The Wild and Recent History of ‘Schizophrenia’ and Family Therapy


From Underground Transmissions: “If we are going to understand how folks diagnosed with psychotic disorders are thought about and treated in 2024, it’s really useful to understand that it was VERY, VERY DIFFERENT back in the 1950s, 60s and 70s. It took the biopsychiatric revolution in the 1980s to bury some very promising threads of work for us to rediscover all these years later, much of it in the realm of what is known as systemic family therapy.

The striking thing about the family therapy movement is that it’s had a lot of professional success and its ideas are taught and used in many different mental health contexts, but in the realm of ‘serious mental illness’ and ‘schizophrenia’ it’s nearly impossible to find anyone who publicly talks about the importance of working with complicated family dynamics [sic]. It’s taboo, and the reasons it’s taboo are complex but really worth examining if we want better outcomes for people who struggle in the realms of psychosis.

Back in the 1950-70s there were plenty of people not only practicing with these ideas, but doing funded research on family dynamics and schizophrenia, and I’m going to briefly tell you about one of them right now.

. . . for some reason these ideas don’t seem to get talked about in the clinical realm of working with people diagnosed with schizophrenia and bipolar disorder or other psychotic disorders. And there’s something very disconcerting to me about this disconnect, because the underlying message I hear is that there’s something fundamentally different about people like us—something biologically different, something about our brains, that means we need to be on drugs and not talk about our family dynamics. The contemporary ‘family therapy’ for psychosis I know from working in the first-episode world is a manualized set of ‘evidenced-based’ psychoeducation modules that ‘educate’ families about the biological nature of psychosis and the need to take antipsychotic medications.

Am I the only one who thinks there’s something odd going on here?”

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