Framo, J. (1982). Symptoms from a Transactional Viewpoint. In Framo (Ed.) Explorations in Marital and Family Therapy. New York: Springer.

I.Introduction

The first psychiatric revolution occurred when mental illness was seen as belonging in the province of medicine. The second centered around the discoveries of Freud. The next big revolution will be when everyone shifts to a systems perspective.

II.Traditional Views

A.Traditional Views of Symptoms and Individual Classification - Diagnosis (Dx) does help professionals communicate in a short hand sort of way. There are many generalizations that one can make about manic depressives, borderlines… knowing only the d. However, Szasz points out that our system is screwy, and many different types of d are classified in the same system. What we need is a very specific system to classify related disorders in a systematic and methodologically sound manner. Professionals have a favorite diagnosis, usually one they struggle with themselves, and everybody's got it. Diagnosis have very negative connotations associated with them. Bowen has discussed the family projection hypothesis, whereby family members project certain roles onto other members (usually children) and force the members to conform to these roles, thereby inducing illness.

B.Critique of Psychoanalytic Views on Symptoms and Family - Symptoms are seen as neurosis only, the failure of a defense against an instinct or drive, the substitution of fantasy life for real life coping. This idea is oversimplified; etiology is often unclear; and the person is viewed as making themselves sick, the environment as unimportant. Psychoanalysts say they don't need the family to see it, which is in some sense true because the family is introjected, and they see this. However, certain conflicts that come into existence only when individuals interact can not be seen by psychoanalysts if they never see more than two people at once. Little Hans' parents were getting a divorce, which Freud paid little attention to. Only in the concept of secondary gain does traditional psychoanalysis allow for examination and understanding of interpersonal, real life, here-and-now experiences.

III.Background of Family Transactional Viewpoint

Individuals can not be seen without a backdrop of situation. People train others in such a way as to teach the other to react to them in a certain way. Mental illness, therefore, can openly be understood in context.

A.Family Transactional View of Symptoms - It is impossible to see the entire field at once. The family unit is a nice, manageable, important unit to understand. To classify "abnormal" families, you would have to have an idea of "normal" families. Symptoms serve to reduce conflict, help to meet needs, allow for acting out of old conflicts, and protect against intimacy. Each person carries some psychic functions for the other. This may be very benign, or very harmful. As to what symptoms are displayed, this depends on what the system does and does not allow. Unusual life events and developmental milestones serve to "shake things up."

B.Symptom Producing Situations -

1.irrational role assignments - For Fairbairn, we all seek satisfying object relations. Thus, we solve intrapsychic conflict interpersonally. The child is helpless and seeks to solve this external conflict internally, and deals with internalized objects of others. If the mother is borderline, the child internalizes split objects. As the child becomes an adult, s/he will seek out others to project these internal objects on, and seek out individuals that will most easily fit these objects, and attempt to force others to conform to the roles. If the internalized objects are split, the person can project the "bad" objects onto others, retain the "good" objects, and live out the bad objects in others. If the adult is needing something, roles can be projected on the children to create a person to meet the adult's need (like a divorced parent creating a "spouse" in their child). Often, you can't do therapy with the parent, and you do what you can for the child.

2.blurring of generational boundaries - when the child is "parentified," the child develops non-normally, and thus becomes "sick" meeting the other person's needs. The child can't develop and become differentiated from the parent, and as a result, carries the parent's level of low differentiation into adulthood and other relationships as the parent did.

C.Symptom Maintenance and Reduction - Symptoms are maintained or reduced to the extent that they serve the needs of the relationship of those in the relationship. Some symptoms can not be seen except in the context of family interactions. Some symptoms are "pseudo-symptoms" or passports into therapy masking real symptoms. Some symptoms help to re-establish old behaviors and patterns. People do not "grow out" of symptoms, unless there is some change in needs. Thus, a small change in the role assignment, opinions, or perceptions of others can have snowball effects in the person's relationships and family.

D.Sharing Symptoms -

1.Since each person gives their symptoms to the other, the marriage is different than the individuals. Secondary gain goes 2 ways.

2.The other person helps maintain the symptom. The obese wife has a husband who chastises her, thus she eats to assuage herself. The overbearing husband justifies the wife's affair.

3.Some relationships maintain balance by sharing a symptom and triangulating it to be a third party

4.Symptoms may get the person out of the family

5.Vicarious gratification can also be a secondary gain to the other family members (a mother with a sexually promiscuous daughter can vicariously sleep around)