Abstract
In this important addition to the series ‘Cornell Studies in the History of Psychiatry’, Deborah Weinstein cites the 1955 film ‘Rebel Without a Cause’. One early sequence shows three of the main teenage characters being questioned at a police station for alleged delinquency. In each case, tensions between parents and offspring are highlighted with the James Dean character, having been admonished by his mother and his grandmother for his misbehaviour, screaming: ‘You’re driving me crazy!’ As Weinstein comments, the clear implication here was that for these teenagers ‘family life was the cause of their problems, the damage was psychological in nature, and psychiatric treatment made sense as a potential solution’. Such a ‘chain of connections’, she continues, ‘was part of the same cultural logic on which family therapy drew’ (p. 145). The visual nature of this analogy is deliberate and a point well made since, as Weinstein shows, family therapists actively sought to observe families in action. They did so by a variety of means, including therapists and researchers living with troubled families, observing them through one-way mirrors, or capturing them on film.
But what was family therapy; who were its advocates; and what did it seek to achieve? It clearly had roots in early forms of psychiatry and psychological medicine, child guidance and marriage guidance being obvious cases in point. But post-war American family therapy’s fundamental premise was that the psychologically-troubled patient – and there was a particular focus on schizophrenia and on delinquency – had to be seen not simply as an individual presenting symptoms but rather as an integral part of his or her family. More than this, though, family therapists ‘produced a new definition of what a family could be – namely, a unit of disease, which had previously been contained in individual bodies’. It was thus the family which should be the object of intervention and treatment and not just the family member in mental distress (p.15).
As such an approach might suggest, family therapists drew not only on psychological medicine. One of the virtues of Weinstein’s book is that she shows how family therapy theory engaged with, for example, the emerging discipline of cybernetics. The latter sought to examine how various structures might maintain equilibrium through mechanisms such as knowledge feedback loops, and family therapists adapted these ideas to what they essentially saw as the self-contained and self-regulating family organism. Such arguments resonated beyond America with the British psychiatrist R.D. Laing, for instance, expressing admiration for some of the findings of family therapy research and practice. But family therapy also drew on other disciplines such as sociology and, most notably, anthropology with some of its leading proponents coming from these disciplines. So in 1957 the anthropologist Jules Henry set up what he described as a ‘naturalistic study’ of families with psychotic children, and this involved him actually living with a number of the families concerned. Although not himself a clinician, and although he does not appear to have made any direct therapeutic interventions, Henry had no doubt that his research and findings had therapeutic implications. Also, like other family therapists, Henry believed that identifying and describing the ‘diseased’ family would help clarify what constituted the ‘normal’ family (pp. 136ff).
This brings us to what family therapy sought to achieve. In the first few decades after World War II the family was seen in America, and in other liberal democracies including Britain, as the key social institution upon which depended social stability and social adjustment. Clearly, then, family malfunction, as evidenced by the mental ill-health of one of its members, was a concern for society as a whole and not just for the individuals concerned. The model of the family on which such arguments was based consisted of a heterosexual married couple – husband and wife with prescribed roles – and children. This model increasingly came to be challenged in the last quarter of the twentieth century from a variety of angles such as changing patterns of marriage and divorce; and on the grounds of gender and race. Equally important, and not least in the American case, were concerns about the notion of the family as a closed system and this fed into debates in the 1960s in the USA about the relationship between ‘culture’ and poverty. Of course, and as Weinstein points out, American society (and not just American society) is still in thrall to ‘family values’. But while in the 1950s and 1960s family therapists were optimistic ‘about the extent of change they could induce through therapeutic intervention’, notwithstanding the pessimistically perceived scale of the problem, and while such interventions ‘had implications for both societal and personal well-being’, these aspirations have been notably scaled back (p. 180). Weinstein skilfully and carefully guides us through this complex history, a history which has lessons not only for those interested in post-war America but for all those engaging with the relationship between the family, society and the state in liberal democracies from 1945 to the present.