Illness, Family Theory, and Family Therapy: I.Conceptual Issues

Abstract

This article examines and clarifies controversies about the concept of illness in the field of family therapy. We contend that illness, as traditionally understood in all cultures, is a relational, transactional concept that is highly congruent with core principles of present-day family theories. Family therapists need not buy into a biotechnical, reductionistic reframing of illness as disease. Rather, it is more appropriate to conceptualize and work with illness as a narrative placed in a biopsychosocial context. Such a narrative includes how shared responsibility for coping and for finding solutions can take place, without becoming involved in disputes about causal models.

Parental illness and disability: a family systems framework

“…At the time of a medical diagnosis, a primary developmental challenge for a family is to create a meaning for the illness experience that promotes a sense of competency and mastery (Kleinman, 1988;Rolland, 1994aRolland, , 1998Wright et al, 1996;Wynne et al, 1992). In the initial crisis phase, it is useful for clinicians to enquire about key beliefs that shape families' illness narratives and coping strategies.…”

Pathways to Problems – The Evolution of ‘Pathology’

“…The choice of attempted solution has varying implications for the client: being regarded as 'ill' or 'inadequate' may reinforce a negative labelling and lead to them becoming fixed in the sick role. Although accompanied by a concerned, caring position, this may serve to pathologize and conscript the person to become helpless and hopeless (Kleinman, 1988;White, 1995;Wynne et al, 1992). Alternatively, the confusion and anxiety that may result from the family assuming blame may aggravate their distress or even encourage attempts to prove that they really are 'ill' in order to absolve the others.…”

The development of family therapy in Japanese psychosomatic medicine

“…The second is that, because the model itself had a challenging history against the medical model or the concept of illness, it has not always been accepted in the medical field, including psychosomatic medicine. Wynne et al [2] describe this issue clearly ( Table 1).…”