Family Functioning The General Living Systems Research Model CRITICAL ISSUES IN PSYCHIATRY An Educational Series forResidents and Clinicians Recent volumes in the series: ADOLESCENT SUBSTANCE ABUSE: A Comprehensive Guide to Theory and Practice Yifrab Kaminer, M.D. CASE STUDIES IN INSOMNIA Edited by Peter J. Hauri, Ph.D. CHILD AND ADULT DEVELOPMENT: A Psychoanalytic Introduction for Clinicians Calvin A. Colarusso, M.D. CLINICAL DISORDERS OF MEMORY Aman U. Khan, M.D. CONTEMPORARY PERSPECTIVES ON PSYCHOTHERAPY WITH LESBIANS AND GAY MEN Edited by Terry S. Stein, M.D., and Carol J. Cohen, M.D. DECIPHERING MOTIVATION IN PSYCHOTHERAPY David M. Allen, M.D. ETHNIC PSYCHIATRY Edited by Charles B. Wilkinson, M.D. EVALUATING FAMILY MENTAL HEALTH: History, Epidemiology, and Treatment Issues John J. Schwab, M.D., Judith J. Stephenson, S.M., and John F. Ice, M.D. EVALUATION OF THE PSYCHIATRIC PATIENT: A Primer Seymour L. Hallek, M.D. FAMILY FUNCTIONING: The General Living Systems Research Model John J. Schwab, M.D., Helen Gray-Ice, M.D., and Florence R. Prentice, Ph.D. THE FREEDOM OF THE SELF: The Bio-Existential Treatment of Character Problems Eugene M. Abroms, M.D. HANDBOOK OF BEHAVIOR THERAPY IN THE PSYCHIATRIC SETTING Edited by Alan S. Bellack, Ph.D., and Michel Hersen, Ph.D. RESEARCH IN PSYCHIATRY Issues, Strategies, and Methods Edited by L. K. George Hsu, M.D., and Michel Hersen, Ph.D. SEXUAL LIFE: A Clinician’s Guide Stephen B. Levine, M.D. STATES OF MIND: Configurational Analysis of Individual Psychology, Second Edition Mardi J. Horowitz, M.D. A Continuation Order Plan is available for this series. A continuation order will bring delivery of each new volume immediately upon publication. Volumes are billed only upon actual shipment. For further informa- tion please contact the publisher. Family Functioning The General Living Systems Research Model John J. Schwab Helen M. Gray-Ice Florence R. Prentice University of Louisville Louisville, Kentucky KLUWER ACADEMIC PUBLISHERS NEW YORK, BOSTON, DORDRECHT, LONDON, MOSCOW eBook ISBN: 0-306-47191-4 Print ISBN: 0-306-46396-2 ©2002 Kluwer Academic Publishers New York, Boston, Dordrecht, London, Moscow All rights reserved No part of this eBook may be reproduced or transmitted in any form or by any means, electronic, mechanical, recording, or otherwise, without written consent from the Publisher Created in the United States of America Visit Kluwer Online at: http://www.kluweronline.com and Kluwer's eBookstore at: http://www.ebooks.kluweronline.com FOREWORD The family, that most fundamentalof human groups, is currently perceived to be changing in response to social, biological, cultural and technological developments in our postmodernsociety. While the observed changes in families have been considered by some sociologists to be evidence of adaptation and, therefore, normal, the authors oft his volume, consider them maladaptive. Viewing society from the point of view of clinical psychiatry, they point to greatly increased numbers of children born to single mothers, soaring rates of divorce, a statistically confirmed increase in mental disorders, increase in reported incest, high rates of depression in younger people and escalation of the amount of reported family violence as evidence that the family, as a social institution, is in crisis and can either move toward renewed vitality or continued deterioration. Perceiving a need to obtain information about family functioning that might lead to the increased stability and well-being of this critically important type of system, Dr. John Schwab and his associates designed and camed out a research program that began with a thorough review of relevant literature beginning with LePlay’s study of 300 families in the 1850’s and including important recent statistical studies. They found that although these studies represent advances in understanding the family system, some serious problems with the research remain, one of which is confounding variables such as family function and mental or substance abuse disorders so that if a family member has a problem, such as drug abuse, the family is classifieda sd ysfunctional. The research program reported here began in the early 1980’s when so many people with family problems were treated at the clinic that it aroused concern about the well-being of the family as a social institution. Previous studies, although they had supplied valuable data about the frequency, distribution, and correlates of mental disorders, had focused upon individual patients and had not evaluated dynamic group factors. The focus here is on the family group; its mental health and well-being as its members interact in everydayl ife. A variety of methodological approaches were used, including a model, the general living systems (GLS) and Assessment Instrument, the Bell and Schwab family functioning instrument (the GLS), which was developed for use in this research. It is based upon our living systems theory, which identifies 19 subsystems essential at each of seven levels of living systems. v vi Living systems theory has been applied in research, therapy, or planning in many different kinds of living systems including organizations like hospitals and military units and in individual psychotherapy. In this research, the GLS instrument was found to be effective in identifying patterns of family interaction, helping family members to think about aspects of their relationship that they had not considered pertinent and stimulating thoughts about problem solving. It proved to be nonthreatening, to aid in identifying strengths as well as problems in families and to be liked by family members. It also avoided the circularity of the functioning-illness tautology that often limits approaches to the serious problem of the association between family functioning and mental illness or substance abuse. This book should interest not only psychiatrists and other clinical personnel working with families, but academic psychologists and sociologists, social workers, systems theorists and researchers, and others concerned with problems at the levels of the family, and the community, and the society. James GrierMiller and Jessie LuthiMiller PREFACE About 2300 years ago, Aristotle (1952) defined the family as the basic social unit and described its socialfunctions. Two millennia later Rousseau (1 763) declared that it was the only natural institution, and through the ages, the pivotal importance of the family in society has been confirmed by the reciprocal effects of individual--family--community interactions. Those interactions determine the soundness or malaise of each of the three levels of biosocial organization and thus influence individuals’ character formation and personality development, the integrity of the family unit and its functioning, and societal well-being. The major reasons for our studying the family stem from the need to obtain information about its functioning that might lead to its increased stability and well-being. For almost 75 years, from the time of Ogburn, Burgess, Locke and their colleagues’ work in the 1920s-1940s to Skolnick’s in 1991, the debilitating effects of the increasing marital and family instability throughout this century have often been both discounted and rationalized despite the cries of distress from family members in broken homes, some schoolteachers, a few of the clergy, and a handful of family scholars. We cannot regard the changes occurring in the family as just being in accord with the rapid rate of social change during the past century, as many have argued. Instead of seeing the changes as adaptive, we think they are maladaptive. For five reasons, we need to acknowledge that the family is now in a crisis, at a turning point toward either vitality or debilitation. The first is that the status and fate of the family are inextricably tied to the health of the state and the well-being of its citizens. That fundamental truth was observed by the philosophers of ancient Greece, confirmed by political philosophers and other scholars many times since, and reaffirmed since LePlay’s (Silver, 1982) pioneering investigations during the mid-19 th century (see Chapter 11). The record of history reveals that changes in the family, such as those that have been taking place in the USA in this century, are painfully analogous and, in many ways, similar to those that occurred in classical Greece after the Peloponnesian War and continued during the two centuries of its decline from about 400 BC to 200 BC. Also, before the “Fall of Rome”, the centuries-old Roman family became increasingly decadent. During the 2nd and 4th centuries AD, multiple divorces and various forms of marriage (traditional marriage dignitas, the less binding marriage concubinitas, etc.) became common, similar to what is now vii viii occurring in the USA (conventional marriage, covenant marriages, domestic partners, etc.). What do those parallel situations signify? The second is the extent of suffering so often produced by divorce and the pathologies associated with broken homes, especially the plight of the children who receive inadequate parenting and care. Perhaps most important, we do not know the long-term effects of the extensive family disruption on character formation and personality development. Already, the wide-scale blaming of others, litigation, and unwillingness to assume responsibility that threaten to become national characteristics (“the nation of cry-babies”) reflect changes in ideals and character in the 150 years since Emerson’s “Self-Reliance” (18 44). Third, the antifamilism of the past few decades has become extreme. On June 1, 1999, newspapers reported that “US quits gathering marriage, divorce stats” (Peterson, 1999). Budget cuts have led the National Center for Health Statistics (NCHS)to discontinue gathering detailed data annually on marriages and divorces. Moreover, the short form of the 2000 Census that 80% of Americans will receive will not even ask about marital status. Family researchers, demographers, sociologists, and others are reacting with alarm to this dramatic development. Although a selected 16 million Americans will receive the long census form that requests detailed information, projections from that 20% of the population are bound to be inadequate, especially in view of the unprecedented extent of marital and family flux. Diane Solles, a family therapist who emphasizes “smart marriages, happy families,” responded: “the message is that nobody cares anymore” (Peterson, 1999, “Defenders”, A4) The demographer Andrew Cherlin at Johns Hopkins University stated that this change “handicaps my ability to give useful information”, and Theodora Ooms from the Resource Center on Couples and Marriage Policy stated that “the feds are cutting back on what they tell us, and it is frustrationg to those of us who are trying to understand what is happening.” A University of Chicago sociologist asked how social scientists can tell “What divorce means to kids if you don’t know how many kids (affected by divorce) there are, the ages and education of their parents, income, the very most fundamental pieces ofi nformation” (Peterson, 1999, A4). David Blankenhorn, founder of the Institute for American Values, declared that the budgetary cutbacks “tell us something about the values in our society.” Governor Frank Keating who has been trying to reduce the Oklahoma divorce rate by one-third by 2010, stated: “In my state it is easier to get out of a marriage contract with kids than a Tupperware contract” (Peterson, 1999, “Defenders”, A4). Although anti-government groups look at the reduction of data as a step that helps to ensure “privacy” for families, the issues of values are obviously paramount. At this time, limiting information about marriage and divorce can only be harmful to families. Its consequences are bound to be ix antifamilistic, and “giving up” the need for the data appears to be sending a “giving up” message about family stability and well-being. Columnist Mike Manius responded: “There are federal employees counting the number of California red-legged frogs, and coffin cave mold beetles--two endangered species--but no one counts divorce.” (Peterson, 1999, A4) The fourth is concern about the apparent increased frequency of mental disorders, many of which, genetically and socially, are products of family life. They need to be seen in a social psychiatric perspective. Will borderline personality disorder become epidemic? What does the efflorescence of multiple personality disorder and addictive disorders represent? Portend? Is their prominence during the past few decades reflecting our “borderline” society with the relative neglect of its children and unwillingness to accept that ”the health of nations is more important than the wealth of nations” (Durant, 1990)? Although the meaning and the consequences of the prevalent marital and family disruption are being variously interpreted, the harsh statistics about its related pathologies- medical, psychiatric, and social--cannot be rationalized or dismissed. Finally, ”the mental health function” of marriage and family life cannot be ignored. Although the family is being subjected to immense stress, especially the all-too-pressing financial problems, the weakening of supports associated with the disintegration of the community, and the shifting ideals and practices inherent to a consumer-driven society, as an institution the family has had remarkable endurance. For most persons it gives life meaning and purpose and has often sustained its members “for better or for worse, in sickness and in health.” Its mental health functions have long promoted well-being and hope and have been a refuge against despair. Studies of family functioning, therefore, need to focus on family health and well-being as well as dysfunctions and pathologies in order to learn more about how the mental hygiene functions of marriage and family can be enhanced. In Chapter 1, we discuss the extreme instability of the family and concern about the prevalence of pathologies and problems in our rapidly changing society. Many family scholars and therapists and some social critics blame them on our so-called dysfunctional families, but seldom define function/dysfunction even while they castigate the “dysfunctional family” of the mentally ill, the alcohol and drug abusers, and the delinquent and criminal. Moreover, tautologies are commonplace; for example, one’s having an “alcohol problem” is irrefutable evidence per se that his or her family was dysfunctional. Therefore, we have focused our research on the controversial concept of family function/dysfunction In Chapter 2, we review the history of family function/dysfunction and cite related research from the English studies of a century ago and the early USA studies up to the present. We emphasize the need for definitions, if not rigor, and then, in Chapter 3, we supply a summary of the theoretical