Thank you for your observant and considered expressions.
While I have seen families around sz (and other psychiatric) pts who seemed to be pretty “free of problems,” they have been in the distinct minority. Most have displayed some sort of aberrations running the gamut from gross and obvious physical (including denied and/or hidden sexual) and/or verbal abuse to occasional but (surprising and) pithy (and humiliating) cracks about the pt in front of others to very confusing and conflicting verbal expressions that fly in the face of either other verbal expressions or obvious non-verbal behavior.
I was confused by this myself for some time until I ran into all those authors I cited above, as well as the “psychological games theorists” of the 1950s - 1970s, including Eric Berne, Thomas Harris and Stephen Karpman. Karman’s Drama Triangle (see Karpman drama triangle - Wikipedia and http://www.karpmandramatriangle.com/).
At that point I began to observe to notice to recognize what I was seeing in those families (including my own) through the eyes of the games theorists. Things began to make sense In A Hurry. I was seeing family dynamics quite similar to those I had seen in the families of the alcoholics and drug addicts at major treatment facilities years before.
I don’t want to go way down into explanations here, and I do want to say that it serves no useful purpose to blame the parents and the siblings for what they did to protect their own fragile egos. (“I am not responsible for my disease, but I am responsible for my recovery.”) But when those fragile egos gang up (see “psychopathological concentration theory”) on a “duty victim” with sufficient genetic precursors…
I have to respectfully disagree. One may have to have been on the front lines (with the prescribers as well as the patients) to see how the prescribers are manipulated by the drug salesmen and their very often gorgeous young “detailers.” If you haven’t been on those front lines, you couldn’t possibly see this.
Yes and No. I offer my family as a mini case study but I think sz is an illness, not just a set of learned behaviours. I do read all the scientific papers I can get my hands on, and I think that there are different forms of it, which need to be separated out but definitely there is a form which is an auto-immune disorder. And it causes brain damage. Your psyche and your body are not separate entities. I actually do NOT believe that the mind or psyche DRIVES any disease process.
Why does it have to be One Way >>>>OR<<<< The Other? (Polarized appraisal being the universal hallmark of almost all cognitive mental illness, btw.)
If you’re into reading scientific papers, then, you may want to dig into all the ones on “epigenetics” and “neuroplasticity.” Because, regardless of what we want to believe, there’s a ton of hard scientific evidence to dispute such belief.
Moreover, there’s a fast-growing mountain of scan-based empirical support for remodeling the brain with cognitive and mindfulness-based psychotherapies. See Google Scholar.
Notice the ‘just" in the sentence you quoted. So I wasn’t polarizing. Learned behaviour may contribute to onset and deterioration but I don’t believe it is the cause in MOST cases. Note that I also said that I don’t believe all types of sz have the same underlying etiology. But the physical evidence of damage to the CNS prior to apparent onset is enough to prove a disease process. Sz is not “poor thinking”, “personality disorder” or a “symptom of abuse.” The fact that a person with sz needs to exercise quite extraordinary self control to overcome it, doesn’t mean that it has a psychological root cause. In my family one of my sisters was regularly battered by my father and verbally abused by my mother. She does not have any positive symptoms of sz. She does have hypothyroidism and her daughter, who has been the apple of both her parents’ eye, is starting to show prodromal symptoms. My son, also never battered or abused, no drugs, no alcohol, successful, dropped out of med school when the prodrome started.
I think the searching for “reasons” in “psychological” environmental factors is also a symptom - demonstrates the “external locus of control” which is one of the main features of people with untreated or undertreated sz.
I have to also point out that while my family was pretty unhappy I have seen all the behaviour you detail AND WORSE in families in which noone has a SMI. So yes, epigenetics is a part of the puzzle. But for the epigenetics to have any effect, you need to have a set of damaged genes first.
Interestingly, in my family, those of us who “went down” with some type of schizophreniform disorder or diabetes all had really bad and repeated throat or respiratory viral infections when we were young. So, for my money, in my family, what ‘primed the trigger’ was a virus - and when scientists talk about the epigenetic effect of the environment, they are often talking about the biological environment, not psychological. But of course, there’s no money in that for psychotherapy - the single form of treatment that insurance companies pay for that has NO evidence base whatsoever.