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Toward a Theory of Schizophrenia
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Melissa Bridges
March 12, 2015
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Toward a Theory of Schizophrenia
1 TOWARD A THEORY OF SCHIZOPHRENIA by Gregory Bateson, Don D. Jackson, Jay Haley, and John Weakland, Veterans Administration Hospital, Palo Alto, CaliIornia; and StanIord University Behavioral Science |1956| 1(4): 251-254. Schizophrenia--its nature, etiology, and the kind oI therapy to use Ior it--remains one oI the most puzzling oI the mental illnesses. The theory oI schizophrenia presented here is based on communications analysis, and speciIically on the Theory oI Logical Types. From this theory and Irom observations oI schizophrenic patients is derived a description, and the necessary conditions Ior, a situation called the "double bind"--a situation in which no matter what a person does, he "can't win." It is hypothesized that a person caught in the double bind may develop schizophrenic symptoms. How and why the double bind may arise in a Iamily situation is discussed, together with illustrations Irom clinical and experimental data. This is a report on a research project which has been Iormulating and testing broad, systematic view oI the nature, etiology, and therapy oI schizophrenia. Our research in this Iield has proceeded by discussion oI a varied body oI data and ideas, with all oI us contributing according to our varied experience in anthropology, communications analysis, psychotherapy, psychiatry, and psychoanalysis. We have none reached common agreement on the broad outlines oI a communicational theory oI the origin and nature oI schizophrenia; this paper is a preliminary report on our continuing research. THE BASE IN COMMUNICATIONS THEORY Our approach is based on that part oI communications theory which Russell has called the Theory oI Logical Types (17). The central thesis oI this theory is that there is a discontinuity between a class and its members. The class cannot be a member oI itselI nor can one oI the members be the class, since the term used Ior the class is oI a diIIerent level oI abstraction--a diIIerent Logical Type--Irom terms used Ior members. Although in Iormal logic there is an attempt to maintain this discontinuity between a class and its members, we argue that in the psychology oI real communications this discontinuity is continually and inevitably breached (2), and that a priori we must expect a pathology to occur in the human organism when certain Iormal patterns oI the breaching occur in the communication between mother and child. We shall argue that this pathology at its extreme will have symptoms whose Iormal characteristics would lead the pathology to be classiIied as schizophrenia. Illustrations oI how human beings handle communication involving multiple Logical Types can be derived Irom the Iollowing Iields: 1. The use of various communicational modes in human communication. Examples are play, non-play, Iantasy, sacrament, metaphor, etc. Even among the lower mammals there appears to be an exchange oI signals which identiIy certain meaningIul behavior Ior as "play," etc.2 These signals are evidently oI higher Logical Type than the messages they classiIy. Among human beings this Iraming and labeling oI messages 2 and meaningIul actions reaches considerable complexity, with the peculiarity that our vocabulary Ior such discrimination is still very poorly developed, and we rely preponderantly upon nonverbal media oI posture, gesture, Iacial expression, intonation, and the context Ior the communication oI these highly abstract, but vitally important, labels. 2. Humor. This seems to be a method oI exploring the implicit themes in thought or in a relationship. The method oI exploration involves the use oI messages which are characterized by a condensation oI Logical Types or communicational modes. A discovery, Ior example, occurs when it suddenly becomes plain that a message was not only metaphoric but also more literal, or vice versa. That is to say, the explosive moment in humor is the moment when the labeling oI the mode undergoes a dissolution and resynthesis. Commonly, the punch line compels a re-evaluation oI earlier signals which ascribed to certain messages a particular mode (e.g., literalness or Iantasy). This has the peculiar eIIect oI attributing mode to those signals which had previously the status oI that higher Logical Type which classiIies the modes. 3. The falsification of mode-identifying signals. Among human beings mode identiIiers can be IalsiIied, and we have the artiIicial laugh, the manipulative simulation oI Iriendliness, the conIidence trick, kidding, and the like. Similar IalsiIications have been recorded among mammals (3, 13). Among human beings we meet with a strange phenomenon--the unconscious IalsiIication oI these signals. This may occur within the selI--the subject may conceal Irom himselI his own real hostility under the guise oI metaphoric play--or it may occur as an unconscious IalsiIication oI the subjects understanding oI the other person's mode identiIying signals. He may mistake shyness Ior contempt, etc. Indeed most oI the errors oI selI-reIerence Iall under this head. 4. Learning. The simplest level oI-this phenomenon is exempliIied by a situation in which a subject receives a message and acts appropriately on it: "I heard the clock strike and knew it was time Ior lunch. So I went to the table." In learning experiment the analogue oI this sequence oI events is observed by the experimenter and commonly treated as a single message oI a higher type. When the dog salivates between buzzer and meat powder, this sequence is accepted by the experimenter as a message indicating that "the dog has learned that buzzer means meat powder." But this is not the end oI the hierarchy oI types involved. The experimental subject may become more skilled in learning. He may learn to learn (1, 7, 9), and it is not inconceivable that still higher orders oI learning may occur in human beings. 5. Multiple levels of learning and the Logical Typing of signals. These are two inseparable sets oI phenomena--inseparable because the ability to handle the multiple types oI signals is itselI a learned skill and thereIore a Iunction oI the multiple levels oI learning. According to our hypothesis, the tern "ego Iunction" (as this term is used when a schizophrenic is described as having "weak ego Iunction") is precisely the process oI discriminating communicational modes either within the selI or between the selI and others The 3 schizophrenic exhibits weakness in three areas oI such Iunction: (a) He has diIIiculty in assigning the correct communicational mode to the messages he receives Irom other persons. (b) He has diIIiculty in assigning the correct communicational mode to those messages which he himselI utters or emits nonverbally. (c) He has diIIiculty in assigning the correct communicational mode to his own thoughts, sensations, and percepts. At this point it is appropriate to compare what Divas said in the previous paragraph with von Domarus' (16) approach to the systematic description oI schizophrenic utterance. He suggests that the messages (and thought) oI the schizophrenic are deviant in syllogistic structure. In place oI structures which derive Irom the syllogism, Barbara, the schizophrenic, according to this theory, uses structures which identiIy predicates. An example oI such a distorted syllogism is: Men die. Grass dies. Men are grass. But as we see it, Von Domarus' Iormulation is only a more precise--and thereIore valuable--way oI saying that schizophrenic utterance is rich in metaphor. With that generalization we agree. But metaphor is an indispensable tool oI thought and expression--a characteristic oI all human communication, even oI that oI the scientist. The conceptual models oI cybernetics and the energy theories oI psychoanalysis are, aIter all, only labeled metaphors. The peculiarity oI the schizophrenic is not that he uses metaphors, but that he uses unlabeled metaphors. He has special diIIiculty in handling signals oI that class whose members assign Logical Types to other signals. II our Iormal summary oI the symptomatology is correct and iI the schizophrenia oI our hypothesis is essentially a result oI Iamily interaction, it should be possible to arrive a priori at a Iormal description oI these sequences oI experience which would induce such a symptomatology. What is known oI learning theory combines with the evident Iact that human beings use context as a guide Ior mode discrimination. ThereIore, we must look not Ior some speciIic traumatic experience in the inIantile etiology but rather Ior characteristic sequential patterns. The speciIicity Ior which we search is to be at an abstract or Iormal level. The sequences must have this characteristic: that Irom them the patient will acquire the mental habits which are exempliIied in schizophrenic communication. That is to say, he must live in a universe where the sequences oI events are such that his unconventional communicational habits will be in some sense appropriate. The hypothesis which we oIIer is that sequences oI this kind in the external experience oI the patient are responsible Ior the inner conIlicts oI Logical Typing. For such unresolvable sequences oI experiences, we use the term "double bind." The double bind The necessary ingredients Ior a double bind situation, as we see it, are: 1. Two or more persons. OI these, we designate one, Ior purposes oI our deIinition, as the "victim." We do not assume that the double bind is inIlicted by the mother alone, 4 but that it may be done either by mother alone or by some combinations oI mother, Iather, and/or siblings. 2. Repeated experience. We assume that the double bind is a recurrent theme in the experience oI the victim. Our hypothesis does not invoke a single traumatic experience, but such repeated experience that the double bind structure comes to be a habitual expectation. 3. A primary negative injunction. This may have either oI two Iorms: (a) Do not do so and so, or I will punish you," or (b) "II you do not do so and so, I will punish you." Here we select a context oI learning based on avoidance oI punishment rather than a context oI reward seeking. There is perhaps no Iormal reason Ior this selection. We assume that the punishment may be either the withdrawal oI love or the expression oI hate or anger--or most devastating--the kind oI abandonment that results Irom the parent's expression oI extreme helpless- ness.|3| 4. A secondary injunction conflicting with the first at a more abstract level, and like the Iirst enIorced by punishments or signals which threaten survival. This secondary injunction is more diIIicult to describe than the primary Ior two reasons. First, the secondary injunction is commonly communicated to the child by nonverbal means. Posture, gesture, tone oI voice, meaningIul action, and the implications concealed in verbal comment may all be used to convey this more abstract message. Second, the secondary injunction may impinge upon any element oI the primary prohibition. Verbalization oI the secondary injunction may, thereIore, include a wide variety oI Iorms; Ior example, "Do not see this as punishment"; "Do not see me as the punishing agent"; "Do not submit to my prohibitions"; "Do not think oI what you must not do"; "Do not question my love oI which the primary prohibition is (or is not) an example"; and so on. Other examples become possible when the double bind is inIlicted not by one individual but by two. For example, one parent may negate at a more abstract level the injunctions oI the other. 5. A tertiary negative injunction prohibiting the victim Irom escaping Irom the Iield. In a Iormal sense it is perhaps unnecessary to list this injunction as a separate item since the reinIorcement at the other two levels involves a threat to survival, and iI the double binds are imposed during inIancy, escape is naturally impossible. However, it seems that in some cases the escape Irom the Iield is made impossible by certain devices which are not purely negative, e.g., capricious promises oI love, and the like. 6. Finally, the complete set of ingredients is no longer necessary when the victim has learned to perceive his universe in double bind patterns. Almost any part oI a double bind sequence may then be suIIicient to precipitate panic or rage. The pattern oI conIlicting injunctions may even be taken over by hallucinatory voices (14). The effect of the double bind 5 In the Eastern religion, Zen Buddhism, the goal is to achieve Enlightenment. The Zen Master attempts to bring about enlightenment in his pupil in various ways. One oI the things he does is to hold a stick over the pupil's head and say Iiercely, "II you say this stick is real, I will strike you with it. II you say this stick is not real, I will strike you with it. II you don't say anything, I will strike you with it." We Ieel that the schizophrenic Iinds himselI continually in the same situation as the pupil but he achieves something like disorientation rather than enlightenment. The Zen pupil might reach up and take the stick away Irom the Master--who might accept this response, but the schizophrenic has no such choice since with him there is no not caring about the relationship, and his mother's aims and awareness are not like the Master's. We hypothesize that there will be a breakdown in any individual's ability to discriminate between Logical Types whenever a double bind situation occurs. The general characteristics oI this situation are the Iollowing: 1. When the individual is involved in an intense relationship; that is, a relationship in which he Ieels it is vitally important that he discriminate accurately what sort oI message is being communicated so that he may respond appropriately. 2. And, the individual is caught in a situation in which the other person in the relationship is expressing two orders oI message and one oI these denies the other. 3. And, the individual is unable to comment on the messages being expressed to correct his discrimination oI what order oI message to respond to, i.e., he cannot make a metacommunicative statement. We have suggested that this is the sort oI situation which occurs between the pre- schizophrenic and his mother, but it also occurs in normal relationships. When a person is caught in a double bind situation he will respond deIensively in a manner similar to the schizophrenic. An individual will take a metaphorical statement literally when he is in a: situation where he must respond, where he is Iaced with contradictory messages, and when he is unable to comment on the contradictions. For example, one day an employee went home during oIIice hours. A Iellow employee called him at his home, and said lightly, "Well, how did you get there?" The employee replied, "By automobile." He responded literally because he was Iaced with a message which asked him what he was doing at home when he should have been at the oIIice, but which denied that this question was being asked by the way it was phrased. (Since the speaker Ielt it wasn't really his business, he spoke, metaphorically.) The relationship was intense enough so that the victim was in doubt how the inIormation would be used, and he thereIore responded literally. This is characteristic oI anyone who Ieels "on the spot," as demonstrated by the careIul literal replies oI a witness on the stand in a court trial. The schizophrenic Ieels so terribly on the spot at all times that he habitually responds with a deIensive insistence on the literal level when it is quite inappropriate, e.g., when someone is joking. Schizophrenics also conIuse the literal and metaphoric in their own utterance when they Ieel themselves caught in a double bind. For example, a patient may wish to criticize his therapist Ior being late Ior an appointment but he may be unsure what sort oI a message that act oI being late was--particularly iI the therapist has anticipated the patient's reaction and apologized Ior the 6 event. The patient cannot say, Why were you late? Is it because you don't want to see me today?" This would be an accusation, and so he shiIts to a metaphorical statement. He may then say, "I knew a Iellow once who missed a boat, his name was Sam and the boat almost sunk, . . . etc.," Thus he develops a metaphorical story and the therapist may or may not discover in it a comment on his being late. The convenient thing about a metaphor is that it leaves it up to the therapist (or mother) to see an accusation in the statement iI he chooses, or to ignore it iI he chooses. Should the therapist accept the accusation in the metaphor, then the patient can accept the statement he has made about Sam as metaphorical. II the therapist points out that this doesn't sound like a true statements about Sam, as a way oI avoiding the accusation in the story, the patient can argue that there really was a man named Sam. As an answer to the double bind situation, a shiIt to a metaphorical statement brings saIety. However, it also prevents the patient Irom making the accusation he wants to make. But instead oI getting over lets accusation by indicating that this is a metaphor, the schizophrenic patient seems to try to get over the Iact that it is a metaphor by making it more Iantastic. II the therapist should ignore the accusation in the story about Sam, the schizophrenic may then tell a story about going to Mars in a rocket ship as a way oI putting over his accusation. The indication that it is a metaphorical statement lies in the Iantastic aspect oI the metaphor, not in the signals which usually accompany metaphors to tell the listener that a metaphor is being used. It is not only saIer Ior the victim oI a double bind to shiIt to a metaphorical order oI message, but in an impossible situation it is better to shiIt and become somebody else, or shiIt and insist that he is somewhere, else. Then the double bind cannot work on the victim, because it isn't he and besides he is in a diIIerent place. In other words, the statements which show that a patient is disoriented can be interpreted as ways oI deIending himselI against the situation he is in. The pathology enters when the victim himselI either does not know that his responses are metaphorical or cannot say so. To recognize that he was speaking metaphorically he would need to be aware that he was deIending himselI and thereIore was aIraid oI the other person. To him such an awareness would be an indictment oI the other person and thereIore provoke disaster. II an individual has spent his liIe in the kind oI double bind relationship described here, his way oI relating to people aIter a psychotic break would have a systematic pattern. First he would not share with normal people those signals which accompany messages to indicate what a person means. His metacommunicative system-- the communications about communication -- would have broken down, and he would not know what kind oI message a message was. II a person said to him, "What would you like to do today?" he would be unable to judge accurately by the context or by the tone oI voice or gesture whether he was being condemned Ior what he did yesterday, or being oIIered a sexual invitation, or just what was meant. Given this inability to judge accurately what a person really means and an excessive concern wish' what is really meant, an individual might deIend himselI by choosing one or more oI several alternatives. He might, Ior example. assume that behind every statement is a concealed meaning which is detrimental to his welIare. He would then be excessively concerned with hidden meanings and determined to demonstrate that he could not be deceived --as he had been all his liIe. II he chooses this alternative, he will be continually searching Ior meanings behind what people say and behind chance occurrences in the environment, and he will be characteristically suspicious and deIiant. 7 He might choose another alternative, and tend to accept literally everything people say to him; when their tone or gesture or context contradicted what they said, he might establish a pattern oI laughing oII these metacommunicative signals. He would give up trying to discriminate between levels oI message and treat all messages as unimportant or to be laughed at. II he didn't become suspicious oI metacommunicative messages or attempt to laugh them oII, he might choose to try to ignore them. Then he would Iind it necessary to see and hear less and less oI what went on around him, and do his utmost to avoid provoking a response in his environment. He would try to detach his interest Irom the external world and concentrate on his own internal processes and, thereIore, give the appearance oI being a withdrawn, perhaps mute, individual. This is another way oI saying that iI an individual doesn't know what sort oI message a message is, he may deIend himselI in ways which have been described as paranoid, hebephrenic, or catatonic. These three alternatives are not the only ones. The point is that he cannot choose the one alternative which would help him to discover what people mean; he cannot, without considerable help, discuss the messages oI others. Without being able to do that, the human being is like any selI-correcting system which has lost its governor; it spirals into never-ending, but always systematic, distortions. A DESCRIPTION OF THE FAMILY SITUATION The theoretical possibility oI double bind situations stimulated us to look Ior such communication sequences in the schizophrenic patient and in his Iamily situation. Toward this end we have studied the written and verbal reports oI psychotherapists who have treated such patients intensively; have studied tape recordings oI psychotherapeutic interviews, both oI our own patients and others; we have interviewed and taped parents oI schizophrenics; we have had two mothers and one Iather participate in intensive psychotherapy; and we have interviewed and taped parents and patients seen conjointly. On the basis oI these data we have developed a hypothesis about the Iamily situation which ultimately leads to an individual suIIering Irom schizophrenia. This hypothesis has not been statistically tested; it selects and emphasizes a rather simple set oI interactional phenomena and does not attempt to describe comprehensively the extraordinary complexity oI a Iamily relationship. We hypothesize that the Iamily situation oI the schizophrenic has the Iollowing general characteristics: 1. A child whose mother becomes anxious and withdraws iI the child responds to her as a loving mother. That is, the child's very existence has a special meaning to the mother which arouses her anxiety and hostility when she is in danger oI intimate contact with the child. 2. A mother to whom Ieelings oI anxiety and hostility toward the child are not acceptable, and whose way oI denying them is to express overt loving behavior to persuade the 8 child to respond to her as a loving mother and to withdraw Irom him iI he does not. "Loving behavior" does not necessarily imply "aIIection"; it can, Ior example, be set in a Iramework oI doing the proper thing, instilling "goodness," and the like. 3. The absence oI anyone in the Iamily, such as a strong and insightIul Iather, who can intervene in the relationship between the mother and child and support the child in the Iace oI the contradictions involved. Since this is a Iormal description we are not speciIically concerned with why the mother Ieels this way about the child, but we suggest that she could Ieel this way Ior various reasons. It may be that merely having child arouses anxiety about herselI and her relationships to her own Iamily; or it may be important to her that the child is a boy or a girl, or that the child was born on the anniversary oI one oI her own siblings(8), or the child may be in the same sibling position in the Iamily that she was, or the child may be special to her Ior other reasons related to her own emotional problems. Given a situation with these characteristics' we hypothesize that the mother oI a schizophrenic will be simultaneously expressing at least two orders oI message. (For simplicity in this presentation we shall conIine ourselves to two orders.) These orders oI message can be roughly characterized as (a) hostile or withdrawing behavior which is aroused whenever the child approaches her, and (b) simulated loving or approaching behavior which is aroused when the child responds to her hostile and withdrawing behavior, as a way oI denying that she is withdrawing. Her problem is to control her anxiety by controlling the closeness Iind distance between herselI and her child. To put this another way, iI the mother begins to Ieel aIIectionate and close to her child she begins to Ieel endangered and must withdraw Irom him; but she cannot accept this hostile act and to deny it must simulate aIIection and closeness with her child. The important point is that her loving behavior is then a comment on (since it is compensatory Ior) her hostile behavior and consequently it is oI a diIIerent order oI message than the hostile behavior--it is a message about a sequence oI messages. Yet by its nature it denies the existence oI those messages which it is about, i.e., the hostile withdrawal. The mother uses the child's responses to aIIirm that her behavior is loving, and since the loving behavior is simulated, the child is placed in a position where he must not accurately interpret her communication iI he is to maintain his relationship with her. In other words, he must not discriminate accurately between orders oI message, in this case the diIIerence between the expression oI simulated Ieelings (one Logical Type) and real Ieelings (another Logical Type). As a result the child must systematically distort his perception oI metacommunicative signals. For example, iI mother begins to Ieel hostile (or aIIectionate) toward her c child and also Ieels compelled to withdraw Irom him, she might say, "Go to bed, you're very tired and I want you to get your sleep." This overtly loving statement is intended to deny a Ieeling which could be verbalized as "Get out oI my sight because I'm sick oI you." II the child correctly discriminates her metacommunicative signals, he would have to Iace the Iact that she both doesn't want him and is deceiving him by her loving behavior. He would be "punished" Ior learning to discriminate orders oI messages accurately. He thereIore would tend to accept the idea that he is tired rather than recognize his mother's deception. This means that he must deceive himselI about his own internal state in order to support mother in her deception. To survive with her he must 9 Ialsely discriminate his own internal messages as well as Ialsely discriminate the messages oI others. The problem is compounded Ior the child because the mother is "benevolently" deIining Ior him how he Ieels; she is expressing, overt maternal concern over the Iact that he is tired. To put it another way, the mother is controlling the child's deIinitions oI his own messages, as well as the deIinition oI his responses to her (e.g., by saying, "You don't really mean to say that," iI he should criticize her) by insisting that she is not concerned about herselI but only about him. Consequently, the easiest path Ior the child is to accept mother's simulated loving behavior as real, and his desires to interpret what is going on are undermined. Yet the result is that the mother is withdrawing Irom him and deIining this withdrawal as the way a loving relationship should be. However, accepting mother's simulated loving behavior as real also is no solution Ior the child. Should he make this Ialse discrimination, he would approach her; this move toward closeness would provoke in her Ieelings oI Iear and helplessness, and she would be compelled to withdraw. But iI he then withdrew Irom her she would take his withdrawal as a statement that she was not a loving mother and would either punish him Ior withdrawing or approach him to bring him closer. II he then approached, she would respond by putting him at distance. The child is punished Ior discriminating accurately what she is expressing, and he is punished Ior discriminating inaccurately--he is caught in a double bind. The child might try various means oI escaping Irom this situation. He might, Ior example, try to lean on his Iather or some other member oI the Iamily. However, Irom our preliminary observations we think it is likely that the Iathers oI schizophrenics are not substantial enough to lean on. They are also in the awkward position where iI they agreed with the child about the nature oI mother's deceptions, they would need to recognize the nature oI their own relationships to the mother, which they could not do and remain attached to her in the modus operandi they have worked out. The need oI the mother to be wanted and loved also prevents the child Irom gaining support Irom some other person in the environment, a teacher, Ior example. A mother with these characteristics would Ieel threatened by any other attachment oI the child and would break it up and bring the child back closer to her with consequent anxiety when the child became dependent on her. The only way the child can really escape Irom the situation is to comment on the contradictory position his mother has put him in. However, iI he did so, the mother would take this as an accusation that she is unloving and both punish him and insist that his perception oI the situation is distorted. By preventing the child Irom talking about the situation, the mother Iorbids him using the metacommunicative level---the level we use to correct our perception oI communicative behavior. The ability to communicate about communication, to comment upon the meaningIul actions oI oneselI and others, is essential Ior successIul social intercourse. In any normal relationship there is a constant interchange oI metacommunicative messages such as "What do you mean?" or "Why did you do that?" or "Are you kidding me?" and so on. To discriminate accurately what people are really expressing, we must be able to comment; directly 10 or indirectly on that expression. This metacommunicative level the schizophrenic seems unable to use successIully (2). Given these characteristics oI the mother, it is apparent why. II she is denying one order oI message, then any statement about her statements endangers her and she must Iorbid it. ThereIore, the child grows up unskilled in his ability to communicate about communication and, as a result, unskilled in determining what people really mean and unskilled in expressing what he really means, which is essential Ior normal relationships. In summary, then, we suggest that the double bind nature oI the Iamily situation oI a schizophrenic results in placing the child in a position where iI he responds to his mother's simulated aIIection her anxiety will he aroused and she will punish him (or insist, to protect herselI, that his overtures are simulated, thus conIusing him about the nature oI his own messages) to deIend herselI Irom closeness with him. Thus the child is blocked oII Irom intimate and secure associations with his mother. However, iI he does not make overtures oI aIIection, she will Ieel that this means she is not a loving mother and her anxiety will be aroused. ThereIore, she will either punish him Ior withdrawing or make overtures toward the child to insist that he demonstrate that he loves her. II he then responds and shows her aIIection, she will not only Ieel endangered again, but she may resent the Iact that she had to Iorce him to. respond. In either case in a relationship, the most important it his liIe and the model Ior all others, he is punished iI he indicates love and aIIection and punished iI he does not; and his escape routes Irom the situation, such as gaining support Irom others, are cut oII. This is the basic nature oI the double bind relationship between mother and child. This description has not depicted, oI course, the more complicated interlocking gestalt that is the "Iamily" oI which the "mother" is one important part (11, 12). ILLUSTRATIONS FROM CLINICAL DATA An analysis oI an incident occurring between a schizophrenic patient and his mother illustrates the "double bind" situations. A young man who had Iairly well recovered Irom 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 stiIIened. 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 aIraid oI your Ieelings." The patient was able to stay with her only a Iew minutes more and Iollowing her departure he assaulted an aide and was put in the tubs. Obviously, this result could have been avoided iI the young man had been able to say, "Mother, it is obvious that you become uncomIortable when I put my arm around you, and that you have diIIiculty accepting a gesture oI aIIection Irom me." However, the schizophrenic patient doesn't have this possibility open to him. His intense dependency and training prevents him Irom commenting upon his mother's communicative behavior, though she comments on his Iold Iorces him to accept and to attempt to deal with the complicated sequence. The complications Ior the patient, include the Iollowing: 1. The mother's reaction oI not accepting her son's aIIectionate gesture is masterIully covered up by her condemnation oI him Ior withdrawing, and the patient denies his perception oI the situation by accepting her condemnation. 11 2. The statement "don't you love me anymore" in this context seems to imply: a. "I am lovable." b. "You should love me and iI you don't you are bad or at Iault." c. "Whereas you did love me previously you don't any longer," and thus Iocus is shiIted Irom his expressing aIIection to his inability to be aIIectionate. Since the patient has also hated her, she is on good ground here, and he responds appropriate with guilt, which she then attacks. d. "What you just expressed was not aIIection", and in order to accept this statement the patient must deny what she and the culture have taught him about how one exit presses aIIection. He must also question the times with her, and with others, when he thought he was experiencing aIIection and when they seemed to treat the situation as iI he had. He experiences here loss-oI-support phenomena and is put in doubt about the reliability oI past experience. 3. The statement, "You must not be so easily embarrassed and aIraid oI your Ieelings," seems to imply: "You are not like me and are diIIerent Irom other nice or normal people because we express our Ieelings." "The Ieelings you express are all right, it's only that you can't accept them." However, iI the stiIIening on her part had indicated "these are unacceptable Ieelings," then the boy is told that he should not be embarrassed by unacceptable Ieelings. Since he has had a long training in what is and is not acceptable to both her and society, he again comes into conIlict with the past. II he is unaIraid oI his own Ieelings (which mother implies is good), he should be unaIraid oI his aIIection and would then notice it was she who was aIraid, but he must not notice that because her whole approach is aimed at covering up this shortcoming in herselI. The impossible dilemma thus becomes: "II I am to keep my tie to mother I must not show her that I love her, but iI I do not show her that I love her, then I will lose her." The importance to the mother oI her special method oI control is strikingly illustrated by the interIamily situation oI a young woman schizophrenic who greeted the therapist on their Iirst meeting with the remark, "Mother had to get married and now I'm here." This statement meant to the therapist that: The patient was the result oI an illegitimate pregnancy. This Iact was related to her present psychosis (in her opinion). "Here" reIerred to the psychiatrist's oIIice and to the patient's presence on earth Ior which she had to be eternally indebted to her mother, especially since her mother had sinned and suIIered in 12 order to bring her into the world. "Had to get married" reIerred to the shot-gun nature oI mother's wedding and to the mother's response pressure that she must marry, and the reciprocal, that she resented the Iorced nature oI the situation and blamed the patient Ior it. Actually, all these suppositions subsequently proved to be Iactually correct and were corroborated by the mother during an abortive attempt at psychotherapy. The Ilavor oI the mother's communications to the patient seemed essentially this: "I am lovable, loving, and satisIied with myselI. 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 diIIerent Irom me ('not normal'). You need me and me alone because oI these handicaps, and I will take care oI you and love you." Thus the patient's liIe was a series oI beginnings, oI attempts at experience, which would result in Iailure and withdrawal back to the maternal hearth and bosom because oI the collusion between her and her mother. It was noted in collaborative therapy that certain areas important to the mother's selI- esteem were especially conIlictual situations Ior the patient. For example, the mother needed the Iiction that she was close to her Iamily and that a deep love existed between her and her own mother. By analogy the relationship to the grandmother served as the prototype Ior 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 kniIe which barely missed the little girl. The mother said nothing to the grandmother but hurried the little girl Irom the room with the words, "Grandmommy really loves, you." It is signiIicant that the grandmother took the attitude toward the patient that she was not well enough controlled, and she used to chide her daughter Ior being too easy on the child. The grandmother was living in the house during one oI the patient's psychotic episodes, and the girl took great delight in throwing various objects at the mother and grandmother while they cowered in Iear. Mother Ielt herselI very attractive as a girl, and she Ielt that her daughter resembled her rather closely, although by damning with Iaint praise it was obvious that she Ielt the daughter deIinitely ran second. One oI the daughter's Iirst acts during a psychotic period was to announce to her mother that she was going to cut oII all her hair. She proceeded to do this while the mother pleaded with her to stop. Subsequently the mother would show a picture oI herselI as a girl and explain to people how the patient would look iI she only had her beautiIul hair. The mother, apparently without awareness oI the signiIicance oI what she was doing, would equate the daughter's illness with not being very bright and with some sort oI organic brain diIIiculty. 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 Iurther shock treatments, and as soon as the girl was out oI the room she asked the doctor iI he didn't Ieel 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 herselI had had a psychotic episode when she discovered that she was pregnant. The Iamily whisked her I away to a small sanitarium in a nearby tour, and she was, 13 according to her own statement, strapped to a bed Ior six weeks. Her Iamily 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 emotions. One was in relating her own psychotic experience; the other was on the occasion oI her last visit when she accused the therapist oI trying to drive her crazy by Iorcing her to choose between her daughter and her husband. Against medical advice, she took her daughter out oI therapy. The Iather was as involved in the homeostatic aspects oI the intraIamily 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 Irom the patient (e.g., she Irequently reIerred to a character named "Nervous Ned") the therapist was able to elicit Irom him that he Iind hated his job and Ior years had been trying to "get out Irom under." However, the daughter was made to Ieel that the move was initiated Ior her. On the basis oI our examination oI the clinical data, we have been impressed by a number oI observations including: 1. The helplessness, Iear, 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 Iather that both create double bind situations or extend and ampliIy those created by the another, and we have seen the Iather passive and outraged, but helpless, become ensnared in a similar manner to the patient. 2. The psychosis seems, in part, a way oI dealing with double bind situations to overcome their inhibiting and controlling eIIect. The psychotic patient may make astute, pithy, oIten metaphorical remarks that revea1 an insight into the Iorces binding him. Contrariwise, he may become rather expert In setting double bind situations himselI. 3. According to our theory, the communication situation described is essential to the mother's security, and by inIerence to the Iamily homeostasis. II this be so, then when psychotherapy oI the patient helps him become less vulnerable to mother's attempts at control, anxiety will be produced in the mother. Similarly, iI the therapist interprets to the mother the dynamics oI 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 Iamily (especially when the patient lives at home during psychotherapy) this leads to a disturbance (oIten severe) in the mother and sometimes in both mother and Iather and other siblings (10, 11). CURRENT POSITION AND FUTURE PROSPECTS Many writers have treated schizophrenia in terms oI the most extreme contrast with any other Iorm oI human thinking and behavior. While it is an isolable phenomenon, so much emphasis on the diIIerences Irom the normal--rather like the IearIul physical segregation oI psychotics--does not help in understanding the problems. In our approach we assume that 14 schizophrenia involves general principles which are important in all communication and thereIore many inIormative similarities can be Iound in "normal" communicatiol1 situations. We have been particularly interested in various sorts oI communication which involve both emotional signiIicance and the necessity oI discriminating between orders oI message. Such situations include play, humor, ritual, poetry, and Iiction. Play, especially among animals, we have studied at some length (3). It is a situation which strikingly illustrates the occurrence oI metamessages whose correct discrimination is vital to the cooperation oI the individuals involved; Ior example, Ialse discrimination could easily lead to combat. Rather closely related to play is humor, a continuing subject oI our research. It involves sudden shiIts in Logical Types as well as discrimination oI those shiIts. Ritual is a Iield in which unusually real or literal ascriptions oI Logical Type are made and deIended as vigorously as the schizophrenic deIends the "reality" oI his delusions. Poetry exempliIies the communicative power oI metaphor--even very unusual metaphor--when labeled as such by various signs, as contrasted to the obscurity oI unlabeled schizophrenic metaphor. The entire Iield oI Iictional communication, deIined as the rationale Ior depiction oI a series oI events with more or less oI a label oI actuality, is most relevant to the investigation oI schizophrenia. We are not so much concerned with the content interpretation oI Iiction--although analysis oI oral and destructive themes is illuminating to the student oI schizophrenia--as with the Iormal problems involved in simultaneous existence oI multiple levels oI message in the Iictional presentation oI "reality." The drama is especially interesting in this respect, with both perIormers and spectators responding to messages about both the actual and the theatrical reality. We are giving extensive attention to hypnosis. A great array oI phenomena that occur as schizophrenic symptoms---hallucinations, delusions, alterations oI personality, amnesias, and so on--can be produced temporarily in normal subjects with hypnosis. These need not be directly suggested as speciIic phenomena, but can be the "spontaneous" result oI an arranged communication sequence. For example, Erickson (4) will produce hallucination by Iirst inducing catalepsy in a subject's hand and then saying, "There is no conceivable way in which your hand can move, yet when I give the signal, it must move." That is, he tells the subject his hand will remain in place, yet it will move, and in no way the subject can consciously conceive. When Erickson gives the signal, the subject hallucinates the hand moved, or hallucinates himselI in a diIIerent place and thereIore the hand was moved. This use oI hallucination to resolve a problem posed by contradictory commands which cannot be discussed seems to us to illustrate the solution oI a double bind situation via a shiIt in Logical Types. Hypnotic responses to direct suggestions or statements also commonly involve shiIts in type, as in accepting the words "Here's a glass oI water" or "You Ieel tired" as external or internal reality. or in literal response to metaphorical statements, much like schizophrenics. We hope that Iurther study oI hypnotic induction, phenomena, and waking will, in this controllable situation, help sharpen our view oI the essential communicational sequences which produce phenomena like those oI schizophrenia. Another Erickson experiment (12) seems to isolate a double bind communicational sequence without the speciIic use oI hypnosis. Erickson arranged a seminar so as to have a young chain smoker sit next to him and to be without cigarettes; other participants were brieIed on what to do. All was ordered so that Erickson repeatedly turned to oIIer the young man a cigarette but was always interrupted by a question Irom someone so that he turned away 15 "inadvertently" withdrawing the cigarettes Irom the young man's reach. Later another participant asked this young man iI he had received the cigarette Irom Dr. Erickson He replied, "What cigarette?", showed clearly that he had Iorgotten the whole sequence, and even reIused a cigarette oIIered by another member, saying that he was too interested in the seminar discussion to smoke. This young man seems to us to be in an experimental situation paralleling the schizophrenic's double bind situation with mother: An important relationship, contradictory messages (here oI giving and taking away), and comment blocked--because there was a seminar going on, and anyway it was all "inadvertent." And note the similar outcome: Amnesia Ior the double bind sequence and reversal Irom "He doesn't give" to "I don't want." Although we have been led into these collateral areas, our main Iield oI observation has been schizophrenia itselI. All oI us have worked directly with schizophrenic patients Iled much oI this case material -has been recorded on tape Ior detailed study. In addition, we are recording interviews held jointly with patients and their Iamilies, and we are taking sound motion pictures oI mothers and disturbed, presumably preschizophrenic, children. Our hope is that these operations will provide a clearly evident record oI the continuing, repetitive double binding which we hypothesize goes on steadily Irom inIantile beginnings in the Iamily situation oI individuals who become schizophrenic. This basic Iamily situation, and the overtly communicational characteristics oI schizophrenia, have been the major Iocus oI this paper. However, we expect our concepts and some oI these data will also be useIul in Iuture work on other problems oI schizophrenia, such as the variety oI other symptoms, the character oI the "adjusted state," beIore schizophrenia becomes maniIest and the nature and circumstances oI the psychotic break. THERAPEUTIC IMPLICATIONS OF THIS HYPOTHESIS Psychotherapy itselI is a context oI multilevel communication, with exploration oI the ambiguous lines between the literal and metaphoric, or reality and Iantasy, and indeed, various Iorms oI play, drama, and hypnosis have been used extensively in therapy. We have been interested in therapy, and in addition to our own data we have been collecting and examining recordings, verbatim transcripts, and personal accounts oI therapy- Irom other therapists. In this we preIer exact records since we believe that how a schizophrenic talks depends greatly, though oIten subtly, on how another person talks to him; it is most diIIicult to estimate what was really occurring in a therapeutic interview iI one has omit a description oI it, especially iI the description is already in theoretical terms. Except Ior a Iew general remarks and some speculation, however, we are not yet prepared to comment on the relation oI the double bind to psychotherapy. At present we can only note: 1. Double bind situations are created by and within the psychotherapeutic setting and the hospital milieu. From the point oI view oI this hypothesis we wonder about the eIIect oI medical "benevolence" on the schizophrenic patient. Since hospitals exist Ior the beneIit oI personnel as well as--as much as--more than--Ior the patient's beneIit, there will be contradictions at times in sequences where actions are taken "benevolentl y" Ior the patient when actually they are intended to keep the staII more comIortable. We would assume that whenever the system is organized Ior hospital purposes and it is announced 16 to the patient that the actions are Ior his beneIit, then the schizophrenogenic situation is being perpetuated. This kind oI deception will provoke the patient to respond to it as a double bind situation, and his response will be "schizophrenic" in the sense that it will be indirect and the patient will be unable to comment on the Iact that he Ieels that he is being deceived. One vignette, Iortunately amusing, illustrates such a response. On a ward with a dedicated and "benevolent" physician in charge there was a sign on the physician's door which said "Doctor's OIIice. Please Knock.ยจ The doctor was driven to distraction and Iinally capitulation by the obedient patient who careIully knocked every time he passed the door. 2. The understanding oI the double bind and its communicative aspects may lead to innovations in therapeutic technique. Just what these innovations may be is diIIicult to say, but on the basis oI our investigation we are assuming that double bind situations occur consistently in psychotherapy. At times these are inadvertent in the sense that the therapist is imposing a double bind situation similar to that in the patient's history, or the patient is imposing a double bind situation on the therapist. At other times therapists seem to impose double binds, either deliberately or intuitively, which Iorce the patient t o respond diIIerently than he has in the past. An incident Irom the experience oI a giIted psychotherapist illustrates the intuitive understanding oI a double bind communicational sequence. Dr. Frieda Fromm-Reichmann (5) was treating a young woman who Irom the age oI seven had built a highly complex religion oI her own replete with powerIul Gods. She was very schizophrenic and quite hesitant about entering into a therapeutic situation. At the beginning oI the treatment she said, "God R says I shouldn't talk with you." Dr. Fromm-Reichmann replied, "Look, let's get something into the record. To me God R doesn't exist, and that whole world oI yours doesn't exist. To you it does, and Iar be it Irom me to think that I can take that away Irom you, I have no idea what it means. So I'm willing to talk with you in terms oI that world, iI only you know I do it so that we have an understanding that it doesn't exist Ior me. Now go to God R and tell him that we have to talk and he should give you permission. Also you must tell him that I am a doctor and that you have lived with him in his kingdom now Irom seven to sixteen--that's nine years--and he hasn't helped you. So now he must permit me to try and see whether you and I can do that job. Tell him that I am a doctor and this is what I want to try." The therapist has her patient in a "therapeutic double bind." II the patient is rendered doubtIul about her belieI in her god then she is agreeing with Dr. Fromm-Reichman, and is admitting her attachment to therapy. II she insists that God R is real, then she must tell him that Dr. Fromm-Reichmann is "more powerIul" than he--again admitting her involvement with the therapist. The diIIerence between the therapeutic bind and the original double bind situation is in part the Iact that the therapist not involved in a liIe-and-death struggle himselI. He can thereIore set up relatively benevolent binds and gradually aid the patient in his emancipation Irom them. Many oI the uniquely appropriate therapeutic gambits arranged by therapists seem to be intuitive. We share the goal oI most psycho- therapists who strive toward the day when such strokes oI genius will be well enough understood to be systematic and commonplace. 17 REFERENCES 1. Bateson, G. Social planning and the concept oI "deutero-learning". ConIerence on Science, Philosophy, and Religion, Second Symposium. New York: Harper, 1942. 2. Bateson, G. A theory oI play and Iantasy. Psychiatric Research Reports, 1955, 2, 39-51. 3. Carpenter, C. R. A Iield study oI the behavior and social relations oI howling monkeys. Comp. Psychol. Monogr., 1934, 10, 1-168. 4. Erickson, M. H. Personal communication 1955. 5. Fromm-Reichmann, F. Personal communication, 1956. 6. Haley, J. Paradoxes in play, Iantasy, and psychotherapy. Psychiatric Research Re ports, 1955, 2, 52-58. 7. Harlow, H. F. The Iormation oI learning sets. Psychol. Rev., 1949, 56, 51-65. 8. Hilgard, J. R. Anniversary reactions ill parents precipitated by children. Psychiatry, 1953, 16, 73-80. 9. Hull, C. L., et al. Mathematico-deductive theory oI rate learning. New Haven: Yale Univ. Press, 1940. 10. Jackson, D. D. An episode oI sleepwalking J. Amer. Psychoanal. Assn., 1954, 2, 503-508 11. Jackson, D. D. Some Iactors inIluencing the Oedipus complex. Psychoanal. Quart.,: 1954, 23, 566-581. 12. Jackson, D. D. The question oI Iamily homeostasis. Presented at the Amer. Psychiatric Assn. Meeting, St. Louis, May 7, 1954. 13. Lorenz, K. Z. King Solomon's ring. New York: Crowell, 1952. 14. Perceval, J. A narrative oI the treatment experienced by a gentleman during a state oI mental derangement, designed to explain the causes and nature oI insanity, etc. London: EIIingham Wilson, 1836 and 1840. 15. Ruesch, J., & Bateson, G. Communication: the social matrix oI psychiatry. New York: Norton, 1951. 16. von Domarus, E. The speciIic laws oI logic in schizophrenia. In J. S. Kasanin (Ed.), Language and thought in schizophrenia. Berkeley: Univ. oI CaliIornia Press, 194-~. 18 17. Whitehead, A. N., &; Russell, B. Principia mathematics. Cambridge: Cambridge Univ. Press, 1910. (Manuscript received June 7, 1956)
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