FUNCTIONAL AND DYSTUNCTIONAL FAMILIES

Dr. Amaku c

6^TH jULY 2023

WHAT IS A FAMILY?

• A family is a social and intimate nurturing group of individuals sharing a past, a present and a future, including all who contribute in one way or the other to the family culture, connected biologically, legally, or by choice; from whom one can reasonably expect a measure of support in the form of food, shelter, finance and emotional nurturing.
• Family can also be defined as:
• A group of people who are closely related by birth, marriage or adoption (Relatives).

WHAT IS FAMILY? CONT’D

• A group of people living together and functioning as a single household usually consisting of parents and their children.
• All the people who descended from a common ancestor (lineage).
• Group with something in common: a group whose members are related in origin, characteristics or occupation
• A group of intimates who share a common history and wish to share a common future (Ransome and Van Dervoord 1973)

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Why Family in Family Medicine?

• Influences the causation of acute disease.
• Has a serious impact on the rehabilitation of chronic disease patients.
• Determines therapeutic success or failure (including medication compliance).
• Determines the degree of mental health and illness.
• Plays a major role in preventive and wellness aspects of health care (through culture, beliefs, religion and spirituality).

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• Generates, prevents, tolerates or corrects health problems within its membership.
• Genetic faults
• Alcoholism
• Disease transmission
• Prolonged family stress
• Skill and Confidence of a family functioning together
• Interlocking Health Problems
• Source of decision-making on health and personal care

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FAMILY STRUCTURE AND TYPES

• Two or more adults with or without children-nuclear (dyad, step parent family, binuclear divorced with joint custody)
• Extended family
• Single parent family
• Gay and Lesbian family
• Consanguineous relationships
• Extramarital relationships
• Household
• Communal families
• Monogamy/polygamy
• Bigamy/Polyandry/Polygyny
• Patrilineal/matrilineal
• Endogamous/exogamous

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THE FUNCTIONAL FAMILY�

• There’s no such thing as a “perfect” family.
• Families fight. They sometimes hurt each other.
• Parents make mistakes, and children do, too.
• Families can be imperfect and functional at the same time.
• A functional family is filled with mutual love, respect, humor, and boundaries.
• To understand dysfunction within families, we need to understand what it is that makes a family functional and healthy.
• Families don’t have to be perfect to be functional. Arguments will happen, and kids will probably break the rules sometimes. But in a well-functioning family, these don’t lead to abuse or breakdowns.

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According to the American Academy of Pediatrics, a functional family:�

• Enjoys spending time together: They’re able to have fun together despite daily stress and responsibilities.
• Clearly defines rules and roles: Here, every member of the family sticks to the rules.
• But a crucial feature of a functional family is that the rules are flexible and can change as members of the family grow and change.
• Part of these established rules is that there are boundaries in place. For example, children aren’t brought into conflicts between parents. And parents don’t try to act like their children’s peers.

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• Embraces mutual respect: The adults are respected as the people in charge, but children are also respected as individuals with their own personalities and desires. Every child is treated equally, and siblings aren’t made to compete against each other for their parents’ love.

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• Doesn’t have abuse and neglect: Parents provide care for their children, and children aren’t expected to take on adult responsibilities. Every member of the family feels safe, and the home is free from violence (both physical and psychological).

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• Engages in healthy conflict: Conflict is allowed in a functional family. When someone doesn’t agree, they’re allowed to express their anger (in respectful ways). No one is shamed for experiencing conflict or appropriate emotion.

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• Celebrates individual differences: Family members are encouraged to have their own feelings about things. The family can change — including parents and children — without anyone getting upset. Each person is free to strive for their individual goals and express their needs.

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What is a dysfunctional family?

• A dysfunctional family is a family in which conflict, misbehaviour and even abuse on the part of individual members of the family occur continually, leading other members to accommodate such actions. ~
• Children sometimes grow up in such families with the understanding that such an arrangement is normal.
• “Troubled family that has a negative effect on the physical or psychological well-being of its individual family members”

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The dysfunctional family

Can also be said to be a family with

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• multiple 'internal‘ influences–eg sibling rivalries, parent-child– conflicts, domestic violence, mental illness, single parenthood,

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• or 'external‘influences–eg alcohol or drug abuse, extramarital affairs, gambling, unemployment—that affect the basic needs of the family unit

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Reasons/Causes for dysfunctional families.

1. Family History Of Dysfunction: 
1. Parenting styles are behaviors learned through observing and reflecting from their parents or caregivers.
2. So dysfunctional parents may easily reflect the same behaviour.
3. They do not know what healthy parenting is, so they cannot teach their children.
4. The cycle continues till it is broken and then goes down the right path.

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2. Health Issues And Mental Illness�

•  A chronic illness, cancer, or even an accident that might have resulted in the amputation of a limb can make a person feel less useful than they previously were=> low self-worth. This situation is deflected onto others as a form of coping mechanism.
• Psychological causes like depression, anxiety, or personality disorders can change a person’s mood directly or through medication.
• Eg, a person with a psychological illness might develop conflicts in the family without proper treatment. People with mental health issues can be emotionally unavailable or unpredictable, which doesn’t create a secure attachment in children.

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3. Addiction�

•  Addiction is one of the major reasons for discord in family relations. First, denial that a family member can be an addict.
• Then the attempts to prevent them from getting any substance.
• This results in withdrawal syndrome.
• It is difficult for children and partners to understand why another substance or behavior (e.g., gambling, gaming, porn/affairs) can be more important than them.

4. Perfectionism And Constant Criticism: 

• The perfectionist parent who is conditioned to keep everything in a specific order might prove unhealthy for other family members in the long run.
• It might be a learned behavior from their parents or an innate compulsion. This entails criticism (sometimes too overwhelming to be excessive), swearing, scolding, sarcasm, insults, jabs, etc

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5. Authority�

•  An authoritarian parenting style that imposes rules, expects results, and doesn’t entertain any slip-ups can lead to weak family bonds.
• It hinders a child’s growth and encourages unhealthy behaviors like not speaking up, accepting wrongdoings, or getting abused without defending themselves.

6. Lack Of Empathy

• Lack of empathy comes from a lack of understanding of emotions. This can make an individual socially isolated, hampers their ability to communicate strongly, and they tend to behave coldly and devoid of kindness.

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7. Ineffective Communication�

• Lack of socialization might lead to a lack of effective communication. It also roots from their unwillingness to listen, but they need to always respond.
• People in dysfunctional families do not reflect whether their response is useful, hurtful, or completely irrelevant.
• They always have to have the last word. They are usually aggressive and don’t easily confide in anyone.

8. Lack Of Privacy And Independence

• This comes from a lack of trust in the child or the need to know and persuade events the way they prefer it.
• While a healthy family would talk, a dysfunctional family works through room raiding to be in loop with the family members

9.Finances�

•  When there is a deficit in financial resources, the stress can hugely affect the family members directly or indirectly.
• Parents usually try to protect their children during such a crisis in a healthy family.
• However, in a dysfunctional family, the parents start neglecting the child’s needs to save money while spending it on themselves, alcohol, and other indulgences.

TYPES OF DYSFUNCTIONAL FAMILIES

1) EMOTIONALLY UNAVAILABLE FAMILY

• Family members are not available for each other for various reasons:
• Parents working long hours
• Working over seas or traveling
• Families on screen most times

2) ADDICT FAMILY

• A family with one or both parents being addicts of some substance are always absent for their kids and may sometimes be financially unstable.
• They neglect the child when in trance and do not care for their basic needs such as proper living conditions, healthy diet, clothing, education and medical expenses.

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TYPES OF DYSFUNCTIONAL FAMILIES

3) ABUSIVE FAMILY

• Abusive family members use the threat of physical punishment as a means to accomplish a task or control there partner or children.
• The child might have witnessed the verbal abuses, cuss words, rudeness or violence or being at the receiving end of the punishment.

4) POOR COMMUNICATION FAMILY

• Members here do not know to communicate.
• They interact only when necessary and continue their tasks without crossing each others path

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• They do not discuss issues but believe their money will solve all problems.
• There is no healthy exchange of words or views (either silence or shouting or screaming) – complete apathy.

5) HIGH-CONFLICT FAMILY

• Family members here are pugnacious.
• They use harsh words taunts, sarcasm, jabs , insults, physical voilence
• The intensity of the fights keeps increasing with every hurtful word spoken.

6) EXPLOITATIVE FAMILY

• Members here exploit thei children or partners.
• Exploitation may be for money, possessions or personal work.

7) AUTHORITARIAN FAMILY

• Here, one or both parents exert authority and control over the children.
• They make strict rules that have to be followed by children without any questions asked.
• The parents order the children to stick to the family’s rigid system

Characteristics of a dysfunctional family

1. Promote the over-dependence of some of its members, which limits their growth and personal development. These are hyperprotective families that create insecurity and addiction in their members.

2. Establish a too open relationship so that family feelings are canceled. Usually happens in families too permissive, which end up generating a sense of uproar in their members.

3. It does not apply clear rules and limits, so that members do not know what their duties and rights are. In these dysfunctional families, the rule is that some of its members assume dominant roles and others are subject to it, creating a dangerous power imbalance. As a result, a member, usually the mother, is often overwhelmed by the unreasonable demands of the others.

4. It does not respect the generational distance and reverses the hierarchy of power, so that the parents subordinate themselves to the child, who ends up becoming a little tyrant. It may also happen that parents confuse the hierarchy with authoritarianism, preventing their children from expressing their opinion.

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5. At the base of dysfunctional families there are often communication problems. Members do not want to express their feelings or ideas, thus repressing them or expressing them indirectly by triggering defensive behaviors. In this way, messages are not clear and cause new family problems.

6. Applies rigid roles and behavior patterns that prevent members from adapting to change, so that in the face of the slightest crisis, they react with rigidity and resistance, this causes family problems to become acute and affect all members.

7. Its members are not empathic and sensitive to others, so that the family does not meet the minimum requirements of acceptance and affection. Some members may even feel rejected.

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8. There is a low level of tolerance, so it ends up blaming one of the members and treating him unfairly.

9. Are practiced bad behaviors, such as humiliation, contempt or the lack of respect.

10. There are models of emotional manipulation through which family members are controlled.

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The consequences of living in dysfunctional families�

• 1. Rebel: not only rebel against the authority of the parents, but have problems with all those who have some power, from teachers to the police. These children often end up being labeled as “problematic” and develop behavioral problems.
• 2. Scapegoat: this is a child who has been accused of most family problems, so he developed a deep sense of guilt that can turn him into the boxing sack of others by adult.
• 3. Guardian: This child usually takes on the role of parents, so it grows too fast and loses much of his childhood because he has solved family problems alone or has been a mediator in adult conflicts.

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• 4. Lost: he is a discreet, quiet and timid child, whose needs were ignored, so he learned to hide and repress his emotions. He usually becomes an adult who believes he is not worthy of being loved because he does not have a good self-esteem.
• 5. Manipulator: is an opportunistic child who exploits the mistakes and weaknesses of other members of the family to get what he wants.

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• Social isolation or loneliness
• Behavioral or personality disorders
• Bad or low self-image
• Extremely self-critical
• Low self-esteem, self-confidence, and self-worth
• Anxiety or depression
• May exhibit self-harming tendencies
• Difficulty expressing thoughts and feelings
• Poor academic performance
• Difficulty concentrating and focusing on one task
• Prone to substance abuse
• Difficulty establishing healthy adult relationships
• Easily and frequently getting angry
• Lack of child-like innocence (too mature for their age)
• Lack a role model and discipline

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Comparing a healthy with dysfunctional family

Comparing a healthy with dysfunctional family

Comparing a healthy with dysfunctional family

TOOLS FOR DIAGNOSING FAMILY FUNCTIONING

The Family APGAR.

This is a useful tool in assessing the presence and severity of family dysfunction. It was introduced by Gabriel Smilkstein in 1978 to assess adult satisfaction with social support from the family

A – Adaptation

P – Partnership

G – Growth

A – Affection

R – Resolve

ADAPTATION�

• I can turn to my family for help when something is troubling me.
• That derives from the confidence that family members are prepared to accommodate the necessary adaptation to accommodate the support the affected family member needs.

• PARTNERSHIP
• I am satisfied with the way my family talks things over with me and shares problems with me.
• The readiness of family members to identify with and participate in finding a solution to the need of each other.

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GROWTH�

• I am satisfied that my family accepts and support my wishes to take on new activities or directions.
• That means the individual can count on the support of his family as he undertakes plans and efforts to grow and develop in any aspect of his life/career.
• AFFECTION
• I am satisfied with the way my family expresses affection and responds to my emotions, such as anger, sorrow and love.

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• That means the individual is assured of the love, affection and understanding of his/her family members.

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RESOLVE

• I am satisfied with the way my family and I share time together.

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• Time together by the family is helpful in offering opportunity for family members to reflect and resolve issues facing them.

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THE FAMILY APGAR

• Smikstein APGAR scoring is a useful tool that can be used quickly to screen individuals for Family functioning.
• It is a Questionnaire based tool that is scored 0, 1 and 2 respectively for “hardly ever”, “some of the time” and “ almost always” to determine the individual’s perception to the respective issues represented by the acronym.

Scores 0 to 3 ---- Dysfunctional family

4 to 6----- Poorly functional

7 to 10----Functional family

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How to deal with Dysfunctional Families

• it’s important to understand that just as healthy families can become dysfunctional, a dysfunctional family can become healthy – with help.
• Each situation is different. For example, if you are dealing with alcohol or drug abuse problems you will have numerous issues to deal with including getting help for the addict as well as healing the family members who are affected.
• Resentment and trust issues will also need to be dealt with.�

• If you are dealing with a family member who holds irrational or fanatical religious beliefs, you won’t be able to change him or her. However, you can change how the family reacts to that person.
• Because stress is at the heart of most dysfunctional family problems, learning to handle stress and teaching the rest of your family how to do so is an important step.
• By stopping the blame and focusing on solutions, you can empower the dysfunctional family to heal.

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THE SOLUTION

• A Lot of counselling
• The solution is to become your own loving parent.

• Find the freedom to express all the hurts and fears kept inside and gain freedom from the shame

• and blame carried over from the past.
• Become an adult who is no longer imprisoned by childhood reactions.
• Recover the child within you, learning to accept and love yourself.
• Move out of self-imposed isolation.

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• Rediscover feelings and buried memories.
• Gradually release the burden of unexpressed grief; slowly move out of the past.
• Learn to re-parent ourselves with gentleness, humor, love and respect.
• Learn to see our biological parents as the instruments of our existence.

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• Receive experience, strength and hope from others.
• Restructure unhealthy thinking one day at a time.
• Release our parents from the responsibility for our actions today.
• Become free to make healthy decisions that allow us to act, not react.
• Progress from hurting, to healing, to helping.
• Awaken to a sense of wholeness we never knew was possible.

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• Come to see parental alcoholism for what it is and know how that affected you as a child and continues to affect you as an adult.
• Learn to keep the focus on yourself in the here and now.
• Take responsibility for your own life and supply your own parenting.
• See beautiful changes in all your relationships, especially with God, yourself and your parents

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• Functional family therapy (FFT) is a short-term, in-home counseling method that focuses on strengthening families to help reduce problematic adolescent behaviors. It includes five phases that build upon each other.

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CONCLUSION

• We need to work on our homes to prevent it from becoming dysfunctional
• We need to stabilise our homes before we c
• an manage that of others
• YOU CAN NOT GIVE WHAT YOU DO NOT HAVE

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Did I succeed in boring you to death?

• QUESTIONS?