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Dedicated to the Mothers in my life.
Come writers and criticsWho prophesize with your penAnd keep your eyes wideThe chance won‘t come again . . .For the times they are a-changin
–Bob Dylan. The Times, They Are A-Changin’ (1964)
New medications. Expert guidelines. DSMs. The recovery model. Peer support. If you could choose just one issue to convey the progress of psychiatry over the last 50 years, which would you pick?
Starting with Dylan’s song, written when my own career started, I would suggest something different-and that is how we view mothers in psychiatry. Given the role of mothers, the temptation to blame them for their children’s mental illness is natural to some.
Take the “Schizophrenogenic Mother.” If my memory is still reasonably accurate after all these years, this is how the etiology of schizophrenia tended to be explained, when I started residency in 1972. Along the lines of the “double bind” theory of Gregory Bateson, such mothers gave select children contradictory messages that could never be answered correctly. This confused the child who eventually wound up with psychotic thoughts, grew out of touch with external reality, and “became schizophrenic.” No surprise, then, that treatment that focused on preventing double binding or trying to help the patient avoid it was ineffective.
Actually, my exposure to the practice of blaming mothers for psychiatric illnesses occurred quite early. Part of my internship was in child psychiatry. I was taught about the “Refrigerator Mother”-the one who was so cold emotionally that a child could “end up autistic.” Treatment? Figure out how to make the mother emotionally warmer, which didn’t seem to work either.
Earlier, in medical school at Yale, I considered a research project on mothers from a different perspective. If mothers were depressed or anxious during pregnancy, would that adversely affect the emotional health of her child, I wondered? Unfortunately, technology wasn’t ready for that kind of study.
The times are changing-for the better. Today, I never hear the terms “schizophrenogenic mother” or “refrigerator mother.”
Back then, psychiatry was a more fertile field for women and mothers than other medical specialties. Even so, few women had leadership roles such as residency training directors (a role that would be particularly conducive to mothering skills).
To add insult to this injurious perspective, male psychiatrists more often than not planned our annual American Psychiatric Association meetings over Mother’s Day weekend. That didn’t stop the male psychiatrists who were married to mothers of their children from attending.
The times are changing-for the better. Today, I never hear the terms “schizophrenogenic mother” or “refrigerator mother.” There is a different research focus on mothers (and fathers). It includes the risks of psychiatric medications during pregnancy, balanced against the risks to the fetus from the mother’s depression or anxiety. It also focuses on the complex genetics that may be passed on as a vulnerability to mental illness.
Treatment is often medication and/or psychotherapy that follows the patient’s wishes under the recovery model. Yes, mothers can still be involved in treatment, but in a more effective way. For instance, it is important for the mother and father of a child who has schizophrenia to avoid expressing negative emotion to the child. There seems to be more empathy in understanding how difficult it is to live with a child who has schizophrenia. NAMI emerged as a support system for mothers and fathers to advocate better treatment for their children with severe mental illness.
The numbers and influence of women psychiatrists, including psychiatrists who are mothers, has increased. I’m not saying this development is inevitably positive or that female psychiatrists don’t at times model after men who should not necessarily be role models. The current APA President and President-Elect are women. The editors of Psychiatric Times are women.
Our annual APA meeting in Atlanta is upon us-after Mother’s Day. The policy to hold the meeting after Mother’s Day was established some years back after increasing protests. Hopefully, that provided us the chance to express our appreciation for mothers, including those in my family who inspired this blog.
The times have indeed changed, and we in psychiatry and our patients are better for it. Wouldn’t you agree?