Families Matter

Why Societal Origin and Family Structures
Are Important


The Course

Family

Throughout the centuries art has offered a mirror in which societal dimensions are subtly reflected. It may be said that the media, and especially film, is our generation's artistic and creative canvas. Like Rembrandt, Monet or Picasso, Shakespeare, and others in their times, the writers, directors, actors and producers become collaborative global artists. They illustrate, teach and mirror our strengths and foibles. Through their eyes and ears a new portrait subtly emerges and reweaves the quilt of who we, and those around us, might be. I believe a portrait can convey more than most photographs and a poem more than an outline. Similarly, the theoretical and vocabulary inadequacies of today's training and psychiatric theories can be approached through a more holistic and intuitive medium.


I propose a course, specifically for family therapists that will examine elements and delineate examples of this 21st century film-art and point out its relevance to Systemic Family Therapy as well as to more traditional healers and teachers. If a picture is worth a thousand words then certainly one would find value in a moving picture with the right words that will illustrate universal elements of human growth and facilitate interactive understanding. A review of vignettes that illustrate the larger system circles in peoples' lives will make more real and discernible, both views and  possible interventions for our patient' sakes. For instance, "The Jazz Singer" one of the first "talkies", originally presented in the late 1920's accurately portrays some immigrant vs 1st generation family assimilation issues. "The Way We Were" starring Robert Redford and Barbara Streisand tried to describe a Midwest Anglo republican interacting with a Jewish ghetto radical. Her tribal affiliations are clearly distinguished from his "normality". Can we explore whether his predictable and repetitive behavioral patterns are also a manifestation of a different tribal belonging?

Woody Allen, most notably in the movie "ANNIE HALL" and more subtly in his other early productions has attempted to describe what it means to live an ethnically Jewish northeast urban life. Presumably the writer, Ms Streisand and Mr. Redford have used their own life experiences as a guide for portraying these descriptions.

"THE SOPRANOS" written and created by David Chase is another production that conveys the role of subcultural (Sicilian) influences on important parts of current urban North American society. Mr. Chase has said it relates to his own life experiences.

The TV series "MODERN FAMILY" manages some peripheral descriptions of the differences in ethnic family experiences between people of Anglo and Central American origin.

In another descriptive framework, the TV series "SEINFELD", "CURB YOUR ENTHUSIASM" and other works by Larry David offer a different 2nd and third generation urban Jewish ethnic experience.

For an example of viewing Seinfeld through a more traditional non-systemic and non-cultural, psychiatric viewpoint please consider the following:

"It’s 9 a.m.on aTuesday morningat Robert Wood Johnson University Hospital and 10 medical students sit around a conference table covered by coffee cups and clipboards.Preparing to start their morning rounds, the students chat about what they watched on television the night before."Jerry’s girlfriend doesn’t like George," third-year student Marlene Wang says, referring to the iconic 1990s sitcom "Seinfeld." "And he just couldn’t live with the idea of this person not liking him."This isn’t a discussion about nothing. More than 15 years after the final episode, "Seinfeld" is the basis for"Psy-feld,"a teaching tool designed to help medical students identify and discuss psychiatric disorders.

Every Monday and Thursday, third- and fourth-year medical students in the hospital’s psychiatric rotation are assigned to watch the6 p.m.episode of "Seinfeld" on TBS. They begin rounds the following morning by discussing what psychopathology was demonstrated on the episode.Wang says George demonstrates signs of narcissism as he neglects his own girlfriend to focus on Jerry’s. But fellow third-year student Ryan Townsend isn’t convi"I wouldn’t say he is completely narcissistic because he actually starts to enjoy the idea that she doesn’t like him,"Townsend says from the other end of the table."Narcissists can’t stand the idea that people don’t like them."

The discussion is exactly what Anthony Tobia said he had in mind when he created what he calls Psy-feld in 2009. Although not a course, it is required part of the training Tobia provides."You've a very diverse group of personality traits that are maladaptive on the individual level,"said Tobia,an associate professor of psychiatry at Rutgers-Robert Wood Johnson Medical School."When you get these friends together the dynamic is such that it literally creates a plot: Jerry’s obsessive compulsive traits combined with Kramer’s schizoid traits, with Elaine’s inability to forge meaningful relationships and with George being egocentric."

Database of showsYes, for those who remember, there is a "Seinfeld" episode with a subplot about Kramer acting out diseases for medical students. But, no, that’s not where Tobia got the idea for Psy-feld.The concept stems from a discussion with students about the final episodes of TV shows. That connected "Seinfeld" to an idea a student had for making a teaching tool about the characters in "Lost."

While it’s not unusual for medical school instructors to make reference to a television show or movie, requiring about 150 students a year to watch "Seinfeld" twice a week is, Tobia said."You cannot possibly pitch this idea to administration atRobert Wood Johnson Medical Schoolwithout getting buy in from your chairman, and that’s not easy,"Tobia said."Which is why most courses will start with what is traditional and allow course directors and teachers to reference film."

Tobia is so sold on the concept he’s created a database of every "Seinfeld" episode and its teaching points. All 180 episodes and nearly everycharacter in the series can be used for Psy-feld, he said. For instance, five of Elaine’s boyfriends are the topic of an academic paper Tobia penned explaining how the men display core character traits that match the themes of delusional disorder.

Other characters, like Jerry’s foil, Newman, are"very sick,"Tobia said. "Newman’s sense of self, his meaning in life, is to ensure that he frustrates Jerry," Tobia said."We actually have talked about Newman in that context and related him to Erik in 'The Phantom of the Opera.' The Phantom, while he starts out as being the tutor to the Prima Donna, actually has his life change and he is bent on revenge and that becomes who he is…and that’s Newman."

The 'aha' moment

Fourth-year medical student Jason Breig struggled at first to see past the show’s humor.

Elaine’s difficulties with men seemed like bad luck, and George was just funny, he said. But after a few episodes, he said he began watching with a different perspective."You start watching and you’re like,‘What is going on with George?’Breig said.

Wang, who identified George’s egocentrism, said watching "Seinfeld" gives her more practical and relateable examples than any textbook could.

"In this way, it just gives you a more solid picture of the pathology rather than just giving you words,"Wang said.

The hope is that students have an"aha"moment, the kind that doesn’t come from a PowerPoint presentation, said Tom Draschil, one of the psychiatric department’s chief residents. Nothing in medicine can fully be learned without experiencing it real life, Draschil said. But watching it on television helps, and the funnier a program is, the more teaching points it has for psychiatry, he added.

Tobia uses a similar approach in a monthly elective for medical students. In a lecture hall, students watch a full-length film, like "Fargo," and live-tweet their thoughts about characters’potential disorders at the bottom of the screen. He’s also pitching a course that would involve real-time Twitter discussion as students watch TV’s most can’t-miss shows live in their own home.

"In order for a surgeon to teach from a movie or TV show, there has to be surgery," Tobia said."In order for an internist to teach from a movie or TV show, there has to be the portrayal of an illness. Well, every movie, every TV show has human behavior, so a psychiatrist should be able to teach."

One of the course's first questions will be, "What distinguishes these descriptions of Jerry, George, et al from a systemic perspective?"

We will note the "pathology", "symptom categorization" and "syndrome delineation" that colors the primary focus of traditional psychiatric approaches. Presumably "medical insurance reimbursement" is at least partly responsible for a pattern that started with the medical background of Dr. Sigmund Freud. Murray Bowen MD, also steeped in the medical approach, addressed the challenge of helping people from a very different perspective and a different way of viewing people's interpersonal and emotional lives.

We may also ask, "Who are these people? What brings them together? What sustains the 7-year televised friendship with multi million worldwide viewers? What sustains their record setting audience and payroll? Are they simply ‘pathology’ on display?

Some Seinfeld episodes address systemic family data more than others. George's parents, and his connection to them, are described in greatest detail. Next comes Jerry's family. Apparently, Elaine, Kramer, Newman and other characters have no or minimal family contact and so there are no revelations. Interestingly, none of the main characters ever interact with grandparents, siblings or even cousins.

To go one step further, the course will ask, "What can the individualistic and pathology outlook make of the TV series about Tony Soprano et al?" "Is there an alternative to Dr. Melfi?"

Who is Don Vito Corleone?

Dr. Melfi seems to blame Tony’s mother and/or father. Did Sonny Corleone have similar “abusive” parents? Did the Don?

The course will offer a view (as in Seinfeld) that sees the "Don" and Tony (and their pals) as who their families raised them to be; that the variance of the problematic interpersonal pattern within the group, is much smaller than the variance in our larger society. Both these very successful TV series were based on ethnic groups that emigrated from historically abusive, impoverished societies that were ruled by one or another abusive, tyrannical group. These groups consistently exploited the majority of "citizens". These societies, when properly understood, will explain the media humor and pathos encased in the personal life of these "ethnic" characters. In our opinion even though the United States as a country is made of many immigrant groups, it is only the groups from the eastern and southern countries of the globe that are called “ethnic groups”. The non-Northern Europeans are “ethnic”. Minnesotan Lutherans are not. Why? Citizens of Germanic ancestry make up the largest demographic in the USA. Why are they not called “ethnic” ?

It is not only Tony’s abusive mother/father that contributed to his “issues.” Tony’s life was partially determined by events before his mother was born. He, his pals, the "Don" and the Seinfeld crew, all came from an abusive pattern that was not individual. Their origins and their character were formed in response to a population wide abuse. Italy, Greece, all of Southern and Eastern Europe endured multi-century abuse by geopolitical forces very similar to what is happening now in the Middle East and Africa. The monstrous behaviour of ISIS is not new. The barbaric terrifying and society devastating encroachments on southern and eastern Europe are centuries old. Multi-generational invasions and repeated alien occupations created different tribal (as opposed to single national) identities that filtered down to families and individuals. Repeated societal instability and exploitation evoked repeated sub-rosa push-backs from the indigenous populations. Familiarity with Dr. Bowen’s multigenerational process, when seen in a cultural, wider circle, will help bounce between the “ethnic” and the individua'sl traits.

Whether caused by a culture of violence as in southern Italy, or cultural separation as in the pogrom-attacked eastern shtetl, or intermittent and self deprecatory submission as in Ireland, long term instability fostered a reciprocal alienation of citizen from legitimate governance. Instead of trust and cooperation they were dealing with pervasive chaos, intrusion, unjust laws and the government’s expoitation of citizens.

There are other works that can be better used to illustrate multi-generation cultural dimensions in a more detailed presentation. Such a descriptive presentation of a specific extended ethnic pattern has been presnted in the movies "MY BIG FAT GREEK WEDDING I and II". In some ways, these movies proceed several steps further than those mentioned above, in that they are much more detailed in focusing on certain "family of origin" life styles and patterns. Note that those mentioned above, focus on current events rather than historical origins while "Wedding" uses a much wider lens. "Greek Wedding" compares and contrasts elements of seemingly incompatible ethnic (Greek vs. Anglo) ways of interacting; not only between two individual characters but between two families and generations.

The darker side of various first and second generation "Mediterranean (southern and eastern) cultures" is displayed in the more recent TV series "The Slap". This TV series explores different 3 generation cultural attitudes that influence adult lives and are then carried into child rearing and even careers. Tribal patterns and attitudes including attitudes toward gender differences are clearly displayed. Parenthetically, as in these two dramas, is it a coincidence that today's headlines are screaming about the differences between the "southeast or Mediterranean, (Greek, Italian, Bulgarian, Serbian etc.)" and "North West European (German, Scandinavian)" way of doing things macro-economically?

Below, please read excerpts from a 2014 article written by a non-economist. He is more focused as a cultural reporter on the societal contributions of the recent Greek economic tragedy.

"I was in Greece last month when that country’s distinguished film director Michael Cacoyannis died at the age of 89.... It has always been this column’s contention that the greatest cultural works speak resonantly of things far beyond the cultural realm, and here’s the thing: I can’t help feeling that the world’s economists would better understand the nature of the Greek financial crisis if they were to sit in a darkened room with ... (the movie about Zorba the Greek) … for a couple of hours….

"The film is based on the novel by …(the) writer Nikos Kazantzakis, and tells the story of an uptight Englishman, played by Alan Bates, who travels to Crete and encounters the life-enhancing, terminally irresponsible Zorba, played by Anthony Quinn. Bates has manners and education; Zorba has animal magnetism and the ability to dance. Weirdly, they get on....

"Kazantzakis was far too subtle a writer to portray …Crete society … as some kind of romanticised idyll. There was a darkness in his story that was faithfully reproduced by Cacoyannis: the stoning of an adulterous widow, the ransacking by local villagers of a wealthy foreigner’s house just moments after she dies….

"I was reminded, watching Greek television obituaries, that Cacoyannis was roundly criticized by his countrymen for sending this message around the world: that Greece in the 1960s was in many respects a brutal and rather primitive society, despite the best intentions of its political classes to drag it into the modern world....

"But if they thought the film would put people off, they were spectacularly wrong. Along with Never on Sunday, released four years earlier and featuring another life-enhancing and terminally irresponsible character, a happy whore played by Melina Mercouri, Zorba the Greek was the greatest advertisement Greece would ever have. Foreigners forgot about the stoning and ransacking, and gasped in wonderment at the spontaneity of it all. Here was a country where you could simply dance your troubles away. Where you could let loose with your emotions but always be forgiven for your roguish charm. Where charisma counted for more than measured judgment....

"Greece was all about Dionysian abandonment as well as Apollonian good sense and restraint. Tourism took off in Greece, as uptight northerners fled to the beaches in search of the spirit of Zorba: scorching heat, easy sex, a glorious disdain for prim respectability.... (in the movie) Dionysus has triumphed over the forces of order."

"...‎In My Big Fat Greek Wedding, Wasp values are crushed by bouzouki-wielding sybarites. In Mamma Mia, Meryl Streep – Meryl Streep! – makes merry with former lovers on her island of delights.

"You will not, of course, be expecting a penetrating analysis of the Greek financial crisis in this (article)… space. But I leave you with these thoughts: Zorba … (the movie) … was great for the (Greek) balance of payments (tourism) but could the Greeks themselves have become rather too infatuated with him? With the roguish charm, the charisma, the terminal irresponsibility? With the devil-may-care attitude towards economic planning?

"Well, the devil ... (Germany and northern Europe) ... does care. And so does the rest of the world. It was the abiding achievement of Athenian classicism that it understood this precarious balance, between the forces of order and chaos, that made for peace and prosperity. The perfect proportions of the Parthenon symbolized the attainment of that equilibrium. But it was no more than an evanescent moment. War and destruction were around the corner.


"Being of half-Greek parentage, I naturally wish Greece well in its efforts to find a way out of its current predicament. But please, enough with Zorba. He was a fool. It’s good to be uptight about the budget deficit. And some troubles just can’t be danced away."
peter.aspden@ft.com

A sharper family focus offers the opportunity to grasp more clinically relevant material that can further our intuitive understanding of the role culture plays in expanding and limiting who we are, and who our patients really are. In turn, this knowledge can lead to more productive steps towards solutions.

Mother and Son

There have been many metaphors within psychology’s theoretical orientations. Bowen assumed a "systems" orientation and metaphor in describing a person's life. Within these always self-regulating and self -perpetuating systems the single most determinative principle is the need for stability and balance (homeostasis). A basic tendency towards balance, stability and wholeness is assumed for all people as well as for a larger group. From this assumption it follows that the dysfunctional (not pathological) aspects of behavior are rooted in some attempt to maintain or rebalance the emotional system of which they are a part. Rather than pursuing avenues of pathology the systemic family therapist might be more interested in the family history, patterns and modes of interactions, stabilizing triangle patterns and the wider view in the context of their current family and interpersonal relationships. In our view, the ever-expanding system circles will be underlined, illustrated and followed down through to the family and the individual.

We believe that the family process is the mechanism that enforces pack principles. The pack’s (historically, the extended family) job has always been to funnel tribe-compatible citizens into the "society". A German pack cannot develop citizens compatible with Somalian society. And visa-versa. To the extent that this is true it follows that the family framework is a crucial and indeed powerful intermediating component in understanding the various elements (such as economy, schools, police, and social or work relationships.)

The specific benefit of this course is to illustrate and explore the actual cultural influences on the dysfunctional family and individual behaviors and thus illustrate and suggest to the parents, patients and therapist a functional framework for life repair. As in the dysfunction that can occur in a mixed marriage, if a therapist treats a couple from a culture with which the therapist is not intimately familiar, he will find himself in a mixed marriage with that couple.