threat: threat: threat: threat: a recurring family dynamics

THREAT: THREAT: THREAT:

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by Shirley A. Smoyak, R.N., M.S., M.Phi1.

URSES have long recognized the N relevance of the patient's family to the understanding of and intervention in a pathological situation. In contrast, until recently the focus of psychiatry and psychology has been predominantly on intrapsychic processes, and the family has often been viewed as disruptive, benign, or irrelevant. However, this viewpoint is shifting, as Handel points out.

Many clinical investigators are com- ing to believe, or at least to adopt as a working assumption, that mental illness is a function of the bonds operative in a family as a whole. While this view may thus far be no more than an article of faith, it is an article of faith whose tenability merits extended scrutiny through research, for it can- not be said that any competing view of the origins of mental illness has estab- lished itself beyond reasonable doubt.'

Work with families logically belongs in the province of systems analysis, rather than intrapsychic or even interpersonal analysis. Since human beings are socialized within family systems to play their future societal roles, it is neces- sary to seek an understanding of the various styles and workings of these in- tricate systems as they affect the cog- nitive and emotional development of

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their members. A family approach yields quite different outcomes from an individual patient approach because the basic premises are different and influence the practitioner’s viewpoint markedly.

Therefore, if nurses are to develop ex- pertise in working therapeutically with troubled families, they need to identify recurrent family dynamics which lead to disruption, states of crisis, or mal- functioning of individual members. To identify a recurring family dynamic, the process of interaction among the members must be operationalized, that is, the specific recurring interaction must be spelled out with utmost clarity. Only after many instances of these repetitious family phenomena have been collected can they be examined and analyzed for similarities and differences.

As soon as one begins to work on this very large task of studying recurring family dynamics which lead to some kind of system disturbance, it becomes obvious that one of the confounding problems is our language. Because our present terminology for describing human behavior had its origins in the days of intrapsychic psychiatry, the words are largely descriptive of individual behavior or individual processes rather than interpersonal or system processes. Consider, for instance, concepts such as anxiety, frustration, am- bivalence, conflict, aggression, dominance, and submission. When the study of human behavior began to move from a within-self view to an interpersonal one, the age of the hyphen was born. Thus, clinicians and theorists spoke of dominance-submission, masochism-sad- ism, aggressive-passive patterns, and so on. There was even some attempt to describe the relationship per se rather than

the actors. “Empathy” is an example of such an interpersonal concept.

The problem of language is much greater when a systems model is used. Single word concepts do not seem to be able to handle adequately the concep- tual traffic that systems analysis requires. For instance, “equilibrium” is a systems concept, but no one is quite sure to what it refers; an observer can sometimes say that a particular system is in “dsequilib- rium,” but having said that, he has not described how it got that way. Of course, a third word and second hyphen might be added to indicate a triangular process, but the resulting compound would not specify who was doing what. The present trend towards deriving an adequate language for this new approach seems to be the use of a phrase, such as “coalition across generations.”

Terminology is not the only problem. The literature at the moment is not of too much help in specifying either the dynamics or the intervention tactics. True, several rather large anthologies and review books on family provide an accurate overview of what is still to be learned: and an issue of Comprehertsiue Psychiatry was devoted to family treatment and marriage counseling: why, when, how, and by whom.’ However, each of the disciplines currently working in the area of family therapy is still at the very early stages of categorization and systematization of the phenomena under study. There have been several major attempts to provide classification schemes, but these schemes have not been focused on the interaction process per se and hence seem to be of limited use by clinical practitioners.

Langsley and his associates, in an

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attempt to evolve a classification of crises, developed a tentative listing of types of family crisis. The list consists of: “bolt from the blue” crisis; the caretaker crisis; the developmental crisis; and the exacer- bation crisis. They conclude, however, that “These categories have not really been satisfactory and most cases seen by the Family Therapy Unit fit into the ex- acerbation model. To date, a typology of crises which deals with stress and the family is not available. This challenge is a worthy

Fleck has concentrated on categorizing family functions. The list of family functions he suggests includes: parental coalition, nurturant tasks, enculturation of the younger generation, emancipation of offspring from the family, and family crises. His approach is to study deficien- cies in and deviations from salient family functions and tasks. His conclusion is, “It is not possible at present to establish specific correlation between such defects and clinical psychiatric en ti tie^."^

Other efforts at systematization have utilized the “microscopic” method, whereby behavior is sliced up into micro- units for analysis. Bales et al. at the Harvard Social Relations Laboratories have been using this approach for a number of years with groups of various kinds. Bachrach recently reported using electronic and computer methods to ana- lyze bits of schizophrenic speech.’

This gap in theory on which to base practice is a challenge to every nurse who is working with families. If the nurse’s goal is to be therapeutic in her relationships with families, she first must make an effort to discover just which nurse intervention tactics are therapeutic and which ones are not. The only route

to this goal is via research. This is not to say that every nurse-therapist must spend a set number of hours in basic research. However, I believe that every nurse-therapist needs to know what she does not know about family practice and ought to look for ways in which she might share her data with nurses who are engaged in more active research projects in the area of family.

The search for understanding in the family field ought to take the direction of operationalizing recurring family dynamics so that the nurse can generate family theory and develop appropriate intervention strategies. These theories and strategies would need testing for cross-cultural relevance. Very little so far has been done in the area of ethnic differences among families and how, these affect interaction mechanisms. The data which are available are largely descriptive and not specifically addressed to family therapy issues.’

In line with my belief about the re- sponsibility of those who work with families to share their data and any theory they may have developed, I am presenting a theoretical interpretation of the use of threat as a recurring dynamic in families. My ideas about threat were generated from contact with disturbed families seen in therapy in a variety of clinical settings - a county psychiatric hospital, a state hospital, a Veterans’ Ad- ministration hospital, and several out- patient health centers. My approach to interpreting the data was a middle- ground one between the macroscopic and microscopic approaches, that is, I did not resort to very small sub-bits of communication for analysis nor am I proposing all-inclusive, grand-theory

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dimensions. According to my operationalization of

the recurring dynamic of threat, it is originally set off as a solution to the problem of defining the limits of separateness and connectedness in family members. Families, as systems,, might be described in terms of life styles or usual operating modes and more finely cate- gorized in terms of their operating values for the total system and operating values for the individual family members. Hess and Handel say that, “The ways in which a family is a unit and the ways it provides for being a separate person are, in one sense, what every family’s life is about.”’ A crucial family issue is that of confront- ing and handling the exigencies surrounding separateness and connectedness. The family defines acceptable ways for its members to be separate individuals and also ways for them to contribute to family cohesion and solidarity. Research data concerning how this issue is handled among many kinds of families are as yet lacking.

Families are not sufficient unto themselves. They are forced to adapt to and integrate with other families and the larger societal system. Family responses to their environing others can be cate- gorized as generally friendly and trust- ing or as generally unfriendly and tend- ing toward avoidance. In the former case an individual family member would probably be allowed more room to ex- periment outside of the family system, with separate interpersonal relationships. In the latter case family connectedness would be stressed, and there would be severe admonitions against any behavior which might lead to “too much’ separateness. In other words, when a fam-

ily perceives its environment as unfriendly, it also perceives efforts at separateness by one of its members as threats to dis- solution of the connectedness and ulri- mately of itself.

As yet there are no substantive con- firming research data, but from unsys- tematized empirical evidence it seems that the view families hold of what the outside is and how it is to be managed is a crucial variable which affects its intra- family definitions of the proper or nor- mative amounts of separateness and connectedness. The more a family anti- cipates the impact of a hostile world, the less autonomous, creative, or selfdirect- ing any individual member may be. Under the conditions of perceived assault or destruction from the outside, the individual member is more likely to be expected to direct his energies toward family preservation rather than toward self-realization. A kind of we’ll-all-be- saved-or-perish-together ideology seems to operate. System survival is given top priority. This system-survival phenom- enon may also exist in corporations, states, and countries.

Besides the value attached to separateness, the style of achieving separateness varies from family to family. On the one hand, there is the. aloof, detached, totally isolated and private, autistic style and, on the other hand, there is the autonomous, creative, active, individualistic style. Connectedness, too, may be played in various ways. It may have a pervasive, far-reaching “forever” qual- ity, which Wynne et al. describe as pseud~mutuality.~ In pseudomutual families the members are preoccupied with fitting together into formal, narrowly- defined roles at the expense of any one

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individual’s identity. Divergence is for- bidden. The authors contend that “the pseudomutual relation involves a char- acteristic dilemma: divergence is perceived as leading to disruption of the relation and therefore must be avoided; but if divergence is avoided, growth of the relation is impossible.”1° Hess and Handel note that some families desire closeness and intimacy, but are afraid of it, “A family of this kind may be able to approach its desire only through much formalized or ritualized action, such as giving gifts, celebrating birthdays and holidays, making excursions.”11

Threat is a technique employed by a family to produce and maintain (or to reinstitute ) connectedness, to decrease efforts at separateness, and hence to ensure the survival of the family as a group. It is interesting to note that those in poverty, lower-class, and minority groups perceive a hostile world and use threat to control their family members’ behavior and also that these groups have higher rates of mental illness than other groups.

Threat as a control technique may be operationalized as follows:

1. The family system perceives its surrounding environment as hostile.

2. Family values of connectedness thus come strongly into the fore-

ground. 3. One or more family members act

in a “separateness” fashion, that is, their behavior is autonomous, individualistic, selfdirected.

4. A family member or members take action to bring the separating individual into line by:

a. threatening to leave the family

system (including suicide) b. threatening to forbid reentry

of the separating individual into the system

c. threatening an aggressive act (either verbal or physical or both) against the separating individual or another family member

d. threatening a withdrawal of affection and support.

5 . The “deviant” family member comes into line by stopping the separateness action and again espousing connectedness values.

6. Equilibrium is temporarily re- stored. However, the member who has actively experienced being threatened also has learned to use this technique. In a subsequent incident, he may become the active threatener, inducing another family member who is temporarily moving toward separateness to return to connectedness behavior.

In families in which the outside world does not loom so darkly, threat technique does not seem to work so effectively or is not used to the extent that it is in troubled families. Moreover, there are individuals whose families of origin use threat as a constant theme but who some- how are able to withstand the threats and still value separateness so strongly that they succeed in separating themselves from the pathological patterns. What is not known with any certainty is what enables these individuals to withstand the assault while others succumb to the threats and incorporate threat as an operative pattern.

Threat, as I have operationalized it,


can be illustrated by the Albas, a lower- class family living in the Southwest. My association with this family came about when 16-year-old Linda Alba was admitted to a private psychiatric hospital after attempting suicide. The psychiatrist who admitted her suggested to the family that family therapy was the treatment of choice, and he and I functioned as co- therapists. All of the sessions were tape- recorded, and the typescripts have served as the source for this description of the situation.

The family consisted of Mr. and Mrs. Alba and their two daughters, Laura and Linda. Mr. Alba, in his middle fifties and of middle-European extraction, had been raised by a bed-ridden widowed mother and two physically abusive older brothers. His account of his boyhood was one long tale of misery: his withdrawal from school before completing the eighth grade in order to go to work and help support the family, the orders and abuses from his older brothers and his bosses, and in the early years of his marriage the struggle to make ends meet. His wife, slightly younger than he, did not finish high school and was presently working part-time in a bakery. Although she was not as willing to talk about her early childhood, she said many times, “My story’s the same as his. I can’t remember anything good ever happening. I’m so ashamed.” Laura, in her mid-twenties, amid much protest from her parents, had left home temporarily to go to New York and earn a masters degree in a professional field. Linda’s presenting symptoms included self-destructive acts and catatonic-like behavior. On a prev- ious admission to the hospital, she had spent much time sitting in a closet and

holding onto a stuffed animal. Mr. Alba’s boyhood had been replete

with experiences with threat. In one par- ticularly emotionally charged family session, he told of his refusal to turn over his paycheck one Friday afternoon to his sister-in-law, who at the moment was the treasurer of the extended family. In a thick, guttural voice and with halt- ing speech not very acquainted with Eng- lish grammar, he described in graphic detail how he walked past his sister-in- law in the narrow, dimly-lighted hallway of a three-story frame house and pro- ceeded up the steep stairs to the top floor where he lived with his mother. His brother threatened to come after him and kill him. Mr. Alba responded by hurling furniture down the staircase at him. This was just one instance of what happened when a member acted separately and was brought back toward the connectedness end of the continuum.

From his mother Mr. Alba had re- ceived another kind of threat. Although the situation with his brother was almost intolerable, he said he could not leave because, “It would have killed my mother if I did. I had to stay and just go on as best I could with the way things were.” Data were not obtained on just how Mr. Alba knew that his leaving would produce her death. There were no clues to the mother’s messages about how she would interpret his leaving. After her death he left the family house and severed ties with his brothers.

While Mrs. Alba never offered any specific instances, there was the distinct impression that she, too, had experienced being threatened. In Mr. and Mrs. Alba’s

PDJ Publications has granted the author permission to include parts of a published monograph in this article.

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relationship as man and wife and as parents, they used threats and counter- threats repeatedly and unwittingly. The impression was that the threatener did not interpret his actions as threatening, but instead as efforts to solve a problem or to communicate. When in one of the family sessions the older daughter point- ed out their frequent loud, threatening interchanges, the father said, “Why honey, that shouldn’t have bothered you. It was nothing. Parents have to talk, you know.” Then the younger girl said the threatening talk had given her “chills,” too. To this he said, shaking his head in a puzzled way, “I don’t get it. You mean to sit there and tell me after all these years that you’re all tied up in knots because Mama here and me said a few things now and then? This younger generation beats me. They don’t know what real trouble is.”

When a family argument reached full storm, Mrs. Alba would cry, withdraw to the bedroom, and not eat for days. Mr. Alba would threaten suicide or homicide or both, or say he was leaving forever. Both occasionally packed their suitcases. In the family therapy sessions both girls said that their earliest recollection of their parents was of their battles and threats of leaving or of killing themselves or each other. Although the parents never acted on these threats (un- less not eating is seen as a kind of suicide) Linda did act and had made several attempts at suicide.

In this family, the roles of deviant member and active threatener were ro- tating ones. Often the switching of roles occurred with lightning rapidity, as in the following incident recounted by Mr. Alba. “Well, it’s news to me but maybe

now I can see that them two [meaning the girls] didn’t like it much when I worked a lot and didn’t come home or when I went off in my little corner and read the news. Anyhow, one day I came into the room and there’s Laura all red- eyed and there’s Linda in the don’t-touch- me mood she gets [describing the onset of a catatonic period] and where’s the mother? She’s in bed. They had her all worked up. So I says, ‘O.K., if that’s the way you guys want it, I’ll take a gun and shoot all three of you and turn it on myself!’ I didn’t really mean it, but at least that brought them to their senses.”

As has been mentioned, Laura did leave the family for a while to study in New York, but was unable to maintain the separateness and returned home to live with the family again. In explaining her return, she said, “I guess you might say the pull was so strong I could feel it all the way in New York. Oh, don’t look at me so funny, Dad. Those letters were enough to bring me back. Anyway, here I am. And crazy as you all - we all - are, it’s my family and I’ll stick with them.”

This family also used accusations as a kind of subversive threat in a pre- ventive vein. Occasionally, the mother, out of the blue, would accuse one or both of the girls of being ashamed of her and their father. The accusation would be denied and some proof to the contrary would be offered. For instance, at one point Laura said, “Now Mother, even though you didn’t graduate from high school, you know you’re the best speller in our family. I’ll bet she can spell words you [the therapist] would miss.”

The Albas were an excellent illustra- tion of family connectedness without


warmth - of closeness and intimacy accompanied by fear of overt expression. Mr. Alba said that he loved his daughters and that they should know that without his having to tell them. When Laura pleaded with him just to try saying it once, instead of giving gifts that he could not afford, he answered, “Well, honey, that’s not my nature.” They use ritual extensively to prove their family bonds. For instance, there was much discussion about whether Linda could have an extended pass from the hospital so that she and Laura could go to the opera, which was described as a “family tradi- tion.” When the father reported that his daughters had given him a birthday party he was very tearful and then said, “Geez, look at me. A grown man! I don’t know why I just can’t say it when people are nice to me. Maybe I don’t expect it.”

Laura and Linda told of a pact, in- volving the drawing of some blood, that they had made when they were very young. They swore that even if their mother and father left home, as they had often threatened to do, the two of them would stick together “forever.”

In the family sessions, Laura was the first one to suggest that threat was an operative pattern with them and to make the generational connection. She put it this way: “Don’t you see? Linda and I have been doing just what .we see you do. Dad, you left your family, and now you think that when I go off to school I’m leaving you and we’ll all fall apart. I think Linda does what she does to make you two stick together when I’m not around. She’s afraid when I’m gone.”

A theory, such as outlined, allows the practitioner to intervene in a logical, researchable way. Theory both gives

direction for practice and, when well defined, paves the way for testing the effectiveness of the intervention strategy used.

REFERENCES 1 Handel, Gerald, “Introduction,” in Gerald

Handel, (Ed.) The Psychosociaj Zntwior of the Family, Chicago: Aldine Publishing Co., 1967.

sFor instance, see Gerald Handel, (Ed.) The Psychosocial lnterior of the Family, Chicago: Aldine Publishing GI., 1967, and Ivan Boszormenyi-Nagy and James Framo (Eds.) Intensive Family Therapy, New York: Hoeber Medical Division of Harper & Row, 1965.

~Compsehensiue P~ychktry, Vol. 7, No. 5, October, 1966.

4 Langsley, Donald, et al, “Family Crisis ”her- apy - Results and Implications,” in Family Process, Vol. 7, No. 2, p. 157, September, 1968.

6Fleck, Stephen, “On Approach to Family Pathology,” in Comprehensive Psychiatry, Vol. 7, No. 5, p. 319, October, 1966.

6Bachrach, A. J., “Structural Analysis of Schizophrenic Speech: Sound Spectographic Data,” Paper presented at Conference on Schizophrenia, Eastern Psychiatric Research Association, Inc., New York, November 14, 1968. For instance, Oscar Lewis’ work with Mexi- can and Puerto Rican families and Beatrice Whiting’s Six Cultwes.

* Hess; Robert and Gerald Handel, “The Family as a Psychosocial Organization” in Gerald Handel, (Ed.) The Psychosocial lnterior of the Family, Chicago: Aldine Publishing Co., 1967, p. 10. Wynne, L. C., I. M. Ryckoff, J. Day, and S. I. Hirsch, “Pseudomutuality in the Fam- ily Relations of Schizophrenics” in Psy- chiatry, Vol. 21, pp. 205-220, 1958.

loBoszormenyi-Nagy, Ivan and J. Framo, quoting Wynne in their introduction to Ivan Boszormenyi-Nagy and James Pramo, Itatmrivs Family Therapy, New York: Hoeber Medical Division of Harper & Row, 1965, p. 13.

l1 Hess and Handel, op, cu. p. 13.

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threat: threat: threat: threat: a recurring family dynamics

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