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Fam Proc 1:156-166, 1962

ABSTRACTS OF LITERATURE
Some of the papers on the family which have appeared since 1960
ALANEN, YRJ, Some Thoughts on Schizophrenia and Ego Development in the Light of Family Investigations., Arch. Gen. Psy., 3: 6, 650-656, 1960. Noting a divergence between the studies of the family environment of the schizophrenic and classical psychoanalytical conceptions, the author reviews the problem and attempts to bring the points of view closer together. He notes four points in the pathological ego development of the schizophrenic: defective establishment of initial important object relationships, inadequate separation from symbiotic object relationships, absence in the family of the schizophrenic of healthy identfication patterns and opportunity for ego mastery, and disturbances in the process of role taking and identity formation in the family and broader environment. ALBERT, ROBERT S., Stages of Breakdown in the Relationships and Dynamics Between the Mental Patient and His Family, Arch. Gen. Psy., 3: 6, 682-690, 1960. Since a family is a social system of many different roles which are interlocked, the absence or illness of a member produces a reaction through the family. Two guiding premises are: (a) with disruption, the ongoing dynamics move patient and family into a poorer state with less possibility of a return to earlier, healthier stages of interaction, and (b) in the earlier stages other members of the family are equally ill and susceptible candidates for becoming the patient. Three stages of interaction disruption are given. The uncoupling stage where the patient-to-be is seen as the peculiarly differing family member. The stage of patient-family dislocation where there is a new pattern of family behavior; participants are not only upset but begin to see themselves as helpless. The patient isolation stage where the patient is consensually declared by others the object of a legitimate withdrawal of trust. Toward the end of this stage family and patient are readied for his removal from the family. Given a description of stages as a model, there could be better prediction and preparation for dealing with cases. APPEL, KENNETH E., GOODWIN, HILDA M., WOOD, HOWARD P. and ASKREN, EDWARD L., Training in Psychotherapy, the Use of Marriage Counseling in a University Teaching Clinic, Am. Jrn. Psy., 117, 8, 709-711, 1961. In the department of psychiatry at the University of Pennsylvania School of Medicine, residents may participate in a teaching program which includes treatment of married couples. Marriage counseling is discussed and a case example given of the sort of case presentation given to psychiatric residents. BASAMANIA, BETTY W., The Emotional Life of the Family: Inferences for Social Casework, Am. Jrn. Ortho., 31: 1, 74-86, 1961. A casework view of the Bowen research project where families with a schizophrenic member were hospitalized. Observations of 11 families are categorized into (a) interrelated personality problems among family members, and (b) interaction problems among family members. Case examples are given. A discussion of family therapy procedures is presented with the emphasis upon relating to more than one individual at a time. Inferences for social casework emphasize the dimension of the emotional life of the family rather than the integration of sociological concepts with casework practice. BECK, SAMUEL F., Families of Schizophrenic and of Well Children: Methods, Concepts, and Some Results, Am. Jrn. Ortho., 30: 2, 247-275, 1960. A report on a research study attempting to differentiate and compare families with schizophrenic children, families with neurotic children, and families with normal children. A list of 106 trait items about individuals in families were Q-sorted by a psychiatrist and three social workers. The clusterings are said to indicate similarities and differences. Discussants: Gregory Bateson, Henry S. Mass, Irving D. Harris. BOWEN, M., Family Psychotherapy, Am. Jrn. Ortho., 31: 1, 40-60, 1961.

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A discussion of the research program where parents and their schizophrenic offspring lived together on a psychiatric ward. The paper includes a description of the history of the project, the sample of families, and the theoretical approach. The emphasis is upon the family as a unit of illness rather than upon individuals in the family group. Principles and techniques of family therapy emphasize utilizing the family leader, avoiding individual relationships with family members, and not accepting the position of omnipotence into which the family attempts to place the therapist. Results are discussed and examples given with case material. BRODEY, WARREN M., Image, Object and Narcissistic Relationships, Am. Jrn. Ortho., 31: 1, 69-73, 1961. A discussion of the family unit with a conceptualization involving externalization, the narcissistic relationship, and the image relationship. "... in the object relationship the inner image of the object is being constantly redesigned to fit with the experience of the existing other.... In the image relationship, the inner image of the object is being used to constantly redesign the experience with the existing other.... The image relationship works toward omitting the unexpected, constricting and stereotyping the relationship." It is suggested that the psychotic member has escaped from the bizarre pseudo-logicalness and stereotypes of the family, but his astonishingly perceptive comments are dismissed by the family as entirely crazy. CAREK, D. J., HENDRICKSON, W. J. and HOLMES, D. J., Delinquency Addiction in Parents, Arch. Gen. Psy., 4: 4, 357-362, 1961. A discussion of parental participation in the cause and cure of delinquency traits. These parentally sanctioned traits "have been observed with regular frequency in some 400 cases" of hospitalized adolescents who had not been admitted primarily for delinquency in the legal sense. It is suggested that a rough analogy for parental participation is to be found in the drug addict. This analogy includes the parents' need for vicarious neurotic fulfilment, the specificity of the need, the elaborate measures used to pursue satisfaction, and the threat to treatment of the withdrawal crisis with separation. Clinical examples are used to illustrate seven mechanisms parents use to communicate unconscious approval. Complete separation is advised with anticipation of parental anxiety if the child abandons delinquency. COHEN, RICHARD L., CHARNEY, ISRAEL W. and LEMBKE, PERNILLA, Parental Expectations as a Force in Treatment, Arch. of Gen. Psy., 4: 5, 471-478, 1961. A discussion of parental involvement with severely disturbed children based upon 175 cases referred to the inpatient unit of Oakbourne Hospital. It is suggested that intake-diagnostic procedures include exploration of parental motivation to anticipate later parental resistance to the child's treatment. Parental resistance to treatment is described in terms of conflict in several areas; conflict over unresolved dependency needs, over the emerging impulse life of the child, over destructive or rejecting impulses toward the child, over confusion of the basic identity of the child, and over unresolved impulses toward their own parents and/or society. Recognition of parental attitudes and the use of several professional disciplines in a case increases success in treatment. CUMMING, JOHN H., The Family and Mental Disorder: An Incomplete Essay, in Causes of Mental Disorders: A Review of Epidemiological Knowledge, 1959, New York, Milbank Memorial Fund, 1961. This essay is called incomplete because it reviews only a portion of the very large number of studies which attempt to relate mental disorder with the family. After a review of ideas about the functions of the family unit, an attempt is made to provide a typology of family studies by surveying studies in the field with emphasis upon the structure and function of socialization processes. Relating the various studies to each other, the author concludes "It is clear that organized study of the area of the family and mental illness is in a state of chaos." Dr. Morris Carstairs. He reviews the paper and covers a number of recent family studies in Britain. DYSINGER, ROBERT H., A Family Perspective on the Diagnosis of Individual Members, Am. Jrn. Ortho., 31: 1, 61-68, 1961. A discussion of the characteristic view of health matters by members of families containing a schizophrenic hospitalized as part of the Bowen study. Typically mother, father, and identified patient are intensely involved emotionally over health issues, and siblings are not included in the same way. Confusion over feelings, physical symptoms, and definite illness exists, and attempts to do something effective about a health matter are often stalemated. The clinician must find a way to

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diagnose without supporting the inaccuracies involved. The author suggests that an intense emotional problem in the parental relationship is handled through a set of mechanisms that operate to support an inaccurate assumption that the problem is the health of one child. The development of psychosis in the child demonstrates the inefficiency of this displacement and also can become a focus for the perpetuation of the family mechanism. EASSON, W. M. and STEINHILBER, R. M., Murderous Aggression by Children and Adolescents, Arch. Gen. Psy., 4: 1, 27-35, 1961. A review of murderous aggression in families, with a detailed discussion of seven boys who had made murderous assaults and one boy who had committed murder. They were seen in psychiatric consultation over a twelve month period. The background family psychopathology varied in character and malignity but showed definite psychodynamic patterns. All cases demonstrated that one or both parents had fostered and condoned murderous assault. Typically the boys were emotionally tied to mother in a hostile way, the fathers were not available for healthy identification, and the boys were allowed to retain weapons even after episodes of violent and menacing behavior. In each case the child was informed of parental expectations that he would be violent even to the point of murder. EHRENWALD, JAN, Neurosis in the Family, Arch. Gen. Psy., 3: 3, 232-242, 1960. Assuming that it is maladjusted attitudes rather than specific nosological entities which are subject to psychological contagion, this article discusses the potentially communicable nature of disturbed interpersonal attitudes. Examples are given of a family covering four generations, and three smaller family groups, presenting obsessive-compulsive, psychosomatic, and hysteric features. Four major propositions are offered. Psychological contagion (1) may be conducive to the development of similar or dissimilar clinical symptoms, (2) it is directly proportional to the duration of exposure, and within certain limitations inversely proportional to the age the exposure takes place, (3) it is determined by an individual's susceptibility and resistance to it, and (4) it is in direct proportion to the archaic nature of the disturbed attitudes and messages they convey as well as their emotional charge. Epidemiologically, the emphasis is upon "elementary units of behavior as are included in our Inventory of Traits and Attitudes" rather than on the manifest symptoms. EVANS, ANNE S., BULLARD, DEXTER M., Jr. and SOLOMON, MAIDA H., The Family as a Potential Resource in the Rehabilitation of the Chronic Schizophrenic Patient: A Study of 60 Patients and Their Families, Am. Jrn. Psy., 117: 12, 1075-1083, 1961. As part of a study of the relative value of drugs on social therapies in the treatment of chronic schizophrenia, the success or failure of plans for discharge was often found to be dependent upon the relationship between the patient and his family. This descriptive report summarizes some of the findings about these families, including the discovery that a surprising number of families maintained an active interest in the patient and regularly visited him after years of hospitalization. The need for psychiatric social workers and additional community resources are emphasized as important for facilitating discharge. Discussants: Herman Denber, M.D., Ruth I. Knee FARINA, AMERIGO, Patterns of Role Dominance and Conflict in Parents of Schizophrenic Patients, J. Abnor. Soc. Psy., 61: 1, 31-38, 1960. A report on a study designed to investigate the reported association between the sex of the dominant parent and the premorbid adjustment of the schizophrenic son. Additionally, the investigation includes examination of the conflict between parents of the schizophrenic. A standardized situation is provided where parents are posed hypothetical situations related to child-rearing. Indices of dominance are such measurements as who speaks the most, whose decision is accepted, and so on. Paternal dominance was found associated with good premorbid adjustment of schizophrenic sons and poor adjustment was associated with mother being dominant. Conflict between parents was measured by number of interruptions, disagreements, etc. Parents of schizophrenics showed more conflict than control parents. FERREIRA, ANTONIO J., The "Double-Bind" and Delinquent Behavior, Arch. Gen. Psy., 3: 4, 359-367, 1960. A discussion of the double-bind theory as it relates to delinquency. Double-binds are not confined to schizophrenic relationships but appear in the genesis of delinquent behavior. In delinquency, the source of messages is split: messages of distinct logical type, conflicting in themselves, emanate from two equally important parental figures. The child is a "victim"

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in that he is caught, for example, between a message emanating from father which requires certain behavior from him and a message from mother which is a destructive comment about that message. A case history is presented, and formal sequences of this delinquent pattern are diagrammed in symbolic logic style. FLECK, STEPHEN, Family Dynamics and Origin of Schizophrenia, Phychosom. Med., 22, 333-344, 1960. A comprehensive review of the Lidz project with a discussion of the findings and of the general problem of investigating the family of the schizophrenic. Of the 16 families studied, all were severely disturbed. Typical characteristics include a failure to form a nuclear family, family schisms, family skews, blurring of generation lines, pervasion of the entire atmosphere with irrational, usually paranoid ideation, persistence of conscious incestuous preoccupation, and sociocultural isolation. Case examples are presented. GARMEZY, NORMAN, FARINA, AMERIGO and RODNICK, ELIOT H., The Structured Situation Test: A Method for Studying Family Interaction in Schizophrenia, Am. Jrn. Ortho., 30, 3, 445-451, 1960. A report on a research study investigating the interaction in families of schizophrenics by asking parents to respond to imaginary situations with children. The parents of 12 schizophrenic sons with long term marginal sociosexual adjustment, 12 sons with adequate social adaptation prior to psychosis, and 12 sons hospitalized with tuberculosis are compared. The parents are exposed to twelve hypothetical situations and their reactions are recorded and classified according to evidence of dominance and extent of conflict behavior. Differences are found among the three groups. HALEY, JAY, Observation of the Family of the Schizophrenic, Am. Jrn. Ortho., 30: 3, 460-467, 1960. A report on a research project examining families containing a schizophrenic child by observation of conjoint family therapy sessions, filmed structured interviews, and an experimental situation. The family is seen as a self-corrective system which is "governed" by the behavior of each family member. A particular type family will not utilize all possible behavior but confine itself to a limited range, which presents a possibility of classifying families into types. The limited range of a family system can be described in terms of rules and prohibitions, which, when infringed, activate family members to behave in such a way as to reinforce the system. The general communicative behavior of the schizophrenic family is described and a film is shown for illustration. An experiment to differentiate this type of family from others is described as a way of achieving more objective measurements of family patterns. HOLLENDER, MARC H., MANN, WARREN A. and DANEHY, JOHN H., The Psychiatric Resident and the Family of the Hospitalized Patient, Arch. Gen. Psy., 2: 2, 125-130, 1960. Problems of the resident who must deal with the families of patients hospitalized in acute diagnostic and treatment centers. An examination of the difficulties of residents in this area, a discussion of the ambiguities in the situation, such as whether the resident represents the patient or the hospital, and comments on whether or not the resident should be the one who maintains contact with the family. JACKSON, D. D., RISKIN, JULES and SATIR, VIRGINIA, A Method of Analysis of a Family Interview, Arch. Gen. Psy., 5: 4, 321-339, 1961. The authors examined the first five minutes of a family therapy interview without knowing the diagnosis of the child in the family. This "lind" analysis included a prediction of the psychopathology of the patient and some character traits of his brother. The information available was only the parents' conversation and this was examined from the point of view of their communicative behavior, their needs and defenses, and their possible early life experiences which would lead them to interact in this way. The purpose of the study was to illustrate a method of analyzing a family system. JACKSON DON D. WEAKLAND and JOHN H., Conjoint Family Therapy: Some Considerations on Theory, Technique, and Results, Psychiatry, 24, 30-45, 1961. A report on conjoint family therapy of families with a schizophrenic member with a discussion of the theoretical point of view, the procedural arrangements, and typical problems. Case material is used to illustrate characteristic sequences in the therapy. The emphasis is upon the current interaction within these families and their resistance to change. Results are presented, and there is a discussion of countertransference problems and the shift in psychotherapeutic approach characteristic of therapists who attempt family psychotherapy.
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LEWIS, VERL S. and ZEICHNER, A. N., Impact of Admission to a Mental Hospital on the Patient's Family, Ment. Hyg., 44, 503-509, 1960. A report on a study of the effect on families when a member is hospitalized for mental illness. The study is based upon interviews with members of the families of 109 patients admitted to Connecticut's three state mental hospitals. Reported with tables are such categories as the recognition and acceptance of mental illness, the ways of coping with the patient's illness, assessment of help of resources used, and treatment given prior to hospitalization. LICHTENBERG, JOS D. and PING-NIE, PAO, The Prognostic and Therapeutic Significance of the Husband-Wife Relationship for Hospitalized Schizophrenic Women, Psychiatry, 23: 2, 209-ny213, 1960. A discussion of the types of husbands of hospitalized schizophrenic women and the importance of taking the spouse into account in psychotherapy. Observation of 43 patients indicated the husbands fell into certain groups, although no prototype personality was found. In terms of prognosis, the husbands are classified as constructively active, obstructively active, rejecting, maintaining the previous pathological relationship and vacillating. Ways to include the husband in the therapeutic program were attempted and are recommended. MITCHELL, CELIA B., The Use of Family Sessions in the Diagnosis and Treatment of Disturbances in Children, Soc. Casewk, 41, 283-290, 1960. A discussion of family casework where the family as a whole is interviewed in contrast to individual interviews with family members. The family sessions are supplemented by interviews of family pairs, triads, or individuals. A case is presented which is being filmed at the Family Mental Health Clinic of the Jewish Family Service. Sessions with the whole family provide unique insights on many levels, help a child accept treatment more readily, lay bare the involvement of all family members in the problem, and further the growth of family members. PARLOFF, MORRIS B., The Family in Psychotherapy, Arch. Gen. Psy., 4: 5, 4455-451, 1961. A discussion of the research trends in family therapy with emphasis upon some of the theoretical modifications which accompany present forms of family therapy. Historically, the avoidance of family members in psychoanalysis began to change with child analysis and an interest in actual parental characteristics. Later, with Sullivan and others, a shift was made to the study of pathology inherent in the nature of relationships. In treatment, a shift was made from family members seen individually by different therapists to a single therapist treating several family members. The influence of group therapy provided "the greatest single advance in the interpersonal relationship treatment technique," and from there it was a short step to working with a patient's actual family rather than his transference family. The child began to be seen less as a victim and more as a part of the organic unit of the family. Psychiatric emphasis is moving in ever-widening circles away from the individual: from the intrapsychic structure of the individual to the relationship between patient and parent to the family as a subcultural unit and to the total cultural context. PARSONS, ANNE, Family Dynamics in South Italian Schizophrenics, Arch. Gen. Psy., 3: 5, 507-518, 1960. If family factors play an etiological role in schizophrenia, comparative studies of the family background of schizophrenics in different cultures is important. After observation of south Italian patients in the United States, a sample of 25 patients hospitalized in public hospitals in Naples and vicinity was investigated. Patterns in the families are described in terms of exclusive dyads, imbedded dyads, competitive and unstable situations, and isolates. The description of the source of breakdown emphasizes points of potential weakness in the family structure. Comparing pathological family constellations in different cultures, the taboo areas are important, and the problem of differentiating the normal from the pathological must be resolved. "We would doubt that these problems can ever be resolved in a framework in which any particular set of social values or conditions is considered as inherently schizogenetic." PEASE, DAMARIS and HAWKES, GLENN R., Observation and Parent-Child Interaction, Am.Jrn. Ortho., 30: 3, 453-459, 1960. A review of some of the procedures for direct observation of family interaction emphasizing the need for developing categories, training observers and achieving reliability of observed behavior, and using an appropriate statistical method.

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PING-NIE, PAO, The Use of Patient-Family-Doctor Interview to Facilitate the Schizophrenic Patient's Return to the Community, Psychiatry, 23: 2, 199-207, 1960. A discussion of the use of conjoint interviews with family members to ease a schizophrenic patient's move from the hospital to the outside world. After intensive psychotherapy, a crisis may come when the patient is faced with going home. Prior to the actual time for return, he may have avoided thinking about the problem or denied it as a problem. After preparing both family members and patient, joint interviews are held which allow the family members and patient to deal with each other in preparation for living together with less distress. Four cases are given as examples, including one where the outcome was unfavorable. PULVER, S. E. and BRUNT, M. Y., Deflection of Hostility in Folie Deux, Arch. Gen. Pay., 5: 3, 257-265, 1961. Three cases are presented to illustrate a description of the psychodynamics of the transfer of delusions. The partners are divided into the primary and secondary with the primary partner strongly dependent upon the secondary. As the primary partner begins to feel taken advantage of and increasingly angry, his anger against the secondary partner is projected onto an outsider as paranoid delusion. When the secondary partner does not support the delusion, the direct hostility toward the secondary partner becomes intolerable and the secondary partner deflects it by accepting the delusion and joining in the projection. RITCHIE, AGNES, Multiple Impact Therapy, An Experiment, Soc. Wrk., 5: 3, 16-21, 1960. A description of the Multiple Impact Therapy used in the Youth Development Project at the University of Texas Medical Branch in Galveston. The method consists of a brief, usually two-day, intensive study and treatment of a family in crisis by a guidance team composed of psychiatrist, psychiatric social worker, and clinical psychologists. The team deals with a family six or seven hours a day for two days. These families come distances of 50 to 450 miles and the method was developed for families who could not regularly visit. There are two basic assumptions to the method: a family facing a crisis is more receptive to change, and dramatic change occurs in early stages of treatment. Team members meet together with the family, separate for individual interviews, and join each other's interviews. Disagreements between team members are exposed to families for their observation and participation. Procedures and some results are described. ROSENBAUM, C. P., Patient-Family Similarities in Schizophrenia, Arch. Gen. Psy., 5: 2, 120-126, 1961. A discussion of the family of the schizophrenic based upon conjoint interviews with such families on several research projects. It is suggested that the disordered thinking and interpersonal relations of the schizophrenic have recognized counterparts in his family. Such primary symptoms of schizophrenia as disorders of association, selective inattention, and ambivalence, as described by Bleuler, are compared with similar thought patterns in the family, illustrated with case material. These family members follow a pattern of avoiding complete transactions as a way of maintaining a facade of continuing relatedness and avoiding the "horror of utter unrelatedness." A review and synthesis is made of research in the field of the schizophrenic family with the emphasis upon the appropriateness of schizophrenic symptoms in this context. SANUA, VICTOR D., Sociocultural Factors in Families of Schizophrenics; a Review of the Literature, Psychiatry, 24: 3, 246-265, 1961. A review of family studies which includes problems of methodology, studies using hospital records, interviews with relatives, data from psychotherapy, studies using tests, cross cultural comparisons, European studies, and comparison of the schizophrenic environment and that of other pathologies. The author concludes that etiological factors fall into four general categories: (1) Undesirable traits in the parents, (2) family structureearly parental or sibling deaths or broken families, (3) undesirable interpersonal patterns, and (4) genetic or constitutional factors. He points out the inconsistency and wide variation in methodology and sampling with a neglect of important social variables and suggests an international research organization to coordinate research in mental illness. TABACHNICK, NORMAN, Interpersonal Relations in Suicidal Attempts, Arch. Gen. Psy., 4: 1, 42-47, 1961. This description of the interpersonal context, largely familial, of the attempted suicide is "a product of reflection of over 100 cases of suicidal attempts studied by a team of social scientists at the Suicide Prevention Center in Los Angeles." It is suggested that one could deduce from the fact that attempted suicides are dependent and masochistic that the significant individuals in their environment would also be dependent and masochistic. Observation supports such an expectation, and

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in numerous situations both members of the unit are suicidal. Three cases are presented as examples of the symbiotic relationship of mutual dependence. Treatment suggestions are separation by hospitalization and intervention to decrease the mutual dependence.