The cybernetics of physical illness. Barry Dym. Fam Proc 26: 35,48 1987

Based on General Systems Theory, Batesonian ideas of systems and feedback loops. I've just finished reading this paper as part of an online exam I have.

I understand the basis gist being - a medical model considering only causal and effects of a symptom is too linear, one must consider biopsychosocial impacts and recursive cycles.

However some points I wanted to explore

1. What does equipotentiality of functions mean? I understand it to mean, in the context of systemic thinking, that one action, say the behaviour of one person, can be replaced by the similar behaviour of someone else, thus maintain the status quo. An anxious Dad of a child with ME who gets distracted by his dying father, may then be replaced by an anxious Mum.

2. This paper made me think about 'symptoms'. Once we try and remove a physical symptom, according to Dym theory, then potentially a recursive pattern of family interaction remain. Having 'outcome measures' and specific symptom screening tools are perhaps only indicators of the symptom and by applying this theory, as family therapists how would we formulate or identify other areas of measurement? How would one know when the recursive pattern has ceased for an appropriate amount of time?

3. Some of the interventions Dym hints at seem quite strategic and paradoxical. The theory is a useful framework of which I will try and make use of, though unsure how strategic I will be with it. How about being strategic and open with this? A new way of introducing paradox and strategic work which has, in the past yielded great examples of success (see Hoffman, an Intimate Portrayal, page 13-14 where she gives examples from Erikson and Haley).

4. This is making me think about current cases I have now. I may be consciously focused on eradicating the symptom (albeit not physical in one case, and in another a physical symptom is present). So scanning the entire field may be of use in my practice.

5. Dym may have been talking about Externalisation to some extent when he talks about separating the symptom from the cycle in which it's embedded. At the same time he is careful not to give the impression that the symptom is then seen in isolation - the latter being different from my understanding of externalising.