Fam Proc 25:325-336, 1986 Features of Families with Major Affective Disorders HELM STIERLIN, M.D., PH.D a GUNTHARD WEBER, M.D. b GUNTHER SCHMIDT, M.D. c FRITZ B. SIMON, M.D. c a Professor and Chief, Department of Psychoanalytic Basic Research and Family Therapy, University of Heidelberg, Mönchhofstrasse 15a, 6900 Heidelberg, West Germany. b Psychiatrist and Family Therapist, Institute for Systemic Therapy, Schlosshof 3, 6908 Wiesloch, West Germany. c Psychiatrist, Department of Psychoanalytic Basic Research and Family Therapy, University of Heidelberg, Mönchhofstrasse, 15a, 6900 Heidelberg, West Germany. This article reports the authors' observations on 22 families in which a young adult member has been diagnosed as manic-depressive, and on 11 families in which a member has been diagnosed as suffering from major schizoaffective disorder. All families could be described as extremely rigid and bound-up systems. Many of them were characterized by a "restrictive parental complementarity" and reciprocal delegation, and they shared certain cognitive features and assumptions. "Manic-depressive" families showed similarities as well as differences when compared with families in which there were schizophrenic and serious psychosomatic disorders. Over the last several years we have been interested in treating, studying, and comparing families with different types of serious disturbances such as schizophrenic psychoses and severe psychosomatic illnesses. Several years ago we also included in our studies families with manic-depressive members. We hoped to learn, by way of comparison, new things particularly about families with schizophrenic members ("schizo-present families") as well as so-called "psychosomatic families." Given this interest and motivation, we found that most of the current literature on manic-depressive psychosis, with its stress on genetic and neurophysiological factors, was of little help. One earlier research project did prove stimulating: the classic study by Cohen et al. (3) that was published almost 40 years ago. These psychotherapists reported their experience with 12 manic-depressive patients whom they had treated with psychoanalytically oriented psychotherapy at Chestnut Lodge over an extended period of time. Interestingly, these authors did not focus solely on their patients; they also were interested in the family backgrounds. They noticed, for example, that the manic-depressive patients considered their families to be "different," that is, defective and more liable to social decline than other families in the same social environment. Consequently, social prestige and conventional success values were unduly important for these families. Also, these authors noted a rigid splitting of parental roles: The mother was usually seen as the decisive, orderly, and prestigious parent, the father as a rather weak outsider and as despised (overtly or covertly) by the mother. We also benefitted from recent studies by Ablon et al. (1) and Davenport et al. (5, 6, 7). These authors examined dynamic features (including child-rearing practices) of several generations of families in which a manic-depressive disorder was diagnosed. They reported on families (in some cases multigenerational) with bipolar manic-depressive members who had been inpatients and outpatients at the National Institute of Mental Health. These families showed repetitive maladaptive patterns, including avoidance of affect, unrealistic standards of conformity, absence of intimate relationships apart from the family, displaced parental low self-esteem, and fear related to heritability of illness. Cytryn et al. (4) had found similar patterns in families with a manic-depressive parent, especially the dysfunctional child-rearing behavior that results in early emotional and behavioral disturbances in the offspring. Description of the Heidelberg Sample During the past 6 years, we have treated in Heidelberg a total of 33 families in which at least one young adult member showed a major affective disorder. In the following discussion, our perspective will allow us to formulate some hypotheses about similarities and differences with regard to other rigid family systems. To introduce this perspective we will describe a rather typical family from our sample whom we shall call the Anfelds. Table 1 Heidelberg Sample of Index Patients _____________________________________________________________________________________________________________ 1