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CHAPTER 3
Theory in the Practice of
Psychotherapy
Murray Bowen, M.D.
There are striking discrepancies between theory and practice in psychother- apy. The therapist's theoretical assumptions about the nature and origin of emotional illness serve as a blueprint that guides his thinking and actions during psychotherapy. This has always been so, even though "theory" and " therapeutic method" have not always been clearly defined. Primitive medi- cine men who believed that emotional illness was the result of evil spirits had some kind of theoretical notions about the evil spirits that guided their therapeutic method as they attempted to free the person of the spirits. I believe that theory is important now even though it might be difficult to define the specific connections between theory and practice.
I have spent almost three decades on clinical research in psychotherapy. A major part of my effort has gone toward clarifying theory and also toward developing therapeutic approaches consistent with the theory. I did this in the belief it would add to knowledge and provide better structure for research. A secondary gain has been an improvement in the predictability and outcome of therapy as the therapeutic method has come into closer proximity with the theory. Here I shall first present ideas about the lack of clarity between theory and practice in all kinds of psychotherapy; in the second section I will deal specifically with family therapy. In discussing my own Family Systems theory, certain parts will be presented almost as previ- ously published (1,2). Other parts will be modified slightly, and some new concepts will be added.
Bowen 43
BACKGROUND TO THEORY IN PSYCHOTHERAPY
Twentieth-century psychotherapy probably has its origin in Freud, who developed a completely new theory about the nature and origin of emotional illness. Before him, mental illness was generally considered the result of some unidentified brain pathology, based on the structured model used by medicine to conceptualize all disease. Freud introduced the new dimension
of functional illness which dealt with the function of the mind, rather than
brain pathology. His theory was derived largely from patients as they remembered details of early life experiences and as they communicated this detail in the context of an intense emotional relationship with the analyst. In the course of the analysis it was discovered that the patients improved, and that the patient's relationship with the analyst went through definite, predictable stages toward a better life adjustment. Freud and the early analysts made two monumental contributions. One was a new theory about the origin and nature of emotional illness. The other was the first clearly defined theory about the transference relationship and the therapeutic value of a talking relationship. Although counseling and "talking about prob- lems" may have existed before, it was psychoanalysis that gave conceptual structure to the "therapeutic relationship," and that gave birth to the profession of psychotherapy.
Few events in history have influenced man's thinking more than psycho- analysis. This new knowledge about human behavior was gradually incor- porated into psychiatry, psychology, sociology, anthropology, and the other professional disciplines that deal with human behavior, and into poetry, novels, plays, and other artistic works. Psychoanalytic concepts came to be regarded as basic truths. Along with the acceptance there were some long term complications in the integration of psychoanalysis with other knowl- edge. Freud had been trained as a neurologist. He was clear that he was operating with theoretical assumptions, and that his concepts had no logical connection with medicine or the accepted sciences. His concept of "psycho" pathology, patterned after medicine, left us with a conceptual dilemma not yet resolved. He searched for a conceptual connection with medicine, but never found it. Meanwhile, he used inconsistent models to conceptualize his other findings. His broad knowledge of literature and the arts served as other models. A striking example was the oedipal conflict, which came from literature. His models accurately portrayed his clinical observations and represented a microcosm of human nature; nonetheless, his theoretical concepts came from discrepant sources. This made it difficult for his succes- sors to think in concepts synonymous with medicine or the accepted sciences. In essence, he conceptualized a revolutionary new body of knowl- edge about human functioning that came to exist in its own compartment, without logical connection with medicine or any of the accepted sciences.
Bowen 45
discrepant data in a scientific way. If the scientific method is pursued long enough, it should eventually produce the data and facts that are acceptable to the basic sciences. This has not occurred. The debate has gone through the century with the psychologists accepting psychoanalytic assumptions as fact and believing that the scientific method makes the field into a science, while workers in the basic sciences are still unconvinced. This is where research in the mental health field is today. The directors of research and experts who control the funds for research are schooled in the scientific method, which tends to perpetuate fixed postures. My own position on this is that, "There is no way to chi square a feeling and make it qualify as a scientific fact." This is based on the belief that human behavior is a part of all nature, so that it is as knowable and predictable and reproducible as other phenomena in nature; but I believe that research should be directed at making theoretical contact with other fields, rather than applying the scientific method to subjective human data. This has been a long-term conflict I have had with research in mental illness. To summarize, I believe that research in emotional illness has helped to contribute to the separation of theory and practice, and to the notion that psychological theory is based on proven fact.
There are trends in the training of mental health professionals that support the separation of theory and practice. Early in the twentieth cen- tury the popularity of psychoanalysis was increasing, but overall, psy- chiatry, and also the public, was still negative about it. By the 1940s and 1950s, psychoanalytic theory had become the predominant theory. By that time the psychoanalysts had developed so many superficial "differences" among themselves that the new trainees of the 1940s and 1950s were con- fronted with a spectrum of different "theories" all based on basic psycho- analytic concepts. They learned psychoanalytic theory as proven fact and the therapeutic relationship as the treatment for emotional illness. The trainees from that period are now the senior teachers in the field. The number of superficial "differences" have increased. Starting in the 1950s and increasing into the 1960s, we have heard much antipsychoanalytic talk by people who use basic psychoanalytic concepts in theory and practice. In the present era we have the "eclectic," who tells us that there is no single theory adequate for all situations and he chooses the best parts of all the theories to best fit the clinical situation of the moment.
I believe that all the differences belong within the basic framework of psychoanalysis, and that the eclectic shifting may be more for the needs of therapist than the patient. The average training programs for mental health professionals contain a few didactic lectures on theory appended to the basic training An overwhelming amount of time goes to tutorial training, which emphasizes the therapeutic relationship, learning about one's own emo- tional problems, and the management of self in relation to the patient. This
46 Theory in the Practice of Psychotherapy
produces professionals who are oriented around the therapeutic relation- ship, who assume they know the nature and origin of emotional illness, who are unable to question the theoretical base on which the field rests, and who assume the therapeutic relationship is the basic treatment for emotional problems. Society, insurance companies, and the licensing bodies have come to accept this theoretical and therapeutic position, and have become more lenient about providing payment for psychotherapeutic services. Counse- lors, teachers, police, courts, and all the social agencies that deal with human problems have also come to accept the basic assumptions about theory and therapy. Mental health professionals relate to theory in a spectrum. At one extreme are the few who are serious students of theory. A larger group can state theoretical positions in detail, but they have developed therapeutic approaches discrepant with the theory. A still larger group treats theory as proven fact. These last are similar to the medicine men who knew that illness was caused by evil spirits. Professional expertise becomes a matter of finding more ingenious techniques for externalizing the bad spirits. At the other extreme are the therapists who contend there is no such thing as theory, that theoretical efforts are post hoc explanations for the therapist's intuitive actions in the therapeutic relationship, and that the best therapy is possible when the therapist learns to be a "real self ' in relation to the patient.
In presenting these ideas about the separation of theory and therapy in the mental health professions, I have inevitably overstated to clarify the issues. I believe that psychoanalytic theory, which includes the theory of the transference and talking therapy, is still the one major theory to explain the nature and origin of emotional illness, and that the numerous different theories are based more on minor differences than on differences with basic concepts. I believe Freud's use of discrepant theoretical models helped make psychoanalysis into a compartmentalized body of knowledge that prevented successors from finding conceptual bridges with the more ac- cepted sciences. Psychoanalysis attracted followers who were more disciples than scholars and scientists. It has evolved into more of a dogma or religion than a science, with its own "scientific" method to help perpetuate the cycle. I believe it has enough new knowledge to be part of the sciences, but the professionals who practice psychoanalysis have evolved into an emotional ingroup, like a family or a religion. Members of an emotional ingroup devote energy to defining their "differences" with each other and defending dogma that needs no defense. They are so caught up with the ingroup process that they cannot generate new knowledge from within, nor permit the admission of knowledge from without that might threaten the dogma. The result has been a splintering and resplintering, with a new generation of eclectics who attempt to survive the splintering with their eclecticism.
48 Theory in the Practice of Psychotherapy
other relationship. One variable deals with the importance of the family member to the rest of the family. The family would respond quickly to the outside emotional involvement of an important family member who is relating actively to the others. It would respond slowly to a withdrawn and inactive family member unless the outside relationship was fairly intense. The most important variable has to do with the assumed, assigned, or actual importance of the significant other person. At one extreme is the significant other who assumes or is assigned magical or supernatural importance. This includes voodoo experts, leaders of cults, great healers, and charismatic leaders of spiritual movements. The significant other can pretend to repre- sent the diety and to have supernatural power. He pleads for the other to " believe in me, trust me, have confidence in me." The assuming of great importance and the assigning of importance is usually a bilateral operation, but there probably could be situations in which the importance is largely assigned, and significant other goes along with it. These relationships oper- ate on high emotionality and minimal reality. When successful, the change can come rapidly or with instantaneous conversion.
At the other extreme are the situations in which the evaluation of the significant other is based largely on reality, with little pretense, and with little of the intense relationship phenomenon. The principal ingredient is knowledge or skill. Examples of this might be a genetic counselor, an estate planner, or a successful professor who has the ability to inspire students in his subject, more through knowledge than relationship. In between these two extremes are relationships with healers, ministers, counselors, physi- cians, therapists of all kinds, and people in the helping professions who either assume or are assigned an importance they do not have. The assum- ing and assigning of importance is clearest in its extreme forms in which the pretending of importance is sufficiently grotesque for anyone to notice. Actually, the assigning and assuming of importance, or unimportance, is present to some degree in all relationships, and present enough to be detect- able in most relationships on careful observation. A clear example is a love relationship in which each has an overvalued image of the other. It is also easy to recognize the change in a person who is in love. Overall, the degree of assigning and assuming overimportance in the therapeutic relationship is on the high side. Psychoanalysis has subtle techniques to encourage the development of a transference, which is then dealt with in the therapy. Other methods do even more of this, and efforts to correct the distortion are even less.
Another set of variables revolve around the way the significant other is introduced into the system. At one extreme, the significant other pleads, exhorts, advertises, evangelizes, and makes promises of the great things if he is invited in. At the other extreme, the significant other enters the system only on unsolicited invitation and with a contract either verbal or written
Bowen 49
that comes closer to defining the reality of the situation. The rest fall
somewhere between these two extremes. Other variables have to do with the
length of time the significant other is involved in the system. The successful
involvement depends on whether or not the relationship works. This in-
volves the family member devoting a reasonable amount of thinking-feeling
energy to the relationship without becoming too emotionally preoccupied.
An important set of variables revolves around what it means to modify
relationships within the family. I avoid using change here because of the loose way this word is used within the profession. Some speak of an emo- tional conversion, a shift in mood, a shift in attitude, or a shift from feeling sad to happy as being "change" or emotional "growth." The word growth has been so misused during the past decade, that it has become meaningless. In contrast, other people do not consider change to have taken place with- out basic, documentable, structural alteration in the underlying situation that gave rise to the symptoms. Between these two lie all the other manifes- tations of change. It is common for mental health professionals to consider the disappearance of symptoms as evidence of change.
The more the relationship with the significant other person is endowed with high emotionality, messianic qualities, exaggerated promises, and evangelism, the more the change can be sudden and magical, and the less likely it is to be long term. The lower the emotionality and the more the relationship deals in reality, the more likely the change is to come slowly and to be solid and long lasting. There is some degree of emotionality in any relationship, especially in the helping professions where the principal ingredient is services rather than materials, but it is also present around those who deal in materials, such as supersalesmen. The emotionality can exist around the charismatic person who attracts the assignment of impor- tance from others. Emotionality may be hard to evaluate with public figures who attain their positions from superior skill and knowledge, in which emotionality is low, and who then operate on reputation, in which assigned importance is high. The doctor-patient relationship encompasses a wide range of emotionality. At one extreme it can be almost all service and little relationship, and at the other extreme the emotional component is high. The physician who operates with a posture which says, "Have no fear, the doctor is here," is assuming great importance, and also using it to calm anxiety. The physician who says, "If doctors could only be half as important as their patients think they are," is operating with awareness and less assumption of importance. Emotionality is sufficiently high in medicine that the placebo effect is routinely built into responsible research to check the emotional factor.
Psychotherapy is a service that deals in a higher level of emotionality than the average doctor-patient relationship. The level of assumed and assigned importance is on the high side. The well-trained therapist has
Bowen 57
relationship is that I handle the transference well. However, a therapist with knowledge of the facts inherent in systems theory, and especially a knowl- edge of triangles (discussed below) can deal largely in reality and facts and eliminate much of the emotional process that usually goes into a transfer- ence. Indeed, it is possible to routinely reproduce an operational version of the same expertise in a good percentage of professional trainees. This is in contrast to usual training methods in which the result of training depends more on the intuitive and intangible qualities in the trainee than on knowl- edge. One never reaches the point of not being vulnerable to automatically falling back into the emotionality of transference. I still use mechanisms to reduce the assumed and assigned overimportance that can get into any relationship. When one acquires a reputation in any field, one also acquires an aura of assigned overimportance that goes beyond reality. Among the ways I have dealt with this is by charging average fees, which helps avoid the emotional pitfalls inherent in charging high fees. The therapeutic effort is so different from conventional therapy that I have developed other terms to refer to the therapy process; for instance I speak of "supervising" the effort the family makes on its own behalf, and "coaching" a family member in working with his own family. It is accurate to say there is some emotion- ality in any relationship, but it is also accurate to say that the emotionality can be reduced to a low level through knowledge about emotional systems.
THE THERAPEUTIC RELATIONSHIP IN FAMILY THERAPY
The separation between theory and therapy in most family therapy is far greater than with individual therapy. The vast majority of family thera- pists started from a previous orientation in individual or group therapy. Their family therapy descends almost directly from group therapy, which came out of psychoanalytic theory with an emphasis on the theory of the transference. Group therapy led to far more differences in method and technique than individual therapy, and family therapy lends itself to more differences than group therapy. I have referred to this as the "unstructured state of chaos" in family therapy.
Family therapists deal with the therapeutic relationship in a variety of ways. Some great family therapists, who were adept at dealing with transfer- ence in individual or group therapy, continue their adeptness in family therapy. They use psychoanalytic theory for thinking about problems in the individual, and transference theory for thinking about relationships. There are those who speak of "getting into and getting out of ' intense relation- ships with individual family members. They are confident in their skill and ability to operate freely within the family. They operate more on intuition
52 Theory in the Practice of Psychotherapy
than any special body of knowledge. Their therapy is difficult for trainees to imitate and reproduce. Most therapists use some version of group therapy in their effort to keep relationships "spread out" and manageable. Another group uses cotherapists, usually of the opposite sex; their rationale is derived from psychoanalytic theory that this provides a male-female model for the family. The cotherapist functions to keep some degree of objectivity when the other therapist becomes emotionally entangled in the family. Others use a team approach in which an entire mental health team meets with a family or group of families in a problem-focused group therapy method. The team, or "therapeutic group," is composed of members of the various mental health professions. The team-group meetings are commonly used for "training" inexperienced professional people who learn by partici- pation in the team meetings, and who can rather quickly gain the status of " family therapist." Trainees begin by observing, following which they are encouraged to become part of the group by expressing their "feelings" in the therapy meetings. These are people who have never had much training in theory, or in the emotional discipline of learning the intricacies of trans- ference and countertransference. Theory is usually not explicit, but the implicit format conveys that emotional illness is the product of suppressed feeling and poor communication, that treatment is the free expression of feelings and open communication, and that a competent therapist is one who can facilitate the process. Family therapy has also attracted therapists who were never successful at individual therapy, but who find a place in one of the numerous kinds of group therapy methods being used in family therapy. These admitted overstatements convey some idea of the many kinds of family therapy methods and techniques that are in use.
Group therapy has long acted as though it did not have a theory. I believe the reasons for this are that family therapy for the most part is a decendant of group therapy, that family therapy has started variations in method and technique that were not possible in group therapy, and that the separation between theory and practice is greater in family therapy than any of the other therapies. All these circumstances may account for the fact that few family therapists have much awareness of theory.
My approach differs from the mainstream of family therapy. I have learned more about the intricacies of the therapeutic relationship from family research than from psychoanalysis or the psychotherapy of schizo- phrenia. Most of this was learned from the study of triangles. The automatic emotional responsiveness that operates constantly in all relationships is the same as the therapeutic relationship. As soon as a vulnerable outside person comes into viable emotional contact with the family, he becomes part of it, no matter how much he protests the opposite. The emotional system oper- ates through all five senses, and most often through visual and auditory stimuli. In addition, there is a sixth sense that can include extrasensory
54 Theory in the Practice of Psychotherapy
before they began to hear about each other. I have described my version of that in other papers (1, 2, 6). Among those who started with family research on schizophrenia was Lidz and his group at Johns Hopkins and Yale (7), Jackson and his group in Palo Alto (3), and Bowen and his group in Bethesda (4, 8). The psychoanalytic principle of protecting the privacy of the patient-therapist relationship may account for the family movement's remaining underground for some years. There were strict rules against the therapist's contaminating the transference by seeing other members of the same family: the early family work was done privately, probably to avoid critical colleagues who might consider this irresponsible until it was legiti- mized in the name of research. I began formal research in 1954 after several years of preliminary work. During 1955 and 1956 we each began to hear about the others and to meet. Ackerman had been thinking and working toward family concepts in social service agencies and clinics (9). Bell, who remained separate from the group for some years, had a different beginning. His first paper was written some seven or eight years after he started (10). There were others mentioned in the earlier summaries.
For me, 1955 to 1956 was a period of elation and enthusiasm. Observing entire families living together on a research ward provided a completely new order of clinical data never before recorded in the literature. Only those who were there could appreciate the impact of the new observations on psy- chiatry. Other family researchers were observing the same things, but were using different conceptual models to describe their findings. Why had these findings, now so commonplace, been obscured in previous observations? I believe two factors to account for this observational blindness. One was a shift in the observing lens from the individual to the family. The other is man's failure to see what is in front of him unless it fits his theoretical frame of reference. Before Darwin, man considered the earth to have been created as it appeared before his eyes. He had stumbled over the bones of prehistoric animals for centuries without seeing them, until Darwin's theory permitted him to begin seeing what had been there all the time.
For years I had pondered the discrepancies in psychoanalytic theory without finding new clues. Now I had a wealth of new clues that could lead to a completely different theory about emotional illness. Jackson was the other of the early workers who shared the theoretical potential. Lidz was more established in his psychoanalytic practice than Jackson and I, and he was more interested in an accurate description of his findings than in theory. Ackerman was also established in psychoanalytic practice and training, and his interest lay in developing therapy and not theory. I had built a method of individual therapy into my research design for studying the families. Within six months there was evidence that some method of therapy for family members together was indicated. I had never heard of family therapy. Against the strong theoretical and clinical admonitions of the time,
Bowen 55
I followed the dictates of the research evidence and after much careful planning started my first method of family psychotherapy. Later, I heard that others had also thought of family therapy. Jackson had been approach- ing on one level and Ackerman was approaching on another. In 1956 I heard that Bell had been doing something called family therapy, but I did not meet him until 1958.
J'he first family sectional a, mationa1 meeting was organized by Spiegel-
at the American Q.rthczpsyychiatric,meeting_in,Chicagain March, Ig57. He
was Chairman of the Committee on the Family of the Group for the Advancement of Psychiatry and he had just heard about the family work in progress. That was a small and quiet meeting. There were papers on research by Spiegel, Mendell, Lidz, and Bowen. In my paper I referred to
the "family psychOtherapy" used in my research since late 1955. I believe
that may have been the first time the term was used in a national meeting. However it happened, I would date the family therapy explosion to March,
- In May, 1957, there was a family section at the American Psychiatric meeting, also in Chicago. In the two months since the previous meeting, there had been an increasing fervor about family therapy. Ackerman was secretary of the meeting, and Jackson was also present. Family ideas gener- ated there led to Jackson's book, The Etiology of Schizophrenia, finally published in 1960 (4). At the national meetings in 1958, the family sessions were dominated by dozens of new therapists eager to report their family therapy of the past year. That was the beginning of the family therapy that was quite different from the family research of previous years. The new people, attracted by the idea of family therapy, had been developing empiri- cal methods and techniques based on the psychoanalytic theory of individ- ual and group psychotherapy. The family research and the theoretical thinking that gave birth to family therapy were lost in the rush.
The rush into family therapy in 1957 and 1958 produced a wild kind of therapy which I called a "healthy, unstructured state of chaos." There
were almost as many different methods and techniques as there were new
therapists. I considered the trend healthy in the belief the new therapists would discover the discrepancies in conventional theory, and that the con- ceptual dilemma posed by family therapy would lead to new concepts and ultimately to a new theory. This did not occur. I did not realize the degree of therapeutic zeal that makes psychiatrists oblivious to theory Family therapy became a therapeutic method engrafted onto the basic concepts of psychoanalysis, and especially the theory of the transference. New thera- pists tended toward therapeutic evangelism, and they trained generations of new therapists who also tended toward simplistic views of the human dilemma and family therapy as a panacea for treatment. Family therapy not only inherited the vagueness and lack of theoretical clarity from conven- tional psychiatry, but it added new dimensions of its own. The number of
Bowen 57
FAMILY SYSTEMS THEORY
The evolution of my own theoretical thinking began in the decade before I started family research. There were many questions concerning generally accepted explanations about emotional illness. Efforts to find logical an- swers resulted in more unanswerable questions. One simple example is the notion that mental illness is the result of maternal deprivation. The idea seemed to fit the clinical case of the moment, but not the large number of normal people who, as far as could be determined, had been exposed to more maternal deprivation than those who were sick. There was also the issue of the schizophrenogenic mother. There were detailed descriptions of schizophrenogenic parents, but little to explain how the same parents could have other children who were not only normal, but who appeared supernor- mal. There were lesser discrepancies in popular hypotheses that linked emotional symptoms to a single traumatic event in the past. This again appeared logical in specific cases, but did not explain the large number of people who had suffered trauma without developing symptoms. There was a tendency to create special hypotheses for individual cases. The whole body of diagnostic nomenclature was based on symptom description, except for the small percentage of cases in which symptoms could be connected to actual pathology. Psychiatry acted as if it knew the answers, but it had not been able to develop diagnoses consistent with etiology. Psychoanalytic theory tended to define emotional illness as the product of a process between parents and child in a single generation, and there was little to explain how severe problems could be created so rapidly. The basic sciences were critical of psychiatric explanations that eluded scientific study. If the body of knowledge was reasonably factual, why could we not be more scientific about it? There were assumptions that emotional illness was the product of forces of socialization, even though the same basic emotional illness was present in all cultures. Most of the assumptions considered emotional illness as specific to humans, when there was evidence that a similar process was also present in lower forms of life. These and many other questions led me to extensive reading in evolution, biology, and the natural sciences as part of a search for clues that could lead to a broader theoretical frame of reference. My hunch was that emotional illness comes from that part of man that he shares with the lower forms of life.
My initial family research was based on an extension of theoretical formulations about the mother-child symbiosis. The hypothesis considered emotional illness in the child to be a product of a less severe problem in the mother. The hypothesis described the balancing forces that kept the rela- tionship in equilibrium. It was a good example of what is now called a system. Very quickly it became apparent that the mother-child relationship was a dependent fragment of the larger family unit. The research design was
58 Theory in the Practice of Psychotherapy
modified for fathers and normal siblings to live on the ward with mothers and the schizophrenic patients. This resulted in a completely new order of observations. Other researchers were observing the same things, but they were using a variety of different models to conceptualize findings, including models from psychoanalysis, psychology, mythology, physics, chemistry, and mathematics. There were some common denominators that clustered around the stuck togetherness, bonds, binds, and interlocking of family members with each other. There were other concepts for the balancing forces, such as complementarity, reciprocity, magnetic fields, and hydraulic and electrical forces. Accurate as each concept might be descriptively, the investigators were using discrepant models.
Early in the research, I made some decisions based on previous thinking about theory. Family research was producing a completely new order of observations. There was a wealth of new theoretical clues. On the premise that psychiatry might eventually become a recognized science, perhaps a generation or two in the future, and being aware of the past conceptual problems of psychoanalysis, I chose to use only concepts that would be consistent with a recognized science. This was done in the hope that inves- tigators of the future would more easily be able to see connections between human behavior and the accepted sciences than we can. I therefore chose to use concepts that would be consistent with biology and the natural sciences. It was easy to think in terms of the familiar concepts of chemistry, physics, and mathematics, but I carefully excluded all concepts that dealt with inanimate things, and studied the literature for concepts synonymous with biology—that is, I used biological concepts to describe human behav- ior. The concept of symbiosis, originally from psychiatry, would have been discarded except for its use in biology where the word has a specific mean- ing. The concept of differentiation was chosen because it has specific mean- ings in the biological sciences. When we speak of the "differentiation of self," we mean a process similar to the differentiation of cells from each other. The same applies to the term fusion. Instinctual is used exactly as it is used in biology, rather than in the restricted, special meaning of its use in psychoanalysis. There are a few minor exceptions to this overall plan, which will be mentioned later. In the period when I was reading biology, a close psychoanalyst friend advised me to give up "holistic" thinking before I got "too far out."
Another longterm plan was directed at the research staff, and was based on the notion that the clues for important discoveries are right in front of our eyes, if we can only develop the ability to see what we have never seen before. Research observers can see only what they have been trained to see through their theoretical orientations. The research staff had been trained in psychoanalysis, and they tended to see confirmation or extensions of psychoanalysis. On the premise there was far more to be seen if they could
60 Theory in the Practice of Psychotherapy
of the emotional system, an intimate part of man's phylogenetic past which he shares with all lower forms of life, and which is governed by the same laws that govern all living things. The literature refers to emotions as much more than states of contentment, agitation, fear, weeping, and laughing, although it also refers to these states in the lower forms of life—contentment after feeding, sleep, and mating, and states of agitation in fight, flight, and the search for food. For the purposes of this theory, the emotional system is considered to include all the above functions, plus all the automatic functions that govern the autonomic nervous system, and to be synonymous with instinct that governs the life process in all living things. The term emotional illness is used to replace former terms, such as mental illness and psychological illness. Emotional illness is considered a deep process involv- ing the basic life process of the organism.
The intellectual system is a function of the cerebral cortex which ap- peared last in man's evolutionary development, and is the main difference between man and the lower forms of life. The cerebral cortex involves the ability to think, reason, and reflect, and enables man to govern his life, in certain areas, according to logic, intellect, and reason. The more experience I have had, the more I am convinced that far more of life is governed by automatic emotional forces than man is willing to acknowledge. The feeling system is postulated as a link between the emotional and intellectual systems through which certain emotional states are represented in conscious awareness. Man's brain is part of his protoplasmic totality. Through the function of his brain, he has learned many of the secrets of the universe; he has also learned to create technology to modify his environment, and to gain control over most of the lower forms of life. Man has done less well in using his brain to study his own emotional functioning.
Much of the early family research was done with schizophrenia. Since the clinical observations from those studies had not been previously de- scribed in the literature, it was first thought that the relationship patterns were typical of schizophrenia. Then it was discovered that the very same patterns were also present in families with neurotic level problems, and even in normal families. Gradually, it became clear that the relationship patterns, so clear in families with schizophrenia, were present in all people to some degree and that the intensity of the patterns being observed was related more to the anxiety of the moment than the severity of the emotional illness being studied. This fact about the early days of family research conveys some notion of the state of psychological theory twenty years ago that is not appreciated by those who were not part of the scene at that time. The family studies in schizophrenia were so important that they stimulated several research studies of normal families in the late 1950s and early 1960s. The influence of the schizophrenia research on family therapy was so impor- tant that family therapy was still being considered to be a form of therapy
Bowen 67
for schizophrenia as much as ten years after the family movement started. The results of the early studies on normal families might be summarized by saying that the patterns originally thought to be typical of schizophrenia are present in all families some of the time and in some families most of the time.
My work toward a different theory began as soon as the relationship
patterns were seen to repeat over and over, and we had achieved some notion about the conditions under which they repeated. The early papers were devoted mostly to clinical description of the patterns. By 1957, the relationship patterns in the nuclear family were sufficiently defined that I was willing to call a major paper, "A Family Concept of Schizophrenia." Jackson, who was reasonably accurate in his use of the word theory, had coauthored a paper in 1956 called, "Toward a Theory of Schizophrenia" (3). He urged me to use the term theory in the 1957 paper, which was finally published in 1960 (4), but I refused on the basis that it was no more than a concept in a much larger field, and I wanted to avoid using theory for a partial theory or a concept. The situation in the late 1950s was an absolute delight for me. It satisfied my theoretical curiosity that schizophrenia and the psychoses were part of the same continuum with neurotic problems, and that the differences between schizophrenia and the neuroses were quantita- tive rather than qualitative. Psychoanalysis and the other theoretical sys- tems viewed psychosis as the product of one emotional process, and the neuroses as the product of another emotional process. Even today a majority of people in psychiatry probably still hold the viewpoint that schizophrenia and the neuroses are qualitatively different. It is usual for mental health professionals to speak of schizophrenia as one thing, and the neuroses as another type of problem; they also still speak of "normal" families. However, I know they are all part of the total human dimension, all the way from the lowest possible level of human functioning to the highest. I believe that those who assume a difference between schizophrenia, the neuroses, and the normal are operating from basic psychoanalytic the- ory without being specifically aware of it, and that they base the difference on therapeutic response rather than on systems theory. I believe psychiatry will some day come to see all these conditions as parts of the same con- tinuum.
The main part of this family systems theory evolved rather rapidly over a period of about six years, between 1957 and 1963. No one part was first. A concept about the nuclear family emotional system and another about the family projection process had both been started in the early descriptive papers. They were both reasonably clear by the time it was possible to compare the patterns in schizophrenia with the total range of human problems. The notion that all human problems exist on a single continuum gave rise by the early 1960s, to the concept of.differentiation of self. The notion
