Systemic therapy and psychosomatics is an interactive and process-oriented form of diagnosis and treatment. It is used for circular, i.e. loop-related illnesses.
From the perspective of systemic therapy, natural psychosomatic interactions (i.e. between mind and body) take place through information, interaction, feedback and self-control. At the same time, every medical treatment also has an intentional or unintentional effect on a person's conscious and unconscious experience, as well as on their somatic (physical) processes and social behavior.
Systemic therapy and psychosomatics are also characterized by the fact that they
- social,
- psychological or
- somatic
disorders and illnesses with effects on the patient, family and relationships. It thus integrates social relationships, the mind and body into a therapy with the patient, family and society; furthermore for cooperation with social and medical institutions.
Systemic therapy is not only aimed at a linear (one-sided) diagnosis or treatment, for example of the body. In addition to this, the self-organization of the psyche and soma is also considered and activated, also in ecological terms. Diagnostically, this is possible through an environmental, family and socio-medical approach.
Therapeutically, this is achieved through controlled psychosomatic or somatopsychic impulses and correspondingly retrospectively effective therapeutic interventions. In associative terms, this is achieved through the activation of memory and the development of stable psychological constructs.
In summary, systemic treatments within the framework of systemic therapy enable healing processes on a psychosomatic and somatopsychic level at the same time.
The application of systemic perspectives and intervention techniques to medical issues and healthcare structures is based on three principles:
- Integration of psychological and physical factors in diagnosis and therapy
- Cooperation between therapist, patient and family
- Integration of specialists from medicine, psychology, education and social therapy with the formation of interdisciplinary (multidisciplinary) teams for diagnostics and therapy
More than almost any other professional group, doctors are qualified to develop interdisciplinary working groups that represent patient-oriented medicine. In this way, systemic therapy and medicine shows a way in which the cooperation of doctor and therapist with patient and relatives can achieve competence, efficiency and quality of life.
The term cybernetics goes back to Norbert Wiener. He derived the term from the Greek word "helmsman" and used it to describe the feedback mechanism in his book "Mensch und Menschmaschine, Kybernetik und Gesellschaft" (1948). In German, the term "Regelungstechnik" can be used as a synonym for cybernetics.
The example of a thermostat illustrates the principle of a cybernetic system: the person demands a certain room temperature, which the thermostat compares with the actual temperature. If the values differ, the thermostat regulates the room temperature to the required level.
According to Ludwig von Bertalanffy, a cybernetic system is a "special system that differs from other systems through the principle of self-regulation". As an open system, it has changeable relationships between its parts, which are varied by unforeseeable external influences. This changeability enables the system to balance itself in an internal and external process. This is referred to as a steady state: components are dropped, other components are added and an overall balance is maintained.
There is no such thing as objectivity
Open systems develop an interaction with their environment, they complement each other and alternate in their tasks. In doing so, they retain their primary purpose. They remain true to themselves, so to speak. They can only change themselves ("black box"), even if they are influenced from outside. This is the principle of self-organization. In cybernetics, Heinz von Foerster speaks of the mutual influence (circularity) and reproducibility (recursivity, back-reference) of living systems.
Self-organization processes of living systems are therefore circular and recursive. In a circular interaction, the controller is therefore also the one who is influenced and the one who changes.
Example: A doctor assesses a patient both neutrally and not because the patient influences him unconsciously or consciously through his social background, language, expression, age, gender and type of illness (e.g. histrionic disorder). At the same time, both actors influence themselves through their projection. An objective view is therefore not possible.
Objectivity is therefore always also subjectivity. Heinz von Foerster therefore formulates that there is no objectivity, just as there is no real truth (see his book "Truth is the invention of a liar").
The circularity, recursiveness and the associated dialogical regularity of life can be expressed most clearly by the terms psyche and soma (the soul controls the body and vice versa). The term "systemic psychosomatics" therefore encompasses general medicine, psychiatry, psychosomatics and psychotherapy. In this context, the term psychiatry ("mental illness theory") and the term psychotherapy ("treatment of the soul") cannot didactically convey the circular and recursive meaning of psyche and soma, even if they do so in terms of content. The term psychosomatics also does not quite do justice to the interconnectedness of mind, brain, body and environment.
To put it more precisely, it is actually a "socio-psycho-neuro-immuno-bio-somato-physical medicine".
The following classification applies to individual medical specialties:
- Psychological medicine: psychiatry (with neuropsychology), social medicine (with sociology and family medicine)
- Somatic medicine: neurology (with neurophysiology and physical medicine), internal medicine (organ and hormone medicine, immunology), environmental medicine (biological and physiological environment).
Meaning and purpose of a system in systemic therapy
Cybernetics or systemic therapy offers a way of recursively understanding the concept of "meaning" and "life" of a system and thus of a sick person:
The purpose (benefit) "of a complex system, such as a living being, is itself" (H. von Foerster). A purpose does not need a meaning (goal) separate from the system. The purpose is the meaning. For example, a small child plays, enjoys it and does not question itself. The meaning and purpose of its existence at this moment is its joy.
Niklas Luhmann goes further in his social cybernetics by stating that the individual "does not" exist in social systems, but rather his communication style and his communication. (Quote: "Social systems consist only of communication, not of individuals, and as such create themselves"). Accordingly, we are because we inform, communicate and understand (circularity). Because we do this, recursivity (back-reference) arises, i.e. we learn from each other, develop and pass on our knowledge and skills to the next generation. The aim of this process is our self-preservation as human beings.
In the psychological and somatic sense, however, Luhmann, von Foerster, Bertalaffny, Maturana and others make the same observation: life (and therefore therapy) succeeds through circularity and recursivity.
Self-organization and self-organizing systems in systemic therapy
A self-organizing system defines its basic structure as a function of its experience with itself and its environment. This definition of the term "self-organization", formulated by Farley and Clark in 1954, already has strong connections with current topics, such as the cybernetics of neural networks.
The following is characteristic of self-organizing systems:
- The nature of a system has an influence on its individual parts (interaction takes place).
- The parts of the system decide how to react to its limitations.
- They act accordingly.
An example illustrates this clearly: a group has an influence on the individual through language, language content, activities, interests, intensity and form of the relationship with each other. The individual group members "decide" how they react to the group through affects, choice of topics of conversation and ideas. The individual and the group act accordingly. Self-organization can be seen in many processes such as biology, psychology and sociology etc.
People form a picture of their world interactively and self-organizationally and experience feelings in the process. This creates constructs for them, which they classify hierarchically according to their meaning and assign to structures. At the same time, it is a bit of a thing of the past. This is because a new comparison of inner and outer images is constantly taking place.
Example: I observe a certain behavior in another person, which I interpret in a certain way and therefore infer a certain character of this person (formation of a construct). Further observations contribute to supporting or revising my opinion.
Example of a construct: For a long time, the earth was considered to be the center of the cosmos around which all other celestial bodies revolved. This view was based on observations and interpretations.
The sum of the constructs, which are constantly being formed anew, then subjectively give people the feeling of having a coherent realistic perception, a point of view or a realistic perspective. However, this is not entirely correct: constructs are always a compromise between reality and assumed reality.
It is about constructs, not truths
Diagnostically and therapeutically, systemic psychosomatics is therefore about constructs, not truths, as is often thought. Mental and somatic processes are adaptive (i.e. they adapt). "They have the ability of organisms and self-regulating systems to adapt to changing environmental conditions" (Surhone, Timpledon, Marseken, 2010). They are geared towards survival, as nature has demonstrated for millions of years.
Nature adheres to a hard but effective rule: it wants to preserve what it needs in order to remain in balance. It does not want to destroy the balance from time to time, as humans do through their perfectionist and therefore destructive nature. From a homeostatic and therefore also medical point of view, the question therefore arises as to why we humans endanger the environment through our perfect technology and its waste products, which cause global warming, for example. From a cybernetic point of view, for example, it is ineffective how we weaken our immune system through air pollution, too much disinfectant and antibiotics. It is equally ineffective that we jeopardize our innate social skills such as consideration, helpfulness and tolerance through strictness, devaluation and perfection.
We are obviously relying on nature to heal itself. In this case, however, it will probably be minor and major catastrophes that regulate us against our will, as has happened time and again in the history of mankind. From a medical point of view, it is of course always to be hoped that people, and therefore patients, will be helped by their ability to be circular and recursive by accepting the rules of nature as part of it.
Insights are constructs
According to Jean Piaget's "Evolutionary Epistemology" (2010), reality and the cognitive apparatus adapt to each other because our senses, our brain and our thinking have developed and adapted to this world in the course of evolution.
"The perceptions of our neuronal networks are therefore real" (J. Piaget, 2010), i.e. adapted to what we see.
Example: Rescuing a drowning person does not prove that the person did not want to drown. Perhaps he wanted to take his own life. Therefore, the real is at best what we perceive and fits our actions. We do not know whether it reflects reality. Only one thing is decisive for the rescuer: the other person was drowning. He saved him. His so-called reality was therefore reality because it made sense and "worked". The background of the alleged drowning eludes his reality or is not relevant for the rescuer. Otherwise he would no longer be able to rescue people quickly and successfully.
A person's insights, feelings, thoughts and experiences are reflected dynamically, i.e. characterized by constant, albeit very slight, change in the network of his brain's organic perception and its synergetic processes. In this way, it is not only cognition that changes, but also the reality we experience. This certainly changes in subjective experience. The forms of cognition are therefore process-oriented and never static. Furthermore, cognition is subjective.
Health is balance
Systemic therapy is about giving expression to all the senses and the emotional-cognitive perception (images and symbols) of a sick person in order to get in touch with what moves them. The brain researcher Wolf Singer says (2005): "Cognition only takes place where we observe, organize thinking and form ideas. Everything beyond this does not exist for us, but is stored in the subconscious". This means that our conscious perception always leads to a particularly high level of activity in neuronal networks. This requires malleability and a high number of new connections that enable learning. This is the functional sense of attention and awareness.
Cognition can therefore only take place where our consciousness allows it as a construct. In this respect, every therapeutic result is relative and impermanent. It is relative because most of what moves us is not or cannot be recognized. It is unstable because new insights are constantly emerging that change and thus relativize the old ones. Ultimately, therefore, it is not the insights that are therapeutically relevant. What is important is that the insights enable an inner homeostasis, i.e. a balance.
It is crucial that the constructs developed through knowledge are accepted internally by the person. It is not necessarily decisive whether they correspond to so-called objective reality, which nobody knows physically or epistemologically anyway.
Homeostasis therefore means a balance of knowledge, not absolute truth. In this respect, those who believe in their constructs are healthy. They are at peace with themselves. However, some people are ill because they constantly question the so-called truth. They are not at peace with themselves.
Life and its symbols
Regardless of the complexity of human action, thinking and feeling, human life is characterized by fundamental rules: It is interaction (exchange of information) and synergetics (interaction of networks), whether mental, emotional or ecological (biological, physical, social).
Memories of words, images, associated feelings and ideas interact and develop neurogenic patterns. They also represent themselves as constructs and ideas. These shape the experienced and perceived reality. They also include symbolic images, which combine real images, ideas and feelings projected onto them.
Of symbols, sketches and constructs
It is possible that humans have been using them since the very beginning, as ancient cave paintings show. They represented a sketch of a simplified reality as people perceived it at the time. Through them, man was able to "grasp", store, assess and symbolize life (lion as a symbol of power, horse as a symbol of strength, sun as a symbol of fertility, etc.). [Rock engravings in Scandinavia (Bronze Age, approx. 4000-3000 years); sun symbol in Aspeberget (The most beautiful sun depiction in Scandinavia in Aspeberget shows women with long braids of hair. The sun was a symbol of fertility and abundance among the Scandinavian peoples].
If one or more symbols (constructs) in our individual or collective perceptions are changed therapeutically, e.g. through new symbolic images, the relationship of all other images or patterns and their neuronal networks to each other also changes. In this respect, images and images as constructs can contribute to recovery in the same way as calming experiences in reality.
A very simple example of how images shape a society: at the time of N. Copernicus and G. Galileo, it was a challenge for society and its church to decide whether the Earth was the center of the cosmos or just one planet among many. For the world of the 16th century, the discovery of the earth as a planet of the sun was initially without threat. However, the construct of the Earth as the center of the cosmos was lost. At first, the church tried to defend its constructs until the stronger influences of the Enlightenment prevailed. From then on, people's world view and thus their position in this world changed fundamentally until the present day, simply because an image or symbolism changed.
The earth at the center of the cosmos: The geocentric world view in Schedel's World Chronicle (around 1493)
Symbolism can also be used therapeutically by changing images and ideas in our consciousness. This can be achieved by upsetting "false connections" (so-called disturbance) and relying on the self-regulation of the body, the psyche or social processes. However, this can also be achieved through positive ideas or constructs.
Every medical treatment, including systemic therapy, offers an opportunity to come into contact with oneself through somatic symptoms, psychological conflicts, but especially through internalized symbols, images and ideas.
For Viktor von Weizsäcker, the founder of psychosomatics, it was the somatic illness itself with its symbolism and meaning and the time of its occurrence. Karl Jaspers, psychiatrist and philosopher, emphasized in his existential philosophy the existence of the human being shaped by images and ideas ("being I, being self and the search for meaning"). For C.G. Jung, psychiatrist and analyst, it was symbols and fairy tales that brought collective memories and imprints to light. For S. Freud, neurologist and psychoanalyst, it was the constructs of transference fantasies and the memory of the person concerned. For the biophysicist H. von Foerster, it was the human constructs shaped by knowledge that reflected his psyche. For the physician and surgeon Hans Kilian, it was the determination of doctor and patient.
When symptoms, conflicts and internalized images, i.e. a person's symbols and experiences, are worked out with care and analytical ability, treatment involves an interactive, cybernetically speaking, synergetic approach.
Therapeutically, systemic therapy is therefore about the implementation of treatments that are based on information and feedback as a central concept. According to N. Luhmann, the feedback of self-reproducible processes does not work without meaning ("social and psychological systems operate with meaning"). This means that treatment without meaning (or a goal) cannot be effective for the patient and the therapeutic environment. In the context of systemic therapy, for example, the patient is willing to confide in the therapist, who is therefore willing to validate the patient. In a further process, the patient is prepared to allow something in his life to be questioned in a benevolent way, and the therapist is prepared to irritate him in a therapeutic sense in order to set self-organizing and self-regulating processes in motion.
Disturbance and self-organization in systemic therapy
If we assume that people and their environment act as a self-sustaining(autopoietic) system and that change can be brought about through disruption, the question naturally arises as to how an intervention must be designed so that it disrupts and brings about change (preferably in the desired sense).
This is possible through a targeted "irritation or disturbance of non-intact control circuits" (a so-called disturbance) and thus activation of self-organizing healing processes.
This in turn is achieved through a changing feedback loop: the patient reacts differently to a therapeutic irritation than usual, this behavior causes a different behavior in his environment, which in turn confirms, irritates or corrects him, etc. Interactive processes are thus also maintained, reinforced or corrected during treatment.
Basically, however, in a treatment characterized by the process of self-organization, one lets it "flow", allows associations, ideas and fantasies of all kinds, one "goes along with the patient" and finds the "I" or "self" of the patient in order to find the "self" of the patient. "self" of the patient, which is ultimately what psychosomatic treatment is all about. Because those who are in harmony with themselves are more likely to heal than those who are torn apart.
