DK: I have said that “something happens” in interviews with a multigenerational extended family that often results in change of some kind in the weeks following the interview. Sometimes the something is explicit, like a confrontation, or an expression of affection, but more often the “something” is subtle, not visible.

I worked with a couple, Tom and Liz,  several years ago; these were two fairly accomplished people, both pastors of different denominations. They were serious thinkers invested in making the world a better place. Their frustrations with their work came home to the marriage and resulted in dissatisfactions for which they sought my help. Tom  was the pastor of a large suburban church and often frustrated by the mundane responsibilities of budget, and fund raisers. He liked ideas and engaging around ideas.

Tom  had decided to be a minister around age 14. His father, a physician, ” wanted his son to go into the ministry. His parents and a brother who lived in another city came for a session. At one point the reverend asked his dad why it was so important to the father, that he, Tom , went into the ministry.
“I was happy you went into the ministry because I thought that was what you wanted.”
“What if I hadn’t gone to seminary?”, the son asked.
“I’m not sure what you are asking. As far as I am concerned you were in charge of your life.” I continued to see them. Tom,  my patient, was surprised to learn his father was not so invested in having him be a minister. Eight weeks later, he decided to go to law school and resigned from his church. That is the kind of “something” that can happen as a result of the extended family group consultation.

images-3When an extended family gets together in my office they enter an emotional hot tub. My job as therapist is to provide a time and a place for this family reunion with an outsider. I also provide a structured interview that goes backward in time. The interview is organized around learning more about the family, the focus is away from the identified patient. The way the interviews are likely to fail is that nothing happens. That is because the family tends to be too cautious.
I have been referring to this experience as a “family group psychosis.” I prefer this strong ambiguous word because it helps characterize the subtle powerful emotional experience that activates the effective “something”. I have considered other words that refer to a state of arousal, altered perception, altered behavior, and altered consciousness. None properly suggests what I want to convey. I will say a little about why I use “psychosis”.

Psychosis is most commonly used to designate a Psychiatric disorder, a problem. It is used informally to refer to craziness, to make fun, affectionately or with hostility, of someone who is out of the ordinary. What exactly a psychosis is, is poorly defined, describing a psychosomatic or what I call a psychosomatisystemic (systemic refers to interactive relational quality) state, in which a person’s powers of self-observation are temporarily altered. The psychosis is a process that takes over a person. The psychosis in the psychiatry clinic is non-voluntary, and conscious decision (cognitive behavioral training) has little to do with whether the state continues. In working with families with psychotic member, some have the idea that the patient can stop doing what they are doing.

images-3When the world around pressures for more self control, the patient is likely to become crazier, more isolated. I say to the family, If you think he can quit, how about if you try acting crazy? If it is voluntary, you should be able to do it. Usually no one does anything. Although I have a few stories where someone in the family, takes me up on the suggestion, and the patient tries to straighten them out. This leads to my belief that craziness is an interpersonal phenomenon. And that it is inadvertently supported by the intimate system of relationships.

The way the dictionary describes psychosis fits my usage in the “family group psychosis” perfectly. From the Greek, psychosis means “animation” or “principle of life.” The verb form has the implication “to give soul or life to.” This is remarkable in my view. If psyche refers to soul, psychosis is soul in action. That is exactly what happens when most families get together. There is a nonverbal energy present. Psychosis is useful because of the extreme disruption of reasoned thought implied. It also carries the implication of poor capacity for self-observation. When it goes well the interview often adds soul; reminding the family they are a ‘we’, uncovering the spiritual energy which is a partial definition of ‘soul’.

Psychiatry has a way of knowing organized around diagnosis (diagnosis: to know by dividing). In the psychiatric context, the meaning of ‘psychosis’ is delimited. More specifically, in my Symbolic Experiential Family Therapy framework I use language in the interest of depathologizing behavior, in the interest of blurring distinctions between normal and pathologic, of undermining the division implicit in diagnosis. My use of language in the clinic is aimed at promoting repair.

If we think of ourselves as among the normals, we can use psychosis to separate ourselves from the painfully confused. We feel protected by the distinction. But if we are among the painfully confused and attempting to rejoin the healthy, those with well-defined social roles, the clear distinction between psychosis and health makes it more difficult to join the healthy. We then feel excluded by the distinction.

To be continued….

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