I take a holistic, joined-up approach to thinking, learning and understanding the world. In terms of health beliefs this encapsulates mind, body and soul, and incorporates both individual, wider relationships and other social factors. Therapeutically, an approach which dovetails this approach is family therapy – otherwise known as systemic therapy. In this approach one considers the shared experience of illness and injury and how relationships impact on both illness and individuals. One aim of systemic therapy is to draw on the strengths of individuals and the group and to highlight examples of positive coping in the face of adversity. Recently I summarized systemic theory as based on the following premises:
• Social systems such as families consist of individuals but also relationships, boundaries, hierarchies;
• The parts of a system are inter-related (one part of a social group cannot be understood in isolation from the rest of the group);
• Members of a system are governed by communication patterns (we are constantly in communication with each other even when we choose not to communicate);
• People act on the basis of their beliefs;
• Even behaviours that have negative consequences may have a positive intention;
• The causality of social problems is often ‘circular’; that is to say, the origin of a problem may be different from that which maintains it, and causal and maintaining factors may be distributed across members.
Now to examples of how this plays out in reality …
First a family situation:
• A man who drinks each day and is dependent on alcohol;
• A woman who is depressed and cannot leave the safety of her own house;
• A young girl who is routinely starving herself.
Most definitely each of these is a complex problem in itself but consider how different yet understandable this situation becomes when we are made aware these individuals are part of the same family unit.
Second, a situation affecting the wider health system:
• Due to a financial shortfall there are cuts to services at a local hospital, particularly for people with chronic conditions who require long-term care;
• A group of independent hospitals notices a turn in the market and increases its fees for respite and day centre services across the country;
• A key 3rd sector organization finds it has to double its number of volunteers to cope with the demand for 24-hour telephone and long-term support.
Note how tempting it is to order these events in linear time? Yet any linear analysis depends on when one begins observations and so in many ways it makes more sense to view each development as impact or radiating outwards, forwards and backwards (circular causality).
Third, an example affecting political systems:
• Two neighbouring Governments take differing policies around the control of state media and wider internet access and both have policies and rules that limit the freedom of movement for individuals;
• The inhabitants of the country with greater freedoms are made aware of other countries offering a better quality of life and are able to mobilize to put pressure on their Government to change certain policies;
• For those inhabitants of the country with greater state controls the situation remains the same and the overall feeling of dissatisfaction rises.
Just imagine how rapidly such a situation might escalate…