Authored by Robert Noone, Ph.D

Note: This blog post is the Forward to the recently published book, Death and Chronic Illness in the Family, edited by Peter Titelman and Sydney Reed (2019), and reprinted with permission from the publisher, Routledge.

The consideration of death, especially of one’s own mortality, has been a preoccupation of the human since the evolution of the wondrous primate brain allowed for the awareness of the future and so of one’s end. The reality of death is never far from consciousness. Along with the effort to understand life and how it came to be, the human has struggled to comprehend death and its meaning. It is a subject many seek to avoid considering and yet in one form or another it influences our daily lives.

The reality of death involves more than the concern about our own mortality. Few life experiences are more difficult than the death of one we love. Its impact persists for some time as we attempt to adjust to and accept the loss of one to whom we are deeply attached. At some level, either consciously or unconsciously, we are also aware of the degree to which our well-being depends on our important others. A significant illness or potential loss of those we are most connected to is a source of anxiety. A threat to their health and safety can be experienced as a threat to our own self.

Loss and the grieving process have been a central subject in psychology and pastoral care. Its impact on the health and well-being of individuals is well known. For the greater part of the past century a significant focus in psychotherapy has been on the impact of a major loss on an individual’s current functioning. The grieving process has been principally seen as a psychological phenomenon influencing the individual psyche.  And the recovery from loss has been viewed as an intrapsychic process, the resolution of which requires time and the support of others.

The development of a family systems theory by Murray Bowen represented a radical shift in understanding human behavior. To many in the helping professions, Bowen’s family systems theory represents one of a number of therapeutic approaches the practitioner might apply with an individual or family in psychotherapy or counseling. It is often thought of as a school of thought entailing a transgenerational approach. Ideas entailed in the theory may be selected and “integrated” with other approaches perceived to fit with one’s personal point of view, but the profound shift in thinking required to grasp Bowen theory is often overlooked.

The death or threatened loss of a family member or loved one highlights differences between Bowen theory and other conceptual approaches. The concepts of the family emotional system and differentiation of self provide a significantly different perspective on how one views and experiences the impact of death and loss on individuals and families.

Conventional thinking for the most part focuses on the feelings, the subjective reaction to a death. The awareness and exploration of one’s feelings and their open expression is seen as central to the resolution of a loss.

A figure-ground shift occurs when a loss is seen as occurring in the context of the family emotional system. Its impact is no longer seen as an individual process, but one that occurs amidst the interdependent relationship system of the family. The emotional reverberations occurring in the family must also be considered as members respond not only to their own loss, but to the reactions to loss of others they are connected to. The chain reactions to a loss in the family affect all in varying degrees. Knowledge of one’s functional position in the family, that of others and of the member who died is an important aspect of resolving a loss. The functioning of each family member influences the functioning of those they are connected to as the experience of loss reciprocally influences those in the family system. Knowledge of the impact on the functioning of family members and one’s relationship with them provides a broader view of the impact of a loss on self.

The concepts of differentiation of self and the multigenerational family emotional process can aid one to see the degree of emotional interdependence at play in oneself and in others. This knowledge can add a clarity that a focus on the subjective feeling states alone cannot. The loss of a family member is an important event and in general is a time in which the family is in a state of flux. It represents a time in which one can potentially learn more about the family and an opportunity to develop a more personal relationship with important others.

During such periods, Bowen theory can serve as a guideline in coming to know the predictable shifts which occur in a family’s functioning. It is not uncommon, for example, that the loss of an important family member can lead to an increase in emotional distance among some members and/or an increase in family stuck togetherness. Bowen theory can assist individuals in navigating through such automatic emotional responses in a manner which can contribute to a more open and resilient system.

Chronic Illness and Death in the Family: Bowen Family Systems Theory Perspectives represents an important collection exhibiting the value of Bowen theory in understanding the impact of a loss and its resolution. Death and chronic illness are a part of every family’s heritage. Each loss has the potential to impact the adaptiveness of a family, contributing to an increase or decrease in its functioning. The chapters in this volume provide a rich and broad range of theory, application, and personal experience by professionals who have considerable experience in developing a knowledge of Bowen theory.

Sydney Reed and Peter Titelman bring their own longstanding study of this family systems theory in contributing to and editing this important work. Murray Bowen’s Family Reaction to Death, included in this volume, represented a milestone in understanding loss from a systems perspective.  Chronic Illness and Death in the Family provides another resource for those interested in understanding the impact of death and loss in their professional work and in their personal lives.