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Beyond the Double Bind
BOOK REVIEWS Beyond the Double Bind. Edited by Milton M. Berger, New York: Brunner/Mazel Publishers, 1978, 254 pp ., $17.50
lated conflict. The implication is that if someone doe s not have a genetic predisposition to schizophrenia, he will not develop schizophrenia no matter how severe the environmental circumstances. Murray Bowen discusses the genetic aspects of schizophrenia and des cribes the "multi-generational phenomenon" which gradually evolves into schizo phrenia by a process of natural selection. It is these contradictions from author to author which create confusion and lead me to wonder whether there is any agreement as to what schizophrenia is, what causes it, or even whether the "double bind" is constructive or destructive in child development. It is conceded by some of the authors that, when faced with a "double bind," a child may also develop creative solutions to su ch conflicting messages. If all these statements are accurate, it is possible that the "double bind" is nothing more than a conflictual situation which acts as a stressor in the family system. Perhaps it is no more specifi c in creating psychopathology than the child's loss of a parent is in producing depression. Thus this present effort to clarify the question fails to achieve its goal.
Reviewed by Paul C. Laybourne, Jr. , M .D. * This book consists of the deliberations of a conference held on the "double bind." There are papers generated by the faculty panel and reports of audience participation, as well as a discussion from the participants. There are nine contributors on the panel and the content varies from the training of dolphins to the genetics of schizophrenia. The first chapter by Gregory Bateson, Don D. J ackson, Jay Haley, and John Weakland entitled "Toward a Theory of Schizophrenia" is reprinted from Behavioral Science, October, 1965. This lucidly written contribution describes the "double bind" as a spe cific human interaction consisting of a primary negative injunction and a secondary injunction that conflicts with the first at a more abstract level. Like t he first injunction, the secondary injunction is enforced by punishments or signals which threaten survival. The authors also des cribe a tertiary negative injunction that prohibits the victim from escaping from the field. In this sense, the double bind is a definable conflictual situation. Unfortunately, with the passage of time, double bind has been used in many ways and no longer seems to have specificity. Jay Haley most clearly expresses the ambivalence of the panel regarding how the "double bind" theory should be currently viewed. Originally the "double bind" spoke of a victim; subsequently, therapists have entertained the idea of generating a paradox or bind so that a person would be forced to behave appropriately. Haley, in a chapter on ideas which handicap the therapist, states that he has discarded the biologi cal or genetic theory of schizophrenia since he contends that it cannot be proven. He also indicates that he has found it necessary to dis card the term "dou ble bind" and return to Bateson's original term "paradox." In contra st, Arnold Winston states that explanations which are entirely based on famil y structure, pro cess, or conflict do not provide the necessary etiological basis. At the present time, the most likel y explanation is based on the idea of an inherited genetic predisposition to schizophrenia which is then activated or precipitated by environmental or developrnentally-r e-
Appetite and Lack of Appetite in Infancy and Early Childhood. By P. Rahamimoff, M.D. Huntsvill e, Ala.: The Strode Publishers, Inc., 1979, 179 pp ., $15.00. Reviewed by John B. Griffin, Jr., M.D. t Dr. Rahamimoff is a pediatrician practicing in Israel who has written an account of his clinical experience in treating disorders of appetite in infancy and early childhood. He draws from an experience of over 12,000 cases, with eating disorders constituting over 5,000 of this number. The data presented are des criptive and the reader who is seeking hard data from carefully controlled double blind studies is likel y to be disappointed in the paucity of su ch data in this book. Dr. Rahamimoff describes treatment programs which he found to be effective. He dis cusses in depth th e theoretical explanations for the success of his program. Within this framework he gives information which should be of interest to both child psychiatrists and pediatricians. The author gives a poignant description of the manner in which con cen tration camp survivors wer e affected in their child rearing practices by their concen-
• Dr. Laybourne, is Professor of Psychiatry and Family Practi ce and Associate Professor of P ediatrics, University of Kansas Medical Center.
t John B. Griffin, Jr., M.D. is Professor of Psychiatry, and Director of Medical Student Edu cation, Emory University School of Medicine, Atlanta, Georgia. 307
lated conflict. The implication is that if someone doe s not have a genetic predisposition to schizophrenia, he will not develop schizophrenia no matter how severe the environmental circumstances. Murray Bowen discusses the genetic aspects of schizophrenia and des cribes the "multi-generational phenomenon" which gradually evolves into schizo phrenia by a process of natural selection. It is these contradictions from author to author which create confusion and lead me to wonder whether there is any agreement as to what schizophrenia is, what causes it, or even whether the "double bind" is constructive or destructive in child development. It is conceded by some of the authors that, when faced with a "double bind," a child may also develop creative solutions to su ch conflicting messages. If all these statements are accurate, it is possible that the "double bind" is nothing more than a conflictual situation which acts as a stressor in the family system. Perhaps it is no more specifi c in creating psychopathology than the child's loss of a parent is in producing depression. Thus this present effort to clarify the question fails to achieve its goal.
Reviewed by Paul C. Laybourne, Jr. , M .D. * This book consists of the deliberations of a conference held on the "double bind." There are papers generated by the faculty panel and reports of audience participation, as well as a discussion from the participants. There are nine contributors on the panel and the content varies from the training of dolphins to the genetics of schizophrenia. The first chapter by Gregory Bateson, Don D. J ackson, Jay Haley, and John Weakland entitled "Toward a Theory of Schizophrenia" is reprinted from Behavioral Science, October, 1965. This lucidly written contribution describes the "double bind" as a spe cific human interaction consisting of a primary negative injunction and a secondary injunction that conflicts with the first at a more abstract level. Like t he first injunction, the secondary injunction is enforced by punishments or signals which threaten survival. The authors also des cribe a tertiary negative injunction that prohibits the victim from escaping from the field. In this sense, the double bind is a definable conflictual situation. Unfortunately, with the passage of time, double bind has been used in many ways and no longer seems to have specificity. Jay Haley most clearly expresses the ambivalence of the panel regarding how the "double bind" theory should be currently viewed. Originally the "double bind" spoke of a victim; subsequently, therapists have entertained the idea of generating a paradox or bind so that a person would be forced to behave appropriately. Haley, in a chapter on ideas which handicap the therapist, states that he has discarded the biologi cal or genetic theory of schizophrenia since he contends that it cannot be proven. He also indicates that he has found it necessary to dis card the term "dou ble bind" and return to Bateson's original term "paradox." In contra st, Arnold Winston states that explanations which are entirely based on famil y structure, pro cess, or conflict do not provide the necessary etiological basis. At the present time, the most likel y explanation is based on the idea of an inherited genetic predisposition to schizophrenia which is then activated or precipitated by environmental or developrnentally-r e-
Appetite and Lack of Appetite in Infancy and Early Childhood. By P. Rahamimoff, M.D. Huntsvill e, Ala.: The Strode Publishers, Inc., 1979, 179 pp ., $15.00. Reviewed by John B. Griffin, Jr., M.D. t Dr. Rahamimoff is a pediatrician practicing in Israel who has written an account of his clinical experience in treating disorders of appetite in infancy and early childhood. He draws from an experience of over 12,000 cases, with eating disorders constituting over 5,000 of this number. The data presented are des criptive and the reader who is seeking hard data from carefully controlled double blind studies is likel y to be disappointed in the paucity of su ch data in this book. Dr. Rahamimoff describes treatment programs which he found to be effective. He dis cusses in depth th e theoretical explanations for the success of his program. Within this framework he gives information which should be of interest to both child psychiatrists and pediatricians. The author gives a poignant description of the manner in which con cen tration camp survivors wer e affected in their child rearing practices by their concen-
• Dr. Laybourne, is Professor of Psychiatry and Family Practi ce and Associate Professor of P ediatrics, University of Kansas Medical Center.
t John B. Griffin, Jr., M.D. is Professor of Psychiatry, and Director of Medical Student Edu cation, Emory University School of Medicine, Atlanta, Georgia. 307