Terminal Illness Impact on Family Functioning and Bowenian Therapy Abstract This paper will discuss the adjustments that accompany terminal illness within a family setting. The methods that are applied in the theory of choice will be explored as to whether the treatment is appropriate for this type of tragedy. The compatibility of this theory and this issue will be explored when dealing with the family unit. Terminal Illness Impact and Bowenian Therapy A family is two or more people who consider themselves family and who assume obligations, functions, and responsibilities generally essential to healthy family life. (Barker, 1999. p. 55). Families create patterns that are passed on from grandparents to parents and from parents to children. These become the traditions and part of the value systems that are instilled in the lives of all that are involved. Murray Bowen developed his views of theory pertaining to family systems theory. His view is a theory of human behavior that views the family as an emotional unit and uses systems thinking to describe the complex interactions in the unit. (www. thebowencenter. org/pages/theory. html). His perspective of the family as a whole having an impact on each individual family member was also shared by many of his colleagues.
The objective was to work with the family to understand that unresolved conflict with our original families is the most important unfinished business of our lives. He started out working with mother and child, and then he added fathers to the equation. (Nicholas & Schwartz. 2009, p. 138). The interactions between family members generate how a crisis is handled. If a family is close knit, it may be a considered a sign of weakness to let outsiders know how they are feeling or if there is a problem within the family.
Generation to generation brings an aspect to the next generation about how a matter such as terminal illness is handled. The emotional interdependence presumably evolved to promote the cohesiveness and cooperation families require to protect, shelter, and feed their members. (www. thebowencenter. org/pages/theory. html). Older family members such as great grandparents may come from an era that believed in privacy or the cultures may consider this type of problem a bad omen. This is not necessarily a bad thing, but maybe not a good one either. Stress causes may reactions in many different ways.
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According to Bowen, the family is viewed as an emotional unit and uses system thinking to describe the complex interactions in the unit. (www. thebowencenter. org/pages/theory. html). A family has a specific purpose for everyone included. It gives a sense of familiar, a sense of completeness, and a sense of belonging. Attachment to the family member that is sick is ultimate for the entire family. The bond sometimes becomes more of an issue than the actual stress of the patient having a terminal illness. Terminal illness and death, however, would appear to be the ultimate way to resolve the attachment bond. Clair, 2000, p. 512). Terminal illness is an infection or disease which is considered ultimately fatal or incurable. It can go undetected, patients cannot afford proper care, or the illness is virulent enough that it will resist medical intervention. (www. wisegeek. com/what-is-a-terminal-illness. htm). Terminal illness impacts the entire family. The family consists of more than just parents and children. Grandmothers, grandfathers, aunts, and uncles make up family as well. There are people who become part of a family through interactions throughout people’s lives.
Friends can be just as much a part of the family as the biological members. Some people have better relationships with outside people than those who are born to them. Some parts of the family may not fit as well as others because even though a family is considered a functioning unit, all parts do not always work. When there is anxiety or stress within the family, the individual members show how they can function on their own. Differentiation of self from the family of origin is defined as the ability to function autonomously as an individual without being emotionally dependent upon or attached to the family process. Murdock & Gore, 2004, p. 319). Behind closed doors families have an order of rank. There is an order that an individual serves in the community, but the family is the most important role someone can have. The individual that has the strongest backbone so to speak is usually the person higher up the rank chain. This person is usually the tradition carrier. This is usually the one who has the ability to keep the family functioning in time of stress. The responsibility that accompanies being a family member may be more than some people can handle.
When a serious illness is an issue that families deals with every day, somehow there will be problems. If there is an imbalance between togetherness and separation forces in the family system, anxiety is experienced within the individual. (Ecke, Chope, & Emmelkamp. (2006), p. 84). Stress is any influence that interferes with the normal functioning of an organism and produces some internal strain or tension. (Barker, 2003. p. 420). Discovering that a tragedy of this type is a problem within any family is not a good thing, yet sometimes it takes a crisis to fix what is wrong.
Stress contributes to the way an individual’s life will function. When a family is going through a traumatic event, the functioning of the individual is not what is thought about. The fact that someone that is loved is going through a hard time is a major factor. It is not a time to think about other members of the family, it is centered on the person who is sick. Most families put the differences aside so that the issue at hand can be dealt with. Bowen viewed that the two forces: togetherness and individuality centered on the two counterbalancing each other. (Nichols & Schwartz. 009. P. 140). If a family member has an unresolved issue of some sort with other family members, then how can it be expected for the family to function in a time of distress? Resolving an emotional attachment to the family is what this theory says must take place in order for the functioning to work. As adults we are expected to fulfill certain roles and positions. As productive aspects of the community as well as within the family as a participating member, this must be accomplished. It reflects back to the upbringing and the culture that a person comes from.
When a family is not able to function as a whole unit, stress can be a good thing because it gives the family a common goal in which to work towards fixing together. Terminal illness can be a surprise as well as an expected occurrence. It can cause strain on a family emotionally, financially, and physically. Dealing with grief and loss, may make the family feel as if they are on a roller coaster ride. The ability of a family’s survival is a part of the foundation on which the family is built. Illness can last for short periods of time as well as for extended periods.
Every member of a family handles situations differently. According to Kubler-Ross, grief has stages that a person goes through. Denial, anger, bargaining, depression, and acceptance is the order in which a person is suppose to grieve, but it may not necessarily work out that way. (Zastraw & Kirst-Ashman, 2007. p. 566). Some stages may be skipped or some may not be gone through at all. The ability to pass from one stage to the next is how the family system functions is an aspect of Bowen’s theory. In Bowen’s theory, the stress response expands beyond the individual to include the family.
He theorized that if a family functions under the strain of stress then the individual could function. The family as a unit revolves around the fact that each member of the family plays an important role. If one of the members can not pull their weight, then the entire family could suffer. If one person is not able to accept and handle what is thrown out when dealing with an issue such as terminal illness then the entire family system could suffer. The way a family works is dependent on how its members can work together as a single functioning unit. Families create alliances in many ways.
Sometimes in families parents are each others’ support while the children usually stick together. Usually alliances are formed as well as the normal array. Children gravitate to the grandparents or to a favorite aunt or uncle as well as other relatives. The family figures out how to make the family work by the way the alliances are formed. The way problems are handled can easily be passed from generation to generation. Culture plays a part in how families deal with issues within the family. Children are affected more often during this type of situation in the family.
The adults feel that the children should be protected at all cost. Grieving is a normal process of life as well as being a part of the family circle. Grief is the multifaceted response to death and losses of all kinds, including psychological, emotional, social, and physical reactions according to Waldrop. (Waldrop, 2007, p. 198). Telling a child that a parent or grandparent has a sickness that may take them away is somewhat difficult to do. If a child is not an appropriate age to understand the concept of what a terminal illness is, then they cannot grieve properly.
This is a part of the family system that has a breakdown. The children not understanding and being able to cope and function as individuals in the system gives the theory some weight. Even adults who do not come to terms with the severity of the stress of dealing with a terminal illness will cause extra stress for the family. People who are not biological member of a family can still be family members. Doctors, nurses, and other caregivers become a part of the family because of the relationship that is build when they come into ontact with the family. As an individual tries to demonstrate the capability of growing and becoming a productive part of society, the way a family creates bonds is essential to that goal. As people interact relationships from all walks will make paths become intertwined. Some of these relationships become as strong as relationships that come from within the family and just as important. Bowen believed that a family functions as a unit if the individuals in the family system can function on their own.
His theory is to help the individual and the entire family is helped. When a serious crisis comes along and the family members must deal with the emotional, psychological, and even the physical aspects, the ability to put small things aside to look at the overall picture comes into play. It is shown that families work only as well as the members in the family work. Different theorists have used the initial framework of family systems as the basis for their ideas and it has been shown many times that as a system the family works whether functional or dysfunctional.
This theory of Bowen has shown that in order for the family to function in a crisis the individual family members must be able to work together to form the unit. It takes every member doing his or her part. Taking care of individual needs in order to build and maintain healthy relationships is a must. The family does operate as a unit running on the mind, body, and soul of each and every member. It is critical that each member be able to interact and function with the other members. Murray Bowen had the conception that the unit that makes a family can function as a whole if the members can work together.
It is a must that a family needs all of the members in order to create the bound of togetherness that is required to perform completely. There are other theories that would also fit this issue of terminal illness, but Bowen’s Theory also fits that illness and it shows that family members have an impact on a family while dealing with a serious problem. Family means many things to many people. It requires work regardless of the situation that a family is in. The acceptance of loving your family is part of the bond that will not allow a family to stray away from one another even though there will be struggles.
The perception that a family is only functioning if all are participating is not always true. The fact that members can allow themselves to see, give, and say that love is in their hearts and minds, makes a family a wonderful place to be. The theory of Bowen’s and his colleagues helped to create ways for families and their members to have an available resource of treatment. It is good to know that there are options out there that are beneficial to families and their members. References Barker, R. L. (ED). (2003). The Social work dictionary (5th ed. ) Baltimore, MD: NASW Press.
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Health and Social Work, 12 (4), 197 -206. Wright, J. , (2009). Self-soothing – a recursive intrapsychic and relational process: the Contribution of the Bowen Theory to the process of self-soothing. Australian and New Zealand Journal of Family Therapy, 30 (1), 49 – 41. www. thebowencenter. org/pages/theory. html retrieved on October 16, 2011 at 4:30p. m. www. wisegeek. com/what-is-a-terminal-illness. htm retrieved on November 1, 2011 at 1:15 a. m. Zastrow, C. , & Kirst-Ashman, K. (Ed). (2007). Understanding human behavior and the social Environment (7th ed. ) Belmont, California: Brooks/Cole.
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