Double Bind: Psychiatry's Lack of Insight

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Here is the article I mentioned ...

 

>Psychiatry's Lack of Insight: Four Double-Binds That Place Patients in a

>Living Nightmare

>Al Siebert, Ph.D.

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>

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>----

>

>My educational experiences in psychiatric facilities made me aware of

>four

>powerful double-binds that mental patients must try to survive.

>

>A double-bind is when a person hears words said to them in such a way

>that

>the accompanying actions or non-verbal communications directly

>contradict

>the spoken words. For example, a mother might scream at her child " I

>love

>you and you better believe it or I'll whip you! " In a TV show a comedian

>smiles and says to his wife's dog in a soft, gentle voice " You are a

>dirty,

>stinking, flea bag. I hate you. " The dog happily wags its tail to the

>man's

>non-verbal communications.

>

>Research by Chris Argyris shows that 19 out of 20 people act toward

>others

>in ways inconsistent with the words they say. In families and

relationships,

>this can be " crazy making. " The horror for many people forced to submit

>to

>psychiatric treatments is that they encounter extreme double-binds from

>mental health practitioners who lack insight into their mixed messages.

>

>The first double-bind has to do with a belief held by many psychiatrists

>that before treatment can start, the patient must accept the fact that

>he

or

>she is mentally ill.

>

>I was present in the office of a psychiatric resident, for example, when

>he

>got into a shouting match with a patient who refused to believe he was

>mentally ill. Tony was a 20 year old, unemployed factory worker. He was

>in

>our facility because he had lost his temper during an argument with his

>father and beat up his father in a fist fight. Also present in the room

were

>his wife, the psychiatric resident in charge of the case, myself, the

social

>worker, and a large male aide.

>

>The resident said " Tony, your behavior is sick. We can treat you here as

>an

>out-patient, but you must understand you are mentally ill before we can

make

>any progress. "

>

>Tony shouted " No, I'm not. You doctors are crazy if you think I'm

>mentally

>ill! "

>

>Doctor: (voice raised) " We've argued about this before. You must believe

you

>are mentally ill or we can't help you. "

>

>Tony's face got red. His nostrils flared. His breathing quickened. He

>yelled, " I'm not mentally ill! "

>

>Tony's wife reached over and put her hand on his arm.

>

>The doctor yelled " Yes you are! "

>

>Tony yelled " No I'm not! "

>

>Doctor: " Yes you are! "

>

>And so it went.

>

>Finally the doctor said the aide " take him back. "

>

>This incident helped me see how determined the psychiatric staff can be

>in

>trying to make a person accept their thoughts about him as what he must

>believe about himself. This is a common practice.

>

>A double-bind occurs when the person is told he is mentally ill because

>his

>main complaint is that people are trying to force thoughts into his

>mind.

>

>Here is a case illustrative of the " You Must Believe You are Mentally

>Ill "

>double-bind. One day a 25-year-old male was admitted to our hospital

>unit

>with a diagnosis of " acute paranoid state. " As described at staff

>rounds,

>his main complaint was that people were trying to force thoughts into

>his

>mind.

>

>I got permission from the resident in charge to interview the man, whom

>I

>will call Ron. The interview took place in my office. Ron was about six

feet

>tall, clean-shaven, was in good physical shape, and had " all American "

>look

>about him. He was nicely dressed in slacks and clean shirt. He carried

>himself well.

>

>I asked him " Why are you here? "

>

>Ron: " My wife and family say I don't think right. (clenches jaw) They

>say I

>talk crazy. They pressured me into this place. "

>

> " You're a voluntary admission, aren't you? "

>

>Ron: " Yes. It won't do any good though, they're the ones who need a

>psychiatrist. "

>

> " Why do you say that? "

>

>Ron: " I work in sales in a big company. Everyone there is out for

>themselves. I don't like it. I don't like to pressure people or trick

>them

>into buying to put bucks in my pocket. The others seem to go for

>it,...selfish, clawing to get ahead. I tried to talk to my boss, but he

says

>I have the wrong attitude. He rides me all the time. "

>

> " So what is the problem with your family? "

>

>Ron: " I've talked about quitting and going to veterinarian school. I

>like

>animals. I'd like that work. My wife says I'm not thinking right. She

>wants

>me to stay with the company and work up into management. She went to my

>parents and got them on her side. "

>

>We talked for awhile about how his wife and parents wanted him to live

>up

to

>their dreams for him. I said " I still don't see the reason for your

>being

>here. "

>

>Ron: " They're upset because I started yelling at them how selfish they

>are.

>My wife wants a husband who earns big money, owns a fancy home and

>drives

an

>expensive car. She doesn't want to be the wife of a veterinarian. They

can't

>see how selfish they are in trying to make me fit into a slot so they

>can

be

>happy. Everyone is telling me what I should think and what should make

>me

>happy. "

>

> " So you told them how selfish they are? "

>

>Ron: " Yes. They couldn't take it because they believe they are only

>interested in my welfare. " He sagged in his chair and held his face in

>his

>hands.

>

> " Did you tell the admitting physician about them trying to make you

>think

>right? "

>

>Ron: " Yes. Everyone is trying to brainwash me. My wife, my parents, the

>sales manager. Everyone is trying to push their thinking into my head. "

>

> " How do you feel about all this? "

>

>Ron: " I feel angry. They say they have done this to help me, but they

>don't

>care about me. They're all selfish. Afraid I'll upset their tight little

>worlds. I shouldn't be here. "

>

>Ron's doctor was obediently acting as trained. The doctor told Ron he

>had

to

>accept that he was mentally ill because he believed people were trying

>to

>force thoughts into his mind. Two days later Ron signed out. It was

>rumored

>that he took off for California.

>

>The " You Must Believe You Are Mentally Ill " double-bind in it's pure

>form

>occurs when the person is told, " Because you believe that people are

>trying

>to force thoughts into your mind, you must now accept into your mind the

>thought that you are mentally ill. "

>

>Although this psychiatric practice has never been researched, it is

>common

>for mental patients to hear such messages. In their book How to Live

>with

>Schizophrenia, psychiatrists Abram Hoffer and Humphry Osmond state to

> " the

>schizophrenic " reading the book: " As a patient, you have a grave

>responsibility to yourself and to your family to get well. You will have

>no

>problem if you are convinced that you are ill. But no matter what you

think,

>you must do all you can to accept the statement of your doctor that you

>are

>ill... "

>

>Top | Bottom

>

>The second double-bind is in the assertion to patients that all the

>actions

>being taken are entirely for his or her own good. As Ron found out with

>his

>family, when he upset them by confronting them with their selfishness,

their

>reaction was to regard his thinking as crazy. They were convinced they

>were

>unselfish people who only had his best interests in mind. Unfortunately

>for

>mental patients, they encounter the same blind hypocrisy in psychiatric

>facilities. Here is an example:

>

>One time I walked by a psychiatric resident who was standing in the

>hallway

>outside his office door. He was shaking his head as he watched a patient

>walk away.

>

>I asked him, " What's wrong? "

>

>He said, " That patient refuses to believe I'm working entirely for her

>own

>good. "

>

> " Are you? "

>

> " Of course! "

>

> " Do you enjoy being a doctor? "

>

> " Yes. "

>

> " By working with her aren't you learning how to be a psychiatrist? And

won't

>you enjoy the prestige, money and working conditions that psychiatrists

>have? "

>

> " Yes. "

>

> " If you help her, won't you gain her appreciation? "

>

> " Yes. "

>

> " If you get her out of the hospital, won't that help reduce your taxes? "

>

> " Yes. "

>

> " If she's out doing a good job supporting herself, won't that make the

world

>a better place for you to live in? "

>

> " Yes. "

>

> " And you want her to believe you are working entirely for her own good? "

>

> " But I am! " he protested as he turned and walked back into his office.

>

>The second, " We're Doing This for Your Own Good, " double-bind comes from

>self-deceptive efforts to maintain the illusion that the actions taken

>to

>remove, eliminate, or " cure " people of undesirable thoughts and feelings

are

>entirely unselfish.

>

>Top | Bottom

>

>The third double-bind is to perceive someone as being " a schizophrenic "

>and

>then express humanitarian love and compassion for them.

>

>The activity of allowing one's mind to engage in " negative nouning " is

>similar to swearing. Perceiving someone as mentally ill is a stress

reaction

>in the mind of the beholder. It constricts and reduces the person into

>something not fully human. When the viewer sees a person as a defective

>or

>sick it prevents the viewer from experiencing the diagnosed person as

unique

>in a special way (the basis for love.)

>

>The authors of DSM-III recognized diagnostic labeling as a problem and

>took

>the following position: " A common misconception is that the

>classification

>of mental disorders classifies individuals, when actually what are being

>classified are disorders that individuals have. For this reason, the

>text

of

>DSM-III avoids the use of such phrases as " a schizophrenic " or " an

>alcoholic, " and instead uses the more accurate, but admittedly more

>wordy

> " an individual with Schizophrenia " or " an individual with Alcohol

>Dependence. "

>

>Yet, even with the adoption of this position by the American Psychiatric

>Association in 1980, statements about " schizophrenics " abound in modern

>psychiatry. Psychiatrist E. Fuller Torrey, for example, tours the

>country

>telling audiences " there are over 100,000 active schizophrenics roaming

>the

>streets of our cities. "

>

>An example of the " Love for Schizophrenics " double-bind can be found in

>Torrey's recommendations on " How to Behave Toward a Schizophrenic. " He

>states, " In general, the people who get along best with schizophrenics

>are

>those who treat them most naturally as people. "

>

>Silvano Arieti is a leading authority on schizophrenia. In concluding

>his

>award winning book Understanding and Helping the Schizophrenic: A

>Guidebook

>for Family and Friends, he states: " ...where modern psychiatric science

>and

>our hearts meet, is the place in which help for the schizophrenic is to

>be

>found... "

>

>The experience of people viewed as schizophrenic is something like being

>told by a smiling, powerful authority " I have only love and compassion

>for

>rotten assholes like you. "

>

>Top | Bottom

>

>The fourth double-bind. The bizarreness of the three double-binds

>described

>above can lead to a fourth. The sequence of mixed messages that throw

>supposedly schizophrenic people into a living nightmare goes as follows:

>

> " You must accept into your mind our assertion that you are mentally ill

>because you believe that people are trying to force thoughts into your

>mind. "

>

> " You must believe our self-deceptive statements that we are not acting

>selfishly when we force you to submit to treatment that you don't want.

>You

>must believe we are doing this to you only for your own good. "

>

> " You must believe that we are acting out of love and compassion for the

>undesirable thing you are. "

>

>If a person protests about any of the above and tells the therapy staff

they

>are the crazy ones, the fourth double-bind message is: " Your claim that

>we

>are crazy and harming you proves how really mentally ill you are. You

>are

so

>sick you lack insight and don't appreciate the help we are offering to

you. "

>Top | Bottom

>

>Conclusions

>Observations of what is said to patients in psychiatric facilities

>reveal

>that traditional psychiatric practices subject patients to four major

>double-binds.

>When one looks with empathy at what people regarded as schizophrenic

>experience in psychiatric facilities, it is no surprise that treatment

>efforts are so ineffective and that patients react as they do.

>Withdrawal,

>deterioration of social functioning, and saying things that the staff

>experience as delusional are legitimate, valid responses to the mixed,

>double-bind messages the patients receive.

>

>The current situation in hospital psychiatry is similar to what Dr.

>Ignaz

>Semmelweis discovered when he saw that hospital physicians were the

carriers

>of deadly infections from one pregnant woman to the next. The physicians

>scoffed and ridiculed Semmelweis because their intentions were to help

>women, not kill them.

>

>In the same way, hospital psychiatrists ridicule suggestions that they

>act

>in ways that worsen and maintain the mental conditions they claim they

>want

>to cure. The lack of insight in modern psychiatry is more extreme than

>the

>lack of insight in patients.

>

>Top | Bottom

>

>References

>American Psychiatric Association, 1980. Diagnostic and Statistical

>Manual of Mental Disorders, 3rd Edition (DSM-III).

>Washington, DC: APA, p. 6.

>

>Arieti, S. (1979). Understanding and Helping the Schizophrenic.

>NY: Simon and Schuster, p. 228.

>

>Argyris, C., Putnam, R., and Smith, D., (1985). Action Science.

>San Francisco: Jossey-Bass.

>

>Hoffer, A. & Osmond H. (1966) How to Live with Schizophrenia.

>NY: University Books, p. 153.

>

>Modrow, John. (1996) How to Become a Schizophrenic

>(2nd ed.). Seattle: Apollyon Press.

>

>Rosenhan, D.L. (1973). " On Being Sane in Insane Places, "

>Science, No. 179, 250-258.

>

>Torrey, E.F. (1983) Surviving Schizophrenia,

>NY: Harper & Row, pp. 160-161.

>

>

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>

>Notice to students, editors and publishers: If you quote or reprint any

part

>of this research paper, please send an electronic copy to Al Siebert at

>asiebert, or a hard copy to: Al Siebert, Ph.D., P.O. Box

>505,

>Portland, OR 97207.

 

 

 

 

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