Addiction, compulsion, disordered eating and mental illness typically show up in people from families that have experienced significant losses from which they have never fully recovered.

Sadly, too many families have experienced these losses from violence - war, suicide or crime. Financial tragedies including dispossession, or more commonly, as a side effect of intolerance, over-control, or neglect can also trigger a sense of loss. Whatever the source, developmental trauma, which can be defined as “interruptions in one’s sense of safety,” occurs at both the systemic and individual levels. When these safety interruptions occur and are overlooked, tolerated or perpetuated by caregivers, the roots of developmental trauma are planted and will exert their influence throughout members’ lifespans. They will determine essential aspects of the system’s functioning, and, in an insidious fashion, be passed on to the next generation.

Families burdened by these legacies of loss find themselves caught in repetitive cycles of illness and relapse, reinforced by learned responses that are transmitted across generations. Rather than see these families as dysfunctional, it has proven more useful to think of them as “wounded.” The wounded family system displays a set of environmental characteristics dubbed “the dastardly D’s.” These include higher than preferred levels of:

• Disorder
• Disconnection
• Danger
• Deprivation
• Doubt
• Denial

These dastardly Ds are toxic to healthy development. They are fed by and made worse by stress. In response to this stress which occurs both at ordinary (predictable) and extraordinary (unexpected) levels, members cope in ways that are intended to make the Ds more tolerable or less noticeable. In turn, the system becomes more rigidly entrenched in inter-generational patterns of impaired coping. A brutal cycle develops in which stress-induced reactions increase the systemic levels of: chaos and inconsistent development (disorder); separation, estrangement, feuds and isolation (disconnection); absent or insufficient emotional and spiritual help (deprivation); risk of being assaulted, shamed, banished or humiliated (danger); uncertainty, fear, and unpredictable or capricious decision-making (doubt); and, lastly, no one finds it safe or even necessary to talk about any of it (denial).

As is true for humans in the face of most stress, family members adopt ways of avoiding or managing the impact of the dastardly D’s and their associated psychological and emotional pain. Generally, these involve adopting coping methods that perpetuate the cycles of loss and illness and reinforce the D’s and their insidiousness. “Stress-Induced Impaired Coping” is the term I have coined to describe this systemic condition. All members of wounded family systems experience the condition in one form or another, regardless of how high functioning they may appear.  Secrets and shame generally underlie the impaired coping, reinforcing an oft-unspoken sense in members that there is “something too terrible to face.”

Systemic Family Therapy works to:

• Shift the system toward health and away from the six Ds
• Uncover the covert dynamics and make room to tell each other the truth
• Reduce the power of long-held beliefs that keep members stuck
• Interrupt the cycles of loss, illness, relapse and disease
• Protect the next generation from inheriting Stress-Induced Impaired Coping

This vignette describes a family burdened with inherited trauma stress

The Johnsons have been married 22 years and have three children.

Jeremy, 20 is beginning his junior year at college, away from home for the first time having earned an AA degree at a local community college. Jessica, just 18, should be a senior in high school this year but she missed her second semester of junior year because she went to residential treatment for anorexia. Julia, the baby, turned 14 over the summer and has earned sufficient high school credit to be a sophomore having taken AP classes at community college each of the past two summers (including the summer before her freshman year of high school). Julia spends all her free time with her horse, Rocky, whom she’s begun to jump and show. When home she’s buried in a book. Mom recently lost her mother for whom she provided in-home care for the past three years, the final year in hospice (Alzheimer’s and heart disease). Dad is an international finance VP, and travels more than 100 days per year, mostly to the Far East. Dad’s father was killed in Vietnam where Dad was born; he is bi-racial Vietnamese/American though prides himself on “looking 100% American.” He has no contact with his birth mother. Was raised by his father’s parents in Sacramento, CA. Jeremy finished his senior year of high school in independent study having been asked to leave mainstream school for marijuana possession (with accusations of dealing) and defiance of authority. He has had school trouble since tenth grade. Middle daughter, Jessica, always an honor student, “basically stopped eating,” according to Mom, “around the time her grandmother entered hospice.” Today, Jeremy continues to use some marijuana and Jessica has episodes of food restriction. In contrast, Julia had her picture on the cover of the local weekly soaring a jump on Rocky. Today Dad’s off to Taiwan for four weeks (“a long one this time”) and Mom is thinking about getting a volunteer job and finding Julia a second horse.

An examination of this system through the lens of the dastardly Ds would promote deeper understanding about its workings and have the potential to bring members together in the service of creating serenity, sustainability, and safety. Here’s a brief peek at how each might be thought or inquired about.

DISORDER
Note the inconsistent way in which the children have developed. Imagine the chaos in the environment associated with the eating challenges, caregiving demands and father’s inconsistent presence.

DISCONNECTION
Sounds like it’s frequently “every man for himself.” Father travels, mother is pulled in multiple directions, all seem disconnected from any sort of unifying ethos or sense of togetherness. Father is disconnected from his roots and family of origin and prefers things that way. This is not about blame; rather it’s based on an effort to understand the environmental forces that reveal the system’s distress and simultaneously keep things stuck.

DANGER
Questions that help explore this aspect more fully include: How safe is it to express oneself in this family? Is it OK to be curious about members’ roots? What are members valued for? Praised for? Who is looking out for whom?

DEPRIVATION
Opening the clinical conversation with members of such a system often works well by talking about the developmental and emotional resources available to members: To whom can you turn for help? How are crises managed? How does love get expressed? Who spends time with whom and under what conditions? What do you wish there was more of? Less of? What is true about our ancestors and their emotional and spiritual upbringing?

Returning to Health - Systemic Family Therapy   

Systemic Family Therapy begins with an effort to engage the family members who are willing to attend to describe “the deal” they are in with each other and the role they see themselves occupying. Each member is invited to speak to how they each participate in the deal. It’s helpful to keep the following questions in mind:

• What is the nature of our family deal: How do we constellate? How do members cope? What behaviors are we reinforcing for each other? What behaviors do we discourage (consciously or unconsciously)?
• How do I tend to participate in the deal?
• What are the effects of how I participate; on me? on the system? on the loved one(s) I perceive to be unhappy, in trouble, sick or struggling?
• What forces in me from my family of origin inform, or drive, how I’ve learned to participate in this way?

As this initial exploration deepens next steps include taking an inventory of each member’s:

• Feelings and emotions
• Beliefs and “rules”
• Behaviors in which they engage to try and make things different or to fix
• Metaphors that describe the roles members are pulled to play or caught in

The  next installment of this blog will examine each of these.

Kenneth Perlmutter is the Clinical Director at Mind Therapy Clinic. Find more information on  Multi-Family Support Group Therapy and Kenneth Perlmutter, PhD. See our Group Program Schedule to sign up for Multi-Family Support Group.