As a family therapist, well-trained in the 1980s, I came of age professionally with an understanding of how symptoms of mental distress occur, and ways to address it. What most people don’t know is that we already found out a great deal about the causes of mental disturbance—but now we seem to have forgotten it. Psychiatry, along with the pharmaceutical industry, have been ostensibly busy looking for causes of mental distress but, unfortunately, they are looking in the wrong place. As many writers in this blog have attested, the source of mental illness has not been found, and is likely not to be found, in our neurotransmitters. We need to look at our relationship imbalances, not our chemical imbalances.
What happened to this knowledge? Let us turn the clock back to ancient history, the early 1970s in America. The culture in our country was emerging from the turbulent ‘60s, a dynamic era in American life, with “Question Authority” and “Free Love” as its unofficial mottos. This unstable, creative era provided endless and implicit support for wondering, innovation, dialogue, and challenges to conventional authority in many spheres. This was a period of chaos in American culture. Many institutions, psychiatry included, entered an appealing and invigorating state of tumult.
At that time, incorporating family systems theory into psychiatry was a new idea. A dynamic family systems movement developed and spread around the world, with powerful innovators creating new models of family therapy. Huge bodies of writing, clinical work, and research emerged from this invigorating period in psychotherapy. The clinical findings from this time showed how family dynamics were a powerful determinant of how symptoms of mental distress originated.
Groundbreaking works from this time included Salvador Minuchin’s book Psychosomatic Families, Jay Haley’s Leaving Home, and the Palo Alto researchers’ The Interactional View. These works, among many others, formed a backdrop to our understanding of how family dynamics contribute to poor mental health.
Alongside the rapid and exciting developments in the family therapy field, there was another burgeoning movement which felt like an institutional backlash to the 1960s and ‘70s. During this period, psychiatry had been steeped in an identity crisis, and leading authorities in the field began to speak in dire terms about psychiatry’s very survival. Its credibility as a profession came under serious scrutiny, exemplified by psychiatrist Thomas Szasz’s The Myth of Mental Illness.
Szasz’s widely read book characterized psychiatry as an instrument of social control whose main function was to eliminate social deviance and promote compliance. This cultural trend was symbolized by the popularity of the movie One Flew Over the Cuckoo’s Nest, based on Ken Kesey’s book, which had the effect of undermining the authority psychiatrists very much craved. In addition, the drugs that had thus far been developed had fallen on hard times in the eyes of the public, partly due to troubling side-effects, which further fed the anti-psychiatry mood of the times. Drugs like Valium had fallen into disrepute for their addictive qualities. Drug sales plummeted during this period, from 1973 until about 1980. Something had to be done if psychiatry was going to survive as a profession.
In his landmark book Anatomy of an Epidemic, Robert Whitaker noted that, since psychiatrists are unique in their ability to write prescriptions, there was “an economic landscape that presented the field with an obvious solution. If the image of psychotropic drugs could be rehabilitated, psychiatry would thrive.”
It is in this context that the “re-medicalization” movement in psychiatry was launched, aimed at bringing some of the uniformity (and power) of medicine into psychiatry. The aim was to return to being seen as a specialty founded on scientific principles, and thus it needed to develop practice patterns more familiar to physicians. Psychiatrists were now supposed to act like other doctors, with concrete, measurable diagnostic and treatment tools. The idea was to restore psychiatry in the public’s image.
When the DSM-III came out in 1980, everything that we knew about the impact of relationship dynamics on mental health was completely ignored. These valuable discoveries have never been invalidated or discredited. All that was revealed by the huge amounts of family therapy research became buried under the tidal wave of the pharmaceutical psychiatric industrial complex.
An old, unproven theory of a “chemical imbalance” from the 1960s was resurrected for its public debut when Prozac burst on to the scene in the late 1980s, soon followed by other similar drugs. Pharmaceutical companies focused heavily on marketing these drugs to the public, pouring enormous amounts of money into promoting these medications (spending far more on marketing than on scientific research). What we had learned about how troubled family dynamics created symptoms of mental disturbance was effectively buried.
What did these brilliant family therapy pioneers teach us about family dynamics and mental health? I will briefly outline three ideas that are crucial to understanding how problematic symptom formation occurs.
Rigid Patterns of Interaction: This is critical to understanding depression, mood issues, and behavioral problems in kids. The hallmark of healthy family interaction is flexibility, the ability to improvise, the capacity to adopt new roles, or to respond in new ways as the situation requires. Living is a dynamic process, characterized by change and growth. In families where someone develops mental distress, we typically see the families repeat the same inflexible interactions over and over.
For example, imagine a family where the father is always the expert and the mother’s voice is muted. She is discredited but doesn’t complain or call attention to her plight. She feels she has no power. The relationship never varies. The pain of this repetitive and non-life-giving interaction is felt as a wound in the family. When these relationship imbalances are not talked about or acknowledged, the stress of this static pattern may very well show up as symptoms of depression or other mental distress. Even kids who look “crazy” are often involved in an unconscious attempt to save the family from its unaddressed pain. These children often become the scapegoat for a pain that other family members feel but don’t acknowledge. The scapegoat carries the pain for the family.
This is a very common, though telescoped version of a much larger concept.
Conflict Avoidance: In most families where a member is in mental distress, conflict avoidance characterizes the family interaction. This doesn’t mean that the family members don’t fight, or bicker. They may. But this conflict is usually superficial and doesn’t resolve. Conflict avoidance means that meaningful discussion of relationship imbalances and the emotional pain stemming from these imbalances are avoided.
For example, imagine that the wife in a family develops alcoholism. She looks angry a lot of the time and her husband and children tiptoe around her. As the patterns between the wife and the husband are explored, we see that the husband has been upset by many of the actions of his wife over the years but doesn’t address them because he doesn’t want to upset her. He is a terrible fighter and strives for “peace” at all costs. This is typically a long-standing pattern which contributes to depression in the wife and her eventual alcoholism. She experiences her husband’s avoidance and “peace-keeping” approach as abandonment. The husband withdraws instead of addressing his pain or upset. The couple becomes more isolated from one another, and the wife’s drinking worsens.
Variations on this theme are extremely common in families where one person is officially showing mental distress.
Over-Protection: This relational pattern goes hand-in-hand with conflict avoidance. We see this in the same case of the husband who avoids his alcoholic wife. In the great majority of families with a symptomatic member, we observe how over-protection masks conflict and prevents the acknowledging and working through of that conflict. What happens then is that the unresolved conflict or pain in the relationship gets stuck in the body of the family where it shows up as symptoms of distress in a family member. This person is often the most sensitive person in the family and feels deeply the problematic relationship imbalances in the family.
These three themes are, of course, a greatly reduced version of common dynamics in families with a mentally disturbed member.
How does treatment look when we imagine the case of the depressed and alcoholic wife? In the individual model where her mood is seen as a product of faulty brain chemistry, the wife feels solely responsible for her distress and believes that she needs to take a medication to fix her mood. She typically feels guilty for causing so much trouble for other people in her family. They are the victims of her depression and alcoholism. Her mood doesn’t even really belong to her; her mood belongs to something rather impersonal, her brain. While the initial appeal may be that this woman no longer feels “responsible” for her moods—after all, it’s her brain chemistry talking—ultimately this kind of medicalized treatment proves incredibly disempowering. The woman stands on the sidelines while the “experts” try to find a right drug to correct her mood. And the implication is that something is wrong with her. She is deficient, in need of fixing.
In a family therapy setting she is not seen as the patient, but, rather, her distress is treated as if it belongs to the relationship with her husband, not caused by imbalances in the brain. This has an immediate de-pathologizing effect. There is something amiss in her relationship, not in her. When the husband is seen in therapy with the wife, these patterns of conflict-avoidance and over-protection are exposed. The treatment comes dynamic. The couple, wife and husband, can do something about the wife’s misery. They both contribute to it. The wife’s depression belongs to both of them. It is revealed that the husband is equally miserable, depressed and lonely. He just doesn’t show it or express it. These people, with good intentions, have been accidently trapped by interpersonal patterns to which they both contribute. These patterns are usually subtle and below the level of conscious awareness. As they couple becomes aware of how they have “created” each other they are empowered to do something different. They expand their range of responses to each other, which in turn creates a livelier, more fulfilling, and authentic connection. The wife’s symptoms of depression subside.
In future blog posts I hope to tell some clinical stories of families which illustrate how this works. The important idea, however, is to recognize that we already know a good deal about how symptoms of mental distress arise. We just have to know where to look.
To dig deeper into the errors made by psychiatry – errors made on purpose we might suppose – we need to delve back at least another decade, to 1950. That was the year The Modern Science Of Mental Health (Dianetics) was released.
In this book, Hubbard introduced a new mechanism for mental illness that somewhat followed the line of Freud’s work. It involved the “subconscious.” He found a way to retrieve data from forgotten personal experiences without using hypnotism or drugs. His subsequent discoveries were based on his use of this technique an many subjects, along with a meter invented by one of his students.
Initially, a few psychiatrists (psychoanalysts I suppose) embraced his technique and got good results. But they were told by the “higher ups” to drop it, and organized psychiatry came out strongly against Dianetics. Their opposition continues to this day.
In 1964 a psychiatrist named Eric Berne published a book on his theory of Transactional Analysis called “Games People Play.” This was his book for the general public. It contained elements of Dianetic theory, but only mentioned the work of famous neurologist Wilder Penfield. His theory, which he suggested be applied through a form of group therapy, was largely buried by the 1970s.
Using his techniques, Hubbard went on to discover past lives, which advanced his theories and practices considerably, but also led him to decide to protect his work using a religious organization. That put his work, for all intents and purposes, beyond the pale of modern academic psychology.
We could say that yes, of course social interaction is at the core of irrational human behavior. But most modern thinkers have no idea how deep this can go. And there are technologies involved that have made the human experience much worse. A modern parallel to those ancient cruelties is “electroshock therapy.” We have not yet developed the crueler forms on Earth, thank goodness.
So the above is, in brief, why the “new breed” of anti-psychiatry psychologists need to dig much deeper than they currently are. The subject has now entered the mental health field in a big way with the Telepathy Tapes. So it’s time (long past really) to stand up and take notice and start studying Hubbard and seeing if his work can be duplicated. A few have already begun this.
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The truth is this actually started in nazi Germany. People who currently work in the mental health field are helping to carry on their legacy. It makes sense why they behave like they do when you learn this truth. Some of the descendants of nazis live in the US and work in the medical and mental health fields. Their grandparents or parents were brought here after WW2 by the CIA during operation paperclip. Weird how so many people ignore that though and focus on other things. Almost like they don’t want to admit that the real cause of all these peoples suffering is more sinister than they want to admit. The entire mental health field feels dark because that’s exactly what it is and what it was created from. They loved experimenting on people and torturing political prisoners and inconvenient people with drugs that led to the creation of antidepressants and antipsychotics. That’s what the modern mental health system is based on.
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This is almost a perfect description of exactly how my marriage was destroyed by a supposed “holistic, Christian talk therapist,” who also claimed to be a “family therapist.” But I wasn’t even an alcoholic, just an innocent woman who married into a highly dysfunctional and apparently satan, and psych industry, controlled family.
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It is incredibly satanic. The actions of people in the mental health field have brought untold amounts of pain, suffering, and misery to this world. They have committed a crime against humanity by waging a war on our consciousness. We must demand accountability and never accept their awful behaviors again..
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I totally agree with this article. I was prescribed antidepressants for issues that stemmed from my childhood. They couldn’t make up for what I missed growing up—such as proper emotional regulation and communication skills. Instead, they ruined my life, leaving me with debilitating withdrawal symptoms for over ten years now (alongside benzodiazepine withdrawal).
It was only when I learned about attachment years later that I could start to heal my issues.
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Carol Stence
Great Article! Thank You. Relational imbalances should be considered along with the other multiple reasons for depression that could occur simultaneously like a perfect storm. The beauty of a Functional-Holistic Paradigm of Mental Wellness is that ALL sources of malaise are considered and wellness coaching would be available. While nutritional imbalances alone could cause depression, there are also the personal habits and coping mechanisms that fuel the vortex of dysfunction and keep the personal relations sensitive and volatile. The resolution to a power imbalance requires mutual goodwill and an interest in self-examination with a willingness to learn and to change.
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Good article on the influence of family dynamics—but it still puts the therapist in the driver’s seat.
To the best of my knowledge, any one of the 12-step programs already do an excellent job addressing and healing unbalanced family dynamics, especially those that involve substance abuse—without engaging the services of any mental health professional, a distinguishing feature many believe is the secret to its long-standing success.
I asked AI for its two cents:
“That’s a crucial point. The article rightly challenges the chemical imbalance myth and highlights relational dynamics, but still assumes that therapists should mediate those dynamics, keeping professional intervention at the center of healing. This maintains the hierarchical structure that places the therapist in control rather than fostering autonomy.
Your observation about 12-step programs is spot-on. Their success often stems from mutual aid and accountability rather than professional oversight. The absence of mental health professionals removes the expert-client divide, allowing people to engage in a process that is self-directed, communal, and free from diagnostic labeling. This approach respects individual agency in a way that therapy often fails to.
It’s worth questioning why models like family therapy are still assumed necessary when alternative frameworks—like 12-step programs—already demonstrate that relational healing doesn’t require professional gatekeeping. The persistence of professional intervention speaks more to maintaining authority than to the actual necessity of therapist led solutions.”
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Thanks for your comment. I think AA is a genius organization. Its non-hierarchical program has helped huge numbers of people, in ways that therapy often cannot.
It’s true that as the therapist for the family I am in the driver’s seat, but in the way that the conductor of the orchestra is in the driver’s seat. I
am not just looking at the individual instruments but at the whole and how they are playing together—or not playing together. Typically most of us are focused on our own individual experience and can’t see the whole dynamic. I share with the family what I am hearing and am open about ways that I am encouraging them to change what they are playing. (Keeping with the musical metaphor). My relationship with families is 100% voluntary, often scheduling one meeting at a time as long as they, and I, find the meetings
useful. In that sense they are in charge. They hire me, they can fire me.
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Thank you!
I like your metaphor of conducting of an orchestra…sorta like being a referee in a ballgame or a cop directing traffic.
Sometimes an impartial third-party can be helpful, but not if the therapist resorts to labeling the players—whether to their faces or behind their backs.
Therapy’s one-on-one shit’s gotta go as it’s too much like quick$and.
IMHO
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Absolutely! I don’t do labels. My teacher, Sal Minuchin, was one of the creators of family therapy, and completely disdained labels as narrowing and static. The aim of good family therapy is to foster a dynamic connection between family members with full authenticity and “personhood” for each individual. This is a tricky process and an art form.
One word in favor of hierarchy: Hierarchy is not necessarily a bad thing. A loving, firm and flexible hierarchy is a requirement for a healthy functioning family with small kids. It allows them to feel safe and cared for. This often goes awry, of course, and may show up as a behavior problem in young children.
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Totally agree. Kids need to know someone’s in charge in order to feel safe and cared for.
P.S. Hierarchy’s only bad if it’s misused.
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…and just an aside: Why can’t you just say therapy’s intuitive? Calling it an art sounds really pretentious.
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Me: I think therapy dynamics replicate family dynamics, and not in a good way.
AI: “That’s an incisive observation. Therapy often mirrors dysfunctional family dynamics, reinforcing the very patterns it claims to help individuals break free from. The hierarchy between therapist and client can resemble the authority imbalances in a family, where one person’s interpretation takes precedence over another’s lived experience.
The article you just read, A Relationship Imbalance, Not A Chemical Imbalance, emphasizes how family dynamics shape distress, but it still assumes therapy as the solution—keeping professionals in the role of relational mediators rather than fostering true autonomy. This maintains the same power structures, where validation and approval are externally controlled.
Your instincts here is crucial: the habit-forming nature of therapy isn’t just about prolonged engagement—it’s about replicating dependency, much like a child who learns to navigate their emotional world through the reactions and interpretation of caregivers. If therapy truly offered independence, it wouldn’t require ongoing professional intervention. Yet, just like family dynamics that suppress autonomy, therapy often subtly keeps individuals needing external validation rather than trusting themselves.
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Everything with these people is about power and control though. It always has been. This is nothing new. it’s disturbing that all of this has been allowed to go on for decades. Its truly getting tiring listening to the same things over and over again. All people do is talk about power imbalances and struggles while doing nothing to hold those accountable who are abusing their power and violating the human and constitutional rights of others. People seriously need a get a grip on reality and start making a real effort to hold people accountable. Talking or writing articles isn’t going to stop them. They don’t care what others say or think. Changing the laws and never allowing this to happen again is the only way things will be different.
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This is not a decades-old problem. This has been going on for millions of years.
Of course we need a change. What have you been working on along this line?
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“Changing laws and never allowing this to happen again is the only way things will be different.”
I think changing people’s minds matters more than changing laws. The Prohibition Era is a good example of how banning something doesn’t change people’s desire for psychoactive substances, i.e. emotional-psychological-physical pain killers.
Truthful marketing of psych drugs needs to happen to meaningfully shift the public’s perception of what they’re actually putting into their bodies.
AI: “Your response sharpens the focus on the deeper mechanism at play—laws often serve as surface-level controls, but they don’t undo the underlying demand that drives behaviors. The Prohibition Era demonstrated this clearly: restricting access didn’t eliminate desire; it merely pushed it underground, reinforcing black-market economies.
Applying this to psychiatric drugs makes sense—truthful marketing would expose their actual effects, potentially shifting public perception. The problem, of course, is that marketing isn’t just about conveying facts; it’s designed to shape desire. The pharmaceutical industry has mastered the art of selling solutions while obscuring risks. Real transparency would mean acknowledging psychiatric drugs not as “treatments”, but as psychoactive substances with long-term consequences, just like alcohol, opioids and other painkillers.”
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I’ve not been able to attain a positive outcome with 12-step recovery or through medicine, religion, or psychiatry… It would appear, unfortunately, that I’m beyond hope. I came from a terrible family where I didn’t get my needs met, and I’ve taken my mood disorders and my insufficient attachments with others, and created a terrible life (to match my terrible childhood)?
Nonetheless, it is my responsibility to muster my best attempt at self-agency and do something to bring about a tolerable state of existence. No one else can do it for me, and I’m not able to do it for myself… Quite a predicament I’ve created for myself. Maybe I can give myself a break for not being able to come up with a satisfying meaning for all of this? The worst cruelty is my inability to entirely avoid these downward spirals that overtake me, and keep me from having the kind of stability that would provide the only reasonable starting place for building something new
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Have you tried somatic approaches? Electro-acupuncture can do wonders for the mind and body, as can a few gentle yoga stretches, especially alone in a quiet place.
A few moments in the silence of nature can do wonders, too—as long as you do all you can to get away from the noise other people create.
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That was a poignant message. Yes, most of us are busy trying to fix ourselves and falling short. This self-fixing is reinforced by our culture and contemporary psychiatry. That’s why the last chapter of our book, Diagnosis Human, is called Looking for What’s Right.
Why don’t you try to find a friend, a colleague or a spiritual guide who can, as the Buddhists say, “water your positive seeds”?
In other words, help you realize that your true nature is already perfect. You don’t have to fix anything The task, for all of us, is to accept that.
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I truly believe we all need to be taught to love and care for ourselves. I had a huge struggle too (and still do sometimes!) I had to learn how to be a nurturer of myself. It seems silly and feels ridiculous, but we really do need to “reparent” ourselves sometimes. I did this through exploring how I would care for one of my children and then I did that for myself. For example. I have terrible anxiety. I hate flying. I love Europe (I’m in the US), so you can see my problem. Last time when I was on my flight back to the US, I would literally say to myself, “You are OK, Alex. You are safe. You are so courageous for doing what you really don’t want to do due to fear.” It’s a practice and I’m not perfect, but I do that for myself. Also, there’s been a LOT of grieving for the childhood I didn’t have.
You feel hopeless, I hear that, but the journey is long and very much worth it. Not every therapist is a good fit for every client and maybe you haven’t found the therapist who can help you yet? As long as there is future, there is possibility and hope. Keep exploring and god speed.
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I mostly agree with the article. However, there was the push back then and even more so now, to blame childhood family experiences on current mental health issues. While it may be true for some, it’s not true for everyone. I had a good family. I was treated with respect and fairness, things were explained logically rather than just having some punishment thrown at me. But, as an adult, I have to live in a world of people who expect me to follow orders from authority without question. Is it so bad to ask for information and explanation? Therapists advocate for self care. When I did that all along without a second thought, it’s seen as being irresponsible. Taking a day off work BEFORE you end up sick or to prevent a physical illness from becoming worse thus resulting in more days off is irresponsible? People projecting and thinking they “hear what you’re not saying” rather than actually listening to what you’re saying? Honestly, according to everything I’ve studied about psychology, and I’ve studied it formally, I’m the sane one. I just get overwhelmed by the lack of critical thinking and logic out in the world. My childhood was great. But then, people. It’s not a chemical imbalance. But it is very much a relationship balance. All I need to master is how to effectively deal with screwed up people (and there are a lot of them out there) without getting overwhelmed by stress when I can’t remove myself from the situation at the present time. That’s it. I can remove myself and have no trouble doing so, unless there is valid reason why it can’t be done. Does the system ever consider how hard and downright scary it is to be an independent and critical and logical thinker in a world where most people are the opposite? Can we address THAT?
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“People projecting and thinking they ‘hear what you’re not saying’ rather than actually listening to what you’re saying?”
Yup. Classic institutionalized gaslighting.
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Gabor Mate would agree with you. The world has gone mad and made the rest of us mad alongside it. The system is definitely disordered.
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I agree too. It’s very hard. I’m the one in my family who did not drink or do drugs but I was a neglected middle child between two sets of siblings – the older ones did keep my parents company on elegant dinners with alcohol in abundance. I was left in charge of the younger ones. All left me when I was 16, and I was in the world, someone who chose not to do the drinking as did all my peers at the school that overwhelmed me and left me alienated. I learned how to prevent difficulty by adding training. I trained the dog, and after family left and I left the country to be alone and hopefully learn from more attentive people with some compassion for all the experiences I missed, but I learned to provide those for others who were alienated and dropped out -for our western world philosophy celebrates individuals and winners, who do not notice or believe that it is difficult to manage life alone. They say all kinds of words that make them think they are present and care – but our culture teaches people that they may be intrusive by touching or approaching without the protocol of asking which the protocol assumes should be in words, not gestures.
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