Families in Psychiatry

Thinking about the institution of marriage – Part II


 

An earlier column reviewed the institution of marriage up to the middle of the last century. Since the 1950s, postmodernism has been gathering momentum, beginning as a critique of art, architecture, philosophy, and how we think about society and culture. Views on many aspects of our lives, as we live it, began to change.

Postmodernism stands in contrast to the "modern’ " or scientific view that touts a singularity of truth and a singular view of the world. Social construction is a type of postmodern theory that states that truth, reality, and knowledge are based in the social context of that particular person. This aspect of postmodernism is most applicable to mental health professionals assessing and treating patients, and to families in specific social and cultural contexts.

A postmodern view of the family considers the traditional view of the family, the "nuclear family," as only one view. Other forms of family and other views of marriage that had been marginalized, considered deviant and nonconforming, are now brought forward and considered as viable alternatives. Postmodernism discards many assumptions that we have been taught. One assumption that is being reexamined, for example, is that sexual nonexclusivity or extra-relationship sex, or romantic involvements are symptoms of troubled relationships or forms of sexual acting out.

Another assumption that needs to be reexamined is the notion that family structures found in other cultures are "abnormal" or dysfunctional. These assumptions are not necessarily true or false but require assessment in context of the relationship at hand. Postmodernism challenges us to assess each family variation on its own merit.

Beginnings

In the 20th century, Monica McGoldrick, Ph.D., one of the strong voices in family therapy, advocated for increased sensitivity to cultural variation. Her book, "Ethnicity and Family Therapy" (New York: The Guilford Press, 2005), describes characteristics of common ethnicities in American society.

Family therapists have attempted to address "nontraditional" families with articles, for example, about raising a biracial child, what to do if your child identifies as gay, etc. Most older articles focused on helping families "cope" with the nontraditional. Family therapists are now more willing to acknowledge "difference" as a normal rather than a pathological variant, and to recognize strengths inherent in diversity.

Acknowledging diversity

Marlene F. Watson, Ph.D., brings a nuanced understanding of the African American family, detailing the effect of slavery on the individuals in the family, and how internalized racism can be recognized and managed in family therapy (e-book, "Facing the Black Shadow," 2013). This is an important book for therapists, especially those who come from traditional families, as it articulates the reality of African American lives in a way that therapists can apply to clinical practice.

Dr. Watson illustrates through case examples how internalized racism affects marriages, and offers effective ways to help couples negotiate and overcome the negative aspects of their heritage. A postmodern stance also will help the couple recognize the resilience and strengths that are inherent in overcoming adversity.

Linda M. Burton, Ph.D., and Cecily R. Hardaway, Ph.D., highlight the role of "othermothers" in raising children in low-income families, be they white, Latino, or African American. They define "othermothering" as a form of coparenting, distinct from stepparenting. Women othermother children who are their romantic partners’ children from previous and concurrent relationships. Compared to stepfamilies, these multiple partner fertility relationships are more prevalent among young couples with limited financial resources, contentious relationships, and serial childbearing through serial repartnering.

In general, low-income women and women of color take on this style of coparenting to help the biological parents of relatives and friends who have limited social and psychological capital to protect and raise "good children"(Fam. Process. 2012;51:343-59). Family therapists will become much more effective if they understand and recognize that the motivation behind this form of mothering fosters resilience in the mothers. The more we know and understand alternate family structures, the more we can work toward building and sustaining resilience.

Assimilation has for many decades been the main focus of political and therapeutic endeavors. In postmodern times, transnationalism described a new way of thinking about relationships that extend across national boundaries and cultures (Fam. Process. 2007;46:157-71).

Immigrants maintain connections with their countries of origin with children who are parented by grandparents, or other relatives, perhaps in several countries at the same time. Family members use Skype, often daily, to connect with the matriarch or patriarch "back home."

Postmodern theories of social justice and cultural diversity work well with immigrants, bringing multiple perspectives into the treatment room. Immigrants bring many complex and diverse values in relation to marriage, gender, parenting, and religious practices. A social justice approach focuses on the racism and discrimination that is common in the lives of immigrants. Marriage might take place across nations, be arranged, or might be mixed race or mixed nationalities. Therapy that acknowledges these complexities will be most helpful. We still need to think further about global family life, how relationships evolve over long distances, and how to develop systemic and transnational interventions for separations and reunifications.

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