Any symposium on family psychiatry with which Dr. John Howells has been connected holds real promise for the reader, and this group of papers is no exception. His home base in England, the Institute of Family Psychiatry at Ipswich, operates on the concept that the family, rather than the individual, is the unit that requires attention if psychiatric symptoms are in evidence. He described his theories and their clinical application in his book Family Psychiatry nearly 20 years ago, and a number of additional volumes and useful techniques have eventuated from his work since that time.
It all makes such good sense, and when I think back on how we older clinicians did not dare to involve family members in our treatment methods even though the most inexperienced of us could sense that some close family member must be involved, I become sad.
However, John Howells needs no encomiums from me, nor does his introduction to this symposium . The same may be said of Stephen Fleck's "Family Functioning and Family Pathology," for this has been his special interest for a number of years, and, as the reader will see, it recommends itself.
Meissner's "The Family and Psychosomatic Medicine" intrigues me. Why we never saw the significance of family-member influence when we were immersed in the work of Flanders Dunbar and Alexander and French in the '30s is hard to explain. But then perhaps we did see it, but the fear of lèse majesté kept us neophytes quiet.
Meissner points out that in many disturbed families the parallelism between physical and psychological disturbance is striking. "There is some evidence to suggest," he adds, "that both psychological and physical disturbances tend to cluster among family members rather than to affect individual members." He sums up his dissertation nicely by noting that "the family therapy approach undoubtedly adds a new dimension and a quite different emphasis in the treatment of psychosomatic problems, though the powerful drives and needs that sustain the family affective system are not easily done away with." In other words, while we have a powerful instrument to work with, it is not a cure all.
As to Peter Martin's "Marriage Disorder in Family Disorder," the concluding article in this issue, this, as expected, is excellent. He lays out the patterns of marriage disorders, borrowing from his book on marital disharmony, and his section blends nicely with the articles that precede it. One is tempted to comment on the examples he gives, for they recall problems we have seen, but space requirements constrict us. Like the articles mentioned above, his particularly is well done, and, in fact, the whole segment of four papers (the first of two sections) will be of great use to clinician and teacher alike. All told, this is a first-class symposium on family psychiatry, and this elderly clinician wishes he had been exposed to it 40 years earlier.