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The Pathological Family: Postwar America and the Rise of Family Therapy

by Deborah Weinstein. New York, Cornell University Press, 2013, 280 pp., $26.95 (paper).

Reviewed by Alison M. Heru, M.D.
Am J Psychiatry 2013;170:932-933. doi:10.1176/appi.ajp.2013.13040505
View Author and Article Information

The author reports no financial relationships with commercial interests.

Denver, Colo.
Dr. Heru is Associate Professor of Psychiatry, University of Colorado, Denver.

Accepted April , 2013.

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Deborah Weinstein sets out to “examine the dense connections between therapeutic culture and family life,” noting that “the concurrent expansion of a therapeutic ethos and the growing fixation on the family in postwar America were deeply intertwined” (p. 3).

She defines the postwar period as extending from the conformist 1950s through the end of the activist 1960s. During this period, the idea that mental illness, or at least neurosis, could be cured by psychoanalysis was being challenged. The rise of the new psychotherapies (family therapy, group therapy, behavior therapy, and cognitive therapy) was based on the belief that the source of the people’s problems were, more than likely, based in the real world and not in the psyche of the individual. Individuals became to be seen as existing in a sociocultural context, and the family was seen as the crucible where personalities were formed.

Weinstein gives the early family therapist a starring role in the new drama of the unfolding of alternative therapeutic domains, stating that family therapy “played a vital role in shaping the relationship between therapeutic culture and the changing meanings of family life in twentieth-century America” (p. 13). She uses family therapy as a window into “the complex heterogeneity of the therapeutic orientation of the twentieth century” and “the complex dialectic between the therapeutic and political at the heart of the psychological orientation of postwar America (p. 176).

Many family psychiatrists will be thrilled to see the prominence given by Weinstein to the role of family therapy in shaping the therapeutic culture. However, the title, The Pathological Family, is a sinister foreshadowing of the book’s main thesis. Weinstein begins this book with television’s portrayal of the 1950’s family as the dominant American cultural family narrative and then co-opts family therapy into perpetrating the move of the “cause” of sanity and insanity from the individual psyche into the bosom of the family (the mother’s bosom mostly). This thesis seems forced and over drawn.

The author is correct when she states that therapy and the family in postwar America are deeply entwined. After two world wars, most countries experienced ruptures in their social structures, with returning service men and their families living in quiet distress. Many fathers, husbands, and sons did not return. Women and other minorities began pushing for rights and recognition, and conservative societies (mostly male-dominant cultures), began pushing back. The 1950’s television shows were nostalgic before they even ran a season. It was in this context that family therapy emerged as one of many therapeutic efforts to address emerging social issues.

Weinstein sees family therapy as more than a part of the American “romance with psychology,” characterizing early family therapists as visionaries providing us with a powerful vehicle for carrying social ideals forward. I disagree. I think the early family therapists were part of the psychiatric community’s struggle to find new ways to help patients when psychoanalysis failed to deliver the expected cure. The urgent need for new paradigms was driving inventiveness, not the other way around.

The book is a slim 180 pages, with 70 pages of additional notes and bibliography. There are five chapters. The first chapter, Personality Factories, traces the roots of family therapy back to the child guidance, mental hygiene, and marital counseling movements of the 1920s and 1930s. The family became identified, in the collective social mind, as the site for the development of healthy individuals, and by extrapolation, unhealthy families became the “cause” of unhealthy and mentally ill individuals. Family therapy then led us down a dark and disreputable road that demonized families trying to cope with a loved one who had serious mental illness. This tale unfolds, without cynicism, in chapter 2, “Systems Everywhere”: Schizophrenia, Cybernetics, and the Double Bind.

The third chapter, called The Culture Concept at Work, tries to link a nascent interest in culture with family therapy. The fourth chapter, Observational Practices and Natural Habitats, examines the practice of family therapists to admit families for weeks, sometimes months, to psychiatric units for observation. The last chapter, Visions of Family Life, describes how family therapists offered their theories as explanation of relationships in plays such as The Odd Couple and The Cocktail Party. All great fun, but in the end, the same game that the psychoanalysts played.

Surprisingly, Weinstein gives only a marginal mention in the epilogue to one of the earliest suppressed narratives in family therapy: the struggle not to see domestic violence as a systemic issue. This long and bitter fight brought many female family therapists to prominence, ending male dominance in the family therapy profession.

This book is full of fascinating facts and great dialogue from the archives of the early practice of family therapists. Even if we no longer accept many of their ideas as therapeutic or correct, psychiatry has forever been changed by their introduction of the systemic paradigm.




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