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Illness and the family.

Introduction Every family goes through different phases in its life cycle and each new phase presents a potential threat to its organization. It is a threat to the family's organization because it is a threat to its equilibrium that steady state which has been achieved in order to guarantee the continuity necessary for the growth of each family member and the family as a whole. One such threat to family homeostasis is illness. Sudden, serious illness will usually shake the family system: when a member is suddenly not functioning in his/her normal way then this not only affects all the other family members, but also the overall functioning of the 'family machinery'. Let us take an example. Mr Smith has had a coronary. How does this affect his wife and children? His wife may not only worry about whether he is going to survive it or not, but she may blame herself for his heart attack, because she thinks it happened shortly after she had a row with him. Their daughter may be in a state of panic because she thinks her dad is going to die. The son might be most worried about how mum is going to cope with feeling responsible for her husband's illness. Mum may then be worried sick as to how she can calm down her daughter. The son might feel left alone with his anxieties about dad, as mum and sister huddle together; and so on. We could include also the emotional reactions of the in-laws and mum's reaction to their feelings, to complicate matters further. If one steps back a bit and views from a distance these reactions and interreactions then one might gradually see a shape: a pattern the pattern of how the family adapts to the serious illness of one of its members. Since families are organisms, systems which can only operate if certain functions and roles are allocated, these functions need to be reallocated to other family members if one person becomes ill. This redistribution of functions and power requires adaptation in the family; some families are better at that than others. At the extreme, some families do continue to operate in the face of serious illness as if it never happened illness and its effect on the family is denied. Others may be paralyzed by it for weeks or months, so much so that other family members develop symptoms. Most families, however, gradually establish a new status quo, a new modus vivendi. The oldest son may temporarily step into dad's shoes and be in charge of certain things in the home. Mum may have to do some of the things dad had been responsible for. As mum is doing extra work, her daughter will have to change some of her demands and possibly take over some of mother's functions in the home. An in-law may move in temporarily to fill a gap, and so on. It is mostly the families that are not able to adapt to the new situation that need to be the concern of the general practitioner, and it is in these cases that some intervention or family counselling may be necessary. The example I gave was one of sudden serious physical illness. Psychological and psychosomatic illness can produce quite different reactions in families. Mode of onset and severity as well as chronicity are all factors which contribute to how the family and its members will cope with the illness. It is obvious that a sudden serious illness will affect the family quite differently from a chronic ailment. Moreover, the degree of severity may determine the degree to which the family needs to reallocate functions and roles in order to provide continuity. It is, though, also the case that there are families which collapse whenever any illness occurs however trivial it may appear to the diagnosing practitioner.