The Pathological Family: Postwar America and the Rise of Family Therapy by Deborah Weinstein (review)

“The power of the family at midcentury,” writes Deborah Weinstein in The Pathological Family: Postwar America and the Rise of Family Therapy, “becomes particularly apparent when one examines the history of family therapy, which emerged as a new clinical field after World War II” (p. 2).

Family therapy today is a profession, blended with marriage counselors and the child guidance field within training programs, professional organizations, and much of their publishing. Yet Weinstein specifically describes “old school” family therapy’s origins with its quirky, visionary, and (disciplinarily) diverse founders, their game-changing and sometimes damaging metaphors, and their uneven epistemologies that continue today to rely on experts over sustained clinical research. Weinstein’s history lends itself well to the project of understanding the weird contradictions of postwar America. Like postwar America itself, family therapy was simultaneously conservative and liberating.

Chapter 1, “Personality Factories,” shows how families became emphasized as the “linchpin” (p. 26) between individual and society—and responsible for nothing less than well-being at the national level and psychosis or maladjustment at the individual level. The “broader sociocultural trends” (p. 27) surrounding family therapy included America’s love affair with individual psychology, plus concern with preventing a resurgence of fascism. This gave the moral imperative for healthy individuals to become ideal citizens. Family therapy delivered a paradigm shift (a phrase early family therapists loved invoking!): the family—not the individual—was the patient. “Family” was the source of pathology and its solution: cause and consequence in a framework that saw circularity as a resource.

The other sociocultural trend implicated in family therapy is revealed by creepy images in chapter 1 of mothers as lurking sources of harm. Taking us briskly from family therapy’s early, naturalistic descriptions of family (such as pioneer Nathan Ackerman’s evolutionary pastiche, “The father’s body is specialized for strength and potency. He is the protector of mother and young” [p. 29]) to early diagnostic interest in “schizophrenogenic mothers,” readers put it together: even as family therapy was breaking from psychoanalysis’s individual focus and moving toward context, it was trapped by its singular focus on family with its entrenched gaze of patriarchy.

The second chapter, “‘Systems Everywhere’: Schizophrenia, Cybernetics and the Double Bind,” shows how pioneers’ focus on schizophrenia offered cases for detecting patterns and guiding interventions. Weinstein skillfully sketches ideas and inspiration for the eclectic tools of family therapy. Early on, they observed paradoxes, chief among them “the double bind”—a case of an impossible command that amounts to “come here, go away.” This pattern seemed present often in families with a schizophrenic member. While theorists recognized double binds came from anyone, clinical eyes were ceaselessly on those double-binding moms.

In “Systems Everywhere,” Weinstein uses remarkable original material, including transcripts of research meetings. When anthropologists Gregory Bateson and John Weakland, psychiatrists Don Jackson and William Fry, and communication analyst Jay Haley began meeting in Palo Alto in 1952, they recorded themselves and archived diagrams. One passage shows what at first seems like a smallish argument about epistemology. Haley and Weakland find the others a little too in love with their hypotheses, and Jackson replies by contending that after all, physicists theorized long and hard before they ever actually saw an electron. It is wonderfully awkward. The passage concludes with Haley’s saying, “All I’m doing is saying let us keep in mind that this (the double bind) is unobservable and hypothetical and try to work from this toward the observable” (p. 67).

This debate over epistemology loomed large as I read chapter 4 about pioneering psychiatrist Murray Bowen’s hospitalizing entire families. Bowen had the imagination to say, let’s just look at the whole thing and the authority to say we need to study it. The hospitalizations...