Genetic and psychosocial evolution and the future of psychiatry.
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Biomedical subjects
Publications and source records attributed to T Lidz.
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Several critics of the theory of the importance of the family environment in the etiology of schizophrenic disorders claim and have sought to prove that the disturbance of family transactions and communications demonstrated by Lidz et al. ( Lidz , T., Cornelison , A., Fleck, S., et al. The intrafamilial environment of the schizophrenic patient: VI. The transmission of irrationality . AMA Arch. Neurol . Psychiatry, 79: 305-316, 1958), Wynne and Singer ( Wynne , L. C., and Singer, M. T. Thought disorder and family relations of schizophrenics: II. A classification of forms of thinking. Arch. Gen. Psychiatry, 9: 199-206, 1963; Singer, M. T., and Wynne , L. C. Thought disorder and family relations of schizophrenics: IV. Results and implications. Arch. Gen. Psychiatry, 12: 201-212, 1965), and others derive from the presence of and concerns about the schizophrenic offspring. The author knows that three of his former nonpsychotic patients each had a child who later became schizophrenic. Two of the three were seen during his residency before his formulation of any hypothesis concerning the intrafamilial environment of schizophrenic patients. The cases reinforce the retrospective findings ( Lidz , T., Fleck, S., and Cornelison , A. Schizophrenia and the Family. International Universities Press, New York, 1965) that the marriages of the parents and the family environments were seriously disturbed before the onset of a schizophrenic disorder in an offspring.
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The authors present various reasons why their analysis of the data provided by the Danish-American studies of the relatives of adoptees who became schizophrenic demonstrates that the data do not support the investigators' claims that their studies provide conclusive evidence of a significant genetic factor in the etiology of schizophrenia. When taken together with the authors' earlier demonstration that the investigators' more direct study of the adopted-away offspring of schizophrenic parents failed to provide statistically significant evidence of a genetic influence, these adoption studies indicate that although genetic factors may play some role in the etiology of chronic schizophrenic disorders, such findings are far from definite or proven.
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Studies of the adopted-away children of schizophrenic parents that have claimed to have shown a strong genetic factor in the etiology of schizophrenia have had a great impact on psychiatry, including effects on the direction and support of research. An examination of these studies, however, controverts these conclusions. The authors demonstrate that without the inclusion of parents with manic-depressive and indefinite diagnoses in the index group, there is no statistically significant difference between the number of offspring with schizophrenic spectrum diagnoses in the index and control groups.
Many of the most significant changes in concepts of personality development and maldevelopment derive simply from belated appreciation that the child grows up in a family; and that the child requires considerable positive input from those who raise him to grow into a reasonably integrated person. Only recently have psychiatrists and psychoanalysts begun to focus on the influence of the family transactions throughout the formative years. The paper briefly presents the requisites a family must provide to assure the integrated development of its offspring and groups them under four headings: the parental nurturant functions that change with each phase of the offspring's development; the influence of the dynamic organization of the family on the offspring's intrapsychic structure, affecting self-boundaries, gender identity, superego directives, and so forth; conveying through family transactions the basic social roles and societal institutions to the child; transmitting the instrumental techniques of the culture, and particularly its language with its system of meanings and logic upon which virtually all ego functioning depends. The paper considers the evidence that the "choice of the neurosis" -- or more correctly, the choice of the psychiatric syndrome -- does not depend only upon fixation at various phases of pre-genital development, but also, and perhaps primarily, upon the panphasic influence of the intrafamilial environment. It is of particular importance to recognize that there is a very direct relationship between the family transactions, the separation-individuation process, bounary formation, the attainment of various degrees of object constancy, problems of splitting, superego directives, and what can be conscious and what need be repressed into the unconscious. The failure to recognize the import of the family has interfered with the formation of an integrated developmental theory that can unite various aspects of the developmental process that have remained more or less isolated from one another -- drive theory, object relations, ego psychology, separation-individuation, and cognitive development. Finally the question is raised if in providing guidance to parents we have been amiss in not focusing on such matters as who the parents are, how they relate to one another as well as to the child, the values they communicate by their behaviour -- matters that are fundamental and to which almost all else is secondary, but about which relatively little has been said or taught.
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