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Sorry for the hiatus but I've been more than a little distracted by events that require intense attention in the medical realm. But the above title is more than a "tittle"!  For I have also had numerous occasions to think about, let's just say, family dynamics.

My brother used to say to my parents that we are a "dysfunctional" family--in the days when this was a popular term and 12 step programs and concepts were in their halycon days of high repute. I was into this too, almost by necessity, as I was exposed not once but twice to alcohol recovery programs in my 2 sequential residency programs. I continued to get large doses of 12-stepping when I assumed the mantle of directorship of the program we had at Mendota, begun by Dr. Spenader, who once chased an alcoholic onto the roof, and was looking for a better solution. I also was exposed to, and trained in, family counselling, which has always had a special attraction to me. I still do some of that, and would do more, but for the time constraints and I might add the progressive depersonalization and deprofessionalization of my discipline. I have also noticed that I have developed special interests also in physical illnesses that I was exposed to as a child in our household, such as asthma.

There are two concepts I learned from counsellors and counselling practice that fascinate me; no, three fascinating concepts: The first is that people are usually what they say they are--or the opposite; famous example: "Methinks the lady doth protest too much."

The second is like unto it: that when families push one person forward as "the problem", it usually means that this person is a scapegoat for the overall tension and disharmony caused by the whole family system--and that these systems develop on their own with little or no planning, foresight, or insight.

I suppose the third is that everyone uses defense mechanisms for temporary relief of family discomforts; and the unhealthy use of these accounts for much if not most of the dysfunctional aspects of the "modern" family, which by all accounts reflects the horrible state of our nation and culture; which is why at least half of marriages disintegrate, often after a short time but unsurprisingly often after many years; the reason generally is that the worldview of one or both evolves into modernity, which holds the nuclear family in contempt. The work of Harvard sociologist C.F. Zimmerman, "Family and Civilization" published in 1949, is a classic study of the evolution of societies and families as they age and tend to align with each other with very little lag time. "Postmodernity" is even worse but a nesessary view to accomplish a more complete disintegration--which is its whole point if you think about it. It may be biologically determined, even, like "apoptosis", from which we daily benefit--"programmed cell death."  (Now there's a cure for cancer--if we could harness it...)

The main point being, someone has to bear the burden of bad relationships. People usually are not content to blame or implicate themselves, which raises the discomfort level to "Unbearable"! It is an overwhelming temptation to be overly concerned about the problems of other family members who may appear to be vulnerable enough or passive enough to bear the burden. Of course the consequences of this can be dire or even life-threatening for the scapegoat. Plus families often take great care not to go too far, lest the scapegoat, uh, escapes! He or she is much needed for the "dysfunctional functions" of the whole system. The defense mechanisms with which I am most familiar are denial--which may be universal, but who am I to say?--plus projection , rationalization, and intellectualization-- mechanisms with which Freud was all too well acquainted--and from which he could have learned a lot more except for the hubris factor. (What was he compensating for, I wonder?)

(and, "What about Bob?") (an example of a scapegoat running rampant;)

All that aside, I suppose that all families, like all religions, are essentially reactionary--either to a deficit presented by the old guard, or just a human need that has been suppressed or overlooked. Either way, the goal seems to be either self-justification or group-justification.  Children react to their parents, and it's not always very pretty--parents themselves are often scapegoated by their children--almost universally in adolescence! But in adolescence it serves a function--painful as such separations are--"breakin' up is hard to do" It is only when such attitudes are carried into adulthood that the "evolution" stops dead in its tracks and regresses. And the breakups are revisited ad nauseam. Adolescent thinking often becomes senescent thinking as well.

The majority of "las familias de dolor" never grow out of their need for pain--all in moderation of curse!-- or repair it even with insight therapy. And of course medications don't help unless they calm the person to the point where they can consider the problem from a less ruffled state of mind. So I am not against them any more than I am against adolescence; provided they are used as they should be and are designed to be: a stepping stone or minor aid to insight and accepting responsibility for my own half of the larger problem.

As usual time does not permit me to say much more today--I will just say that I too have been guilty of scapegoating, projection, and stereotyping--out of fear of what might happen if a real relationship might develop.  I am certainly not alone in this--but it's always more convenient to blame the other person, is't not?