Families

I started a career in psychiatry in 1966.  Without life experience, the impact of mental suffering is nonplussing.  At the time the ‘anti-psychiatry’ of David Cooper and R.D. Laing was at its height, and I guess it oriented me towards a belief that there is sense behind the madness.  Another approach was to develop a more intellectual/research interest.  And I made one or two short contributions, mostly about families.
 
In 1967, I pursued my psychiatric formation by moving to a large mental hospital, Shenley Hospital.
 
1967 Birth order and schizophrenia
Nature 220: 490
When I started in psychiatry, there was a lot of interest in birth order, and a number of psychiatric journals published papers with statistics that were detailed enough to be reused.  By aggregating various sets of data, I produced enough to test a new hypothesis.  Whereas all previous data had looked at the 1st, 2nd, 3rd… child in the family, it was possible to turn that around and look at last, last-but-one, last-but-two, etc.  And I got a result, a statistically significant one– the last-but-one was over represented!  Even the most organically oriented psychiatrists had to admit this was not a genetic influence but must be some family dynamic
 
1970 Evidence for a birth order factor in schizophrenia
British Journal of Psychiatry 117 293-301
My communication in Nature of which I still feel proud, was noticed by Elliott Slater of the MRC Genetics Unit at the time, and Editor of the British Journal of Psychiatry, who encouraged me to develop a more sophisticated statistical analysis and discussion for this 1970 paper.  This work set me on a path towards wondering about early the experiences of those who become schizophrenic, especially amongst siblings.
 
1972 Patients who lapse from group psychotherapy
British Journal of Psychiatry 120: 558- 559 (Letter)
I confirmed my hypothesis that people from large families would tolerate group therapy with 4-8 other members than those form smaller families.
 
1973 Schizophrenia and family function
British Journal of Social Psychiatry 7:
I was also reading psychoanalysis, and was now familiar with and using Bion’s notion of the three basic assumptions – dependency, fight/flight and pairing.  This paper postulated that families go through a cycle of assumptions (appropriate in this case), related to the stage of child rearing: starting with pairing necessary for conception, then dependency once the child comes to be born, and then a flight/flight assumption during adolescence.
 
2015 Minding each other: Couples and primitive processes.
Chapter in Novakovic (Ed.) Couple Dynamics: Psychoanalytic Perspectives in Work with the Individual, the Couple and the Group
Bion’s later writing on links and containing has implications for couple relations.  These are explored in the terms of the ideas on group dynamics explored in the publications above, in 1.3c.