By Elaine A. Malec, PhD
To understand families and how they work, imagine the mobile above a baby’s crib. It is usually made up of crisscrossed arms with bobbles hanging from strings of various lengths, perfectly balanced. Although each bobble is hanging from a different length of string, the mobile is able to be balanced because each bobble is weighted differently.
In families, each person participates in keeping the “balance” by, in part, their “weight” or position in the family. This is why we refer to families as systems. Each person is interdependent on every other person. For example, a family of four (husband, wife, daughter and son) would create multiple relationships. The adult male is a husband to an adult female (wife) but is also a parent (father) to a male child (son) and also a parent (father) to his female child (daughter). A male child is the son to an adult female (mother) and also a male child to an adult male (father. He is also a male sibling to a female child, and on it goes. Each person has different roles within each relationship. A husband’s role would be different than a father’s role, even though the same person is fulfilling the different roles. As the family grows each relationship continues to be connected to all the other relationships.
If the adult male becomes seriously ill, all of his relationships are affected. He may be the primary income-earner. His role as a husband may have included keeping tabs on the finances or being his wife’s main emotional supporter. His role as a father may have included being the disciplinarian or the parent who brought laughter and ideas for fun. His place and role in the family has helped keep the family “balanced” as in the mobile. His position in the family has a lot of influence; it carries a lot of “weight”. Now include his role as a brother or uncle or son of his family of origin and we can see how complex a family system can be.
When providing medical treatment for someone who is struggling with a life-limiting disease, the care must be able to recognize the family dynamics behind the patient. An adult male who presents with acute anxiety and resistance to a discussion about hospice belongs to a family system where his roles provide balance to everyone within that system. He is unable to imagine how his family will function without his participation. It would be as if the mobile lost one of its arms; it would collapse and cease to be a mobile.
The inclusion of palliative care early in the process speaks to this real issue of treating the complete person. It puts the husband, the father, the person back into the patient. No wonder the studies which have looked at the benefits of palliative care have showed there is a reduction in emotional and psychological symptoms, a decrease in hospital emergency admissions and an improvement in the quality of life which results in an increase in longevity.
The next part in our series on Palliative care and the family system will look at how the spoken and unspoken “rules” that families abide by can help or obstruct care for the ailing family member.