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Book Review: Psychiatric Medicine

with a degree of immaturity similar to one's own, so when the second generation selects a child as the focus of the "family projection system", this child will receive the cumulative deficiencies of the four grandparents. The diagnosed schizophrenic, then, is the product of a "multigenerational transmission system" and is more properly regarded as a part of a schizophrenic family system. An important clinical observation was that removal of the identified patient from the family might result in a sibling developing symptoms. The family system seemed to need a sick member. This led to the concept of "triangulation", a process whereby two people whose mutual tension exceeds a comfortable level try to induce their tension in a third person and in doing so, become more comfortable themselves. Members of a family constitute an "undifferentiated ego mass", which is, in effect, an emotional system in which tension is readily transmitted between members by triangulation. Maturation or therapeutic work is achieved by "differentiation of self', which means, essentially, the development of the ability to replace one's automatic participation in the emotional triangulation process in the family with rational goal-directed discourse and action. This is to be distinguished from the "emotional cut-off' in which one avoids being "triangled" by distancing oneself rather than by differentiating oneself within the family system. An interesting recent paper, which constitutes Chapter 21, "On the Differentiation of Self', gives life to these ideas, and gives a view of Bowen himself, as he describes his therapeutic efforts within his own family of origin.