Schizophrenogenic mother

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Schizophrenogenic mother is a neopsychoanalytic term that stands for the psychogenetic approach to the etiology of psychoses . The term goes back to Frieda Fromm-Reichmann and postulates that the family environment, especially the early mother-child relationship, causes schizophrenia . For the first time, the concept pointed to the importance of interaction conditions in the development of affective and cognitive structures .

The concept is considered scientifically obsolete in psychiatry and clinical psychology and is no longer accepted as an etiological factor in the development of schizophrenia . Since the 1960s, pharmacological treatments have come to the fore in psychiatry.

Theory according to Fromm-Reichmann

The term schizophrenogenic mother indicates that the cause of psychosis is not explained genetically or organically, but with psychosocial factors in the family environment. For the psychoanalyst Fromm-Reichmann, schizophrenia was a mental illness triggered by specific maternal behavior and not a primary disorder of the brain functions. Since she localized these influences in early childhood, the mother-child relationship was in the foreground of her research. She examined certain aspects of the mother-child relationship that impaired the child's integrated and independent identity or personality development.

Fromm-Reichmann saw a possible cause of a sick relationship as a mother who was neither able to draw a clear line between herself and her child nor to differentiate between her own needs and feelings and those of her child. It is an extraordinarily deep penetration and intervention in the child's life, disregarding his feelings and needs, overprotective protection and uninterrupted control and monitoring. Such mothers feel empty as women and would convey to the child the feeling that their life would be pointless without it.

In this way, the child can get the feeling that it is his duty to be his mother's purpose in life and not to be allowed to part with her without ruining her and himself. This early childhood belief in omnipotence could lead to psychotic decompensation in adolescence when trying to break away from the mother . Since the mother-child relationship does not develop according to the requirements of the individual and family life cycle, the process of individuation is disrupted.

history

Prior to the development of the theory of the unconscious by Sigmund Freud psychiatry came from a hereditary cause of schizophrenia. The messages of the schizophrenics were accordingly regarded as incomprehensible and meaningless. Freud pointed out that in the delusions and in the hallucinations life story would be expressed as "repressed reality". However, a therapy with the tools of psychoanalysis fail at the transfer inability of schizophrenics. He suspected that changing the psychoanalytic process would make therapy possible.

From the 1940s onwards, psychoanalysts in America ( Sullivan 1882–1949) and Europe ( Federn 1871–1950, Boss 1903–1990) began to conduct therapies with schizophrenics. Fromm-Reichmann built on these experiences. As a Freud student, she assumed that schizophrenia and other severe mental disorders differ only quantitatively and not qualitatively from neuroses or “normal” mental and emotional reactions. With “intensive psychotherapy” she sought to gain insight into the history of the disease, trauma and the dynamics of the symptoms and thus set new standards in the therapy of schizophrenia. By the 1950s, Sullivan's Interpersonal Theory, which sees schizophrenia in the context of interpersonal relationships, was widely accepted in the United States. The Briton Ronald D. Laing also explained schizophrenia as causally influenced by family relationships.

Although the term “acquittal of the family” was coined as early as 1982 and the “schizophrenogenic” parenting theory is now scientifically outdated, it is still part of some psychodynamic theories . In 2001, Theodore Lidz , one of their main representatives, complained that the current research results in biological psychiatry were on the wrong track .

The attachment theory , the development risks and psychopathologies and the importance of the bond for the child's resilience explored. It indicates the active part of the child in the early parent-child relationship .

In Finland, Open Dialogue has been developed as an alternative treatment approach in acute psychotic crises since the 1980s and has become a model in many countries around the world since 2008. In- patient treatment is largely avoided and neuroleptic drugs are only used in exceptional cases and in small doses.

Cons

Although considered "scientifically unsustainable," the concept of the schizophrenogenic mother is a well-known topos . The concept continues to have medical relevance insofar as it conflicts with the currently recognized causes of the development of schizophrenia . This could lead to an “impairment of the willingness to treat in accordance with the guidelines”, since misconceptions about the causes of the disease would potentially lead to incorrect treatments.

It is also criticized that the concept of the schizophrenic mother would burden mothers of sick children with a non-existent guilt for the development of the disease. To burden people with a non-existent guilt for the development of the disease in addition to the suffering of their child's illness is problematic and brings "endless, unnecessary suffering". If convalescent patients are prevented from returning to their families by «ideologically influenced» therapists after an inpatient stay, the effects are "catastrophic" and the chance for a tolerable aftercare in cooperation with the family is wasted.

Per

The development of schizophrenia has not yet been clarified. In the development and persistence of the disease, experts assume that different factors (genetics, environmental factors, biographical factors and many more) interact. Even if psychological and sociological theories usually cannot be empirically proven, this does not mean that social factors have no influence.

Newer psychotherapeutic and psychosocial interventions have gained further evidence of their effectiveness and play an essential role in treating symptoms from the outset and in coping with the disease later on. The already existing feelings of guilt were previously reinforced by (misunderstood) theories of professionals.

literature

  • Frieda Fromm-Reichmann: Intensive Psychotherapy . Basics and technology. Hippocrates, Stuttgart 1959.
  • Josef Rattner (Ed.): Frieda Fromm-Reichmann . In: Changes in psychoanalysis . Europaverlag, Vienna-Munich-Zurich 1980.

Individual evidence

  1. ^ Alfred Adler: The organic substrate of the psychoneuroses, 1912
  2. ^ Frieda Fromm-Reichmann : Notes on the development of treatment of schizophrenics by psychoanalytic psychotherapy. In: Psychiatry 11, (1948) pp. 263-273.
  3. ^ Fritz B. Simon, Ulrich Clement, Helm Stierlin: The language of family therapy . A vocabulary. Critical overview and integration of systems therapy terms, concepts and methods. Velcro-Cotta, 2004
  4. ↑ Although the Diagnostic and Statistical Manual of Mental Disorders (DSM) does not consider the specific aetiology of schizophrenia and other severe psychoses to be complete, early psychogenic models such as the "schizophrenogenic mother" are no longer accepted by the psychiatric profession. Since the 1960s, pharmacological treatments have come to the fore in psychiatry and since the 1980s the theory that family dynamics may be involved in schizophrenia has become unacceptable in Germany. Cf. K. Hahlweg et al .: Family care as a behavioral therapeutic approach to relapse prevention in schizophrenic patients , in M. Krausz, D. Naber (eds.) Integrative Schizophrenia Therapy. Karger, Freiburg 2000
  5. ↑ Helmut Remschmidt: Manuals of mental disorders in children and adolescents: schizophrenia. Springer-Verlag, 2011. Section 3.8.1
  6. ↑ German Society for Psychiatry and Psychotherapy, Psychosomatics and Neurology: S3 Schizophrenia Guideline (short version) Archived copy ( memento of the original from March 4, 2016 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. Retrieved September 6, 2014 @1@ 2Template: Webachiv / IABot / www.dgppn.de
  7. ↑ Klaus Dörner , Albrecht Egetmeyer, Konstanze Koenning: acquittal of the family. Cologne: Psychiatrie-Verlag, Cologne 2014 (reprint of the 1982 edition), ISBN 978-3-86739-141-2
  8. ↑ Deutsches Ärzteblatt of October 21, 2015: Schizophrenia: open dialogue helps patients navigate through initial therapy
  9. ↑ German Society for Psychiatry and Psychotherapy, Psychosomatics and Neurology e. V. (DGPPN) (Ed.): S3 guideline for schizophrenia from March 15, 2019
  10. ↑ Isabel Kathrin Maurus: The inclusion of relatives in psychiatric-psychotherapeutic treatment from the perspective of professional helpers: An empirical-exploratory questionnaire study
  11. ↑ Handbook on the international WPA program against stigmatization and discrimination against schizophrenia (German translation), 1999
  12. ↑ Heinz Häfner : Wrong ideas about the causes of schizophrenia. In: The Schizophrenia Riddle. A disease is deciphered. Munich 2000, pp. 242-246
  13. ^ [1] Social psychiatry 04/2014: Asmus Finzen : Psychiatry - an imposition for the family? , accessed on March 28, 2019
  14. ↑ Neurologists and psychiatrists online
  15. ↑ medmix of August 1, 2018: Dr. Darko Stamenov: There are numerous theories about the cause of schizophrenia, but the understanding of this complex disease is becoming more and more detailed.
  16. ↑ Peter Falkai, Rebecca Schennach, Tania Lincoln, Annette Schaub, Alkomiet Hasan: Schizophrene Psychosen. In: HJ. Möller G. Laux, HP Kapfhammer: (Ed.) Psychiatry, Psychosomatics, Psychotherapy. Springer Reference Medicine. Springer, Berlin, Heidelberg 2016 [2] Springer Verlag: Springer Reference Medicine book series (SRM): Psychoses
  17. ↑ Workbook PsychoEdukation bei Schizophrenia (APES), Verlag Schattauer, 2005.