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Families in psychiatry: homage to Dr. Murray Bowen.

Dr. Denis Fiallos Montero, who L./describes himself as "an old-time psychiatrist" who grew up during the Family Therapy days, wrote to me to point out "a great omission" in my recent discussion about some of the pioneers in our field ("Dr. Minuchin and the Ashtray" October 2012, p. 4).

Whom did I fail to mention? The late Dr. Murray Bowen.

Dr. Bowen was the originator of the American Family Therapy Association and served as the group's first president, from 1978 to 1982. (See the Bowen Center website for details of his enduring legacy at www.the-bowencenter.org.)

This column is dedicated to these two gentlemen.

Individuation as a concept

The spirit of Murray Bowen sits in the corner at every family therapist's family gathering and reminds us about triangulation! He told us clearly that one of the main tasks of individuation is finding the right level of differentiation from our parents.

Concepts of emotional fusion and emotional cutoff are helpful at this time of year, as many of us struggle with conflicted thoughts and feelings about our families of origin.

At one end of the differentiation spectrum is emotional fusion (overly close fused relationships); at the other end of the spectrum is emotional cutoff (disconnection between family members or refusal to engage with certain family members).

Bowen described emotional cutoffs as "the natural mechanisms people use to counter high anxiety or high emotional fusion that arise from unresolved issues with our family of origin" (Family Evaluation, New York: W.W. Norton and Co., 1988). He and his longtime colleague Dr. Michael E. Kerr noted that unresolved family issues get passed down through the generations, with successive generations being affected by seemingly mysterious emotional behaviors.

Common laments at this time of year are "I feel like a child when I go home," "I feel guilty when I go home," and "I want to take care of those parents of mine and make them do the right thing!" Or we think things like: "I feel angry that my parents do not understand or approve of me." Friends give advice: "Just go home for a short time. Try to avoid sensitive issues. Try to not get into things with them, and then you all will get along."

Gritting your teeth and powering through a family visit is exhausting. However, what is the alternative?

Bowen thought that to develop a healthy sense of self, you must be in good relation with your family of origin, and that all adults in the family should be in "comfortable emotional contact." A self-report scale called the Differentiation of Self-Inventory (DSI) is based on Bowen's theory and measures emotional functioning, intimacy, and autonomy in interpersonal relationships.

Its subscales assess interpersonal and intrapsychic dimensions of differentiation problems (i.e., emotional reactivity and difficulty taking an "I" position) (J. Counseling Psychol. 1998;45:235-46). The DSI has questions like: "I would never consider turning to any of my family members for emotional support," and "I often feel unsure when others are not around to help me make a decision."

Personal connections to theory

Bowen's theories are helpful to me in thinking about my family of origin. I recently returned to Scotland to visit my Aunt Charlotte. My aunt is the living embodiment of an emotional cutoff.

The original family insult occurred before she was born. Her beloved brother Charlie, the first-born son, was killed in a car accident when he was a young child. Charlotte was the replacement child," prescribed by the general practitioner to help my grandmother recover from the grief and loss of her son.

Of course, this was not a successful prescription, and the grief and sense of loss continued. However, more tragically, Aunt Charlotte's mere presence triggered feelings of grief, anger, and guilt for her parents and sister.

Aunt Charlotte was the weakest and most sensitive member of our family. She suffered from asthma and, as an adult, was the victim of a car accident that left her cognitively impaired. (No one seemed to think it was ironic that the accident heightened the family's anger and distaste for her, rather than provoke sympathy that she could now no longer live a productive life.)

Mentioning Aunt Charlotte's name in our household raised everyone's blood pressure. As a young teenager, I was acutely aware of the "unfairness" of the family's responses to her. Although we all knew about Charlie's death, we had little understanding of the connection between his death and how Aunt Charlotte was perceived.

I do remember the strong negative feelings in the house at holiday times, but neither my family nor I, as an adolescent, understood what was being enacted. As an adult, I have come to understand that the grief, anger, and emotional tension experienced by Charlie's death were shifted and projected onto Aunt Charlotte.

Encouraged to seek a life of her own, she eventually moved away, to a small town, close to where her mother had been born and raised. She enjoyed volunteering at the house where Mary, Queen of Scots, had lived, a woman who herself was one of Scotland's most tragic figures. The best way the family could function, it seemed, was to use emotional cutoff. As an adult, I have been able to go back and talk with her and her friends, discussing the grief and trauma in the family. Understanding that an emotional cutoff was used to manage the unbearable emotional tensions in the family brings understanding and a way to think about what happened over the years. How much better if her parents and sister had been able to understand this, too!

Forerunner of the genogram

Bowen focused on helping family members develop emotional objectivity about their family relationships. Bowen would draw a family diagram, the forerunner of the genogram, and talk through the family influences on each member. His goal was to help the patient develop emotional object and a greater intellectual understanding about their family of origin. He wanted to help the patient understand the emotional tasks of differentiation. In the case of Aunt Charlotte, therapy might not have been able to restore her to the family, but at least therapy would have given her and our family a deeper appreciation of the impact of trauma on family relationships and subsequent generations.

Healthy relationships with one's family of origin mean having the right amount of differentiation. You know you have it when you can relate to your family members without regressing to the "child" position or the "parent" position--and when going home feels good, not fraught with angst, anger, or other strong and difficult emotions.

However, if it still doesn't feel good because of unresolved problems, it is still possible to develop greater emotional objectivity and a deeper intellectual understanding.

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DR. HERU is with the department of psychiatry at the University of Colorado at Denver, Aurora. E-mail Dr. Heru at cpnews@elsevier.com. Scan the QR code to see an archive of her columns.
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Title Annotation:OPINION
Author:Heru, Alison M.
Publication:Clinical Psychiatry News
Article Type:Letter to the editor
Date:Jan 1, 2013
Words:1216
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