No account of the history of twentieth-century psychiatry is complete without a discussion of the “schizophrenogenic mother,” a sinister figment of the imagination of misogynist psychiatrists. The “schizophrenogenic mother,” we are told, was held solely and completely responsible for the genesis of the suffering labeled “schizophrenia” in her children — at least, in those bad old days before the advent of modern psychopharmaceutical drugs and direct-to-consumer advertising. As Allan F. Mirsky and colleagues noted in an article about the Genain Sisters, “The 1950’s was the era in which the concept of the ‘schizophrenogenic mother’ was widely accepted by some psychoanalysts (e.g. Theodore Lidz and Frieda Fromm-Reichmann).”1
In The Feminine Mystique, author Betty Friedan proclaimed:
“It was suddenly discovered that the mother could be blamed for almost everything. In every case history of a troubled child; alcoholic, suicidal, schizophrenic, psychopathic, neurotic adult; impotent, homosexual male; frigid, promiscuous female; ulcerous, asthmatic, and otherwise disturbed American, could be found a mother… Clearly something was ‘wrong’ with American women.”2
This blame-the-mother theme recurs frequently in the psychiatric literature from mid-century till fairly recently. As psychologist Stella Chess wrote in 1965:
“The standard procedure is to assume that the child’s problem is reactive to maternal handling in a one-on-one relationship… Single bits of data fitting in with these speculations are quoted as typical of the child’s feelings and the mother’s attitudes and are taken as proof of the thesis of noxious maternal attitudes as universal causation.”3
Or as John Neill, MD, observed a generation later, “It became standard practice to believe that mothers were the cause of their children’s psychosis.”4
But did psychiatrists really “blame the mother” to the exclusion of all other causes? Where did this notion come from?
As with most myths, the myth of psychiatry’s reliance on the schizophrenogenic mother has a grain of truth behind it. In a 1948 article, German psychiatrist Frieda Fromm-Reichmann, a contemporary of Freud, wrote:
“The schizophrenic is painfully distrustful and resentful of other people, due to the severe early warp and rejection he encountered in important people of his infancy and early childhood, as a rule, mainly in a schizophrenogenic mother.”5
Dr. Fromm-Reichmann was a psychoanalyst famed for her compassion and her skill in reaching even the most seemingly intractable cases of “schizophrenia” with intensive psychotherapy — and without neurotoxic drugs. The above remarks were a passing aside in a paper that wasn’t even primarily about the etiology of schizophrenia, but rather was devoted almost exclusively to the dynamics of the therapist-patient relationship.
Examination of the writings of Dr. Fromm-Reichmann’s psychoanalytically-oriented colleagues in the 1950s and ’60s reveals that from the beginning they understood perfectly well that the concept of the schizophrenogenic mother was not sufficient to explain the genesis of schizophrenia, and that this condition was most likely the product of disturbed families, not just disturbed mothers. For examples, Trude Tietze, MD wrote back in 1949 of the role of fathers:
“Very little is known about the fathers of schizophrenic children. No systematic exploration of fathers was undertaken in connection with the present study; however, eight fathers were interviewed and the impression was that they, too, had great personality difficulties. They seemed to be perfectionistic and obsessive people, as sick as their wives.”6
Similarly, psychiatrists Ruth and Theodore Lidz wrote, ““In our data, it is apparent that the paternal influences are noxious as frequently as the maternal.”7 Their findings were replicated in studies by Clardy,8 Nuffield,9 and Wahl,10 among others, and other researchers noted the role of any and all family members. Psychiatrist D.D. Jackson thought schizophrenia should be studied as a “family-borne disease involving a complicated host-vector-recipient cycle that includes much more than can be connoted by the term ‘schizophrenogenic mother.’”11 Lidz and colleagues concurred, noting:
“As our studies were uncovering serious difficulties in all areas of transactions in these families, we preferred to bring balance to the topic by directing attention to the total situation before focusing on the mother.”12
On the other hand, the mother-child relationship is arguably the most important human relationship there is. Is it really such a stretch to suggest that bad consequences may follow when this relationship goes awry?
Tietze’s paper, above, discusses the case history of a young woman with schizophrenia whose mother was obsessed with preventing her daughter from masturbating. This woman would sniff her daughter’s hands throughout the day as a spot check for masturbation, and she had two surgical mutilations performed on her infant child’s clitoris — one when the child was one year old, and one when she was two. This same woman would inspect her daughter’s vulva every night and beat her if she judged the child’s labia were “irritated.”
Could it be that this woman’s actions had something to do with her daughter’s problems later in life? Almost definitely. But acknowledging the role of trauma inflicted by a given individual’s mother is not the same as laying all blame for “mental illness” at the feet of motherhood.
Is the question is merely academic? No. Consider the response to an op-ed by psychologist L. Alan Sroufe that appeared in the New York Times in 2012. The piece discussed the 2009 MTA study by Brooks13 and colleagues in which 600 children with the diagnostic label “ADHD” were followed for eight years, and which found no long-term benefits of medication for this condition for any of twenty-four outcome variables. Dr. Sroufe concluded:
“The illusion that children’s behavior problems can be cured with drugs prevents us as a society from seeking the more complex solutions that will be necessary. Drugs get everyone — politicians, scientists, teachers, and parents — off the hook. Everyone except children, that is.”
Not everyone saw it that way. A reply to Dr. Sroufe’s op-ed by author Judith Warner accused him of wanting to make “A trip back to an era… when children with psychiatric ills were believed to be victims of toxic ‘schizophrenogenic mothers.’”
Neither the MTA study nor Dr. Sroufe’s op-ed made any mention at all of “schizophrenogenic mothers.” And this tempest-in-a-teapot misses the larger issue here: A large, multiyear study found no long-term benefits to powerful, brain-altering drugs that had been given to literally millions of children. These were findings that merited serious discussion — not scolding evocations of “schizophrenogenic mothers.”
More recently, an article appeared in the Washington Post recounting some of the history of Chestnut Lodge, the private institution in Maryland where Dr. Fromm-Reichmann performed her groundbreaking work. The article was largely dismissive in tone, telling readers:
“As understanding of the biological and chemical causes of mental illness grew, Chestnut Lodge’s unquestioning embrace of Freudian psychoanalysis came to look dated. Could debilitating — and occasionally dangerous — psychosis really be treated by talking about your mother?”
Aside from the fact that psychotherapy can’t be reduced to “talking about your mother,” there is still no credible evidence for a chemical or biological cause for schizophrenia or any of the other “functional disorders” commonly treated by psychiatrists. The article did not mention this fact, nor did it point to any relevant public health outcome that has improved since modern-day psychiatric drugs were introduced.
Meanwhile, since the time Fromm-Reichmann carried out her work, a mountain of evidence has accumulated linking schizophrenia to sexual abuse, physical abuse, emotional abuse, and a wide variety of other categories of adverse childhood experiences.14 15 16 17 The correlation between adverse childhood experiences and schizophrenia is robust, reliable, and dose dependent. It cuts across national boundaries, income brackets, and ethnic identities. It has been verified again and again in prospective cohort studies,18 population-based cross-sectional studies19, and case-control studies.20 The perpetrators of the abuse may be fathers, stepfathers, grandfathers, uncles, older brothers, cousins, nonrelatives — and yes, sometimes mothers.
These studies also have shown there is no specifically “schizophrenogenic” style of parenting. Rather, any of a variety of toxic influences (some largely outside the parents’ control, such as childhood illness or death of a parent) may tip the balance towards schizophrenia or any other “mental illness.” For example, one study found that between 45% and 60% of patients diagnosed with schizophrenia had been subjected to child sexual abuse.21 (And, as the reader no doubt already knows, the great majority of childhood sexual abuse is perpetrated by men, not women.) This is a finding that ought to be greeted with alarm, not sneers about “blaming the mother.”
But it should also be greeted with hope, since child sexual abuse and other adverse childhood experiences are problems we can do something about.
The real myth of the schizophrenogenic mother is the idea that psychiatrists ever seriously promoted the idea that mothers are solely responsible for schizophrenia in their children. And this myth has for too long been used as a straw woman to divert attention from serious discussion of the role of abuse and trauma in the genesis of schizophrenia and other types of mental distress, and to promote biological explanations and pharmacological interventions for these conditions instead. It’s time to lay this myth to rest for good.