Interfaces: Toward a New Generation of Systemic
Models in Family Research and Practice
CARLOS E. SLUZKIw
After reviewing Engel’s bio-psycho-social proposal and Kandel’s ‘‘principles for an
integration between mind and brain,’’ the author introduces a set of akin propositions
that aim at integrating neurosciences, genetics, the mind, and the social world into a
succinct set of systemic formulations focusing on interlevel interfaces, with profound
implications for the training, practice, and research in the field of family processes and
therapy.
Keywords: Systemic Models; Neuroscience; Genetics; Family Therapy
Fam Proc 46:173–184, 2007
T
here has been a recent upsurge of publications exalting a paradigm that reenergized the world of psychosomatic medicine and enriched the field of familyoriented health care: namely, the pioneering bio-psycho-social model proposed by
George Engel in 1977 (Engel, 1977, 1980; Frankel, Quill, & McDaniel, 2003; Rolland &
Williams, 2005). The bio-psycho-social model entailed, at the time of its formulation, a
qualitative step forward in the evolution of the integration of biological, psychological,
and social variables beyond its predecessor, the ‘‘psychosomatic’’ lens, which implied,
but generally did not include explicitly, micro- and macro-social variables.
The author of this article was immersed for many years in the complex interdisciplinary terrain of a systems-oriented, family-based, socially concerned psychotherapy and clinical psychiatry, including the development of community-oriented
programs and services, and teaching of students and colleagues with a variety of
professional backgrounds. In those varied contexts, he strived to retain a systemic
view and a guiding bio-psycho-social model, frequently under the attack (or the
temptations) of the Sirens that sang the oh-so-comfortable reductionistic approaches
of biomedicine. But models, even the most elegant, are the product of their times.
wProfessor, Department of Global and Community Health, College of Health and Human Services, George
Mason University, Fairfax, VA, and clinical professor of psychiatry, George Washington University Medical
School, Washington, D.C. E-mail: [email protected]
This article was delivered at the festschrift conference in honor of Lyman C. Wynne M.D. Ph.D., University of Rochester School of Medicine and Dentistry, Rochester, New York, September 9 and 10, 2005, as
homage to the pioneering work and the humanistic spirit of that colleague and mentor, who has consistently
pushed the boundaries of our traditional paradigms toward a post-Cartesian, integrated vision of humans as
simultaneously (and indivisibly) biologic, psychological, and social beings.
173
Family Process, Vol. 46, No. 2, 2007 r FPI, Inc.
174
/
FAMILY PROCESS
Engel’s model was dated almost 30 years ago, and the many recent developments in
the biological and the social sciences may justify a respectful but critical revisitation of
that paradigm and related models. This article aims to do so, and then to suggest some
reformulations, with full awareness that the latter are built on the shoulders of giants.
ENGEL’S BIO-PSYCHO-SOCIAL APPROACH
Engel’s 1977 bio-psycho-social model, epitomized by his seminal Science paper, was
hailed as an alternative approach to the biomedical view and praised (Wynne, 2003)
both as an attack on reductionism and a plea for a systemic view of practice. It consists, in ultimate analysis, of a detailed specification of the ecosystemic hierarchy and
continuum lodged between the biosphere and the subatomic particles. At the same
time, the many examples that enriched Engel’s publications and countless others in
its support have been centered in the mind-body interface.
Engel did not write for the converted. In fact, for those professionals already immersed in systemic models at the time of its publicationFamong them, many family
therapistsFEngel’s paradigm contained an already very familiar tune.1 Engel acknowledged explicitly the influence of the novel wave of systemic principles that was
permeating the so-called soft sciences (making them less soft) and the so-called hard
sciences (making them less hard). Engel wrote for the medical profession in general
and, more specifically, for those professionals dealing with the body-mind interface
and with medical education. For them and for many others for whom that model was a
first exposure to systemic thinking, the impact was, and still is, extremely substantial
(e.g., Frankel et al., 2003).
Engel’s writings and those of his followers display a richly textured, multilayered
complexity whenever the model is applied to clinical examples. However, its formulation proper appears linear in its structure; it consists of a list of levels of systems,
from biosphere to molecule, each inclusive of the previous one; and it lacks any explicit
evolutionary (temporal) dimension.
KANDEL’S ‘‘FIVE PRINCIPLES FOR AN INTEGRATION BETWEEN BODYAND MIND’’
Many scientific breakthroughs and epistemic shifts took place in the lapse following
Engel’s original publication. Among those that merit highlighting was the flood of
neurosciences research fostered by the strong support of the National Institute of
Mental Health (NIMH), made explicit by its designation of the 1990s as ‘‘the decade of
the brain.’’ This trend led to an explosion of molecular, biochemical, neurophysiologic,
and genetic and genomic research at the expense of a drastic reduction of support to
psychosocial research projects.2
1
Von Bertalanffy’s writings on general systems (1950, 1968), Ashby’s contributions (1954), the
legendary Macy conferences starting in 1946, and Wiener’s (1961) own pioneering synthesis of
cybernetics had already produced a major impact on the behavioral sciences (see Buckley, 1968, and
Grinker, 1967, for some early echoes). In good measure, this impact spearheaded the development
of family therapy, directly through Bateson’s coworkers and followers at the Mental Research
Institute (e.g., Bateson’s 1972 collection of articles; Watzlawick, Beavin, & Jackson, 1967), but,
equally important, indirectly through the tremendous influence of the systemic paradigm in most
of the other pioneers and subsequent generations in the field.
2
This reflected the current U.S. government’s political slant that consistently eschewed socially
oriented programs.
www.FamilyProcess.org
SLUZKI
/
175
In 1998, perhaps as a reaction to the reductionstic trend of most of the NIMH’s
sponsored projects and rhetoric, and acknowledging the need to integrate the
revolutionary advances in genetics into a broader view, Eric Kandel, a neurophysiologist and psychiatrist recipient of the 2000 Nobel award in physiology, proposed
‘‘five principles for an integration between mind and brain’’ (Kandel, 1998). This
formulation reached a new generation of psychiatrists and, interestingly, of psychoanalysts, which somehow heralded those principles as providing the opportunity to
‘‘rewrite metapsychology on a scientific foundation’’ (David Olds, cited by Kandel,
1999 p. 64).3
Although apparently not explicitly inspired by Engel’s formulationFEngel is not
listed among Kandel’s referencesFby focusing on a few of the multiple interfaces of
the overinclusive systemic series proposed by Engel, Kandel’s model enriched and
refined the formulation of interfaces and made explicit not only reciprocal influences
but also a directionality in the processes that interconnect them.
The following is a set of principles proposed by Kandel (1998; parentheses are
mine):
I. All mental processes, even the most complex psychological processes, derive
from operations of the brain. (Does ‘‘derive’’ mean that mental processes
are a product of operations of the brain? If affirmative, it subsumes psyche to
soma!)
II. Genes and their protein products are important determinants of both the
patterns of interconnections between neurons in the brain and the details of
their functioning. (Needless to say, that does not exclude the many intrauterine contextual factors that affect the evolution of the brainFfrom maternal undernourishment, substance abuse, or disease [e.g., measles] to
teratogenic medications or toxic substancesFnor does it exclude interconnections that develop or fail to develop later in life according to contextual
factors.)
III. Altered genes do not, by themselves, explain the variant of a given major
mental illness. Social or developmental factors also contribute very importantly. . . . Learning, including learning that results in dysfunctional behavior,
produces alterations in gene expression. Thus all of ‘‘nurture’’ is ultimately
expressed as ‘‘nature.’’ (This statement qualifies the previous one. Could it be
said that, following the form of the first principle, major mental illnesses derive, at least in part, from social or developmental patterns?)
IV. Alterations in gene expression induced by learning give rise to changes in
patterns of neuronal connections. These changes not only contribute to the
biological basis of individuality but presumably are responsible for initiating
and maintaining abnormalities of behavior that are induced by social contingencies. (This proposition seems to qualify principle II.)
V. Insofar as psychotherapy or counseling is effective and produces long-term
changes in behaviors, it does so through learning by producing changes in gene
expression that alter the strength of synaptic connections, and structural
changes that alter the anatomical pattern of interconnections between nerve
3
Kandel’s formulation attracted the attention of many researchers and practitioners rooted in
psychoanalysis because it successfully challenged a vision of that model as a closed cosmogony.
Fam. Proc., Vol. 46, June, 2007
176
/
FAMILY PROCESS
cells of the brain. He then ties this to a quantitative evaluation of the outcome
of psychotherapy. (This principle appears to be a benign expansion of proposition III that acknowledges, this time constructively, the influence of social
factors and learning.)
Applying the Ockham’s Razor principle of parsimony that calls us to simplify
propositions as long as their descriptive or explanatory power remains intact, Kandel’s principles are weaved together, in my view, on the basis of three key tenets: (1)
Mind is biologically based; (2) Genes determine the biological base; and (3) ExperienceFincluding learning and psychotherapyFstructurally alters this genetic expression.
Kandel’s principles add an evolutionary component, both Darwinian and in the
sense of human development, but are clearly skewed toward the gene-body dyad,
underplaying the reciprocal nature of the influences between the levels he specifies.4
A REFORMULATION OF PROPOSITIONS: AN EMPHASIS ON INTERFACES
Since Kandel’s formulation, a major scientific event has taken place: namely, the
monumental feat of mapping the whole sequence of the human genome, completed in
2003 by an international consortiumFonly 8 years after the first outline for this line
of research. A wealth of research ensued, including large-scale studies of gene expressionFwith extraordinary implications for evolutionary biologyFand specific
studies that determine the involvement of sequence in tumor formation, with enormous therapeutic potentials.5 Further, the evolutionary rules followed by proteins and
cells for an adequate development of the nervous system, and the psychosocial experiences needed to alter the genetic expression appear to be becoming unveiled (Insel,
2005). Our understanding of the complex and rich nuances of the gene-environment
interface was expanded during the past decades by the pioneering research projects
led by the Wynne/Tienari team and by David Reiss and his associates (McGuire, Ne4
Following are two examples of reciprocity. (1) Caspi, McClay, Moffit, and Mill (2002), researching on why some children who are maltreated grow up to develop antisocial behaviors
whereas others do not, traced back a genetic susceptibility modulated by a functional polymorphism in the gene encoding the neurotransmitter monoamine oxidase A (MAOA). Maltreated
children with a genotype that facilitates high levels of MAOA were less likely to develop antisocial
problems (Rhee & Waldman, 2002). (2) The research conducted by the Tienari/Wynne team, discussed next, seems to indicate that the characteristics of the family interactive style will modulate
the expressiveness of genetic proclivities toward schizophrenia in ‘‘high-risk’’ adopted offspring
raised by those families.
5
Genomics has also become a field filled with economic potentials, and hence mined by the
private industry in developments parallel to pharmacology: attempts to exploit advances for economic reasons, patent wars, and promises of panaceas. To that should be added the ethical
quagmires entailed in the potential use of genetic markers for differential selection criteria by
managed care, health insurance, mortgage-related insurance (this use is being considered in the
United Kingdom, with considerable controversy, specifically for Huntington’s disease, to prevent
defrauding of insurance companies; Morrison, 2005), and the distortion of genetic findings at the
service of racist politics. This presentation does not explore these perilsFthere is an increasingly
rich and eloquent literature on the subjectFbut only highlights the constructive potentials of the
interface between genomics and the psychosocial world. For a discussion of bioethics with specific
reference to neuroscience and the double-edged sward of genetics, see World Health Organization
(2002; especially chapters 6 and 7); Duster (2003); President’s Council on Bioethics (2003); and the
special issue on neuroethics in the journal Cerebrum (Vol. 4, No. 4, 2004).
www.FamilyProcess.org
SLUZKI
/
177
iderhiser, Reiss, Hetherington, & Plomin, 1994; O’Connor, Neiderhiser, Reiss, Hetherington, & Plomin, 1998; Pedersen et al., 1989; Plomin, Chipuer, & Neiderhiser,
1994; Reiss, 2000; Reiss, Cederblad, et al., 2001; Reiss, Pedersen, et al., 2001; Rende,
Plomin, Reiss, & Hetherington, 1993; Tienari et al., 1987; Tienari, Sorri, & Lahti,
1985; Tienari et al., 1994, 2000, 2003, 2004), and by other researchers exploring the
interface between family processes and genetics.6 This line of research is consistent
with Bronfenbrenner and Ceci’s (1994) bioecological postulation that environmental
variables, including parental styles, play an important role in determining whether
biological factors lead to the development of psychiatric disorders.
These new insights justify a reformulation of both Engel’s and Kandel’s propositions, enriching them with these new insights and expanding them toward a paradigm
formulated to make explicit the systemic interfaces adjacent to the psychosocial field,
where our area of specialty is lodged.
The first proposition of this new set is, I believe, simply a tight reformulation of the
core focus of Engel’s view:
I. Mental processes, the neurobiological stratum, and the social/relational
world operate as a system, and as such reciprocally influence each other
One could question whether they ‘‘operate as a system’’ or they are a system, one
meaningless without the other. It should be noted that ‘‘the social/relational world’’ is
inclusive of several systemically related layers: the family, the personal social network, the community, the socioeconomic environment, the ecological niche, and so on.
And, in turn, ‘‘the neurobiological stratum’’ is inclusive of several subsumed layers,
from organism to cellular components, all in turn systemically related.
In this formulation, ‘‘social/relational world’’ encompasses two distinct levels: the
‘‘micro-social’’ level of the family and the immediate relational network, and the
‘‘macro-social’’ level of the world in which the family is immersed, including socioeconomic variables, mobility, cultural variables and practices, race and ethnicity
contexts, and other traits of social inclusion/exclusion that impact individual and familial resources and resilience. The micro-social world of the family is, in fact, an
intermediate structure, both exquisitely sensitive to shifts in the neurobiological and
mental level of processes, and readily affecting them; it is also equally sensitive to
6
The Wynne-Tienari ‘‘high-risk adopted-away’’ project consisted of a longitudinal study of a
large sample of families who had adopted newborns whose biological mothers fit the DSM-III diagnosis of schizophrenia (‘‘high-risk’’ sample, meaning that these offspring had 10 times the statistical probability of developing severe psychopathology as compared with the average population)
or whose biological mothers were free of psychopathology (the ‘‘low-risk’’ cohort). These families
were followed over time, their interpersonal dynamics studied, and the mental health of the
adopted offspring evaluated until early adulthood. Although the ‘‘high-risk’’ sample presented
more psychopathology than the control sample, the correlation between family interactional deviancy and offspring psychopathology was statistically meaningful in both cohorts. This shows
beyond doubt the impact of the family environment in buffering the expression of pathology (or, to
state it in reverse, to enhance resilience and creativity). In turn, Reiss and his coworkers focused
on understanding the complex ratio between genetic factors and family relations on the development of competence (as well as psychopathology) in children and adolescents, with emphasis on
differences among siblings. Rather than exclusionary approaches, these lines of research have shed
a bright light on how nature and nurture interact in human development. These projects are
discussed more in detail in presentations on the interaction between genomics and family delivered
by Sluzki at recent congresses (2005a, 2005b).
Fam. Proc., Vol. 46, June, 2007
178
/
FAMILY PROCESS
traits and changes in the macro-social realm. At the same time, the family and personal social networks tend to buffer changes in either level of processes.7
The second proposition specifies the nonstatic, evolving nature of that system,
making explicit what, in Engel’s proposal, is implicit:
II. Mental processes, the neurobiological stratum, and the social/relational world coevolve.
Coevolution entails both short- and long-term reciprocal changes. Long-term reciprocal changesFfrom the concomitant evolution of the cranial capacity (and brain
size and complexity) and the evidence of increasingly complex mental processes as
represented by tasks and social transformations, to the way humans have changed
nature and the way that those changes change them in turnFhave been eloquently
argued in the evolutionary (Darwinian and Neo-Darwinian) literature (e.g., among
many, Barkow, Cosmides, & Tooby, 1992; Bronfenbrenner & Ceci, 1994; Dawkins,
1996; Gazzaniga, 1992; Wright, 1994). Short-term reciprocal changesFthat is,
changes within a life spanFalso include a broad range of literature, from Bowlbyinfluenced developmental psychology to evidences at all ages.8
The next three propositions simply specify in a more detailed manner the relationships between levels, ‘‘fracturing’’ the sequence of their reciprocal loops into
segments.
III. Changes in the social world unavoidably impact both the psychic
world (the mental processes) and the somatic stratum, directly through
the neuro-endocrine subsystem and indirectly through mental processes.
This proposition covers two assertions. One is that stability and change in the social
worldFcrucially, the family, but including the larger social environmentFimpact the
emotional and cognitive processes of the individual, but that mind and body are a
unity; hence, the body, far from being a distant realm, should be included in the assessment of the impact of any psychosocial event. The other is a reminder that there
are two intertwined but distinct overall alarm systems in the organism: a fast-moving
one, the autonomous nervous system, and a slower one, the neuro-endocrine system.
Each affects different target processes, each adaptive and crucial for survival, but each
tied to both somatic and mental symptoms when acute circumstances exceed the
adaptive repertoire or when these systems are chronically activated.
IV. Changes in the neurobiological system unavoidably affect both the
mental processes and the immediate social world.
Within the complex loop that includes body, mind, and the social world, this
proposition accentuates that somatic well-being and somatic disorders affect not only
7
Sufficient and effective personal social networks, of which the family is a central component,
protect the individual member from the raw impact of social changes. Further, quality social
networks buffer the impact of changes at any level and facilitate the reequilibration between levels
(e.g., Berkman & Kawachi, 2000.)
8
This includes a study by Maguire and colleagues (2000). Maguire is a rather well-established
researcher made famous by this article; the picturesque nature of his sample showed that experienced taxi drivers develop structural changes in the hippocampus.
www.FamilyProcess.org
SLUZKI
/
179
the body but also the cognitive and emotional world of those who suffer from them,
and those in their meaningful social network.
V. Changes in the mental processes translate into changes both in the
somatic stratum and in the immediate social milieu.
This proposition, far from controversial, acknowledges the well-documented impact
of cognitive and emotional states on the body (the basis, in fact, of psychosomatic
medicine, from Hans Selye’s General Adaptation Syndrome on) and on the relational
milieu (in fact, this proposition, complementarily tied with the above-listed proposition III, constitutes a basic assumption of couples and family therapy).
VI. All these processes are affected by, and affect, the genetically programmed constraints (a characteristic inherent to all biological entities).
This proposition acknowledges the reciprocal interface with heredity, building on
Kandel’s statements and enriching them, as a reminder that this is one of the core
influences that characterize living systems.
VII. The set [social milieu !
mental processes !
neurobiological
processes] is sensitive to changes facilitated by psychotherapy (a social
practice that perturbates one or more of the set’s interfaces).
This proposition, a specification of the third one, is discontinuous from the others, a
sort of ‘‘insiders’ comment’’ to remind us, psychosocial operators, of the systemic
nature of our professional purview and, ultimately, that by restraining our view to
only one layer, we may lose the view of the forest.
From Seven Propositions to Four BasicTenets
For the sake of parsimony, the above seven propositions may be reduced, in turn, to
four basic tenets: (1) Mental processes, the neurobiological stratum, and the social/
relational milieu operate as a system or set, and as such reciprocally influence each
other; (2) This set coevolves; (3) This set of processes is affected by, and affect, the
genetic constraints of individuals; and (4) This set is sensitive to changes that may
occur within each component, in their relational milieu, or in the natural9 or social
environment (including those changes facilitated by purposeful endeavors such as
psychotherapy).
These tenets convey the rich tension between what has been called ‘‘morphogenesis’’ (the forces toward evolution and change) and its counterpart, ‘‘morphostasis’’
(the restraints that anchor sameness); the two coexist as a characteristic of living
systems. Adaptive coevolution is limited by the constraints of each component (i.e., it
is ‘‘structure-determined’’; Maturana & Varela, 1980) and of the setting, and its
changes are facilitated by shifts in the ecology and by random mutations. That is,
9
Natural refers to cataclysmic environmental events such as earthquakes, volcanic eruptions,
tsunamis, floods, tornadoes, typhoons, and droughts, including those that are the result of global
warming, exploitation of resources, or poor agricultural practicesFthat is, regardless of the fact
that some, if not many, of those events are the long-term result of human ignorance, greed, or plain
disregard.
Fam. Proc., Vol. 46, June, 2007
180
/
FAMILY PROCESS
species-specific limitations are ruled in large part by the limitations inherent to the
species genetic program. In turn, the genetic program evolves at its own paceFwith
occasional mutations that take place in a probably random fashion, mutations that in
turn may persist or be wiped out according to their fit with the milieuFa basic evolutionary assumption. But both the natural and the social milieu also evolve at their
own paceFeither on their own or by purposeful or unintentional alternations generated by the inhabiting speciesFcreating a slowly moving target, shifting the contextual conditions for the fit.
Implications of These Formulations for the Field of FamilyTherapy
We social scientists have, understandably, a social sciences bias, or at least a
privileged focus for speculation and for action: We intervene at the level of the psychosocial world of people. Further, from the perspective of these formulations, human
problems are problems of calibration of fit between levels of processes within the biopsychosocial realm, including the interface with the macro-environment within
which this more micro-system is immersed. As agents of change, our areas of action
may be targeted at one or another level of the system (the body, and its subsystems;
the mind in its complexity; the family and other small social systems; society in its
different expressions) but unavoidably will also be located at the interface between
systemic levels. Changes we may foster are ultimately changes toward perturbing
(increasing deviation), dampening (reducing deviation), and/or calibrating or fitting
(‘‘tuning in’’) interfaces. This view, I believe, challenges the arrogance of certitude
because it destabilizes directionality and enhances a view of the world as an unstable
system, away from equilibrium. From this perspective, the proposed formulations are
not only a challenge; they are a call to battle against the flood of reductionistic biomedical views materialized as evidence-based biopractices (and their funding!), while
being careful not to throw the baby of the biological and genetic variables out with the
bath water of our fervor in the confrontation. They are also a call of caution against
the temptation of directional hypothesis (and the definition of victims and perpetrators) that plagues our models and practicesFsometimes for practical reasons, sometimes for political reasons.
If we accept that the focus of the therapist should include the vast territory of
subsystemic (or intersystemic) interstices, it follows that therapists should not only be
learned about those subsystems and the process of fit and misfit between them, but
also, equally important, about keeping the interfaces as a central locus of their practices, because these interfaces are the territory of a good part of the source of pain and
suffering, and of assessment and change. Therefore, training of future therapists
should illuminate those interfaces, educating them about each component, the way
they influence each other, and their potential misfits, destabilizing any traditional
narrative of dominance of one level of analysis over the others. It will also have to cross
the micro-macro demarcations in ways that do not halt at the individual or family
level, but include a thorough view of reciprocity in more corporeal-material and
macro-social ways than perhaps thought so far.
In the specific case of the interface between genetics and the psychosocial world,
one of the many clinical corollaries of Lyman C. Wynne and Pekka Tienari’s research,
as well as that of David Reiss and collaborators, is that the individual’s genetic program is a proclivity, not a destiny, and the most challenging and core task of a family is
www.FamilyProcess.org
SLUZKI
/
181
one of calibrating the fit between the different personal styles and assets of the different members of the group. To acknowledge both the existence and the malleability
of the genetic potentials empowers families toward the recognition and even the celebration of differences in styles and potentials in one another, especially in offspring.
It also fosters efforts to calibrate each person’s own styleFto tune it up to the others’Fso as to maximize the positive components of interfaces and to minimize the
negative ones. This view may rob part of the doom-and-gloom that our culture instills
in our views of genetic proclivities. Although therapeutic narratives based on ‘‘origin’’
or ‘‘cause’’ tend to instill hopelessness because they are past-oriented, fixed, and guiltinducing, narratives based on ‘‘fit’’ are empowering because they increase agency.
That is, narratives based on fit offer the possibility of doing something about the
problem, focusing on the reciprocity of styles and talentsFwe are each and all shaped
by genetic proclivities!Fand on the task of calibrating that reciprocity, developing
tolerance and agency.10
A question that may be pertinent refers to the nature of a teaching curriculum that
may incorporate those tenets into the training of psychotherapists. It may be reasonable to assume that family therapists in training should become also informed
about (1) the workings of each of those systemic levelsFgenetics, neurobiology, psychosocial processes, and interpersonal dynamics; (2) the complex processes of fit and
misfit between levels, and (3) sensitivity to macro socio-epidemiological variables,
including socioeconomics, working conditions, culture, education, socioeconomic status, race, ethnicity, and gender impact on well-being/resilience and stress/vulnerability. In turn, the supervisory processes should favor the inclusion of all those
variables in the reasoning underlying the practice of therapists in training. One can
even foresee the development of a variety of therapeutic trends built on a different
balance between these principles.
The same considerations should apply to research in family processes, including
research in therapy. Family-centered research may be, and frequently is, focused on
variables pertinent to that level and not to others. However, that approach assumes
that either other systemic levels are invariant, or their variations are irrelevant (i.e.,
that family variables are robust and resistant to change even when other systemic
levels vary). That invariant attribute is being questioned by many of the research
projects discussed above. It behooves us, therefore, to assure that whenever family
research is being conducted, variables at other systemic levelsFboth inclusive, such
as social network, sociocultural, and socioeconomic variables, and embedded, such as
neurophysiologic variablesFbe traced. The latter, we should recognize, may be less
easily accessible to many psychosocial researchers because of the procedural complexity of their assessment, or less accessible for practical or legal reasons.
With regard to practices, bridging the distance between the rather general nature of
the propositions listed above and the practice of therapy may require a double process:
to inductively develop practices derived from these formulations, or to deductively
spell out what practitioners guided by those principles do in their daily work. Both
pathways open up a new field of clinical research. It defines our practices not only as
therapeutic/corrective but also preventive. For instance, it includes in our professional
area of responsibility the calibration between parental and offspring behaviors and
10
The same logic may be applied to all the other interfaces. In fact, the focus on medicine was at
the core of Engel’s plea to think of diseases ‘‘of the body’’ as bio-psycho-social events.
Fam. Proc., Vol. 46, June, 2007
182
/
FAMILY PROCESS
the modification of child-rearing behaviors of parents of children at risk, including
children with emotional/behavioral problems or with parents with psychiatric disorders (Johnson, Cohen, Chen, Kazen, & Brooks, 2006).
The traditional fronts of debate in our field, and perhaps even the basic assumptions of the field and of other fields, are shifting as the reciprocity of biologically determined and socially produced variables is being reconsidered. But, as what may in
fact be an optimistic colophon, perhaps many of the propositions of this article are
already seeping into our field, appearing here and thereFif not yet as main tenets of
our models, at least in the theories of practice or ‘‘theories in action’’ (as Argyris &
Schön, 1974, 1978, called them; also Schön, 1983), then as assumptions that de facto
guide the daily practices of a growing number of therapists, evolving as our world
(view) evolves.
REFERENCES
Argyris, C., & Schön, D. (1974). Theory in practice: Increasing professional effectiveness. San
Francisco: Jossey-Bass.
Argyris, C., & Schön, D. (1978). Organizational learning: A theory of action perspective. Reading,
MA: Addison-Wesley.
Ashby, W.R. (1954). Design for a brain. New York: Chapman and Hall.
Barkow, J., Cosmides, L., & Tooby, J. (Eds.). (1992). The adaptive mind: Evolutionary psychology and the generation of culture. Oxford, England: Oxford University Press.
Bateson, G. (1972). Steps to an ecology of mind. New York: Ballantine Books.
Berkman, L.F., & Kawachi, I. (Eds.). (2000). Social epidemiology. New York: Oxford University
Press.
Bronfenbrenner, U., & Ceci, S. (1994). Nature-nurture reconceptualized in developmental
perspective: A bio-ecological model. Psychological Review, 101, 568–586.
Buckley, W. (1968). Modern systems research for the behavioral scientist: A sourcebook. Chicago:
Aldine.
Caspi, A., McClay, J., Moffit, T.E., & Mill, J. (2002). Role of genotype in the cycle of violence in
maltreated children. Science, 297, 851–855.
Dawkins, R. (1996). The blind watchmaker: Why evidence of evolution reveals a universe without
design. New York: W.W. Norton and Company.
Duster, T. (2003). Backdoor to eugenics (2nd ed.). London: Routledge.
Engel, G.I. (1977). The need for a new medical model: A challenge to biomedicine. Science, 196,
129–136.
Engel, G.I. (1980). The clinical application if the biopsychosocial model. American Journal of
Psychiatry, 137, 535–544.
Frankel, R.M., Quill, T.E., & McDaniel, S.H. (Eds.). (2003). The biopsychosocial approach: Past,
present, future. Rochester, NY: University of Rochester Press.
Gazzaniga, M. (1992). Nature’s mind: The impact of Darwinian selection on thinking, emotions,
sexuality, language and intelligence. New York: Basic Books.
Grinker, R.R. (Ed.). (1967). Toward a unified theory of human behavior: An introduction to
general systems theory (2nd ed.). New York: Basic Books.
Insel, T.R. (2005). Commentary. In E.R. Kandel (Ed.), Psychiatry, psychoanalysis, and the new
biology of mind (pp. 27–31). Washington, DC: American Psychiatric Publishing.
Johnson, J.G., Cohen, P., Chen, H., Kazen, S., & Brooks, J.S. (2006). Parenting behaviors associated with risk for offspring personality disorder during adulthood. Archives of General
Psychiatry, 63, 579–587.
www.FamilyProcess.org
SLUZKI
/
183
Kandel, E.R. (1998). A new intellectual frame for psychiatry. American Journal of Psychiatry,
155, 457–469.
Kandel, E.R. (1999). Biology and the future of psychoanalysis: A new intellectual frame for
psychiatry revisited. American Journal of Psychiatry, 155, 457–469.
Maguire, E.A., Gadian, D.G., Johnsrude, I.S., Good, C.D., Ashburner, J., & Frackowiak, R.S.J.,
et al. (2000). Navigation-related structural change in the hippocampi of taxi drivers. Proceedings of the National Academy of Sciences, 97, 4398–4403.
Maturana, H.R., & Varela, F.J. (1980). Autopoiesis and cognition: The realization of the living.
Boston: Reidel.
McGuire, S., Neiderhiser, J.M., Reiss, D., Hetherington, E.M., & Plomin, R. (1994). Genetic and
environmental influences on perception of self worth and competence in adolescence: A study
of twins, full siblings, and step siblings. Child Development, 65, 785–799.
Morrison, P.J. (2005). Insurance, unfair discrimination, and genetic testing. The Lancet, 366,
877–880.
O’Connor, T.G., Neiderhiser, J.M., Reiss, D., Hetherington, E.M., & Plomin, R. (1998). Genetic
contributions to continuity, change and co-occurrence of antisocial and depressive symptoms
in adolescence. Journal of Child Psychology and Psychiatry and Allied Disciplines, 30, 323–
336.
Pedersen, N.J., Lichtenstein, P., Plomin, R., DeDaire, U., McClearn, G.E., & Matthews, K.A.
(1989). Genetic and environmental influences for Type A-like measures and related traits: A
study of twins reared apart and twins reared together. Psychosomatic Medicine, 51, 428–440.
Plomin, R., Chipuer, H.H., & Neiderhiser, D. (1994). Behavioral genetic evidence for the importance of the nonshared environment. In E.M. Hetherington, D. Reiss, & R. Plomin (Eds.),
Separate social worlds of siblings: Impact of the nonshared environment on development
(pp. 1–31). Hillsdale, NJ: Erlbaum.
President’s Council on Bioethics (2003). Beyond therapy: Biotechnology and the pursuit of
happiness: A report of the President’s Council on Bioethics. New York and Washington: Dana
Press.
Reiss, D. (with Neiderhiser, J.M., Hetherington, E.M., & Plomin, R.). (2000). The relationship
code: Deciphering genetic and social influences on adolescent development. Cambridge, MA:
Harvard University Press.
Reiss, D., Cederblad, M., Pedersen, N.L., Lichtenstein, P., Elthammar, O., & Neiderhiser, J.M.,
et al. (2001). Genetic probes of three theories of maternal adjustment: Genetic and environmental influences. Family Process, 40, 261–272.
Reiss, D., Pedersen, N.L., Cederblad, M., Lichtenstein, P., Hansson, K., & Neiderhiser, J.M., et
al. (2001). Genetic probes of three theories of maternal adjustment: I. Recent evidence and a
model. Family Process, 40, 247–259.
Rende, R., Plomin, R., Reiss, D., & Hetherington, E.M. (1993). Genetic and environmental influences on depressive symptomatology in adolescence: Individual differences and extreme
scores. Journal of Child Psychology and Psychiatry, 34, 1387–1398.
Rhee, S.H., & Waldman, I.D. (2002). Genetic and environmental influences on antisocial behaviour: A meta-analysis of twins and adoption studies. Psychological Bulletin, 128, 490–529.
Rolland, J.S., & Williams, J.K. (2005). Toward a biopsychosocial model for 21st-century genetics. Family Process, 44, 3–24.
Schön, D. (1983). The reflective practitioner. New York: Basic Books.
Sluzki, C.E. (2005a). The interface between genomics and the family field. Plenary presentation
at the AFTA-IFTA June 2005 International Conference on Family Therapy, Washington DC.
Journal of Family Psychotherapy (in press, 2007)
Sluzki, C.E. (2005b, August). The social nature of biological processes. Keynote presentation at
the IV World Congress of Psychotherapy, Buenos Aires, Argentina.
Fam. Proc., Vol. 46, June, 2007
184
/
FAMILY PROCESS
Tienari, P., Lahti, I., Sorri, A., Naarla, M., Moring, J., & Wahlberg, K.E., et al. (1987). The
Finnish Adoptive Family Study of Schizophrenia. Journal of Psychiatric Research, 21, 437–
445.
Tienari, P., Sorri, A., & Lahti, I. (1985). Interaction of genetic and psychosocial factors in
schizophrenia. Acta Psychiatrica Scandinavica, 71, 19–30.
Tienari, P., Wynne, L.C., Läksy, K., Moring, J., Nieminen, P., & Sorri, A., et al. (2003). Genetic
boundaries of the schizophrenia spectrum: Evidence from the Finnish Adoptive Family
Study. American Journal of Psychiatry, 160, 1587–1594.
Tienari, P., Wynne, L.C., Moring, J., Lahti, I., Maarala, M., & Sorri, A., et al. (1994). The
Finnish Adoptive Family Study of Schizophrenia: Implications for family research. British
Journal of Psychiatry, 164, 20–26.
Tienari, P., Wynne, L.C., Moring, J., Läksy, K., Nieminen, P., & Sorri, A., et al. (2000). Finnish
adoptive study: Sample selection and adoptee DSM-III-R diagnoses. Acta Psychiatrica
Scandinavica, 101, 433–443.
Tienari, P., Wynne, L.C., Sorri, A., Lahti, I., Läksy, K., & Moring, J., et al. (2004). Genotypeenvironment interaction in schizophrenia-spectrum disorder. Long-term follow-up study of
Finnish adoptees. British Journal of Psychiatry, 184, 215–222.
Von Bertalanffy, L. (1950). The theory of open systems in physics and biology. Science, 111, 23–
29.
Von Bertalanffy, L. (1968). General systems theory. New York: Braziller.
Watzlawick, P., Beavin, J.H., & Jackson, D.D. (1967). Pragmatic of human communication. New
York: Norton.
Wiener, N. (1961). Cybernetics. Cambridge, MA: MIT Press.
World Health Organization Advisory Committee on Health Research. (2002). Genomic and
World Health. Geneva, Switzerland: Author.
Wright, R. (1994). The moral animal: Why we are the way we are: The new science of evolutionary
psychology. New York: Vintage Books.
Wynne, L.C. (2003). System theory and the biopsychosocial model. In R.M. Frankel, T.E. Quill,
& S.H. McDaniel (Eds.), The biopsychosocial approach: Past, present, future. Rochester, NY:
The University of Rochester Press.
www.FamilyProcess.org