Communication deviance in families of schizophrenic and manic patients

Levels of communication deviance (CD) distinguish parents of schizophrenic patients from parents of nonpsychotic patients, but the prevalence of intrafamilial CD in other psychotic disorders has not been examined. Levels of CD were compared across biological parents of schizophrenic (n = 39) and bipolar manic (n = 16) patients and across patients themselves. CD ratings were based on Thematic Apperception Test protocols (parents only) and family interactions (parents and patients). Total levels of CD did not distinguish between groups of parents or patients. However, instances of odd word usage were more frequent among parents of manic patients than among parents of schizophrenic patients on both CD measures. Also, during the interaction task, odd word usage was more frequent among manic patients, whereas schizophrenic patients made more ambiguous references. Results suggest that high levels of intrafamilial CD are not unique to schizophrenia.     

Parent and Child Effects on Cognitive Performance: An Experimental Approach to the Etiological and Responsive Theories of Schizophrenia

While many theorists have assumed that the family has an etiological part in the development of schizophrenia, most findings, since they come predominantly from observations after the illness has occurred, could plausibly be interpreted as family responses to the illness. In this experimental study, we constructed artificial families in order to measure independently of each other the effects of parents of schizophrenics on children and the effects of schizophrenic children on parents. Findings from a cognitive task requiring abilities to attend and abstract show that the presence of a schizophrenic child has only minor disruptive effects upon the performance of normal parents; parents of schizophrenics also have little effect upon normal children. Instead, the most consistent effects are those of normal parents on the schizophrenic child. Adolescent schizophrenic patients whose cognitive performance deficit is apparent prior to the experiment show significant improvement after having worked on the cognitive task with normal parents; their cognitive deficit disappears, and their performance is not different from matched normal children. Further investigation will center on the quality of the normal parents' “normalizing” effects.     

Short-Term Stability of Task-Generated,Interactional Patterns in Families of Schizophrenic Patients

Both researchers and therapists who study schizophrenia make inferences about enduring family roles from observed patterns of interactional talking behavior within families. Evidence regarding the stability of these patterns is rarely investigated. The present study examined the short-term stability of intrafamilial speech patterns (who talks to whom) across two consecutive discussions. The sample was composed of families containing a recent-onset, adult schizophrenic patient. All discussions involved two biological parents and a young adult patient (N = 28 ). Families were classified into one of three interactional role-structure categories based on the intrafamilial speech patterns in two 10-minute discussions obtained in the same session. In addition, the affective style ( 4 ) of the content of the discussions was coded. The results indicated that intrafamilial speech patterns were relatively stable across two discussions despite variations in the focus of the problem discussed. Further, when one parent was predominant in the discussion, a higher rate of negative affective statements was observed than when both parents were equal participants. The results provide further support for the use of discussion tasks in generating meaningful family interaction data.     

Obsessive-compulsive disorder patients display enhanced latent inhibition on a visual search task

Latent inhibition (LI) is a phenomenon that reflects the ability to ignore irrelevant stimuli. LI is attenuated in some schizophrenic patient groups and in high schizotypal normal participants. One study has found enhanced LI in patients with obsessive-compulsive disorder (OCD [Swerdlow, N. R., Hartston, H. J., & Hartman, P. L., 1999. Enhanced visual latent inhibition in obsessive-compulsive disorder. Biological Psychiatry, 45, 482-488]). The present experiment replicated this finding using a within-subject visual search LI task, with OCD patients displaying more LI than healthy controls. The contrasting LI effects in schizophrenia and OCD are discussed in terms of how these groups differentially process relevant and irrelevant stimuli, and how that outcome affects subsequent behavior.     

Researching the Family Theories of Schizophrenia: An Exercise in Epistemological Confusion

Some, but not all, of the family theories of schizophrenia entail a shift from the Aristotelian/Cartesian/Newtonian epistemology of individual psychology to a systemic epistemology of pattern. Perhaps the most significant (and underappreciated) aspect of this epistemological shift pertains to etiology: The family theories of schizophrenia espoused by Bateson et al. and by Wynne and Singer do not claim that parents or families cause schizophrenia. The persistent failure of researchers to appreciate this has led to many fruitless studies that have sought to discover a causal link between the thought disorder and communication deviance of parents and the schizophrenia of their offspring. This paper reviews from an epistemological viewpoint the empirical literature that has attempted to assess the validity of the family theories of schizophrenia. Particular attention is given to restating and extending the epistemology of pattern within which schizophrenia occurs. The conventional psychiatric approaches to schizophrenia are shown to play an active role within the schizophrenic pattern.     

Disconfirmatory feedback in families of schizophrenics

A new approach to the study of family communication and psychopathology, in particular schizophrenia, using Saugstad's theory about use of language as its point of departure is presented. Conflicts between family members were observed and measured using a new unrevealed difference technique, the Colour Conflict Method (CCM). Communication was analysed in terms of continuous feedback processes, using the new computerized method, Confirmation-Disconfirmation Coding System (CONDIS). Feedback mechanisms in the internal communication of families of schizophrenics, normals, and non-schizophrenic pathological controls (n = 21) are described. The findings show that families of schizophrenics lack the ability to adapt their communication to changing situational requirements. When conflicts were introduced, families of schizophrenics-in contrast to non-schizophrenics within the extended schizophrenia spectrum and normals-increased their frequency of disconfirmatory feedback reactions instead of expressing disagreements openly. This was due to active disqualifications occurring between the parents and from the parents towards their schizophrenic offspring, who reacted with incomprehensible egocentric communication acts.     

Children of parents with unipolar depression: A controlled 1-year follow-up

An earlier cross-sectional study indicated that children's health and adjustment is at risk when their parents are depressed. Here, we report the associated longitudinal changes in children and families when parental depression either remits or continues. Comparisons are made among three groups established at a 1-year follow-up: previously depressed parents whose symptoms have remitted (N = 34 remitted parents), previously depressed parents who continue to be depressed (N = 23 nonremitted parents), and sociodemographically matched control families (N = 95). Although remitted parents and their family social environments improved, their children were still functioning more poorly than children of controls. Both the children and the families of nonremitted parents continued to function more poorly than controls. A social-environmental framework indicates that parents' functioning as well as family stressors and resources are concurrently and predictively linked to children's health.     

ABSTRACTS OF LITERATURE

Schizophrenia is due to a combination of genetic and environmental factors. The author asserts that there has previously been an error in conceiving the patient as being molded completely by external circumstances. In fact, it is the patient's behavior, which is a transformation of family irrationality, that constitutes schizophrenia. In 75 per cent of cases of schizophrenia seen by the author in private practice, the mother did not fit the image of the so-called “schizophrenogenic mother.” In this technique for teaching family therapy, the students take the roles of the family. Procedures, selection of players, formulating the problem, the value of the experience, and ground rules are described. This is a case report and follow-up over nine years of an alcoholic woman. The patient and husband were treated for 35 sessions by cotherapists in conjoint marital therapy. Although there was improvement in the family patterns and in drinking behavior during the treatment, the improvement did not last after termination. The case suggests that marital therapy in the absence of other treatment interventions is ineffective in changing the long-run course of women alcoholics. Based on the author's practice on an inpatient unit that specializes in the study of aggressive behavior, he describes family dynamics and treatment when the identified patient suffers from “episodic violent behavior.” The sample focuses on adolescents, most of whom had episodes of suicidal behavior and who had some evidence of “organic involvement.” Typical family patterns include overly close alliances by the adolescent with one or both parents and transmission by parents of inconsistent values regarding aggression. Family therapy is seen as the preferred treatment approach and emphasizes family ways of handling dyscontrol episodes and the responsibility of the patient for his or her actions. No results are reported. This study attempts to link family variation and core relationships in types of families with the mental health of children. Sample was from a black, poor, urban community defined in terms of the adults present in the home. Eighty-six family types were found falling into ten major classes. Measures of mental health in children were done on psychological well-being of the children and on Social Adaptational Status. Results indicate that family type is strongly related over time to child's SAS and his or her psychological well-being. Mother-alone families entail the highest risk in terms of social maladaptation and psychological well-being of the child; the presence of certain second adults has important ameliorative functions—mother/grandmother families being nearly as effective as mother/father families, with mother/stepfather families similar to mother-alone in regard to risk. Inferences from this data and implications and interventions are discussed. This is a clinical essay on the role of family therapy for black families. In addition to the usual family stresses, black families are subject to the additional strain of discrimination. Support is achieved mostly from the family and from the kinship network, rather than the community. Treatment strategies for this situation are proposed. This essay reviews recent regulations concerning consent procedures and protection of privacy as they apply to children and their families. Rigorous sample selection, nearly complete follow-up, and objective assessment of outcome are virtually impossible at this point. It is concluded that compliance with current “subjects' rights” regulations sometimes seems potentially more harmful to the subjects than the research itself. One case example is presented in support of the hypothesis that brief family therapy has the potential to lead to individual personality changes that are long-lasting. The identified patient was a 15½ year old boy with the symptom of having a falsetto voice. Father, mother, and child were seen in twelve family therapy sessions with changes in the boy's self-image documented in “man-figure” drawings. Nine-month follow-up revealed no recurrence of the presenting symptom and an improvement in social and familial relationships of the identified patient. This is another in a series of papers from a divorce-counseling project. The focus in this paper is on preventive clinical interventions developed for children of various ages in divorcing families. Developmental assessment was achieved with a “brief” history from the parents, detailed information from school, and “direct observation” of the child. This paper covers treatment strategies, interventions, failures, therapist's role, and professional dilemmas in divorce counseling of 60 families with 131 children between the ages of 3 and 18 at the time of divorce. The technique of counseling was to see one parent and child separately by the same therapist three to six times over a three-month period. This is a research study to provide data on the question of whether the disturbed behavior of parents with a schizophrenic child preexists or is a response to an identified patient's pathology. Method was to administer a conceptual task called the Twenty Questions Task individually to each family member and to the family as a unit with a sample of 36 schizophrenic families, 13 non-schizophrenic controls, and 38 normal controls. Results “indicated that far more schizophrenic sons than control sons were much more efficient individually than with their families.” A number of schizophrenic sons performed competently as individuals, but the subsequent performance of parents and sons together on the same task was generally inferior to that of the son alone. Results suggest that the parental behavior plays a part in the etiology of schizophrenia.     

Symbiosis and Confirmation Between the Parents of the Schizophrenic

Parents of schizophrenics (N = 17 ) were compared with parents of nonschizophrenic hospitalized patients (N = 14 ) and parents of normals (N = 15 ) on the degree of symbiotic enmeshment and confirmation of individuality in the parental relationship. Symbiosis was divided into six component variables: undifferentiation, dependency, intervention, disapproval of other relationships, separation difficulty, and injunctions. Confirmation was bifurcated into acknowledgment and accommodation. Projective tests (TAT and Make-A-Picture-Story) and interviews were used to measure both variables. The results suggest that mothers of schizophrenics tend to be symbiotically attached to their husbands and view their husbands as forming the same type of attachment to them. Fathers of schizophrenics do not tend to be symbiotically involved with their wives but fail to confirm them. The implications of the results for the family system of the schizophrenic are discussed.     

The “Shadow-of-Death” and Its Implications in Four Families,Each with a Hospitalized Schizophrenic Member

This paper summarizes the salient points from tape recordings of conjoint sessions with four families, each with a hospitalized schizophrenic member carrying a poor prognosis. As the sessions progressed, a profound and overwhelming sense of frustration, foreboding, doom and despair emerged, as if the family were attempting to preserve what seemed destined to die. Each family as a whole was involved in what can best be described as a vicious circle of displaced and distorted mourning for a dead family member. This had deep and unresolved emotional significance for one or other parent. This same parent was also more obviously involved with the schizophrenic child, whose own symbolic family role included both being protected from anything in life carrying the possibility of death and distracting others from the source of this “shadow-of-death.”     

Smooth-pursuit eye tracking in first-episode psychotic patients and their relatives.

We wished to determine the specificity of smooth-pursuit eye tracking dysfunction to schizophrenia and the prevalences of dysfunction among functionally psychotic and normal individuals. Therefore, we investigated pursuit tracking in a large sample of psychotic patients, normal subjects, and first-degree relatives (N = 482). Patients were recruited as part of an epidemiological study of first-episode psychosis that used a broadly based referral network to identify all cases in a major metropolitan area over a 2 1/2-year period. Patients received diagnoses of schizophrenia, schizophreniform disorder, psychotic mood disorder, and paranoid or other psychotic disorder based on the third edition of the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 1980). The distribution of tracking performance was bimodal for the schizophrenic patients and their relatives, perhaps reflecting major gene action. Moreover, poor tracking ran in families. Pursuit tracking dysfunction was relatively specific to schizophrenic patients and their relatives and occurred infrequently in other psychotic patients and normal subjects.     

Children vulnerable to psychopathology: The Stony Brook high-risk project

The study of children at risk for the development of schizophrenia is a promising research strategy for increasing our understanding of the etiology of schizophrenia. This paper describes the methods and procedures of such an investigation. Three groups of children are being followed: those who have a schizophrenic parent, those who have a depressive parent, and those whose parents have no psychiatric history. There are three major foci of our assessment procedures. First, the patient, spouse, and family environment are examined. Second, the children are assessed in school from the vantage point of both peers and teachers. Finally, the children are tested with several laboratory measures of cognitive processes, attention, emotional responsivity, and social interaction.This research was supported by Grant MH-21145 from the National Institute of Mental Health and by funds from the W. T. Grant Foundation.     

Hard-to-manage preschool boys: Family context and the stability of externalizing behavior

Preschool boys identified by their teachers as active, inattentive, and impulsive (N=42) were compared with matched classroom controls (N=43) and with parentidentified problem boys (N=27) on measures of family functioning often associated with children's problem behaviors, including family history of psychopalhology, stressful life events, and family composition. Teacher-identified and parent-identified problem boys did not differ on measures of family adversity, and both groups came from less well functioning families than comparison boys. Mothers of problem boys, regardless of referral source, were more negative and controlling toward their sons when observed in a compliance task. Children's problem behaviors were moderately stable over a oneyear follow-up period; initial symptom levels, maternal self-reported depression, and negative maternal control predicted follow-up ratings of externalizing problems.Thanks are expressed to Clea Angell, Clare Flanagan, Julie Hunt, Patricia Huszar, Andrea Lurier, Sarah McAuliffe, Jasmine Sardessai, and Teri Sobolik for help with data collection, coding, and analysis. We are grateful to the staff of the many preschools in the Pittsburgh area who facilitated our work. Special appreciation is expressed to the children and parents who participated in this study.Portions of these data were presented at the Rochester Symposium on Developmental Psychopathology, Rochester, New York, October 1988, and at the Society for Research in Child and Adolescent Psychopathology, Costa Mesa, California, February, 1990. This work was supported by grant R0I MH32735 from the National Institute of Mental Health to Dr. Campbell.     

Involuntary Rest Pauses (Irps) in Schizophrenics and Normals

Normal and schizophrenic Ss (N=24 each) performed a simple tapping task. The prediction that more involuntary rest pauses would be produced by schizophrenics than by normals was borne out. A discussion is given of the relation of these results to the interpretation of schizophrenia in terms of “arousal”.     

A sociocultural stress, appraisal, and coping model of subjective burden and family attitudes toward patients with schizophrenia

A sociocultural stress, appraisal, and coping model was developed to understand relatives' burden of care and negative affective attitudes toward patients with schizophrenia. Ninety-two African American and 79 White patients and a significant other (80% mothers) completed 2 10-min family problem-solving discussions. In addition, the Kreisman Rejection Scale and a global self-report rating of family burden were administered to relatives, and a self-report rating of substance use was administered to patients. Results indicated that subjective burden of care and patients' odd and unusual thinking during the family discussion each independently predicted relatives' attitudes toward patients, suggesting that negative attitudes are based in part on both patients' symptoms and perceived burden of care. African American relatives' perceived burden was also predicted by patients' substance abuse. Finally, White family members were significantly more likely than African Americans to feel burdened by and have rejecting attitudes toward their schizophrenic relative suggesting that cultural factors play an important role in determining both perceived burden and relatives' attitudes toward patients.     

A taxometric analysis of cognitive and neuromotor variables in children at risk for schizophrenia

A taxometric model was applied to detect a subgroup or taxon of children conjectured to be at highest risk for developing schizophrenia or related disorders in a sample of offspring of schizophrenic, depressed, and normal parents. Measures of cognitive and neuromotor performance in childhood were used as indicator tests in the analyses. A taxon consisting chiefly of children of schizophrenic parents was detected. Forty-seven percent of those children were assigned to the taxon, compared with 16% of the children of depressed parents and 4% of the children of normal parents. Assignment to the taxon is assessed in relation to the current functional status of the subjects in young adulthood.     

Mother— and Father—Child Mutuality in Anglo and Indian British Families: A Link with Lower Externalizing Problems

We observed mother- and father-child dyadic mutuality (responsiveness, interaction reciprocity, and cooperation), and its association with child behavior problems, in a socioeconomically and ethnically diverse sample of 125 male (51%) and female 7-to-9-year-old children. Dyadic mutuality and positivity were coded from in-home videotaped structured tasks, and parents completed ratings of child externalizing problems. Mothers showed more mutuality than fathers. The same child showed moderately similar mutuality with both of her or his parents (r = .47). Mutuality was higher among Anglo parents compared to Indian parents, an effect that was due in part to acculturation (i.e., years since immigration, native language use, traditional native culture attitudes). Greater mutuality, when coupled with dyadic positive affect, was associated with fewer externalizing problems (R2 = .24). This pattern held across gender, ethnic, and sociocconomic groups.     

Pursuit Rotor Reminiscence in Schizophrenics and Normals

Normal and schizophrenic Ss (N=24 each) did pursuit rotor tracking and reminiscence was the score of interest; rest pauses of 2, 12, and 30 min., and 1, 6, and 24 hr. were interpolated in counterbalanced order after 5 min. of practice. It was predicted, on the basis of previous work, that schizophrenics would show greater reminiscence after the longer rest pauses, normals after the shorter rest pauses. The expected cross-over effect was found, but at a non-significant level only. There were no order effects. A discussion is given of the relation of these results to the interpretation of schizophrenia in terms of ‘‘arousal.”     

Personal Pronoun Usage in Families of Schizophrenics And Social Space Utilization

Personal pronoun usage of individuals in interaction is proposed as an index of the social functioning of both the individuals and the groups. The interaction of schizophrenic young adults, male and female, with their mothers and fathers, is compared with that of normal young adults with their parents in these terms. Previous findings regarding disproportionate use of the first person singular by schizophrenics are confirmed, and it would appear that this behavior is not learned tom their parents who are low in usage of these pronouns. Findings of other studies regarding male-female differences in schizophrenics and coalition patterns and social control mechanisms in their family interactions are also suggested by the data.     

Rebuilding security: group therapy with children affected by September 11

This article examines group therapy with children and adolescents impacted by the September 11 terrorist attacks on the World Trade Center, with a focus on the role of metaphor, enactment, and the creative arts therapies in trauma treatment. Attention is given to the importance of fantasies, family structure, and culture in determining how the child constructs and processes the events. Examples are derived from ongoing, trauma-focused groups with traumatically bereaved children who lost parents, as well as from ongoing drama therapy groups in which traumatic themes emerged.