Family Fragments: Pressure and Proximity in First-Episode Psychosis

Author

Cassandra B. Seltman, The Graduate Center, City University of New YorkFollow

Date of Degree

6-2024

Document Type

Dissertation

Degree Name

Ph.D.

Program

Social Welfare

Advisor

Vicki Lens

Committee Members

Rufina Lee

Barbra Teater

Subject Categories

Clinical and Medical Social Work | Clinical Psychology | Mental Disorders | Psychoanalysis and Psychotherapy | Social Work | Theory and Philosophy

Keywords

Schizophrenia, Psychosis, Family, First-Episode, Psychoanalysis, Family Dynamics

Abstract

This study explores the value of assuming a position that decenters the identified patient in families with a member with schizophrenia. Instead, a systemic view of the family is taken, as subject to pressures from without and within, and utilizing observable processes for the management and discharge of tension. It attempts the difficult balance of thinking dynamically without sacrificing scientific rigor, considering the social without discounting the biological, and exploring the functionality of the family without collapsing into blame, reductive cause-and-effect thinking, and the search to prioritize one true origin.

When treating family members as discrete units around an identified patient, information about the dynamic processes at work in the family system is lost. Using long-form semi-structured interviews, the study aims to fill this gap, drawing from the qualitative methodology of narrative as well as the core concepts of Murray Bowen’s Family Systems Theory (developed primarily from the 1950s through the late 1980s) to study the interaction between family dynamics and the prodrome and first-episode of psychosis. Many of these concepts are made thinkable by the work of psychoanalysts Sigmund Freud and Jacques Lacan, whose thought is called upon to theorize the relation between time, proximity, and pressure in families sharing a particular set of phenomena known as schizophrenia.

Seven families with a member with a diagnosis of schizophrenia were interviewed. Family members were interviewed first together and then individually, allowing for a family history to be taken, a timeline of illness collected, and observational methods to be employed. The interviews were coded for both inductive and deductive themes. Bowen’s concepts of differentiation, emotional cut-off, and triangles were among the most relevant. Considering these findings, the goal of treatment is not to suppress or destroy a single pathogenic element, but to make adjustments to the distribution and discharge of tension in the context of the emotional family system, requiring and inciting modifications in all relations. Ultimately, the complexity of these findings beckons us to move beyond the current pessimistic paradigm of family treatments as opportunities for families to assist the individual at the center of concern with coping skills and medication compliance. In addition, it requires further engagement with the intricate correspondence of individual, familial, and societal entanglements which most often occur below the level of conscious awareness. In its wake lies the imperative for an integrated approach and echoes the clarion call for interventions that consider the many fractal dimensions of the experience of being part of a family.

Recommended Citation

Seltman, Cassandra B., "Family Fragments: Pressure and Proximity in First-Episode Psychosis" (2024). CUNY Academic Works.
https://academicworks.cuny.edu/gc_etds/5751