Theodore Lidz

Schizophrenia and the family.

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Ego Differentiation and Schizophrenic Symptom Formation in Identical Twins

OR THE PAST seven years we have been studying intensively the intrafamilial environment in which sixteen schizophrenic paF tients had been raised. The methodology and a number of findings of the study have been reported elsewhere (4,5, 14-18). Among the patients was an identical twin whose co-twin became extremely disturbed immediately after the patient was hospitalized. The patient was treated in the Yale Psychiatric Institute and continued in analytically oriented psychotherapy after discharge, while his twin managed to remain at home receiving analytically oriented treatment from a therapist who kept detailed process notes of each sessi0n.l The parents and an older brother were interviewed repeatedly, and the interaction among family members was observed closely. All five members of the family were given a battery of projective tests. The study of these twins, together with all of the other members of the family, and the intrafamilial environment they created, permitted a unique opportunity to examine the special problems of ego development confronting twins and the impact of the family dynamics in shaping the personalities and the pathology of these twins in particular. We believe that if we wish

The family, language, and the transmission of schizophrenia

IT HAS long been my belief that our understanding of the nature and etiology of schizophrenia has been blocked by the deficiencies in our grasp of personality development and integration. At the recent international conference on the etiology of schizophrenia in Rochester, I tried to convey in broad outline an approach to both personality development and to the study of schizophrenia that seems-to me-to take into account our current knowledge and also provides hypotheses to direct future studies (Lidz, 1967). I do not wish to repeat what many at this Conference heard in Rochester. The essence of what I said is simple and may even seem obvious to some. For an infant to grow up-even one that is properly endowed genetically-and develop into a reasonably well-integrated and competent individual, he requires positive direction and guidance in a suitable interpersonal environment and social system. However, the developmental theories used in psychiatry, including psychoanalytic theory, implicitly or explicitly consider that a normal infant will develop into a functioning and reasonably stable adult as a concomitant of his physical maturation unless he receives very faulty nurturance in his first few years, or he is seriously traumatized. Indeed, innate sources of libidinal fixation-unknown and undemonstrated but readily hypothesized-are invoked as explanations of various types of psychopathology by analytically oriented psychiatrists as readily as other psychiatrists fall back on hypothetical genetic anomalies and metabolic impairments of brain functioning in schizophrenia. The extent and complexity of the positive forces required to mold the personality and equip the child with essential adaptive techniques have largely been overlooked because they are built into the institutions and mores of all societies which could not survive if they were not-and into the omnipresent family which everywhere has the implicit task of carrying out the basic socialization and enculturation of the new generation. Man’s biological make-up requires that he grow up in a family-or some planned substitute for it-not simply for his protection and nurture during his lengthy immaturity, but to be directed into an integrated person who possesses the techniques, knowledge, and roIes he requires for survival and for adaptation in that physical and social environment in which he happens to grow up. I discussed the requisites that the family must provide a child under four overlapping and somewhat arbitrary headings. 1. The parental nurturant functions: how parents must meet the child’s changing needs and supplement his immature capacities in a different manner at each phase of his development. The influence of the nature of the nurture on the individual’s emotional

The Developing Guidelines to the Psychotherapy of Schizophrenia

The past decade has not been felicitous for the psychotherapy of schizophrenic disorders. Indeed, it is being taught in so few places that there is danger that the light will go out, and that the knowledge and skills that had gradually been accumulated will be lost. The reasons are not difficult to find. The major hope for overcoming this great destroyer of the mind and spirit has been placed in psychopharmacology and in advances in our knowledge of the neurochemistry of the brain. Studies of adopted-away children have supposedly produced incontrovertible evidence that we are dealing with a disorder whose etiology is basically genetic. Economics and politics have led to the dispersion of schizophrenic patients into dilapidated hotels and boarding houses, straitjacketed by drugs so that they create little problem for society. Experiments with so-called long-term intensive psychotherapy, carried out for all of six months, and other studies of the results of the work of relatively untrained therapists, have been used to indicate that though psychotherapy may be helpful, it is hardly worth the time and expense. But now times may be changing. Neuroleptic drugs, though useful when properly administered, have not provided an answer, and, when used in heavy dosages for long periods of time, they may impede chances for improvement or recovery. The mounting incidence of tardive dyskinesias is forcing a reconsideration of prolonged pharmacotherapy.

Family studies and changing concepts of personality development.

Summary Many of the most significant changes in concepts of personality development and maldevelopment derive simply from belated appreciation that the child grows up in a family; and that the child requires considerable positive input from those who raise him to grow into a reasonably integrated person. Only recently have psychiatrists and psychoanalysts begun to focus on the influence of the family transactions throughout the formative years. The paper briefly presents the requisites a family must provide to assure the integrated development of its offspring and groups them under four headings: the parental nurturant functions that change with each phase of the offsprings development; the influence of the dynamic organization of the family on the offsprings intrapsychic structure, affecting self-boundaries, gender identity, superego directives, and so forth; conveying through family transactions the basic social roles and societal institutions to the child; transmitting the instrumental techniques of the culture, and particularly its language with its system of meanings and logic upon which virtually all ego functioning depends. The paper considers the evidence that the “choice of the neurosis” — or more correctly, the choice of the psychiatric syndrome — does not depend only upon fixation at various phases of pre-genital development, but also, and perhaps primarily, upon the panphasic influence of the intrafamilial environment. It is of particular importance to recognize that there is a very direct relationship between the family transactions, the separation-individuation process, boundary formation, the attainment of various degrees of object constancy, problems of splitting, superego directives, and what can be conscious and what need be repressed into the unconscious. The failure to recognize the import of the family has interfered with the formation of an integrated developmental theory that can unite various aspects of the developmental process that have remained more or less isolated from one another — drive theory, object relations, ego psychology, separation-individuation, and cognitive development. Finally the question is raised if in providing guidance to parents we have been amiss in not focusing on such matters as who the parents are, how they relate to one another as well as to the child, the values they communicate by their behaviour — matters that are fundamental and to which almost all else is secondary, but about which relatively little has been said or taught.

Weibliches in Männliches verwandeln: Männlichkeitsrituale in Papua Neuguinea

Bei der Untersuchung derjenigen Zeitspanne in der Kindheit, die sie den odipalen Ubergang nannte, konzentrierte sich die Psychoanalyse vornehmlich auf die Rivalitat zwischen Vater und Sohn um die Mutter. Bis vor kurzem wurde noch den Problemen der mannlichen Entwicklung, die durch die anfangliche Identifikation des kleinen Jungen mit seiner Mutter entstehen, wenig Beachtung geschenkt (Greenson 1966; Lidz u. Lidz 1977, 1984; Stoller 1966, 1968, 1974). In Ubereinstimmung mit derjenigen Kultur, innerhalb derer sie sich entwickelte, ist die Psychoanalyse im allgemeinen davon ausgegangen, das der Besitz eines Penis ausreichte, um die Entwicklung des Jungen zum Mann zu gewahrleisten. Madchen und Frauen hingegen wurden am Penisneid leiden und hatten Schwierigkeiten mit der Akzeptanz ihrer weiblichen Identitat. Freud dachte, das die Entwicklung eines Madchens komplizierter sei als die eines Jimgen, weil sie die anfangliche Besetzung des Liebesobjekts von einer Frau auf einen Mann, von ihrer Mutter auf ihren Vater, ubertragen musse, wahrend der Junge seine Bindung an das weibliche Objekt beibehalten konne.

Patients whose children became schizophrenic.

Several critics of the theory of the importance of the family environment in the etiology of schizophrenic disorders claim and have sought to prove that the disturbance of family transactions and communications demonstrated by Lidz et al. (Lidz, T., Cornelison, A., Fleck, S., et al. The intrafamilial environment of the schizophrenic patient: VI. The transmission of irrationality. AMA Arch. Neurol. Psychiatry, 79: 305–316, 1958), Wynne and Singer (Wynne, L. C., and Singer, M. T. Thought disorder and family relations of schizophrenics: II. A classification of forms of thinking. Arch. Gen. Psychiatry, 9: 199–206, 1963; Singer, M. T., and Wynne, L. C. Thought disorder and family relations of schizophrenics: IV. Results and implications. Arch. Gen. Psychiatry, 12: 201–212, 1965), and others derive from the presence of and concerns about the schizophrenic offspring. The author knows that three of his former nonpsychotic patients each had a child who later became schizophrenic. Two of the three were seen during his residency before his formulation of any hypothesis concerning the intrafamilial environment of schizophrenic patients. The cases reinforce the retrospective findings (Lidz, T., Fleck, S., and Cornelison, A. Schizophrenia and the Family. International Universities Press, New York, 1965) that the marriages of the parents and the family environments were seriously disturbed before the onset of a schizophrenic disorder in an offspring.

Book Reviews: Anxious Pleasures: The Sexual Lives of an Amazonian People

I n his aptly titled book, the author provides it study of the sexual lives of the pcople of hlehinaku, a village of thc Amazonian Xingu tribe. The well-written atid readily readable book liolds considerable significance for psychoanalysts as well as anthropologists, particularly for thc following reasons. The book portrays a small society that not only permits extramarital promiscuity to ;in extent perhaps never before rccorded, but the promiscuity promotes ratlicr tlian disrupts tlic societal integration. I t records how, despite the striking male dominance and the multiple liaisons in which the men are engaged, the nicn have ;in underlying fear of worncn and their sexuality. This work attributes the anxieties, as have other recent studies, to men’s residual core feminine idcntity derived from thc child’s primary identification witli the rnotlicr. Another reason, which Gregor does not emphasize or fully appreciate, is the marked similarity of a number of rather unusual beliefs and practices of tlicse South American Indians to those of various tribcs in I’apua New Guinca-two peoples about as geographically remote from one anothcr as possible, and from such different cultural lines that an explanation of the similarities by cultural diffusion would have to go back at least 25,000 to 30,000 ycars, almost to the cvolution of Homo sapiens. The hfehinaku arc extremcly open about sexuality, both in behavior and discussion. Little is hidden from children who may follow a parent o u t of the village to watch the sexual act; recount, not without pride, the numbcr and idcntity of a parent’s lovers; and thcmselves engage in intercourse some years before puberty. Marriage supposedly provides exclusive sexual rights to the partncrs, but both men arid women soon engage in an extensive network of liaisons. Husbands are usually only possessive and jealous early in the marriage. Although