PATHOGENIC RELATIONSHIPS IN SCHIZOPHRENIA

The authors interviewed 185 individuals at 11 army posts to gather data on performance level of 13 soldiers who developed overtly schizophrenic psychoses after at least one year of service in the army. The level of work performance and the development of overt psychotic symptoms depended on the type of relationship established with significant other persons. Three types of relationships were distinguished: quasitherapeutic, pseudotherapeutic, and contratherapeutic.

The quasitherapeutic relationship is one in which the significant other conveyed to the patient a feeling of acceptance as a person and an expectation of behavior in accordance with group norms, i. e., he both provided support and set limits. In the pseudotherapeutic relationship the significant other, who seemed to obtain some gratification from having the patient dependent upon him, provided solely support. Rigid expectations of work performance without any emotional support was characteristic of the significant other in the contratherapeutic relationship.

Information from those who knew him indicated that the patient did adequate, sometimes even outstanding work in the quasitherapeutic relationship. This relationship was disrupted when either the patient or the significant other was transferred to another post. In the pseudotherapeutic relationship the patient continually made greater demands for support and his work preformance progressively deteriorated. In the contratherapeutic relationship the patient rapidly developed overtly psychotic symptoms. Both the pseudotherapeutic and contratherapeutic relationships led to hospitalization.

It has been pointed out by a number of authors (Nathan Ackerman, Gregory Bateson, Don Jackson, Adelaide Johnson, Erich Lindemann, and Stanley Szurek) that deviant behavior of an individual may represent psychopathology of the family group. The data gathered in this study indicate that groups other than the family can be pathogenic. Psychiatric attention to the family of a patient has both contributed to understanding of the development of psychopathology and led to new therapeutic methods. Extending this interest to the patient's relationships in his work and social groups may produce similar results.