The family in problem maintenance

Interactions revolving around the patient's illness may act to maintain it.

1. First, the illness becomes a way of 'solving' a family problem, the best that can be achieved. Anorexia nervosa in a teenager due to attend a distant university may lead to her abandoning this plan since she feels unable to care for herself. Were she to leave, parental conflict would become more exposed and her mother, with whom the patient is in coalition against her father, would find herself unsupported. The illness therefore keeps the patient at home and enmeshed in the parental relationship, and also provides a focus for shared concerns and an ostensible sense of unity.

2. Maintenance of the illness does not solve a family problem, but may have done so in the past. An interactional pattern persists even though it lacks utility. In the previous example, the father's mother died 9 months later. His wife subsequently expressed feelings of closeness, feelings not experienced by him for years; their relationship gradually improved. Both parents, however, continued to treat their daughter as incapable of achieving autonomy, reinforcing her own uncertainty about coping independently if she were to recover.

3. Persistence of illness reflects a perception by the family of themselves and their problems, to which they are bound by the persuasive power of the narrative they have shaped for themselves. This may have stemmed from the helping professionals' explanatory schemas.

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