The Merits of a Systemic Vision and the Usefulness of the Genogram in Psychosomatics: Application to Psychodermatology

Abstract

Background: The authors first demonstrate the necessity of a more complex vision of psychosomatics. This can be achieved by a systemic approach. The authors’ previous research has clearly revealed that one of the most typical relationship characteristics of these families is the tendency to avoid expressing conflicts and emotional tensions. Difficulties in verbalizing emotional experiences stem from the fact that emotions are carefully filtered to conserve a ‘pseudoharmony’ in the family system. This ‘myth of unity’ seems to form the farreaching cement of the family beyond which ‘fantasies of rupture’, fears of family disaggregation can be found. Method: By constructing the genogram we discover the presence of traumatic events in the past of these families. The theme of loss often dominates these histories and is associated with deep emotional experiences of separation anxiety. Case Reports: Two clinical cases are presented. In the first, a woman consulted us for a recent acne aggravation. She progressively relates this to her mother’s sudden death. The genogram reveals that this mother has lost her mother due to a curious bigamy situation, that the patient did not know until 18 the secret of her birth, and that nothing was clear about the roles of the 3 different ‘fathers’ she had in her life. The second clinical case is a woman with atopic dermatitis dramatically increased after her marriage. In constructing her genogram she can express old grievances towards her father. We discover also that her father gave up his career to stay with his mother after his own father’s death. Eczema was necessary for our patient to take the time with her family of origin before leaving to live abroad. Conclusion: These cases illustrate that psychosomatic symptoms are belonging to three levels that are not antinomic: biological, psychological, and relational. These levels are complementary when seen from a perspective of complexity. The therapist’s function is to broaden the creative areas of freedom, giving the possibility for the patient and her/his family to understand the complex meaning of the symptom and free themselves from it.

Basic knowledge in psychodermatology

“…We then asked ourselves if these myths of unity at all cost, which was so frequent in these families, arose as shared defensive constructions, bulwarks against fears of loss and separation anxiety. This prompted us to learn about these families’ histories more systematically by constructing and working on their genograms 34 …”

A Case-control Study on Family Dysfunction in Patients with Alopecia Areata, Psoriasis and Atopic Dermatitis

“…As one of the authors has already underlined in a previous publication (31), there is a need for a more complex vision of psychosomatics. It is thus not a question of determining whether anxiety, depression, or family dysfunctioning came first.…”

Genograms: Use in Therapy with Asian Families with Diverse Cultural Heritages

“…(Lim and Lim 2008, pp. 20-21) In situations where it is taboo for families to express negative emotions or broach family secrets, psychosomatic symptoms often provide a valuable source of information for therapeutic work (Poot and Onnis 2001). These authors note that often there are traumatic events and themes of loss in the past of these families.…”

“…Like the money genogram (Mumford and Weeks 2003), the genogram can ease the discussion of sensitive topics. Poot and Onnis (2001) report that genogram construction allows for the client and his or her family to understand the problem differently. The therapist, in opening up a new way of looking at the psychosomatic illness, broadens ''the creative areas of freedom,'' and helps the client and his/her family to understand ''the complex meaning of the symptom and to free themselves from it'' (p. 81).…”