Social breakthrough

Keeping in mind that there can be multiple explanations for a single event, Chris’s progress following our Family Constellation sessions with Dr. Stern in July 2006 went like this:

In November 2006, Chris entered into weekly psychotherapy with Dr. Stern. That same month, Emily, the daughter of my university roommate, stayed with us for a weekend. She and Chris went skiing for a day. “How was Chris?” I asked her. “Quiet,” she said. “He was very polite and considerate, but only spoke to me if I spoke to him first.”

In February Emily came back for another visit and some further skiing. “How was Chris?” I asked her, hoping that I knew what she would say. “Oh, just great. He talked with me the whole time. I didn’t need to prompt him. What a big change from November!”

The magic had happened. Chris could now converse with people he didn’t know or didn’t know well. Sometime between November and January, seemingly from one day to the next, he began acting “normal,” despite the fact that he was still on low doses of two antipsychotics and had been on them for thirty-six months and in a day program for twenty-two of those thirty-six months. His day program had ended six months earlier. He left the day program still very much into his shell and not able to establish eye contact with people.

Using holistic therapies, he achieved social breakthrough after seventeen months of vitamin supplements, eight months after the assemblage point shift, six months after Family Constellation Therapy and after three months of seeing Dr. Stern once a week.

He began phoning up friends he hadn’t seen for years to suggest that they get together. He wanted to be around people. This was huge. For Ian and me, it was like a stone had been lifted from us.

From February 2007 on, Chris continued to improve. Dr. Stern and Chris’s holistic psychiatrist worked together over the next year to gradually eliminate his medications while continuing his weekly psychotherapy. His weight dropped as the medications were lowered. By March 2008, he was off all his medications. To illustrate the extreme caution that needs to be exercised when lowering medications, it took almost one whole year for Chris to come off 25 mg of clozapine. By June 2008 his weight was normal once again and he was able to exercise more.

Ian’s and my mistake following this breakthrough was to begin to build up our expectations of Chris. We became impatient for his moving on with his life.

The German psyche

What is it about German speaking psychiatrists? The pantheon of psychiatry’s superstars includes Freud, Jung, Fromm-Reichmann, to name but three. I also have found that those who have most influenced my perception of schizophrenia tend to be German speaking: Daniel Paul Schreber, Dietrich Klinghardt, Bert Hellinger, and Geerd Hamer. Of course, I am stereotyping, but I believe that German thinkers understand the complex underpinnings of self better than most of us.

I read an interview recently in the Financial Times with Simon Rattle, the principle conductor and artistic director of the Berlin Philharmonic Orchestra. Mr. Rattle is British, but has observed the German temperament closely in his tenure with the orchestra. The interview brims with his astute observations. “The (German) necessity of rules and strictness is a way of dealing with an enormously powerful impulse: Germans are among the most emotional people on the planet. Maybe it has to do with the fact that as a nation they are always drawn back to nature and the forest.” He believes that concept of German precision is a “self-imposed correction to the German psyche. Without it there would be complete chaos, because everyone is so emotional.”

Ergo, the German psyche is therefore well suited to understanding schizophrenia.

“Maestro Chef”, Interview with Sir Simon Rattle, Financial Times, June 20/June 21 2009

You wait for the magic to happen

When you finish a Family Constellation, according to Dr. Dietrich Klinghardt, you walk away from it, you do not analyze it, and you wait for the magic to happen.

The magic was still to come for Chris. That would happen several months later. In the meantime, I decided that our household needed to become more of an Asian household, in the sense of honoring our ancestors. Through my mother’s cousin, I located an old photograph of my maternal grandmother and grandfather, the first time I had seen them together, and put it in a silver frame in a place of honor, along with other old black and white photos of various ancestors.

Our family vacation that summer continued the theme of honoring our relatives. We visited a number of battlefields and war cemeteries in France. At Vimy, I learned where I could write for Ian’s grandfather’s war record, and followed up on that when we got home. At Arras, in northern France, I bought a pot of artificial flowers wrapped in cellophane. We drove on into Belgium where we stopped in Adegem to seek out the grave of my father’s cousin, who was killed at the age of 20 securing the supply route between Bruges and Antwerp after the D-Day landing. We left the flowers at the gravesite. Chris lingered at the grave, clearly moved by something.

We returned home tired and drained. The vacation was unfestive, but necessary in the larger scheme of things.

Take this burden

Two days later we were back for our second Family Constellation, save for Alex who had suddenly discovered commitments he could not possibly break. All the pleading in the world got us nowhere. Alex is tough like that. Dr. Stern understood and reflected that it is a good way to be, to be tough. In reviewing the outcomes of the previous session, Ian and I agreed that we felt closer to the reality of our ancestors’ lives. Chris seemed to politely agree.

This time, it was my turn and I placed the outlines of the shoes on the floor without thinking too much about where to place them. My parents, my sisters, and my mother’s mother, father, and brother became shoes on the floor. Dr. Stern took up her position as interpreter of personal dramas. She started out slowly, but horror gradually pervaded her body as she recounted, from the point of view of my grandfather, his wife’s premature death from scarlet fever transmitted by my mother, who was four years old at the time. Dr. Stern put her hands over her cheeks and shook her head in dismay while rocking slightly back and forth. The presence of my grandfather was also there in the room, in abject despair over the unfortunate turn of events in his life.

Ian and I cried harder into the tissues provided by Dr. Stern and wiped our eyes. We were caught up in the drama. Dr. Stern, also quite tearful, looked up at Chris from time to time to gauge his responses. Chris, once again, was keenly following the action without saying much. Taylor, slumped in his chair in the corner of the room, was out and out bored, verging on sullen.

As I looked at the patterns on the floor, my mind began to wander. I was acutely aware of the injustices my mother had experienced, beginning with her mother’s death. This particular family injustice began earlier than that, however. My great grandmother died when my grandmother was very young, just as my grandmother left my mother prematurely.

I never knew my maternal grandfather, having met him once when I was about three years old and once more when I was in my early teens. His fourth wife was slightly younger than my mother. They lived many miles away, but the lack of communication was not due to the driving distance between us. My mother, who was not given to saying unkind things about people, did not speak much about him. Her mother’s death left her estranged from my grandfather, who she felt blamed her for her mother’s death.

Dr. Stern paused to observe sadly that there was a pervading sense of death and chill in the room. Perhaps there was. The atmosphere was changed. Dr. Stern caught something in Chris’s reaction that she felt was important. At the end of the session, she said she thought she had it, and she turned to Chris and said that he should no longer have to carry this burden. He could begin to live. We left that day, totally exhausted but rejoicing in the family members who had gone before and we forgave them and them us. Harmony was created where before there had been disharmony caused by death.

Putting yourself in someone else’s shoes

Dr. Stern was a tall, elegant woman with upswept blond hair and precise, German-accented English. She appeared to be in her late forties. Because of our particular circumstances, she conducted the Family Constellation with only our family members present. Normally, other participants or “actors” stand in for your relatives and interact in a dramatic interpretation. Instead of “actors” standing in for the family members Dr. Stern improvised by drawing the outlines of shoes on papers to represent the individual family members (a left and right shoe per paper). Chris, Alex, Taylor, Ian and I sat in chairs in a corner of the large office, wondering what would happen next.

We began with Ian’s paternal grandfather’s story. Dr. Stern asked Ian to put the shoes of the grandfather, grandmother, Ian’s father, his father’s older brother who died before Ian’s father was born, and his father’s two sisters on the floor.She asked him to do it spontaneously and not to think too much where the shoes should be placed.

Dr. Stern then literally stood in the shoes of each of the individuals and spoke for them, letting her voice rise and fall, speaking angrily or softly, or clenching her hands if she felt so moved. She gave voice to each of them, based on her intuition from reading the paragraphs I had given her. She was Ian’s Scottish grandfather emigrating to a new land, only to be sent back to the old world to fight a trench war, then returning to a strange land as an invalid, a convalescent beginning a family life. His firstborn son, carried away by death. Ian and I wept openly for father and first born son, who we did not know in life but felt a bond to in the present. Taylor and Alex looked bored, occasionally exchanging suppressed smiles.

Every so often, Dr. Stern would glance sideways at Chris, to see how he followed the unfolding drama and to see what his reactions were. Chris was attentive and interested. After three long hours, we were all grateful to leave.

Preparing for the Family Constellation

For the Family Constellation I booked three three-hour appointments for the whole family, spanning a little over one week in July 2006, as Dr. Stern was leaving on vacation shortly after that. I had done all the groundwork by creating a family tree, starting with Chris, Alex, and Taylor and working back four generations on both sides of the family, up to and including Ian’s and my grandparents. I wrote a short paragraph for Dr. Stern on what I knew about the lives of each of our ancestors, focusing on the disappointments or tragedies of the individuals. Where I felt I did not have enough information, I asked other members of my family for help.

I had faith that Family Constellation Therapy was the missing link for which I had been searching. I truly felt that if magic was going to happen for Chris, then this therapy would make it happen. I took Dr. Klinghardt’s and others observations to heart, that schizophrenia was a manifestation of a magical belief system. This belief system may come in part from beliefs that have been passed from generation to generation within the family. This belief system could also be thought of as the family energy field. The traumas of the present generation merely reflect the beliefs of the previous generations. In the specific context of schizophrenia, it is thought that the person with schizophrenia is particularly susceptible to feeling an ancestral burden.

In Family Constellation Therapy it is helpful to know the broad picture of the members of the family tree going back four or five generations: who died young and/or tragically; who might have benefited at someone else’s expense; who stepped aside so that others could join the family (e.g. a previous husband or wife,) who went to prison; who was the black sheep, and so on. Include as family members all known miscarriages, stillbirths, abortions, and first wives or husbands. This is no time to be shy or to try to hide the truth. An experienced psychiatrist will sense if something in the constellation is hidden.

Ian’s and my family tree included paternal uncles who died early, one two days after birth in 1903 or 1908 and one who died at the age of three in 1924. I was struck by the fact that my father’s brother was buried in the family plot along with his parents who died years later, but he was unnamed and one of the dates on his grave appeared to be wrong. According to the gravestone, he was either five years old or two days old when he died. We knew it to be two days, so one of the numbers on the gravestone was wrong or else just eroded over time. In Family Constellation terms, not naming a baby and having the wrong death date on the gravestone denies the baby his rightful place in the family memory. On Ian’s side of the family, Ian’s father was given the same name as an older brother who died, as if the older brother was replaced by the younger one. What impact, I wondered, would that have on the family energy field?

My father’s father died when my father was eight years old. Ian’s paternal grandfather fought in World War I and came home with injuries, later developing an alcoholism that left a mark on the family. Ian’s maternal grandparents were divorced, which precipitated a flood of divorces in the generations that followed.

My maternal grandmother died in 1923 when my mother was four. She was my grandfather’s second wife, so I included the first wife (who ceded her position to my grandmother by dying) in the tree as well.

The past impinging on the present is an observation that is not new (ask any writer), but to me, who never gave it much thought in the context of my own family, it was breaking new territory. Looked at from the perspective of the dashed plans and hopes of previous generations, the feeling of sadness was overwhelming.

Family Constellation Therapy

In the final weeks of Chris’s attendance at the day program, I began in earnest to look for a psychiatrist who practiced Family Constellation Therapy. Given the special circumstances of our geographical location, it took a while to find that person. After a number of months, I found Dr. Maria Stern, a trilingual psychotherapist with a practice in our city.

Family Constellation Therapy and shamanic healing operate at level 4 of the healing pyramid. Dr. Dietrich Klinghardt speaks of level 4 as the intuitive level, the realm of dreams, trance, meditative states, out-of-body experiences, and the collective unconscious. Level 5, the peak of the healing pyramid, is the spiritual level, the realm of your personal relationship with a higher power, call it God, if you will. No shaman or doctor of priest can help you at level five. Healing at this level is up to you.

Family Constellation Therapy, also know as Systemic Family Therapy, was developed by German psychotherapist Bert Hellinger. It is based on the premise that all members of a family, living and dead, have the right to their place in the family tree. If someone is denied this right to belong through an untimely death, imprisonment, or perhaps being the family “black sheep” another family member will (usually unknowingly and often generations later) exclude him or herself as an act of atonement for the injustice.

Bert Hellinger writes that many of us unconsciously “take on” destructive familial patterns of guilt, pain, anxiety, depression, alcoholism, and even illness as a way of belonging or being loyal to our families. Bonded by a deep love, a child will often sacrifice his own best interests in a vain attempt to ease the suffering or solve the “unfinished business” of another family member. As Swiss psychiatrist Carl Jung famously observed, “Nothing has a stronger influence psychologically on their environment and especially on their children than the unlived life of the parent.”

According to Dr. Klinghardt, schizophrenia often has its roots at the fourth level of healing because schizophrenics are particularly sensitive to these familial exclusions or injustices and will act out the role of victim. Dr. Klinghardt maintains that if schizophrenia is not cured at the physical level (level 1), it is usually because the issues lie at level 4. According to the Family Constellation theory, the root of the issue is almost always found three or four generations removed from the present. The parents and current family environment aren’t directly responsible for the origins of the schizophrenia, but they are implicated because of the way the parent might unconsciously deal in the present with the aftermath of the family event from the past. I see this as yet another example of how an energy imbalance might be expressed within the family.

What is particularly compelling about Family Constellation Therapy is that it can put to rest so-called family curses or stop recurring patterns of illness or destructiveness from being passed from generation to generation.

The ties that bind

In search of a new doctor after Chris left the day program and while we continued to look for a psychotherapist, Ian and I approached our family doctor. We figured a general practitioner would be less inclined to make clinical judgments about Chris, would be more open to our desire to eliminate the medication, and would have less difficulty working with Chris’s holistic psychiatrist to get him off the medications.

We naively hoped that our family doctor wouldn’t be scared off by the diagnosis of schizophrenia. Our family doctor, without having seen Chris since he became ill, was clearly uncomfortable with taking him on in this new context. We explained that we were working closely with a holistic psychiatrist who was advising on the supplements and that we needed a local doctor to see Chris regularly to observe for himself that Chris wasn’t cracking up and to lower the prescription meds based on the psychiatrist’s recommendations. The united approach and a plan failed to convince our family doctor.

Locating a doctor shouldn’t be such a big deal (even Dr. Hoffer writes that a regular GP could handle this), but that’s the position in which people with a diagnosis of schizophrenia find themselves. Psychiatrists, not family doctors, write the prescriptions for the chemical straitjackets that bind the schizophrenic to the care of a psychiatrist. Most family doctors are reluctant to treat psychiatric patients because they have not received much training in mental illness.

One problem with getting off drugs is the drugs. The drugs are very powerful and lowering their dosage can have frightening and dangerous ramifications if not done properly. The only way to reduce the dosage is very slowly, with proper psychological, nutritional, and vitamin support. These days, information on how to get off psychiatric drugs can be found on the Internet, complete with virtual coaching. I consider clinical supervision essential for anyone planning to withdraw from drugs. Unfortunately, a lot of people are essentially clueless and/or reckless and will persist in dropping medication cold turkey, with predictable results. Psychiatric patients can be difficult customers.

The unreasonable, emotional parent

In June 2006, twenty-two months after starting, Chris’s time in the day program was up. He had squeezed an extra four months out of it due to his poor clinical presentation, but now it was definitely at an end. Dr. ‘L’ arranged for Chris to check in with the doctors for his medication monitoring while we looked for someone else.

At our second to last appointment with Dr. ‘L’, I left the meeting spitting nails I was so angry. It seemed to me during the meeting that Dr. ‘L’ was again trying to drive a wedge between Ian, Chris, and me, in order to gain the upper hand concerning our (Ian and me) wanting to eliminate the medication. Dr. ‘L’ knew that Ian was the more “reasonable” parent, meaning Ian was more inclined than I to urge caution about where we were headed. Chris, as usual, took a limited part in the conversation, so I felt I was left twisting out there on my own once again. “Fine,” I screamed at Chris, while simultaneously jumping up and down on our walk home, “do nothing, stay ill, I’ve had it! I will not sit down with Dr. ‘L’ one more time! You can count on that!”

After a few days, it dawned on me that if I didn’t attend the final meeting, Dr. ‘L’ perhaps had a good shot at convincing Ian of the foolhardiness of our position. Dr. ‘L’ could then raise the medication. There was no bloody way this was going to happen, so I attended the final meeting and took the high road. I even said somewhat tenderly, “I will almost miss you, Dr. ‘L’,” which was perfectly true as far as it went. He understood. It wasn’t his fault, I suppose, that he was stuck in a paradigm belief that psychosis could be effectively managed by medications.

Science getting in the way of cure

The day program that Chris attended for two years denied the existence of all causes of psychosis, except in the case of street drugs. Periodically, someone connected with the local hospital or with the social services network would speak to the bi-weekly meeting of family and patients about the evils of pot and other recreational drugs. This enraged one of the mothers, who, barely holding back tears, objected to the constant focus on pot, which her daughter had never used.

Over the course of time that I attended these meetings, I began to feel that the interest of the wider medical/social welfare community in patients in the program verged on voyeurism and/or profiteering. It seemed like every two weeks a new “guest” was introduced at the meeting who was a researcher, or someone involved in drug prevention programs, or a visiting doctor from another treatment program. We were just lab rats, to be studied for someone else’s scientific interest. Where was the individual in all of this, to say nothing of the cure?

In the focus on cure, as opposed to science, little progress has been made by many. More than a hundred years ago, Daniel Paul Schreber, addressed his psychiatrist: “There would then be no need to cast any shadow upon your person and only the mild reproach would perhaps remain that you, like so many doctors, could not completely resist the temptation of using a patient in your care as an object for scientific experiments apart from the real purpose of cure, when by chance matters of the highest scientific interest arose.”
Daniel Paul Schreber, “Memoirs of My Nervous Illness,” New York Review Books Classics (January 31, 2000)