Storie permesse, storie proibite: polarità semantiche familiari e psicopatologie
The paths by which one mind may come to influence another are curious indeed. Thus a new book by the Italian psychologist Valeria Ugazio exploring the family backgrounds of those suffering from phobias, obsessive-compulsive disorders, and anorexia begins by drawing on observations made by the British anthropologist Gregory Bateson while he was working among the Iatmul Indians of New Guinea in the late 1920s. Behind both authors the anticonformist inspiration of the eighteenth-century English poet William Blake is frequently apparent, while between them lies the rise and fall of one of the most controversial recent adventures in psychotherapy, the so-called systemic approach.
Bateson was born in 1904 into a family with a history of scientific controversy. His father, William, a distinguished naturalist, was responsible for giving the study of genetics its name and was both translator and vociferous champion of Mendel’s work on hybrids and heredity. Gregory was named after the Austrian monk, no doubt with the hope that he would follow in his footsteps. Ironically, while Bateson never sought to belittle the study of genetics, his legacy has been to stress the importance of the social environment in activating, or not, the potential available in any individual’s genetic makeup.
Explaining to his disappointed father that he was giving up zoology for the relatively new subject of anthropology, Bateson spoke of his need for “a break with ordinary impersonal science.” He had grown up in a house where Blake’s pictures hung on the walls, where art and poetry were revered as the acme of human achievement yet at the same time considered “scarcely in the reach of people like ourselves.” Gregory’s elder brother, Martin, who aspired to become a poet rather than a scientist, argued bitterly with his father. Infatuated with a girl who never gave him the slightest hope, he shot himself by the statue of Eros in Piccadilly Circus, a suicide note and a poem in his pocket. The circumstances might have been invented to demonstrate the limitations of “ordinary impersonal science.”
Although in her book Storie permesse, storie proibite (“Stories allowed, stories forbidden”) Valeria Ugazio draws only on Bateson’s ideas and not on his biography, one can’t help feeling its relevance to her thesis. The idea behind her title is that the way family members talk about themselves and others, giving particular importance to certain qualities and achievements, will make some “life stories” (or ways of seeing one’s life as narrative) available to a child while denying the possibility of certain others. Clearly, after his brother’s suicide, an artist’s life was a “story forbidden” to Gregory. On the other hand it was the achievement to which his family attached the greatest value, and there can be no doubt that they were ambitious for their son. His choice of anthropology and, as he always insisted, its specifically “human” element can be seen as a way of combining the scientific and artistic and hence resolving the particular career conundrum his parents had created for him. Significantly, on the opening page of his first book, Naven, a study of New Guinea Indians, Bateson would reflect on the advantages of a novelist’s eye when it came to describing a foreign culture.
The artist…can leave a great many of the most fundamental aspects of culture to be picked up not from his actual words, but from his emphasis. He can… group and stress [words] so that the reader almost unconsciously receives information which is not explicit in the sentences and which the artist would find it hard—almost impossible—to express in analytic terms. This impressionistic technique is utterly foreign to the methods of science….
At once it was clear that Bateson’s project was to grasp, as an artist might, a sense of the wholeness and interrelatedness of a culture, rather than to report particular facts. But family background demanded that this be done in a scientific way. It’s not surprising, then, that his second project, in Bali, undertaken with his wife, Margaret Mead, was the first to make systematic use of photographs in an ethnographic study.1 Because of his resistance to the analytic and reductive it was important that the photographs not be seen separately: “In this monograph,” Bateson wrote of the book that came out of his work in Bali,
we are attempting a new method of stating the intangible relationships among different types of culturally standardized behaviour by placing side by side mutually relevant photographs. Pieces of behaviour, spatially and contextually separated—a trance dancer being carried in a procession, a man looking up at an airplane, a servant greeting his master in a play, the painting of a dream—may all be relevant to a single discussion; the same emotional thread may run through them.
In the late Twenties, when Bateson began his career, British anthropology was dominated by the figure of A.R. Radcliffe-Brown, who was fond of describing societies using the analogy of the organism. The life of a people was to be viewed as an active system of functionally consistent, interdependent elements where social phenomena “are not the immediate result of the nature of individual human beings, but are the result of the social structure by which they are united.”
Though he originally found it exciting, Bateson had a number of objections to this view. He felt its stress on the functional was reductive and left no space for the aesthetic; it also suggested that there was no tension between the “interdependent elements” of the society, and, related to that, it deduced all individual behavior from social structure in a suffocating determinism to which Bateson, with his own family experience, must have felt an instinctive repulsion. It was in opposition to this that he developed the first of the ideas for which he will be remembered, his so-called “schismogenesis.”
Bateson had been observing the radically different behavior patterns of men and women among the Iatmul Indians. The more the men were exhibitionist and boastful, the more the women were quiet and contemplative. It was clear that the one behavior pattern stimulated the other in a process that led to strong personality differentiation within an overall group ethos. The process of reciprocally stimulated personality differentiation—schismogenesis—could be complementary or symmetrical. Among the Iatmul men the process is symmetrical: they are involved in a dynamic of escalating competition, each seeking to outdo the other. Between the men and women of the tribe, however, the process is complementary, each becoming ever more the opposite of the other.
Schismogenesis, as Bateson saw it, was a powerful process and could be damaging, not only because it tended to violent extremes, but also because it could deny an individual any experience outside that promoted by this social dynamic. Bateson called his book Naven because this was the name of the bizarre series of rituals which he saw as “correcting” the schismogenetic process and guaranteeing stability. In these ceremonies men dressed up as women and vice versa. The women now assumed, with great excitement and relief, what was the traditional behavior of the men while the men were abject and passive, even submitting to simulated rape.
What Bateson was suggesting then was a complex process of interaction which did not deny the possibility of individual behavior but nevertheless saw it as taking place within a social process underwritten by a fundamentally conservative tendency that would always tend to counterbalance any movement away from the norm. Bateson had not heard of the word “cybernetics” when he formulated these ideas, but when he learned of the concepts of feedback and closed self-corrective circuits, it was evident that this would offer him an analogy that could substitute for Radcliffe-Brown’s unitary organism.
Almost twenty years after Bateson’s death, Valeria Ugazio, who lectures in psychology at the University of Turin, approaches the concept of schismogenesis with the same combination of respect and dissatisfaction that Bateson brought to Radcliffe-Brown. Bateson had expected that complementary and symmetrical schismogenesis would be found in personal relationships, in cases of psychological disorder, in contacts between cultures, and in political rivalries. Hence there is nothing revolutionary in Ugazio’s considering the process as essential to personality development within the family, or suggesting that character is formed by how people place themselves in relation to others in a group. But what Bateson did not do is to speak of the “content” of a process of schismogenesis. For Ugazio, on the contrary, this is essential. Reciprocal differentiation between family members, she claims, takes place along lines of meaning, or “semantic polarities.”
Consider, for example, a family whose talk about itself and others can be characterized by the polarity “dependence/independence”:
Family conversations will tend to be organized around episodes where fear and courage, the need for protection and the desire for exploration, play a central role. It is within this critical semantic dimension that schismogenetic processes will take place. As a result of these processes, the members of these families will feel and define themselves as shy and cautious, or, on the contrary, courageous, perhaps even rash; they will find companions who are willing to protect them or alternatively in need of protection…. Admiration, contempt, conflict, suffering, alliances, love, and hate will all occur around the themes of dependence/independence. In these families there will be some who—like the agoraphobic—are so dependent and so in need of protection as to require that someone be beside them in even the most ordinary day-to-day situations. But there will also be some members of the family who, on the opposite side of the polarity, provide examples of extreme independence.
Every family, Ugazio maintains, will “converse” and thus “compose itself” around a number of semantic polarities. The family mentioned above, for example, might also talk about themselves and others in terms of winners and losers, or generosity and meanness. Nevertheless one polarity will tend to dominate. The position a child assumes along that critical line will be crucial for the formation of his or her personality.
Ugazio’s second addition to Bateson’s theory of schismogenesis is her insistence on the importance of what she calls “the median position.” Bateson had seen the complementary and symmetrical processes he described as necessarily leading to extremes, but in a fascinating reconsideration of Naven, Ugazio draws attention to a number of men Bateson mentions only in passing who neither engage in male theatricals nor become part of the admiring audience. In the general schismogenetic process, there will be some, Ugazio claims, who react by insistently readjusting their position this way and that in response to the excesses of those on either side of them. In certain polarities, independence/dependence, for example, such a process might be positive, approaching a golden mean, but in others it could lead to all kinds of anxiety. For example, where the dominating polarity is saintly self-denial over against “evil” self-indulgence, there is little middle ground to be had. Here a child seeking a median position in an already established play of opposites is likely to find himself oscillating between a pleasurable indulgence that arouses guilt and a virtuous denial that provokes a sense of yearning and loss.
Again, Bateson’s own background would have provided Ugazio with a good example. David Lipset’s biography of the anthropologist2 portrays an adolescent who determinedly sought out a median position between his “poetic” brother, Martin, and his “scientific” father, William, in a situation where poetry was considered an indulgence legitimate only for the most gifted and science a self-denying crusade to advance human knowledge. An equilibrium was hard to find, as Bateson’s frequent feelings of guilt when embarking on his first anthropological projects suggest. His lifelong obsession with mechanisms of self-adjustment, transforming, as it were, his personal difficulties into his science, would seem to confirm this reading, which also allows apparently minor details of his working methods to take on unexpected meaning. About Bateson’s research on schizophrenia at the Palo Alto Veterans’ hospital, Lipset remarks:
Although the project’s interstitial position between disciplines and between institutions had meant a degree of financial insecurity, Bateson often remarked that he protected his scientific freedom in this way, sheltering it under “three umbrellas.” His project was housed in a hospital, was funded by grants from independent agencies, and these were administered through the anthropology Department at Stanford University. “When you have three bosses,” he was fond of saying, “you have none.” Each institution maintained that the other was supervising.
Or, as one of Bateson’s colleagues remarked, “Nobody knew what the hell he was doing.”
Well, what the hell was a British anthropologist doing in the psychi-atric ward of a California hospital? It’s a question to which Ugazio addresses herself at length, and one whose answer will bring us to her own most important innovation in Storie permesse….
Fascinated by the relationship between his own work and the fast-developing field of communications theory, Bateson accepted an invitation to join a study of “human communication in psychotherapy.” It was a period when he immersed himself in both the harsh realities of psychiatric medicine and the theoretical complexities of “digital” and “analogic” forms of communication in verbal and nonverbal speech, developing the idea that all messages imply a hierarchy whereby one element—perhaps literal meaning—is placed in context by another—perhaps body language. The latter allows the recipient to put the former in context. It was out of this study that his most famous concept, the idea of the double bind, was developed.
Bateson was working with schizophrenics, who frequently fail to appreciate the sense in which a message is to be understood. A routine question from a waitress—“How can I help you?”—might be understood as a sexual proposition and elicit a most inappropriate response. Or again, to be told by the same girl that a dish on the menu is not available might be understood as part of an elaborate international conspiracy and lead to an angry scene. Instead of looking for the cause of this disturbance in the isolated or traumatized psyche (as psychoanalysis tends to do), or in a specific organic dysfunction (as traditional medicine demands), Bateson suggested that the schizophrenic has rather “learned” to “live in a universe where the sequences of events are such that his unconventional habits of communication will be…appropriate.” His disorder, that is, is part of a larger system.
What were these “sequences of events” and the system they implied? We can imagine a child who from birth receives contradictory messages from the person most involved in his upbringing, usually the mother: the content perhaps seductive, but the body language discouraging, or vice versa. Bateson’s example of such behavior in the paper Toward a Theory of Schizophrenia (1956) has often been quoted. A young man recovering from an acute schizophrenic episode was visited in the hospital by his mother.
He was glad to see her and impulsively put his arm around her shoulders, whereupon she stiffened. He withdrew his arm and she asked, “Don’t you love me any more?” He then blushed, and she said, “Dear, you must not be so easily embarrassed and afraid of your feelings.” The patient was able to stay with her only a few minutes more and following her departure he assaulted an aide….
The example is followed by a two-page analysis in which Bateson remarks among other things on the fact that the schizophrenic’s apparent state of subjection does not allow him to comment on his mother’s contradictory behavior. She rejects affection, demands affection, then criticizes her son for an inhibition she has herself just induced. Ultimately, Bateson claims, the patient is up against the impossible dilemma: “If I am to keep my tie to mother, I must not show her that I love her, but if I do not show her that I love her, then I will lose her.”
Bateson maintained that a lifetime of such behavior would induce a structural trauma, as if the mind were constantly put before conundrums of the variety “All statements on this page are false.” Faced with this “double bind,” the child himself begins to communicate in the same way, wildly dissociating verbal and nonverbal communication, and confusing literal and metaphorical statements. As a result, conversation with a schizophrenic can often follow the pattern of a bizarre series of non sequiturs where the “normal” party to the dialogue frequently suspects that he is being made fun of.
It would be hard to exaggerate the enthusiasm which Bateson’s double bind aroused. For those in psychotherapy who had begun to suspect the limitations of an exasperated delving into the individual psyche, the idea that a mental illness was part of a system of communication and might thus be treated by altering the way people operated together, rather than by dealing with them individually, was extremely exciting. No complex histories need be elicited, no insight painstakingly imparted. All you had to do was change people’s behavior in such a way that the schizophrenic response was no longer “appropriate.”
A school of therapy rapidly developed which involved getting a whole family together to be interviewed by one or two therapists while others watched, taped, and even filmed the session through a one-way mirror. After discussion at the end of the session, members of the family would be ordered to perform some task or follow some instruction designed to alter the way they behaved together. A hyperactive, domineering mother, for example, might be ordered to spend a month in bed. In 1975, reviewing a group of books about the family therapy movement, the psychoanalyst Elsa First remarked in these pages: “Many in the family therapy movement prefer to think of themselves as anthropological consultants to very small tribes in distress, rather than as doctors who cure individual ‘cases’ of psychological illness.”3
Yet all was not well. As Ugazio points out, Bateson soon realized that the connection of his theory of a special kind of communication problem, the double bind, to an illness as complex and intractable as schizophrenia had been a mistake. The theory didn’t suggest why one member of the family was affected rather than another; it didn’t explain the difference between the preschizophrenic and the schizophrenic, or why some double binds might be damaging and others, as Bateson believed, therapeutic. But the worst blow to the theory came in 1966 when the original members of Bateson’s team were invited to consider material presented to them by psychiatric patients and their parents and to pronounce on any double binds. Faced with numerous accounts and audiotapes of family conversations, their disagreement was complete. Apparently they had no criteria for identifying what was a double bind and what was not.
To complicate matters, a conflict had arisen between Bateson and Jay Haley, his most talented collaborator. Haley was a practical therapist and eager to use the ideas the project had been developing to get results. While Bateson would spend weeks chatting amiably with schizophrenics and taking notes, Haley wanted to save them, to transform them. Bateson, however, was uneasy about his manipulative and invasive methods. The guiding principle of Bateson’s work had been that social behavior is part of a delicate interacting ecology and that the mistake of traditional science was to believe that it could isolate areas of study and act upon them from a stable position outside it. However well-meaning, intervention into something so complex as a schizophrenic’s family might make things worse. It is hardly surprising then that just as Haley’s hands-on manual Strategies of Psychotherapy appeared in 1963, Bateson abandoned the Palo Alto project to study patterns of communication among dolphins in the Virgin Islands. Nobody could reasonably expect him to change the lives of dolphins. His real goal in Palo Alto, he explained rather defensively, had never been therapy, but research.
Valeria Ugazio does not disguise the fact that she came to Bateson not directly but through the influence of her first mentor, the Milan-based psychotherapist Mara Selvini. For precisely as the “systemic approach” lost its intellectual father in the US, it gained a new and charismatic champion in Italy. Selvini came to international notoriety with one of the earliest studies of anorexia, Self-Starvation, in later editions of which she offers a Batesonian model for “the anorectic family”: the disorder was to be seen, that is, as the result of a system of relationships and patterns of communication in the family.4
Selvini connected the rapid rise of anorexia to the process of transition which was then radically altering the Italian family, eroding the old imperative of group solidarity in favor of a philosophy of self-realization. The situation was particularly disorienting, Selvini claimed, for women, who after being expected to sacrifice everything for husband and children now saw themselves as potentially equal players on the family stage. The result, at least in the families she was dealing with, was a sort of covert, never-to-be-resolved power struggle where each person was chiefly bent on self-realization but nevertheless obsessively determined, in deference to the old ethos, to disguise every personal initiative as a gesture of self-sacrifice. A typical discussion in family therapy runs thus:
MOTHER: I have forbidden her (the patient) to wear miniskirts because I know her father doesn’t like them.
FATHER: I’ve always supported whatever my wife forbade the girls in my name. I felt it would be wrong to contradict her.
Ultimately, Selvini claimed, the contradictory desire to think of oneself as the person who has sacrificed most while in fact seeking to control everybody else could lead to a situation where authority is only acceptable when it springs from a pathology and is thus apparently beyond the individual will. Not for nothing, she claimed, does the refusal to eat combine an apparent gesture of self-sacrifice with a disorder that will demand attention and confer control as the family begins to function entirely in relation to the patient’s symptom.
Systemic theorists never sought to explain the exact shift in the chemistry of the brain when a neurotic or psychotic symptom is first manifested (an achievement that has so far eluded the most advanced medical research), but rather looked for consistent patterns relating a disorder to the surrounding system of relationships. Thus, aside from taking account of the general transition in family life, Selvini concurred with other observers in finding that the families of anorectics tended to be characterized by an extremely strong mother complemented by a chronically weak father. (The dialogue above is again typical in this regard.) In such a situation the “sacrifice” of not eating, a weapon directed far more at the mother than at the father, could be justified by the anorectic at a subliminal level as an attempt to redress the balance of power while in fact amounting to a determined attempt take over the traditionally dominant male role for herself.
Selvini’s work offers an effective response to Elsa First’s ironic remarks at the expense of an “anthropological” approach. Her most brilliant book, Paradox and Counter Paradox,5 presents, among scores of others, the example of the young anorectic Mimma, who claims that her problem has to do with her fear of food poisoning. In general discussion with the family it emerges that to accommodate this fear her parents have transformed their kitchen into a sort of operating theater: all cutlery and utensils are sterilized and before sitting down to eat everybody puts on a white surgical coat, sterilized rubber gloves, and a surgeon’s cap. The therapist suggests that given this state of affairs Mimma is perhaps not the only unbalanced member of the family. There is a collective craziness at work here. This interpretation is immediately and vigorously denied by parents and siblings alike. Only Mimma is “crazy.” From a systemic point of view, however, Mimma, in line with the general search for power, is running the whole show and at the same time truly suffering more than anyone else.
Selvini’s undoubted success with anorectics6 led to her achieving almost guru status in the late Seventies, both in Italy and abroad. Very much in the tradition of Haley, she got her results by heaving a weighty therapeutic challenge into the tortured mechanisms of such families through a process of intuitive provocation and paradoxical prescription. “At what point”—a young anorectic might be asked after three or four sessions—“did it occur to you that by not eating you could finally show your lily-livered father how to bring Mother into line?” Or, at the end of another session a patient might be told that the therapists had come to the conclusion that her disorder was absolutely necessary for guaranteeing the equilibrium of the family and that until other changes occurred they could advise nothing better than that she continue to eat as little as possible. At this point the patient’s spirit of antagonism might be relied upon to function in her own interests rather than against them.
Having emerged, then, from a study of schizophrenia, the systemic approach was achieving its best results by creating a quite different disturbance. Significantly, however, when Selvini turned her attention away from anorexia to schizophrenia and attempted to satisfy Bateson’s hope that there would one day be an elaborate model describing the family relationships underlying the disorder, she could not repeat her success.
In Toward a Theory of Pathological Systems (1969), Jay Haley had sought to save the idea of the double bind by extending it to include three players in a so-called “perverse triangle,” this as a result of his observation that schizophrenics tended to be deeply involved in their parents’ relationships. In her book Family Games: General Models of Psychotic Processes in the Family,7 Selvini elaborated on this, painting a picture of stalled and embattled marriages where a child is drawn by one parent into a covert alliance against the other, only to realize at a moment of crisis that the favored parent is in fact exploiting him or her as a strategic element in the ongoing marital struggle. Not only is the child shocked and betrayed, but he also finds himself unable to protest, because the alliance itself is the source of feelings of guilt.
Selvini’s innovation here was to introduce the element of history into the systemic approach. Her portrayal of the anorectic’s family had been largely ahistoric, involving an ongoing, never-declared power struggle. Now, however, there was a precise series of events, a development that went some way toward countering the objection that the double bind did not explain why a symptom broke out at a particular moment. One could not appreciate how to alter a system of relationships and communication patterns, Selvini suggested, or what resistance such an attempt might provoke, until one understood what events underlay it.
As a method both of research and therapy, Selvini proposed that the therapist dismiss the children, including the schizophrenic patient, from therapy, see only the parents, and instruct them to announce to other family members that everything that happened in therapy was a secret they would not betray. After this they were to begin a series of unannounced evening disappearances designed to create the impression that a marital complicity had been reestablished.
The results of the approach were explosive. The frequency with which members of the family would complain that they were being excluded from the parental relationship, to the extent of calling the police because “he would never go out with her without telling me first,” convinced Selvini that the model she was developing was accurate. She also claimed dramatic improvements in patients whose parents had managed to put together at least a façade of complicity, thus liberating the child from the anxiety, excitement, and dilemmas of involvement in their parents’ relationship. Unfortunately, however, she could provide few statistics for lasting transformations. Even more crucially for the fate of her ideas, she made the mistake of describing these relationships in “the schizophrenic family” as “giochi sporchi” which, translated into English, produced the even more unfortunate-sounding “dirty games.” It seemed she was not only blaming the parents, but accusing them of callous indifference to the welfare of their children.
Family Games was published in 1989, but even before its appearance its preliminary presentation in 1986 was violently attacked by Carol Anderson in the pages of the Journal of Marital and Family Therapy. Anderson (who is now editor of the influential review Family Process) rightly took Selvini to task for her cavalier approach to documentation and statistics, but in the end her objections were more emotional than methodological. “I thought,” she wrote, “of the pain experienced by the families I’ve known as they struggled with their problems. How would they feel if they heard their desperate patterns of coping being described as ‘dirty games’?”
The position of outrage adopted by Anderson and others was testimony to a deep swing in opinion that no doubt went far beyond the borders of psychiatry and clinical psychology. However, in the particular field of family therapy her position consolidated a growing alliance with mainstream psychiatry which has always insisted, despite, it must be said, the absence to date of any conclusive results, that schizophrenia is mainly organic and genetic in nature.8 As Ugazio points out in her book, with regard to schizophrenia the systemic approach has encountered difficulties. It has also raised innumerable hackles. Even if Selvini was right in her analysis of the family systems surrounding schizophrenics (decades of literature on such families suggests she was not entirely wrong), nevertheless dealing successfully with their resistance to change was to prove far more difficult than it had been with the anorectic’s family and in any event far beyond the powers of a therapist with a few dramatic tricks up her sleeve. For a child who from earliest consciousness has been lured into a triangle in which the parents are perpetually at dagger’s point, it will be hard to believe that Mom and Dad have suddenly resolved their problems and chosen to exclude you. At a moment of psychotic crisis, tranquilizers and dopamine-blockers, though never a cure, are a more reassuring alternative than a long and perhaps agonizing reexamination of tangled relationships.
From this point on, then, family therapy largely threw in the towel when it came to schizophrenia. Or at least where such therapy is still used it seeks less and less to achieve a “cure” through a radical reorganization of a family’s way of communicating and concentrates instead on helping families live with a symptom to be treated primarily through drugs.9 “Often one has the impression,” wrote Selvini in her reply to Anderson, “that the times of Gregory Bateson and his colleagues are only a glorious memory.”
It is in the light of this defeat that Ugazio’s decision to exclude schizophrenia from her book must be understood. In reelaborating Bateson’s theories, as well as drawing on a huge range of reading in psychology and philosophy, she seems determined to give back to systemic therapy an intellectual dignity compromised by the many books that have told scarcely credible tales of dramatic cures, unsupported by theory or methodology. Basically, she seeks to produce an overwhelming combination of argument and evidence to demonstrate that the well-defined disorders she has chosen to discuss—phobias, obsessive compulsions, and anorexia—are indeed the result of the way sufferers have reacted to particular family situations. Her implication is that once we have established that ground, perhaps we can get back to “the stumbling stone for every psychological interpretation of mental illness,” schizophrenia.
The crucial innovation of Ugazio’s book is the way she combines Bateson’s theories of schismogenesis and the double bind. It is the schismogenetic manner in which character forms around semantic polarities in the family, she claims, that can, in special circumstances, place certain members rather than others in the position of intolerable dilemma known as the double bind.
Ugazio’s reformulation of the latter idea, designed to meet all the objections described above, is complex and draws heavily on the work of communication theorists V.E. Cronen, K.M. Johnson, and K.M. Lannamann.10 As well as insisting on the importance of the personal history of the eventual sufferer, Cronen and his colleagues suggested a certain ingenuousness in Bateson’s original formulation. It is not that one side of a given message is true but hidden (a mother’s antipathy) and the other false but apparent (her veneer of affection), but rather that the “social reality” of the eventual sufferer is constructed around a lifetime of contradictory but equally “true” (in the sense of sincerely meant) messages. In this scenario there is no question then of isolating a single message that would present a double bind for everybody. Context is all.
Let us return to the family that puts a high price on independence. This is the kind of family, Ugazio maintains, whose schismogenetic dynamics can lead to one member’s suffering from a phobia. How? We can imagine an adventurous, entrepreneurial father, frequently absent, a mother who assumes a “complementary” position, very much attached to her husband, admiring his spirit, but thinking of herself as at the other extreme of the independence/dependence polarity. A first son is encouraged to occupy a position symmetrical to the father’s and does so. He will compete for the palm of independence. The mother at once admires and is concerned, perhaps a little lonely. A second son becomes extremely attached to her. She finds consolation in his presence while never withdrawing her love and admiration from her husband and first son. As he becomes more conscious of the family situation, the second son senses that to win the kind of regard afforded to the others, he must be as radically independent of mother as they are. But in detaching himself from her he will lose the privileged position he has occupied to date and around which he has constructed his identity.
Without there being any single contradictory message, or anybody “behaving badly” in any way, an environment has been created where both the self-esteem of independence and the gratifications of attachment begin, at least for one member of the family, to seem at once absolutely desirable yet mutually exclusive. What life story can such a person construct for himself? Ugazio gives detailed case histories showing the kind of strategies a person who has grown up in such a situation will develop. Thirty-year-old Alberto has a proudly independent lifestyle counterbalanced by a series of superficial relationships which allow him to put off any serious emotional commitment. Elisa, on the contrary, has married an independent man, but has so successfully presented herself as fragile that despite his ambitions he has agreed to their living next door to her parents, where she remains very closely attached to her mother. Both of these patients can be seen to be occupying one side of the dependence/independence polarity while yearning for the other.
Ugazio describes the situations that may undermine such strategies and lead to the development of phobias. Alberto comes for therapy because he is no longer able to use an elevator and suffers severe panic attacks when he travels on planes. His claustrophobia developed shortly after his father died, and after his recent girlfriend dropped him. It is not, Ugazio remarks, the loss or new responsibility resulting from the father’s death that has led to the crisis, but the intense intimacy that was established with the father during his sickness. This, together with the loss of a girlfriend, is forcing Alberto to acknowledge an intense need for attachment; but for him to succumb to that need would bring an unacceptable loss of self-esteem. As he seeks to ignore and repress the issue, the claustrophobic symptoms, horror of enclosed spaces, and in particular those enclosed spaces he needs to use if he is to continue his independent life style become a powerful metaphorical reminder of his aversion to, and yet his need of, the tightly enclosed relationship. Though he has no plans to enter therapy with his family, Alberto chooses a systemic therapist because he feels that this will not involve the development of a close relationship of the variety associated with traditional psychoanalysis. Thus even while gritting his teeth and admitting a problem, he is simultaneously seeking to reinforce his independence. In the first session he demands to become like “a tower that will not fall.”
With a “strategy” diametrically opposed to Alberto’s, giving more importance to attachment yet yearning for independence, Elisa’s crises are agoraphobic rather than claustrophobic. They force her to stay at home. The first came as she stepped on board the cruise ship for her honeymoon and felt overwhelmed by panic. Ugazio remarks: “Going to Greece meant a decisive move away from the protective relationship with her mother…. Not to go meant damaging her marriage and the independence and self-esteem that went with it.” In her case, the ensuing mental disorder does not so much resolve the problem as remove it from discussion. Her husband will give up the cruise and many other adventurous projects over the decade before they enter therapy, not because Elisa isn’t genuinely enthusiastic and supportive, on the contrary, but because she is ill, she can’t go out.
While those suffering from phobias such as Elisa’s face a double bind that makes self-esteem and long-term attachment mutually exclusive, the obsessive-compulsive, in Ugazio’s model, has the more profound problem of being obliged to choose between opposite and equally unacceptable visions of self. Here the patient’s family constructs its conversation around the opposites sacrificial renunciation/ selfish indulgence. The sufferer is a child adopting a median position, not unlike the position Bateson occupied between his father and brother. A huge appetite for life, stimulated by those in the family occupying the selfish side of the polarity, makes a path of self-renunciation unbearable to contemplate. But the label of selfishness placed on almost any engagement with pleasure destroys self-esteem, which, for reasons of early attachment, largely depends on the judgment of someone occupying the renunciatory side of the polarity.
The classic symptoms of obsessive-compulsive behavior are of two kinds: compulsively repeated actions like washing hands or checking that a door has been locked (Ugazio recounts the case of a man who stopped his car every few hundred yards to see if he had run over a child or an animal). These may be seen as the neurotic reactions of one for whom every adventure into life generates guilt. The obsessions, on the other hand, take the form of the invasion of highly erotic or violent images over which the mind has no control. These can be seen as the repressed yearnings of one who is determinedly seeking self-esteem in renunciation and repression.
Again Ugazio offers examples suggesting how the condition can arise in particular family situations and the strategies developed to deal with it. Particularly intriguing is her account of the tendency to cultivate a hierarchical vision of “evil” which allows a “selfish” self to flourish just so long as it remains under the control of a superior “sacrificial” self. The case history of a hard-working priest living with his mother but allowing himself homosexual adventures in third world countries is instructive here. At age thirty, the priest had been hospitalized for two months with an acute obsessive-compulsive disorder involving extreme anxiety, intense, unwanted erotic images, and severe insomnia. After decades of relative health his symptoms recur when he is fifty-nine. Usually on return from his “holidays” his mother (decidedly on the renunciatory side of the critical polarity), though not privy to his secret, had been extremely severe in her attitude toward him, giving a welcome sense of punishment and facilitating his renewed acceptance of his “higher” self. But after the most recent trip the elderly lady was indulgent and spoke of “not always being there to look after him.” Suddenly the priest feels that the guarantee that his homosexuality will remain strictly circumscribed is gone. The conflict between selfishness and renunciation is renewed with, again, obsessive erotic images, insomnia, and anxiety as the result.
Ugazio makes it clear that her book is to be seen more as an analysis of the causes of the disorders she discusses than a manual of therapeutic approaches. She gives no prescriptions, makes no large claims. On the contrary she recognizes that by linking these disorders to the very process by which the patient’s character has been formed, her model demands that successful therapy achieve nothing less than a reconstruction of the patient’s way of experiencing and understanding the world, and in particular the world of relationships. All the same, and despite these sensible caveats, it seems only legitimate that the reader ask what hope her new systemic model offers for the sufferers she describes.
The issue of therapy is finally if rather unsatisfactorily addressed in the book’s last chapter. Ugazio clearly does not favor the dramatic forms of intervention proposed by Haley and Selvini. Nor does she take Bateson’s pessimistic line that such matters are too delicate to be interfered with at all. Rather she suggests that, having established the critical semantic polarity which dominates the patient’s life and within which he is unable to find a satisfactory position, the therapist can begin to look for other polarities around which the family of origin composed itself, since, as she insists, no family, however fierce the schismogenetic process, will be limited to just one polarity. Insofar, she claims, as she has alleviated and in many instances eliminated the symptoms of the patients described in the book, this has been achieved by gradually playing down the importance of the critical polarity and building on any others available in the patient’s experience to generate self-esteem in different ways and lead him or her to contemplate an entirely different life story. In this process, the original double bind does not so much disappear—after all, most of us are aware of, for example, a certain incompatibility between complete independence and close attachments—as become less urgent and all-determining.
In line with this approach, Ugazio concludes by remarking that one of the great dangers of therapy arises when therapist and patient concede the same importance to the same semantic polarity. Obsessive-compulsives, she claims, will tend to go to traditional Freudian analysts, because Freud himself saw the world in terms of indulgence and repression. This explains why, while offering such brilliant accounts of the disorder, Freud himself lamented his limited success in curing it. He could not move patients away from a vision he shared. Any inflexible approach to mental disturbance thus runs the risk of becoming, as Blake put it, another of man’s “mind forg’d manacles,” and may lead to situations where the therapist is actually exacerbating the patient’s difficulties. It is with this caveat that Ugazio ends her book by suggesting that “with respect to this [her own] as well as to other models of mental disturbance I believe the therapist must maintain a wise irreverence.”
The modesty here is exemplary, yet after the brilliance of her analysis of how double binds and illnesses can occur, one cannot help wishing that Ugazio had spent longer describing the process by which they can be eroded. And since various asides in Storie permesse indicate that she has worked with schizophrenics for many years, one likewise wishes that she had thrown caution to the winds and said more about possible uses of her model in dealing with that most intractable of disorders. All the same, the remarkable combination of imaginativeness and realism in Ugazio’s work raises expectations that she will venture further in the explorations that began when Gregory Bateson first arrived in New Guinea.
This study will be reissued in November as Margaret Mead, Gregory Bateson, and Highland Bali: Fieldwork Photographs of Bayung Gedé, 1936-1939 by the University of Chicago Press. ↩
Gregory Bateson: The Legacy of a Scientist (Prentice-Hall, 1980). ↩
“The New Wave in Psychiatry,” The New York Review, February 20, 1975. ↩
See Self-Starvation: From the Intrapsychic to the Transpersonal Approach to Anorexia Nervosa (Jason Aronson, 1978). ↩
Jason Aronson, 1978; originally published as Paradosso e contro paradosso (Milan: Feltrinelli, 1975). ↩
Selvini’s last book, Ragazze anoressiche e bulimiche (Milan: R. Cortina, 1998), includes a follow-up of patients dealt with twenty years ago, recording an impressive success rate. Those who worked with Selvini concur that she was a far greater therapist than writer, raising the problem how far one can rely on an “approach” and how much depends on the charisma of the practitioner. ↩
Norton, 1989. ↩
A recent publication in The New England Journal of Medicine suggests that the presence of a schizophrenic among family members increases one’s own chance of developing the condition by only 5 percent. Nor, given that one shares habits of communication with one’s family members, is that necessarily due to genetics. Living in the city rather than the country turns out to be a much greater danger statistically speaking, a factor that could point to either organic or social causes. The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) produced by the American Psychiatric Association mentions only behavioral, not organic, factors for diagnosing schizophrenia. Indeed the presence of organic alterations or pathologies which may be involved in the mental disorder explicitly excludesthe patient from being considered schizophrenic. There is no organic test or scan of any kind which can identify the presence of the disorder. With regard to a genetic component, the manual concludes laconically: “Although much evidence suggests the importance of genetic factors in the etiology of Schizophrenia, the existence of a substantial discordance rate in monozygotic twins also indicates the importance of environmental factors.” A study of the adopted children of schizophrenic and normal parents in Finland showed that the mental health of the adopting parents was at least as important as that of natural parents. Meantime, talk of such causes as an enlarged right ventricle of the brain and viral infections during fetal development is still largely speculative and no nearer to explaining the onset of the disease in late adolescence or early childhood than Bateson’s earliest formulation of the double bind. (See Christopher D. Frith, The Cognitive Neuropsychology of Schizophrenia, Lawrence Erlbaum, 1992). In short, this is a field where the consensus that has built up around what is now an orthodox point of view is disproportionate to the evidence actually produced. On its side, it must be said, the organic approach has the advantage that it does not lay the responsibility at anyone’s door while offering the hope that one day a miracle drug will simply cause the problem to disappear. ↩
Expressed Emotion in Families: Its Significance for Mental Illness, by Julian Leff and Christine Vaughn (Guilford Press, 1985), describes attempts to train families to deal with schizophrenics on their return from psychiatric institutions. These attempts mainly involve teaching family members to avoid expressing intense emotion and where possible even eye contact. The research published in the book shows that the rate of relapse is higher when a schizophrenic returns to his or her family of origin and highest when the return is to a mother living alone in a situation where both mother and schizophrenic are unemployed. ↩
V.E. Cronen, K.M. Johnson, and K.M. Lannamann, “Paradoxes, Double Binds and Reflexive Loops, an Alternative Theoretical Perspective,” Family Process, Vol. 20, pp. 91-112. ↩