This is a rewrite of what I submitted two years ago.
Froma Walsh in 1978 discovered some rather remarkable facts about schizophrenia. 41% of schizophrenics had a grandparent die(GD) within two years of their birth, over four times more than would have been expected in the general population. A solid explanation for that has never emerged.
Bowen theory has ideas that point toward a plausible explanation.
Research Data
In the general population, around 10% of people have had a grandparent die within plus or minus two years of their birth. Froma Walsh surveyed 70 schizophrenics in their Center for Family Studies Project at Michael Reese Hospital in Chicago. 29 of them(41.4%) had a grandparent who died within two years of their birth. In a small community sample of 25 people, 2(8%) had a GD near their birth, in the neighborhood of the 10% generally reported in larger surveys. Another comparison group, people hospitalized for nonschizophrenic emotional illnesses, had 20% GD near birth, 9 of 45.
Modern statisticians translate this into Odds Ratios. Schizophrenics are more than four times as likely to have had a GD near their birth than people in the general population. Hospitalized nonschizophrenics two times more likely. Research reported with Odds Ratios without a bigger picture are easy pickings for simplistic causal reasoning.
So, what accounts for these results? Is GD near birth a cause of schizophrenia? That’s how it would be reported in the mainstream media. GD near birth has also been interpreted as a maternal stressor that alters the brain development of the infant. Does that account for the results?
Bowen theory offers more plausible explanations for these facts.
Bowen’s description of Family Reaction to Death
I drew the ideas used in this explanation from three papers: “A Family Concept of Schizophrenia”(1960), “The Use of Family Theory in Clinical Practice”(1966), and “Family Reaction to Death”(1976). Bowen himself made most of the argument I am using in a theory section of “Family Reaction to Death”, entitled ‘Family Emotional Equilibrium and the Emotional Shock Wave’.
Bowen asserted that a large percentage of families have some kind of emotional shock reaction to the death or loss of an important person in the multigenerational family. Furthermore, the extent and intensity of that system reaction will depend, to a large degree, on the level of emotional integration of the system. Better differentiated families might have a reaction, but the effects won’t be as serious or long-lasting as are the effects in a low differentiation family. The latter can generate serious symptoms lasting for years in the family system, including the development of intense parent-child symbioses with any child who happens to be born near the time of death of an important central figure in the multigenerational family. This is consistent with what I have observed in families with serious symptoms and low differentiation emotional process.
Some dynamics of that reaction in low differentiation families
For a good grasp of this phenomenon, one must consider the variety of features that can be found in low differentiation systems. These include intense chronic anxiety, weak individual selfs, more serious symptoms, more intense cross-generational symbioses, more intense family projection process, intense emotional process of all types, more emotion and thought contagion, fuzzy boundaries, less clear thinking and less effective problem solving, more crises and life events, denied or dissociated connections between events and people, unregulated primary process, high expressed emotion, more delusions, parental communication deviance, absence of support for self development, and more active interference with self development.
These low differentiation families, given the intense anxiety, the continual crises, and the serious symptoms, have a difficult time maintaining any kind of functioning stability. Often a central figure can lend a tenuous stability to the system functioning. That central figure often is a part of several cross-generational symbioses that give some stability to the system. Then, when that central figure is lost due to death or disability, that source of stability is gone. Anxiety, symptoms, and instability go sky high in the system. This is the emotional shock wave. Some of the serious symptoms provide a little bit of a focus that can stabilize parts of the system functioning a little. When a baby is born or an infant is present while the multigenerational system is destabilized, symptomatic, and anxious, then an intense parent-child symbiosis can develop around that child. That intense symbiosis can stabilize that part of the system to some degree. However, in the case of schizophrenia, that intense parent-child symbiosis with an at-risk child may result in schizophrenia twenty years later.
Another important feature of the emotional shock wave is a strongly denied interdependence. A long quote from Bowen’s Family Reaction to Death paper describes that better than I can(FTCP p.325). “…(Emotional Shock Wave) operates on an underground network of emotional dependence of family members on each other. The emotional dependence is denied, serious life events appear to be unrelated, the family attempts to camouflage any connectedness between the events, and there is a vigorous emotional denial reaction, when anyone attempts to relate the events to each other. It occurs most often in families with a significant degree of denied emotional “fusion” in which the families have been able to maintain a fair degree of asymptomatic emotional balance in the family system…”
This perspective is consistent with some informal observations made by Froma Walsh when she talked with families of their hospitalized study patients, who had the GD near birth of the patient. Most of the families of the schizophrenics who had the GD near birth had never seen the coincidence of the death and the birth. When told of it, there were strong emotions expressed about the grandparent death, in contrast to the families of the nonschizophrenics, who also had GD near birth. The latter mostly already realized the coincidence, could recall clearly the difficulty of having the two coincide, remembered their sadness, but did not have the strong and persistent emotion shown by the families of the schizophrenics. Nor did the families of nonschizophrenics and average families deny any impact of the coincidence of the death and birth.
Bowen, with his observations of families organized around a central figure, denial of dependence, and the role of symptoms and symbioses in stabilizing of the system, provides a way to begin thinking about Walsh’s counter-intuitive findings in schizophrenia.
References
Bowen, M. (1960). A Family Concept of Schizophrenia. In The Etiology of Schizophrenia, edited by Don D. Jackson., 346-370. New York: Basic Books, Inc. doi:10.1037/10605-012.
Bowen, M. (1966). The Use of Family Theory in Clinical Practice. Comprehensive Psychiatry, 7:345-374.
Bowen, M. (1976). Family Reaction to Death. In Family Therapy, edited by Philip Guerin, 335-348. New York, Gardner Press.
Walsh, F. W. (1978). Concurrent Grandparent Death and Birth of Schizophrenic Offspring: An Intriguing Finding. Family Process, 17(4), 457-463.
Watt, N. F. & Nicholi, A. N.. Early Death of a Parent as an Etiological Factor in Schizophrenia. American Journal of Orthopsychiatry 49.3 (1979): 465-73.
Yates, B. T., Fullerton, C. S., Goodrich, W., Heinssen, R. K., Friedman, R. S., Butler, V. L., & Hoover, S. W. (1989). Grandparent Deaths and Severe Maternal Reaction in the Etiology of Adolescent Psychopathology. The Journal of Nervous and Mental Disease, 177(11), 675-680.
Jim Edd,
i find this piece very interesting, both in the main point and in the description of low levels of differentiation that can lead to schizophrenia. I have observed how the death of a grandparent can be destabilizing in a family, and it makes sense to me that the death occurring within a couple of years of a child’s birth could affect the child’s development. The grandparent’s death destabilized the parent, who then focused on the child. However, the last part, where you describe the intense emotional reaction to the memory of the death, does not fit with my observations. In many families, I have seen a continued denial of the connection of schizophrenia to the death and continued denial that the death undermined or destabilized functioning at all. The other difference is that the process occurs at times at other developmentally significant periods, like adolescence, for the child. Thoughts?
Yes, I too have seen that continued denial but not universally. There is variation in this phenomenon. I’ve seen plenty of intense emotion when certain facts are realized or remembered. Then weeks later some of those will remember the realization and some will have reverted to the denial or dissociation.
Yes, the grandparent’s death can destabilize a parent, but my point is that in a low differentiation family, it is more likely to destabilize the whole family.
Thanks for your comments.
This is a real interesting piece and stimulates thinking along with Laurie’s comments. I am thinking that the ability to connect life events with shifts in one’s functioning and interconnection with others in the family is probably a challenge at most levels except maybe the higher levels. But it would make sense that the level of attachment particularly at the most intense levels would interfere with one’s ability to know their level of interdependency accurately. It seems we all live with some denial of the intensity of our attachments. My cousin was born 5 months after my maternal grandmother died. She and her parents are a good example of an intense symbiosis. My cousin had cerebral palsy with minimal mobility. She was aphasic and over time developed scoliosis. My aunt always said that any time there was tension or distress between the parents, Kate would get very upset. And that would shift the focus back to Kate. She was named after my grandmother. She had two siblings, both males and my aunt would say they pretty much raised themselves. All of this is so natural and yet at this level the process clearly influenced my cousin’s ability to function on any level separate from her parents. She died in her thirties following surgery for scoliosis. The emotional process was a major factor in her limited functioning, and probably was a major factor in the course of her physical symptoms as well.
Yes, I agree that we all live with some degree of denial or lack of awareness of the intensity of our attachments, and denial of connections between emotional events. Your description of the emotional process in your family goes well beyond figuring out whether to call it symbiosis, family projection, or whatever. You describe the emotional process. Thanks Ann.
I like the list of characteristics of the low differentiation families – it is a vivid portrait, Jim Edd. I concur with Laurie’s comments and Ann’s, both also well written. Except if I understood it, the families that did not deny the association between birth and death were the control families that serve as a comparison of presumably better differentiated family systems with the families of schizophrenic patients.
Wondering what you are going to do with this piece?
Yes, the nonschizophrenics were from two comparison groups: hospitalized nonschizophrenic patients and a small group from the general population. Next I’l try to publicly present it. There are still things about low differentiation family systems that I don’t understand and continue to work on.