The family as resource for mental health

Written by Adeoye Oyewole - Nigeria

The family has long been recognized as a fundamental unit of social organisation in the lives of humans. Regardless of the specific pattern of family life, the foundational narratives, myths, legends and folklore; all cultures emphasise the power of family relations in moulding the character of the individual and serving as an exemplar of the moral and political order of the society.

Psychiatry, as a discipline, has been constrained by western medicine's focus on the individual patient in the development of interest in the family other than as a source of genetically transmitted diseases. Scattered through the writings of Sigmund Freud are interesting but provocative comments about family relationships and their possible roles in the development of mental illness. Freud insisted that certain patterns of defense mechanisms at individual levels such as identification, introjections and projection could be transmitted across the generations in a family.

The family as a potent socialising template has been viewed through different paradigms with the ultimate goal of ensuring that it serves the ultimate purpose of furnishing a wholesome environment for members to develop sound mental health, especially the growing children.

Ackerman introduced the idea of working with the nuclear family of a disturbed child by gathering information over two or more generations to gain insight into the problem of the child. Murray Bowen, in his studies of psychotic children, found that their capacity to differentiate themselves emotionally from their families (especially from their mother), was impaired by the consequences of unresolved losses, trauma and other upheavals in the lives of parental and grand parental generations. He developed a methodology of describing the family structure with a particular respect for significant family events.

Family is viewed as an open system which consists of a set of inter-related elements that function as a unit in a particular environment, with potent interaction with the biological and socio-cultural environments. This model has been very useful in several intervention programmes with delinquent youths where they often came from financially impoverished, emotionally deprived families headed by a demoralised single parent who alternated between excessive discipline and helpless delegation of executive family responsibilities to a child.

The dynamics of the family relationship is capable of providing environment that can prevent, modify or ameliorate mental health problems. The family could be reactive in event that a mental illness occurs at a time of family upheaval. The escalating combination of the illness and the upheaval may invariably make it unmanageable.

The family could be a resource in supervising medications, ensuring clinic attendance, detecting early signs of relapse or providing a home environment that promotes and maintains recovery. However, the family could serve to perpetuate mental illness when the patient is enmeshed in the conflict between the father and mother who could erupt into a catastrophic conflict if the child gets well, since the joint commitment to the care of the patient provides a focus of shared concerns and an ostensible sense of unity. This attitude emanating from the dysfunctional family relationship may perpetually keep the patient sick, since both parents may continuously maintain that their child is incapable of autonomy, even when the patient gets better.

Sociologists typically stress the functional aspects of the family as a child-rearing unit by defining families as groups of co-resident adults responsible for the production, socialisation and education of offspring; while the anthropologists stress the kinship and inter-generational aspects of families through which descent lines are traced.

Cultural differences abound in the formation of the family, but the universal features are important. In nearly all cases, marriage forms the basis upon which a family is built as a social-cultural affair that involves rituals and ceremonies representing social approval, with specified role playing and reciprocal obligations dictated by culture.

For me, this is one of the most valuable aspects of our culture that reinforces the marital union irrespective of the challenges that abound. However, as we undergo cultural metamorphosis in the light of globalisation of our values, it may be crucial that the strong African respect of the marital union and family life must be preserved.

One major aspect that needs preservative reinvention is the issue of leadership in the family where the man is expected to provide support, direction and stability.

Our emerging modern families suffer from inappropriate hierarchy and faulty generational boundaries between the various sub-systems in the family. It is not all the time that we have a 'delinquent family' oftentimes chaotic, leaderless and disorganised. Some could be middle class, intact, articulate but enmeshed. The members avoid overt expressions of dissent or challenge to ostensible family unity, which may culminate into maladaptive coalitions between parent and child, especially when a child becomes sick, snowballing into loss of appropriate hierarchy and boundaries.