Case Example: Nick
Nick, a 16-year-old, moved with his family from a large city in the Northwestern United States to a Southern rural town during the summer before his eleventh-grade year. Nick is a second-generation member of a Chinese family; his grandparents immigrated during the 1950s; his father, whose job transfer caused the move, is an engineer and his mother an elementary schoolteacher. Up to the point of the move, Nick’s medical and psychological histories had been “unremarkable to date.” In his home city, he was an avid gaming enthusiast, and a natural on the baseball field. Nick was well liked by his circle of friends who accepted his bisexual orientation without judgement. In contrast to his large, racially diverse high school in his home city, his new school was small, and comprised 550 predominantly white students. Cliques among students were well formed and hard to penetrate. In his new environment, Nick had trouble making friends, was terribly homesick, and kept his sexual orientation a secret for fear of being bullied. By the end of the fall semester, Nick’s grades had dropped to an all-time low and he was spending most of his time in his room alone, either sleeping or gaming. He had not touched a baseball in months. Additionally, he was having a great deal of stomach pain and was diagnosed with a bleeding ulcer, causing him to miss a great deal of school. Nick’s family realized he was in trouble.
As we can see from the case examples on pages 1 and 2, both Nick’s and Martina’s family are in trouble, and affected by an array of problems stemming from caregiver stress, economic inadequacy, adolescent development, social exclusion, and health challenges. Whether Nick or Martina and their families will be able to effectively deal with the problems they are faced with depends on a number of individual, family, and societal factors including how they define their situation, their ability to respond to family demands, resources and assets at their disposal, individual competencies and strengths, social support, and societal tolerance and understanding regarding the conditions and situations with which each family is confronted. For example, whether Nick will thrive, survive, or deteriorate during his junior year and beyond is contingent on his ability to get the help he needs, find support, and transform his experience into something that has meaning and ultimately enhances his development. How might this happen? First, Nick is lucky: he is smart and has loving and supportive parents and siblings who believe in him. Nick’s family has health insurance and financial resources and are able to get him in to see a counselor who understands the challenges Nick is facing and is nonjudgmental about Nick’s bisexuality. Nick also receives the medical attention he needs for his ulcer. He begins to feel better about himself, breaks his isolation, and with his family’s support, decides to try out for the baseball team the spring of his junior year. A new family moves in next door and Nick becomes friends with the teenage daughter, Zoe, who is also into gaming. Nick feels safe with her – she too was a city girl and a non-conformist in her politics and dress. She has a small group of gaming and political friends and Nick decides to “come out” and with his counselor’s help, Nick shares his sexual orientation with his new-found friends and joins their causes for civil rights. Between medical and psychological treatment, making the baseball team, and the support of his friends and family, Nick’s senior year looks bright. Nick’s path is one of transcendence over adversity. But he did not necessarily do it alone.
Case Example: Martina
Mexican-born Martina is an 81-year-old widow with an array of medical needs. She has painful arthritis and is showing the early signs of dementia. Martina lives with her daughter, Lisa, and her four grandchildren aged 4 to 14. Lisa is a single mother who does shift-work at a local poultry factory near an urban center. She, Martina, and the kids live in a third story two-bedroom apartment in a tough neighborhood punctuated with occasional gang-related violence. Once a caring grandmother and a help to Lisa and the children, Martina has increasingly become a “burden” to the family. Martina has trouble walking and caring for herself and personality changes include irritability and forgetfulness. For example, recently after making dinner, Martina left the stove on overnight. Now, 14-year-old Johnny is left in charge of Martina and the children while Lisa works evenings. However, Johnny has taken up with a new set of friends and rather than holding down the fort, he is out most nights on the streets leaving Martina and the younger children to fend for themselves. Lisa is at a breaking point – she is unable to carry the load of caring for her children, work, and dealing with Martina’s caregiving and health needs. Lisa is also grieving the loss of the loving mother she once had, before Martina’s dementia. While Martina has Medicare coverage, Lisa’s earnings are barely enough to get by. Based on Lisa’s commitment to keeping her family together and caring for her mother at home, Lisa has taken an extra shift on weekends to make ends meet.
Perhaps Lisa, Martina and their wider family are not so lucky. Lisa is teetering on the poverty line, and without the financial resources that Nick’s family has, she will have a tough time meeting the demands of her situation. Lisa’s children are at risk of endangerment unless adequate supervision and developmentally enhancing care can be found. Martina will continue to deteriorate without the proper medical and physical care. Johnny may end up joining one of the gangs in his neighborhood without some kind of intervention to promote his well-being. It is clear he cannot handle the adult-like family responsibilities Lisa has given him. Lisa has too many responsibilities as a single-mother and caregiver to Martina. She needs support and help and since she has no kin to rely on, it will have to come from the outside. Tired and alone, Lisa, herself is at risk for burn-out.
All families have problems. Some of these problems stem from change within and outside the family. Other problems are connected to developmental transitions and challenges inherent in certain caregiving arrangements, such as caring for an elder or infirm family member. Further, problems may be intensified or seemingly irresolvable due to discrimination and social inequality. Family Problems: Stress, Risk, and Resilience examines an array of critical challenges faced by contemporary families such as Nick’s and Lisa’s, and digs deep into their origins, effects, and perhaps most importantly how families may still thrive and grow in the face of adversity. Additionally, an essential question posed throughout the book is: when do family issues become “problems”?
