Unraveling the Double Bind of Biopsychiatry

Toward a Creative Revisioning of the Mental Health Paradigm

“Bateson’s theory of the double bind came from a theoretical attempt to imagine the kind of interpersonal communication context in which psychotic ideas and symptoms would seem adaptive.” - Dr. Mary Olson

Systemic Family Therapy emerged in the mid-20th century as a groundbreaking way to understand and treat mental health issues by looking beyond the individual and focusing on the complex web of relationships within a family. Gregory Bateson’s concept of the Double Bind—where a person receives conflicting messages that create a no-win situation—offers a lens to see how these seemingly contradictory pressures can spiral into deep psychological distress. But what’s crucial to understand is that these binds aren’t just about a parent telling you one thing and doing another—they’re about being trapped in a whole system that pushes and pulls you in different directions, leaving you no safe way out.

In my own life, the double binds I experienced weren’t just about conflicting messages—they were about being caught between two vastly different worldviews. My mother, shaped by the second wave of feminism, was fiercely independent and driven, but that drive meant she didn’t want to be the stay-at-home mom society expected her to be. On the other side, my father was rooted in a 1950s mentality, where a man’s word was law, and any deviation from the norm was met with anger. When my parents’ marriage fell apart when I was three, I was left to navigate the wreckage of their unresolved conflicts. My mother’s lingering resentment towards my father was something I absorbed deeply, feeling as though there was something fundamentally wrong with me, as if I was the battleground for their unresolved war. I also internalized my father’s rage and used it to drive myself forward, often feeling I had to prove my worth by rebelling against both of their expectations. But it wasn’t just a family issue; my internal binds were a reflection of the broader societal tension between changing gender roles and traditional expectations, leaving me caught in the middle of a cultural shift that shaped my sense of identity.

The psychotic breakdown I experienced as a teenager was so clearly an attempt to heal from and incorporate this mess of conflicting messages. Bateson’s theory of the double bind came from a theoretical attempt to imagine the kind of interpersonal communication context in which psychotic ideas and symptoms would seem adaptive. My mind, caught in the crossfire of these conflicting worldviews and unspoken expectations, tried to make sense of the chaos by breaking down, in the hopes of breaking through into something new and more evolved. It was as if my psyche was screaming for a way out, a way to reconcile the irreconcilable. I believe it’s this way for every young person who struggles with what gets called psychosis: on a very deep level its an attempt to heal. I’m not saying hereditary vulnerability isn’t a factor, I’m saying that the genetics are less important than what’s happening in someone’s day to day reality. In other words, saying psychosis is primarily about “biological brain disease” is an enormous cop-out that lets a lot of people off the hook from thinking about their own behavior and reflecting on the larger systems that affect our lives.

IFS as a Synthesis of Systemic Strategies

Internal Family Systems (IFS), the main model I use in my own practice, builds on the insights of systemic family therapy, taking the idea of a complex, interconnected system and applying it to our internal world. In IFS, we’re not just dealing with a singular self, but with a whole family of internal parts—each part shaped by different experiences, traumas, and relationships. The brilliance of IFS is that it doesn’t just help us understand these parts; it helps us heal them. It recognizes that these parts, no matter how extreme or destructive they may seem, are actually trying to protect us in some way, often in response to those very same double binds Bateson described.

For me, the internal conflict wasn’t just between different emotions—it was between the internalized anger and unresolved tension that had nowhere to go. My mother’s anger at my father became my anger at myself, a part of me that believed I was somehow responsible for their unhappiness. My psychotic episodes were like eruptions of all these buried parts, each one screaming for attention, for resolution. Working with the IFS model helped me see that these parts weren’t my enemy—they were desperate attempts to protect me from a world that felt impossible to navigate. By working with these parts, I began to unravel the internal double binds that had been mistaken for a biological defect.

One of the key things I’ve come to realize through this work is that the roots of mental health diagnoses like psychosis are often deeply intertwined with systemic dysfunction, both within the family and the broader society. The conflicts and double binds that arise in these systems can manifest as severe mental health issues, but they’re not signs of inherent defectiveness. They’re cries for help, signals that something in the system is broken. By understanding and addressing these double binds, both internally and externally, we can find a path toward healing that is more compassionate, more effective, and ultimately more human.

Conclusion: The Biopsychiatric Model as a Double Bind

The dominant biopsychiatric model of mental health, which views conditions like psychosis, bipolar disorder, and schizophrenia primarily as brain diseases, often traps individuals in its own kind of double bind. On one hand, it offers a medical explanation for distress, which can provide some relief and validation. But on the other hand, it reduces complex human experiences to mere chemical imbalances, often ignoring the deeper systemic and relational roots of mental suffering. This model leaves individuals feeling powerless—caught between the need for treatment and the realization that the treatment itself may be perpetuating their suffering by not addressing the true sources of their distress.

Just as I was caught in the double binds created by my family’s unresolved conflicts, many people find themselves ensnared in the double binds of the mental health system, where the very solutions offered can sometimes deepen the problem. The system tells us that our distress is solely the result of a faulty brain, while ignoring the profound impact of trauma, systemic dysfunction, and societal pressures. This creates a scenario where true healing is often out of reach, because the root causes are never fully addressed.

Call to Action: Toward a Revisioning of the Mental Health Paradigm

I invite mental health professionals, policymakers, and individuals alike to rethink the way we approach mental health. If we are going to actually reach young people who end up in our care, we need to move away from a one-size-fits-all model that reduces our struggles to mere biology. Instead we need to embrace a more holistic, compassionate approach that considers the full context of our lives and takes seriously the lived experience of people who get diagnosed with things like psychosis and bipolar disorder. We’ve been living for too long in a mental health paradigm that ignores the context of people’s suffering by reducing it to “brain disease.”

I would love to see Systemic Family Therapy reintroduced into the world of First Episode Psychosis, and I believe the way to do this is by training clinicians in the Internal Family Systems model. I have this imagine of us needing a time machine to go back and retrieve all the therapeutic wisdom that got buried and left behind in the 1980s with the rise of Biopsychiatry and Managed Care. In many ways, IFS feels like that well crafted time machine—carrying an incredible wealth of wisdom from the past that has the potential to reshape the future of mental health care and change the whole paradigm of how we think about people who get diagnosed with “serious mental illness.” .

By addressing the systemic double binds that have crippled both the way we practice mental health care and the organizations that provide the care, we can create a mental health system that truly supports healing—on individual, family and systemic levels. There are many pieces of the solution, and I believe the legacy of Systemic Family Therapy and modern IFS practice hold some important answers.

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