Family Nursing Theory and Literature Review
Application of Murray Bowen’s Family Systems Theory in the Analysis of the Impact of Mental Illness in the Family Unit (Viewed as a System) and its Management Family Nursing Theory and Literature Review
The Bowen Family Systems theory is arguably the best family theory that explains the complex interrelationships that exist between family members and their effect on mental health. This paper looks at the conceptual framework of the theory, its influence on other scholars (by way of a literature review), and application to nursing practice. Some of its strengths and one major weakness are also examined.
Problem Background and Overview of Bowen’s Family Systems Theory
Mental illness is one of the health problems that have the most far-reaching effects on the family as a unit. The fact that a family member suffers from mental illness is usually a source of great social distress, guilt, and isolation for other family members. Members of the same family normally have strong emotional bonds with each other such that what affects one member will more often than not affect the rest (Bowen Centre for the Study of the Family, 2019). This is because of the interdependent nature of members of a family unit, and is true with mental illness. According to Corrigan and Miller (2006), social stigma from members of the society has a negative mental impact on members of the family of persons with mental illness. Several studies have revealed that relatives of those with mental illness experience significant family stigma directed at them for merely being related to a mentally ill person. Participants expressed high likelihood of being hostile to family members of those with mental illness (Corrigan & Miller, 2006). One particular study showed that 1 in 4 family members fear that they may be blamed for their relative’s mental illness. Because of this, family members of mentally ill persons would prefer to keep their relationship to the sick person secret for fear of blame and shame (Corrigan & Miller, 2006). Family Nursing Theory and Literature Review
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The Murray Bowen theory of family systems considers the family as a unit or system held together by strong emotional ties in which the relationship between members of the unit operate in a systems fashion (Bowen Centre for the Study of the Family, 2019). As such, emotional discomfort in one member may affect all the other members negatively. However, one member may be affected more than others and hence shoulder a disproportionate amount of the system’s distress. This may therefore lea to symptoms of mental illness such as depression (Bowen Centre for the Study of the Family, 2019). All this is explained by a conceptual framework put forward by Bowen, and it includes eight interrelated concepts. These are (i) differentiation of self and emotional fusion, (ii) triangling, (iii) nuclear family emotional system, (iv) family projection process, (v) emotional cutoff, (vi) multigenerational transmission, (vii) sibling positions, and (viii) societal emotional process (Brown, 1999; Bowen Centre for the Study of the Family, 2019). In (i), the greater the fusion or closeness with each other, the lesser is the ability to adapt to stress. In (ii), the triangle is a reciprocal relationship among three family members – a triad. In an emotional relationship between two family members (a dyad), a third person may be introduced to diffuse the tension in the dyad. In (iii), stress may come from couple conflict, dysfunctional symptoms in a spouse, depressive symptoms in a child, and emotional distance. In (iv), the parents may project their emotional issues to the child without knowing it, leading to him having problems later in life. In (v), a family member may emotionally or physically distance themselves from the others in a quest to disrupt the fusion (emotional interdependence) in the system. In (vi), emotional problems are handed down from one generation to the next through parents to children. In (vii), the position of a child in the family (first born, last born, and so on) may influence the type of triangling that they form and with whom. Finally, in (viii), the emotional relationships in the family system are reflected outwards to the extended society. In fact, doctors, therapists, and nurses can become part of a triangle in a family system on therapy (Brown, 1999; Bowen Centre for the Study of the Family, 2019).
Literature Review in Light of the Bowenian Theory
The Bowenian theory of family systems introduced above attempts to provide an explanation to the origin of mental stress in families which may later lead to overt mental illness. Bramlett and Blumberg (2007) made a comparison between children raised by both biological parents and those living with single parents, adoptive parents, and foster parents in a bid to find the influence of family structure on mental and physical health. They found that family structure indeed impacted the mental health of children. Children with both biological parents had better mental health than the others (Bramlett & Blumberg, 2007). Barrett and Turner (2005), in agreement that family structure affects mental health status sought to find out the confounding influence of socio-economic status, social stress, and family process on this relationship. They concluded that all three parameters individually and in combination significantly contributed to the development of symptoms of depression in a family member. Therefore, family type determines the risk for mental health problems (Barrett & Turner, 2005). Bowen explains this in that the bonds in the triangles formed may be put under stress, a third member of the triangle may be missing (giving a dyad), or the third member may pull out (as in divorce). On their part, Corrigan and Miller (2006) found out that about 20% to 33% of family members of those with mental illness confess to having experienced stigmatization and social isolation by the public due to discrimination. They also revealed that family stigmatization by the public is apportioned according to the role of the family member (mother, father, sibling, and so on). They concluded, importantly, that family stigma is a hindrance to family participation in treatment modalities of the mentally ill; like group family therapy (Corrigan & Miller, 2006). Last but not least, Haefner (2014) looked at how the Bowenian theory of family systems can be applied in family therapy in practice. She importantly averred that symptoms of mental illness may be reflective of emotional issues in the family (Haefner, 2014). This is exactly what the Bowen theory explains, resulting from the eight intertwined concepts like triangling and sibling positions. Family Nursing Theory and Literature Review
The Bowenian theory therefore suggests a balance in the family relationships. For instance, too much emotional fusion or closeness between family members may be detrimental to mental health. Therefore, differentiation of self at the right time may be the key to emotional independence and maturity. This in turn helps to keep mental illness symptoms at bay. In my considered opinion, therefore, the Bowenian theory best describes the problem of mental illness in the family context, explains it, and offers solutions. Two clear strengths of the Bowenian theory of family systems is that it provides a foundation for family therapy and gives a theoretical framework for the tailoring of treatment of mental illness. One main weakness, however, is that it disproportionately focuses on the mother’s role in the development of symptoms in the child (Brown, 1999).
Application and Relevance to Nursing
The Bowen Family Systems theory is applicable to nursing and is useful in understanding the origin of patient symptoms and their management. The nurse can therefore involve the family in the treatment with better results. A case example is a child who was brought up by the mother up to seven years after which the biological father came into his life. The dyad between mother and son is stressed when it becomes a triangle with the father. The relationship of the son and mother is strained and the son loathes the father (Haefner, 2014). Counselling and explanation is needed so that the family can understand what is happening, thanks to the Bowenian theory. It is then clear that mental illness in individual families can be effectively addressed by using this theory due to its in depth analysis of the root of symptoms. The reason why mental illness occurs according to this theory has already been addressed above.
Bowen’s Family Systems theory provides a compelling explanation as to why mental illness is impacted by family structure, socio-economic status, and other factors. This is what was learnt in the literature review, in which the family structure played a major role in causation. However, more research needs to be done to find out the extent of the role of fathers in symptom development in the child. Additional research is also needed to assess the effect of the environment on the family system and symptom development. Family Nursing Theory and Literature Review
Barrett, A.E. & Turner, R.J. (2005). Family structure and mental health: The mediating effects of socioeconomic status, family process, and social stress. Journal of Health and Social Behavior, 46(2), 156-169. Doi: 10.2307/4150395
Bowen Centre for the Study of the Family (2019). Theory. Retrieved from https://thebowencenter.org/theory/
Bramlett, M.D. & Blumberg, S.J. (2007). Family structure and children’s physical and mental health. Health Affairs, 26(2), 549-558. Doi: 10.1377/hlthaff.26.2.549
Brown, J. (1999). Bowen Family Systems Theory and practice: Illustration and critique. Australian and New Zealand Journal of Family Therapy, 20(2), 94-103. Doi: 10.1002/j.1467-843819-99.tb00363.x
Corrigan, P.W. & Miller, F.E. (2006). Blame, shame, and contamination: The impact of mental illness and drug dependence stigma on family members. Journal of Family Psychology, 20(2), 239-246. Doi: 10.1037/0893-3220.127.116.11
Haefner, J. (2014). An application of Bowen family systems theory. Issues in Mental Health Nursing, 35, 835-841. Doi: 10.3109/01612840.2014.921257
Family Nursing Theory and Literature Review