Godmindfamily, Chapter 4

Chapter 4: Bowen Theory, Unidisease and Symptoms – A Godmindbody Perspective

I can see that Bowen’s framework may be useful when trying to understand and improve family relationships: there are definitely recurring intergenerational familial patterns of behaviour, emotional fusion with other people is a real phenomenon, quite often (but not always) the sibling personality profiles in Bowen Theory’s Secrets are accurate, people are usually more emotional with their nuclear families than they are with outsiders due to conditioning, the welfare state has produced too many ‘underfunctioning’ citizens, nations do function in a way as giant families, triangles obviously emerge in human relationships, with one person typically in the outside position, and mollycoddling with an excessive focus on one child often goes awry, with better outcomes for the other children.

I do think Kerr slightly overstated the harmfulness of mollycoddling and intrafamilial fusion however, because he saw the most extreme examples of it as a psychiatrist and picked out some famous insane people for his case studies in Bowen Theory’s Secrets, leading to a somewhat skewed sample. Neglecting children can be equally harmful – look at the largely vapid ‘daycare generation’ and the many serial killers, violent criminals and disordered personalities with abandonment issues. Not being loved makes it hard to love and love restrains sin, perhaps more than knowledge.

A prime example is Jeffrey Dahmer, whose parents didn’t devote much time to him. He was left alone in the family home for months at age 18, when his parents divorced. Dahmer explained that he killed to create a complaint ‘zombie’ who would never leave him. Of course, that in no way excuses what Dahmer did.

While we can’t totally control others – they were given free will by God, in that they are free to do as they please – Bowen was right that improving one’s self-differentiation can disrupt poor behavioural patterns in family systems by denying the other parties the reaction that fuels the dysfunction. If all the relevant parties commit to change, with the right understanding, obviously the chances of a better outcome are higher – hence the potential utility of family therapy.In certain cases, however, emotional cutoff is actually the best (or least-worst) move. For example, if someone’s father is a psychopathic war criminal, the child is probably best advised to steer clear rather than trying to mend fences with a guy who will do his best to exploit them for his own ends. Jesus said, ‘Don’t think that I came to send peace to the earth. I didn’t come to send peace, but a sword. For I came to set a man at odds against his father, a daughter against her mother and a daughter in law against a mother in law,’ (Matthew 10:34–35). That doesn’t mean family members who don’t share your faith should be ruthlessly shunned or persecuted on that basis, but if they want to cut you off because of your God, and can’t be persuaded to a more tolerant view, then you should let them go rather than abandon your faith, provided that faith is actually correct.

Anxiety is a main cause of symptoms, yes, Bowen and Kerr are right about that, which is good. But it's only the fear of symptoms and the associated negative beliefs about symptoms that are really important in pathogenesis. Stresses in the family or outside of the family, and anxiety about other family members, are secondary in symptom development, and don't need to be eliminated in order for the individual to heal. This insight significantly lowers the bar for healing. Kerr’s unidisease concept does not seem to provide simple or easy solutions with a lot of success stories, at least for physical symptoms, in contrast to Doctor Sarno’s work on TMS (The Mindbody Syndrome). Most of Sarno’s success stories did not talk about improving their family relationships, for example, although some definitely did, by being more honest, assertive and establishing stronger boundaries.

The family member who most accommodates the others (overfunctions) in a family is often the most anxious/goodist person in the family, and anxious people (including perfectionists) tend to get symptoms because they tend to worry about symptoms and are prone to adopting negative beliefs – that may inadvertently become self-fulfilling prophecies – as a defence mechanism against disappointment. The cause of the symptoms here is the negative beliefs and symptom-anxiety, not so much the familial stress or general anxiety. That symptom-anxiety and health related negative beliefs are all that need to be addressed for healing to occur and doing that may be a component of differentiation of self, but it is not identical with it. We know this because some people with functional or even happy families get TMS – if they worry about symptoms. Of course, even well differentiated people have gotten sick and died, and those illnesses are nonetheless psychogenic. And then there are those people – increasingly rare – who suffer tremendous stress and trauma with highly dysfunctional relationships or families, yet remain symptom free.

‘Underfunctioning’, introverted and isolated people are more prone to symptoms than extroverts with big social networks largely due to ‘holiday syndrome’ – the minds of unemployed introverts are less occupied than people with a busy work schedule and lots of social functions to attend, so there is more headspace and time leftover for introverts to worry about symptoms and adopt beliefs that are harmful to themselves. They also tend to be what Bowen would call poorly differentiated, but not always.

Sometimes, social isolation is very positive and can provide time and space for learning, without being influenced by false, trendy ideas. Examples of this include Buddha, Saint Antony and especially Jesus (e.g. the 40 days). Jesus did not have a high-income job or a fancy degree – he was effectively homeless during his ministry – but Bowen acknowledged him as a model of high differentiation of self because of his helpfulness. These examples are exceptions to the rule, though, and most people experience isolation negatively.

Systems thinking does provide valuable insights about interpersonal dynamics, but it can also make it seem like the individual is more dependent on the family (and the environment in general) for their mental and physical health than they actually are, by downplaying the importance of the individual. God will judge each person according to his or her deeds, which demonstrates the responsibility placed upon the individual by the Creator. Others, including family members, often exert a negative influence on behaviour and personality, but the individual nonetheless has the power to not be influenced, to control their own beliefs, especially if God is on their side. I don’t know to what extent Bowen would have agreed with that statement.

If you believe that during periods of family stress you are liable to get sick, whether due to perceived low SD or the inherent stressfulness of the events themselves, then this belief will become a self-fulfilling prophecy. I understand Kerr wrote that stress is created by how people react to events, not so much the events themselves, which is true, but it is possible to get stressed out – to react averagely or poorly to life events – and not experience symptoms. We know this because it happens all the time.

Adherents of Bowen Theory might come to believe they must resolve their family issues, remove themselves from an anxious family environment and become more differentiated in order to heal or prevent symptoms, when all they really need is to believe that symptoms will disappear thanks to comprehension of the right information (which also lowers symptom-related anxiety), and act on those beliefs by resuming normal activities. To be fair, you could argue that Sarno’s theory is also too ‘stress dependent’, overemphasising unconscious emotions that don’t need to be investigated for healing.But simply believing symptoms will go away and acting accordingly is easier to do than changing the personality and managing emotional reactions to family members, which some people just cannot do. People now expect to get ill when they are stressed, because medicine has accepted that stress plays a major role in various diseases, which to some extent has become a self-fulfilling prophecy – and Bowen’s theory does not fully account for this. I cannot blame Bowen theory for the overemphasis on stress in disease, however: that is part of a much deeper cultural trend of the last 80 or so years. Many other alternative and mainstream medical paradigms are worse than Bowen Theory, which is actually one of the better models out there for understanding symptoms, relationships and behaviour.

Indeed, Bowen had a better understanding of disease than conventional doctors and deserves credit for that, and for being bold enough to recognise that virtually all chronic disease (including cancer) has an emotional causation. I agree with Bowen/Kerr’s scepticism of diagnoses, but shifting the diagnosis from the individual to the family unit also comes with risks. Sometimes, especially in severely dysfunctional cases, family problems need to be addressed, at other times (e.g. in some borderline cases), focusing attention on the problem and worrying about it can make it much worse and the family would be better off simply ignoring the issue and carrying on. There is a concerning tendency in 21^st century culture to pathologize and thereby exacerbate – and medicate – what is basically normal behaviour.

Symptoms are transmitted through families, yes. This occurs more because of the nocebo effect than some inexorable hereditary factor: someone sees their parent suffering badly from a symptom and then comes to fear that particular symptom a lot and possibly expects to develop the symptom themselves. The fear and expectation then become a self-fulfilling prophecy, that manifests biologically.

Bowen and Kerr kept seeing the intergenerational development from healthy grandparents to subclinical schizoid parents to schizophrenic children partly because the psychiatric and medical systems have increasingly (over)diagnosed people and nocebo inducing information has also proliferated over time, especially in the Information Age. This information only elicits a nocebo effect when people believe it, but unfortunately, most people believe false medical information because it is widely accepted, and they are socially fused. That combination of a flawed conventional medical paradigm – and dubious alternative medical modalities – with the internet and new devices largely accounts for why chronic disease and mental disorder rates have risen in the past 20 years. I believe a lot of hereditary diseases with genetic components work in this way. Bowen partly understood that process, but with a bit too much emphasis on factors other than symptom-related anxiety and beliefs.

There are cases, however, where the parent’s anxieties about their child’s health obviously became a self-fulfilling prophecy, but only because the child believed the parent’s fears were valid, in yet another example of a nocebo effect.

For example, Jenny has a six-year old daughter, Anna. Jenny’s little sister had cystic fibrosis and died when she was young. Jenny had a miscarriage before Anna was born. Shortly after Anna was born, she developed a tendency to chest infections. All of this contributes to Jenny’s anxiety around Anna’s health. Jenny takes great precautions to prevent Anna from ‘catching anything’, always keeping her warm, and isolated from other kids and their germs as much as possible, and she cleans the house scrupulously. Despite – or rather, because of – these restrictions, Anna keeps getting chest infections and tonsillitis. She picked up on her mother’s anxiety, which exerted a nocebo effect on her mind and body, and weakened her immune system, rendering her vulnerable to otherwise harmless pathogens, in yet another instance of the self-fulfilling prophecy. If Jenny understood what was going on, educated her daughter and ceased all her counterproductive restrictions, Anna would have a much better chance of improved health and emotional independence from her mother.

Bowen was right to highlight the kind of dynamic described above, which also applies to certain cases of dysfunctional behaviour in children. It’s very clear when someone in a family receives a psychiatric diagnosis that well-meaning relatives walk on eggshells around them and ‘expect’ them to exhibit mental symptoms; this is not particularly helpful and can exert a suggestive effect on the patient, albeit unintentionally. Far too many people are constantly giving each other nocebo effects with their well-intentioned, but misguided health advice. I’ll list some examples here: ‘running on roads will destroy your cartilage’; ‘try wearing this steel bracelet, it helps your joints’; ‘hanging upside down helps my back pain, you should try it’; ‘don’t eat that, it will give you inflammation’; ‘these probiotics will heal your leaky gut’.

The best part of Kerr’s book Bowen Theory’s Secrets was the short section on supernatural phenomena and the power of belief in healing. That was really great, but underdeveloped. Understanding how belief in recovery can heal is more useful for addressing symptoms than all of the rest of the book combined, although there are other valid reasons for understanding family dynamics, such as improving relationships. Bowen’s therapy could successfully resolve symptoms, and I believe it has done so, but only when patients believe the explanations and believe it will work on their symptoms. Overall, Bowen was much better at understanding family and interpersonal dynamics than he was at healing symptoms, especially physical symptoms. Read the next chapter here: https://www.robertensor.com/post/godmindfamily-chapter-5