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As a potter molds clay to form a beautiful creation, so does the strong family support and good values does. Family bonds are a link from the beginning and guide to future. Early influences are fundamental to individual development. Everyone wants to belong and feel accepted. A sense of belonging is derived from the strong bond of family. Family is where roots take hold and grow. We are molded within a unit, which prepares one for the experiences of the world and reactions to those experiences. A close family bond is like a safe harbor where one finds refuge. From trusting that someone will pick us up when we fall, as a toddler, to someone being there for us as we experience the storms in life. Family bonds help to instill trust, hope and belief in ourselves. The other hand if family doesn’t have attachment, poor relationship, insecurity and anger can lead to negative consequences like isolating, low self image, anger and pain inside them. If one isn’t loved as a child, they may later seek love and acceptance in a way that brings them harm. This not only affects the emotional, physical and social well-being. The poor self-image may be with the patients throughout life, causing inability to make positive choices or be close to others. Strong family bonds help us to thrive in all aspects of life. Lack of these bonds can lead to forever seeking that something which is missing and one should not take the value of family bonds for granted.
Along the farm duties, family usually faces burdens. Yip (2005) identified three types of burdens in family care giving of persons with mental illness. Objective burdens are financial burdens, time and effort in care giving of family caregivers. Subjective burdens are feelings of loss, shame, worry, anger, and hopelessness of family caregivers towards their relatives with mental illness. Finally, there are burdens in management of problem behaviors like assault, mood swing, unpredictability, and other negative symptoms due to mental illness of a family member.
Along with the burdens, there are benefits when family stay with mentally ill person. Often patients listen to their family because they are close to each other and every disease needs cure and family is the major support. They can help their family member to involve in the social and family activities, by involving them in rehabilitation program, encouraging other family members and friends to invite the ill family member to join them in activities and by respecting the need of solitude.
My patient was a 17 years old female, forth among seven siblings, with the diagnosis of schizophrenia. Her pre morbid personality was that she was always a different child, quite and always thinking. She had no friends and was never interested to talk to her sisters as well. She never took part in household chores and when asked to help, she used to get angry, and never participated. She had a jealousy component in her as the mother always admired her elder sister and degraded her. Before hospitalization she even had hallucinations and delusions. While talking to the patient, she verbalized that “I don’t like my sisters because everyone compares them with me.” Patient’s mother also accepted that she had always given importance to the elder sister and pointed out the client that she is the laziest person of the family. May be this could be a reason of patients anger, frustration and not having a caring attitude towards family.
Significance of family support in Pakistani context:
Family support is a very important part of our entire Pakistani nation. Family support is given a lot of importance in terms of family bonding, love and affection. On the other hand there are few families which do not pay attention to this important issue. The family support is important because it effects on physical, psychological and social well being of an individual. In the Pakistani context no such study is been done on family’s role in one’s life. According to Mansoor (2008) “Family system in Pakistan” states that “each member of a Pakistani family has respect for the older family members. The parents feel responsible for teaching their children the basic beliefs of the chosen religion.” Looking at the scenario mentioned above the family has paid less attention to the child because of huge family, house hold responsibilities and low socio-economic system. According to my understanding when a child grows in a close kit family they learn to appreciate all the members of family and never hesitate to accompany their elders or younger’s in public. I believe that strong family bond serves as catalysis for everyone’s joy. This is because the family has its rules and regulations and when these rules and regulations are strictly followed it brings joy to the whole family and helps in community building. There is always the belief that good families can make a good society. Strong family bonds create an atmosphere of interference in the affairs of one another. For example a strong and united family the elders do not abandon the family, but they keep taking care of their parents and their younger ones in times of troubles.
Significance of family support in western world is on appendix 1.
Analysis of concept in the light of literature:
During the 1950s, Murray Bowen gave family system theory. Theory affirms that the individual can change behavior if aware of the impact of current and historical family behavior. It works on family as well as on the emotional health of an individual. Bowen summarized his theory using seven interlocking concepts. First three concepts apply to overall family and other four are related to family characteristics.
Differentiation of self
The concept of differentiation of self measures all human functioning on a continuum from the greatest emotional fusion of self boundaries to the highest degree of differentiation or autonomy. In my patients scenario “self” was suppressed from the childhood in the result of that her family relationship were not strong. A lot of family criticism was there. Children were not allowed to take their own decision; instead they have to do whatever parents asked. The example is secular studies were compromised and the client was put in Madrasa to learn and recite Quran. As a result the family bonding went down. Her issue were not given importance and taken as a least important person of the family. She was never paid attention for whatever she did; the reason could be huge family, less differences between children and poverty.
The continuum of differentiation of self is discussed more in detail in appendix 2.
Triangle is a predictable emotional process that takes place when difficulty exists in a significant relationship, and the third entity is included. In my patient’s scenario, the triangle has three ends. One is father, another mother and the third is the patient. The conflicts between parents have a great impact on child and that can leave lifelong effects on one’s life. In my clients scenario the parents had conflicts between them and research indicates that the longer parental conflict continue, greater the tension between the parents, the greater the likelihood that psychological difficulties will result for children such as emotional and behavior problems, anxiety, depression, sleep problems, low self-esteem, school problems and a number of other difficulties.
The example of family triangle is on appendix 3.
Nuclear Family Emotional System
These are patterns of interaction between family members and the degree to which these patterns promote emotional fusion. In my clients picture she was always projected that she never participates in house hold chores and is the laziest person of the family. This indeed led to low self esteem and hopelessness. Most of the patients develop hopelessness because of shame and guilt of being poor. According to Patel & Kleinman (2003) stated that “hopelessness is a core experience: it is associated with spouse and family abuse, forced marriages, limited educational and work prospects, stigma for failing to produce a son, and the migration of husbands to urban areas for employment.”
The family projection process
It is the projection of spouses’ problem onto one or more children to avoid intense emotional fusion between the spouses. This also fits into the clients scenario that because of poverty and low socio economic status parent and child were not able to create bond between them. “The economic stressors such as unemployment, low income, and lack of affordable housing, are more likely to precede mental illness.”(Hudson, 2005 )
Multigenerational Transmission Process
This refers to the transmission of a family projection process. The nature and degree of intensity of emotional responses are passed down from generation to generation. Levels of differentiation are affected through generations based on levels of differentiation of partners as they marry. This was not exactly explored during the interaction but it could be a part of patient’s illness.
The concept of emotional cutoff describes people managing their unresolved emotional issues with parents, siblings, and other family members by reducing or totally cutting off emotional contact with them. In my patients case she became isolated from the family. This could be because she has some concerns from the family but they were never addressed and she got emotionally cutoff from it.
There is an impact of sibling position on development and behavior. Most of the time it is practiced that older child is the leader and the younger’s are the followers. My patient follows exactly in this category. She is forth among seven siblings. She never liked her mother to say that “be like your elder sister” and never liked to follow her elder sisters. (Stuart, 2001)
See appendices 4 for the factors left.
At individual level, a mental health nurse can take time for the patient and encourage them to ventilate their feelings. Moreover, while giving teaching to the patients, nurse can discuss the coping strategies. She can provide holistic care and address the problems and concerns accordingly, as the need of the individual. The nurse can provide the most important information’s to the patient that is the need for the understanding their own responsibility. Make them aware of the importance of family support which is necessary for them. The interventions done on the client includes family teaching on dealing with hallucination and delusions that was informal. Mother was given teaching on stress management and coping mechanism. Client was involved in occupational therapy example making sit upon, coloring, drawing, collage work, making bands and so on to see the concentration level and keep the patient busy and asked the family to keep patient involved.
At group level family can also involved with patient, to be aware of patient’s condition and involve them actively in patient’s care. The individual can be involved in group therapies for example milieu and occupational therapy. Moreover, in Pakistan, organizations should be made which can involve families who have clients with mental illness so that they can share their concerns, ventilate their feeling and reform solutions to problems. Some organization can also work to reduce the poverty and socio-economic instability, which is one of the leading factors of mental illness.
At institutional level different groups of health care professional can be train for the risk assessment, can conduct the educational session on importance and role of family in one’s life. Moreover, seminars can be held for general public regarding awareness of mental illness, coping skills to reduce stress and to ventilate their feeling. Hence, I would like to recommend that health care workers should be more vigilant towards client’s health.
At governmental level, organizations should be made to teach skills to clients for earning and to feel them self-empower. In addition, it is role of a nurse to identify the concerns in clients, spend time with the clients for their ventilation of feelings, should not be judgmental regarding clients complains and try to resolve their issues collaboratively with clients, families and other health care providers.
My own learning & Reflection:
Through this paper writing my horizon of thinking about family role has more broaden. I always had a thought that mental illness occurs more often with parental conflicts but it has many other dimensions to look at. Going through different researches I came to know that love and affection are the important aspects which can help a mentally ill patient to live a normal life and when one is deprived from it can end into many other issues. The misconceptions I had before about mentally ill patients were that they are harmful and attacking but now I realized that they are only looking for love and someone to listen them. Mentally ill patients are also human and they should be treated as human beings, this is their right and they should get it.
In conclusion, low family sociability, the extent to which family members derive and seek gratification from social interaction with others along with a lack of cohesion explicitly, the extent to which family members have bonding towards one another is important. Conflicts between family members, authoritarian family styles, the extent to which parents dominate the locus of rule making and low family sociability play’s a significant role in one’s life. Importance of Family lies in the fact that one can discuss matters with the other family members and search solution from discussions. At times, conflict appears in a family but enough space should be provided to their opinions and views. In modern days, we have seen that joint families have broken up into nuclear families and a nuclear family consists of a couple and their children. In western countries, nuclear families are the norm but in many eastern countries, joint families still exist. Children receive guidance from the family as to what they should do or what they should not do. The Importance of Family lies in the fact that it determines to a large extent the social roles that the children will perform. Family support and bond can help an individual to come out from stressors, mental illness and other health problems.
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Significance of family support in western context:
According to Sven.D. 1998 “There are regions where traditionally the family group has priority over the individual and others are opposite, with the individual and there values having priority over everything else. The geography of these family systems suggests that North America, center and northern Europe has been characterized having relatively weak family links. There are indications that these differences have deep historical roots. There is little to suggest that they are diminishing today in any fundamental manner. The way in which the relationship between the family group and its members manifest itself has implications for the way society itself functions.” According to my thinking, in western world, families have less importance, may be because of their fantasy world, interference they don’t like or freedom they are fond of. In the west, kids are allowed to leave parents at the age of 18 as they are mature and can take their own decisions and responsibility and parents don’t mind it because it’s their trend, as a result single parent family comes into existence. According to Jill Francis, of the National Children’s Bureau, “There are four main reasons why teen age unmarried girls in Britain become pregnant. “The likelihood becoming pregnant as a teen increased if one had parents who were inattentive, unloving, or failed to instill moral values with no family bonding. Girls whose mothers were teenage mums are more likely to do the same”. Here the question arises that if this situation will continue, will there be family bonding in upcoming years? It is important for the family to understand the importance of family role in order to save the generation from mental illness, as families role is one of the biggest factors contributing towards mental disorder. The concept of family is somewhere far but those who belief in family bonding are still holding their hands together.
Fusion with others. Personal autonomy
Blends thoughts and feelings. Distinguish between thoughts
Emotionally reactive when stressed. and feelings. Retains objectively
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