THE “PSYCHOSOMATIC FAMILY” RECONSIDERED: DIABETES IN CONTEXT

Minuchin, Rosman and Baker’s (1 978) Psychosomatic Families is widely cited as a demonstration that the physiological disturbance of some diabetic patients serves a function in their families. We found that the original data did notprovide such a demonstration. We examined the psychosomatic family model in light of recent developments in the study and treatment of diabetes. We concluded that the model decontextualizes the family and assigns to it characteristics that are more appropriately seen as reflections of the disease process, the family coping tasks this entails, and the nature of the family’s relationship with the health care system. The need for new open-systems models of the family’s role in diabetes is discussed. Minuchin, Rosman and Baker’s (1978) Psychosomatic Families is truly a classic work, and it will long be recognized as an important first step for the field. The provocative book is one of the most frequently cited ones from the field of family therapy (Forman, 19861, in large part because of the attention it has received, not only in the family journals, but in pediatrics, psychiatry, psychology, and social work. The claim that ongoing family interaction had been shown to influence free fatty acid (FFA) levels in the blood of diabetic children legitimized further exploration of links from family functioning to such life-threatening problems as anorexia and poorly controlled diabetes and asthma. The book also provided an important theoretical statement, and a decade after its appearance, it retains its position as the most clearly articulated theoretical framework for what Weakland (1977) has called family somatics-our understanding of how the individual’s interactions with the family impact on physical health and vice versa. Finally, the book provided impressive outcome data from the successful family treatment of anorexia nervosa, as well as provocative clinical examples, and it has done much to widen the appeal not only of Minuchin’s structural approach to therapy, but the full range of family therapies. It should be noted that although the book is frequently cited as a convincing demonstration of both the immediate effect of family interaction on physiology and the homeostatic function of the patient’s physiological disturbance in the family, the actual data available in the book were preliminary and summarized in an impressionistic manner. It was stated that a more complete and formal presentation would be forthcoming. A decade later, the publications from the Philadelphia Child Guidance Clinic continue to make strong claims about what these data purportedly demonstrate (Sar