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They come in all sizes, shapes, and descriptions. We call them single parent, dual career, blended, alternative, and makeshift. We have them, for better or for worse. With more awareness and education, we can make the emotional balance, from all the social changes, tilt toward the positive. Regardless of form, families have many ingredients that can be cultivated to have successful outcomes in family happiness and functioning.

A family that functions well has a direct link to facilitating mental and physical well-being for each person in the family. Some original research suggesting the connection of healthier families leading to individual health was done by a psychiatrist, Dr. Salvador Minuchin, and an endocrinologist, Dr. Lester Baker ,who worked with families whose children had diabetes. In a small and uncontrolled study, they looked at children with extremely “ brittle diabetes” (labile blood sugars). The children witnessed family conflict through a one- way mirror, while being hooked up to a blood sugar monitoring device. The physical response in the children was hyperglycemia (high blood sugars) and ketones.

The children at risk, according to Minuchin, were part of families characterized by “enmeshment”-children overinvolved in their families’ issues - overprotection , rigidity, and a lack of skills for conflict resolution. (Minuchin, S., Rosman, B., & Baker, L. (L978). Psychosomatic Families. Cambridge , Mass: Harvard University Press). Minuchin and Baker’s work underscores the potential of the positive power of the family in an individual’s health and well-being. They address the use of family therapy as an effective means of treating difficult- to- control diabetes.

My patient Nancy, a 17 year old girl with diabetes since she was nine, lives in a family with the same parenting styles that Dr. Minuchin warns us about. It is totally understandable that families begin with patterns of overinvolvement,overprotection, and inflexibility as their first response to taking care of the child with diabetes. Actually, diabetes requires these postures in the beginning. Nancy could not bear to see her parents upset. She was already guilty that her diabetes had upset them greatly. She became embroiled- "enmeshed-" with their feelings about the diabetes- their tears and worries, and was unable to feel her own. She would always hear them say they wished they could take the diabetes from her and bear it themselves. She actually felt sorry for them. There was no place for her to cry out about her sadness, fears, or anger at having diabetes.

Growing older, she still could not face her feelings or the behavior required to take care of herself. Her parents had closely watched over her and advised her, and she had depended greatly upon them. She was actually afraid to do anything without them. Their overprotection, well-meaning and natural had left her feeling as a much younger child than she actually was. Their initial response never diversified into encouraging her response,before theirs, or in encouraging her to grow up unafraid, normal, and aspiring to exciting life goals and diabetes management.

When I met Nancy, she never slept out at friends, was disinterested in going for her driver’s license, and no control over her diabetes management.

Families, help or hindrance ...we can learn to nurture whichever direction we want to go in. The notion of healthy families is the sa.me for all families,with or without a chronic illness to fit in. Having diabetes in a family, however, intensifies the need for a family to be effective. There are several key components of a highly well-balanced families. One of the best predictors of success in your adult family life is having experienced a family that was highly functional in your childhood. Next, feeling unconditionally loved as a child is a great part of the necessary positive framework. Unconditional love is an ideal, not a constant state of perfection, that is not easily or smoothly achieved. Predictable rules and predictable warmth, love, and closeness are also parts of making a family work. There is a balancing act required in accommodating the other assets of a healthy family: autonomy and individuality; the themes of mutual dependence and group closeness; and the toleration of differences and conflicts.

These themes involve the idea of boundaries, maintaining the balance of movement to allow the separate states of individuality and closeness at different times. For example, you could be close to your mother and still be yourself, a different and separate person. Flexibility and resilience in feelings, behaviors, conflicts, and tasks are also themes that run through.

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