Family Sickness

A sullen twelve-year-old girl hunches over in a chair, surrounded by her father, mother, sister, brother and a child psychiatrist. Her problem: severe asthma that will not respond to medical attention. After listening to the parents discuss the asthma, the psychiatrist suddenly switches attention to the sister's ample figure. She is clearly overweight. Isn't that a family problem too? As the family starts talking about obesity, the asthmatic girl sits up in her chair.

According to the psychiatrist, Dr. Ronald Liebman, Chief of Psychiatry at Philadelphia's Children's Hospital, that shift in the discussion helped bring the asthma under control. "The patient's overprotective parents," he says, "were focusing so much concern on her that she was responding with ever more severe symptoms." The girl understood that her parents' concern was no longer focused on her alone but on two family problems. After two months of complicated family therapy, the girl's asthma symptoms subsided. The trips to hospital emergency rooms ended, and she missed no more school time.

The case is a classic one in family therapy, the medical movement that arose some 15 years ago from a common clinical observation: many psychiatric patients seem unable to get better because of the pressures their families put on them. Family therapists began by abandoning the one-on-one, isolated relationship of traditional psychiatry to take on a patient's whole family. Their aim: to expose and break family patterns that create individual emotional disorders. Now family therapists are increasingly finding that those patterns also help produce physical ailments, from asthma to heart attacks and--some are convinced--even cancer.

Horrible Fantasies. Psychiatrist Norman Paul of Cambridge, Mass., reports some success in using family therapy to control epilepsy. Working with Dr. Robert Feldman, head of neurology at the Boston University School of Medicine, he triggers seizures in epileptics and later shows a video tape of the attack to the entire family. The results so far: of twelve patients treated over the past three years, four have improved dramatically. One woman, 40, went from four seizures a day to one every eight months. Says Paul: "Epileptics have horrible fantasies about what they do. When they see the tapes, they can come to terms with what they go through and how it affects their families."

Dr. Salvador Minuchin, Director of ihe Philadelphia Child Guidance Center, has already attracted wide attention with his work on anorexia nervosa, the "starvation disease" (TIME, July 28). Now Minuchin and his team are concentrating on asthma and diabetes. In one case of diabetic sisters, ages twelve and 17, doctors found a metabolic defect, but only the younger sister responded to drugs and diet changes. A therapist found out why: each parent constantly tried to get her support in fights with the other parent. The allegiance of the twelve-year-old was not sought. Once the parents stopped trapping the older sister in their struggles, she too began responding to treatment.

In many cases, family therapists argue, an outbreak of physical illness is both a symptom of high stress among family members and an attempt to cope with it. Minuchin says that anorexia nervosa victims are "saviors of the family" because they paper over parental conflicts that threaten to destroy the family. Psychiatrist Philip Guerin, director of the Center for Family Learning in New Rochelle, N.Y., finds that many fathers suffer heart attacks shortly after a grown son or daughter leaves home. His hypothesis: the child may have functioned as a buffer for parental conflict. Psychologist Dina Fleischer of Richmond's Medical College of Virginia reports on the family of a man who had a heart transplant in 1968: when the patient was near death, the family functioned well; when he recovered, the family unraveled; whenever he relapsed, the family functioned well again.

According to Dr. Claus B. Bahnson, family therapist and professor of psychiatry at Philadelphia's Jefferson Med ical College, heart attacks tend to occur in "outer-directed" families--those that stress the need for success and approval by outsiders. Cancer tends to appear in "inner-directed" families. Such families often channel their emotional response to stress internally through the nervous system. This inward surge may upset the body's hormonal balance and, perhaps, immunological processes--two mechanisms that play a significant role in combating cancer.

Cancer Factor. Dr. Michael Kerr, a clinical professor of psychiatry in the family section of Georgetown University Medical School, believes that emotional problems helped produce cancer in 25 of 30 cases he has treated at the Vincent T. Lombardi Cancer Center. "We're not saying that the emotional system of a family causes cancer, but it is a factor."

Though the medical world still remains skeptical of some of the claims of family therapy, major hospitals such as San Francisco General, New York's Albert Einstein and McLean in Boston now have family therapists or other psychiatrists dealing with medical patients and their families, looking for stresses that might impede cures. Says New Rochelle's Guerin, whose center teaches family therapy to a hundred psychiatrists and psychologists a year: "Doctors are picking up on family research. They're beginning to de-isolate the individual. Family therapy is coming of age."

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