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The normality of deviance: an alternate explanation of schizophrenia in the family.

When clinicians became interested in treating schizophrenic patients in individual psychotherapy, some raised troubling questions: How could the patient be helped if he were to be sent right back into the family context that may have exacerbated, if not created, his illness? Perhaps the mother or even the whole family was "sick"? Many felt that family therapy, in which attention was placed on the whole family and the ways it used the patient's symptoms for its own purposes, would be a more promising approach to treatment. Over the years, family therapists developed a variety of treatment techniques and formulated theories to generalize these techniques, but they also reported the enormous strength with which families held onto their pathological relationships. All family therapists can recall endless lists of strategies that families use to sabotage treatment—that is, to retain the family system as it is, schizophrenic patient and all. Further, when one member does change, unintended results sometimes occur: "[Thought] distortions in the patient may clear up only to be followed by a flare-up of pathology in another family member who was previously asymptomatic" (Zuk and Rubinstein 1965, p. 24). Some therapists concluded then that these kinds of families must need a sick person if the family is to stay together.