Family Systems Issue 5.1

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Table of Contents: 5.1
Special Issue on Health Care

FROM THE EDITOR
Michael E. Kerr, MD

ARTICLES: Journal articles reflect natural systems thinking or are relevant to it. These may include concept papers as well as research studies.

BOWEN THEORY AND HEALTH CARE COSTS IN THE UNITED STATES
Polly Caskie, PhD
Although growth in national health spending has slowed since 1993, experts predict this trend will not last. Increasingly expensive technology is more widely used for diagnosis and treatment. An increasing percentage of the population is developing high maintenance, chronic illnesses. Cost containment solutions have offered only short term relief. Bowen theory’s concept of emotional process in society provides a template for interrelating the numerous factors that contribute to increasing health care costs. It suggests that a rising level of societal anxiety can generate short-term solutions and play a part in our failure to stem rising health care costs. Bowen theory offers a way of thinking that can point toward long-term solutions.

THE HEALTH MAINTENANCE ORGANIZATION AS AN EMOTIONAL SYSTEM 
Michael H. Quinn, PhD 
This paper will apply a systems framework to evaluate ideas and assumptions managed care organizations typically use in today’s cost conscious mental health delivery system. These ideas and assumptions will be described as they are often put into practice in health maintenance organizations. The validity and potential usefulness of these concepts will be evaluated in the context of Bowen family systems theory. The paper will include a focus on the findings of one large scale study of mental health service delivery to families (Bickman et al. 1995) that has generated considerable discussion and debate because of its relevance to managed care. Questions, problems, and implications from a systems perspective will be addressed.

ANXIETY AND DIFFERENTIATION: FACTORS IN THE VARIATION IN RESPONSE TO PSYCHOACTIVE MEDICATION
James E. Jones, PhD
From Bowen theory, one can extrapolate the hypothesis that a variation in the level of differentiation and intensity of chronic anxiety in an individual and his or her relationship system influences variation in functioning, which may include variation in response to a psychoactive medication.

WHAT IS HELP? A THEORETICAL AND SOCIAL PERSPECTIVE
Stephanie J. Ferrera, MSW
This essay presents a way of thinking about help that is based on Bowen theory, a body of knowledge about human behavior and relationships that many have found helpful in addressing life’s complex questions. Viewed as part of human relationship systems, helping is guided by a balance of emotional response and conscious thought. The influence of emotional process, and the projection process in particular, on helping relationships is described. The author presents a personal application of this knowledge to issues of help that arose in her own family.

A FOUNDATION FOR PUBLIC HEALTH
Sydney Reed, MSW
While diet, exercise, and a high standard of living undoubtedly contribute to health, research from the social and natural sciences addresses other important factors that contribute to good health and good quality of life. This paper looks at some of this research which describes the relationship between social cohesion, egalitarianism, and health. Egalitarian societies with strong social cohesion promote the health and longevity of their members. Many factors have been identified as contributing to this phenomenon. Currently, however, researchers have no theory to explain the relationship between these various factors. Bowen family systems theory offers such a perspective and provides a framework for understanding the ways that individual health and quality of life are shaped by the ways a community is organized. The community, in turn, is shaped by the ways its members contribute to and benefit from it. 

BRIEF REPORT: Brief reports present important ideas in development and promising research in its early stages.

THE PROJECTION PROCESS IN HEALTH CARE SYSTEMS
Kathleen B. Kerr, MSN, MA
This essay presents an application of Bowen’s concept of the projection process to health care systems. Concepts of differentiation, anxiety, and the family as an emotional system underlie the concept of the projection process. These concepts were first described in families but also apply to health care systems. Emotional process in health care systems can impinge on the functioning of patients. The medical model with its focus on diagnosis and treatment and today’s emphasis on technology can increase the probability of the projection process occurring. Professionals can decrease the intensity of emotional process through attention to their own functioning, especially by recognizing and managing their own anxiety.

BOOK REVIEWS: Reviews on books relevant to Bowen theory and its many applications.

THE HEALTH OF NATIONS 
Leonard Sagan
Reviewed by: Louise Rauseo, RN, CS

MEDICINE AT THE CROSSROADS
Melvin Konner, MD
Reviewed by: Victoria Harrison, MA