Chapter 10

SCHIZOPHRENIC CHARACTERISTICS
IN THE BEHAVIOR OF THE WOMEN

Although Marge's illness was specifically diagnosed as schizophrenic reaction and she was hospitalized for this condition, Mrs, V also showed typical features of this state. She was later hospitalized and her illness was diagnosed as schizophrenic reaction, paranoid type. Although the psychiatric observers concurred that this diagnosis applied to each of the women, it was difficult to identify accurately the behavioral features which are pathonomic for this condition, and so I will have to use my own judgment. I will therefore abstract in this chapter certain features of the women's behavior which I think were deviant, but not necessarily schizophrenic, and I will point to certain features which I think are characteristically schizophrenic.

SCHIZOPHRENIC QUALITIES IN THE INDIVIDUAL BEHAVIOR OF EACH WOMAN

Schizophrenic Qualities in the Behavior of Mrs. V

Mrs. V's behavior showed three qualities which are ordinarily considered schizophrenic.

Flattened affect. Mrs. V showed a definite diminution of facial mobility and paralinguistic variance. She spoke in a monotone and was kinesically immobile most of the time. She did not react by changing her vocal qualifiers, her facial expression, and her other kinesic qualities. This diminution of paracommunicative quality is called flattened affect in psychiatry and is considered a classical indication of schizophrenia (Blueler 19 50).

Cognitive defect. Mrs. V explained her behavior with rationalizations and denials that seemed almost absurd at times. It was hard to believe that she believed them or expected others to do so. And in presenting these she often skipped steps and left unsaid elements of her argument that were important in такing it hold water. Finally she showed little apparent awareness either of the incredibility of her statements or of the dubiety of the other participants.

Indications of schizophrenic misconceptions. There are suggestions that Mrs. V held conceptions that have typically been reported in schizophrenic patients, and she reported experiences that sounded typically psychotic. Here are the two most obvious examples:

1.Mrs. V seemed to have little appreciation of the gravity of Marge's difficulties. She wrote off Marge’s psychosis as a minor illness and she seemed to think Marge could return to her home without any particular problems. It seemed as though she had no understanding of the maturaational process of the young woman or of the changes in classical Sicilian family structure which were occurring with acculturation. It might be inferred that her own devotion to the mother-daughter symbiosis overrode any other perceptions she could have achieved. And maybe Marge's difficulties seemed trivial to her because she had known them all her life.

2.Mrs. V described two personal experiences that seem typically psychotic. She apparently felt influenced by certain ‘French people’ and had hallucinations (mind-pictures). Apparently she once left her marital home and wandered in the streets in a panic, which clinicians identify as paranoid and depersonalized in character.

Marge' s Deviant Behavior

Marge, of course, produced the most obvious deviant and inappropriate forms in Session I. She stood up a number of times in a sudden, dramatic way. She sprawled on the sofa. She exhibited her thighs. She made shocking comments like, ‘I want to be raped.’

Some of these behaviors are deviant — they would not appear in common culture; not even, for the most part, in schizophrenic behavior.

Marge's standing shocked was an example. My guess was that she contrived these behaviors to disturb her mother and used it tongue-in-cheek. Her bizarre sexy behavior gave the same impression. She seemed to be satirizing sexiness.

Other of Marge's behavior was unfamiliar in this context, but we might expect to see it regularly in another situation. Her sprawling behavior is typically seen among children — possibly up until about the eighth year. Her mugging at the camera is also characteristic of the children and so were some of her paralinguistic patterns. Her sexual behavior in appealing was inappropriate for a formal transaction but it is seen in modeling, courtship, and possibly in prostitution.

Notice, however, that none of Marge’s behavior was unrecognizable. It was borrowed from other contexts or loaded with qualities which would not be seen in usual conversation, but it was not wholly unique, unrecognizable, or disordered. This point is worth emphasizing because there is a myth that schizophrenic behavior is somehow original, random, or unlawful. The behavior of schizophrenic patients may be much more bizarre than Marge’s was, but it is so patterned that it is awarded a standard diagnosis and it is usually rather stereotyped and nonvariegated.

Marge showed some subtler deviant behaviors that did not appear contrived. She was almost never quiet. She changed her facial expression often, showing a gamut of configurations from anger to anguish. And her hands were usually in action, stroking her legs, waving a Kleenex, or gesticulating. Her gross movements were often overfast, jerky, arrhythmic, but at times slow and writhing. Her changes in pace and style were more noteworthy than any given pace or style.

Certainly Marge did not show a flattened affect. In fact, Birdwhistell (1963) suggested it be called a fattened affect. Unlike her mother Marge's behavior was replete with paracommunicative changes, well above the usual range.

This sort of variation has been a puzzling problem in schizophrenia. A generation ago most psychiatrists agreed that flattened affect was a necessary symptom of schizophrenia, but so many exceptions appeared that a diagnostic class of schizoaffective types was developed, types for people like Marge with a very labile paracommunicative style. Thus schizophrenic patients may have either a flattened or a fattened affect. In either event they show paracommunicative deviance. As a matter of fact all kinds of measures of physiological and behavioral variables have shown a hypernormal variance in schizophrenic patients.

The contrast in the affective indicators between mother and daughter is striking. It appears that Marge had the job of affective indication for both of them, just as she had the role of metacommunicatively qualifying the historical data of Mrs. V’s account. Maybe Mrs. V was affectively flat because Marge has taken over all of this behavior and vise versa. Maybe the wide paracommunicative variance in schizophrenia is often the resuit of such specialization of communicative function, a specific instance of the general symbiotic complementarity which has been described in the family relationships in schizophrenia (see below).

Marge's Dissociative, Autistic Behavior

The particularly schizophrenic quality of Marge's behavior was most evident in her manner of relating. The grossest example was her oscillation from huddling with her mother one minute to eliciting an alliance from Whitaker and attacking Mrs. V the next. And she would work hard to solicit Whitaker's support, then quickly abandon it. Thus her rapid positional shifts reflected a tendency to flit from relationship to relationship.

Marge used a wide variety of address and transfix behavior in making these shifts. She placed a tactile hold on her mother when confronting her. She occasionally addressed the cameraman. Sometimes she turned to her mother or to Whitaker, but overprojected her voice as if speaking to a large audience. Most often she looked down, muttered inaudibly, and did not project to the others. When her eyes were visible on a few occasions, they did not seem to be appropriately converged. Half of the time Marge did not directly address the others. Yet her remarks were obviously related to the others and were intended to evoke their attention.

At other times Marge dissociated herself from all the others. She seemed for a few seconds to be out of contact. But a closer examination of this behavior showed that she remained in contact in at least one modality. Sometimes she would turn away from the others or sit back and cover her face. Her body would fall into a marked hypotonus. She was not in postural parallelism with the others and she did not move synchronously with anyone. Yet she spoke appropriately and showed that she had been listening to the others. In short Marge was in contact in one modality — a kind of partial, unimodal association which I already described and pictured in Chapter 6.

At other times Marge reversed this unimodal dissociation. She would speak irrelevantly and address her remarks to the camera or to herself but hold her body in parallelism and active hypertonicity.

And her intervals of dissociation were dramatized or exhibited. She would throw herself back on the couch, for exampie, or stand up and speak to an empty portion of the room. In my experience this kind of gross but partial dissociation is characteristic of schizophrenia. In chronic severe schizophrenia the patient appears totally autistic for months or years but may later give evidence of a keen awareness of what is going on. Or conversely he talks actively to you, but you sense his detachedness or remoteness. This mixed picture is reflected in his own subjective experience. He feels at once detached and overly dependent or enslaved. I believe that one who is schizophrenic is inordinately attached to and dependent upon a parental figure, but he denies, hides, and conceals such attachment with an exhibited detachment. And analysis of his behavior shows these incongruent types of relation: one evident in some modality, usually postural-kinesic, and the other shown in some other modality, often speech and subjectivist conception.

I suspect that this ambivalence in Marge’s behavior was related to her tendency to quickly form and break relationships. There was yet another manifestation of interpersonal difficulty in Marge’s behavior. She seemed constrained to relate either to her mother or to Whitaker in a mutually exclusive way, as if she had to choose between them and could not sustain relatedness to both. When she broke with her mother in a Period 2 she did so dramatically and then confronted her mother. When she broke with Whitaker she did this completely and dramatically. I think this sort of difficulty is also typical of people with schizophrenia. These patients seem to be able to relate only in a one-to-one relationship, with this becoming so hazardous for them that they tend to dissociate into aloneness and autism.

I think these difficulties may explain a finding which Davis (1968) reported in the Laban or effort-shape analysis of schizophrenic behavior. She found that these patients do not coordinate their body movements in what I have been calling multiple simultaneous address. It is also reported that schizophrenic patients show unusual patterns of interpersonal distance Horowitz 1966; Натре 1967). These findings are suggestive and deserve more systematic behavioral description.

It is interesting to note that despite the obvious deviances in Marge's behavior, we would clinically consider her mildly schizophrenic or a patient in partial remission, but Mrs. V's behavior, which was not grossly deviant, was undoubtedly schizophrenic and her prognosis was poorer than Marge's. As it turned out, Marge was later discharged from the hospital, but Mrs. V was admitted and has remained hospitalized for years. This is often the case. The dramatically deviant behaviors are not what is typically schizophrenic; rather, the subtle difficulties in relating are.

A SCHIZOPHRENIC CHARACTERISTIC IN THE RELATIONSHIP OF THE WOMEN

We would expect to find concomitant difficulties in the mother-daughter relationship when we observe it at the social level. This proved to be the case.

It would seem likely that a mother and daughter in such a situation would devote most of their attention to the men, rather than form only transient relations with the men and huddle together, continuously confronting each other. I have already described the tendency for the women to huddly together, then disaffiliate and have a confrontation. And we have also seen Marge's tendency to court Whitaker, then disaffiliate with him in a bizarre caricature of sexiness.

There were other features of this mother-daughter attachment that I have not yet sufficiently brought out.

Cross-Monitoring in the Mother-Daughter Relationship

Each time either woman formed a relationship with one of the men the other woman interrupted it. Birdwhistell (1963) has called such an arrangement cross-monitoring.

Marge's Interruptions of Her Mother

Marge was almost continuously trying to gain the attention of the men by one device or another. She would escalate her interruptive behavior until it succeeded or until Malone intervened. One of her dramatic tactics was the position I have called standing shocked.

Marge also used the position which I called resigning in such a dramatic way as to make it potentially interruptive.

Mrs. V's Monitoring of Marge’s Relations to the Men

Altogether Marge crossed her legs ten times in Session I. These occurred as five pairs of leg crosses. Each pair began with a proper quasi-courting action, followed within a moment by the bizarre type described above. The first appealing leg cross always initiated an alliance with Whitaker, and the bizarre formation always terminated it.

We would expect a mother to monitor this kind of sexy, exhibitionistic behavior and sometimes Mrs. V did. But the mother's monitoring was usually directed at Marge's appealing behavior. What Mrs. V monitored, then, was a relatively normal coquettish behavior of appeal to a man.

In addition Mrs. V monitored Whitaker's response to the girl.

Whitaker used to light his pipe just before he moved in toward Marge and after the pattern was repeated three times, Mrs. V began to monitor Whitaker's pipe lighting. My belief is that she monitored pipe lighting because she had learned it preceded Whitaker's alliance behavior with Marge. Thus, I think, she evidenced disapproval of the alliance behavior between Whitaker and Marge, with far more regularity than she did Marge's grossly deviant sexy behavior.

Oscillation as a Locked Relationship

This cross-monitoring seemed to lock the women into relationship. Neither one could relate to a man without the other's interference. Marge would try to relate with sexy behaviors, then disaffiliate with a bizarre behavior we could regard as ‘decourting’ (Figure 10-1).

Figure 10-1:Marge in Bizarre ‘De-courting’ Behavior

THE HISTORY OF A LOCKED RELATIONSHIP

The women's history gave the impression that such lockedin, regressive stasis had been going on for years. They did not seem to be able to break it. If we pool the manifest content of their statements, as Jaffe (1958) does in ‘dyadic analysis, ‘we can make clinical inferences that seem analogous to what we have observed in their communicative behavior.

The statements of the women can be classified into one of four categories of psychoanalytic inference:

1. Statements of symbiotic r elatedness in which one of the women cared for (or did not care for) the other who was helpless, overdependent, or having symptoms often considered to reflect such states•

2. Statements of rivalry or anger between them that seemed to be related to the need to pull apart.

3. Statements of sexuality or of one woman relating to a male.

4. Statements suggesting that the deserted woman was alone or unconscious while the other was guilty or about to face punishment.

The first seven repetitions of these ideas are summarized in Figure 10-2. By referring to the transcript reproduced in the Appendix of this volume the reader can check these interpretations and see that the themes continue throughout the session.

It seemed that these two women were in the position of not being able to live together or to live apart. When alone together, one of them seriously regressed while rejecting regressive or any other satisfactions — the typical schizophrenic dynamic, in my view. When apart, great guilt and anxiety developed, presumably because they shared a fantasy that separation and heterosexuality meant death. It seems the women believed that only one of them could relate to a man, but in doing so she deserted the other and caused her death. Therefore, they seemed to be forever escaping from and then re-establishing their mutual dependency.

Figure 10-2:Lexical Themes in Mother-Daughter Relationship (First Ten Minutes of Session I)

Mrs. V and Marge appeared to have no way to break their attachment. They were able to oscillate from attempting to separate and form other relationships, to returning to their symbiotic attachment. Their relationship lacked a progressive program. It seemed to me that this was evident both in their history and in what was observable in their behavior during the session.

COMMENT: ON THE NATURE AND ORIGINS OF SCHIZOPHRENIA

Varied Theories About the Origins of Schizophrenia

There are widely divergent opinions on the nature of schizophrenia. Disorders at all levels of organization, from the molecule to society, have been postulated. Whatever the origins, the clearest evidences of disturbances are manifest at the organismic level (in disordered thought and behavior) and at the social level (in deviant relationships). Some theorists see the disturbanees of thought as a consequence of abnormal genetic development and as the cause of the overdependence and autism. Others see the disordered parent-child relationship as a consequence of difficulties in the family and consider the social or communicational problems as the cause of the deviant thought and behavior.

It would be widely agreed that a difficulty in the mother-child relationship is characteristic in schizophrenia, whatever the cause and significance of this difficulty. The problem I have described in the relationship of Mrs. V and Marge is typical. There is a degree of symbiotic, hyperdependent attachment admixed with a degree of discord, rejection, and withdrawal (Mahler 19 58). In some cases the autism is apparent while the ties are denied. But in either case the ambivalent combination of interdependence and distance feature the disorder (Hill 19 55; Limentani 19 56).

We cannot say how this symbiotic attachment developed. Some theorists claim that it begins when a mother notices her infant is defective (Bender 1945). Others hold that the mother rejects the child at an early age (Rosen 1953) and the child then tries to cling to the relationship. Still others hold that the mother was possessive and the child has developed autistic behavior in an unsuccessful attempt to fight free from the symbiosis (Levy 1943; Mahler 1963). Recent theorists attribute the mother-child symbiosis to disturbances in the total family (Spiegel and Bell 19 59; Ackerman 1966; Bowen 1966; Jackson 1962) and even in the relations of that family to the larger society (Speck 1967)

Thus we do not know how the schizophrenic relationship develops. But, however it begins, a symbiosis is maintained by vicious cycles at each level of social organization. Suppose I first describe this phenomenon of stasis and then come back to the other, controversial issues.

The Phenomenology: A Deep Belief in the Need for Inte r dependency

The Symbiotic Myth

In cases of symbiotic relatedness, the partners seem to share a myth about their need for each other and this phenomenon is regularly described by schizophrenic patients (Searles 19 55; Wynne et al. 1958). The partners seem to believe that one of them will die if they become separated. The dependent partner, usually the patient, feels he is helpless without the support of the other, but he nevertheless feels guilty about deserting the partner (Galvin 1956; Rosen 1953). The anxiety and guilt on this score is so great that it amounts to a demoraiizing panic at any threat to the cohesiveness of the relationship. This fantasy accompanies a tendency to distrust all other relationships. In short we can claim a subjectivist triad consisting of a sense of personal incompetence, a deep, guilty loyalty to the partner, and a suspiciousness about other, potential relationships.

The Behavioral Coding of Constraints

These fantasies seem to be maintained by metacommunication among the partners and by events in their lives which seem to confirm the myth (see below). The cross-monitoring behaviors I described earlier are but one type of such systemsmaintaining activity. There are also likely to be kinesic signs which represent impending illnesses, imaginary sexual disaster, and the like (Sherman et al. 1968). Such kinesic signals remind the partners of their social incompetence, their debts to each other, and so on, but they are not ordinarily in awareness.

Enacting the Necessary Roles

The maintenance of such a symbiosis when a child grows up into adulthood requires that he remain infantilized, helpless, sick, incompetent, or the like. Accordingly the patient-to-be has to enact such a role. And the relationship must develop a rationale because its deviance becomes increasingly apparent. Consequently a myth is held about the sacrificing parent, the helplessness of the child, and so forth. To debate whether this situation leads to the cognitive defects of schizophrenia or is a consequence of them takes us back to the chicken-egg argument which characterized presystems theories (Singer and Wynne 1965). In any event, belief is shared about the incompetence of the schizophrenic partner. This is reinforced by metacommunicative suggestion and re-enacted in everyday life.

The mother-daughter relationship ordinarily consists of a set of reciprocals for the feeding, discipline, and training of the child. These are applied according to a maturational scale which progressively reduces the mother infant relationship and leads to a growing competence for work, sexuality, marriage, and so forth. This did not happen in the case of Marge and Mrs. V, nor does it generally in cases of schizophrenia. The history indicated that Marge was unable to live outside a hospital. She had engaged in sex, but had not managed a sexual relationship. In the session she showed childish or regressive behavior.

The parent enacts the reciprocal part to the incompetent patient. Although she may critize, and reject as Mrs. V did, she fosters the dependency. She complains about her responsibility, but continues to nurture and encourage the child to remain with her (Levy 1943; Mahler 1958).

Maintenance by Double-Binding

A double-bind theory of schizophrenia was developed in the 1950s to conceptualize these relations (Bateson et al. 1956) ; Haley 1959; Watzlawick, Beavin and Jackson 1967).

In double-binding a covert series of instructions conflicts with the open and acknowledged definition of the situation. The conflicting messages cannot be visualized comparatively because they are not of the same logical type. Thus the paradox cannot be resolved. For example, one set of instructions, usually verbalized, criticizes the child's dependency, but another set, implicit in the relationship and signalled kinesically, may censure and interdict the learning and experience which make maturation possible.

In the case of Marge and Mrs. V, the mother alleged her competence and depreciated Marge’s dependency. Yet there was every indication that Mrs. V had not been able to handle the problems of her life. And Marge kept questioning this competence, but she would sprawl and exhibit childishness just at the point of making her accusation stick.

So the myth of the competent mother and helpless child was partly maintained despite Marge’s ambivalent assault upon it (Abrahams and Vacron 1953).

The signals of monitoring which tended to maintain the relationship were coded kinesically. They did not appear as conscious or lexicated interdictions. I would imagine that Mrs. V did not know she performed them.

Layers of cognitive and metacommunicative myth may be built upon this conflicting system of behaviors. Marge was criticized for enacting her dependent role. Then her psychosis was written off as insignificant. And the women affirmed the value of living together and spoke of going back to the days of Marge’s childhood.

Maintenance by the Failure of Other Relationships

The symbiotic relatedness is maintained by the failure of the partners to develop other relationships. The partners unwittingly exclude others, they unconsciously cause other relationships to fail, and they simply lack the experience and communicative skills to maintain courtship, marriage, and friendship.

The Exclusion of Others

Whatever their origin, the cognitive and metacommunicative difficulties in schizophrenia and cross-monitoring behavior make it difficult for anyone else to join in or intervene in the relationship. In such cases the history often indicates a vicious cycle with the father-husband. The more he is excluded the more remote a figure he becomes, and the lesser his importance, the greater the interdependence between mother and child. Sometimes a father-child symbiosis similarly excludes a mother (Lidz et al. 1957).

Unsuccessful Attempts to Break Out

Marge seemed to be trying to break out of the dilemma. From her standpoint the situation may have seemed something like this. If she continued to relate to her mother as a dependent child she lacked the status or power to alter the relationship. She could not take over, solve problems, or persuade her mother to grasp what was going on. If, on the other hand, she left her mother she was apparently regarded as a distrusted outsider, who had to be brought back to the fold.

In this setting Marge's behavior makes sense. She was trying, I think, to solve the metacommunicative problem — preserve the mother-daughter relationship by changing the ground rules, by attacking the cognitive distortions. Thus she tried to expose Mrs. V's psychosis and incompetence. In a Period 1, however, she seemed unable to gain her mother’s attention and so made ineffectual insinuations. In a Period 2, allied with Whitaker, she was an antagonist.

I would guess, from my knowledge of psychotherapy, that Marge's tactics were learned in her previous psychotherapy. She used ineptly but unmistakably a first approach in the psychotherapy of schizophrenia a tactic for discrediting the mother’s hold, a tactic of confrontation and interpretation.

Another of Marge's behaviors could be construed as an attempt to compromise the dilemma. One of these we heard about in subsequent sessions. Marge was allegedly a prostitute. We could interpret this as a way of relating temporarily to a man. And we could argue that this kind of hit-and-run behavior was reflected in her relationship to Whitaker.

Social Incompetence and the Self-FulfilHng Prophecy

In any event, when Marge did relate outside the home, her relationships were unsuccessful. Her pregnancy and abortion precipitated her regression and psychosis. We can guess that her difficulties with men stemmed partly from her inexperience. She seemed to be afraid of her father (Lidz and Lidz 1949; Frazee 19 53). Her Sicilian background did not suit her for courting without a father or brother to monitor the process. Her way of relating to men in Session I probably reflected her general approaches which were, we can guess, either remote or purely sexual contacts which she probably terminated as she did with Whitaker early in the session.

Mrs. V's behavior seemed to cycle similarly. Her story of leaving her husband when Marge was a child apparently ended in a psychotic panic reaction.

Thus the myth of helplessness is a self-fulfilling prophecy and the interdependency is maintained in the immediate life situation.

Inadequate and Idiosyncratic Communicative Behavior

The development of secret and special communicative behaviors further maintains the attachment. Unsuccessful in communications, the partners keep falling back on each other where their unusual tactile, kinesic, spacing, and metabehavior is understood. I suspect this was the case with Marge. Her crazy pattern of appealing and rejecting with the use of sexual behaviors could not have enabled her to maintain a courtship. Since her attentiongetting behaviors, for example, could easily be seen as seductive, she may have ended up having sexual intercourse in whatever kind of relationship she attempted.

Maintenance by Institutionalization

Whatever the genetic or childhood origins of the dependency, once it is manifest it can be stabilized by becoming institutionalized in the social system.

Family as a Total Institution

A total institution restricts the behavior of its members (Goffman 1961). If a person belongs to one total institution without other social relationships his behavior is constrained almost entirely to the stereotyped roles he serves in that institution. In the case of Marge and Mrs. V, the family constituted a total institution.

This stereotyped performance, which is deviant and overdependent in schizophrenia, justifies the institutionalization. Thus the mother or father feels it necessary to protect the developing schizophrenic child, keeping him home and away from other people. If the schizophrenic child does leave he is likely to marry a counterdependent partner¹ or form a homosexual symbiotic relation which perpetuates the behavior; after all, ‘it is only natural’ to take care of someone who is ‘sick.’ So the parents may take the patient away from a psychotherapist or spouse or college or whatever other relationships the patient is involved in. They take him home to bed, chicken broth, or whatever family means are used for unconscious reindoctrination.

Mrs. V exemplified such activity. Even though Whitaker had explained the sessions, and promised to try to help Marge, Mrs. V’s last appeal was for Marge to come home to her. She even promised to move back to the house where Marge had lived as a child.

Sanctions in the Larger Social System

Such systems of deviance also seem to be supported in the larger social order. Counterdeviant roles are officially recognized, e. g. , those of policeman, custodian, and mental-health professional. There is also evidence that deviances have more general sanction. It seems to be universal for a community to have a town drunk, a known prostitute, a religious fanatic, a comic, a hatchet man. Such official deviants can be counted on to show up at public functions and perform their characteristic deviation.² Despite many complaints about them, such people never seem to be effectively silenced or disposed of. If the holder of these roles should leave town or die, another seems to take his place.

If a deviant is unable to sustain himself in private institutions such as the family or gang, a public institution may take over the role of supporter and custodian. Marge was being indoctrinated into such institutionalization at the time Session I occurred.

The public institution must of course maintain itself and so it unwittingly recruits counterdependent s and patients. It may thus maintain the symbiotic relationship and further ‘protect’ the patient from other relationships. In addition the patient is labeled with a diagnosis which announces his incompetence and confirms it officially.

The Cultural Context of the Problem

In some measure the old country pattern of the cohesive extended family is a background for this sort of difficulty. In many old country traditions the family is to remain cohesive and all offspring are to remain living in the extended family clan for the duration of their lives — sometimes in the same household. In these social arrangements they do not assume leadership until all senior members of the group have died. The Sicilian culture from which Marge and Mrs. V were derived is such a culture. Marge was raised in an Italian enclave where such arrangements were maintained unacculturated.

The Culturally Derived Expectations of the Women

With such a background we could expect that Mrs. V and Marge both would think they must remain together for life. At the end of the session Mrs. V said, ‘My grandfather’s house was my house.’ In fact, we would anticipate that the attempt to leave would produce intense guilt in those indoctrinated in such values.

Usual Provisions in an Extended Family

But an extended family social organization ordinarily would provide for the sexual maturation of the children and provide them with regulated courtship and marital partners. This does not happen, however, if nuclear families become separated in migration or if for some reason they do not effectively intervene in closed mother and daughter relationships. If the father and brother are detached or dead, as well, there would be no chance for such intervention. In southern Italian cultures also there would be no protection for the courtship of the daughter. In such closed families the members are not likely to allow outsiders to fulfill these roles. Consequently the extended family tradition may result in difficulty for its members if it is destroyed without the survivors knowing alternative ways for child rearing.

The Dilemma of Partial Acculturation

Other cultures, such as middleclass American, demand that children leave home in their early twenties or late teens, establish separate households, and assume leadership there. In fact the failure to do so is deeply criticized as an evidence of immaturity. But there are no provisions for learning these abilities in an old country model of development. On the contrary, the child has been taught to remain within the parental domain.

A considerable conflict of values can develop in the children of extended families who are partly acculturated and accept middleclass American values. Marge was, of course, in such a position. We cannot expect that Mrs. V would understand. Thus in acculturation a discrepancy in child-rearing behavior may increase between the metacommunicative values and the actualities of existence.

So we could speculate that the women were caught in a progressive narrowing of opportunities by migration, marital discord, the loss of an effective larger family, and finally by the death of the husband. We can also postulate that a confusing clash of value systems led to distorted metacommunicative conceptions. Mandel and Fischer (1956) have developed a three-generation theory of cumulative neurotic difficulties.

Causation in Schizophrenia and Psychosis

The genetically oriented scientist and the classical psychologist, in fact, might advocate a different view of deviance. They might hold that is a consequence of defective inheritance or destructive early experience. But this view in no way contradicts the idea that traditional dependency and deviation are maintained in the social system. It seems that dependents are selected atan early age, even within the family, and induced into traditional roles which shape their behavior. Whether this training and reinforcement cause or merely maintain the deviance must remain an open question.

We can hold to the general idea that traditional roles and social sanctions have evolved which provide for the care of dependents and deviants and that these provisions maintain deviant behavior. Obviously those who are recruited and who accept a given role have personality traits and motivations suited for its performance.

But we do not have to understand the earliest origin of schizophrenic condition in order to understand it. Once a closed cycle occurs it can maintain itself. With a systems model we recognize that retroaction can maintain a system of effects, even though the original triggering or kicking-off mechansim has ceased to operate (Marayuma 1963). Perhaps, then, a congenital defect, a family crisis, a childhood illness, or any circumstance delays the process of individuation, and the vicious cycle, once in progress, is maintained by forces like those I have described.

Whatever the chains of circumstances, a persistent symbiotic dyad has inevitable vulnerabilities which will lead its members into trouble. The partners will disavow it and others will disapprove, unless it is attractively rationalized. So the partner s try to withdraw from each other; hide and deny their affiliation, blame and hate each other. The schizophrenic syndrome emerges as the child approaches maturity. And the lack of experience and social competence make both partners vulnerable to the panic of separation when sexuality, education, induction into military service, and progressive intolerance force the symbionts to separate. Then, I believe, one or both of them may develop a psychotic reaction. Once the psychosis becomes publie, a second chain of circumstances may be instituted and the patient assumes a socially sanctioned role. When these continue, the schizophrenic patient may develop the advanced picture of institutionalization with autism, loss of interest, and so forth (Scheflen 1965). Thus symbiotic attachment closed by double binding may lead to schizophrenia which leads to psychosis. These conditions may thus be probable consequences of each other, rather than the same states.