach such proportions that it provides insufficient structuring, security, and satisfaction for its members. The instability affects not only the stability of individuals raised in these families but also the stability of the society through undermining the family unit and the culture's ethical directives. As the trend toward isolated families cannot be undone, the continuity of this culture may well depend upon strengthening this unstable family form by gaining coherent concepts of what essentials to family life must be maintained. Questioned about new family forms in communist society, Lidz homilized on family love:
Question: What do you suspect would happen if we tried to eliminate the family?
Lidz: I think we'd have tragedy. I considered this recently particularly in regard to the Chinese communes, where parents are kept apart from their children except for visits once a
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month or every few weeks. My feeling is that for most people, without meaningful family relationships, and the feeling for children whom we must care for and help make life meaningful for, life will not seem worthwhile. A society of such people would, I think, ultimately disintegrate.The import of Lidz's speculations are that even if society does not provide satisfying experience, the family can instill meanings in the child. Life becomes worthwhile in the family so that the meaninglessness of society cannot be criticized. When work in the community is meaningless, the family steps in to save the day.
When Lidz looks closely at the way the nuclear family instills meanings in the child, the outlook is not so bright. The nuclear family tends to drown children in their parents' emotional bath, providing relations so intimate that any independence for the child is prevented. Lidz describes many families in which "children have difficulty in becoming discrete individuals for they are living their mothers' lives rather than their own . . . " Locked into her sex role as mother, one woman interviewed by Lidz said of her son, "He is not just part of my life he is all of my life," a pathetic statement that speaks to the woman's confusion but also to the irrationality of the role of mother in the nuclear family. Lidz's theory of the family proposes to cure the family when the craziness originating in the society overwhelms it. His family therapy would teach the family to function smoothly under the burdens of oppressive norms and roles. By means of family therapy he would transmute misery into happiness without touching the basic conditions of the misery.
There is one tradition of family therapy, however , that has attempted to relate family problems to social problems and to define particular family problems in relation to contemporary family structure. This is the work of R. D. Laing and the anti-psychiatry movement in England. Unlike the modest and limited work of most family therapy, Laing has sought to connect family therapy with an attack on mental-health
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institutions, with new left politics, with Far Eastern mysticism and with a validation of schizophrenic experience as a healing process. Drawing heavily on Sartre's philosophy and on existentialist thought in general, Laing has associated the practice of family therapy with a general radical social theory. For this reason Laing's work will be treated in greater detail than other family therapies.
Laing's work begins not with family therapy but with an effort to uncover the intelligibility of schizophrenic language and behavior. For him Freud's great advance began with his ability to find meaning in the symptoms and utterances of hysterics. Since the late 1950s Laing's own goal has been to find a way to listen to schizophrenics and hear them. His assumption has therefore been that people who are classified as severely psychotic are still human beings with intentions and desires which can be comprehended by other human beings. His purpose is "to make madness, and the process of going mad, comprehensible." He has, in short attempted to humanize schizophrenia, to bring back into the community those who have been abandoned in the asylums. Laing's project is thus similar to that of Michel Foucault , who has argued that since the eighteenth century, since the victory of modern rationalism, the insane have been labeled "irrational," beyond nature, and have been confined and excluded from society with the complicity of the medical profession. Like Foucault, Laing's attempt to humanize schizophrenia has led him at times to celebrate it romantically as an experience which is superior to that of the normal psyche.
There are two sides to Laing's project. First, he searches for a general philosophy of human experience (existentialism) which can account for schizophrenic as well as normal consciousness. Second, he launches a thorough and sharp critique of psychiatry.
Laing is not a particularly consistent or systematic philosopher. Yet his use of existentialism does make his point clear. Contemporary social experience tends to become reified; people treat others as things, not as persons. Consequently they clutch
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their identities so tightly that they become masks, hiding their true selves. Laing tries to relate the phenomenon of reification to broad social and political trends but he is not able to analyze reification the way Marxists have by tying it to capitalism. Instead, Laing looks with great sensitivity at the consciousness of those who are treated as things, finding that the terror of the experience leads to "ontological insecurity" and to a "divided self." Laing has a great facility in taking the side of the psychically oppressed and turning the tables on the normal world. He writes sardonically, for example, "A man who says that men are machines may be a great scientist. A man who says he is a machine is 'depersonalized' in psychiatric jargon."
While reification and madness reign unchecked in the normal world, the mad world represents to Laing a more authentic experience. The mad are protesting against a bad state of affairs which is not recognized as such by the majority. When examined carefully, through a phenomenological analysis, the mad reveal the reigning insanity. Existentialism allows us, Laing thinks, to treat the insane as persons, to validate their consciousness as human. For this reason he, like Thomas Szasz also writing in the 1950s and 1960s, is outraged at the way people are treated by the mental-health industry. People who are considered "abnormal" for some reason by their relatives or friends are brought, Laing and Szasz contend, to doctors who treat them as things, reproducing the worst features of the general society, categorizing them in the crudest manner and subjecting them, involuntarily in many cases, to what Laing describes as a form of torture (confinement without privileges, electric shock, drugs of all sorts, humiliating treatment, etc.).
The label schizophrenia is Laing's favorite target. A loose category, as we have seen, which includes diverse, contradictory forms of experience and behavior, schizophrenia is used by psychiatrists, social workers and others in a mythical way, as if it had the specificity and diagnostic accuracy of the label "pneumonia." People who are so labeled have been "objectified," Laing argues, by the "medical model." They have not been list-
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-ened to or understood, and their experience has been invalidated. Many psychiatrists even believe, like the doctors who treated hysteria before Freud, that schizophrenia is "caused" by a physical or chemical abnormality. Laing quotes from Kraepelin, who began to treat schizophrenia (then called dementia praecox) around the turn of the century. Kraepelin's reports, stunning examples of the medical model, are worth reproducing at length:
The patient I will show you today has almost to be carried into the rooms, as he walks in a straddling fashion on the outside of his feet. On coming in, he throws off his slippers, sings a hymn loudly, and then cries twice (in English), "My father, my real rather!" He is eighteen years old, and a pupil of the Oberrealschule (higher-grade modern-side school), tall, and rather strongly built, but with a pale complexion, on which there is very often a transient flush. The patient sits with his eyes shut, and pays no attention to his surroundings. He does not look up even when he is spoken to, but he answers beginning in a low voice, and gradually screaming louder and louder. When asked where he is, he says, "You want to know that too? I tell you who is being measured and is measured and shall be measured. I know all that, and could tell you, but I do not want to. When asked his name, he screams, "What is your name? What does he shut? He shuts his eyes, What does he hear? He does not understand; he understands not. How? Who? Where? When? What does he mean? When I tell him to look he does not look properly. You there, just look! What is it? What is the matter? Attend; he attends not. I say, what is it, then? Why do you give me no answer? Are you getting impudent again? How can you be so impudent? I'm coming! I'll show you! You don't whore for me. You musn't be smart either; you're an impudent, lousy fellow, such an impudent, lousy fellow I've never met with. Is he beginning again? You understand nothing at all, nothing at all; nothing at all does he understand. If you follow now he won t follow, will not follow. Are you getting still more impudent) Are you getting impudent still more? How they attend, they do attend," and so on. At the end, he scolds in quite inarticulate sounds.It is obvious to anyone reading this passage today that the patient is mocking Kraepelin and the medical profession while also pathetically appealing against the inhumanity of being placed before medical students as a specimen. Kraepelin, how-
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ever, sees none of the meaning of the insane person's words. He goes on:
Although he undoubtedly understood all the questions, he has not given us a single piece of useful information. His talk was . . . only a series of disconnected sentences having no relation to the general situation. As Laing sees it, Kraepelin's general inability to find meaning in the words of someone labeled a psychotic was due to the underlying objectification of the patient in the medical model and is exemplary of most current psychiatric practice.
Freud had gotten beyond the medical model at least partially by assuming significance to the words of neurotics (symptomatic significance), developing a practice of listening to them and a theory of the unconscious which registers the distorted meanings. Laing has tried to develop a parallel method for schizophrenia. What is interesting from the point of view of this study is that Laing has maintained that the only way to render intelligible the words of the schizophrenic is to place them in the context of the patient's family, to go to the family, study its interactions, to see how the patient is labeled and has a fixed place in the family network, to see how the patient responds to this place, internalizing it in distorted ways, struggling to escape from it yet caught in it, and finally to develop strategies to alter these pattern. Laing's success has not been perfect with regard to all of these tasks. He is surely weak on developing a theory and practice of the nonobjectifying therapist. But his achievement has been his ability to demonstrate in case studies how the schizophrenic is intelligible when placed in his family context.
It is difficult to convey here how convincingly schizophrenic experience becomes comprehensible when placed in the family context. To this end Lain has written many case studies (Sanity, Madness and the Family), reproduced the journals of schizophrenics (Politics of Experience), and reported on numerous cases throughout his
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writings. To give the reader some sense of how madness becomes intelligible when studied in relation to the person's family interactions, the case of David will be described briefly and schematically.
David is a nine-year-old diagnosed by a Child Guidance Clinic as "incipient schizophrenia." The boy has seen a psychiatrist and a social worker, who also interviewed the mother. Laing was called in and insisted on visiting the family at their home. The "trouble" with the boy, according to the mother, was that he was "out of control" he did what he wanted and went where he wanted. Laing discovered that the boy went habitually to a construction site to watch the workers, preferring this to going to school. It also became apparent that the mother viewed the boy as being just like her father, who, it turned out, would also disappear without notice from his home. To Lain , there was no schizophrenia here, only a boy's acting out the unconscious wishes of his mother; that is, being his grandfather and disobeying his mother by obeying her. But no one had looked at the setting, the social context of the "bizarre" behavior. Without studying the family the boy's actions would be interpreted individualistically, as stemming from unconscious fantasies (Freud) or as "abnormal behavior" requiring treatment such as drugs and confinement (psychiatry).
After deciding that the behavior can best be comprehended in the family context, the therapist must face the question of how to define this context. Laing has offered different definitions, using different theories at different times. Through the 1960s one constant thread in his work was an effort to define the "family nexus" as the heart of the problem. He sought a method to get at the way people in families are defined by their relationships. The family nexus was conceived as the particular pattern of relations specific to one family. Like Bateson, Laing's model was anti-individualist, but unlike Bateson Laing relied on Sartre's existentialism rather than on communications theory. In The Politics of Experience, Laing attempted to apply Sartre's categories from the Critique
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of Dialectical Reason to the family. The family was, seen as a group in which each member was defined by his relations with other members, by the manner in which each internalized the views of them held by others. These internalizations included an element of "violence," since the family as a group had to maintain its existence against dangers of dissolution. The family nexus, then, was "the 'entity' which has to be preserved in each person" so that the family may continue. Any effort to change the nexus would be treason and would be resisted by other family members. Laing was arguing that for any family to maintain itself a great deal of terror and violence was necessary because members had to deny continually, at a deeply internalized level, their freedom to change or to leave the family.
But nowhere in Laing's account was there an explanation for the terror of family relationships, nowhere was there an analysis of family structure which would indicate why family unity was won at so great a cost. If there is some truth in Laing's account of the family nexus, he would also have to show how it was built up historically in connection with the privatization of family life. The depth of interpersonal experience in the nuclear family, which Laing is describing in all its negative aspects, must be understood as part of a specific family structure which was formed in relation to the formation of a particular society. The profundity of emotional involvements in families is not something found in the same degree at all times and places. Only after the family was reduced to the conjugal unit, after work was removed from the household (not counting housework, of course), after the family severed its ties with the community-only after a wealth of historical change occurred did the level of emotional intensity described by Laing become actual. By viewing the family as a nexus of internalizations under the pressure of the dissolution of the group, Laing is taking Sartre's concept of the group without seeing the family as a special kind of group, requiring special concepts for analysis.
In a later book, The Politics of the Family, Laing, in his effort to analyze the family
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nexus, shifted metaphors from Sartre's to phenomenology to one of mapping, to an analysis of positions and locations. It is often overlooked that Laing's new method still was grounded in an attempt to make intelligible the internalized relations of the family; only now he would be more precise in his categories. The general problem with the nuclear family remained the same for him: in the emotionally tight space of the family, each member "attempts to regulate the inner life of the other in order to preserve his own." Laing was still maintaining that the fault with the nuclear family--and by implication, the ground for schizophrenia was a necessary over-intrusiveness by each member toward the others which is inherent in the structure of this type of family. Ironically, true privacy, the much-vaunted asset of the nuclear family, is not attained there. In nuclear families, parents claimed that they knew what was in their children's minds better than their children and children had difficulty forming their own separateness, their identity being locked up psychically with that of their parents. These confusions of inter-subjectivity became manifest during the child's efforts to separate himself from the family during adolescence and they tend, as Mitchell says, 53 to be more pronounced among girls because girls are allowed less independence in patriarchal culture than boys. Hence Laing's case studies concerned predominately adolescent girls.
In The Politics of the Family Laing began the task of distinguishing the typical experiences of the nuclear family. Most characteristic was the deadly game of "attributions," in which the parent would give an identity to a child: Sally is like her father, or her grandmother. The strategy of attributions is one of mind control: "To get someone to be what one wants him to be . . ." Laing regards attributions as
many times more powerful than orders (or other forms of coercion or persuasion) . . . When attributions have the function of instructions or injunctions, this function may be denied, giving rise to one type of mystification, akin to, or identical with, hypnotic suggestion. Hyp-
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nosis may be an experimental model of a naturally occurring phenomenon in many families . . . So, if I hypnotize you, I do not say, "I order you to feel cold." I indicate it is cold. You immediately feel cold. I think many children begin in a state like this.The trouble with attributions is that, coming from people so emotionally close, it is impossible or very difficult for the child to escape internalizing them. The child's own identity, own experience, own individuality becomes denied in favor of living the mask of the parent's attributions. Now as an ongoing, everyday experience, with no space to escape to, with the child's emotional and physical dependence on the parents, a system of interpersonal relations, of patterned dialogues is constructed gradually based on the bizarre projections and attributions of the parents. In some cases the attributions are so difficult for the child, involve so great a denial of self-when for example the child is a "black sheep" or a scapegoat for everything that goes wrong in the family---that he chooses what is called schizophrenia as an escape from the family nexus, although that usually only strengthens the balance of roles in the family. Schizophrenia for Laing is a type of getting Stuck between the family nexus and the way out, which only serves, from the point of view of the family, to confirm its pattern.
Three types of criticism must be raised against Laing. First, Laing states that the family nexus is unconscious. The family does not know what the situation or the nexus is. Yet he has no theory to account for this type of unconscious (which is very different from Freud's since it is social and interactional). Laing's work has stopped at the surface level: he has done important work in analyzing the structure of family interactions at the emotional level. But Laing is unable to account for the "absences" in family experience, the unconscious, invisible pattern. How is it possible for the therapist to map the family nexus and the family not to see it? Unless Laing can account for the dynamics of the family unconscious, he will not be able to specify the type of knowledge the therapist can attain and the type of intervention the therapist
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can attain and the type of intervention the therapist can make in the family. The fault rests with Laing's failure to get beyond the subjective level of interactions and account for the social structure of the family and the interpenetration of family and society.
This may become more clear when the second criticism is raised. In almost every case study he presents, Laing finds the mother to be the intrusive, attributing, projecting agent. But he does not try to explain this astonishing consistency of events. Why is it the mother who is the "covert schizophrenic" (Bateson) or the schizophregenic agent (Laing and others)? Of course, Laing does not want to blame the mother in a personal way, or even to isolate the mother as a unilinear, determining cause of disease. He wants to remain at the level of family structure and see the process as an interaction. But the crucial interaction turns out to be between the mother and her child (usually her daughter). We must ask, since Laing does not, is there anything in the social function, role and experience of the mother in nuclear families that would lead to the tendency to over-intrusiveness? Answers appear immediately and are related to patriarchy.
Motherhood, after all, is defined in the nuclear family in a unique way---as having the mother's identity connected with the well-being of her children. To a degree not found before in European or North American history, motherhood involves the constant supervision of children with a deep concern not simply for their physical growth and social skills but for their psychic health. Quite simply, when women were relegated to the home, one of their primary tasks was explicitly to supervise the minds of their children, to project into them to attribute to them, to influence them emotionally, and so forth. When it is recalled that women during the early years of their child's growth are restricted to a very queer, as Laing would say, life of total child care in almost complete isolation, it should not be too surprising that they develop deep attachments to their children and sometimes resist, with all their emotional strength, losing the child, losing their total involvement with the child as it matures to
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If the implication of Laing's work is that the schizophrenic is not so crazy and that his parents are rather crazy themselves, it must also be pointed out that the nuclear family requires parents, especially mothers, to perform functions that are rather "crazy" as well. None of the above is meant to imply that Laing's method of analyzing the family nexus at the intersubjective level (which has been sketched only barely) is invalid. Rather it must be supplemented with a historical and social analysis of family structure. And in this way Laing would not be led into the mysticism of schizophrenic experience, toward which he tends, but instead toward critical social theory.
The third criticism of Laing's notion of family nexus concerns his reliance on an absolute subject. The notion of attribution, involving the denial of the subjectivity of others, contains an important element of truth, but in Laing's formulation it tends (1) to assume that the person who is denied is a totally free, unitary presence and(2) to degenerate into an attack on roles. Laing takes over Sartre's concept of the free subject but he uses it in a metaphysical, not an ontological, a substantive and not a structural manner. He assumes that if the subject did not suffer the attribution he would be free, thereby the necessary interdependence of people and their relative subjectivity in mutual recognition is lost. The problem is not to free the subject from the other but so to structure their relations that each can recognize the place and desire of the other. Although at times Laing comes close to this formulation he tends too often to slide into a romantic individualism.
As a consequence, he also tends to attack not simply a particular social form, like attribution, but all social forms. This happens in part through his reliance on Erving Goffman and ethno-methodology, which pretends to see through all social "roles" as crude, secondary masks covering some true reality. The attribution foists a "role" on the child. Its danger, however, lies only in the reified manner in which the role is born. The problem lies not with roles but with their fixity, their inescapability, their class and
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patriarchal nature, their unitary quality. Laing forgets Sartre's maxim that the self is formed only in a situation, only by dealing with the roles and the meanings thrown at us by others. Bad faith for Sartre concerns not simply having a role, like a waiter, but the way the waiter relates to his role. No one can place an attribution on anyone else unless that person is complicit. The trouble with nuclear families, perhaps, is that their close intimacy tends to encourage the giving and receiving of roles which become fixed in the nexus.
Without relating the theory of the family nexus to family structure, Laing was left with the much-criticized resort of romanticizing the schizophrenic. He takes the side of the schizophrenic against his family and the medical establishment viewing the "disease" as a heroic pathway to health, as a natural healing process." It is certainly desirable that people labeled schizophrenic should be seen as human subjects, and that their experience should be treated as valid and perhaps as a necessary process of temporary regression, as something they must go through. But this process of internal flight, of loss of ego, in no way warrants being considered a superior and desirable mental state. Laing often lapses into a celebration of schizophrenics as the spiritual avant-garde of the twentieth century. Such a position undercuts any effort to develop a therapy for psychosis, suggesting instead that the therapist himself take flight into a schizophrenic voyage.
During the 1960s Laing and his colleagues did set up, under the auspices of the Philadelphia Association, a series of therapeutic communities based on the view of the schizophrenic as a spiritual voyager. In Kingsley Hall, the best known Laingian and "asylum," the therapists' role was eliminated, "inmates" explored their regression without hindrances. Here was a place where the patients were treated as subjects, with no hospital staff to objectify and harass them. If Laing is right what the schizophrenic needs is an accepting community where he can act in bizarre ways if necessary without suffering the methods of the mental-health industry. But what are
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the implications of Kingsley Hall for Laing's theory of the family nexus
and family therapy? Laing seems to have concluded that troubled families
cannot be "cured that schizophrenics must leave their families for the
unstructured therapeutic community.
An associate of Laing, David Cooper, in The Death of the Family, carries the concept of the family nexus to its logical political and social conclusions. The book, polemical and often violent in style, argues for the dissolution of nuclear families into communes as part of the revolution against capitalism. Cooper's politics turn out to be more anarchist than Marxist, advocating the emergence of total selves and free subjects against the mystifications of society. He outlines the "factors that operate within the family" as follows: (1) "gluing together of people based on their own incompleteness"; (2) "formation of roles . . . rather than . . . laying down of conditions for the free assumption of identity"; (3) instilling more social controls in children than are needed even in class society; (4) instilling an elaborate system of restrictive taboos in children. These "factors" follow directly from Laing's position. But Cooper goes on to claim that the family, not the economy and not politics, is the fundamental problem of society which must be solved first in the revolutionary process; he thus registers an esteem for the position of the family in society held only by ultra-conservatives. Cooper defines the commune as "a potential alternative form of microsocial organization" through which love can be diffused more widely throughout the community than with the nuclear family. Pairing of lovers might still exist in the Laingian utopia, but relations would not be cemented for life. Children, the main beneficiaries of the new society, would have "free access to adults beyond their biological parental couple." While in many ways attractive, Cooper's Fourierist vision does not relate family problems to wider social structures and does not indicate carefully enough the precise mechanisms of the nuclear family that need to be altered. The Death of the Family is a wild book which swings freely at everything the new left of the 1960s found objectionable with-
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out illuminating very much about the structural sources of discontent. A sure sign of analytic weakness, Cooper talks much about the horrors of the nuclear family without being able to account for the strength of its appeal. At bottom the theoretical problem in the book is that it assumes too quickly that after eliminating current oppressions a pure subject will emerge in a completely non-repressive society. But the glorification of schizophrenic non-repressiveness in Laing and Cooper bears the difficulties it has in Reich and more recently in Deleuze and Guattari: as I have noted above, human society requires a forming or shaping process which precludes any definition of freedom that relies on a pre-social base. The problem is not that society repressively institutes roles which destroy autonomy or the "free assumption of identity." It is rather that hierarchical authority prevents the collective regulation of life in which the needs and desires of all have an equal right to be recognized.
Despite all of these reservations, the theorists of family therapy offer
important contributions to a theory of the family. They define as
nowhere before the emotional system of the nuclear family. If they
do not relate their analysis to history and society they still provide
a basic understanding of the family which may be used in elaborating a
more adequate theory.