Beginning in the 1970’s, Jerry M. Lewis, M.D., director of research at Timberlawn Psychiatric Foundation in Dallas, Texas, began pioneering studies in healthy family functioning. In the late 1970’s, Dr. Lewis shared insights from his research in an hour-long talk, delivered without notes, to a group of social workers on the campus of the University of Texas at Austin. The following is a verbatim transcript of a videotape of that talk.)

A VHS videotape of this presentation, “Healthy Families,” may be borrowed by Texas residents without charge from the Audiovisual Library of the Texas Department of Health (http://www.tdh.state.tx.us/avlib/avhomepg.htm)

Healthy Families

A talk by Jerry M. Lewis, M.D.

We have been involved in investigating, from a research base, dysfunctional families, families that have a great deal of difficulty meeting the needs of the family members. For a goodly number of years, that’s been one of our foci, as it has been other research groups around the country.

Within the last six to eight years, we’ve got particularly hooked into studying a small group of families that were distinguished not by the fact that they were in trouble, but by the fact that they were accomplishing the tasks of family very well. The first thing that you would ask is, well, what are the tasks of being a family? There are, of course, no hard data about this. We’re talking about value judgements. Your idea of what a family is about is just as valid as mine. But here is what we think the business of being a family is about.

The Two Cardinal Functions of the Family

First of all, from an evolutionary viewpoint, the family has functioned as man’s primary survival system for hundreds and thousands and millions of years. What scant archeological and anthropological data we have suggests very strongly that the first function of family is to insure, insofar as possible, the physical survival of the members of that family. In this culture, at this time, that remains, in my judgement, for too many American families, the number one goal. For those families that cannot be certain of food tomorrow or a roof next week, physical survival is still the primary function of the family. As yet we have not been involved in studying families for whom physical survival in this country at this time was a day-to-day issue.

Rather, we have studied a group of families who did not really have to concern themselves day in and day out with physical survival. We’ve studied a group of middle and upper middle class families in Dallas and I’ll tell you more about their characteristics in just a moment.

For such families, families for whom physical survival is not a day in and day out concern, there are two primary functions of the family. These are, at least in my judgement: number one – a family exists to produce autonomous children.

One of the cardinal functions of the family is to produce children who can leave the family, who can function on their own, who no longer need that particular family, who not only can leave the family geographically, but can leave the family emotionally and find new relationships that are of greater importance than those in their family of origin.

So the first function of family, as we define the functions of family in our own research group, is the production of autonomous children. In a peculiar sense, then a family’s function is self-destruction. A family starts with parental marriage. Children are born into the family. Children should be able to leave the family. The family becomes a marriage again and ultimately its life is ended. We’re very much into the developmental sequences of being a family. What are the stages or phases of family life? But our work in this area is very preliminary. I’m not going to talk about it tonight.

The second cardinal function of family, once you get beyond physical survival of its members and once you go beyond the issue of producing autonomous children, is, in our terms, the stabilization of adult personality.

I think the facts are mounting that each of us comes out of childhood with greater or lesser vulnerabilities. We’re scarred. Some of us have very few scars, others of us have significant scarring. For a variety of reasons that, for the most part, at least in most instances, in my judgement, are no one’s fault. Whether or not those vulnerabilities get transmitted to disability is, more than anything else, a function of the nature of our supportive systems, the nature of the family which we’re in the process of evolving.

Over and over again, if you study the lives in detail of people who psychologically have decompensated, who have cratered, whose lives have fallen apart, you find the absence of a strongly supportive family system, the absence of a relationship which provides the necessary forum for the development of intimacy, the port in a storm.

So it is these two functions of a family – the ability to stabilize the parents’ personality functioning and the ability to produce autonomous children – that we talk about when we talk about successful or competent families. This is what we’re talking about – families that succeed in doing those two things.

Background of the Research

Now for a little background – how did we get into this. My own training and our group, our small research group, is an interdisciplinary group with representatives from sociology, psychology, psychiatry (which is my own discipline) and then a number of graduate students from the Dallas area who hook into various aspects of our project. They come from graduate programs in psychiatric nursing, psychiatric social work, the doctor of ministry program at Perkins Seminary at SMU and a variety of other graduate programs.

We got into it because we were interested in understanding the outcome of treatment of emotionally disturbed adolescents. Those of us who were involved part-time in the construction of a treatment program designed not only to measure the outcome of treatment but to search for the correlates of successful treatment and unsuccessful treatment, designed a long-term treatment evaluation project following several hundred youngsters five years after treatment. That project is into its seventh year at this point in time and has another year or two before it will be completed, before all those youngsters will have been followed five years after treatment.

We wish, though, not just to measure success and failure because that’s relatively easy in our particular work. Successes are back in the mainstream of life; failures are dead or chronically hospitalized or a few of them are making marginal adjustments in the community.

We also wish to know what accounts for the differences. How come you succeed with some and fail with others? You have a bright, very well-trained, multi-disciplinary staff, you have a treatment environment in which time is not always breathing down your neck, and yet you fail with some and succeed with others. What are the differences? Well, that’s what that project is all about.

One of the factors which we wish to explore to see how much of the difference between successful and unsuccessful treatment is accounted for, had to do with the families these kids came from, because, quite frankly, in some of our patients the difference between success and failure seemed clinically or impressionistically to be more clearly related to what was going on with mother and dad than it did with what was going on with the kid. Let me remind you that was just in some of the patients.

So we wish to study the families of young patients and we were used to studying families of young patients as most mental health professionals do such work and traditionally they interview the father and the mother and the children and they put together a composite of what the family must be like and that’s valuable kind of work to do but it’s not very adequate for research purposes. So we got into the business of family systems research and I’m going to take a few minutes and describe the methodology because it’s important that you as a group have an understanding of the results that I’m going to talk about in a moment.

Family Systems Research

In family systems research, rather than interviewing or testing individuals in a family and putting together a composite, you bring the family together as a unit and you give the family certain tasks to achieve or certain verbal problems to solve. You record their solutions and then you do a variety of painstaking analyses of the way they go about solving problems, their communication network, how clearly they communicate with each other, what do they do when disagreements come up, how do they deal with feelings, what happens in the presence of conflict, how often do they interrupt each other. A whole host of communication variables are then studied in regard to the family communication system. This is the essence of family systems research or, in our terms a family systems test.

These techniques are not our own. They were developed at National Institute of Mental Health, at Yale at Department of Psychiatry, Stanford Department of Psychiatry, a few other places. And when we got to that stage of our research involving treatment for young people, I was introduced and other members of the group were introduced, to this particular approach to the study of families which was exciting because it produced quantifiable data. It was easy to compare the Smiths to the Jones, because you could compare what percentage of the speeches were interrupted or what percentage of all the family speeches were father’s and mother’s and the children’s so it provided for us a harder kind of data than the usual mental health data in which you usually rely upon the content of what people are willing to tell you about what goes in their family.

So we would bring families together as part of our diagnostic evaluation, present them with five different tasks to accomplish, give ten minutes for each task and their performance on each of these tasks were videotaped. The tasks range from something that we thought was fairly neutral, like plan something together, (that’s not neutral for all families), to something that’s very charged and that is, for example, for the parents to discuss whatever it is that’s the source of greatest pain and pleasure in the parental relationship.

We used to finish this up, when we first got going, we were naïve and we thought, gee, you know, these families are going to be talking a lot about themselves, they spend a day with us or six hours with us through all of this testing and examination, we ought to do something that brings them together at the end of that day.

So we devised what we called a Family Strength Inventory, 25 characteristics of families that most people would think are strengths in a family and we had each family member check off that inventory, whether this characteristic applied very much, a little bit, not so much, to their family. And then they were brought together for the final ten minutes of family testing and they were reminded – you all had a chance to see that Family Inventory of strengths. Now we want, for ten minutes, for you to describe, to talk about together, what are the strengths in your family.

Well, that’s a very coming together kind of final task for families that have some, or feel they have some, but some of our dysfunctional families sat there and looked at each other, were wordless, cried and we quickly changed the routine of the way in which these tasks were presented to families.

Our major research methodology has been this Family Systems testing and I think, perhaps, to share with you the flavor of this, let me give you an example from another laboratory.

Family Myths

A colleague of ours on the West Coast was interested in family myths. He had the notion that every family had a few myths and it would be interesting to discover what are the myths in some families. He felt, in particular, a common myth in many middle-class families was the myth that the father was always the boss in the family.

Now, if you bring a group of middle-class families together and ask them who’s the real boss in the family, 98 out of 100 will say father. Partly, that’s because that’s the way it’s supposed to be. When he did that with a large group of families, 98% of them said dad’s the real boss in this family and everybody agreed. Then he asked them to plan a vacation together and in front of a tape recorder and he just counted interruptions.

Now, as I will perhaps mention later, in healthy families, there’s a lot of interruptions, but the interruptions are evenly dispersed throughout the family, maybe 10 or 15% of mother’s statements get interrupted, 10 or 15% of father’s 10 or 15% of each child’s. In this particular research from the West Coast, in about 15 or 20% of the families that had designated father as the real boss in the family, the pattern of interruptions went like this – 10% of mother’s statements were interrupted before she completed them, 12% of daughter’s, 11% of son’s, 63% of father’s.

Now he really wondered in that instance whether or not those families who identified father as the boss insofar as what they would say but never let him say anything were really dealing with a myth. That’s the kind of systems oriented, process oriented research that we’ve been involved in.

In addition to that, however, we’ve done the usual things. We’ve made home visits so there are at least several psychiatrists and psychologists in Dallas who make home visits, at least if you’re a research family. We visited fathers and mothers at their offices or at their work. We’ve done exhaustive psychological tests with everyone in the family in addition to this Family Systems testing and then we do six hours of interviewing in depth with each family. All of this is videotaped so you end up with rooms and rooms and rooms of videotapes and research data.

Our interest in what I talked about today in the Department of Public Welfare was a broad view of all the families we’ve studies because we’ve studied very disturbed families, kind of disturbed families, not so disturbed families, and then healthy families and I thought I would share with this group today some of our findings about healthy families.

First of all, let me say this, that if you asked the research volunteers in the community for a project studying family health, not everyone who volunteers is healthy. A number of families come to you and are very quickly screened as families in difficulty or moving towards difficulty, who have volunteered for research in part, perhaps, because of their wish to get some help or some assistance with the problem.

So that it is only after a good deal of preliminary screening that judgements are made about how well the family is fulfilling the criteria of producing autonomous children and stabilizing the personalities of both parents that we focus upon a smaller group of the volunteer families who everyone agrees are the healthy group because they do so well the two things I’ve talked about.

No Single Thread

What are the other characteristics of these families? Well, first of all, the title of a recent research publication, a book describing this six or eight years work, was called No Single Thread, Psychological Health and Family Systems. No single thread is the part I’d like to focus upon. There wasn’t any one factor that healthy families had that less than healthy or clearly dysfunctional families did not have. Health at the level of family is very clearly the result of many factors and not just one. That in itself is probably kind of important because there’s a great search in medicine, psychiatry, and psychology. It’s the search for specificity, the search to find one single cause of difficulty or, conversely, one single cause of health. And all of our data suggests very strongly the differences between the healthiest families we’ve ever seen and the most disturbed families we’ve ever seen, are not one cause, but a multiplicity of variables or factors that account for the differences.

As a matter of fact, we now talk about a continuum of competence, with the differences between very competent families and very incompetent families are a matter of the same 12-15-18 variables, all of which tend to run in the direction of health for some fortunate families, few of which tend to run in the direction of health for the most severely disabled families.

Now let me say just a few words about my use of the term “health” because there are some philosophers, some methodologists, some purists in the audience, I’m sure. For us, “health” is a very relative term. You must define it at a particular historical period. We have no question that what is healthy today was probably quite dysfunctional two hundred years ago in this culture. All you can do, if you’re a researcher, is study health at a given period of history because the cultural factors that influence the model of health are different in an agrarian society than they are in post-industrial society.

Secondly, that we make no claim for any one model of health. As a matter of fact, we suggest that in different cultures, as well as in different historical periods, a healthy family would be defined quite differently.

Thirdly, we have no data about other subgroups within our own culture, and in particular, we have no data about the families for whom physical survival is a day to day kind of issue. Our families, the families that we have studies, are families that are middle to upper-middle class, for the most part Caucasian families who are biologically intact, whose oldest child is in mid-adolescence.

So most of our families have been families for between 15 and 20 years. We selected them in this homogeneous way because we wish to follow each family through one developmental milestone, that’s when the first child leaves home. We see that as a developmental period when the old gang begins to break up and when a host of forces can be operative within the family. Currently, as a matter of fact, we’re studying our initial group of research volunteer families now some six years after their initial work with us.

Okay, there is no single variable that distinguishes between healthy and pathological families or between very competent and very incompetent families, but there are a number of variables and I would like to describe two types of variables. The first are very global, very pervasive and very difficult to measure variables that come, for the most part, from interviewing families over a lengthy period of time. Let me talk about some of these global variables first and then get down to the more specific and easily measurable variables.

Healthy Families Reach Out to Others

Healthy families show a strikingly affiliative attitude toward human encounter. If you think for a moment that each family might fall somewhere on a continuum, at one end is a very affiliative attitude and at the other end is a very oppositional attitude. What do these terms mean? What we’re really talking about (it can be applied to the individual, too) is, how open are you to encounters with strangers? We find families that are strongly oppositional; they’re strongly suspicious about every encounter. Their presumption is that someone is going to get hurt, that people, and particularly strangers, are dangerous.

On the other hand, the healthy families that I’m describing to you tonight are strikingly affiliative in their attitude about human encounter. I do not wish to say that they are naïve. I do not wish to say they are incapable of distrust, because they aren’t. But the fact is, someone’s harmful intent must be demonstrated; they don’t go into the situation expecting it. The reason this has been very important to us, this global variable, is it’s such a strong tendency towards a self-fulfilling hypothesis. If a family acts very suspicious and on-guard when they meet a stranger, the stranger is most apt to return those feelings in kind, thereby documenting the initial set. If you meet a stranger, and the stranger is warm and open towards you, you’re very much apt to respond that way to the stranger, so that there is a tremendous tendency for these basic and pervasive sets to be involved in self-fulfilling hypotheses.

Respect for the Subjective Nature of Reality

Another global variable – healthy families have an unusual amount of respect for the subjective nature of reality. Having been trained initially in the hard sciences of chemistry and biology, having grown up in a culture in which now I think a Western model of science, with all of its reductionism, permeates all of our thinking. I really grew up as a scientist, as a physician and ultimately a psychiatrist and researcher, believing there was one reality, that reality was firm and that people ought to be able to share that same reality. I recognize now that there is no one reality, that if we stand on the same corner and watch the same event, we’re going to see it a little differently, that reality is a perceived reality and that therefore, subjective factors become very much involved in how we see reality. Healthy families somehow, somewhere understand this.

There is not tremendous pressure within the family for everyone to see things the same way, for everyone to agree about a given event. There is a general pervasive understanding that things will be a little different to everyone in the family and there is no pressure for that kind of massive and often constricting agreement about the nature of reality.

Another global and pervasive variable having to do with healthy families is their apparent understanding that human behavior is complex, that we rarely do anything for one single reason. As I mentioned this afternoon, in our work together this afternoon, this is most frequently seen when a healthy family comes up against a problem involving the family. They’ll look at the problem, they’ll assess the problem, they’ll get into it early and they’ll try to do something about it and if that doesn’t work, they’ll reassess the problem. They’ll act as if another possible cause is operative, whereas dysfunctional families are much more apt, if they have a problem, they assess the problem, the do something about it; if that doesn’t work, they do the same thing even harder. So there’s a tendency of dysfunctional families to act like a car in one gear, only one gear and there’s only one way to go and it’s just a matter of how much force or how much acceleration you’re going to apply. That’s not the way healthy families operate.

Finally, at the global level and something I don’t understand, I think is probably biological, temperamental or something and that is, all of the very healthy families that we studied had very high levels of initiative. The individuals were highly initiating in their social intercourse with the world around them, so these were people who were constantly going out, constantly involved in a variety of social networks and they over and over again took the initiative. This characteristic of families is one thing I don’t believe we understand and, although I think we would guess there may be something biological about that, I don’t know.

Now, if we turn for a moment to the more easily measured variables, those that we can measure with rating scales, we can train raters in six or eight hours to agree with remarkable unanimity watching videotapes or watching families discuss a problem.

Marriage in Healthy Families:

Sharing Power, Intimacy

Let me first discuss the structure of healthy families. The structure of healthy families is firmly wrapped around the quality of the parental marriage. It’s very difficult at this stage of our own research, of my own understanding of family functioning, to believe that a family can be any healthier than the quality of the marriage between the two adults in the family.

What do I mean by a healthy marriage? Several things set the men and women in these healthy families aside from the marriages we’ve seen in other families. Number one – they share power, that who has the final say-so in any given situation is quite clearly determined by what is the situation is and who is determined to have the greater expertise. There is no suggestion that one parent’s viewpoint always is decisive. There is no suggestion in healthy families of any tendency towards domination and submission. Indeed, the kinds of complimentary relationships the parents in healthy families have are really beautiful to be around. They share power, they respect each other’s expertise and there is no competition. There is nothing of the “I can do anything better than you” business in healthy families, at least those that we’ve studied.

So, that power is shared between the parents and is firmly and securely in the hands of the parents. When I say that, I have to hasten to reassure you that, in healthy families, mother and dad are in charge of what goes on in the family, but they do not use that power in a authoritarian way. They lead the family and do not dominate it. By leadership, what I mean is that they rely heavily upon negotiation. Negotiation is a complex communication process in which people really truly listen to each other, really consider what each other says, search for a consensus and, failing that, work for a compromise. That kind of describes what goes on in the problem solving of healthy families so that, rather than having one dictatorial individual who says “this is the way it’s going to be,” what you find is a very effective coalition which pays tremendous attention to the needs of the children and yet, power, influence, authority is clearly in the hands of the parents, but not used with any kind of authoritarianism.

In addition to this highly effective instrumental quality of the parental marriage, they do things well together, they solve problems well together, they deal with the kids well together. These marriages have the highest level of psychological intimacy of any that we have studied.

It’s really something, you know, to go into the homes and the offices and have these people come into our own research laboratory and really kind of get inside the life of the family and find people who’ve been married 15 or 20 years who are still in love. Juices flow, electricity, something, they’re still turned on to each other. The relationship is not what Kuber and Harroff described as the model American marriage with the quaint term “devitalized.” There isn’t anything devitalized about these marriages. They are not marriages of convenience. They are not marriages of custom. They are marriages that are still very viable, and this viability is obvious in the way they relate to each other, the way they touch each other, the way they talk about their physical relationship with each other. It’s really a very, very, very pretty thing to be a part of in the study.

So the parental coalition is unusual, it’s instrumentally effective, it’s emotionally gratifying to both parents, it’s physically still alive. The sexual aspect of the relationship is gratifying to both participants. Independently and in detailed individual interviews this became very clear.

Closeness and Pseudo-closeness

The other thing about the structure of healthy families is that they achieve a very high level of interpersonal closeness. I have to define closeness a little bit because in our terms and our laboratory, closeness is based on separateness. The reason I say that is because we see a peculiar type of pseudo-closeness in some of our work with dysfunctional families in which people kind of meld together and become one, each one losing individual identity. These are families, unfortunately, who do a great deal of group thinking and, at home, evolving children have tremendous difficulties, as you might anticipate, developing a sense of selfhood.

In healthy families, the individuals are clearly separate from each other. Everyone in the family is able to define his or her separateness by clearly, repetitively, being invited over and over again to define themselves by saying over and over again this is what I think, this is what I feel. Yeah, I understand, Dad, you feel this way about it but this is what I feel. That isn’t a put down, that’s encouraged. One of the ways that the human organism in its developmental pathway learns where his or her’s ends and someone else’s begins, is by being encouraged within the family to over and over again define what one’s feelings are and what one’s thoughts are. It’s only with that kind of separateness that we believe true closeness develops, in which there is clear understanding of the differences between people. So I wanted to distinguish that kind of closeness from what we see as a pathological closeness fusion, loss of identity, which we do not see in healthy families.

As you might anticipate, we’re very interested in the measure of personal autonomy in the family. We get this from the way people talk with each other and communicate.

There are three variables in particular which correlate very high with the autonomy of the developing children. One is, as I have indicated, how clearly are people encouraged to say what they think and feel. The clarity of self-disclosure within a family system is related to the evolving autonomy of the people.

Acknowledging Each Other’s Existence

Secondly, what we call the permeability of the family. By this we really mean, how adequately do family members acknowledge each other’s existence. Let me see, you know, it may be that you all are in families in which every time someone says something, there is some kind of acknowledgement, a nod of the head, a yes or a no, I disagree, but anyway the individual’s uttered words are invariably acknowledged, one way or the other.

The reason I make a point of that is because some of you may not be aware that in our study of dysfunctional families and some other research team studies of dysfunctional families, one of the things that characterizes many dysfunctional families is how infrequently they acknowledge each other’s presence. I have a videotape of a family containing a very seriously disturbed adolescent girl and her nine year old brother. In the course of a ten-minute interactional test, he asks the same question of his family – mother, father, and emotionally disturbed sister, 11 times in ten minutes and no one ever acknowledged that question: with a nod, a wink, a word, a hand. Will it surprise you that we would predict that he will grow up, if that is representative behavior, with an identity problem?

The identity problem is not ‘Who am I?’ The identity problem is ‘Am I?’ Do I have any real existence of my own? Now, again, healthy families are very permeable, they have high levels of acknowledgement of each other, and, in this way, they continue to define each other’s existence and presence.

The third variable, which we think is involved in the development of autonomous individuals, is that people are encouraged to take responsibility for what they feel, think, and do and in healthy families there’s a high level of personal responsibility encouraged. This is what I think, this is what I feel, yes, I did that.

Expressing Feelings

Let me switch for a moment to the whole business of feelings. Many of us grew up in families in which the expression of feelings was masked, modulated, discouraged, forbidden. That is not true in healthy families. Healthy families are the most expressive families in regard to feelings of any families we’ve ever studied. All feelings – when they’re angry, that’s out in the open. When they feel sad, that’s out in the open. When they feel unusually loving or tender, that’s out in the open. The system as a whole is highly involved in licensing and encouraging the clear, open expression of feelings. Healthy families are more apt to respond to an expression of feeling with what we call a highly empathic response.

Let me just for a moment separate empathy from sympathy. By empathy, I mean the kind of response to a feeling message which says to another human being, hey I know what you’re feeling, I’ve been there. It’s a kind of momentary sharing of an affective state, and that is what we call empathy. If you just count responses that are empathic responses to feeling tones that are communicated within the family, the healthy families very much have a higher level of empathic responsiveness than any other group of families.

I could talk about spontaneity because healthy families are very spontaneous. I could talk about the use of humor because healthy families are characterized by a non-malicious use of humor. I could talk about the relative absence of scapegoating in healthy families because we rarely see internal scapegoats in healthy families. We could talk about a lot of other variables that distinguish healthy families from less fortunate families. Rather than do that, I want to take a few moments to discuss two other things, maybe three.

Competent but Pained Families

There’s a group of families who are just short of being healthy. We’ve been very interested in this group of families because, although we don’t have any data about how come they are, we have a nudge, and intuitive hunch, they are more common than the very healthy families. We call these families competent but pained. These are families that do one of the two cardinal tasks of being a family very effectively. They produce autonomous, healthy children, and our studies of helps us to understand that you don’t really need, perhaps, an optimally functioning family to produce healthy kids. That’s reassuring for many of us.

But the competent but pained families do not meet the needs of both the mother and father. They do not stabilize both of those personalities. There’s a pattern to this which we’ve been increasingly aware of, which I share with you for what its worth to you. The fathers in competent but pained families are productive, no more, no less than the fathers in healthy families. They are, for the most part successful people. For the most part, they’re very autonomous. They don’t drink too much. They don’t take pills. They have very little in the way of depression, little in the way of anxiety. They’re job-oriented. They’re very hooked into their kids.

Mothers in the competent but pained families are hurting. They’re dissatisfied with their lives. They tend as a group to be overweight. They see their doctors frequently. They’re often on minor tranquilizers – Valium, Librium, Miltown. And in the extensive individual interviews with this group of women, what you hear more than anything else sounds to me – and I’ve interviewed a goodly number of them – could be subsumed under the phrase “Where Did the Dream Go?” Somehow, life has gone sour for these women and they very clearly lay the blame at their husband’s feet. In effect they say somehow my marriage is not what I thought it would be. Somehow I don’t feel important enough. Somehow I don’t get enough.

There are a couple of different ways to look at this. One – you could look at it like I mentioned this afternoon in earlier conference. You could look at it a kind of chronically dissatisfied, neurotic women who would never be pleased with anything, who, if they just realized how good they had it, they would shape up and do right. That’s one particular interpretation. There may be some truth in that, I don’t know.

I do know that their husbands are different than the husbands in healthy families. They’re less giving. They’re less in touch with their own feelings. They have less left over at the end of the day or the week. They’re less into relationships. They have more solitary hobbies. So that, for me, there’s some validity, obviously, in the complaints these women in the competent but pained families have. They appeared, at the time we studied them, to be on the verge of depressive symptomology of serious magnitude.

We’re very interested in our follow-up study five years later because we were involved with these research volunteer families as clinicians, not helpers, but as people who are studying one aspect of the human dilemma. We’re very interested because we know all of them didn’t crater because the graduate students who are involved in the follow-up project have said, “Hey, do you remember so and so?” And I say, “Yeah, I remember her.” And they say, “You should see how she’s turned her life around. It really is different for her.” But at the time we studied them, half a dozen years ago, these wives in the competent but pained families looked like they were moving in the direction of serious decompensation.

Alright, one other thing that I would mention is that we’ve also been very interested in studying the physical health of families. We’ve identified two types of families and I just share this with you. Our research is at a preliminary level. We’re very interested in why some families have so much physical illness and other families have so little. By physical illness, I mean fractures, heart attacks, cancer, colds, flu.

We’ve been able, by some painstaking kind of history-taking. To identify a group of families, who’ve been families for twenty years, who’ve never had a serious life-threatening illness, who’ve had no hospitalizations, other than for childbirth, have had no fractures. You go into their homes and open their medicine cabinet doors, you’ll find toothpaste and aspirin.

Another group of families, with the same social and economic background, who, in the course of twenty years of being a family, have had sixteen hospitalizations, separate and apart from childbirth, have had three life-threatening illnesses, eleven fractures. You go to their bathrooms, open their medicine cabinet door and everything falls out. Sixty percent of what falls out is over-the-counter preparations. A high percentage of them are for nerves or for gastric distress or those kinds of things.

We’ve been very much involved in trying to understand – how is this possible? What is this all about? We don’t expect any simple answer, but, is their way of being a family in their way of loving, fighting, meeting crises, dealing with life’s inevitable slings and arrows, that somehow influences the family members’ immune systems to be more or less effective in warding off disease agents. We have some leads in that regard and I just mention it to you because, usually, when I do, there are a couple of people who nod, you know, every time I say “these high-illness families,” reminds me of the people next door, that kind of thing.

Healthy Families and Death

Finally, and I will close with this about healthy families. We have some data which suggests that healthy families deal differently with loss. You know, there’s a good deal of work now that suggests that a group of human beings in this culture and this historical period in time, if we’re asked to list what are the worst things that can happen to us, list them in descending order – this has been done for thousands of Americans – that the things that occurs most often than not at the top of everyone’s list, or at the top of more people’s lists than not, is the loss of a spouse or death of a spouse. The second most stressful event that people can imagine happening to them is the death of a child. And, as you go down these lists that other researchers have evolved, all the things at the top of the list that people fear the most involve loss, involve losing someone or occasionally something which is terribly dear to you, so we’ve really been involved in trying to understand how do families deal with loss.

On of the ways that we’re approaching this experimentally, I’ll share with you. One of our family testing vignettes is a little video-taped death-bed scene in which a family is around someone who’s breathing heavily and in difficulty and the family is clustered around the bed wondering and worried and concerned about the fact of whether he is going to live or die. The family doctor says, I don’t know, it could go either way, there’s lots of damage. Click, that’s the end of the story and then the instructions come on and the family is asked to complete the story. There’s no right or wrong ending to the story, just your ending to the story. We want you, as a family to construct an ending to the story. The research task is, how openly can the family deal with a very overt death and dying stimulus. How can they, will they, talk about death and dying after hearing this little audiotaped vignette? Will they even mention it?

Well, let me say to you that one of the very striking things is how few families can discuss death or dying in any personal kind of way. Some families do so in a very abstract way, but a few families, generally the healthier families, talk about it in very personal terms.

Remember when grandfather died. How did we feel, what did we do? And as you watch those families who can openly discuss death or dying, do so on the videotape, there isn’t anything abstract or sterile about the way they do it. You can feel the effect. You can feel the feelings. They can recapture the sadness. So that we really feel that one of the things that healthy families do, that other families of lesser competence do not do, is teach their children about death, something about dying, something about the chronology of life, the continuity of generations.

I can recall, as a child in the small town that I lived in, that, when someone died, they were laid out in the living room and I was dragged along by my parents and we didn’t just stay three or four minutes, you know. You were there for a couple of hours and usually bearing a cake or ham or something. And I think of how it’s changed, how differently many of us have dealt with this issue in contemporary America and how much we’ve excluded, many of us, our children from learning about this part of life. But it seems to me that at least some of the very healthy families that we’ve studied have somehow known not to do this, have somehow made death more a part of life.

The Future of the Family

Finally, since I’m going to have to run for an airplane back to Dallas in a few minutes, let me answer a question. Someone usually says, do I think the family will continue to exist? There are a lot of writers who say the family is dead, that it won’t take another generation or two, and we’ll have an entirely different system, don’t quite know what it is, but there’ll be something different. So, as I’ve indicated earlier, I think the best evidence available suggests the family has been here, the nuclear family, something of what we now know as family – one man, one woman, their children – for millions of years.

That doesn’t mean it’s a perfect system. As a matter of fact, there’s much to suggest that Margaret Mead was right when she said that the greatest social revolution in contemporary times is the switch from the extended to a nuclear family. It just occurred so slowly, we didn’t know it was revolutionary.

So that one of the deficiencies of our family system is that there are too many people who don’t belong to families. Many of them are single, young people. Many of them are the elderly. That’s one major deficiency of the nuclear family system in this culture at this time, is that too may people are excluded. Too many people are excluded from an intimate network or nourishment and confrontation and identity formation.

There’s another criticism by the critics of the family. They say, in effect, man, it’s too much. It’s too much responsibility. You need more people around because otherwise the role of being a parent is too lonely. You’ve only got one other adult to look to for support, for help, for nourishment, and I think there’s some validity to that particular observation.

And yet, it seems to me that we have yet to devise any kind of system which provides for us the two things that seem to be so necessary. One – some intimacy with another human being or with a small circle of human beings and, two – in the final analysis, some sense of our own meaning.

Some of you have read Becker’s recent book, The Denial of Death, in which, from an existentialist viewpoint, he says that the greatest anxiety each of us faces is that our lives have no meaning and that this culture really provides very few models of meaning. How many of us in this room are really going to be famous, extremely wealthy, members of the Dallas Cowboys, Nobel Prize laureates? Not very many of us. So not very many of us are going to find meaning through some sense of heroic involvement with this culture. For most of us, the meaning that we find will come within the circle of our family, the sense of being loved and loving, the sense of having purpose, the sense of passing along for one generation the baton of our culture and whatever changes that have to be worked out.

So it’s because I think that there’s no other system as well defined, with such a historical precedent, to give most of us some sense that life – our life – really had some meaning, that I do not personally see the family in any immediate danger. Thank you very much.