Book Review: Functional Somatic Systems and the DMM

Functional Somatic Symptoms in Children and Adolescents: A Stress-System Approach to Assessment and Treatment, Kasia Kozlowska, Stephen Scher, Helene Helgeland, 2020, Palgrave Macmillan.

Summary review

This is an outstanding book for any professional working with children in the medical, mental health, legal and parenting fields. Using leading edge science and a mind-body-relationship (MBRx) perspective, the authors apply meta-models such as interpersonal neurobiology and the Dynamic Maturational Model of Attachment and Adaptation (DMM) to understand causes rather than symptoms of somatic and related relational issues. They are describing the causes of somatic symptoms which have no objectively obvious cause. With an MBRx perspective, the book offers a comprehensive set of solutions organized around neurobiological, psychological, and relational treatment interventions.

The medical portion of this work is fascinating and complex. Even medical doctors will likely find new information. For non-medical professionals, especially those unfamiliar with MBRx concepts, the topics covered necessitate frequent reference to a dictionary. On the plus side, the authors make good use of graphics, metaphor and case examples to put the issues in accessible context.

The treatment intervention section highlights that no one person or profession can offer all the needed solutions. By the time a relational problem has manifested into a somatic expression, help is best with a team approach. The interventions related to addressing family systems issues, in particular, include techniques any mental health, parenting, and legal professional can apply at macro and micro levels. The author’s basic list of the techniques is available here.

A slightly longer review

Advanced models describing human functioning use a perspective which considers the interaction of mind, body, and relationships (MBRx). This new book uses the MBRx perspective to focus on many specific mind-body medical and psychological problems which occur in the MBRx context, and also interventions. Their MBRx approach ties together issues such as adverse childhood experiences, attachment experiences, circadian interruptions, chronic stress, and the difficulty of turning off persistent activation of the stress response system. (For lawyers, this relates to what underlies high conflict cases.)

Mind-body (and brain)

In MBRx models, brain-body distinctions are broadly considered as one body system since they are inextricably intertwined and there are multiple “brains” in the body. The neuron collection in the brain (brain in the skull) and the massive neuron collection in the intestines (gut brain) are just two neural systems in a body. (The human gut brain has more neurons than the skull brain of many mammals.) Mind is like the software of the body, mental output and input from physical and neural interactions within the body and within relational interactions.

Relational interactions as described by DMM-Attachment

Relational interactions are described most comprehensively with attachment science and theory. The authors use the advanced DMM-attachment model for several reasons.

A child’s attachment experiences shape their neural development, biological regulation processes, and somatic problems. (Those shapes have lifelong impacts.) The authors make a strong argument that disrupted, or even chronically challenged, attachment relationships contribute to the emergence of somatic symptoms. This is why, for people who are unfamiliar with the self-protective strategies and patterns of attachment, somatic symptoms with no clear disease-related causation can be hard to understand.

Attachment experiences also shape how people perceive, process information, and communicate. The DMM’s scientific method for assessing attachment patterns looks at how the mind organizes behavior, and language and speech structure. Especially for children, attachment assessments focus on body movements and expressions. Somatic illnesses are body expressions. Thus, the DMM methodology, when used to understand somatic talk, allows a child’s body to speak about their underlying stress issues. (P. 75 in the PDF.)

Transdisciplinary approach to causes and solutions

MBRx models are transdisciplinary, considering science and theory from medicine, neurobiology, genetics, trauma, psychotherapy, dyadic interactions such as parent-child, family systems, and many more disciplines. The techniques and interventions are likewise transdisciplinary.

Kozlowska talks about how she takes a systems approach which ranges from cellular systems, to neural systems, to muscular systems, to stress systems, to dyadic (parent-child) attachment systems, to family systems, to school and cultural systems. As her attention ebbs and flows between systems, she calls on helping techniques from her experience as a physician, psychiatrist, attachment clinician, psychotherapist, and family therapist.

Interpersonal Neurobiology (IPNB) and the DMM offer transdisciplinary models. Both are heavily attachment-based since early childhood experiences, positive and adverse, foundationally shape neural structure and function.

MBRx systems covered in Functional Somatic Symptoms

The book authors consider a long list of MBRx, and mind-body systems, giving the reader an excellent overview of the range and complexity of systems these modern models are seeking to understand. Systems covered include:

• The autonomic nervous system
• Immune-inflammatory system
• Sleep systems
• Skeletomotor systems
• Hypothalamic–pituitary–adrenal axis (HPA)
• Microbiota-gut-brain axis (MGB)
• Adverse Childhood Experiences (ACES)
• The brain’s restorative-defensive-maintenance modes
• Body stress systems
• The brain’s stress system (amygdala-hypothalmus-periaqueductal grey-symptathetic and vagal nuclei)
• Maintained maladaptive stress system activation
• Maladaptive neural plasticity
• Mind systems including somatic and neurobiological effects on information processing.

MBRx treatment and interventions

Critically, for professionals working with clients, the authors offer a comprehensive list of treatment interventions. These are offered with an MBRx organization, looking at interventions focused on somatic (neurobiological), mind (psychological), and family systems (relational).

The authors are an international group of psychiatrists, from Sydney Australia, Belmont USA, and Oslo, Norway. They are looking at causes rather than symptoms. While they consider drug related solutions, they are focused solutions that minimize or avoid drug approaches.

Conflict Science Institute perspective

From a CSI perspective, Kozlowska and her colleagues offer an approach to addressing somatic problems which is highly consistent with how legal professionals can approach conflict. Many of the techniques they offer can be utilized by lawyers to help regulate and calm clients’ nervous systems, and to help improve client’s memory recall, fact gathering, and decision making.

Some of those techniques are pointed out in our post listing the techniques, and include such things as serving as a Transitional Attachment Figure, using mindfulness techniques to manage the professional’s exposure to secondary trauma, and identifying relevant topics lawyers can raise with clients. One of the important techniques for reducing the intensity of the somatic expression, and associated pain, is to bring attention away from the problem, and they offer specific techniques for how to do that. Again, these techniques can all be ported into a law practice to help resolve conflict.

Some parent-clients need help developing attachment-healing techniques to reduce the trauma caused by attachment-harming co-parents. The techniques in this book can be broadly and generally applied to this effort with good effect.

A current trend in some legal trainings is to consider conflict in trauma terms. Bessel van der Kolk’s Book, The Body Keeps the Score, offers a nice MBRx overview, from a trauma perspective. If you have found the trauma perspective useful, you will this book by Kozlowska, Scher, and Helgeland fascinating and mind opening.