Michael E. Kerr, MD and Murray Bowen, MD: Family Evaluation

Michael E. Kerr, MD and Murray Bowen, MD, Family Evaluation, W.W. Norton & Company, New York, London, 1988

While many clinicians have long recognized the importance of assessing variables from many levels of observation, it has been difficult to do this in the absence of an integrative theory. An integrative theory would provide a systematic way of collecting, organizing and integrating information from all levels of observation. In the absence of such a theory, there is a strong tendency in all clinicians to compartmentalize knowledge and to focus treatment on a particular compartment. Clinicians become knowledgeable about and develop therapeutic expertise in specific areas, but frequently attach too little importance to areas outside their knowledge and expertise. / While a satisfactory integrative theory does not yet exist, an important step toward the eventual development of such a theory occurred within psychiatry during the 1950s and early 1960s. This step was the development of family systems theory by Dr. Murray Bowen. (Introduction, viii)

Family systems theory radically departed from previous theories of human emotional functioning by virtue of its conceptualization of the family as an emotional unit. (viii)

Psychoanalytic theory did have [viii] the concept of object relations, which was sometimes invoked to account for what transpired in relationships; however, this was not really a relationship concept. It was rooted in the psychology of the individual. (viii-ix)

Family systems…The psychology of the individual was not ignored, but was simply placed in a larger context. The traditional concepts were seen to describe rather than to account for human functioning. (ix)
Medicine has reached a high level of sophistication in terms of its ability to describe and categorize a myriad of clinical entities. An enormous number of the mechanisms that are involved in these disease processes are now also well understood. What is not explained, however, is the wide range of clinical outcomes that are possible with almost every diagnosis. There are patients, for example, who suffer a serious attack of multiple sclerosis when they are in their early twenties, but who do not have another symptom the rest of their lives. Other multiple sclerosis patients may be seriously disabled within five years after the initial symptoms. … Notions like “lowered resistance” and “stress” are sometimes invoked to explain clinical variation, but such notions are too poorly defined to be of much value. (ix)

Many previous attempts have been made to use systems thinking to understand the activity of living systems better, but most of them have provoked skepticism in the scientific world. The problem with these attempts is that most have been based on drawing analogies between the organization of living things and systems models drawn from the physical sciences. Analogies are not a sound basis on which to build a theory. (x)
There have also been a number of pioneering efforts to use general systems theory to integrate… It does not appear that a comprehensive natural systems theory will be developed based on this kind of imposition. It seems more likely that separate systems theories will be developed from the direct study of specific natural systems, and that it will then be possible to integrate these separate theories into a more comprehensive one. [bottom up, not top down] (x)

Family systems theory is important because it was derived from the direct study of one type of natural system, the human family. It was not built on analogies, nor was it derived from general systems theory. Bowen attempted to make the theory’s concepts consistent with knowledge from [x] the rest of the life sciences, believing that someday it would be shown that what had been defined in the family and what would gradually be defined in the rest of the natural world would be consistent. Bowen may be the first person to have established that it is indeed possible to develop a systems theory about a living system. The fact that he has done this suggests that systems theories can also be developed about a variety of living systems, such as the cell, the genetic apparatus, and the ant colony. When these theories are developed, it will then likely be possible to integrate them into a comprehensive natural systems theory. (x-xi)

…theory enables a therapist to distinguish between content and process in evaluating a clinical family. Content refers to all the various pieces of information; process refers to the way these pieces of information are related. In a family, these pieces of information are related by virtue of the family emotional process. (xi)

Family assessment is not done at the beginning of therapy and assumed to be complete. Assessments are not written in stone, but are continually modified as new information comes to light. There is an enormous amount of important information, however, that should be gathered in the evaluation process. This information has an important bearing on the direction or emphasis of therapy. Decisions about seeing a husband and wife together or separately, about focusing on the family of origin or the marital relation-[xi]ship, about focusing on the work system more than the family system, and numerous others are all based on the information collected in the evaluation process. (xi-xii)

Family systems theory is based on the assumptions that the human is a product of evolution and that human behavior is significantly regulated by the same natural processes that regulate the behavior of all other living things. (Chapter One, 3)

…systems theory assumes that homo sapiens is far more like other life forms than different from them. (3)

The principles of psychoanalytic therapy discouraged contact between therapist and family members in order to prevent contamination of the therapist-patient transference relationship. But Bowen became intrigued with the family relationships of his patients and began to study them. Since many of the schizophrenic patients were being treated as inpatients, they were readily available for research study. (4)

During the late 1940s and early 1950s, a number of other investigators had also observed this intense relationship between a schizophrenic person and his mother and had described it as “symbiotic” in nature. Most of these investigators attempted to explain the existence of the symbiosis on the basis of psychoanalytic theory, that is, on the basis of the unconscious conflicts and motivations of mother and patient. Bowen, however, having been significantly influenced by years of extensive reading in the natural sciences, attempted to explain the presence of the symbiosis in a different way. (5)

A mother’s intimate involvement with a child during the child’s early years was a general characteristic of mammals and, in most instances, the young mammal gradually grew away from the mother to become an independent adult. In human schizophrenia, however, the mother-child involvement was much more intense than average and was prolonged well into adult life. [Although Bowen’s thinking was not well developed on this point during the Menninger period, he eventually accounted for the intensity of the symbiotic attachment in one generation on the basis of a gradual buildup of that intensity over many generations. The mother of a schizophrenic patient, in other words, had a symbiotic relationship with her own mother only slightly less intense than the one with her child. The mother’s mother had a symbiotic attachment to her mother only slightly less intense than with her child, etc. The more intense the symbiotic relationship, the more each person’s functioning was governed by the emotional aspects of the relationship. When, over the course of generations, the process reached a schizophrenic level of intensity, it prohibited the mother and child from achieving any real emotional autonomy from one another.] / The implication of Bowen’s thinking about symbiosis was that the human was significantly governed by the same natural forces that influence other forms of life. Theoretical explanations of human behavior would have to be rooted in concepts that were consistent with what could be observed about the behavior of all species. This type of consistency had not been achieved with psychoanalytic theory… (5)

In 1954, Bowen left the Menninger Clinic and moved his professional activities to the National Institute of Mental Health. At the N.I.M.H., he initiated a project of hospitalizing entire families that contained a schizophrenic member. (6)

The project at N.I.M.H. ran for five years and involved having entire nuclear families that had a schizophrenic member living on an inpatient research unit for periods ranging from a few months to more than a year. (6)
There were two particularly important new observations… Mother and adult schizophrenic “child” were so involved with another, so influ-[6]enced by one another, that it was difficult to think of them as two separate people. … [and] The father and patient’s siblings all played a part in fostering and perpetuating a problem that was initially thought to exist just between the mother and the patient. Not only was it difficult, therefore, to think of mother and patient as separate people, but it was equally difficult to think of the family as consisting of separate individuals. The emotional functioning of individual members was so interdependent that the family could be more accurately conceptualized as an emotional unit. (6-7)

It was as if one person gained or “borrowed” strength in relationship to the other person having lost or given up strength. The functioning of one person, therefore, could not be adequately understood out of the context of the functioning of the people closely involved with him. / A frequent way in which this reciprocal process was played out was that one family member would become anxious or worried about what he or she perceived as a problem or potential problem in another family member. As this “anxious one” became preoccupied (in fantasies, verbalizations, etc.) with the appearance and behavior of the person perceived to have a problem, the “problem one” would typically exaggerate the very demeanor, attitude, or appearance that the “anxious one” was worried about. This exaggeration of “the problem” would increase, of course, the anxiety of the “anxious one”. An escalating cycle of anxiety and problem behavior would then ensue and result in the “anxious one” getting into more of a caretaking position than he or she wanted and the “problem one” getting into more of a patient or child position than he or she wanted. (7)
Through this reciprocal interacting, the functioning of the family could then create as many problems for the patient or “problem one” as the functioning of the patient could create for the family. Family members, however, usually viewed their anxiety as being “caused” by the patient’s attitudes and behavior and rarely viewed the patient’s behavior as a reflection of their own anxiety-determined functioning. The patient, in turn, tended to perceive himself as an inadequate or defective person and as indeed the “cause” of the family problems. (8)
In the process of this focusing, each person would be driven to become a certain way in relationship to the other person that was different from the way he or she was with people outside the family. / This reciprocal functioning could be so precise that whenever a significant personality characteristic was found in one family member, it was predictable that its mirror opposite characteristic would be found in another family member. [By virtue of studying families with schizophrenia, Bowen was seeing an extreme version of the reciprocal relationship processes. The fact that they were extreme is what made them so readily visible. Bowen later developed the concept of differentiation of self, which accounted for the fact that the processes being described, while present in all families, did not operate with equal intensity and predictability in all families.] (8)
Another phenomenon in the families that supported the concept of the family as a unit was the existence of cycles of distance and closeness. People would move together, move apart, move together, move apart like an accordion. It did not appear that any one family member “caused” these [8] cycles, although characteristically someone got blamed for them. Rather than being created by one person, these cycles were perpetuated by the functioning of each family member. The cycles were orchestrated with such precision and predictability within various family relationships that any explanation for them based on the psychological makeup of individual family members seemed awkward and inadequate. The phenomenon invited an explanation based on seeing the family as an entity in its own right, as a unit with specific relationship processes that were present in every family. (8-9)

If the family is an emotional unit, however, then people often function in ways that are a reflection of what is occurring around them. They have precious little autonomy from their environment. The thoughts, feelings, and behavior of each family member, in other words, both contribute to and reflect what is occurring in the family as a whole. (9)
People have a strong tendency to regard their own thoughts and feelings and what they think are other people’s thoughts and feeling as occurring independently of what is transpiring between them. (9)

One has gained or regained an “outside” perspective when he is able to focus simultaneously on the influence of each family member’s thinking, feelings, and behavior on the family “atmosphere” and the influence of the “atmosphere” on each individual’s thinking, feelings, and behavior. If one emphasizes one side of this equation over another, then a systems perspective is lost. Emphasizing one side is like forgetting that mass depends on gravity as much as gravity depends on mass. (9)

A problem with the ideas of theorists, however, is that they do not include a description of how the parts affects one another to create this “whole”. Without at least some idea about the “how”, it is quite easy to drift away from the realm of science and into the realm of holistic philosophy. (10)

Bowen’s assumption was that family relationship processes had been created from an evolutionary mold and their importance to the relationship between living things was probably well-established long before the emergence of homo sapiens. (10)

The relationship system was a description of what happened, and the emotional system was an explanation for what happened. Saying that people function in reciprocal relationship to one another is a description of a phenomenon, not an explanation. … Saying that the human relationship process is rooted in instincts, has much in common with what occurs in other forms of life, and has a function in evolutionary terms is a step toward accounting for what occurs. (11)

…an emotional process that, as it became increasingly intense, result in people’s being highly dependent on and reactive to one another. As the intensity increased, the reciprocities in functioning became more exaggerated and impairments in functioning more pronounced. At one extreme, people were so intertwined that it was almost impossible to avoid a seesaw effect: One person’s functioning went down in relationship to the other’s going up and vice versa. Near the other end of the continuum, the seesaw effect was still present, but much less pronounced. People had more autonomy in their emotional functioning. (12)
Another way of understanding how families differ quantitatively but not qualitatively is through recognizing that “there is a little schizophrenia in all of us,” an observation frequently made by Bowen. (12)
In addition to there being schizophrenia in all of us, we all function in ways that contribute to the development of schizophrenia in others. Schizophrenia is not a foreign process in the sense of being inflicted on us by a defective gene or an intruding virus. We create the schizophrenia we see around us. We create it by virtue of he way we function everyday. We continually make decisions and do tings that tend to impair as well as promote the functioning of others. All of us participate in groups that function in ways that make it more difficult for certain group members to function. This process is most obvious in the family, but it can occur in any group. When the process reaches a certain quantitative level of emotional intensity (sufficient autonomy has been lost), the stage is set for the emer-[12]gence of clinical schizophrenia or some other serious problem. [Whether a serious clinical problem emerges depends on more variables than those of the family relationship system. If a person with very little emotional autonomy, for example, has ideal life circumstances, he may never demonstrate any overt symptoms normally associated with clinical schizophrenia. He may, for example, have a support system that is quite available to him, but does not pressure him. While that may result in his being in a childlike position for his whole life, the low stress level would make the more obvious clinical signs and symptoms of schizophrenia less likely to appear. If another person with little autonomy develops a serious alcohol or eating problem, the presence of these problems may “protect” him from developing other types of clinical syndromes.] Thought of in this way, schizophrenia is not the product of a biological “defect” or of something that has “suddenly” gone wrong. It is, rather, an outcome. It is the outcome of a biologically rooted process that has many participants and that has gradually taken shape over a long period of time. A family does not change from very good functioning to very poor functioning in one generation. (12-13)
There are some important theories in biology, such as Darwin’s theory of natural selection, but the complexity of life processes has made theory development exceedingly difficult. Many biological systems have been described, but no systems theories of a sophistication equivalent to those in the physical sciences have been developed. (17)

Although the subjective “screen” we place between us and the world around us is always to be reckoned with, no matter what we are observing, the “screen” appears to get “thicker” as we get closer to observing ourselves. The closer we get to ourselves, the greater to see what we want to see or, at least, to see what we have always seen. (18)
The atmosphere of the late nineteenth century, when Freud emerged… Mental illness was generally considered to be the product of a structural defect in the patient’s brain. … He proposed that disturbances in brain function rather than brain structure were the basis of most neurotic and psychotic symptoms. … There are two important ways in which Freud’s theory differs from family systems theory. The first is that because the concepts of psychoanalytic theory were developed from the study of individual concept of object relations does describe relationships, the basic frame of reference remains the individual. [19] … Recognition of the need for relationship concepts stemmed from research that had established that the emotional functioning of family members was remarkably interrelated (reciprocity in functioning) . Once this lack of autonomy in emotional functioning was recognized, theory development then required a way of thinking that could transcend the individual as a frame of reference. (19-20)

A second difference between psychoanalytic theory and family systems theory is that many psychoanalytic concepts appear to have been developed from ways of thinking that emphasize man’s uniqueness as a form of life. Family systems concepts, in contrast, were developed on the assumption that much of the human’s competent as well as dysfunctional behavior is a product of that part of man he has in common with the lower animals. The emphasis of psychoanalytic thinking on man’s uniqueness is suggested in this summary of basic psychoanalytic ideas (not necessarily a completely accurate representation of Freud’s thinking) by Alexander and Selesnick: / The essence of mental disturbance is precisely man’s inability to face himself, to recognize the feelings and motivations that his conscious self repudiates… The unacceptable emotions and impulses that man excludes form his consciousness do not cease to exist, and do influence behavior. In the mentally sick they cause irrational neurotic and psychotic symptoms and in normal persons form the images of dreams. For modern man to admit that under his civilized surface, and for all his moral and religious beliefs, he still harbors the same untamed and undomesticated sexual and hostile impulses that his savage ancestors had, required a great deal of sincerity and moral courage. [Franz G. Alexander and Sheldon T. Selesnick, The History of Psychiatry, New York, Harper & Row, 1966, p. 12.] … While there is validity to this way of thinking in explaining certain aspects of emotional symptoms (psychological mechanisms that may be unique to human beings determine whether a problem is acted out or internalized), it emphasizes the role of more recently developed (in the evolutionary sense) psychological mechanisms in explaining mental illness. If the essence of mental disturbance in man is the “inability to face himself”, what is the essence of mental disturbance in the chimpanzee, the gorilla, the whale? [The obvious assumption being made here is that “mental disturbance” occurs in nonhuman animals. The work of numerous students of animal behavior points to the fact that the equivalent of human “mental illness” occurs in many animals, although we still obviously have much to learn about this. Our preoccupation with the psychic or cognitive manifestations of “mental illness” had probably blinded us to the common denominators between the human and nonhuman emotional dysfunctions.] (19-20)

Wilson also describes behavior in the African wild dog and the chimpanzee of a very similar nature to that described in elephants. By any standards, such behavior would be considered highly “virtuous”. To move toward a natural systems understanding of human behavior, it is necessary to move away from this “animals are brutish” and “humans are virtuous” dichotomy. … Much of man’s virtuous behavior, as well as his dysfunctional behavior, is rooted in his evolutionary heritage. … So often when human resort to violent and brutal behavior, we say that they are acting “like a bunch of animals.” They have abandoned rationality [22] and given into “animal urges.” Perhaps it would be more accurate to say that the periodic emergence of man’s brutal self reflects the shift from a calm and orderly human being to an anxious and disorderly one. The same thing happens in a troop of chimpanzees. They can shift from a calm and orderly state to an anxious state characterized by harshness, seeming indifference, and severe brutality. Many animals main and murder their own kind under certain conditions. When chimpanzees and other nonhuman animals act this way, we rarely say that “they’ve lost all reason”. (22-23)
Since Bowen assumed that the origin of human mental illness was far more a product of what man had in common with all forms of life rather than what made man unique, he discarded the term mental illness and substituted emotional illness. Mental means “of the mind” and Bowen wanted a term that would convey the deeper phylogenetic roots of “mental illness”. He did not think it necessary to invoke a conflict between man’s civilized self and his untamed urges to explain psychosis and neurosis. … Man’s complicated psychology may have added a few unique twists and turns to emotional problems, but the origin of the problems is far more basic than conveyed by the notion of psychological conflict. (23)
Bowen’s theory of family systems was not based on concepts in general system theory. General systems ideas grew out of the assumption that similar mathematical expressions and models were applicable in biology, the behavioral and social sciences, as well as in the physical sciences (von Bertalanffy, 1968). The development of these models was strongly influenced by manmade systems such as the simple domestic thermostat, steam and electric machines, rocketry, and computers. (24)
The human family system sprung from the evolutionary process and not from the human brain. We did not create it. We did not design human relationships anymore than the elephant or gibbon designed their family relationships. Family systems theory assumes that the principles that govern such things are there in nature for us to discover. (24)

The human, by virtue of possessing an emotional system akin to what exists in all life, has major portions of his behavior governed by processes that predate the development of his complex cerebral cortex. While humans are quick to provide “reasons” for their actions and inactions, much of what they do is done by other forms of life unencumbered by such “reasons”. Humans are attracted to one another, mate, reproduce, rear young, help one another, compete, fight, flee, dominate one another, prey on other life, etc. … This viewpoint does not negate the influence of the human’s higher brain centers on his behavior; it simply emphasizes the importance of the substrate on which the activity of higher brain centers rests. (28)

A second purpose served by the concept of the emotional system is that it provides a way of thinking that may help bridge the compartmentalization of knowledge that presently exists about biological processes. This compartmentalization is reflected in the persistence of theoretical dichotomies in biology and medicine, such as psychic versus somatic causes of disease and the very old nature-nurture controversy. It is also reflected in our inability to account adequately for the activity of pathological processes. [28] … The concept’s potential for doing this rests in its assumption that all the various physiological systems of an organism are part of a larger system governed by operating principles that regulate the various parts that comprise it. These operating principles are assumed to be related to those that exist in all natural systems. (28-29)

For example, thinking of the body as an emotional system may enhance our understanding of a clinical problem such as cancer. If the body can be conceptualized accurately as an emotional system, then cancer may reflect some sort of disturbance in the balance of that system. This way of thinking about cancer is quite different from the way of thinking upon which most cancer research has been based. Research on finding the cause of cancer has tended to focuses on what is occurring inside the cancer cell. The research question has generally been, “What has gone wrong with this cell to cause it to behave abnormally?” Research based on the assumption that cancer is caused by a defect or disturbance within the cell may eventually provide an adequate explanation. On the other hand, an adequate explanation may possibly depend on being able to conceptualize the body as a biological unit, for example, as a colony of cells. Cancer would reflect a disturbance in the unit as a while. The disturbance observed within the cell would be a reflection of a disturbance observed within the cell would be a reflection of a disturbance in the larger system of which the cancer-containing organ is a part. / This way of thinking about cancer is, admittedly, quite speculative. (29)
The person who says this usually means that lower animals do not have feelings. For most species, this is probably correct. Systems theory, however, does differentiate between emotions and feelings; this allows the term “emotional” to be applied to all living things. / An example of emotionally determined behavior in a lower animal is the activity of a highly stimulated horder of soldier caste ants vigorously responding to intruders into their colony. The ants neither contemplate the meaning of their actions nor harbor strong nationalistic feelings; they simply act. Another example of emotional reactiveness in a lower animal is the teeth baring of a male baboon in response to a stranger. The automatic movement of a plant, a barnacle, or a moth toward a light source is another emotional response. / More complex emotional reactivity is evident in a young dolphin who, having been too pressured by her trainer to conform, withdraws and refuses to eat. (30)

The feeling and intellectual systems are fairly recent acquisitions by the evolutionary line of animals that led to homo sapiens. When these systems were added and/or better developed during the gradual course of human evolution, they did not replace, except perhaps partially, the functions of the emotional systems. The emotional system continued to be a major influence on human behavior and these newer systems were additional influences. (31)

People can be aware of feelings by virtue of feeling them. This contrasts with emotions, which are not felt. … Feelings appear to be an intellectual or cognitive awareness of the more superficial aspects of the emotional system. People feel guilt, shame, disapproval, anger, anxiety, jealousy, ecstasy, sympathy, rejection, etc. Many other animals frequently act as if they experience similar feelings, but there is little evidence that many of them do. They are simply reacting emotionally. The assumption is that humans are reacting emotionally too, but with a layer of feeling on top of it. (31)

…subjectivity. It is clear that much of the time man’s intellect operates in the service of the feeling and emotional process. … Opinions and actions are justified on the basis of subjective assessments about the world and its inhabitants. (32)

When human beings react emotionally to internal and external stimuli, there can be manifestations of that reaction on emotional, feeling, and intellectual levels. [The phrase “react emotionally” is intended to include the physiological components of emotions as well as the behavioral manifestations.] (32)
An example of manifestations of emotional reactiveness occurring in the emotional, feeling, and intellectual systems simultaneously is when someone reacts to disapproval by withdrawing (an emotionally rooted response [32] observed in all forms of life), feeling sad (a feeling experienced only be higher forms of life), and becoming preoccupied with a sense of inadequacy (a subjectively determined attitude of self that is undoubtedly unique to human beings.) Another example is a person who reacts to perceived disapproval with an aggressive facial expression (emotion), anger (feeling), and a self-righteous assertion of the “correct” viewpoint (subjective). (32-33)
While Bowen developed the concept of these three systems based largely on clinical observation, brain researcher Paul MacLean (1976) developed a strikingly similar model on the basis of neuroanatomical and neurophysiological research. MacLean’s core concept is the triune brain. Discussion of the role of the brain in thinking, feeling, and emotion should not be taken to mean that the brain is the seat of the emotional system. The emotional system in man and the subhuman forms presumably includes processes that operate throughout the organism, not just in the central nervous system. What is occurring in the brain can reflect processes occurring throughout the body, even at the cellular level, and what is occurring throughout the body can reflect processes occurring in the brain. The concept of the emotional system is intended to encompass all of these relationship processes operating in the organism. (33)
…three formations in the human forebrain that are radically different in structure and chemistry. … The three formations of the brain described by MacLean are the reptil-[33]ian brain (R-complex), paleomammalian brain (limbic system), and neomammalian brain (cerebral cortex). These formations are not to be precisely equated with the emotional, feeling, and intellectual systems described by family theory. Systems pertain to functions and interrelationships, and it may never be possible to establish a one-to-one correspondence between functions, interrelationships and anatomical structures. (34)

In evolutionary terms, the R-complex is the oldest of the three brain. … These patters include imitative behavior (perhaps far more influential on human behavior than we realize), predisposition to routine and ritual (clearly very important in human behavior), displacement behaviors (inappropriate behaviors for a given situation manifested when an animal is under stress), deceptive behaviors (MacLean reminds us that Arthur Bremer stalked his victim, George Wallace, for days at a time), and tropistic behaviors (either positive or negative responses to partial or complete representations of animate or inanimate objects). [Paul D. MacLean, A mind of three minds: Educating the triune brain. In Education and the Brain 1978, The National Society for the Study of Education, University of Chicago Press, Chicago, p. 319.] (34)

While reptiles have a perfect memory for what their ancestors have learned to do, MacLean suggests that, due to the reptilian brain having only a rudimentary cortex, these animals are poorly equipped for learning to cope with new situations. As evolution proceeded to the early mammals, however, a more elaborate cortex developed. This primitive cortex provided the mammals with a better means of viewing the environment and learning to survive. In all existing mammals this primitive cortex is found in the limbic love. (35)

There are three subdivisions of the limbic system. The nerve cells of the first division, the amygdala, are involved in feeding, fighting, and self-protective functions. Cells of the second division, the septal division, are occupied with primal functions required for procreation. Experimental stimulation of this area elicits sexual arousal and affectionate behavior. The third division, centered around the mammillary bodies, appears to be involved in nursing and maternal behavior. There is no counterpart of this division in the brains of reptiles (reptiles exhibit little parental care.) / The limbic system also has important global functions, one of which pertains to the experience and expression of emotion. Feelings ranging from fear through ecstasy to feelings of conviction are generated by this part of the human forebrain.

[MacLean] A storm may also spark eureka-type feelings like those associated with discovery, or free-floating feelings of conviction of what is real, true, and important. When we think of how we evaluate the importance of things, nothing could be more fundamental that the realization that the primitive limbic system has the capacity to generate the strong feelings of conviction that we attach to our beliefs, regardless of whether they are true or false. [331]

The neocortex culminates in the human brain in which there develops a megapolis of nerve cells devoted to the production of symbolic language and the associated functions of reading, writing, and arithmetic. Mother of invention, and father of abstract thought, the neocortex promotes the preservation and procreation of ideas. [MacLean, 332] (36)

The most recently evolved portion of the neocortex is the prefrontal cortex. In the evolution from Neanderthal to Cro-Magnon man, the human forehead developed from a low brow to a high brow. The prefrontal cortex lies beneath this heightened brow. While this portion of the neocortex plays little if any role in intelligence, it is the only neocortex that looks inward to the inside world. (37)

…science writer Anne Rosenfeld: … For example, if we accidently bump into an old “flame”, our neocortex may rumble into its well-calculated verbal pleasantries, spinning out the person’s name, asking about what’s happened, keeping up its chitchat, all the while taking in countless bits of information about the person before us and perhaps trying to tell our limbic system to be still. The limbic system, however, swamped with messages from above [37] and below, inside and outside, swirling with memory and old desires and fears, is by no means quiescent. Its messages, through other, lower parts of the brain, may send the heart racing, hands freezing, stomach churning, face flushing, and sexual responses activated despite our attempts at neocortical cool. Or perhaps we are torn with feelings of anger and a desire to escape this discomforting encounter. But we keep on chatting pleasantly. Meanwhile our reptilian brain is stirring, too, running our body through a parade of habitual gestures and “body language” that probably signals our conflict—perhaps we keep shaking hands overlong or somehow feel obliged to scratch a suddenly itchy ear. [Anne Rosenfeld, The Archeology of Affect, DHEW Publication No. (ADM) 76-395, Printed 1976, pp. 5-6.)

The notion that a group of individual organisms could be considered an entity in its own right has a long history in biology under the label of “superorganism.” … In the absence of concepts about the way the group is organized, the notion of “superorganism” has no basis. (38)
E. O. Wilson’s (1985) extensive research on the relationship process of [42] social insects appears to have brought him to the brink of a systems theory about a subhuman animal. He has begun to define certain relationship processes that regulate the functioning of an insect colony. … Because Wilson has been able to define regulatory mechanisms that pertain to the colony as a whole, mechanisms that control the functioning of individual workers, he refers to the insect colony as a “superorganism.” The colony must be understood as an entity in its own right. (43)
Each ant is born with nearly the same set of genes, but the particular genes that are expressed and determine whether the larva grows up to be a worker, a soldier, or a queen, are controlled by environmental stimuli. The type of ant a larva grows up to be, in other words, is not programmed into him at the time of birth. When the young larvae emerge, they are the “raw material” for the present need of the colony. (43)

It is not as if each individual ant “recognizes” the problem and “decides” to help out. On the contrary, the colony “system” has mechanisms for diagnosing an emergency and activating regulatory mechanism that will produce com-[43]pensatory alterations in the functioning of certain colony members. The individual ants are being governed by these mechanisms, which are partially based on feedback loops. (44)
[sociobiology, as distinguished from family systems] …sterile castes in social insects. This caste of insects works selflessly for the colony in the sense of all work and no offspring. If natural selection operates on individual organisms, how can an organism that does not reproduce itself continue to exist in a population? E.O. Wilson refers to this phenomenon as the central theoretical problem of sociobiology: How can altruism evolve by natural selection? … The concept of inclusive fitness relates to natural selection operating at the level of the group or what is referred to as kin selection. While a selfless act may place one’s own ability to mate and reproduce at risk, if the performance of this act facilitates a close relative’s chance to reproduce, it is, in terms of transmitting genes to the next generation, almost as effective. … Sterile caste insects, for example, perform their services for colony mates who share a very high proportion of the [46] same genes. Altruistic genes, for example, could be passed to the next generation indirectly through a close relative rather than through oneself. … An individual’s chances of surviving and reproducing would be related as much to the success of the colony as a while as to his own particular reproductive prowess. As a consequence, the genes that orient the individual to the group and contribute to a group process would be as important, if not more so, than the genes that enhance the individual’s own particular fitness. (46-47)

An important difference between sociobiology theory and family theory is the link sociobiology makes between specific behaviors and specific genes. … Family theory, in contrast, assumes that the functioning and behavior of all organisms are significantly influenced by an emotional system that is anchored in the life process at a level probably more basic than genes. This system is assumed to have its roots in protoplasm itself and it may even influence the functioning of genes. … Darwin’s basic concept of natural selection, as well as the principles of population genetics, are not negated by the concept of the emotional system. The assumption is that these principles may fit into a broader scheme. The grounding of all evolutionary changes in genes by the modern synthesis, while having contributed significantly to our understanding of many aspects of behavior, may have placed some unmerited constraints on Darwin’s ideas. [48] …an individual is, at least in part, motivated by a process that is not contained entirely within that individual; it is contained, rather, within that individual’s relationship system. So family theory attempts to explain certain aspects of an individual behavior in the context of the function of that behavior in the emotional system. (48-49)
The concepts developed by Wilson based on research on social insects are particularly valuable because they highlight the contrast between a sociobiological way of thinking and a family systems way of thinking. At present, since there is no way to prove either theory and since each is an attempt to anchor the understanding of behavior in scientific principles, it is important to be aware of both these ways of explaining the social process. (49)
As adults, the ants will function in reciprocal relationships and the overall system will respond to subtle alterations in its balance. This relationship process is mediated by the emotional reactiveness of the ants to chemical, tactile, and visual stimuli. … As adults, humans function in some degree of relationship reciprocity and are quite sensitive to alterations in the balance of the system. This relationship process is mediated by emotional reactiveness; however, unlike the ants, humans’ reactiveness is more in response to visual and auditory signals than chemical and tactile ones. (50)

[The principles that govern the development of the embryo are one of biology’s greatest puzzles and so a great deal of research will be necessary to validate Wilson’s assumption.] This implication is that, just as an ant society is a colony ants, an embryo is a colony of cells. In a developing embryo, which begins as a small number of unspecialized cells, each cell has the potential (the genes) to develop into one of many specialists, such as a kidney or liver cell. Wilson suggests that, as in the case with an ant colony, these developing cells respond to stimuli that guide the direction of their specialization. The nature of the stimuli a particular cell receives is regulated by mechanisms that govern the embryo as a whole. If the embryo develops abnormally, for example, it may not be the cells that are defective, but the guiding regulatory mechanisms that are out of balance. (50)

While scientists like Wilson view the emotional system (“superorganism” in Wilson’s terms) as having been created by natural selection, family systems theory assumes that fundamental aspects of the emotional system have been in place since the origin of life. Its basic design may even predate the origin of life. Rather than being produced independently in each phylogenetic line as a result of natural selection pressures, the emotional system is assumed to be a universal feature of all living things. All life is systems. (51)

There are also numerous examples of an apparent repulsive “force” between animals. It is the case with many species of animals that when they are forced together by an experimenter, they quickly spread out until they reattain the correct distance for the species. At times this spreading out is so precise that it can be likened to the preciseness of the formation of crystal. If animals are forced into abnormal proximity, they will seek distance through other means, such as hiding or averting direct gaze (Wilson, 1975). [funny]. (53)

When these grasshoppers have ample space, they tend to live solitary and reasonably calm lives. If they are thrown together experimentally, they quickly and precisely reattain the distance characteristic for their species. When, however, for a variety of reasons these insects are in sustained close proximity, they may undergo profound structural and behavioral changes in response to that crowding. Then end result is the conversion, over three generations, of a calm grasshopper into a larger, darker, much more active and gregarious locust. (54)

Even if parents try not to make the oldest child responsible for younger siblings, the process is so automatic that much of it will occur anyway. [A family’s level of differentiation and the particular characteristics of parental attitudes may, within limits, alter the expectations for oldest and youngest children. Parental attitudes and anxieties about an oldest child, for example, can result in that child’s not meeting the expectations of a firstborn. In such instances, the second child will then develop some of the functional characteristics of a firstborn. (55)
The overfunctioning person is typically one who feels responsible for the emotional well-being of others and who works to compensate for perceived (real or imagined) deficits in their functioning. The underfunctioning person, on the other hand, feels dependent on the overfunctioning one to do things that he feels reluctant or unable to do himself. At the extreme, the underfunctioning one may rely on the overfunctioning one to tell him how to think, feel, and act. The overfunctioning one may not experience this degree of reliance as a burden. (56)

An overfunctioning person may get sick by virtue of being required by others and requiring of himself more than he can realistically accomplish. An underfunctioning person may get sick by withdrawing into a self-absorbed and helpless state. This self-absorption is not the product of selfishness, but of having given up too much self-control. An underfunctioning person who has been chronically ill may improve his functioning and experience a dramatic remission of symptoms if his overfunctioning partner becomes ill or dies. (56)

Systems theory, while it includes a description of an individual’s internal processes, broadens the field of focus to include an examination of the harmony and balance of the “patient’s” relationship system. (56)

A patient, for example, who has serious phobic [56] symptoms is usually diagnosed has having a “neurosis” or perhaps some biochemical defect. Systems theory does not discount the possible role of psychological and biochemical factors in phobias, but these factors are seen as only a part of the process and not its cause. / A wife with a serious phobia may, prior to the development of symptoms, be in an overfunctioning position in the family. … If stress on the family increases… As the process progresses, she feels increasingly overloaded, overwhelmed, and unsupported, and may then begin to experience the onset of phobic symptoms. … The wife begins to increasingly depend on her husband and perhaps other family members… Her ability to function for herself becomes increasingly constrained because of her symptoms and because of the family’s willingness to function for her in many areas. …an enduring type of family stability can develop, a stability that is accompanied by the presence of a chronic symptom. It is easier for family members to make accommodations that make it possible to live with the symptom than it is to address the underlying relationship process that fosters the symptom in the first place. (57)
Family systems theory postulates that the operation of the emotional system reflects an interplay between two counterbalancing life forces—individuality and together. (58)

…the theory posits that the development of the physical, emotional, and social dysfunctions bears a significant relationship to adjustments people make in response to an imbalance of individuality and togetherness in a relationship system. (58)

In order to observe the process of a relationship, cause cannot be ascribed to any one aspect of the interaction. (60)

If a wife, for example, notices that her husband has withdrawn from her, she is likely not only to observe this withdrawal intellectually, but also to feel threatened by it and to have an emotionally driven urge to pursue her mate. … If the wife could think objectively, she could observe that her spouse’s urge to withdraw and her desire for more contact are probably feeding on one another. However, since her feeling and emotional reactions are hampering her ability to think clearly, she may blame her husband’s withdrawal on his indifference to her needs and also obsess about her own inadequacies. This is tunnel vision. Certain details that are only a part of a larger process are blown out of proportion and used to explain what is happening. [60] …the husband might think and say, “I would not withdraw if you were not so needy and dependent.” This way of thinking assumes that his wife’s behavior causes his behavior and that her behavior is occurring in a vacuum. The husband does not see that much of her behavior is a mirror image of his own actions. …the wife may get preoccupied with “why” her husband rejects her and the husband with “why” his wife is so needy and dependent. When one person asks the other, “Why do you do what you do?” focus on the relationship process is immediately lost. The focus is lost because the question assumes that the cause of the person’s behavior exists within that person. The question shifts the “locus of control” from the relationship to one person. (60-61)

This emotional process is assumed to be regulated by the interplay of a force that inclines people to follow their own directives, to be independent (individuality), and a force that inclines them to respond to directives from others, to be connected (togetherness). Probably all behavior is simultaneously influenced by both individuality and togetherness, but the predominant intent of a way of thinking or specific action can usually be discerned. (61)

[footnote] Individuality as defined by family systems theory, in contrast, refers to the capacity to be an individual while part of a group. The human is probably unique in the potential to be both an individual and a team player. This potential appears to stem from man’s ability to think and from his ability to be aware of the difference between thoughts and emotions (perhaps a function of the prefrontal lobes of the brain). The capacity to differentiate between thoughts and emotions permit some choice over being directed by one’s “head” or by one’s “gut”. (63)

[footnote 2] When crowded, animals that normally tolerate intrusions on their physical space aggressively defend territories and form dominance hierarchies within those territories. Once a hierarchy is establish, conflict between animals within a territory disappears. A dominance system, which is part of the emotionally driven group process, can function, therefore, to reduce conflict. If this process becomes extreme, however, the advantages to the individual of cooperating with a hierarchy are outweighed by the disadvantages, and a subordinate animal may then fight, flee, or if denied exit, become withdrawn. (63)

Systems theory does not assume that everything in relationships can be accounted for on the basis of the interplay of these forces. Family systems is a theory about an emotional process that governs relationships, but people also form relationships for such non-emotional reasons as conducting business. If relationships remain on an intellectually determined or contractual level, then the individuality and togetherness balance is not a significant influence. (64)

While individuality is anchored in biological processes that are part of every person, the extent to which a person’s individuality is developed is based primarily on learning. This learning appears to occur at many levels, ranging from the conditioning of emotional responses to the intellectual acquisition of knowledge. [Americans are sometimes referred to as a culture that values “individuality” and the Japanese as a culture that emphasizes “togetherness.” This should not be equated with the meaning of these words in family systems theory. What people are usually referring to is the generalization that Americans are “rugged individualists” and the Japanese emphasize conformity to social norms. Both “rugged individualism” and obligatory conformity are strongly influenced by the togetherness force. The “rugged individualist” operates as much in reaction to other as the compliant person. His determination to be independent stems more from his reaction to other people than from a thoughtfully determined direction for self. He has trouble being an “individual” without permanently disrupting his relationships with others. The compliant person has difficulty maintaining his relationships with others without giving up his “individuality”. Rugged individualism and compliance, therefore, are two sides of the same coin.] (64)

A human being has various biological and psychological systems that incline him to function as part of a group and to follow the group’s compass. These internal systems not only orient the person to the directives of the group, but also send out signals that orient others to self. This force to be connected is reflected in the striving to act, feel, and think like others, as well as in the striving to have others act, feel, and think like oneself. (65)

The proportion of life energy people invest in a relationship and the degree to which their lives are governed by that relationship are related to the strength of the togetherness force. The proportion of life energy people retain to direct their own lives independent of the relationship is a product of the strength of the individuality force. (66)

When a high percentage of energy is bound in the relationship, the [67] relationship is described as very stuck together, very fused, very undifferentiated, or as having little emotional separation. When a low percentage of energy is bound, the relationship is described as having a lot of emotional separation. (67-68)

This difference between people in the proportion of life energy prone to be invested and bound in relationship is described by the concept of differentiation of self. The lower the level of differentiation, the greater the percentage of energy that is relationship bound. (68)
[The phrase “emotional separation” is not to be equated with people avoiding each other. The urge to avoid other is a function of a lack of emotional separation. … Nobody achieves complete emotional separation from his family. The degree of a person’s unresolved attachment to his parents influence the degree to which he fuses to the other people and forms a new “symbiotic” relationship. Use of the term symbiosis is appropriate because both people derive benefit from the attachment. Symbiosis is a descriptive term that does not account for the intensity of the attachment. Systems theory explains the intensity on the basis of the underlying balance of individuality and togetherness in the relationship.] (note 6, 68)

As differentiation decreases, individuality is less well developed and togetherness needs are stronger. The individuality of a very poorly differentiated person is practically nonexistent. His emotional reactions are easily [68] triggered, intense, and prolonged, and he has almost no psychological development that permits him to be a separate person. The togetherness needs of a very poorly differentiated person, which are overriding in their influence, are felt as deep yearnings to be loved, accepted and guided through life. As differentiation increases, individuality is better developed, togetherness needs are less intense, and emotional reactiveness is better modulated. The individuality of a well differentiated person, while probably anchored in biological processes, is determined primarily by extensive psychological development. [Saying that individuality is determined by psychological processes means that while the potential to be an individual may have biological roots, the development of that potential is primarily influenced by life experience. If a person grows up under strong pressure to adjust to the anxiety, emotional reactivity, and subjectivity of others, his life becomes strongly governed by emotional, feeling, and subjectivity processes. If he grows up with the freedom not to have his thinking and emotional functioning contingent on others, then his life will be less governed by emotional, feeling, and subjective processes. This freedom makes him less of an emotional reactor and permits the development of more psychological capacity to be a separate individual. Genes appear to influence neither the strength of a person’s togetherness orientation nor his capacity to be an individual.] The togetherness fore is felt not as deep yearnings and needs, but as a basic attraction and interest in one’s fellow man. (69)

Autonomy does not mean selfishly following one’s own directives; it means the ability to be self-determined. Self-determination could result in the choice to be guided by the best interests of the group. (70)
The capacity for autonomous functioning does not mean a person lacks emotions and feelings. It means that while the while the person may respond to input from others on an emotional, feeling, and subjective level, he has the capacity to process these responses on an objective level. The processing at the highest levels of mental functioning is what frees the person from automatic responses and permits choices. A well differentiated person has a togetherness force and is responsive to togetherness determined cues from others. [70] His action or inaction in response to those cues, however, is strongly self-determined. (70-71)

While all relationships ranging from poorly to well differentiated ones are in a state of dynamic equilibrium or balance, the flexibility inherent in that balance decreases as differentiation decreases. (71)

A person who feels rejected and characteristically blames that feeling on his own sense of inadequacy usually is underemphasizing an objective reality to which he is responding. A person who feels rejected and blames it on others usually is underemphasizing his own subjective distortion of reality. Systems thinking incorporates both sides of this “equation”. (73)
All people have emotional and feeling responses to the ebb and flow of relationships. … While life experience may influence the intensity of responses, humans are born with the basic “wiring” that makes them possible. These emotions and feelings, which can be triggered by a perceived threat, spur people to take action to relieve that threat, spur people to take action to relieve that threat. One function served by emotions and feelings, therefore, is to control the balance between contact and separateness in a relationship. (73)

[note 13] Most anxiety is not conscious. It is assumed that an anxious response to a situation is manifested even at a cellular level. The activity of cells that comprise the immune system, for example, is assumed to be influenced by anxiety. Biofeedback is a technique for bringing more of one’s anxiety into conscious awareness, but the technology is still quite limited. (74)

Two very well differentiated people are not easily threatened by one another; as a consequence, their relationship is remarkably flexible. Periods of closeness and distance are tolerated equally well. Each person is free to move toward or away from the other and to have the other move toward or away from oneself without being threatened. … If a very differentiated person does experience the other’s desire for distance as a deprivation, he can think about his feeling and subjective responses and remain autonomous in his actions. If he decides to accuse his spouse of not loving him, it comes out as a humorous acknowledgment of a process rather than as a demand that she change. (74)

Very poorly differentiated people may eventually shun all relationships to avoid the discomfort that is associated wit them. The “street people” are in this category. They avoid and are avoided by others because of the problems generated by enduring relationships. “Insulation” from their exquisite sensitivity to the emotional environment is achieved through chronic psychosis, alcoholism, and drug addictions. Slightly better differentiated people may become “relationship nomads.” When the process gets too intense, they change relationships. People with a little more differentiation but who are still quite vulnerable may avoid intense involvements and successfully maintain relationship network of less intense relationships, ones that allow more distance. (75)
So while moderately differentiated people can have a relationship in calm balance, their sensitivity to words and actions that appear to threaten that balance results, over time, in the relationship’s spawning an average level of chronic anxiety that is higher than that of a better differentiated relationship. People will be both comfortable and uncomfortable in the relationship. They are comfortable with the attachment and uncomfortable with aspects of that attachment that can threaten them. (76)
As the undifferentiation in a relationship increases, the emotional boundaries between people become progressively blurred. As boundaries [76] dissolve, anxiety becomes an increasingly infectious agent. … As boundaries dissolve, there is increased pressure on people to think, feel, and act in ways that will enhance one another’s emotional well-being. All of these processes contribute to the anxiety people experience while trying to maintain a relationship. (77)

Another factor that affects the level of anxiety in a relationship is boredom. As differentiation decreases, people look more to one another to provide a sense of well-being, and the expectations soon exceed what either person is capable of providing. People begin to feel bored and dissatisfied with many aspects of the relationship while simultaneously feeling bound to it. (77)
The result of adaptations made in response to relationship pressure is that the group’s anxiety, which is generated by the emotional reactiveness and patterns of functioning of every group member, is expressed in certain relationships more than others and is absorbed by certain people more than others. This “compartmentalization” of anxiety can stabilize a group by reducing the group’s general level of anxiety. The group’s inherent anxiety and instability become contained within the poor functioning of certain group members and within ritualized forms of interacting. [If the dysfunction of a family member becomes excessive, his poor functioning can have more of a destabilizing than stabilizing impact on the family. In such instances, if the dysfunctional person leaves the family, the family’s anxiety level may actually decrease.] / This compartmentalization process to reduce anxiety does not alter the basic relationship dilemma of a system. Adaptations to relationship pressure are a product of people’s focus on one another and function to relieve the anxiety of the moment. Actions that address the basic relationship dilemma and, consequently, have a potential for increasing the flexibility of a system are based on a broad and long-range assessment of the situation. Their implementation requires a focus on changing self rather than on trying to change others and an ability not to act to relieve the anxiety of the moment. (79)

[note 20] Focusing on others means orienting oneself to the directives of others and/or attempting to orient others to one’s own directives. Becoming less of an individual, therefore, can be reflected in greater conformity to group pressure and in attempting to impose one’s own way of thinking on others. (80)

Another type of response to disturbances…each person give up a little of his individuality or “self” to mold himself more to the wishes of the other. … The stability of [81] this type of adapting is dependent on both people’s feeling they have given in an equal amount. … While harmony can be maintained though this pattern of adapting, the “price” of harmony is a shift in the relationship balance towards more togetherness. It is a “price” because, as the balance shifts, the relationship loses some of its “emotional reserve” or flexibility. … As a consequence of this declining “reserve”, people in a relationship with this predominant pattern will often attempt to insulate themselves from external stresses. … To reduce stress, people may limit contact with others and the relationship will become an “emotional cocoon.” While relationship at any level of differentiation could have this tendency, the lower the level, the more the potential anxiety and the more intense the pressure for insularity. An “emotional cocoon” may achieve enough stability to support the functioning of each person and, therefore, not generate any clinical symptoms. This is the kind of situation, however, where if one partner dies, the other’s functioning may then rapidly decline. (82)

A mirror opposite process to the harmonious “emotional cocoon” is a pattern in which people resist one another’s pressure to accommodate by being adamant about not giving in. people continually pressure one another to think and do things their way, but this pressure is met on both sides with rebellion. As a consequence, the relationship is characterized by disharmony. While this pattern can exist in relationships anywhere on the scale of differentiation, the lower the level, the more dogmatic are people’s postures and the more pronounced the disharmony. … The less well developed each person’s individuality, the more easily threatened each can be by “going along” with the other. [82] … Emotionally based conflict provides a type of solution to the relationship dilemma. The focus on one another provides emotional contact, and the anger and stubborn refusals to do what the other wants provide emotional distance. The result can be a relationship that, although tumultuous, is enduring. The deterioration of a relationship is stabilized through binding or absorbing the anxiety in conflict. What is compromised in a conflictual relationship is the ability to give in when it is constructive for all concerned. To the extent that the anxiety generated by the emotional interdependence is acted out in the interaction (the opposite of surface calm), the individuals do not absorb it within themselves. This externalization of anxiety provides some protection for each person from the development of clinical symptoms. When conflict prevails, it is the relationship that is symptomatic. [?] (82-83)

An “emotional cocoon” and a conflictual relationship can be at the same level of differentiation. At a given level, there is just as much focus on one another and just as much energy consumed, irrespective of the type of interaction. … The intensity of attachment and degree of problem in a harmonious relationship, in other words, can be just as great as in a conflictual relationshipi. In one instance the problem has been bound in harmony and in the other it has been bound in disharmony. / Another pattern of adaptation in a relationship is when one person adapts his functioning to preserve relationship harmony more than the other person does. … It is important to recognize that each member of the relationship thinks and acts in ways that foster this type of interaction. … The one who adapts more “loses” self to the relationship and the one who adapts less “gains” self from the relationship. … In reality, both people “lose” in that, by participating in preserving the relationship balance through adaptations to relieve anxiety, they each become part of a less flexible relationship system. Adaptations to relive anxiety may favor the functioning of one person more than another, but the process puts constraints on both people. (83-84)

The person who gives in more to the relationship pressure promotes relationship harmony, but simultaneously “absorbs” anxiety within himself. While the anxiety does not appear in disharmony between the two people, it does not really disappear. It becomes disproportionately bound within one person. … This absorbed anxiety must be managed in some fashion. The more adaptive one has “lost self” to the relationship and will make internal adjustments in response to that loss. These adjustments, which are the product of emotional reactiveness and not thinking, may be in behavior or in physical and emotional functioning. Some of the adjustments amount to distancing or rebelling internally while outwardly going along with the other. For example, the person may be compliant but also chronically fatigued and sleep excessively. / The mate who has “gained self” from the relationship will also make autmatic internal adjustments in response to the gain. He may feel more energies and able to take on additional responsibilities, one of which may be more responsibility for the functioning of the “de-selfed” one (the one who has given up more self). …place constrained on both people. In fact, there are times when the overfunctioner loses more self to the process than the underfunctioner. The overfunctioner may eventually feel more pressure to adapt to the underfunctioning of the underfunctioner than the underfunctioner feels to adapt to the overfunctioning of the overfunctioner. / Adjustments made by an individual in response to giving up self to the relationship system can play a role in the development of physical, emotional, and soial illness. The development of clinical symptoms, while a complex process that involves more factors than are being discussed here, [85] can reflect an indiviudal’s attempt to manage anxiety. (85-86)

At high levels of differentiation, the pattern of one adapting more than the other preserve harmony usually does not result in one person’s giving up much “self” to the relationship or absorbing much anxiety. The relationship, unless it is under extreme external stress, usually does not contain much anxiety. (86)

Very well differentiated relationship, which contain little inherent anxiety, spawn clinical symptoms only when the relationship is significantly stressed by external events. The relationship has a high level of “emotional reserve” which makes it very adaptive to stress. Intense and protracted stress, however, can exceed the limits of the reserve and a clinical symptom may then develop. (86)

Chronic psychosis and depression can be thought of not just as disease but as symptoms of having given up too much self to the relationship system. The chronically psychotic person’s life is governed by his environment; he is highly sensitive to the amount of emotional support he received from others. The psychotic thought process and depression are ways the anxiety is managed or bound within the person. Chronic psychosis, at least up to a certain level, can provide internal equilibrium for the person. (87)
Once a symptom emerges, a relationship process can develop around the symptomatic person which may foster its becoming chronic. The family may become anxiously focused on the dysfunctional person. This focus on the problems of one person may create a type of togetherness that is fairly stable. [A symptomatic person can serve a stabilizing function for a family in the same way that a symptom can serve a stabilizing function for an individual. In the first instance, anxiety is bound in a part of the family system; in the second instance, anxiety is bound in a part of the individual’s internal system. At high levels of intensity, symptoms can have more of a destabilizing than stabilizing function for both the individual and the family. Sever chronic illness can place so many demands and constrains on the patient and the family that people are more drained than stabilized by its presence.] (87)

In fact, even with moderately differentiated people, it is very unlikely that the anxiety of one relationship will be bound or absorbed in only that relationship. The relationship will become intertwined with other people through predictable patterns defined by the concept of the triangle. By the same token, through the process of triangles, a relationship may absorb anxiety from other relationships. (88)

Before discussing this aspect of differentiation, it is important to consider the possible function that the capacity for differentiation of self has for the species. These speculations about the function of differentiation are derived from comparisons of seemingly parallel research observations made by E. O. Wilson, Paul MacLean, and Murray Bowen. The purpose for comparing these observations is to provide an evolutionary perspective on the concept of differentiation. Any attempt to actually integrate the work of these three men would be premature. (Chapter Four, Differentiation of Self, 89)

Wilson…proposes that “the old vertebrate restrains” on social organization have been broken, not by reducing selfishness but by acquiring intelligence. Man’s ability to remember the past and to plan for future allows him to engage in acts of “reciprocal altruism”. Altruistic acts can be traded at different times and spaced over logn periods, even generation. (91)

MacLean notes that the neocortex developed at first, in the evolution of the higher mammals, somewhat like an impersonal machine. He comments: / Earlier we suggested that the neocortex has the capacity of operating somewhat like a coldly reasoning, heartless computer. It is the kind of computer that makes it possible for monkeys to scheme their way like gangsters into another troop, murder the dominant male, and perform infanticide in the presence of the distressed mothers. It is unnecessary here to draw some human parallels. [MacLean, 1978, p. 339] / Then, slowly but progressively, nature added something to the neocortex, the prefrontal cortex, according to MacLean, that provides foresight in planning for ourselves and other and helps us to gain insight into the feelings of others. Apparently, it is the only part of the neocorex capable of reflecting on internal events. [92] … Empathy, the compassionate identification with another individual, may have become possible because of the evolution of the prefrontal cortex. [If empathy became possible with the evolution of the prefrontal cortex, this does not mean that empathy is a function of just that part of the brain. Other parts of the nervous system probably play a role in it too. The togetherness force may have a role in empathy and that force will probably never be localized to a specific part of the nervous system. Many parts of the nervous system can be shown to contribute to the togetherness force (for example the limbic system), but no one part provides a complete explanation for togetherness. If the assumption is correct that a togetherness force operates in all living systems, as the nervous system evolved, each new part would probably have, among other things, functions for individuality and togetherness. The evolution of the prefrontal cortex is assumed to have added new or more elaborate functions to both togetherness and individuality. These new functions are probably best considered as elaborations of old themes, rather than as processes that are totally “new”. (92-93)
[note 5] Family systems theory assumes that the concept of differentiations can be extended to other animals. Humans, however, appear to have more capacity for differentiation than other species. Research on chimpanzees by Jane Goodall and on rhesus monkeys by Stephen Suomi (presently based at the National Institutes of Health) describes what appears to be individual variation in the emotional functioning of members of the same species. Some individuals are so reactive to even routine life stresses that their functioning is undermined. Others are better able to maintain competent functioning under the usual conditions of their existence. While further research is necessary to make firm conclusions, the monkeys who can maintain fairly stable functioning under a range of stresses could be considered more differentiated than those whose cannot. As more is learned about individual variation in emotional functioning of members within other species, the concept of differentiation may be seen to apply throughout much of the phylogenetic tree. The concept of self (as used in family systems theory), however, can be only loosely applied to other species. The “self” can be so much more elaborately developed in man that he is unique among primates. (93)
The result of these counterbalancing life forces is that no one achieves complete emotional separation form his family; the early attachment is never fully resolved. (95)

There are considerable differences among people in the amount of emotional separation they achieve from their families of origin. These differences are linked to two primary variable: (1) the degree to which a person’s parents achieved emotional separation from their respective families, and (2) the characteristics of a person’s relationship with his parents, siblings, and other important relatives. (95)

So it is possible for one child to [95] achieve a little more emotional separation from his parents than the parents achieved from their parents, and another child to achieve a little less separation from his parents than they achieved from theirs. [Parents are not the cause of the amount of emotional separation achieved by their children. The process operating between parents and a child that promotes or undermines emotional separation between them is strongly influenced by the reactions of other family members to it. Parents play an important role, but the process is affected by the thoughts, feelings, and behavior of every family member. Parents cannot be construes as making others react.] (96)
The degree of emotional separation between a developing child and his family influences the child’s ability to differentiate a self from the family. … In a well differentiated family, emotionality and subjectivity are not strong influences on the relationship between the parents or on the relationships between the parents and the children. … His self-image is not formed in reaction to the anxiety and emotional needed of others; not do others define the child through their own emotionally distorted perceptions. (96)

In a poorly differentiated family, emotionality and subjectivity have a strong influence on family relationships. The high intensity of emotionality or togetherness pressure does not permit a child to grow to think, feel, and act for himself. The child functions in reaction to others. A good example is a rebellious adolescent. His rebellion reflects the lack of differentiation that exists between him and his parents. The rebel is a highly reactive person whose self is poorly developed. He operates in opposition to his parents and others; they, in turn, are sufficiently unsure of themselves that they react automatically to his acting-out behavior. Most of his values and beliefs are formed in opposition to the beliefs of others. Based more on emotional reactiveness than thinking, the beliefs are usually inconsistent. More of the parents’ emotional immaturities influence their relationship with this child than with his siblings. The acting-out child, in turn, responds in a more immature manner to the parents than do the other children. (96)

Complete differentiation exists in a person who has fully resolved the emotional attachment to his family. … He is responsible for himself and neither fosters nor participates in the irresponsibility of others. This level of functioning is arbitrarily assigned a scale value of 100. (97)
The characteristic that best describes the difference between people at various points on the scale in the degree to which they are able to distinguish between the feeling process and the intellectual process. Associated with the capacity to distinguish between feelings and thoughts is the ability to choose between having one’s functioning guided by feelings or by thoughts. The more entangled and intense the emotional atmosphere a person grows up in, the more his life becomes atmosphere a person grows up in, the more his life becomes governed by his own and other people’s [97] feeling responses. … Increasing one’s ability to distinguish between thinking and feeling within self and others and learning to use that ability to direct one’s life and solve problems is the central guiding principle of family psychotherapy. (97-98)
It is the basic level of differentiation that is largely determined by the degree of emotional separation a person achieves from his family of origin. Since one of the main variables that influence how much emotional separation (and basic differentiation) his parents achieved, and since how much the parents achieved was influenced by how much their parents achieved, basic differentiation is determined largely by a multi-generational emotional process. Basic level is fairly well established by the time a child reaches adolescence and usually remains fixed for life, although unusual life experiences or a structured effort to increase basic level at a point later in life can lead to some change in it. Clinical experience suggests that a person must be self-sustaining and living independently of his family of origin to be successful at modifying his basic level of differentiation in relationship to the family. (98)
After the death of someone significant, such as the family’s matriarch, changes in functioning may occur that more accurately reflect the family’s basic level. Serious chronic symptoms may develop that indicate a basic level in the 25-30 range. (100)

Apart from a dysfunctional person connecting with a supportive relationship system, the most effective therapy for a person in the 0-25 range is usually with other people who are in relationship to him. This might be a parent or adult sibling who is functioning on a somewhat higher level and who is motivated to work on himself in relationship to the dysfunctional person. If this parent, sibling, or other person can stay in contact with the poorly functioning one and maintain his own functioning, for example, by not assuming excessive responsibility for the dysfunctional one, the dysfunctional person will often improve. (102)

People in the 35-40 range have low levels of solid self, an important component of basic differentiation, but reasonable levels of pseudo-self, an important component of functional differentiation. Pseudo-self refers to knowledge and beliefs acquired from others that are incorporated by the intellect and negotiable in relationships with others. Pseudo-self is created by emotional pressure and can be modified by emotional pressure. The principles and beliefs of pseudo-self are quickly changed to enhanced one’s image with others or to oppose others. While these opinions and beliefs are incorporated by the intellect, they are strongly fused with the feeling process. This fusion is evident when the opinions and beliefs are expressed with the authoritativeness of a know-it-all, the compliance of a disciple, or the opposition of a rebel. Conviction is so fused with feeling that it becomes a cause. (103)
In contrast to those in the 25-35 range, who under stress will develop transient psychotic episodes, delinquency problems, and other symptoms of that intensity, people in the 40-50 range, when under stress, tend to develop neurotic problems. (105)

A main difference between the 0-25 and 25-50 groups is that the 25-50 people have some capacity for working to raise their level of differentiation. The probability is much [105] higher in the 35-50 range; the 25-35 group tend to lose motivation when they get comfortable. (105-106)

Over 60…With individuality better developed, they have more freedom to move back and forth between intimate emotional closeness and goal-directed activity. … Under sufficient stress people in the 50-75 range can develop fairly severe physical, emotional, and social symptoms, but symptoms tend to be more episodic and recovery is faster. (106)
Giving up some togetherness does not mean giving up emotional closeness. It means that one’s functioning becomes less dependent on the support and acceptance of others. (107)

An effort toward more differentiation does not insist others change and it is not contingent on anyone’s cooperation. (108)

More detachment or neutrality depends on changes in thinking. Such changes are reflected in the ability to be in emotional contact with a difficult, emotionally charged problem and not feel compelled to preach about what others “should” do, not rush in to “fix” the problem, and not pretend to be detached by emotionally insulating oneself. (108)
Many people have an attitude that if only they could get more “love” and attention, they would feel and function better. The concept of differentiation places this assumption in a broader context, namely, that the most needy people have achieved the least emotional separation from their families. … An intense and nonthreatening relationship may relieve the person’s symptoms, but it does so by replicating what once existed in the early parent-child relationship (in reality or fantasy), not by supplying a need that was never met. (109)

Systems based therapy is not an emotionally sterile or a mechanical process. The therapist-patient relationship always has some influence on therapy, but it is not necessary to foster, consciously or unwittingly, much transference for the relationship to be useful to the patient. What is important to recognize is that an intense transference is fostered as much by the basic assumptions and feeling process of the therapist as it is by the functioning of the patient. The emotional functioning of the patient in therapy, in other words, cannot be separated from the emotional functioning of the therapist. It is a system of interaction. Major problems arise when the therapist loses sight of his part in the process and responds to the patient’s transference by diagnosing it as the patient’s problem. (111)

Differentiation of self is one of two principal variables or processes defined by family systems theory to explain level of functioning; the other variable is chronic anxiety. The lower a person’s level of differentiation, the less his adaptiveness to stress. The higher the level of chronic anxiety in a relationship system, the greater the strain on people’s adaptive capabilities. (Chapter Five, Chronic Anxiety, 112)
While everyone experiences acute and chronic anxiety, the difference between people in the amount of chronic anxiety they experience appears to be based primarily on learned responses. (113)

Chronic anxiety… is most accurately conceptualized as a system or process of actions and reactions that, once triggered, quickly provides its own momentum and becomes largely independent of the initial triggering stimuli. While specific events or issues are usually the principal generators of acute anxiety, the principal generators of chronic anxiety are people’s reactions to a disturbance in the balance of a relationship system. (113)

In lieu of the relationship, drinking can provide some relief from anxiety. If husband and wife both assume that the problem is her drinking and not their relationship, this takes pressure off the marriage and allows equilibrium to be restored. (114)

An understanding of the origin of this variation in level of chronic anxiety among individuals and families begins by examining the multi-generational family history. In every family, the level of chronic anxiety shows a gradual increase through the generations in some branches and a decrease in others. (115)
Parents cannot really “protect” their children from transmission of anxieties. The transmission process is too “wired in” to the way parents function and, in addition, children are very prone to picking up anxiety. Trying to protect children from one’s own problems is actually one of the main ways problems are transmitted from one generation to the next. (116)

A child who is most caught up in the family emotional problem separates the least, is the most relationship dependent of the siblings, and “inherits” the most chronic anxiety. [A child is born with a nervous system that has all the biological wiring in place for anxious responses to parents’ and other family members’ anxiety. The child’s anxious response to parental anxieties soon contributes as much to their anxieties as their anxieties contribute to his anxious responses.] (116)
So while differentiation and chronic anxiety are distinct processes, the degree of a person’s differentiation and chronic anxiety are related. More detailed ways to understand this interrelationship will now be explored, but with the caution that there is still much to be learned about this subject. (117)

…the less a person has grown away (emotionally separated) from his family, the more anxiety he has about being on his own and assuming responsibility for himself. Some people deal with this by never leaving home; others leave and “pretend” to have grown up. The degree of pretend is betrayed by the amount of anxiety associated with trying to be a responsible adult. (117)
The anxiety could also be played out in chronic anger about not being “given” what one feels he is “owed”. The latter group of people are just as preoccupied with what others think, but are inclined more toward hostility than guilt. (118)

It’s paradoxical that people lower on the scale have a greater need for emotionally supportive relationships, yet less ability to maintain an intact network. (118)
Overachievement and underachievement are in the same category. Overachievers are approval oriented and bind anxiety by their successes. Underachievers are also relationship oriented, but bind anxiety by promoting the involvement of others in their failures and by thwarting others’ efforts to change them. [There are, of course, other factors that influence overachieving and underachieving.] Preoccupation with physical health and physical symptoms can be another anxiety binder. … Homosexual fantasies can be a manifestation of anxiety—the higher the anxiety, the more intense the fantasies—and the acting-out of [120] homosexual impulses can bind anxiety as well as be a source of it. … The idealization and romanticization of people, places, and activities can bind anxiety. Undervaluing self can contribute to a person’s sense of well-being by reducing the person’s expectations of himself. (119-120)
Temperance at 55 on the scale is unlikely to antagonize others; temperance at 35 on the scale can result in a polarization between “reformers” and “sinners”. (120)

[note 5] It appears that the process of reciprocal functioning may be just as important in internal bodily processes as it is in the family relationship system. There is inadequate statistical support for this assumption, but there are numerous case reports of people who have had a dramatic remission of chronic physical illness at the point at which they became psychotic. People accustomed to acting out their anxieties, who for some reason are forced to give up that outlet, sometimes develop internalized problems such as physical illness or neurotic symptoms. (120)
When some people get anxious, they are more intent on getting others to do things their ways. The more anxious they get, the surer they become that they know what is right or best. Frustration with the resistance of others to their efforts often leads to disappointment and anger; sometimes even to giving up and withdrawing. The mirror image of the bossy person is a person who becomes more helpless when he gets anxious. Helplessness and bossiness feed on each other, pushing two people in a relationship to extreme positions neither really wants. Even though the bossy overfunctioning person is often perceived by himself and others as “strong” and the helpless underfuctioning person as “weak”, both people seek emotional support and acceptance with about the same intensity. They simply “connect” with others in opposite fashions—one through directing others; the other through being directed. The lower the level of differentiation, the more exaggerated the bossy-helpless polarization will become during stressful periods. (122)

Up to a point, it is possible for one person in a family to be distressed without others getting too uncomfortable or reactive to it. If others are not too reactive, this is ideal. The low level of reactivity allows the person who is feeling upset and unsettled to communicate his feelings and thoughts freely, unencumbered by a fear of unduly upsetting others, or by an apprehension that others will respond by sermonizing or withdrawing. Such circumstances provide maximum emotional support for people. / Many attitudes and reactions work against continuation of the “ideal” situation, all of which are related to people’s thinking that others should have an answer for their distress and should alleviate. (123)
Much of what is done in the name of helping others, such as getting others to “express their feelings,” reflect the inability of the “helper” to tolerate his own anxiety. (124)

A mother, for example, usually reacts quicker to her most problem child than does a sibling or father. Rarely, a sibling will be almost as sensitized as the mother to a brother or sister who has problems, but siblings are usually more sensitized to distress in their parents than they are to distress in other siblings. (124)

All this focus on others, which is fed by anxiety, emotional reactivity, and subjectivity, pushes the family into a less functional state, a “regression”. (125)

[note 7] Feelings are not “bad” and thoughts “good”. Feelings are linked to the more automatic aspects of human functioning; thinking seems to be an evolutionary outgrowth of the nervous system’s capacity for self-control. Anxiety can intensify the feeling process to the point that the capacity for objective thinking in completely obliterated. When this happens, there is nothing to counterbalance the feeling process. Objective thinking, in contrast, does not obliterate the feeling process; both can be in awareness simultaneously. Psychological processes such as denial and obsessiveness, which can interfere with a person being aware of his feelings, have nothing to do with objectivity, but are governed by emotional reactivity. (125)

More differentiated functioning by one person prompts others to focus on and be more responsible for themselves. This does not result from demanding that others be different or by threatening them if they do not change, but simply from setting a responsible direction for oneself that is not dependent on anyone’s cooperation. When one person can do this, others will eventually do it too. (126)

Even if one person takes a dogmatic and overly authoritarian stance, if the emphasis is on “I” and not “you”, it can break the anxiety spiral the stem the regression. (126)

The approach to anxiety based on the principles of family systems theory is indirect in the sense that the reduction of chronic anxiety is a by-product of increasing one’s basic level of differentiation. (126)
Anxiety can be reduced in many ways that do not depend on the development of more of a self. for example, physical distance from emotionally significant others or denial of one’s feelings responsiveness to others can provide emotional insulation from people and situations that are difficult. Projection of one’s feeling and attitudes onto others can also relive anxiety within oneself by allowing one to view other people as the problem. (127)

… “stress management” activities. These approaches are not primarily designed to increase the basic level of differentiation of self, but to help people to be more aware of the physiological manifestations of anxiety and to learn techniques of self-control and relaxation. These techniques can be useful adjuncts to working on improving one’s level of differentiation. Sometimes, however, the effectiveness of these approaches appears to be based more on the relationship with the therapist or teacher (or with other group members) than on any new awareness of anxiety and greater ability for self-control. (128)

…symptoms are frequently “exchanged” among family members. This exchange is a product of the borrowing and trading of “self” (pseudo-self) or functioning that occurs among family members. Commonly, one person’s symptom will stabilize or even disappear when his mate or another emotionally significant figure develops a symptom. Frequently, after a symptomatic child enters psychotherapy and improves, his parents will report that a sibling, previously functioning well, has developed problems. One’s spouse previously labile [128] hypertension may stabilize (without a change in medication) after his mate develops a chronic back problem. (129)

People are not more differentiated or emotionally separate from one another; the focus has just moved from one person to another. This can be a “side effect” of stress management approaches that ignore family process. (129)
One compiles with being taken care of because it makes the caretaker feel better and, in some respects, easier to deal with. [The total process of symptom development is more complicated than this, but the calming effect one person’s dysfunction can have on the person who takes care of him can be one important element in the development and maintenance of symptoms. The caretaker does not “want” or “need” the other to be sick, but he is in fact calmer when he feels needed and is doing for others. (129)

People outside the family who are emotionally responsive to it can also contribute their anxiety, emotionally reactivity, and subjectivity to the family cauldron. (130)

Since every family generates clinical levels of dysfunction, labeling one family as “sick” and another as “well” misses the point. Every family, given sufficient generations, spawns schizophrenia or an equivalent dysfunction. Every family, given sufficient generations, spawns fairly high levels of differentiation as well. (130)
When one person can work toward a slightly higher level of differentiation, he will reduce not only his own level of chronic anxiety but the level of the chronic anxiety in the family as well. Symptoms are reduced throughout the family, not just exchanged. (130)

[note 11] Being more of a self is based on rejecting the other or on what is commonly referred to as “outgrowing” the other. The latter is usually associated with a much less active relationship with other person one has allegedly “outgrown”, an outcome that results more from the emotional reactivity of both people than from increased basic differentiation. (130)

Symptoms and aberrant or selfish behavior are assumed to reflect a lack of togetherness rather than to reflect an anxious togetherness in which people have lost individual direction and are functioning in reaction to one another. (132)

A systems orientation provides a different perspective on the human process, but in an emotionally charged atmosphere one must be pretty convinced of the validity of such a perspective to maintain it. In an anxious environment, people who want to make decisions based on a broad and long-term view are pushed aside by people who want quick answers and immediate relief from problems. (132)

The triangle is the basic molecule of an emotional system. It is the smallest stable relationship unit. (134)

The triangle describes the what, how, when, and where of relationships, not the why. Triangle are simply a fact of nature. … Conjecture about why any one person says or does a particular thing immediately takes the observer out of a systems frame of reference. The assignment of motive is necessarily subjective and not verifiable; the assignment of function can be objective and potentially verifiable. [In systems thinking, a particular behavior is understood in terms of its function in the system in which it occurs. “Why” thinking ascribes motives somewhere, either to the individual or to some larger entity. Thinking in terms of interrelationships in functioning does not require that any motive be assigned. Beliefs can be incorporated into systems thinking in this way. While it may not be possible to assign the content of a belief to the realm of fact, the function of that belief for the individual and the group can be factually defined. The content of paranoid ideation, for example, is not factual, but paranoid ideation does have a function. [f(x) is fact b/c we can observe effect.] ]. (134)

A two-person system may be stable as long as it is calm, but since that level of calm is very difficult to maintain, a two-person system is more accurately characterized as unstable. When anxiety increases, a third person becomes involved in the tension of the twosome, creating a triangle [The formation of a triangle is an anxiety-binding process that occurs simultaneously with the other relationship adjustments people make in response to anxiety that were described in Chapter 3.] This involvement of a third person decreases anxiety in the twosome by spreading in through three relationships. The formation of three interconnected relationships can contain more anxiety than is possible in three separate relationships because pathways are in place that allow the shifting of anxiety around the system. … The ability to spread and shift tension, as well as to contain more of it, means that a triangle is more flexible and stable than a two-person system. (135)

Triangles are forever, at least in families. Once the emotional circuitry of a triangle is in place, it usually outlives the people who participate in it. If one member of a triangle dies, another person usually replaces him. The actors come and go, but the play lives on through the generations. Children may act out a conflict that was never resolved between their great-grandparents. (135)

When anxiety in the emotional field of a triangle is low, two people are comfortably close (the insiders) and the third is a less comfortable outsider. This is not a static system; even during calm periods it is in constant motion. Both insiders continually make adjustments to preserve their comfortable togetherness, lest one become uncomfortable and form a togetherness with the outsider. The outsider is not idly standing by, but continually attempts to form a togetherness with one of the insiders. All the participants make predictable moves to achieve their ends. (136)
A triangle has different characteristics during moderately anxiety periods than in calm periods. … The uncomfortable one attempts first to restore a comfortable equilibrium with the other insider, but, due to the higher level of anxiety that exists, it is more difficult to achieve than it was when things were calmer. … When unsuccessful at restoring comfortable equilibrium, the uncomfortable one will initiate a togetherness with the outsider. … In a calm emotional field, the insiders work to exclude an outsider; in a moderate anxiety field, the outsider is actively recruited for more involvement. (136)
This pattern is exceedingly common in families. For examples, as long as an oldest daughter and her father are in conflict, harmony can be preserved between the parents and between the daughter and her mother. (137)
The sympathy keeps the mother and daughter relationship in harmony. The marital tension does not disappear, however; instead, it is acted out as conflict between father and daughter. (138)

During high stress periods, the emotional process in a triangle assumes new characteristic. Now the outside position is the most comfortable and desired. Each member of an overly intense two-person relationship works to get an outside position in a triangle to escape the tensions of the relationship. A mother, caught in intense conflict with her son, may actively recruit the father to “deal” with the son. When he attempts to do so, conflict erupts between father and son and mother withdraws. The son may counter this move by attempting to precipitate conflict between his parents. (138)

(1) A stable twosome can be destabilized by the addition of a third person. For example, a harmonious marriage may become conflictual after the birth of a child. The parents’ ability to keep their relationship in equilibrium is undermined by the investment of time and energy the child’s presence requires. / (2) A stable twosome can be destabilized by the removal of a third person. For example, marital disharmony may increase after a child leaves home. Once out of the home, the child is not as readily available to be triangled into the parents’ problems. / [138] (3) An unstable twosome can be stabilized by the addition of a third person. For example, a conflictual marriage may become more harmonious after the birth of a child. The parents shift the focus of their anxieties from one another to the child. / (4) An unstable twosome can be stabilized by the removal of a third person. For example, conflict in a twosome can be reduced if the two people avoid a third person who had been consistently taking sides on issues in their relationship. Side-taking foments conflict by emotionally polarizing the issues. (138-9)

The lower the level of differentiation in a family, the more important the role of triangling for preserving emotional stability. (139)

If people can maintain their emotional autonomy, triangling is minimal, and the system’s stability does not depend on it. (139)

This process in which anxiety, unable to be contained within one triangle, overflows into one or more other triangles, is referred to as interlocking triangles. In a calm family, anxiety can be contained mostly in one central triangle. Under stress, however, the anxiety spreads to other family triangles and to triangles outside the family in the work and social systems. / Interlocking triangles can significantly reduce anxiety in a family’s central triangle. (140)

Anxiety in the central triangle may have been diminished initially by its diffusion into the system of interlocking triangles, but when this anxiety spreads into the larger system (the mental health center, service agencies, and the courts), it is often amplified (via the emotional reactivity of the helping professionals) and focused back on the family. …the anxiety-induced loss of differentiation and the process of triangling result in the helpers’ becoming a major component of the family’s problem. (141)

There are triangles in which one person can be characterized as the anxiety “generator”, a second person as the anxiety “amplifier”, and the third as the anxiety “dampener”. The “generator” is typically accused of setting the emotional tone for the triangle (and family). Others directly or indirectly imply that the “generator” is the one who upsets people. While the “generator” may be the first person to get nervous about potential problems, he is not the cause of the anxiety that circulates in the triangle. The “amplifier” adds to the problem by his inability to stay calm when the “generator” is anxious. … The “dampener” uses emotional distance to control his reactivity to the others, but at a certain level of tension he can be relied on to become overly responsible for the others… (142)

Another common example of fairly inflexible functioning positions is a triangle of two parents and a child in which the child functions as an emotional appendage of his parents. He chronically adapts his thoughts, feelings, and behavior to reduce tension in the parents. The child may abandon so much control over his own life that as an adult he becomes quite dysfunctional and totally dependent on the parents. … Often the child or young adult is able to manipulate the parents into giving him what he wants. As a result of these manipulations, he is characterized as “selfish and demanding”. Observing the pressure he puts on the parents, outsiders often feel sorry for them and blame the child. … The parents do give up “self” in relationship to the child, but they do not give up as much as the child does. It is the child’s functioning that is most seriously impaired. (143)
While there is not sufficient research available to support firm conclusions, available data suggests that the triangling process [143] exists in several species of primates and other mammals. (143-144)

There appear to be some unique features of triangles in man. More extensive systems of interlocking triangles probably exist in man than in other species and the durability of these systems (throughout the lifetimes of individuals and across many generations) is probably far greater in man than in other life forms. The durability of triangles in human depends, in part, on functions of intelligence such as the ability to recognize individuals and long-term memory. While higher mental functions and psychological factors play an important role in human triangles, the basic process of triangles are deeper than psychological ones. / Triangles are assumed to be rooted in an instinctual process; they reflect the automatic emotional reactiveness of human beings to one another. The precision and predictability of triangles suggest that they may reflect properties of protoplasm itself. Triangles may be anchored in processes “deeper” than genes. (144)

Well differentiated people do not make a “federal case” out of being an outsider, nor does their emotional security depend on being one of the insiders. This keeps whatever traingling that goes on among well differentiated people low-key and flexible. (144)

To have more of the characteristics that can be observed in human triangles, however, these three organism would have to stay in viable contact with one another, an ability that depends on well developed capacities for memory and individual recognition. [Perhaps this could also be achieved by forcing animals together in a physical enclosure.] Again, while the elaboration of triangles during the course of evolution depended on the emergence of higher nervous system functions, the driving forces of triangles are assumed to be very very old. (145)

A basic tenet of systems therapy is that the tension in a two-person relationship will resolve automatically when contained within a three-person system, one of whom is emotionally detached. In other words, despite togetherness urges to the contrary, a problem between two people can be resolved without the “well intentioned” efforts of a third person to “fix” it. It only requires that the third person be in adequate emotional contact with the other two and able to remain emotionally separate from them. The process of being in contact and emotionally separate is referred to as “detriangling”. (145)

If a twosome regains emotional equilibrium in the presence of a detached third person, the existence of symptoms in a relationship suggests that the relationship is linked ot one or more other people who are not emotionally detached from it. (146)

A relationship between two moderately differentiated people provides a good illustration of the role of triangles in symptom development. In the relationship’s early stages, the two people can keep the relationship in sufficient emotional equilibrium that anxiety is low and there is little pressure to triangle a third person. Over time, based on stresses internal pressure to triangle a third person. Over time, based on stresses interal and/or external to the relationship, anxiety will incrase and the two people will exert more togetherness pressure on each another. Mechanisms for binding this anxiety within the twosome, such as conflict, distance, and adapting to preserve harmony, will increasingly come into play. In addition, when the discomfort reaches a certain level, the more uncomfortable member of the twosome will involve a third person in the tension. … The uncomfortable one is “helped” to maintain distance. This changes the character of the original twosome and can result in the previously more comfortable member ending up in a very uncomfortable outside position. He may become symptomatic at this point. (146)
…whenever motives are assigned to the behavior of any person in a triangle, awareness of a process that transcends the motives of individuals is lost. (147)
The effect of having an involved but “untriangled” third person is to “nudge” each martial partner toward accepting more responsibility for the problem and attaching more importance to working it out between them. Acceptance of responsibility for one’s own problem and motivation to work out that problem within the relationship where it has surfaced appear to be the ingredients necessary to override the tendency of feelings and subjectivity to govern interactions. (148)

Systems ideas describe what is—not what “should” be. Differentiation describes the capacity to make a choice; it does not define the “correct” or “best” choice. (148)

The mother is anxious about the prospect of her children not feeling they are being given equal attention, equal “love”. Her anxieties are translation into actions that communicate that she is assuming responsibility for making the children feel they are being treated equally. In response to this, each child grows up feeling that his mother is responsible for making him feel equally “loved” and for correcting any perceived deficits in “fair” treatment. Each child becomes highly sensitive about the “amount” of attention he thinks he receives relative to a sibling. (149)

…the father may be critical of his wife for not treating the children “equally”. When he does this, the triangle consists of the mother at one corner, the father at the second corner, and the two children at the third corner. (149)

Emotional neutrality is unrelated to approving or disapproving of particular aspects of human behavior and unrelated to making rules for oneself about not passing judgment on people’s actions. Adherence to rules usually results in the appearance of being more neutral than is actually the case. Nor does neutrality mean straddling fences or being wishy-washy. One can have a very clear position relevant to what occurs in a family and in society and still be emotionally neutral. Dogmatic positions, the inability ot define where one stands on important issues, and efforts directed at changing others all betray the absence of emotional neutrality. In essence, neutrality is reflected in the ability to define self without being emotionally invested in one’s own viewpoint or in changing the viewpoints of others. (150)

Emotional neutrality is reflected in a number of ways, two of which are especially relevant to triangles: first, the ability to see both sides of a relationship process between two others, and second, the ability not to have one’s thinking about that process clouded with notions about what “should” be. [150] …it is equally important (for purposes of differentiation and detriangling) to be able to be in contact with such a relationship without its triggering feelings and attitudes that define it as “sick” or “abnormal” or “bad” or “pathetic”—as something that “should not” be. Intolerance of aspects of the human process is a manifestation of being triangled into it. (150-151)
A principle for guiding one’s efforts to communicate a neutral position in a triangle is to respond to someone’s efforts to triangle by saying and doing things that push that person together with the one with whom he is having a problem. (151)

Given how common the impulse to keep people apart is, a principle for getting oneself more detached in a triangle by encouraging more involvement between the twosome could not be expected to make “sense” to one’s feelings. … The goal of making such a remark is not to alter the relationship between the mother and son but to convey one’s neutrality about it. (152)

The capacity for neutrality is usually undermined by … being so emotionally influenced by the experience that one spends one’s life emotionally and/or physically running away from the family. All of these reactions are evidence of the way a person is triangled into the situation. (152)
In an effort to detriangle, the daughter might say, “If mother provided all the support you want, her expectations of what you could deliver would soar”. The remark (regardless of whether there is any truth to it) addresses a process between the parents without being critical of either parent’s involvement in it. (153)

[note 10] People usually attempt to detriangle before they are anywhere near being objective and emotionally neutral. (153)

In general, detriangling is most effective in low to moderate anxiety situations. In high anxiety emotional fields, people are usually too uptight to detriangle effectively and the family to too anxious to respond to it. When anxiety is that high, the goal is to stay in contact with people but not let the anxiety dictate one’s actions. When the anxiety is reduced, detriangling comments can then be constructive. (154)

To [156] achieve more emotional separation from either parents, the basic task is to detriangle from the important triangles that involve that parent. (156-157)
Nobody detriangles completely from any triangle, but the process of achieving even small increments of change can result in some increase in one’s basic level of differentiation. (157)

The fact that A’s father is dead is not an impediment to detriangling from the parental triangle. All that is required is for A to establish a relationship with her paternal first cousin. By making emotional contact with the cousin, A activates the original triangle with her parents. She activates it by making contact with a person who is part of the emotional field of her father’s family. The emotional field does not die with the deaths of individual people’ it is carried down the generations through interlocking triangles. The family will respond to A’s contact with her cousin as if she had made contact with her father. This may sound mystical, but all one has to do is make such contacts to appreciate the fact that this happens. (157)

F’s cutoff from her mother was presumably related to wanting to avoid the childlike position she characteristically assumed whenever she spent even just a few days with her. The mother’s reluctance to bridge the cutoff with F presumably reflected her own anxieties about dealing with her. [It is common for a parent-child relationship that was quite involved during the child’s growing up years to convert to a strained distance in adult life. (159)

To detriangle effectively, E has to accomplish several things. First, she has to see the process of the triangle fairly accurately. Second, she must overcome an attitude that has colored much of her behavior previously—that her emotional lot in life would be better if her mother had given her all the attention E felt she needed when she was growing up. E’s anger about this and attitude that she had been treated “unfairly” had been an undercurrent in many of her interactions with the family. [When a person can see the workings of the interlocking triangles in his family, it can help resolve his feelings about the past. The resolution of feelings is not a product of suppression or denial, but relates to getting beyond taking the situation personally and blaming oneself or others.] A third thing necessary for detriangling is an ability to recognize the influence of feelings and subjectivity on one’s behavior and to have some control over automatic responses based on those feelings and subjectivity. (160)
… “Yes, I have been nasty to you. It’s my jealousy over the fact that you could always meet mother’s needs better than I could.” This response avoids a fight with F and is positive about the togetherness that exists between the youngest sister and the mother. In addition, rather than emphasize mother’s involvement with the sister, an issue which is highly emotionally charged, the emphasis is on the sister’s automatic tendency to adapt to relive her mother’s anxiety. [160] … The remark highlights the togetherness process between mother and baby sister, exaggerates it, and encourages it. (160-161)

It would be simpler if one could talk straightforwardly to people who are attempting to triangle you into their problem. It would be simpler if E could say to her sister, “We are acting out one side of the triangle.” The problem is that her sister may not see it that way. It was difficult enough for E to see it that way. Triangles are governed by what might be called an “emotional logic” and respond to comments and actions directed at that emotionality. People acting out the process of a triangle have an amazing ability to ignore the most rational and well presented explanations for what is occurring. Another reason for not “instructing” or “enlightening” the family about what one thinks he sees others doing is that it is usually an attempt to influence the family, which runs counter to differentiation of self. (161)

Maintaining one’s differentiation and detriangling is not an attempt to manipulate or control others, but a way of dealing with others’ attempts to manipulate and control oneself. (161)

Three categories of dysfunction occur in nuclear families: (1) illness in a spouse; (2) marital conflict; and (3) impairment of one or more children. (Chapter Seven; Nuclear Family Emotional System, 163)

Where a symptom occurs in a relationship system (in which family member or in which family relationship) is determined by the particular pattern or patterns of emotional functioning that predominate in that family system. If the predominant pattern is parents’ externalizing their anxieties into their marital relationship, periods of high anxiety are characterized by marital conflict. If the predominant pattern fosters dysfunction in a spouse or in a child, periods of high anxiety are characterized by symptoms developing in a spouse or in a child. The symptoms can be in the form of physical illness (defined conventionally as a “medical disorder”), emotional illness (defined conventionally as a “psychiatric disorder”), or social illness (defined conventionally as a “conduct disorder” or as a “criminal disorder”). (163)
This does not mean that patterns of emotional functioning in a family cause physical, emotional, or social illness; the creation of a specific illness depends on the combination of many factors. However, the patterns of emotional functioning in a nuclear family are a major influence on an individual’s ability to adapt successfully to the presence of factors that can precipitate illness. For example, if the patterns of emotional functioning most active in a family fosters dysfunction in a spouse, that spouse is more vulnerable than other family members to becoming ill in response to such things as the exposure to allergens or toxins, the presence of a genetic predisposition to a disease, the exposure to social attitudes that can foster various types of social irresponsibility. (164)
When one parent in a nuclear family is more physically, emotionally, or socially dysfunctional than other family members, this means that the anxiety generated by the undifferentiated functioning of every family member is being absorbed disproportionately by that symptomatic parent. (164)

The degree to which the undifferentiation of a nuclear family system is absorbed in one relationship or in the poor functioning of one person is the degree to which other relationship or in the poor functioning of one person is the degree to which other relationshis and other people are protected from dysfunction. If one parent’s functioning is impaired, the other parent may function better in reaction to it. If a child’s functioning is impaired, his siblings and his parents may function better in reaction to that dysfunction. If parents are in conflict, the binding of anxiety in the marital relationship frees the children to function better. (164)
The average level of chronic anxiety in a poorly differentiated family is so high that disharmony in one relationship or impaired functioning in one person cannot absorb it all. In such families, several people may be chroni-[164]cally symptomatic. (164-165)

When people leave their families and form new emotionally significant relationships, they tend to select mates with whom they can replicate the more influential aspects of the relationship process that existed in the original family. (167)

All the various ways of adapting to anxiety in relationship systems are part of everyone’s natural makeup. … Learning, however, plays a prominent role in determining which patterns of adapting are most active in a particular person and in a particular family. (167)

The pattern or patterns of emotional functioning that predominate in a particular family may change over time. (167)

Clinical dysfunctions are outcomes of relationship processes, processes that are not unique to the human species. This viewpoint does not exclude the roles of defects in physiological functioning or of exposure to “pathogenic” agents in the creation of illness. Such factors are important. However, systems theory defines variables that influence an individual’s ability to adapt successfully to the presence of internal defects or to the exposure to [168] external agents that have pathogenic potential. Successful adaptation means that even when defects or pathogenic influences are present, they do not disturb an organism’s equilibrium sufficiently to create significant symptoms. [Of course, even a highly adaptive individual can succumb to major internal defects or to an overwhelming assault of external pathogenic influences.] (168-169)

When a person becomes ill, the illness may develop quickly; the relationship processes that increase an individual’s vulnerability to illness, however, have been active for a longer period. (169)

The emotional “fit” in a marriage results from each spouse’s having been groomed by his or her own growing up experience to [169] act out the reciprocal side of his spouse’s transference. This interlocking of transference is not pathological. It seems inappropriate to regard a phenomenon as pathological when it is a universal feature of human relationships. (169-170)

People select mates who are at the same level of differentiation of self: Each person has the same amount of need for emotional reinforcement from the relationship. … The husband functions in relationship to his wife the same way her family did and the wife functions in relationship to her husband the same way his family did. [This can occur even when people are determined to create a family situation that is different from (better than) the one in which they grew up. The repetition of the past in spite of the determination to do otherwise is a product of people’s efforts being based on false assumptions about the nature of the problems in their original family. People can change the superficial appearance of things through efforts based on false assumptions, but underlying processes are not altered. One purpose of therapy is to question the accuracy of assumptions about past generations and in the process to develop a more reliable blueprint for directing one’s efforts with present and future generations.] (171)

The one who appears to be “dominant” may be making decisions based on perceptions of what the seemingly “subordinate” one wants. (172)
A person inclined to assume a dominant position in relationships can feel “lost” without someone to direct… (172)

The person most prone to becoming symptomatic is the one who makes the most adjustments in his or her thoughts, feelings, and behavior to preserve relationship harmony. The one making the most adjustments may be an overfunctioning person who, feeling an exaggerated sense of responsibility about making things “right” for others, is trying to do too much, or it may be an underfunctioning person who, feeling little confidence in his ability to make decisions, is depending on others too much. (172)
The type of symptom that develops (physical, emotional, or social) is connected both to the particular way an individual manages anxiety and to what others in the system focus on in that individual when they get anxious. For example, some families focus on physical [172] health, others focus on real or imagined deficiencies in character and emotional well-being, and other focus or behavior. (172-173)

The wife wanted a child very much and the uncertainty generated by the infertility diagnosis was an important component of her increased anxiety. However, the intensification of basic emotional patterns in the marital relationship after the diagnosis was more influential on the development of her symptoms than her personal reaction to the infertility situation. (173)

[note 10] If an individual cannot control his reactions to another person, and if the reactions are intense, he must distance from that person to control himself. Maintenance of self-control through avoidance and withdrawal appears to be a characteristic of all living things. … A successful effort to raise one’s basic level of differentiation reduces the need for emotional distance. (173)

The husband’s response to his wife symptoms was quite solicitous. He volunteered to shop and to drive her places, and never complained if his wife’s fears threatened cancellation of a social engagement. He seemed comfortable overfunctioning in this way. A new kind of “closeness” entered the relationship, a closeness oriented around the wife’s being a moderately dysfunctional person. [174] …therapy included both spouses and focused on the relationship process rather than on the wife’s symptoms. The husband saw the role of his emotional reactivity in creating distance between them, … She also became less preoccupied with what he said or did, … anxiety declined and the phobias disappeared. (174-175)

…the common denominator in the development of symptoms is a disturbance (actual or threatened) in a person’s most emotionally significant relationships. (175)

Disturbances in relationship systems that isolate people occur in two general ways: (1) A person gets cut off when a relationship is disrupted through an event such as death or divorce; (2) a person gets cut off when, in reaction to [175] the intensity of a relationship process, people withdraw emotionally from one another. In both instances, the lower a person’s level of differentiation, the more likely he will become isolated and anxiety if central relationship are disturbed. (175-176)

Emotional dysfunction exists on a continuum ranging from mild neurotic symptoms that come and go with fluctuations in the level of chronic anxiety to severe psychotic symptoms that are chronic. There are quantitative but not qualitative differences in the patterns of emotional functioning in nuclear families that generate symptoms at various points along this continuum. (177)

The severity of the symptom, in other words, tends to parallel the intensity of the relationship process that helps create the symptom. [It is presumed that the severity of the symptom can be out of proportion to the intensity of the relationship process if a person has major physiological defects or is exposed to large amounts of potentially pathogenic influences in the environment. Two people who develop cancer may each be entangled in equally problematic relationship systems, but if one has a physiological predisposition (genetic or otherwise) to pancreatic cancer, which tends to have a poor prognosis, and the other has a predisposition to breast cancer, which has a better prognosis, a difference in clinical outcomes may be unrelated to emotional factors. In the majority of cases, however, the severity of the clinical problem appears to parallel the intensity of the emotional process.] (177)

A person of 35 on the scale of differentiation, if under sufficient stress to increase his level of chronic anxiety for a protracted period, may have a psychotic reaction, perhaps in his second year of college. However, given his level of differentiation, he is likely to recover completely, not to have another psychotic episode, and to be reasonably responsible for himself throughout the rest of his life. A person at 15 on the scale of differentiation may also have a psychotic reaction, perhaps while in basic training for military service. While the acute symptoms of his psychosis may be identical to those of the person at 35 on the scale, he is less likely to recover an adequate level of functioning. During the rest of his life he will probably have numerous psychiatric hospitalizations and achieve little financial independence.]

Paradoxically, the overfunctioning spouse is willing to do many tasks for his “sick” mate, but he is allergic to dealing with issues that are emotionally charged. The functional spouse is easily overwhelmed by signs his mate is unhappy with him and wants him to change. He deals with childlike demands by giving in; it is easier to go along and avoid the other’s anger. (179)

Both spouses exert about equal pressure on one another to assume certain emotional postures. There are, however, some exceptions to this sort of mutual participation. In some marriages one spouse bulldozes the other spouse into a submissive role. Such overbearing spouses often go through many marriages, recreating the same type of relationship over and over. When the “bulldozed” spouse gets seriously dysfunctional, he or she flees to survive. In other marriages one spouse acts so “weak” and “helpless” that the other spouse is forced into a more dominant role than he or she really wants. The overfunctioning or “dominant” one frequently becomes symptomatic in such marriages. (180)

When a divorce occurs, the “sick” spouse may recover dramtically from whatever physical or emotional illness was present and the “well” spouse may suddenly or gradually collapse into some type of clinical dysfunction. (180)

Chronic severely disabling physical illnesses are more frequent in poorly differentiated families. [It is important to consider the nature of the illness in understanding the extent of disability it creates. Amyotrophic lateral sclerosis (Lou Gehrig’s disease), for example, is not confined to poorly differentiated people. The disability inherent in ALS is so great, however, that even a reasonably differentiated person with ALS is likely to be severely disabled and die. The age of onset of ALS, however, may be related to level of differentiation. A person who develops it in his seventies after a productive life is probably not the same emotionally as a person who develops it in his twenties. In other words, the time at which one is exposed to pathogenic influences important in the creation of ALS may have less influence on when the disease develops than does an individual’s adaptive capacity (related, in part, to differentiation). Once a characteristically disabling and/or deadly disease emerges, however, its clinical course and outcome are probably largely unrelated to the capacity to adapt. In contrast, the clinical course and outcome of disease that are not always virulent may be influenced significantly by emotional variables that affect adaptive capacity such as differentiation and chronic anxiety.] (181)

Physiological systems involved in the development of physical illness that were once thought to operate largely autonomously (the im-[181]mune system and the automatic nervous system) are now known to both influence and be influenced by the central nervous system. The connections between the endocrine system (also involved in physical illness) and the central nervous system have been recognized for a longer time. (181-182)

The existence of a mind-body link and a person-person link means that it is possible for anxiety in one person to be manifested as a physical symptom in another person. (182)

One scenario in which a spouse can get physically ill is when the dominant spouse anxiously focuses on the more adaptive one and the adaptive one feels pressured to change… Another scenario in which a spouse can get physically ill is when he is so heavily depended on by others, and so strongly pressured by himself to produce, that he tries to do more than his body can tolerate. (182)

Therapy was quite helpful. … She was eventually able to worry less about the future, to view her husband as capable of assuming responsibility for his own problems, to hold herself less responsible for fixing everything, and to be less angry at her husband for not fixing everything. (185)
In another case, the wife had had moderate symptoms throughout much of the marriage: labile blood pressure, spastic colon, and phobias. The husband had not had major health problems before he retired. Soon after retirement, however, he developed complications of pulmonary emphysema. When he was sick, the wife’s blood pressure was normal, her colon was quiet, and the phobias were reduced…finally, the husband died. The wife was the more dominant force in the relationship. (185)
The spouse who “chooses” to support the other appears to be the dependent partner, but it is actually this “dependent” one who “assigned” the roles. The “dependent” one does give up “self” in the process and that makes him or her vulnerable to symptoms. Later, when the intensity of the togetherness is increased by changes in circumstances, such as retirement, the dominance of the “dependent” one comes to the surface and the other spouse adapts to the point of symptoms. Such relationships are valuable reminders of the role of the “right amount” of emotional distance in preventing symptoms. There are as many symptoms related to “too little” distance as there are related to “too much” distance. (186)

The spouse who develops social symptoms is the one who has adapted the most to the togetherness pressure of the family. This can be a person in an overfunctioning position or in an underfunctioning position. (186)
The criminal acting-out of people lower on the scale of differentiation is often unremitting. Such people relate to the world primarily through their problems. They are quite emotionally isolated people in many respects. They often form relationships with the legal system similar to those schizophrenic people form with the mental health system. Many poorly differentiated [186] criminals appear to be more comfortable in prison than out. The overall social process no doubt has more influence on the incidence of criminal behavior in the society at any given time, but family emotional process is a major influence on determining which people act out. (186-187)
A principal difference between a conflictual marriage that does not produce symptoms and a harmonious marriage that does produce symptoms is that in a conflictual marriage each spouse is convinced that it is the other spouse who needs to do the changing; in a symptom-producing marriage each spouse is convinced that it is one spouse who needs to do the changing. As will be described later, in a marriage that produces problems in children, each spouse is convinced that it is the children… (187)

When people are convinced that an issue must get resolved for conflict to disappear, it is very easy for them to get polarized on the issue. When people are convinced that their conflict must disappear for the issue to get resolved, polarizations tend to evaporate. (188)

…paradoxically, however, each spouse says and does things that invite the very comments and actions from the other spouse to which he or she is most allergic. A spouse who wants to be told he is “loved” reduces his chances of hearing it when he acts sullen if he does not hear it. People get “turned off” by one another’s neediness. A spouse who does not want to be “dictated to” increases his chances of being dictated to by overreacting and rebelling against the perceived “domination” of the other. Rebellion invites efforts to control and efforts to control invite rebellion. (189)

Some conflictual marriages can be characterized as each person wanting to lean on the other more than the other will permit. Other conflictual marriages are better characterized as each feeling the other wants to control the situation. All conflictual marriages contain both of these elements to some extent. (190)

Hearing the therapist as implying that one spouse is more “emotional” than the other, or hearing toning down reactivity and focusing on oneself as suppression of feelings and selfishness are misperceptions about the nature of differentiation. (191)

The wife had begun to recognize the difference between pretending to be a more separate person and really being a more separate person, the difference between controlling feelings based on suppression and toning down feelings based on thinking differently about the nature of a problem. When a person can see both sides of a relationship process and see that process in a broad context, it is not necessary for him to control his anger at others. Awareness of process help a person get beyond blaming others or blaming some external force and, as a consequence, he becomes less angry. The husband was happy with his wife’s suppression of feelings; she was off his back. However, he reacted strongly when her basic orientation toward him, the amount of energy she focused on him, began to change. (192)

So spouses in a conflictual marriage are less vulnerable to physical, emotional, or social symptoms. In addition, children of conflictual marriages are less vulnerable to symptoms. / While conflictual spouses and their children are less vulnerable to developing symptoms, they are not invulnerable. … So a marriage in which one or both spouses are dysfunctional can also be fairly conflictual. People can also be fairly conflictual and still manage to incorporate their children into many of their problems. (193)

The children of these parents may grow up with basic levels of differentiation higher or lower than the parents, but not 30 points higher or lower. Emotional systems change slowly. (193)

[note 18] The levels of differentiation developed by adopted children are governed by the same emotional processes that govern the levels developed by a family’s biological children. So if a child is adopted as an infant, his level of differentiation will be determined by the emotional process in his adoptive family. If a child is adopted when he is a little older, his level of differentiation will be influenced both by his adoptive family and by the significant emotional attachments he had prior to the adoption. (195)

[note 19] Assessment of differences in basic levels of differentiation between siblings is complicated by the fact that the functional level of differentiation of one sibling can be influenced by the functional level of another sibling. For example, one child can do “everything right” in reaction to another child’s doing “everything wrong.” (196)
The relationship with the most direct influence on the basic level of differentiation is the one with the primary caretaker who, in most instances, is the mother. … The person most significant to a child is usually the one most emotionally invested in him. … While the mother-child relationship usually has the most direct influence on the level of differentiation developed by a child… [196] … A mother-child relationship is influenced through the process of interlocking triangles by other relationships in the nuclear and extended families. The marital relationship is an example. (197)

Emotional distance between the parents increases a mother’s vulnerability to overinvolvement with her children. Or, if a mother is prone to overinvolvement with the children and the father reacts passively to that involvement and distances from his wife, the marital distance makes it more difficult for mother and child to separate emotionally from one another. A father may actively promote his wife’s overinvolvement with the children because it reduces pressure on him to deal with her emotional needs. Another way a father may undermine his child’s separation from the mother is by holding his wife responsible for changing some aspect of the child he is anxious about. He may do this by repeatedly telling his wife what worries him about the child. (197)

Automatic emotional reactivity between mother and child, at its peak in the early months of a child’s life, helps guarantee that the reality needs of the child (food, protection, contact, and various types of stimulation) are met. (197)

The potential for nearly complete resolution of the original symbiosis exists in every mother-child relationship, but the degree of realization of that potential is quite variable. (197)

At one extreme, a mother’s relationship with her child from birth is primarily influenced by the reality needs of the child. Mother is comfortable with the infant’s dependence on her and with her automatic emotional responsiveness to him. She feels neither trapped nor drained emotionally by taking care of the child. As the child grows, mother consistently acts in ways that both allow and foster the child’s growing away from her. … At the other extreme a mother’s relationship with her child from birth is primarily influenced by her anxiety and emotional needs. She may experience considerable emotional well-being or marked anxiety in reaction to the infant’s dependence on her. The well-being is derived from meeting needs for emotional closeness not met in other relationships in the relationship with the child. The anxiety often stems from feeling overwhelmed by the responsibility for the child and feeling inadequate as a mother. … Without considerable support from mother, he has little energy to explore the world and is largely unavailable for other relationships (such as with father). As a consequence, his life orientation is based mostly on knowledge of mother’s beliefs, fears, and anxieties. (198)
While mothers differ from one another in the proportion of things they do that promote rather than undermine emotional separation of a child, the same mother can be different in this regard with each of her children. One mother described this difference as follows: “I have the most immature relationship I have ever had in my life with my first child. I probably have the most mature relationship I have ever had with my second child the relationships with my husband and other two children are somewhere in between.” The mother did not blame the children for the difference in the relationship. She viewed it as a mutual process. (199)
For example, two siblings may have similar personality traits by virtue of the family having focused on the same types of things in both children, but these traits are more pronounced—and potentially more problematic—in the child who has the more undifferentiated relationship with his parents. The content, in other words, is much less important than the intensity of the emotional process that underlies the content. Content varies from family to family and from culture to culture; emotional process is the same (varying only in degree of intensity) in all families and in all cultures. (202)

If a child is continually irresponsible, this does not reflect a failure by his parents to “teach” him to be responsible. Characteristically, the parents have devoted considerable energy to trying to convince the child he “should” be responsible. …This focus on what the child “should” do undermines the child’s emotional separation from the parents and fosters his irresponsibility. [202] … Children are not wild animals that need to be tamed. If parents focus on being responsible for themselves and respecting boundaries in relating to their children, the children will automatically grow toward being responsible for themselves and respecting boundaries in relating to their parents. / When a person is “teaching” responsibility or “differentiation” to others, he is usually “preaching” responsibility or differentiation, which defeats differentiation in both self and others. (202-203)

The more differentiation that exists between a child and his parents, the freer the child is to see his parents as they are. …the less likely it is that the child will idealize or denigrate either parent. He will have a fairly balanced view of each parent’s strengths and weaknesses, a view distorted neither by the anxieties and needs of the parents nor by the anxieties and needs of the child. Objectivity about one’s parents (the ultimate resolution of the transference or unresolved emotional attachment to one’s family) promotes objectivity about oneself. (203)

Society tends to blame the emotional problems of children on the failure of their parents to be sufficiently available, caring, and supportive. In fact, many developmental theories make the same assumption. Parents are not immune to these judgments by others or to the valued opinions of “experts”. (205)

It does not logically follow, however, that because emotional instability and “depression” can result from an infant’s being denied adequate access to its mother that most people who feel “insecure” or “depressed” duffer from “inadequate mothering”. … In the vast majority of instances where people feel insecure, unloved, or rejected, such feelings have emerged as a result of the undifferentiation that exists between a mother and a child. (206)

If a person’s distress is relived by contact, however, that does not mean that his distress is “caused” by lack of contract. … The people most vulnerable to feeling a lack of connection with others are the people who were most intensely connected to their families as children. This connection may have resulted in marked distance or conflict, but it is the connection, whether the emotional tone was positive or negative, that is important to recognize. (208)

A mother-child relationship, regardless of how much emotional separation [208] exists, may be harmonious from the beginning and remain so for life. Children who are the product of such relationships tend to adapt to preserve harmony in adult relationships (the lower the level of differentiation, the greater the tendency to adapt.) (209)

[note 209] Family systems theory assigns less importance to “traumatic events” in understanding an individual’s emotional development than it does to ongoing family process. Events may highlight some aspects of the nature of the process, but the events are not the process. (209)

The overly helpful child often denies his own need for emotional support and pretends to be “strong” in the face of the feigned “weakness” of his parents. The parents’ “weakness” is feigned in the sense that they act more helpless in the face of anxiety than they really are (a helpless posture in a way of dealing with anxiety). (210)
Family myths about who was a “favorite” or who was an “outsider” are also notoriously unreliable indicators of what actually transpired between a child and his family. (211)

An anxious focus on firstborn can also produce a fairly helpless oldest child. In such instances, a second child develops to be more like a firstborn. He becomes a “functional oldest”. (211)

A child born during a period of unusual stress on the family often has unique significance to the mother. (212)

The more parents are able to know the members of their families of origin as individuals in their own right and not as caricatures created by a family togetherness process, the better the chance that their own children will grow up to be individuals in their own right and not amalgams of what their parents define them to be. (213)

The more anxiety parents feel about the prospect of their children’s not feeling “equally loved”, the greater the chance their children will howl (overtly or covertly) about not getting equal treatment. (213)
[note 28] A principle of family therapy is derived from family systems theory is that that parents are more capable than their dependent children of assuming responsibility for change in the family. So even if the presenting problem in a family is a symptomatic child, the primary focus of therapy is the parents’ working toward more differentiation of self—in relationship to each other and in relationship to the children. Family systems theory defines an interdependence of emotional functioning between family members, so a change in functioning of either parent is expected to produce a change in the functioning of a symptomatic child. (215)
The intensity of an adolescent’s rebellion parallels his lack of emotional separation from his family: … (216)

They do the worrying and he does the acting out. He screams for “less hassle” and “more freedom”, but many of his actions invite more involvement of the parents in his life. It is the familiar vicious cycle of a systems process. (216)

A father is usually more reactive to his wife’s anxiety than he is to the actions of the child. He contributes to the child’s problem, however, by trying to relieve his wife’s anxiety through attempting to control the child’s behavior. His approach may range form a passive pleading and cajoling to a dogmatic and authoritarian threatening and punish. All of his actions are largely ineffective because they are based on the assumption that the problem is in the child rather than in the parental triangle. The mother also tries to control the child’s behavior, but she is equally ineffective. (216)

It is paradoxical that the more unsure of themselves and permissive parents are, the more they say (and yell) “No” to the child. The more they say (and yell) “No”, the more the child rebels. … If a parent can be more of a self, the parent can avoid this kind of emotional trap. If a parent says “No” in reference to what he (the parent) will do (“I will not”) rather than in reference to what the child “should” do (“You will not”), the child cannot use the parent to react off emotionally. A child automatically listens to, “I will not”, just as he automatically does not listen to, “You will not”. (217)

A very common clinical course for schizophrenia is one in which the child has few symptoms while he is growing up. Mother usually perceives this child as “different” from birth, as someone special to her in a particular way. She feels the child requires more from her than her other children. [218] … The first serious problems do not occur usually until the child has to function more independently. He may go into the Army and have a psychotic episode in basic training or he may collapse in his first year of college. For the most part, the parents did not see the warning signals and are genuinely surprised by the child’s collapse. … There are usually more influences on a “patient’s” deterioration than simply stopping the medicine. For example, he may stop taking medicine in reaction to increased anxiety in the family. The increase in family anxiety, to which he is very reactive, may have a more important role in his psychotic deterioration than the cessation of psychotropic medication. (219)
Other schizophrenic people are cut off from their families and attached to institutions. … The institutions tend to relate to them the same way their families did nut, since the emotional process between patient and institution is usually less intense than it was with the family, the relationship often provides considerable stability for the patient. (220)
While it is very difficult to modify the basic relationship processes that contribute to schizophrenic, a family can do a great deal to stabilize the situation if each family member focuses on his or her own anxiety and functioning. (220)

It is important to recognize, however, that many people receive the diagnosis of “schizophrenia” who, from the standpoint of family systems theory, do not merit that diagnosis. These are often people in the 25-35 range of basic differentiation who have had one or more psychotic episodes. While these people may be dependent on their families, the degree of their unresolved attachment to the family is less than it is with “true” schizophrenia. There is some possibility for basic change. (220)
Every family, given sufficient generations, tends to produce people at both functional extremes and people at most points on a continuum between these extremes. (Chapter Eight; Multigenerational Emotional Process, 221)
…very unstable functioning in one family member is usually associated with unstable functioning in other family members in the existing and preceding few generations. Similarly, very stable functioning in one [222] family member is usually associated with stable functioning in other family members in the existing and preceding few generations. (223)
…the functioning of the grandparents of a family member whose functioning is unstable in most aspects may have been fairly stable. Such quantum jumps in functioning are uncommon, however. It is much more common for only mild to moderate discrepancies in functioning to exist after four or five generations. (223)

In contrast to the assumption of a random and unpredictable process or to the assumption of a process linked only to genetic transmission, family systems theory assumes that individual differences in functioning and multigenerational trends in functioning reflect an orderly and predictable relationship process that connects the functioning reflect an orderly and predictable relationship process that connects the functioning of family members across generations. This process is referred to as the multigenerational emotional process or as the multigenerational transmission process. (224)

Genes are a component of the emotional system, but they determine neither the specific ways in which emotional process is played out in one generation (marital conflict or [224] sickness in a spouse) nor the specific ways it is transmitted to the next generation (which child is most focused on and what the characteristics of that focus are). (224-225)
People who marry have the same level of differentiation of self. (225)
The total amount of anxiety or undifferentiation in a family system plus the specific ways in which that anxiety or undifferentiation is bound determine each child’s degree of emotional separation. (225)

Since it is likely that there will be more anxiety to bind in this husband’s nuclear family (third generation) than there was to bind in the family in which he grew up, and even more to bind than in the family in which his father grew up, the anxiety-binding mechanisms, taken as a whole, will be more active in this generation than in the previous two generations (paternal line). If this anxiety is heavily focused on one child (fourth generation), that child will separate emotionally from his parents less than they separated from their parents, which was less than this husband’s father separated from his parents. (228)

[note 3] While basic level of differentiation is connected to relationship processes, this does not mean that differentiation is entirely learned or that it is just a psychological process. Differentiation describes the variable mix of individuality and togetherness life forces within an individual and within a relationship system. … Based on learning (which may influence the expression of genes or developmental processes), different types of physiological and physical functioning are characteristic of people at different points on the scale of differentiation. The psychological and physiological or physical aspects of differentiation are interrelated. (228)

Marked downward changes in differentiation (quantum jumps), although uncommon, can occur if the following conditions are present in two successive generations: (1) The primary mechanism for binding family anxiety is focus on one particular child [229] … (2) the nuclear family is poorly connected to emotional support systems, especially to the extended family system (the isolation increases family anxiety and intensify the focus on the child); and (3) there is at least an average amount of stress on the family (unusually favorable circumstances do not ameliorate the effects of the first two conditions). If these conditions are met, a 20-piont difference in basic levels of differentiation between grandparents and a grandchild can develop (about ten points in each generation). (229-230)
[note 4] Systems theory does not conceptualize “unconscious conflicts” to be the cause of “neurotic” symptoms. Systems theory links all symptoms to the emotional system, a system that is not equivalent to the psychoanalytic “unconscious”. (230)

A nuclear family’s ability to sustain contact with emotional support systems is a particularly important influence on the rate of downward or upward progression in basic differentiation. (232)

…the members of a family with a high level of differentiation may be distressed by the death of an important member of the extended family but, in spite of the individual reactivity of people to the event, the balance of the family emotional system is not significantly disturbed. Family members react to the event, but they do not react to each other’s reactions. They do not lean on one another excessively, nor are they “allergic” to one another’s temporarily heightened emotional needs. (234)
One outcome of the marked impairment in adaptiveness that can occur in an individual and in a nuclear family as a result of the multigenerational emotional process is schizophrenia. Schizophrenia is present in all cultures and probably in all families (if sufficient generations are examined). Its equivalent appears to exist in subhuman species. (236)
The facts defined by psychological and biological research on schizophrenic patients can be incorporated into systems theory, but systems theory broadens the conventional conceptualization of schizophrenia to include the relationship system of the “patient” (present and past generations). While diagnosing schizophrenia is based on a particular complex of sings and symptoms present in an individual, family systems theory does not view these signs and symptoms as caused by a “disease” contained within that individual. The individual’s “disease” is considered to be a symptom of a relationship process that extends beyond the boundaries of the individual “patient”. (237)
Preoccupation with psychotic ruminations is a type of internal withdrawal that appears to have two functions. It reduces a schizophrenic person’s social contact, which provides some protection from the anxiety associated with dealing with others, and it insulates him somewhat from his own feelings. So the symptoms of schizophrenia are, at least in part, an attempt to maintain emotional equilibrium within the individual and between the individual and his environment. (239)
The parents of someone in the 0-10 range of differentiation may not have clinical schizophrenia, but their basic levels of differentiation are unlikely to be higher than 20. (Their functional levels may be higher than 20.) (239)
When sever schizophrenia emerges after several generational “quantum jumps” in functioning, the adaptiveness of close relatives is less impaired than when it results from a more gradual generational process. (239)

The occurrence of multiple cases of schizophrenia in one family suggests that an inherited tendency, perhaps related to a specific gene or genes, plays a role in increasing the vulnerability of family members to psychotic symptoms. While genetic “defects” may, at least in some instances, be important in schizophrenia, these “defects”, according to [239] family systems theory, are an incomplete explanation for the severely impaired adaptiveness associated with “hard-core” schizophrenia. [The potential for psychosis may very well be part of everyone’s makeup. Perhaps everyone has the “genes” for schizophrenia. In some instances, the combination of markedly impaired adaptiveness and fairly routine life stress can precipitate a psychosis. In other instances, the combination of reasonably good adaptiveness and extreme life stress can precipitate the psychosis. Whether the potential for psychosis is actually part of everyone is difficult to determine, however, because there are so many other ways people manage anxiety. (239-240)

People with higher levels of differentiation of self (25-35) may have several psychotic episodes during the course of their lives and some impairment of other aspects of their functioning. When psychotic episodes occur, such people are often diagnosed as having “schizophrenia”, but their overall functioning is more stable than that of people lower on the scale. They may function fairly effectively between psychotic episodes. They often marry, have children, and perform their jobs with reasonable consistency. Diagnosing such people as having schizophrenia emphasizes their weakness more than their strengths. People over 35 on the scale can also have a psychotic episode if the amount of stress and other factors exceed their adaptiveness. They may have one episode in a lifetime. Factors such as mechanisms for binding anxiety other than psychosis, favorable life events, and good support systems can reduce the number of functional collapses and psychotic periods of even a poorly adaptive person, but basic level of differentiation is probably the most important predictor of a given person’s clinical course. Family systems theory reserves the term schizophrenia for chronically or very frequently psychotic people whose functioning in very unstable in most aspects of their lives (the lowest levels of differentiation of self.) (240)
There may be an inherited predisposition (genetic or otherwise) to manic-depressive symptoms, but all people who have such symptoms are not equally adaptive. Those with low levels of differentiation have lives that are usually unstable in most aspects. They have frequent and prolonged psychiatric hospitalizations, tumultuous and unstable relationships, and erratic school and job performance. Those with higher levels of differentiation may have only one or two manic or depressive periods in a lifetime. [240] … Similarly, all people diagnosed as having “alcoholism” do not have the same basic level of differentiation. All psychiatric diagnoses, in fact, can be conceptualized on this continuum of adaptiveness or differentiation. (240-241)

The most extreme forms of manic-depression, alcoholism, obsessive-compulsive neurosis, and homosexuality, for example, develop over the course of at least several generations. [Saying the extreme form of these symptoms “develops over the course of at least several generations” does not mean that they were present in a family member in each of of preceding several generations. A person with a basic level of differentiation in the 30 range who manages his anxiety and undifferentiation with a pronounced homosexual lifestyle may not have had a parent with obvious homosexual tendencies. However, he definitely would have had a parent with a basic level of differentiation not markedly differentiation from his own, for example 25-35. A person with a basic level of differentiation in the 45 range may have one or two beief homosexual acting-out experiences when he is under high stress. He would have had a parent with a basic level of differentiation in the 40-50 range. So saying that the intensity of symptoms in generations deep does not necessarily mean that the actual symptoms have been present in preceding generations. It means that basic levels of differentiation are generations deep.] (241)
[note 12] People with bipolar symptoms whose lives are very unstable are frequently diagnosed as having “schizoaffective disorder”, a combination of schizophrenia and manic-depression. Most of these distinctions between dignostic categories may eventually be discarded in favor of a continuum ranging from mild occasional depression to chronic psychosis. Where an individual is on the continuum would be governed by the amount of chronic anxiety he is trying to manage within self and associated degree withdrawl. (241)
Basic levels of differentiation in one generation always limit the range of possibilities of basic levels of differentiation in the next generation. (242)
[note 23] So while one manifestation of a low level of differentiation may be a failure to reproduce, a failure to reproduce does not necessarily indicate a low level of differentiation. A low level of differentiation can also be manifested in uncontrolled reproduction. People continue to have children when it is clear they cannot cope effectively with the ones they already have. (246)

In most families they found the same pattern of earlier age of onset [246] in successive generations in certain family lines. This trend is usually referred to as anticipation. (246-247)

‘The whole course can be run in two generations, but is is more commonly completed in three or four and rarely in more. That is to say, we rarely find families with a history of diabetes I nmore than four generations. / In this picture, those patients that develop the disease in later life appear as cases of first or second generations. They are offshoots of a vine that has been affected for only a limited time—expression of a young family of diabetics. On the other hand, juvenile diabetic patients appear as cases of following generations. In families that show rapid anticipation, they can be representatives of second generations but average rates are more often third or fourth generations. They are shoots from a vine that has been diseased for a long time—expressions of an old family diabetes. [Woodyatt, R.T. and Spetz, M: Anticipaation in the inheritance of diabetes, JAMA, 120:604, 1942.] (247)

While the clustering of a specific disease ina family may often be related more to genetics than to faily emotional process, the clinical course of that disease in different family members is assumed to be significantly related to family emotional process. (248)

The trend toward earlier age of onset and increased severity of symptoms in successive generations that is almost always present in at least some lines of high-incidence families is consistent with the occurrence of generational “quantum jumps” downward in basic levels of differentiation. (249)

In many instances, assessment of the degree of adaptiveness may be more useful in predicting clinical outcome than assessment of the virulence of any pathogenic involved. (250)

Schizophrenia is not foreign to the human condition; it is an exaggeration of the human condition. In contrast, when a theory considers schizophrenia to be the result of a “defect”, the theory is not conceptualizing schizophrenia as one end of a continuum of functioning. (253)

There is no exit from this imprisonment for people with very low basic levels of basic differentiation. They are too embedded in the process. The degree of it fluctuates somewhat with the level of anxiety, but it never really changes. / People with higher levels of differentition can modify this process of blaming self/blaming others and an effort to do so is a major component of most forms of psychotherapy. (254)

People can develop more emotional neutrality, however, by studying their own and other people’s multigenerational families to a degree sufficient to convince themselves that human beings have limited emotional autonomy. If human beings are linked together emotionally across the generations by a process that is fueled by automatic reactions and reinforced by subjectivity, who does one blame? (255)

When people function in reactions to one another, they are functioning based on the automatic emotional reactivity man has in common with the subhuman forms. When people can be in contact but still emotionally autonomous, it is their intellectual systems that are largely influencing the character of their thoughts and actions. (Chapter Nine; Symptom Development, 256)
When symptoms are quite debilitating or life-threatening, it can be difficult to find the time and energy required to modify basic levels of differentiation. Life-threatening symptoms can be modified, however, by changes in functional level of differentiation. (257)

However, it is now generally recognized that most illnesses usually result from more than one “cause”. Illness usually results from the interplay of several factors or processes. (258)

If facts from any level of investigation are ignored in a formulation about schizophrenia, the formulation is not based on a systems model. If facts from any level of investigation are assumed to be the cause of schizophrenia, such a formulation is also not based on a systems model. Schizophrenia is not a “disease” confined within the boundaries of an individual; it is all the processes at multiple levels known to create and reinforce impaired functioning in one individual. (260)

Lawrence LeShan (1977) has developed a psychotherapeutic approach to cancer patients who have not responded to standard medical treatment. His results demand attention. Patients who have failed all medical regimens available for their particular cancer—“the medically hopeless”—have a 50% cure rate with LeShan’s approach. LeShan, whose approach is primarily to the individual, emphasizes the importance of treatment on multiple levels: the biological, the psychological, and spiritual. He defines the spiritual level as “the deep and basic need to have a meaningful framework of existence (LeShan, 1982). LeShan considers the cancer patient to be a person who has “lost his way.” He has despair and hopelessness about ever being able “to sing his own song.” LeShan’s theapeutic goal is not to cure the cancer, but to help [260] the patient “sing his own song” or “live under his own name.” Rather than “the problem being bigger than the person,” LeShan tries to help the person become “bigger than the problem”. His relationship with his patients appears to be a very important component of their being able to acquire or recover a direction in their lives. (260-261)
When a patient with systemic lupus erythematosus is treated with steroids and her spouse is told she should “avoid stress”, this may encourage the patient’s spouse to overfunction even more than he had been doing. The increased overfunctioning, now done in the name of “helping” the “sick” spouse avoid stress, may interfere with the lupus patient’s ability to regain control over her emotional and physical functioning. (261)
A system model does not imply psychotic people should not be given psychotropic drugs or that people with rheumatoid arthritis should not be given anti-inflammatory agents. (261)

The human family is an emotional system and the human body is an emotional system, but each system may require certain unique as well as common concepts to explain the relationship between its parts. There may be no relationship, for example, between cellular differentiation and human differentiation. As natural systems theories are developed at multiple levels, it may be possible, perhaps in a century, to integrate their common denominators into a useful comprehensive theory. (262)

…this does not mean that the family is the cause of the problem. Because intervention on one level can influence processes on other levels does not mean that the symptoms were caused by processes on the level at which one intervenes. (263)

In addition, the number of contacts people have with family does not necessarily reflect the degree of cutoff. Contacts may be frequent, but highly ritualized. (272)

If one does not see himself as part of the system, his only options are either to try to get others to change or to withdraw. If one sees himself as part of the system, he has a new option: to stay in contact [272] with others and change self. This does not mean changing self under pressure from the togetherness; it means changing self based on a process that comes from within the person. (272-273)

Certain extended family systems are “explosive”. They tend to scatter across the country or around the globe, leaving people at great distances from one another. Such families can be reasonably well differentiated or quite poorly differentiated. In the better differentiated “explosive” families, people move apart in the process of pursuing life goals. Though physically distant, they maintain good emotional contact. (274)
Improving emotional contact with the extended family has the potential to significantly reduce serious physical, emotional, and social symptoms in oneself and/or in one’s nuclear family. (276)

A therapist who asks questions about process can help a family member overcome whatever denial or lack of awareness exists about his part in the family process. (284)

Psychoanalytic training addresses this problem by requiring analysts to have [285] a personal analysis. Family systems training addresses the problem by requiring trainees to bridge the cutoff from their families of origin through differentiation of self. Both psychoanalysis and differentiation of self in one’s family of origin enhance a therapist’s ability to monitor the effect of his own emotional functioning on his clinical work. (286)

If both a husband and wife are motivated for therapy, the sessions can be done with both spouses together, with each spouse seen individually (by the same therapist), or with a combination of the two approaches. In the beginning of therapy, both spouses commonly seen together. After a period of weeks or months, often after one or both are clear that the effort involves working on self and not on the other, most of the sessions may be individual ones. … At times, however, seeing people together impedes the progress of one or both of them. There may be a tendency to cover the same ground over and over. When seen together, it is sometimes difficult for people to escape the notion that “we” are trying to change and to embrace the notion of “I” am trying to change. When it is a “we” endeavor, each one often gets preoccupied with whether the other one is doing his or her part. Another problem that can occur with two people together is that each one is so reactive to the other that neither can think in the sessions. (288)
When people seek therapy because of a problem in a child, the child and the parents may be included in the initial evaluation period. As therapy progresses, however, most of time is spent with the parents, either individually or together. The child may have some individual sessions, but he is not the primary focus of therapy. In most instances, even if the present symptoms are in a child, it is not necessary to treat him directly. (288)

There is no “rule” against seeing a spouse or child who is pressured to come for therapy, but if the process is not recognized and addressed, the therapist supports the family projection process. A therapist may have to take a stand and not see a family member unless other family members participate. (289)

Therapy involving an entire nuclear family or some combination of nuclear and extended family members is sometimes requested by a family. Such therapy is generally referred to as family group therapy. Family group therapy conducted by a skilled therapist can be extremely useful for reducing anxiety and relieving symptoms. It is a cumbersome approach, however, for facilitating changes in basic levels of differentiation of self. This is because it is easy for family group therapy to foster a togetherness solution to a problem rather than an individuality solution. [289] … A togetherness solution makes the integrity of the group dependent on the “weakest link”, the first person who gets reactive. An individuality solution is much more durable. (290)

During an evaluation, a therapist addresses ten basic questions: 1) Who initiated the therapy? 2) What is the symptom and which family member or family relationship is symptomatic? 3) What is the immediate relationship system (this usually means the nuclear family) of the symptomatic person? 4) What are the patters of emotional functioning in the nuclear family? 5) What is the intensity of the emotional process in the nuclear family? 6) What influences that intensity—an overload of stressful events and/or a low level of adpativeness? 7) What is the nature of the extended family systems, particularly in terms of their stability and availability? 8) What is the degree of emotional cutoff from each extended family? 9) What is the prognosis? 10) What are the important directions for therapy? / Beginning answers to all of these questions come from information gathered during a family evaluation interview. (290)

The family evaluation interview begins with a history of the presenting problem. This part of the interview focuses largely on the symptoms and on the symptomatic person or relationship. Here it is important simply to let the family tell its story and to listens careful to each family member’s perception of the problem. Fairly exact dates of when the symptoms developed [290] or recurred are important. (290-291)

[note 9] The emphasis on a therapist’s asking questions rather than making interpretations does not imply that a therapist never expresses an opinion. A therapist does have a responsibility to articulate his viewpoint clearly. (293)
The basic information collected about each extended family is similar to the information collected about the nuclear family.

Usually, however, a therapist collects a little less detail about the extended family system than about the nuclear family system. If a family member is motivated, however, to define more of a self in his family of origin, he will eventually assemble a great deal of data about his multigenerational family. Unless a therapist has a specific research interest in a clinical family, it is not necessary for him to be aware of all this information. A therapist provides general principles and guidelines for approach to the extended family and he helps a family member recognize when he is “caught” in the system emotionally, but the family member is on his own in the project in many respects. The information the family member gathers is more important to him than to the therapist.

An older brother with a younger brother, for example, tends to be a leader who works hard and endures hardships. It is natural for him to accept responsibility and to assume that tasks will not get done unless he does them himself or sees to it that someone does them. A younger brother with an older brother does best when others are looking out for him. It is not as natural for him to assume leadership and to accept responsibility as it is for an older brother. He is likely to assume that tasks will get done because others will do them. Charm is often one of his strong points. An older sister with a younger sister wants to stand on her own and take care of others. She may act more sure of herself than she really is. She gravitates to leadership positions, but tends to dominate others. A younger sister with an older sister opts for an adventurous and colorful life. Rather than being motherly or bossy, she tends to be feminine, capricious, and willful. She is rarely a good leader. … Middle children may reflect the experience of growing up in “two” sibling positions: younger than the older sibling and older than the younger sibling. Spacing of siblings is important. Five or more years difference between siblings usually reduces the predictability of the characteristics [314] associated with each position. (314-315)