THE FAMILY

in
HEALTH and DISEASE

DEPT. OF PUBLIC HEALTH & PREVENTIVE
MEDICINE
FACULTY OF MEDICINE
PADJADJARAN UNIVERSITY


Learning Objectives
Define the meaning of family and its values (C2)
Explain the important distinction between the person in
the family and the family in the person (C2)
Explain the advantages of conducting the principles of
the family in the person (C2)
Describe the family life cycle and its developmental tasks
(C2)
Describe the changes in the structure and function of the
family (C2)

WHAT IS THE BASIC PRINCIPLE OF THE
FAMILY TO FAMILY PHYSICIANS ?

THE IMPORTANCE OF THE FAMILY TO
FAMILY PHYSICIANS IS INHERENT IN THE
PARADIGM OF FAMILY MEDICINE

FAMILY MEDICINE DOES NOT SEPARATE
DISEASE FROM PERSON OR PERSON
FROM ENVIRONMENT strong
connection

HEALTH &
DISEASE
PERSONALITY
WAY OF LIFE
PHYSICAL
ENVIRONMENT
HUMAN
RELATIONSHIP
WHAT IS A FAMILY ?

PARTICULAR KINSHIP GROUP
mother, father, children
(NUCLEAR FAMILY)

AS A GROUP OF INTIMATES
WITH BOTH A HISTORY AND A
FUTURE (Ransom and
Vandervoort, 1973)

MOST FAMILIES WILL PROBABLY
REPRESENT THE COMMON
KINSHIP GROUP IN THE
CULTURE FROM WHICH THE
PRACTICE POPULATION IS
DRAWN

WHO FORMS A FAMILY ?

The family is a small social system made
up of individuals related to one another,
biologically



or by reason of strong affections and
loyalty, that comprises a permanent
household (or cluster of households)
and persists over decades
members enter through birth,
adoption, or marriage and leave by
death ~ the roles of members change
over time and through the history of
the groups


WHAT FACTORS CAN CHANGE
COMPOSITION OF FAMILY ?

SOCIOECONOMIC FACTOR : POVERTY
CAUSES FRAGILE FAMILIES, PREMATURE
PARENTHOOD, DIVORCE etc

A MAJOR CHANGE : BIRTH, DEATH,
MARRIAGE, DIVORCE, DISABILITY, LOSS OF
JOB
WHAT IS THE DEFINITION
OF THINKING FAMILY?

is an awareness of the challenges faced by a family
in adapting to the changes ( birth, marriage, divorce
etc)

any change in one part of the family system has
repercussions for the whole family

it is the physicians responsibility for providing
good information and being vigilance/ vigilante for
communication blocks within a family

is being sensitive to unmentioned family stress that
often lie behind depression and somatic
SYMPTOMS

The persons
in the family

The family in
the person
Composite development, evolution of marital relationship
Life events profound impact on family and individual
members
Involves changes in tasks and roles / status
Health issues to be expected at various stages
THE FAMILY LIFE CYCLE (Duvall,1977)
WHAT IS THE FAMILY LIFE CYCLE ACCORDING TO
DUVALL ?
Duvall has developed an eight stage schema of
the family life cycle, but not all of families go
through the complete cycle in sequence


Understanding the family life cycle :
Understand individual development
Make a good hypothesis about the
problems patients are experiencing
2 years
2.5 years
3.5 years
7 years
7 years
8 years
15 years
15 years
1 2
3
4
5
6
7
8
married
couples
childbearing
families
families with
preschool
children
families
with
schoolchil
dren
families
with
teenagers
families
launching
young adults
middle-aged
parents
aging
family
members

the importance is that every stage the family
has to adapt may lead to happiness and
success with later tasks.
Maladaptation may lead to unhappiness,
conflict and can make new health problems.

the family developmental task are centered on
the familys most important function that is
the nurturing of children from birth to maturity.

WHAT IS THE IMPORTANCE
KNOWING DUVALLS FAMILY LIFE
CYCLES TO FAMILY PHYSICIANS ?
Stage critical family development
tasks through the family life cycle
No Stage of
Family Life
Cycle
Positions in the family Stage Critical Family
developmental Tasks
1 Married
couples
Wife, Husband - Establishing a mutually
satisfying marriage
- Adjusting to pregnancy
and the promise of
parenthood
- Fitting into the kin network
2 Childbearing
families

Wife Mother
Husband Father
Infant daughter or son
or both
-Having, adjusting to and
encouraging the
development of infants
- Establishing a satisfying
home for both parents and
infants
No Stage of
Family Life
Cycle
Positions in the family Stage Critical Family
developmental Tasks
3 Families
with
preschool
children
Wife Mother
Husband Father
Daughter Sister
Son brother
- Adapting to the critical
needs and interests of
preschool children in
stimulating, growth
promoting ways.
- Coping with energy
depletion and lack of
privacy as parents.
4 Families
with school
children
Wife Mother
Husband Father
Daughter Sister
Son brother

-Fitting into the community
of school-age families in
constructive ways
- Encouraging childrens
educational achievement
No Stage of
Family Life
Cycle
Positions in the family Stage Critical Family
developmental Tasks
5 Families
with
teenagers

Wife Mother
Husband Father
Daughter Sister
Son brother
-Balancing freedom with
responsibility as teenagers
mature and emancipate
themselves
-Establishing postparental
interests and careers as
growing parents
-Releasing teenagers to
study out of town/abroad
6 Families
launching
young
adults

Wife Mother
Grandmother In law
Husband Father-
Grandfather In Law
Daughter Sister-Aunt
In Law
Son brother Uncle
In Law
- Releasing young adults
into works,military service,
marriage etc with
appropriate rituals and
assistance


No Stage of
Family Life
Cycle
Positions in the family Stage Critical Family
developmental Tasks
7 Middle-aged
parents


Wife Mother
Grandmother- In Law
Husband Father-
Grandfather In Law

-Rebuilding the marriage
relationship
-Maintaining kin ties with
older and younger
generations
8 Aging family
members
Widow Widower
Wife Mother
Grandmother In Law
Husband Father-
Grandfather In Law

- Coping with bereavement
and living alone
-Closing the family home or
adapting it to aging
-Adjusting to retirement
FAMILY LIFE CYCLE
FAMILY DOCTOR
THE PATTERN OF
DISEASE
RISK FACTOR
TREATMENT
PREVENTIVE
SERVICES AT THE
AGE LEVEL
FUNCTIONS OF THE FAMILY
support ( physical, financial, social or emotional or combination
of these) of one another.

establishment of autonomy and independence for each member
( role within family, as well as individualized role that extend
beyond the boundaries of the family, into the society at large)

creation of rules that govern the conduct of family members ~
the rules deals with privacy, interaction patterns, authority and
decision making.

adaptation to change in the environment.

communication with one another.


CARACTERISTICS OF FUNCTIONAL FAMILIES
(HAPPY FAMILIES)

Radiate a sense of integrity and caring

Adult members expose and live by clear human values, express
feelings appropriately, communicate effectively and share
power while negotiating decisions.

A family members children, adolescents, and adults are
encouraged to develop their own life goals and emotional
independence while staying connected with the family as a
whole.

Relatively well with adversity, often coming out of crisis
stronger for the experience.

Individual differ widely, in how they organize and conduct
family life, and their members tend toward a healthy diversity in
many ways
Characteristics of Dysfunctional Families
Instead of integrity, radiate a sense of chaos or
rigidity

Communication tend to be chaotic, rigid or
sparse, paralyzing decision-making processes
and creating coercive power.

Have great difficulty dealing with stressors,
expected and unexpected.

Have an admirable spirit dogged persistence in
the face generations of trials and sorrow
The doctor of the future will give
no medicine, but will interest his
patients in the care of the human
frame, in diet, and in the cause
and prevention of disease.
- THOMAS A. EDISON
References
1. Mc Whinney. A textbook of Family Medicine.
Third Edition, Oxford New York, 2009. pp 217-
45.
2. Lee Gan, Azwar.A, Wonodirekso. Family
Medicine Practice. Singapore, 2004. Section 3
chapter 2 pp 56-62.



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