Illustrations from Clinical Data

An analysis of an incident occurring between a schizophrenic patient and his mother illustrates the double bind situation. A young man who had fairly well recovered from an acute schizophrenic episode was visited in the hospital by his mother. He was glad to see her and impulsively put his arm around her shoulders, whereupon she stiffened. He withdrew his arm and she asked, "Don't you love me any more?" He then blushed, and she said, "Dear, you must not be so easily embarrassed and afraid of your feelings." The patient was able to stay with her only a few minutes more and following her departure he assaulted an aide and was put in the tubs.

Obviously, this result could have been avoided if the young man had been able to say, "Mother, it is obvious that you become uncomfortable when I put my arm around you, and that you have difficulty accepting a gesture of affection from me." However, the schizophrenic patient doesn't have this possibility open to him. His intense dependency and training prevents him from commenting upon his mother's communicative behavior, though she comments on his and forces him to accept and to attempt to deal with the complicated sequence. The complications for the patient include the following:

(1) The mother's reaction of not accepting her son's affectionate gesture is masterfully covered up by her condemnation of him for withdrawing, and the patient denies his perception of the situation by accepting her condemnation.

(2) The statement "Don't you love me any more" in this context seems to imply:

(b) "You should love me and if you don't you are bad or at fault."

(c) "Whereas you did love me previously you don't any longer," and thus focus is shifted from his expressing affection to his inability to be affectionate. Since the patient has also hated her, she is on good ground here, and he responds appropriately with guilt, which she then attacks.

(d) "What you just expressed was not affection," and in order to accept this statement, the patient must deny what she and the culture have taught him about how one expresses affection. He must also question the times with her, and with

82 D. D. Jackson, "The Question of Family Homeostasis," presented at the American Psychiatric Association Meeting, St. Louis, May 7, 1954; also Jackson, "Some Factors Influencing the Oedipus Complex," Psychoanalytic Quarterly, 1954, 23: 566-81.

others, when he thought he was experiencing affection and when they seemed to treat the situation as if he had. He experiences here loss-of-support phenomena and is put in doubt about the reliability of past experience.

(3) The statement, "You must not be so easily embarrassed and afraid of your feelings," seems to imply:

(a) "You are not like me and are different from other nice or normal people because we express our feelings."

(b) "The feelings you express are all right, it's only that you can't accept them." However, if the stiffening on her part had indicated "These are unacceptable feelings," then the boy is told that he should not be embarrassed by unacceptable feelings. Since he has had a long training in what is and is not acceptable to both her and society, he again comes into conflict with the past. If he is unafraid of his own feelings (which mother implies is good), he should be unafraid of his affection and would then notice it was she who was afraid, but he must not notice that be-cause her whole approach is aimed at covering up this short-coming in herself.

The impossible dilemma thus becomes: "If I am to keep my tie to mother, I must not show her that I love her, but if I do not show her that I love her, then I will lose her."

The importance to the mother of her special method of control is strikingly illustrated by the interfamily situation of a young woman schizophrenic who greeted the therapist on their first meeting with the remark, "Mother had to get married and now I'm here." This statement meant to the therapist that:

(1) The patient was the result of an illegitimate pregnancy.

(2) This fact was related to her present psychosis (in her opinion).

(3) "Here" referred to the psychiatrist's office and to the patient's presence on earth for which she had to be eternally indebted to her mother, especially since her mother had sinned and suffered in order to bring her into the world.

(4) "Had to get married" referred to the shotgun nature of mother's wedding and to the mother's response to pressure that she must marry, and the reciprocal, that she resented the forced nature of the situation and blamed the patient for it.

Actually, all these suppositions subsequently proved to be factually correct and were corroborated by the mother during an abortive attempt at psychotherapy. The flavor of the mother's communications to the patient seemed essentially this: "I am lovable, loving, and satisfied with myself. You are lovable when you are like me and when you do what I say." At the same time the mother indicated to the daughter both by words and behavior: "You are physically delicate, unintelligent, and different from me (not normal'). You need me and me alone because of these handicaps, and I will take care of you and love you." Thus the patient's life was a series of beginnings, of attempts at experience, which would result in failure and withdrawal back to the maternal hearth and bosom because of the collusion between her and her mother.

It was noted in collaborative therapy that certain areas important to the mother's self-esteem were especially conflictual situations for the patient. For example, the mother needed the fiction that she was close to her family and that a deep love existed between her and her own mother. By analogy the relationship to the grandmother served as the prototype for the mother's relationship to her own daughter. On one occasion when the daughter was seven or eight years old, the grandmother in a rage threw a knife which barely missed the little girl. The mother said nothing to the grandmother but hurried the little girl from the room with the words, "Grandmommy really loves you." It is significant that the grandmother took the attitude to-ward the patient that she was not well enough controlled, and she used to chide her daughter for being too easy on the child. The grandmother was living in the house during one of the patient's psychotic episodes, and the girl took great delight in throwing various objects at the mother and grandmother while they cowered in fear.

Mother felt herself very attractive as a girl, and she felt that her daughter resembled her rather closely, although by damning with faint praise, it was obvious that she felt the daughter definitely ran second. One of the daughter's first acts during a psychotic period was to announce to her mother that she was going to cut off all her hair. She proceeded to do this while the mother pleaded with her to stop. Subsequently the mother would show a picture of herself as a girl and explain to people how the patient would look if she only had her beautiful hair.

The mother, apparently without awareness of the significance of what she was doing, would equate the daughter's illness with not being very bright and with some sort of organic brain difficulty. She would invariably contrast this with her own intelligence as demonstrated by her own scholastic record. She treated her daughter with a completely patronizing and placating manner which was insincere. For example, in the psychiatrist's presence she promised her daughter that she would not allow her to have further shock treatments, and as soon as the girl was out of the room she asked the doctor if he didn't feel she should be hospitalized and given electric shock treatments. One clue to this deceptive behavior arose during the mother's therapy. Although the daughter had had three previous hospitalizations, the mother had never mentioned to the doctors that she herself had had a psychotic episode when she discovered that she was pregnant. The family whisked her away to a small sanitarium in a nearby town, and she was, according to her own statement, strapped to a bed for six weeks. Her family did not visit her during this time, and no one except her parents and her sister knew that she was hospitalized.

There were two times during therapy when the mother showed intense emotion. One was in relating her own psychotic experience; the other was on the occasion of her last visit when she accused the therapist of trying to drive her crazy by forcing her to choose between her daughter and her husband. Against medical advice, she took her daughter out of therapy.

The father was as involved in the homeostatic aspects of the intrafamily situation as the mother. For example, he stated that he had to quit his position as an important attorney in order to bring his daughter to an area where competent psychiatric help was available. Subsequently, acting on cues from the patient (e.g., she frequently referred to a character named "Nervous Ned"), the therapist was able to elicit from him that he had hated his job and for years had been trying to "get out from under." However, the daughter was made to feel that the move was initiated for her.

On the basis of our examination of the clinical data, we have been impressed by a number of observations including:

(1) The helplessness, fear, exasperation, and rage which a double bind situation provokes in the patient, but which the mother may serenely and un-understandingly pass over. We have noted reactions in the father that both create double bind situations, or extend and amplify those created by the mother, and we have seen the father, passive and outraged, but helpless, become ensnared in a similar manner to the patient.

(2) The psychosis seems, in part, a way of dealing with double bind situations to overcome their inhibiting and con-trolling effect. The psychotic patient may make astute, pithy, often metaphorical remarks that reveal an insight into the forces binding him. Contrariwise, he may become rather expert in setting double bind situations himself.

(3) According to our theory, the communication situation described is essential to the mother's security, and by inference to the family homeostasis. If this be so, then when psychotherapy of the patient helps him become less vulnerable to mother's attempts at control, anxiety will be produced in the mother. Similarly, if the therapist interprets to the mother the dynamics of the situation she is setting up with the patient, this should produce an anxiety response in her. Our impression is that when there is a perduring contact between patient and family (especially when the patient lives at home during psychotherapy), this leads to a disturbance (often severe) in the mother and sometimes in both mother and father and other siblings. 83

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