We all know about Family Group Psychosis. We just never had a name for it. Check out Dave Keith’s description of that heightened state of (often disguised) insanity that occurs around important holidays–like Christmas–and significant events, like weddings. Here he tells us about a madcap clinical case where Family Group Psychosis led to a woman’s surprising transformation.
Dave: Christmas is coming, the goose is getting fat. Please put a penny in the old man’s hat. Christmas takes over culture space as it arrives. It probably started out as a festival to celebrate Winter Solstice. So there are various pagan symbols attached. It is a religious festival and it is a consumer festival. After all we are a consumer culture. In Minnesota my father used to sing a song in a Norwegian accent, “I Yust Go Nuts at Christmas”. We all do. Christmas is a festival of consumerism. Could be that Christmas transcends religion. Christmas is many things. As with any festival it represents the disruption of the normal. Psychosis is a disruption of the normal. Psychosis usually is a way of talking about an individual’s behavior, but the whole culture is disrupted at this time.
Christmas is an excellent example of what I refer to as a Family Group Psychosis. A central idea is that family living is largely right-brained and unconscious. Healthy (normally crazy) families have limited capacity for intentional behavior. Instead, they are likely to behave in random out-of-the-head ways that influence intentional decision making. But at times when emotional energy is high non-rational influences affect all members. Culturally, these psychotic episodes occur normally around important events like births, deaths and weddings, but also around holidays (Christmas). These “psychoses” are experiential nodes of continuity and change. Families are likely to celebrate Christmas in very much the same way every year giving evidence of continuity in living patterns. But changes occur at these times. Families come together to acknowledge their continuity, but when families are together and emotionally aroused unpredictable change producing events occur. Craziness is far more infectious than most are able to acknowledge.
I will make a distinction between the clinical psychosis that occurs in an individual and the family group psychosis, which is part of a healthy family’s living. In my mind this model puts the psychosis in an individual on a continuum with healthy family living. The individual’s psychosis is a socially identified experience in which he or she is overwhelmed (panicked) by subjective experience, personally isolated, ambivalently extruded from an intimate relationship (family), and objectified by the community (a physician makes a diagnosis). Then a polarizing process evolves (we are normal, you are sick) that isolates the individual with his or her subjectivity and secures the boundary between sick and normal.
The family group psychosis is culturally invisible, that is blended into the fabric of the community so that it does not become a named phenomenon. When a family group psychosis is visible, it is often a culturally choreographed ritual, such as a baptism, wedding, funeral, or wake. Although anxiety or other emotional symptoms can become quite high in and among the participants, the group behavior is within the bounds of what the community regards as normal. The psychosis in an individual probably begins in the same way. But when the group anger, pain, or anxiety becomes too high, a scapegoat can be nominated, elected, extruded, and isolated. The crucial difference is that the family psychosis is a group experience. Family reunions, the celebration of Christmas, Passover, Easter, births and deaths, and weddings collapse the structure of living, put social propriety in abeyance, and bring a family close together. When a family is closer together, the emotional temperature goes up, and that may be deeply gratifying or painfully disruptive.
The Christmas holiday is a celebration of a birth. The pregnancy begins somewhere in late autumn when family members begin talking about where Christmas will be celebrated this year. The pregnancy is more palpable by Thanksgiving as plans are put into place. Then the nursery is prepared, as ritual decorations are put in place, getting the home ready for the celebration of the birth. Gifts are purchased as part of the celebration. Special foods are prepared. Then comes the glorious day of celebration. The much anticipated new baby is the family spirit.The anticipated renewal of the family spirit which is what happens in most cases, but there are miscarriages, the spirit may have died and is not arousable.
Clinical Illustration: I worked with this family several years ago. Father a real estate developer, a financially successful psychopath, was grandiose, rage-filled (masked) and condescending. The parents, 65 and 63 had been divorced for 18 years. Father had a number of affairs with women over the years but never remarried. The family with Father included continued to do many things as a family at Mother’s home. Mother, a lively, competent, but cautious person, had never had a romantic relationship with another man in her life. The oldest son, Anthony, 34, was a junior partner in the family firm. He was a competent and productive contributor to the business along with a sister, Carmen, aged 30. Anthony had been hospitalized once with a psychotic episode at age 18.
They were referred to me by mother’s internist in early November because the family thought he was on the edge of psychosis; beginning to disorganize. Delusional fragments were floating into his perceptions. Anthony was Mother’s closest partner emotionally. During the series of therapy sessions consisting of discussion of the family patterns, Mother’s irritation and frustration with her ex-husband began to surface as she became more aware she was being exploited. As her anger became more open, Anthony’s anxiety and pre-psychotic language faded into normal conversation. When the therapy moved into December there was talk of Christmas, and about how Christmas would be celebrated at Mother’s townhouse. Mother was known to be a wonderful and accommodating hostess. Usually Father would be there with his current girl friend.
On Christmas Eve Father called me because something had happened to Mother. She left a note saying she wouldn’t be home for Christmas and asked that Carmen, married with three children, host Christmas at Carmen’s home. Both Father and Carmen (the second child) were concerned that Mother was having a nervous breakdown and wanted to know what to do. Shortly after this phone call, Mother called me from a city 100 miles away, and told me that she decided to leave on my (playful) suggestion and spend Christmas with her college roommate, two years a widow. Mother abandoned the family for Christmas, and Anthony’s disorganized thinking was resolved.
At subsequent session after Christmas Father’s angry, culturally invisible distortions became more palpable. This successful, entitled powerhouse was a little boy, who needed his mommy to be a good predictable mommy for all these years. When she slipped out of Father’s triple-layered double bind, the son was released from his role as Mother’s symbiotic partner and Father’s rage fizzled like a wet firecracker. But not to worry, Carmen, the daughter, furious with her mother (and me, for not validating her opinion that her mother had a nervous breakdown), moved in to take care of him. In this family the Father’s dependency was hidden, covert, but it paralyzed the mother who felt burdened by him but was fearful that something dangerous would happen if she left her role. The therapy ended two months later. Both mother and son were operating with more freedom.
My point, easily lost in the details, is that emotional intensity in the family increased when preliminary discussions of Christmas began, then intensified as Christmas approached. The psychotherapy allowed strong emotion to rise to the surface. What was covert gradually became overt, expressed in a family group psychosis. As is always the case, I had no further follow up after therapy ended.