When is a family a “family”?

Friday, December 17th, 2010

I never gave much thought about when is a family a “family”.   But all that changed when I encountered an amazing Brazilian family who taught me the importance of asking this question.  Most of my great learning about families has occurred in direct clinical practice and my experience with this family was no exception.

My New Question:  When is a family a “family”?

I had the privilege of meeting this young Brazilian family while lecturing at the University of Sao Paulo, Brazil.   This young family was kind enough to allow a group of health professionals and students observe me interviewing and learning about the impact of a child’s illness on their family.

 I was surprised that there were more family members present than just the ill child;s parents’ Rafael and Valeria and their five year old handsome son Gustov. Rafel’s sister, brother, and aunt accompanied the young couple exemplifying Brazilian culture and devotion to family.  All of the adult members of this family who attended the meeting were only in their 20’s.

 The couple’s daughter had spent most of her short 18 months of life in hospital with a serious but undiagnosed illness with metabolic and respiratory consequences.   As I listened to this heart-wrenching narrative, I learned that the parents had suffered greatly because of their daughter’s long hospitalization.   In the relating of this illness story, triggered by my therapeutic questions, I now understood where their greatest suffering lie.

Specifically, they all held a common belief that this little Carol had not experienced being a family despite steadfast and committed visits by family members.  They offered their belief that  this child could only truly “experience being a family” if she was at home.  They suffered great anguish that their family was not complete as long as their daughter lived a hospital life rather than at home.  They realized that if their ill child came home, it would require great sacrifices on their part but the goal of “being a family” superseded any concerns or worries about being caregivers.

 Witnessing their great anguish and suffering around their belief that a family is not a family if one member lives in the hospital invited me to offer the recommendation that it is “time to bring your daughter home”.  The family members’ reaction to my advice was to weep in relief.   I believe the family wept because their deepest suffering had been acknowledged based on their belief that they were not a “family” if one person lived in the hospital.  Of course the family realized that this idea of bringing their daughter home would have to be proposed to the health professionals in charge of their daughter’s care plus a plan for how they could care for her at home.

As I often experience, it is having suffering acknowledged and understood that has the potential to offer great relief to families regardless if their desired changes can be met.

 I have made efforts to define a family in our book Beliefs and Illness:  A Model for Healing (2009).  Janice Bell and I defined family as a “group of individuals who are bound by strong emotional ties, a sense of belonging, and a passion for being involved in one another’s lives”  (p. 46).  This definition can certainly apply to  this young and impressive family.

Maureen Leahey and I have also offered a definition from the family’s perspective in our book Nurses and Families:  A Guide to Family Assessment and Intervention” 5th edition (2009). Specifically, we offered the idea that the “family is who they say they are” which was evident by who chose to come to the family meeting.   But these definitions did not capture the family’s feeling or experience of being a family.

But can you “touch” a family?

But despite all my well intentioned efforts to define a family, develop models to assist families, one of my most fascinating realiazations is that you cannot actually “touch” a family.  The best we can do is talk to individuals who think of themselves as being part of a family.   Family is such an interesting notion that has been created and evolved in sacred texts, academic books, novels, television sitcoms, movies, and now in the social media with stories and pictures of one’s family on Facebook and You Tube.

Of course each person’s own beliefs about their experience of family contribute to the discourse.  The concept of family is socially constructed and our beliefs about what constitutes a family are deeply entrenched and often out of our awareness.  But everyone has an idea of when they feel like family and others extend their experience of family by saying “they have become just like family” or reducing this experience to “I don’t have a family”.  It is in the experience of feeling and being a family, that one can actually “touch” a family?

I now routinely ask the question “when do you experience being or feel like a family” in my clinical practice and the answers are incredibly far-ranging and enlightening.   I thank this lovely Brazilian family for teaching me and continuing to add to my understanding about families even after 35 years of direct clinical practice.   This new learning of course influenced the interventions that I offered the Brazilian family.

Maureen Leahey and I have co-produced an educational DVD entitled:  Interviewing an Individual to Gain a Family Perspective”as another effort to expand the notion of family experience with chronic illness even if only able to meet with an individual.

 You might find it enlightening to ask your own family “when do you experience being a family?”   Would you also be willing to experiment asking families especially when one family member is hospitalized, “when do you experience being a  family”?

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