Families

Starting a career in psychiatry is troubling.  Without life experience, the impact of mental suffering of this degree is nonplussing.  It demands something that one has not got.  My way out, I guess, was intellectual, and to make as quick a contribution as I could.  Hence several brief communications (as letters). But in 1967, I pursued my psychiatric formation by moving to a large mental hospital, Shenley Hospital.

1967 Birth order and schizophrenia
Nature 220:490
When I started in psychiatry, there was a lot of interest in birth order, and a number of psychiatric journals published papers with statistics detailed enough to be reused.  By aggregating various sets of data, I produced enough to test a new hypothesis; whereas all previous data had looked at 1st, 2nd, 3rd… in the family, it was possible to turn that around and look at last, last-but-one, last-but-two, etc.  A statistically significant result occurred – the last-but-one was over represented!

1968 Hallucinosis and propanolol
British Medical Journal (Letter)
I had a patient who was treated for cardiac arrhythmia with the new Beta-blocker (Propanolol) and became psychotic with visual hallucinations and suicidal.  On admission we stopped the propanolol with immediate relief of his MH symptoms. When restarted those symptoms recurred. As only a single case, it was not worth more than a letter. But such side-effects seemed important for the record.

1970 Evidence for a birth order factor in schizophrenia
British Journal of Psychiatry 117 293-301
My communication in Nature of which I still feel proud, was noticed by Elliott Slater of the MRC Genetics Unit at the time, and Editor of the British Journal of Psychiatry, who encouraged me to develop a more sophisticated statistical analysis and discussion for this 1970 paper.  This work set me on a path towards wondering about early experience of those who become schizophrenic.

1971 Family constellation and drop-outs from groups
British Journal of Psychiatry (Letter)
The hypothesis was that people from large families would tolerate group therapy with 4-8 other members than those form smaller families.

1973 Schizophrenia and family function
British Journal of Social Psychiatry
I was also reading psychoanalysis, and was now familiar with and using Bion’s notion of the three basic assumptions – dependency, fight/flight and pairing.  This paper postulated that families go through a cycle of assumptions (appropriate in this case), related to the stage of child rearing: starting with pairing necessary for conception, then dependency once the child come to be born, and then a flight/flight assumption during adolescence.