The "equal environments assumption" in MZ-DZ twin comparisons: an untenable premise of psychiatric genetics?

The comparison of MZ-DZ twins in behavioral genetics has produced what seems like irrefutable evidence for the heritability of many psychiatric disorders. But such research depends on the validity of the EEA--the "equal environments assumption"--as an underlying premise. In this paper, several empirical studies which support the EEA are critically reviewed in terms of methodology and the way data has been processed in a mathematical model called "path analysis". It turns out that studies investigating the EEA appear to be largely inadequate in terms of technique, as well as biased in the inferences drawn. Further, the "heritability" estimate--often taken to mean the influence of trait-specific genes--is merely a statistical abstraction derived from a matrix of correlations; this estimate encompasses many buried environmental effects so that "heritability" does not correspond to any underlying DNA structure. In conclusion, many MZ-DZ pedigree studies have dubious scientific value, given the non-viable premise of the EEA, as well as the misleading operational definition of what has been called "heritability".

Limit setting: theory, techniques, and risks

Limit setting is a necessary aspect of clinical treatment but the professional literature on this subject is relatively sparse and does not address many core issues, including some countertransferential and ethical problems raised by the approach. Many clinicians struggle with the "authoritarian" nature of limit setting, especially when they have great power over patients as in a hospital setting. This paper traces the theory of limit setting back to Freud's conception of "acting-out in the transference" and the corresponding need by clinicians to manage nihilistic behavior which threatens the treatment process, whether inpatient or outpatient. When done properly, setting limits makes working with acting-out patients viable, enabling them both to master devastating early experiences and to replace restraint by others with self-control. Techniques are addressed which lead to the responsible and effective use of power, but at the same time observing the social and practical limits inherent in the approach.

The geometry of the eternal triangle

Jealousy is often imputed to psychopathology in the protagonist. Psychodynamically, it can be attributed to an ego-deficiency, chronic insecurity, or a deflected libidinal drive. We propose that, when a primary love relationship is threatened, jealousy is best understood from a systems perspective. Three individuals create the experience of jealousy in one of them, which results in a pathogenic "eternal triangle" composed of: the jealous partner who seeks to woo and/or punish an errant mate; the architect of the triangle who takes a lover to supplement the marriage or supplant the mate; and a third person who intrudes across the boundaries of the couple. Therapists must be aware of the role of each agent in order to deal with the volatile, yet highly enduring configuration of the triangle.

The captive group: guidelines for group therapists in the inpatient setting

Group therapists working with psychiatric inpatients must deal with problems unique to that setting. First, group members are usually in the hospital and the group involuntarily. They need to be recruited to attend the meetings. Second, inpatients tend to use the group as a private forum for communication with the leader. They need to be inducted into the group-as-a-whole, going beyond an exclusive focus on the leader as a need-fulfilling object. Third, members have little idea of what they are supposed to do in the group, or may be too symptomatic to observe the social mores of the group. They need to be trained as group members. Techniques for turning a "captive group" into a therapy group are discussed.

A critique of the scientific status of biological psychiatry

Biological psychiatry has four principal modes of investigation but each has been flawed by errors in procedure and inference such that the bulk of existing findings must be called into question. Pedigree studies are ruined by selective adoption, the use of "throw-away kids" to demonstrate so-called genetic effects, lack of case history data, and lapses in "blind" diagnosis. In particular, the Danish adoption studies are challenged, despite the field's insistence that this research has settled the nature-nurture controversy in schizophrenia. Pharmacological-response studies are the next line of methodology and these are marred by a spurious assumption that drugs which work must be correcting a biochemical imbalance that causes the condition. Thirdly, neuropsychological-neurophysiological studies are "heuristic" fishing-expeditions to find a presumed abnormality to account for psychopathology, without doing the prospective longitudinal research necessary to validate such theory. Lastly, biochemical correlates of emotion are treated as if each emotion must have a distinct neuronal substrate rather than possibly representing a general visceral arousal where cognition defines the feeling. All told, biological psychiatry is often more reductionist than acknowledged, does not come up to current scientific standards, and uncritically cites work which is, or should be, discredited. At the heart of the problem is an implicit ideology within biological psychiatry, with insufficient awareness of its social ramifications: "blaming the victim's body" protects the status quo by holding protoplasm at fault for maladjustment rather than the person, family, or community.

Countersymbiotic suicide

In the course of studying the outcome of treatment for severely disturbed schizophrenics on a special ward, the authors encountered three instances of suicide with many features in common. All three cases involved young Hispanic male patients who demonstrated pathologically symbiotic relationships with their mothers. None had a history of overt suicide attempts prior to their actual death by jumping. These incidents occurred while the patients were en route to, or at, the maternal home on an unauthorized leave from the hospital. We present the case histories and offer a dynamic interpretation. In each case, it is likely that the underlying desire was to kill the mother. This either was not permissible or, alternatively, the patients' ego boundaries were not sufficiently clear to permit differentiation of self and mother. The patients saw any attempt, short of suicide, to loosen the symbiotic bond as being futile, hence, our terminology of the event as "countersymbiotic suicide."

Love: a psychometric approach

A new psychometric instrument, the Love Scale, was developed for measuring feelings and attitudes associated with being in love. A series of items was constructed to provide measures of five components assumed on the basis of philosophical speculation and previous research to be basic to the love experience: Respect, Congeniality, Altruism, Physical Attraction, and Attachment. Both the total and the subscale scores proved to be highly reliable. The significant differences between Love, Dating, and Friendship groups clearly indicated that the Love relationship can be distinguished empirically from that of Dating or Friendship. Most important to a Love relationship appeared to be Attachment and Physical Attraction.

Civil liberties versus involuntary hospitalization

The authors examine the issue of involuntary hospitalization for mental illness with particular reference to legal rights and civil liberties. Follow-up data of patients treated on a closed ward, as well as other available evidence, indicate that society is not ready for the abolition of involuntary hospitalization. The authors believe that the most fundamental right of the patient is that of adequate treatment, and therefore this should take precedence over an absolute right to liberty.