Post by Mike on Jun 30, 2013 15:50:17 GMT
“Thanatologist” is Inspired by R.D. Laing and A. Esterson’s seminal work “Sanity, Madness and the Family” (1964), its role in shaking up the prevailing psychiatric orthodoxy of the time and its contribution to contemporary understandings of and approaches to Schizophrenia once the shine of the radical had worn off.
“[…] Prior to this investigation, the Espesito family had been recognised as offering an unfavourable and potentially schizophrenogenic environment for their son Jonathan (18). However, our team was the first to suggest that Jonathan’s Schizophrenia was intelligible specifically in terms of the family situation. The prevailing view to date is that Jonathan’s acute symptoms are a matter of heredity, and that his first major Schizophrenic episode was triggered by the psychological trauma sustained from the death of his mother, Carla Espesito, when he was aged sixteen. He has spent nearly two years in hospital.
CLINICAL PERSPECTIVE
The team first encountered Jonathan and his parents in a diagnostic capacity, in the summer of 1962, shortly before Jonathan’s sixteenth birthday. At this juncture, Jonathan’s affect was impoverished or flattened; he experienced auditory hallucinations, severe anxiety and delusions of persecution, which preoccupied him intensely to the impairment of everyday social function. It was judged by the team that the appropriate action in Jonathan’s case – due in part to his age, to avoid subjecting him to the potentially traumatic experience of commitment to psychiatric hospital at such a vulnerable time, in the context of his mother’s illness - was to engage in a six-monthly period of care at home, to be regularly monitored in situ by our team of psychiatrists, culminating in a second evaluation at the end of that period to determine the best way to proceed with further treatment. This allowed the team both to gain a realistic sense of the extent of Jonathan’s condition and to evaluate its environmental influences.
INTERVIEWS
The first interview we undertook was with Giovanni and Carla Espesito, while Jonathan undertook psychiatric evaluation separately. Later in the course of the monitoring period we took pains to conduct further informal interviews with each parent separately at home. What we uncovered was an extremely complex web of mystification and delusion as endemic state of the family unit; a severely dysfunctional environment for all concerned.
(1) FATHER
Giovanni Espesito is a former mechanic of excellent professional reputation who manages two garages. He is a quintessential self-made man; fiercely proud, independent, self-reliant. He is also stubborn, self-absorbed, unforgiving and unsympathetic. As dominant member of the household, he dispenses the most overt mystifying behaviour. His relationship with his son is founded on intense projective idealisation (viewing his son as a manifestation of all the qualities he himself prizes), in which he is impervious to and actively invalidates any contradictory behavioural evidence from his son that is recognised by others; however, his own contradictory observations manifest as sudden outbursts of intense disappointment and all-encompassing negativity that shatter the illusion and create incredible friction within the family. Vacillating between these two extremes, he has little time for the reality of his son’s everyday behaviour and experience. His relationship with Jonathan’s mother Carla is similarly divided between largely fantastical extremes unrecognised as such. Throughout our interactions he displayed a stunted affect, quick to violent verbal and physical behaviour.
(2) MOTHER
Carla Espesito was a housewife. Tragically, Jonathan’s six-month evaluation coincided with her own diagnosis of inoperable lung cancer. A lifelong smoker, she had waited too late to have her symptoms examined, and once diagnosed continued to smoke heavily and disregard all medical advice. Initially we ascribed Mrs Espesito’s evident depression and learnt helplessness to her unfortunate condition; however we have come to speculate that these traits were in fact long-established components of her behaviour. Dominated psychologically by her husband, Mrs Espesito appeared to defend herself from her own emotions by mystifying her son with a stream of contrary judgments, invalidations, reinforcing his own state of learnt helplessness. While initially she exhibited a repeat pattern of seeking her son’s endorsement then invalidating it, or him, over time she became more apathetic, impoverished of affect, and treated excited behaviour of any sort in him on any scale as a fatalistic confirmation of psychological disturbance.
(3) JONATHAN
Our initial interview with Jonathan, during his psychiatric evaluations, allowed us to form the conclusions stated above. We feel that the interview we undertook at the end of his six monthly evaluation, shortly after his mother’s death, was most revealing. This was undertaken without his father present, at our insistence.
At this meeting, after some encouragement Jonathan introduced himself to us verbally, but as Jonathan “Stolti”, not Espesito. It transpired that this was a cruel Italian nickname given him by his father, meaning “stupid, foolish”, at times when his father’s displeasure was invoked. We had observed during Jonathan’s evaluations at home that his father set strict, yet conflicting standards of behaviour inside the home and out; within the home, Jonathan was expected to adhere absolutely to a traditional Italian code of family behaviour. Giovanni Espesito was enthralled by his fiercely matriarchal mother, who had died some years before, and kept the house exactly as it was the day she died. Any transgression or alteration of this status quo was punished severely by Mr Espesito, and both Jonathan and his mother Carla were intimidated and coerced into accepting it. Therefore, Giovanni enforced a psychologically brutal patriarchy while enshrining and bowdlerising the legacy of his own domineering mother; establishing an environment in which contradiction was an essential condition. Outside the home, it was a different story; Jonathan was so named by his parents to help him assimilate into English society and minimise his difference. His father in particular pushed aggressively for his son’s socialisation and integration into the local community, as a matter of family pride, not losing “face” and a facet of his unstable idealisation/expectation of his son. That Jonathan could be so encouraged to adhere to opposite extremes of social behaviour inside the home and out, and had two “given” names from his father that directly manifested this contradiction whilst simultaneously invalidating him, gives clear insight into the intricate web of mystification that he was caught in.
Following his mother’s death, which was clearly very traumatic for Jonathan in spite – or perhaps because of - her own mystifying, contradictory and dysfunctional behaviour towards him, his symptoms worsened considerably and our second interview took place in the early stages of a period of involuntary commitment to hospital prompted by our own intervention; his father consented legally while appearing both characteristically unsympathetic and wilfully oblivious to the severity of the situation.
During this interview Jonathan was extremely introverted, displayed inappropriate affect and physical signs of extreme anxiety such as tremors and repetitive hand-wringing. He avoided eye contact at all times and his persecutory delusions were manifest, such as an insistence on sitting in the furthest corner from the door, in a position to observe it at all times, seated in a protective and/or defensive posture. Finally, he exhibited a severe disorder of thought or communication in that his statements rarely showed a logic or connectivity with each other, to the casual ear. From his statements we pieced together that he held his father responsible for his mother’s terminal illness and death; that he considered death to be a personified, active, but not physically manifested force (which the team speculatively identified with classical personifications of Death such as the Greek Thanatos, with all its Freudian associations); and that he felt his father to be one of many active and vindictive agents operating in the world according to its instruction. He was irrationally convinced therefore, without evidence, that his father had introduced the influence of death into the family home and was therefore culpable in the loss of his mother. He is also convinced that agents of death are tracking his everyday movements continuously. He adheres to this belief with an unshakeable conviction ironically reminiscent of his father.
We believe that while Jonathan’s Schizophrenic symptoms have a strong basis in trauma, many of the predispositions to his current diagnosis and prognosis are intelligible as natural responses to a profoundly dysfunctional family situation and social praxis as opposed to pathological process.[…]”
“[…] Prior to this investigation, the Espesito family had been recognised as offering an unfavourable and potentially schizophrenogenic environment for their son Jonathan (18). However, our team was the first to suggest that Jonathan’s Schizophrenia was intelligible specifically in terms of the family situation. The prevailing view to date is that Jonathan’s acute symptoms are a matter of heredity, and that his first major Schizophrenic episode was triggered by the psychological trauma sustained from the death of his mother, Carla Espesito, when he was aged sixteen. He has spent nearly two years in hospital.
CLINICAL PERSPECTIVE
The team first encountered Jonathan and his parents in a diagnostic capacity, in the summer of 1962, shortly before Jonathan’s sixteenth birthday. At this juncture, Jonathan’s affect was impoverished or flattened; he experienced auditory hallucinations, severe anxiety and delusions of persecution, which preoccupied him intensely to the impairment of everyday social function. It was judged by the team that the appropriate action in Jonathan’s case – due in part to his age, to avoid subjecting him to the potentially traumatic experience of commitment to psychiatric hospital at such a vulnerable time, in the context of his mother’s illness - was to engage in a six-monthly period of care at home, to be regularly monitored in situ by our team of psychiatrists, culminating in a second evaluation at the end of that period to determine the best way to proceed with further treatment. This allowed the team both to gain a realistic sense of the extent of Jonathan’s condition and to evaluate its environmental influences.
INTERVIEWS
The first interview we undertook was with Giovanni and Carla Espesito, while Jonathan undertook psychiatric evaluation separately. Later in the course of the monitoring period we took pains to conduct further informal interviews with each parent separately at home. What we uncovered was an extremely complex web of mystification and delusion as endemic state of the family unit; a severely dysfunctional environment for all concerned.
(1) FATHER
Giovanni Espesito is a former mechanic of excellent professional reputation who manages two garages. He is a quintessential self-made man; fiercely proud, independent, self-reliant. He is also stubborn, self-absorbed, unforgiving and unsympathetic. As dominant member of the household, he dispenses the most overt mystifying behaviour. His relationship with his son is founded on intense projective idealisation (viewing his son as a manifestation of all the qualities he himself prizes), in which he is impervious to and actively invalidates any contradictory behavioural evidence from his son that is recognised by others; however, his own contradictory observations manifest as sudden outbursts of intense disappointment and all-encompassing negativity that shatter the illusion and create incredible friction within the family. Vacillating between these two extremes, he has little time for the reality of his son’s everyday behaviour and experience. His relationship with Jonathan’s mother Carla is similarly divided between largely fantastical extremes unrecognised as such. Throughout our interactions he displayed a stunted affect, quick to violent verbal and physical behaviour.
(2) MOTHER
Carla Espesito was a housewife. Tragically, Jonathan’s six-month evaluation coincided with her own diagnosis of inoperable lung cancer. A lifelong smoker, she had waited too late to have her symptoms examined, and once diagnosed continued to smoke heavily and disregard all medical advice. Initially we ascribed Mrs Espesito’s evident depression and learnt helplessness to her unfortunate condition; however we have come to speculate that these traits were in fact long-established components of her behaviour. Dominated psychologically by her husband, Mrs Espesito appeared to defend herself from her own emotions by mystifying her son with a stream of contrary judgments, invalidations, reinforcing his own state of learnt helplessness. While initially she exhibited a repeat pattern of seeking her son’s endorsement then invalidating it, or him, over time she became more apathetic, impoverished of affect, and treated excited behaviour of any sort in him on any scale as a fatalistic confirmation of psychological disturbance.
(3) JONATHAN
Our initial interview with Jonathan, during his psychiatric evaluations, allowed us to form the conclusions stated above. We feel that the interview we undertook at the end of his six monthly evaluation, shortly after his mother’s death, was most revealing. This was undertaken without his father present, at our insistence.
At this meeting, after some encouragement Jonathan introduced himself to us verbally, but as Jonathan “Stolti”, not Espesito. It transpired that this was a cruel Italian nickname given him by his father, meaning “stupid, foolish”, at times when his father’s displeasure was invoked. We had observed during Jonathan’s evaluations at home that his father set strict, yet conflicting standards of behaviour inside the home and out; within the home, Jonathan was expected to adhere absolutely to a traditional Italian code of family behaviour. Giovanni Espesito was enthralled by his fiercely matriarchal mother, who had died some years before, and kept the house exactly as it was the day she died. Any transgression or alteration of this status quo was punished severely by Mr Espesito, and both Jonathan and his mother Carla were intimidated and coerced into accepting it. Therefore, Giovanni enforced a psychologically brutal patriarchy while enshrining and bowdlerising the legacy of his own domineering mother; establishing an environment in which contradiction was an essential condition. Outside the home, it was a different story; Jonathan was so named by his parents to help him assimilate into English society and minimise his difference. His father in particular pushed aggressively for his son’s socialisation and integration into the local community, as a matter of family pride, not losing “face” and a facet of his unstable idealisation/expectation of his son. That Jonathan could be so encouraged to adhere to opposite extremes of social behaviour inside the home and out, and had two “given” names from his father that directly manifested this contradiction whilst simultaneously invalidating him, gives clear insight into the intricate web of mystification that he was caught in.
Following his mother’s death, which was clearly very traumatic for Jonathan in spite – or perhaps because of - her own mystifying, contradictory and dysfunctional behaviour towards him, his symptoms worsened considerably and our second interview took place in the early stages of a period of involuntary commitment to hospital prompted by our own intervention; his father consented legally while appearing both characteristically unsympathetic and wilfully oblivious to the severity of the situation.
During this interview Jonathan was extremely introverted, displayed inappropriate affect and physical signs of extreme anxiety such as tremors and repetitive hand-wringing. He avoided eye contact at all times and his persecutory delusions were manifest, such as an insistence on sitting in the furthest corner from the door, in a position to observe it at all times, seated in a protective and/or defensive posture. Finally, he exhibited a severe disorder of thought or communication in that his statements rarely showed a logic or connectivity with each other, to the casual ear. From his statements we pieced together that he held his father responsible for his mother’s terminal illness and death; that he considered death to be a personified, active, but not physically manifested force (which the team speculatively identified with classical personifications of Death such as the Greek Thanatos, with all its Freudian associations); and that he felt his father to be one of many active and vindictive agents operating in the world according to its instruction. He was irrationally convinced therefore, without evidence, that his father had introduced the influence of death into the family home and was therefore culpable in the loss of his mother. He is also convinced that agents of death are tracking his everyday movements continuously. He adheres to this belief with an unshakeable conviction ironically reminiscent of his father.
We believe that while Jonathan’s Schizophrenic symptoms have a strong basis in trauma, many of the predispositions to his current diagnosis and prognosis are intelligible as natural responses to a profoundly dysfunctional family situation and social praxis as opposed to pathological process.[…]”