At the 2018 Midwest Symposium on Family Theory and Family Therapy in Wilmette IL, Peter Gianaros from the University of Pittsburgh cogently argued that SES(socio-economic status determined with a composite measure) partially predicts(correlation approximately 0.30) adult serious physiological symptoms, indicators of risk for serious symptoms, and neurobiological indicators of chronic stress/anxiety. Notice that the correlation is modest, with many exceptions to the correlation.
I would expect that level of differentiation of the individual and/or the family(Diff) would do the same thing, also a modest prediction with many exceptions. Murray Bowen asserted that lower differentiation family systems have more serious physiological, emotional, and social symptoms. So far, fragments of evidence from Bowen researchers are consistent with that assertion(Caskie, Baker, Klever, Skowron).
There are pieces of evidence here and there that appear to imply that Diff is also very modestly associated with SES, probably a correlation quite a bit less than 0.30. That strongly implies that Diff and SES predict different aspects of the symptoms and physiological indicators, and that also implies that a composite measure consisting of Diff and SES would predict more of the physiological symptoms and risk than either alone does.
Oddly, the research on adverse childhood experiences(ACE) supports, I think, some of the Diff assertions. In some ACE research quite independent of research on SES or Diff, the ACE score for an individual also modestly predicts adult physiological and emotional symptoms, social functioning to some degree, and physiological and neurobiological risk indicators.
Why do I say that ACE research is consistent with the assertion that Diff predicts adult serious symptoms and risk indicators? When one looks at the10 categories of childhood experiences in the ACE score, they appear to be describing a subset of low differentiation family systems. Not all, just a subset. And despite the popular focus on childhood abuse and neglect, ACE also includes 5 categories of what the researchers call “household dysfunction”. All ten taken together, to my mind, describe certain kinds of low differentiation families.
I fully suspect that Diff would have a statistical association with ACE. And some of the ACE research implies a very modest association between ACE and SES.
What are the clinical implications of all this? Pretty simple. If you want to understand serious adult conditions, use some kind of composite measure of SES, Diff, and ACE, not just any one of them alone. Just because one guy in a family is low SES, or one guy in the family was abused as a child, or one guy in a family is at genetic risk for life-threatening asthma does not mean that any of those alone implies or predicts serious adult symptoms. Probably not so much. Use a composite of those variables together to make these predictions.
References
Baker, K. and Gippenreiter, J.(1996). The effects of Stalin’s purge on three generations of Russian families. Family Systems, 3(1), 5-35.
Dong, M., Anda, R. F., Felitti, V. J., Dube, S. R., Williamson, D. F., Thompson, T. J., Loo, C.M., Giles, W. H. (2004). The interrelatedness of multiple forms of childhood abuse, neglect, and household dysfunction. Child Abuse & Neglect, 28(7), 771-784. doi:10.1016/j.chiabu.2004.01.008
Felitti,V., Anda, R., Nordenberg, D., Williamson, D., Spitz, A., Edwards, V., Koss, M., and Marks, J.(1998). The relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: the Adverse Childhood Experiences (ACE) Study. American Journal of Preventive Medicine, 14(4), 245-258.
Felitti,V. and Anda, R.(2010). The relationship of adverse childhood experiences to adult medical disease, psychiatric disorders and sexual behavior: Implications for healthcare. In The impact of early life trauma on health and disease: The hidden epidemic(pp. 77-87). Lanius, R. A., Vermetten, E., & Pain, C(Editors). Cambridge, UK: Cambridge University Press.
Kerr, M. and Bowen, M.(1988). Family Evaluation.
Klever, P. (2001). The Nuclear Family Functioning Scale: Initial development and preliminary validation. Families, Systems, & Health, 19(4), 397-410. doi:10.1037/h0089468
McEwen, B.S. and Gianaros, P.J.(2010). Central role of the brain in stress and adaptation : links to socioeconomic status, health, and disease. Ann N Y Acad Sci 1186, 190-222, 2010
Skowron, E. A., & Friedlander, M. L. (1998). The Differentiation of Self Inventory: Development and initial validation. Journal of Counseling Psychology, 45(3), 235-246. doi:10.1037/0022-0167.45.3.235
Wager, T.D. and Gianaros, P.J.(2014). The Social Brain, Stress, and Psychopathology. JAMA Psychiatry, 71(6):622-624. doi:10.1001/jamapsychiatry.2014.288.
Jim Edd, I’m intrigued by your ideas on SES and your careful documentation and incorporation of statistics. I have also posted thoughts sparked by Peter Gianaros at the CFC Midwest Symposium.
In clinical practice and in general understanding of human functioning, I think we see the interplay of SES, ACE and Diff, with each arena encompassing many variables. Can these mutually influencing variables even be separated from one another? Can they be defined and measured? Can we go further to identify specific interventions that make the biggest difference in health and other social measures?
Gianaros introduced another factor: subjective SES. Individuals and families interpret and respond the their socioeconomic situations differently, which may have to do with level of chronic anxiety and level of differentation as well as the emotional climate in the family and in the community.
This brings me to say that I think your point on using a composite of variables is right on target. I think that is what clinical experience and life experience equips us to do…with a lot of help from theory and research.
Thanks Stephanie.
I’ll give my oprinions on your three questions. No, in a living system, variables can’t be separated in any absolute sense, they will always have at least a little association with each other. But they can be defined and measured, as long you accept that the measurement will be probabilistic and not absolutely certain.
In living systems, my opinion is that you can identify interventions that help to some extent, especially when they are put together with other actions which help a little. No silver bullets.
Jim Edd,
I have read and re-read this article over the week and found it interesting, as well as providing research suggestions. I plan to look at the work of Gianaros. Your approach is different from the way I have thought about symptoms, but it makes sense. I have thought about differentiation of self as being the significant factor, combined with level of stress, because that is what Bowen stated. I have thought that ACE score and SES variations are the results of variations in differentiation of self. But ACE and SES could show degrees of stress. Bowen’s view that symptoms result from level of differentiation AND combined with level of stress is what I have accepted as the determining factors for symptoms. I like the way you think things through for yourself. Are you the younger brother of a sister? As an oldest, I think I do less questioning. Thank you for this.
You’re welcome. I’m the older brother of a brother. And I have a 51 year reasonably fun marriage to an oldest. Go figure.
Certainly level of differentiation and level of stress are very important for the variation in symptoms. But they aren’t the only considerations. Think of exceptions. Better differentiated families who have some nasty illnesses. Or less differentiated families who have reasonably decent health.
Just because there are exceptions does not invalidate your point about the importance of differentiation and stress in generating symptoms. It just qualifies it.
And certainly ACE and SES are influenced by level of differentiation and stress. SES a little and ACE quite a bit more so. Stuff is influenced by a lot of stuff. Differentiation is an important part of that mix but not the only thing.
I like this dialogue about exceptions. I have been thinking about them lately. For example, the family projection process (FPP). In what % of symptomatic children is the FPP a factor? The primary factor? In what % is it hardly a factor at all? We have generated very little data that can help us answer such questions scientifically. We have disciplined observers confirming that this process can be very important, and very helpful to some family leaders. But I have been guilty of confirmation bias is this area with clients who have symptomatic children.
I think the Bowen network would benefit from a good paper on the exceptions. This is important for keeping Bowen theory open.
You certainly picked up on one of my points. FPP is a good example. Your three questions address the crux of the exceptions issue. Thanks for your comments.
I enjoyed your thoughts here Jim and I think psychological science is recognizing that an any single variable has small effects and it is a combination of variables that add up. It reminds me of the importance of systems thinking. I wish I had more time to comment. More later.
One other thing. Slavich at UCLA has a stress lab at UCLA in which they have data showing better predictiveness than ACES in the life stress variable.
Bring it on. The more the merrier, when you get good predictions from collections of variables, rather than one or another.