Every family, considered as a transactional system, tends to repeat these patterns with a high frequency and consequently gives rise to redundancies. The latter enable the observer to deduce the rules, often secret and generally implicit, governing the functioning of a given family at a given moment and helping to maintain its stability.
If we define the family as a self-governing system based on rules established through a series of trials and errors, then its members become so many elements of a circuit in which no one element can be in unilateral control over the rest. In other words, if the behavior of any one family member exerts an undue influence on the behavior of others, it would be an epistemological error to maintain that his behavior is the cause of theirs; rather must we say that his behavior is the effect of past interaction patterns. The study of this type of family transaction is therefore the study of fixed behavioral responses and of their repercussions.
We have spoken of an epistemological error; the latter results from the arbitrary separation of a given behavioral pattern from the pragmatic context of the preceding patterns with which it forms an infinite series.
When I speak of "epistemology" I am not referring to an esoteric discipline reserved for professional philosophers. Every one of us, by his very being in a world he has to share with others, is bound to take a stand vis-à-vis his particular mode of existence, and hence to adopt a certain epistemology.
Again, when I speak of epistemological errors or bad faith, I am referring explicitly to a common error of modern Western culture (and hence of psychiatry): the idea that there is a "self" capable of transcending the system of relationships of which it forms a part, and hence of being in unilateral control of the system.
It follows that even such behavior patterns as reduce the ostensible victim to impotence are not so much stimuli as responses. In other words both partners in the transaction are mistaken --- the manipulator who believes in his omnipotence no less than his apparently powerless victim.
But if both are mistaken, where does the real power lie? It lies in the rules of the game played in the pragmatic context of the behavioral responses of all the protagonists, none of whom is capable of changing the rules from the inside.
By defining the patient as a pseudo-victim, we are avoiding the blind alley of moralistic psychiatry. It would appear that R. D. Laing and his school, precisely because they have adopted Sartre's distinction between praxis and process, have fallen into just this moralistic trap. By contrast, if we treat the family as a system in which no one member can hold unilateral sway over the rest, then praxis and process become synonymous. "Persecutor" and "victim" become so many moves in one and the same game, the rules of which neither one can alter from within --- all changes depend on strategic interventions from without.
In the particular case of a family with an anorexic patient, we find that the epistemological error of the whole group is that all of them believe that the patient, because of her symptom, wields power over the rest and renders them helpless. If we were to take a snapshot during the very first therapeutic session, we should see an anguished expression on the parents' faces, the patient sitting apart from the rest, straight as a statue, pallid and detached, her face showing utter indifference to the others' distress. Her behavior is a clear message, not least to the therapist:
- If you think you can get me to break my fast, you'll have to think
again. Just look at me: I am nothing but skin and bones and I might
easily die. And if death is the price I have to pay for my power, then I
shall willingly pay it.
This shows that the patient completely misjudges her own situation. To begin with, she is prey to a most disastrous Cartesian dichotomy: she believes that her mind transcends her body and that it grants her unlimited power over her own behavior and that of others. The result is a reification of the "self" and the mistaken belief that the patient is engaged in a victorious battle on two fronts, namely against: (1) her body and (2) the family system.
Now this error could not be called a mental illness, were the patient to adopt it voluntarily and were she to declare quite openly that she will take no food until she gets what she wants. This would constitute a rational choice on her part, not a "mental condition." Instead the anorexic sticks rigidly to the family rule that no one member may assume leadership in his own name. That is precisely why she derives her powers from an abstraction: her illness. It is the latter that wields power, afflicts her own body and makes others suffer for it. Like every mental symptom, the anorexic symptom, too, is a paradox oscillating between two illusory poles: spontaneity and coercion.
This raises the following problem: does the symptom indicate that the patient does not want to eat (spontaneity) or does it rather show that she cannot (coercion)? If we take the epistemological view we have just adumbrated, then we must answer both questions in the affirmative. The anorexic herself, however, insists that only the second alternative is correct, that is that she really cannot eat.
In dealing with such patients, the psychotherapist must therefore pay careful heed to:
- the false epistemology shared by all the family members, that the patient is in unilateral control of the whole system;
- the patient's belief that her self (or mind) transcends her body and the system, and that she can wage a successful battle on two fronts;
- the fact that this battle is never waged in the first person, but in the name of an abstraction: the disease for which the patient cannot be held responsible; and
- the fact that this abstraction is considered "evil" because it inflicts suffering on all concerned.
The therapist must devise his strategies accordingly and, in particular, he must aim at correcting the false epistemology underlying all these phenomena. But how is he to do that? By academic discussions, by communicating his insights, or by critical remarks? If he takes any of these courses, he will, as we have found to our cost, be sent away with a flea in his ear. What he must rather do is, first of all, reduce all members of the system to the same level, that is assign them symmetrical places in the system. Having observed the prevailing communication patterns, and avoiding the temptation of participating in any of the mutual recriminations, he will make it a point, and one that never fails, to approve unreservedly of all transactional behavior patterns he observes. We refer to this type of intervention as positive connotation, and the therapist must extend it to even those forms of behavior that traditional psychiatry of psychoanalysis pillories as destructive or harmful. Irritated though he may be by overprotectiveness, encroachment, parental fear of filial autonomy, he must always describe them as expressions of love, or of the understandable desire to maintain the unity of a family exposed to so much stress and the threat of dissolution.
In much the same way he must also lend a positive connotation to the patient's symptom. To that end, he will use what material he has collected to prove that the patient keeps sacrificing herself, albeit unwittingly, for a completely unselfish end: the cause of family unity.
This first and fundamental step in the practice of positive connotation is full of implicit messages: