MINUCHIN, S., ROSMAN, B. L. and BAKER, L. Psychosomatic families: anorexia nervosa in context. Cambridge, Massachusetts,  Harvard University Press, 1978. Pp.  vii + 851. £10.50.

Dr Minuchin and his team were drawn into investigating the families of diabetic children, whose diabetes the paediatricians found uncontrollable by the usual methods, and they found that pathological family interaction lay behind the uncontrollability of the physical illness. Serial measurements of serum-free fatty acids in each child during interaction with its family showed clearly the pathological biological response to phases of each episode. The exciting discovery made was that the real stress for the child came not from family conflict, but from the family's habitual techniques for avoiding conflict, and Minuchin developed a therapeutic technique of deliberately exacerbating family conflict to the point where it could be resolved instead of simmering endlessly on. ‘Normal families are able to disagree.’

He was led to make generalisations about ‘psychosomatic families’, and formed an exploratory model that he carried over to work with the families of patients presenting with anorexia nervosa. He found that typically:

1. the family members are very closely over-involved with each other—‘enmeshed’;

2. they are over-protective of each other;

3. they are rigid—resistant to such changes, for example, as should accompany the growth and maturation of children;

4. because of the first three features above, they have an abnormally low tolerance of conflict. Often the child presented as patient is found to be involved in unresolved conflict between the parents.

When a family presents with an anorexic member, Minuchin's management begins with a diagnostic family interview, during which lunch is served, and the therapist while building