As part of my ministerial education this semester, I’m doing a chaplaincy internship at UCLA Santa Monica Medical Center. Part of the experience is learning clinical skills intended to increase one’s ability to effectively minister to ill people and their families. Another part, intimately related to the first, is deeply self-reflective; that is, our cohort of five interns and our two supervisors work to identify and alter the ways our own inner dynamics—mostly our scars and blind spots and defenses—might hinder us from being available and helpful to those we serve. It is a challenging, yet very revealing and rewarding process.
The work has also caused me to revisit a brilliant book on Family Systems Theory by Edwin Friedman, entitled Generation to Generation. In a nutshell, this theory (sometimes called Bowen theory after its originator, Murray Bowen) locates the chief source of pathology not in the individual who most clearly manifests symptoms (the “identified patient”), but rather in the dysfunctional nature of the larger relational system in which such individuals function. This view has made significant inroads in the fields of mental and emotional health. For instance, many chemical dependency centers now explicitly treat the whole family, not just the addicted person. But as Friedman points out, there is far more resistance to the notion that relational dynamics are a factor in physical illness. But here’s a story (which I’ve abridged) that Friedman relates at the start of Chapter 5, “Body and Soul in Family Process”:
“A widower’s teenage son came into conflict with his new stepmother, who suffered from lupus, an autoimmune disease. She demanded that his father punish him, and when the father tried to temper her demands, she had a physical reaction—in this case a reduction of her blood platelets, causing her to bruise. This cycle continued, until finally, fed up with the tyranny of his wife’s symptoms, he told her that he would not continue to support her strict punishments. The boy needed more flexible handling. She could let her white count go to zero if she wanted, but he was through responding to her anxiety. She began to show more bruises and told him that she had to go to the hospital. He told her to “go ahead” without offering to take her. She went to bed instead. Within a week her count had gone back up, higher than it had been in years, and the lupus stabilized after that.”
In examining such phenomena, Friedman points out that “An organic view of body and soul (“soul” here being equated with what this theory calls a family’s, or any close group’s, “emotional field”) is not a mind-over-matter approach to medicine, a deprecation of the vital importance of physicians and their skills, or a rationale for faith healing. On the contrary, it is new discoveries in medicine itself that have laid the groundwork for understanding the emotional and, therefore, the interrelational aspects of physical illness.”
Seen from the hospital setting I’ve been in, where such understandings are still largely absent, I have been struck again by what I see as the immense healing potential of this perspective. And I wonder what health outcomes might look like if such a systems-oriented model became the norm. As a chaplain I couldn’t even state, as I did above, that my work is to “minister to ill people and their families.” Rather I—and every other health care provider—would attend to families, period.
Since the need for healthcare touches nearly everyone at some point, I also wonder how such an orientation might serve to help break the intergenerational cycle of dysfunction(s) that unconsciously holds so many families in its grip (like it did my own). And if to some degree it could, then it seems to me that the work of pastoral care—so often viewed in isolation—would also gradually extend multiple levels of healing to the wider community. I imagine this is a dynamic many ministers—and, if they became aware of the healing potential of Family Systems Theory, loads of health care providers—would be honored to help facilitate. I know I would.
-Peter Farriday, Ministerial Intern